Pharmacy Billing Requirements

OMB 1240-0050

The NCPDP Standardized Pharmacy Billing Data Requirements are the electronic billing format used by pharmacies throughout the country to request payment for prescription drugs through data clearinghouses. They identify the provider, claimant, prescribing physician, drug by NDC (National Drug Code) number, prescription volume and charge. Similar data elements are required to process paper-based pharmacy bills.

The latest form for Pharmacy Billing Requirements expires 2022-09-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Supporting Statement 1240-0050 2022v2.docx Supporting Statement A
20 CFR 725.701 and 725.705 BLBA Supporting Reg.pdf Supplementary Document
20 CFR 30.701 EEOICPA Supporting Reg.pdf Supplementary Document
20 CFR 10.801 FECA Supporting Reg.pdf Supplementary Document
Pharmacy Billing Requirements Instruction

All Historical Document Collections

202208-1240-004 Approved without change	Extension without change of a currently approved collection	2022-08-23
201903-1240-003 Approved without change	Extension without change of a currently approved collection	2019-07-11
201901-1240-005 Approved without change	Revision of a currently approved collection	2019-02-13
201601-1240-010 Approved without change	Extension without change of a currently approved collection	2016-01-29
201507-1240-006 Comment filed on proposed rule and continue	Revision of a currently approved collection	2015-11-18
201209-1240-002 Approved without change	Extension without change of a currently approved collection	2012-12-19
201003-1240-050 Approved without change	Extension without change of a currently approved collection	2010-03-26