Allows a Prescriber to Prescribe Medication Using Weight-Based Dosing

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Standard	NCPDP Structured and Codified Sig Format Implementation Guide Version 2.2	Final	Production		No	$	No
Implementation Specification	NCPDP® SCRIPT Standard, Implementation Guide, Version 2017071	Final	Production		Yes	$	Yes
Implementation Specification	NCPDP SCRIPT Standard, Implementation Guide, Version 2023011	Final	Feedback requested	Feedback Requested	Yes

Limitations, Dependencies, and Preconditions for Consideration	Applicable Value Set(s) and Starter Set(s)
Please refer to CMS.gov for more information regarding Medicare Part D electronic prescribing requirements and sign up to receive the latest announcements. Included in the Structured and Codified Sig Format of electronic prescribing transactions are elements, fields and values that are directly related to the prescriber's instructions for use. The following elements of the Sig are required when Structured Sig is sent: Code system Dose Route Of Administration The following elements of the Sig are conditional (only required when prescriber specifies) when Structured Sig is sent: Vehicle Site of Administration Timing Duration Maximum Dose Restriction Indication The following elements of the Sig are required when Structured Sig is sent and when dose is to be calculated: Dose Calculation: Used where a body metric such as metric weight (kg) or surface area (m*2) is used to calculate a dose for a patient. May often be used in conjunction with the Rate within TimingAndDuration and/or the Vehicle. The SCRIPT 2017071 Observation element in the NewRx transaction supports the use of a patient's height, weight and other vital signs: Inclusion of VitalSign (most recent patient's height and weight) and ObservationDate (YYYY-MM-DD height and weight observed/taken) is required for patients 18 years old and younger on all new and renewal prescriptions from a prescriber to a pharmacy. If the height and/or weight have changed and a prescriber is sending an approved renewal response, the response should be coded as Approved with Changes. ObservationDate is now mandatory when Observation Segment Measurement is sent. ObservationNotes may contain other pertinent information pertaining to weight-based calculations. It is recommended that developers adopt logic that results in a prescription that calculates a weight-based dose to suggest a measurable dose (e.g., rounded to the +/- 5-10% of the calculated dose). Measurable dose should be based on home dosing tool precision. For example, a weight-based dose calculation may result in instructions to give a child 4.7mL amoxicillin 400mg//5mL (375mg) when the measurable dose should be 5mL (400 mg is still a safe dose and easier to measure with a 5mL or 10mL oral syringe). Both the prescriber and the pharmacy must have their systems configured for the transaction in order to facilitate successful exchange, including the ability to send or receive verify, status, or error transactions.	LOINC® 2.63 codes supporting SCRIPT 2017071 <Observation> segment: 8302-2 Body height, measured [LOINC] 3141-9 Body weight, measured [LOINC] 3140-1 Body surface area, derived [LOINC]

Limitations, Dependencies, and Preconditions for Consideration

Applicable Value Set(s) and Starter Set(s)

Please refer to CMS.gov for more information regarding Medicare Part D electronic prescribing requirements and sign up to receive the latest announcements.
Included in the Structured and Codified Sig Format of electronic prescribing transactions are elements, fields and values that are directly related to the prescriber's instructions for use.
The following elements of the Sig are required when Structured Sig is sent:
- Code system
- Dose
- Route Of Administration
The following elements of the Sig are conditional (only required when prescriber specifies) when Structured Sig is sent:
- Vehicle
- Site of Administration
- Timing
- Duration
- Maximum Dose Restriction
- Indication
The following elements of the Sig are required when Structured Sig is sent and when dose is to be calculated:
- Dose Calculation:
  - Used where a body metric such as metric weight (kg) or surface area (m*2) is used to calculate a dose for a patient.
  - May often be used in conjunction with the Rate within TimingAndDuration and/or the Vehicle.
The SCRIPT 2017071 Observation element in the NewRx transaction supports the use of a patient's height, weight and other vital signs:
- Inclusion of VitalSign (most recent patient's height and weight) and ObservationDate (YYYY-MM-DD height and weight observed/taken) is required for patients 18 years old and younger on all new and renewal prescriptions from a prescriber to a pharmacy.
  - If the height and/or weight have changed and a prescriber is sending an approved renewal response, the response should be coded as Approved with Changes.
- ObservationDate is now mandatory when Observation Segment Measurement is sent.
- ObservationNotes may contain other pertinent information pertaining to weight-based calculations.
It is recommended that developers adopt logic that results in a prescription that calculates a weight-based dose to suggest a measurable dose (e.g., rounded to the +/- 5-10% of the calculated dose). Measurable dose should be based on home dosing tool precision. For example, a weight-based dose calculation may result in instructions to give a child 4.7mL amoxicillin 400mg//5mL (375mg) when the measurable dose should be 5mL (400 mg is still a safe dose and easier to measure with a 5mL or 10mL oral syringe).
Both the prescriber and the pharmacy must have their systems configured for the transaction in order to facilitate successful exchange, including the ability to send or receive verify, status, or error transactions.

