Uniform Prescription Drug Cards

Issued and entered this 18th day of June 2003 by Linda A. Watters Commissioner

The Insurance Code of 1956, MCL 500.2213d, as added by Public Act 708 of 2002 (the Act) provides that effective July 1, 2003 the Commissioner shall develop a uniform prescription drug information card and uniform prescription drug information technology based on the standards and format approved by the National Council for Prescription Drug Programs (NCPDP) Pharmacy ID card implementation guide.

The prescription drug information card is to be used by a health benefit plan that provides coverage or administers a plan that provides coverage for prescription drugs or devices and that requires a card or other technology for prescription claims submission and adjudication. The Act applies to all health plan coverages issued or renewed on or after July 1, 2005.

In order to meet the statutory requirement to develop a uniform prescription drug plan and technology, the Commissioner has reviewed prescription drug card technology already available for use by the prescription drug insurance industry. The Commissioner has determined, pursuant to Section 2213d of the Act, that a health benefit plan that utilizes an identification card that meets the standards and format approved by the NCPDP will be found to have met the requirements of the section and be in compliance with the Act. Any other format chosen by a health benefit plan must include all of the standards found in Section 2213d, including but not limited to:

1. The card issuer name or logo on the front of the card.
2. The cardholder’s name and identification number, displayed on the front of the card.
3. Complete information for electronic transaction claims routing including all of the following:
   1. The international identification number labeled as RXBIN.
   2. The processor control number labeled as RXPCN, if required for proper routing of electronic claim transactions for prescription benefits.
   3. The group number labeled as RXGRP, if required for proper routing of electronic claim transactions for prescription benefits.
4. The name and address of the benefits administrator or other entity responsible for prescription claims submission, adjudication, or pharmacy provider correspondence for prescription benefits claims.
5. A help desk telephone number that pharmacy providers may call for assistance.

Health plans that use a card or other technology for health benefits are not required to use a separate card for drug prescription coverage as long as the card contains the information listed above and required by the Act.

Any questions regarding this bulletin should be addressed to:

Office of Financial and Insurance Services
Division of Health Plans
P.O. Box 30220
Lansing, Michigan 48909-7720

Phone (517) 241-4549
Toll Free: 877-999-6442