From Signals to Systems: A Reflection on Advancing Medication Coding in Saudi Arabia

By: Nada Ahmed Alagil

In the complex world of healthcare systems, it’s often the less visible components—like medication coding—that hold the greatest influence. From prescribing and reimbursement to clinical decision-making and benefit design, how we identify and reference medications forms a foundation for safety, integrity, and actionable insight. This is not a technical detail—it’s a systemic necessity.

In 2021, while working on the Essential Benefit Package Reform and the Daman Drug Formulary—focused on scientific name prescribing and generic copayment preferences within a value-based formulary—we encountered a core challenge: the lack of standardized medication coding. Our review, which included local benchmarking (see Table 1) and stakeholder interviews, revealed the absence of a unified scientific name coding system. Multiple coding schemes were in use across sectors, with no standardization between providers and payers, making medication tracking and governance difficult. Identical medications were coded differently across platforms. What initially appeared to be an administrative gap revealed itself as a significant obstacle to enforcing coverage, ensuring patient access, and maintaining data accuracy.

Rather than promoting a pre-built solution, we used real-world operational signals to illustrate the broader impact. Issues such as brand-generic mismatches, duplicate listings, CPOE (Computerized Physician Order Entry) challenges, and financial leakage due to claims misclassification highlighted the need for systemic reform.

Data from the nphies platform further validated these concerns. Discrepancies in prescribing logic and e-claim data, along with inconsistent substitution practices, underscored the risks of proceeding without a unified coding strategy. In response, we formed a working group at the Council of Health Insurance (CHI) to explore potential methodologies and to develop a prototype reference system—not as a replacement for existing systems, but as a bridge between them. This internal effort laid the groundwork for broader policy conversations.

Laying the Groundwork: CHI’s Internal Prototype and Team Collaboration

Before broader national initiatives took shape, an early step was taken within CHI to better understand and address the challenges of medication coding. Internally, we explored how inconsistent identifiers were impacting coverage enforcement, benefit design, and system governance. These insights led to the formation of a multidisciplinary team—particularly with support from health information management colleagues like Talal AlOtabi and Sussan Young—to develop a functional prototype for scientific name coding.

This collaborative effort focused on bridging therapeutic intent with reimbursement logic. The goal was not to replace existing systems, but to model how a unified structure might improve substitution accuracy, PBM operations, and data consistency. The environment encouraged open dialogue and critical thinking, which proved crucial to building a practical solution.

The resulting code structure supported the concept of grouping branded medications under a single therapeutic identity—enabling clearer benefit design, safer substitutions, and better alignment across platforms. It was a foundational exercise that helped shape the conversation that followed.

Rather than positioning this as a finished product, the prototype served as an internal proof of concept—an early building block that informed and preceded national efforts led by SFDA and NHIC.

From Prototype to Policy: National Alignment in Action

These early insights were further developed through a series of collaborative workshops with national stakeholders, including the Saudi Food and Drug Authority (SFDA), the National Health Insurance Center (NHIC), the Ministry of Health (MoH), and Lean Business Services. These sessions became shared spaces for aligning coding structures, validating use cases, and discussing implications for prescribing platforms, claims processing, and policy enforcement. The collective outcome was a more unified understanding of how medication identifiers can support substitution logic, benefit tiering, and pharmacy benefit management (PBM), all while preserving safety and promoting system sustainability.

Over time, national stakeholders began aligning efforts around standardizing identifiers—not through mandates, but through shared insight. In 2022, the SFDA introduced the “Scientific Name Code,” designed to support unified prescribing and regulatory tracking. By 2025, NHIC launched the Medication Reference Identification (MRID) as a national coding system, now in the final stages of automation. These efforts reflect an ecosystem-wide shift, bridging clinical workflows and financial infrastructure.

Table 1: Global Medication Coding Benchmarks

Looking Back: A Quiet but Lasting Shift

This journey was never just about building a code—it was about building alignment. The most sustainable reforms often start quietly: through reflection, mapping, and collaborative advocacy. Medication coding may seem technical, but it is fundamental to delivering value, safeguarding patients, and shaping benefit design. And while many stakeholders contributed to formalizing this space, it’s important to remember that thoughtful, strategic connections—even informal ones—can shape the direction of a system.

This reflection offers a personal lens on the evolution of medication coding in Saudi Arabia. It is not a formal policy statement, nor does it claim institutional ownership. Rather, it highlights how shared technical insight, when communicated with clarity and purpose, can drive meaningful system-level change.