In Episode 21 of Out of the FHIR, I sat down with Pooja Babbrah, Executive Vice President of Strategy and Industry Alignment for NCPDP. We bonded over our shared history in the pharmacy world dating back to the rivalry between Medco and PCS and dug deep into why pharmacy is the sleeping giant of healthcare interoperability.
Here are the key takeaways from our conversation:
1. Pharmacists Are Care Team Members, Not Just Dispensers
We often view pharmacy as a transactional space, but Pooja highlighted the shift toward clinical services. From COVID vaccinations to managing chronic conditions, pharmacists are often the most accessible healthcare providers in rural communities. However, to fully integrate them into the care team, they need access to clinical data (labs, diagnosis) that currently lives trapped in the EHR.
2. The “Better Together” Story: NCPDP + FHIR
A common question Pooja gets is: “Why don’t we just do everything in FHIR?”. Her answer is crucial for architects to understand:
* NCPDP has mastered real-time transactions over the last 40 years (claims adjudication, eligibility). You don’t fix what isn’t broken.
* FHIR is the clinical bridge. It allows pharmacists to pull the clinical context needed for prior authorization or care coordination, which can then be wrapped into an NCPDP standard for the payer. It’s not an or; it’s an and.
3. The AI & Patient Empowerment Frontier
We discussed the controversial but exciting potential of AI in pharmacy. While headlines panic about “AI refills,” the reality is that basic maintenance meds (like statins) are perfect candidates for auto-refill workflows, provided the pharmacist is looped in to check labs and vitals. Pooja and I both agreed that the “Holy Grail” is an AI agent that acts as a proactive partner scheduling appointments, reconciling meds, and reminding you to pick them up so caregivers aren’t left managing complex logistics alone.
4. Interoperability is a Business Problem, Not a Tech Problem
I shared my recent nightmare trying to schedule a colonoscopy stuck in phone queues and filling out 50-question Word documents because the referral data didn’t move. Pooja noted that while the “pipes” (TEFCA, FHIR) are being built, the business incentives to share that data are still lagging.
What’s Next? Keep an eye on the NCPDP Collab (a workflow-focused event in February) and the new consumer-facing real-time benefit check pilots.