LOINC® 2.63 codes supporting SCRIPT 2017071 <Observation> segment:

Comment

Submitted by pwilson@ncpdp.org on 2024-08-13

NCPDP Comment

NCPDP recommends removing NCPDP SCRIPT Standard, Implementation Guide, Version 2022011, as this version was never implemented. NCPDP SCRIPT Standard Implementation Guide, Version 2023011 is the next version named by ASTP/ONC and Medicare. Federally required should be changed to a Yes for the NCPDP SCRIPT Standard Implementation Guide, Version 2023011.

Submitted by pwilson@ncpdp.org on 2023-10-06

NCPDP Comment

NCPDP recommends that ONC update Structured and Codified Sig Format Implementation Guide Version 2.1 to Structured and Codified Sig Format Implementation Guide Version 2.2.

Submitted by shellyspiro on 2023-10-02

Pharmacy HIT Collaborative (PHIT) comment

PHIT supports NCPDP’s recommendation to update Structured and Codified Sig Format Implementation Guide Version 2.1 to Structured and Codified Sig Format Implementation Guide Version 2.2.

Submitted by pwilson@ncpdp.org on 2021-09-29

NCPDP Comments

NCPDP SCRIPT Standards, Implementation Guide, Version 2017071 update adoption level to 3.

Submitted by alsmd1023 on 2020-03-05

Requirement for weight and height for prescriptions

Except for chemotherapeutic agents and a very few other medications, a patient's height is not necessary to determine medication dosing. Medications such as eye drops, ear drops, skin creams, and inhaled medications (bronchodilators, inhaled steroids, etc.) do not require weights at all. These categories should be exempted from requiring height and weight data on prescriptions as refills and even initial prescriptions are often sent in or called in without the child being actually seen in the office. ("Pink Eye" does not always need an office visit!) Imagine how disruptive it would be if you had to leave work, pick up a child from school or daycare, and come to the pediatrician's office just to get an update weight and height for your eye drops or albuterol refill! Moreover, as telemedicine becomes more prevalent, patients may be evaluated by a physician and prescriptions sent in without there being an actual physical visit to an office where updated heights and weights are obtained. This is especially true for behavioral health conditions such as ADHD and anxiety/depression. Again, medications would be refilled without a patient actually being present for a new height and weight. (These medications are not particularly dosed by weight anyway.)

As a practical matter, most pediatricians will not send in prescriptions for patients they have not seen in over a year, but for those patients who are current, as long as we can use the most recent measurements we have on-file, this policy should be workable--especially if you eliminate the height requirement and exempt the categories noted above.

Alan L. Schwartz, M.D.; Pediatrician,

Indianapolis, IN

Submitted by pwilson@ncpdp.org on 2019-09-23

NCPDP Comment

Update the following:

Type-Implementation Specification

Standard Implementation/Specification- NCPDP SCRIPT Standard, Implementation Guide, Version 2017071

Implementation Maturity- Production (effective 1/1/2020)

Test Tool Availability - Yes

Test Tool Link: https://tools.ncpdp.org/erx/#/home

Submitted by pwilson@ncpdp.org on 2018-10-01

NCPDP Comment

Add the following:
1. Observation Element in NewRx Transaction

Type-Implementation Specification

Standard Implementation/Specification- NCPDP SCRIPT Standard, Implementation Guide, Version 2017071

Standards Process Maturity – Final

Implementation Maturity- Pilot

Adoption Level – 1

Federally Required – No

Cost – $

Test Tool Availability – Yes

Submitted by shellyspiro on 2018-10-01

Pharmacy HIT Collaborative's Comments on ONC's Proposed 2018 ISA

The Pharmacy HIT Collaborative supports the use of Structured Codified Sig Format Implementation Guide Version 2.1. The Collaborative also supports the move to NCPDP SCRIPT Version 2017071 as soon as participants can reasonably be ready to implement such a change.