Recently, I was asked to join the National Council for Prescription Drug Programs’ (NCPDP) task group to help define “what is a valid prescriber?” As the pharmacy solution lead at Health Market Science, I bring a wealth of knowledge about the necessary data sources, already found in the HMS Provider MasterFile, to define a valid prescriber. What may be more important is my understanding of the enormous challenges in maintaining a reliable “source of truth”—a challenge not to be minimized as our customers rely on us to consistently deliver accurate, complete and up-to-date prescriber data.
The challenge in defining a prescriber is determining the various attributes (characteristics) required to determine prescriber validity or eligibility. This starts with the NPI number, state licensure, DEA, and then expands to include credential status, date of death, state regulations, and sanctions. The difficulties in accomplishing this are two-fold in that:
- There is no publicly available source that brings all this information together.
- Delivery services are required to configure source data to suit regulations and industry recommendations.
Health Market Science’s Masterfile prescriber validation is rooted in 100% authoritative and primary sourced data. It’s direct from the regulatory agencies that oversee the licensing and credentials required to determine prescriber validity; this source data is then matched, linked, and organized to tie all prescriber-related data to a unique prescriber record.
While any systematic process may not run 100%, Health Market Science’s experience with leading companies over the last decade has resulted in our ability to remediate the toughest data challenges. Our services coupled with the “golden records” of the HMS Provider Masterfile have been finely tuned to solve the industry’s toughest challenges. So even now, we already know how to answer the question “how do we determine prescriber eligibility?” We check:
- state license expiration, status, and furnishing privileges
- DEA number for expiration and controlled substance schedule
- NPI status
- deceased date
- sanctions
The important take-away is that while today’s definition of a valid prescriber may be different from tomorrow’s, Health Market Science has the source data and services required to configure solutions to meet the pharmacy world’s changing requirements.