Codes ... These Two Count

Every industry it seems has its own alphabet soup.?Healthcare and health insurance is no different.??

There are two “codes” that, on the surface, appear as just another set of acronyms, or parts of the alphabet soup – But are absolutely critical for you to be aware of….

They are:

NDC and J Code.

So, what is a J Code?

The Healthcare Common Procedure Coding System (HCPCS) is the system by which medical procedures are billed. ... HCPCS Level II codes or J Codes are the billing codes used for the medical devices, supplies, and drugs when billing for claims to healthcare insurance.

And, a NDC Code?

“NDC” stands for National Drug Code. It is a unique, 3-segment numeric identifier assigned to each medication listed under Section 510 of the U.S. Federal Food, Drug and Cosmetic Act.

But one is not like the other!

So, what’s so different and why does it matter?

J Codes are used in hospital settings versus NDC Codes are used within a pharmacy benefit managers system.

Why does it matter?

Well, the drugs that are associated with J Codes and NDC Codes are brought to market under different pricing indexes and supply chains.?When I say different, I mean completely different.

So, as an example, there are times when there is opportunity to shift the administration and delivery of a J Code drug from a hospital setting to a free-standing facility or within a patients home.?Sounds easy probably – And many times this tactic advantages the member and the plan sponsor financially and administratively.?But, it’s not just as simple as making the request.?Who’s going to manage the change? Who’s going to ensure pricing is improved? Who’s going to assist in minimizing the disruption?

All valid questions and there’s a lot at stake.?

Do you have the support you need?

We’re here to help.?If you’d like to dig deeper into these conversations, let’s talk.?

The Apex Benefits Kinetiq Health Pharmacy Benefits Consulting practice offers a team of in-house Certified Pharmacy Benefit Specialists (CPBS). This team — the largest and most experienced in Indiana and led by an in-house licensed pharmacist — helps our clients derail escalating pharmacy costs and gain increased transparency in pharmacy benefit management (PBM) contracts.??

You can find me on LinkedIn or at?slong.apexbg.com

Until next time, be well!