TO: All Pharmacy
Providers, Vendors, Prescribers, Clearinghouses and Trading Partners
RE:
CMS-0056-F Pharmacy Standards Compliance Update, CMS-4205-F2 and Readiness
Notice
Please share
this Provider ALERT with your pharmacy software vendor.
The Alabama
Medicaid Agency (Medicaid) and Gainwell Technologies are in the process of
implementing the federal CMS-0056-F pharmacy standards changes, which adopt
updated National Council for Prescription Drug Programs (NCPDP) and related
HIPAA transaction standards. These updates are designed to modernize pharmacy
data exchange, improve interoperability and support future pharmacy transaction
processing requirements. Pharmacies are encouraged to contact their pharmacy
software vendors to ensure pharmacy transaction compliance deadlines are met.
Key
Standards and Compliance Dates
The following
standards will require updates by payers, pharmacies, vendors, prescribers,
clearinghouses and trading partners:
·
NCPDP Formulary & Benefit (F&B)
Standard v60
o
Supports electronic exchange of formulary and
benefit information used during prescribing.
o
Federal compliance date: January 1, 2027
·
NCPDP SCRIPT Standard v2023011
o
Includes medication history and electronic
prescribing enhancements.
o
Federal compliance date: January 1, 2028
·
HIPAA ASC X12 271 Eligibility Response
Updates
o
Supports formulary identifiers and pharmacy
benefit information exchanges.
o
Federal compliance date: February 11,
2028
·
NCPDP Telecommunication Standard vF6
o
Supports real-time pharmacy claim adjudication
and related retail pharmacy transactions.
o
Voluntary D.0/F6 dual processing: D.0
transactions will continue to be adjudicated until April 14, 2028. Medicaid
will start accepting F6 transactions on August 14, 2027.
o
Federal compliance date: April 14, 2028
o
D.0 processing ends: April 14, 2028, in
accordance with the CMS-0056 Final Rule.
·
NCPDP Batch Standard v15
o
Supports batch pharmacy claim processing and
related transaction exchanges.
o
Federal compliance date: April 14, 2028
·
NCPDP Batch Subrogation Standard v10
o
Supports pharmacy subrogation and financial
recovery transactions.
o
Federal compliance date: April 14, 2028
All standards
above are adopted under the CMS-0056-F HIPAA Administrative Simplification
Final Rule.
Impact
These updates may affect:
·
Pharmacy claim adjudication and eligibility
verification
·
Coordination of benefits (COB) processing
·
Batch claims and subrogation transactions
·
Electronic prescribing and medication history
exchanges
·
Formulary and benefit transactions
·
Trading partner interfaces and vendor-supported
pharmacy transactions
Pharmacy providers
should work closely with their software vendors, clearinghouses, switch vendors
and trading partners to ensure readiness. Medicaid will no longer be able to
support D.0 transactions on April 14, 2028, in accordance with the CMS-0056
Final Rule.
Testing
Gainwell plans
to conduct vendor and external entity testing from May 5, 2027, through May
25, 2027.
Please email AlabamaNCPDP@gainwelltechnologies.com if
you have any questions.
Next Steps
Updated
companion guides, technical specifications, implementation guidance,
educational materials and additional testing information will be communicated
as they become available. A provider survey will also be forthcoming to gather
information related to F6 implementation readiness.
Additional
information is available through:
·
CMS-0056-F HIPAA Administrative
Simplification Final Rule
https://www.federalregister.gov/documents/2024/12/13/2024-29138/administrative-simplification-modifications-of-health-insurance-portability-and-accountability-act
Medicaid appreciates your
continued partnership as we work toward implementation of these federally
mandated standards.
The Current
Procedural Terminology (CPT) and Current
Dental Terminology (CDT) codes descriptors, and other data are copyright © 2026 American
Medical Association and © 2026 American Dental Association (or
such other date publication of CPT and CDT). All rights reserved. Applicable
FARS/DFARS apply.