URAC releases first-ever pharmacy benefits management accreditation standards for public comment

Seven standards modules address breadth of PBM activities, from drug use management to consumer education

URAC called for public comment today on the first-ever proposed accreditation standards for pharmacy benefit management organizations. The goal of the program is to create a pharmacy benefit management accreditation program for the commercial and Medicare markets that promotes industry best practices; encourages quality improvement; and protects and empowers consumers. URAC is seeking comments from a broad range of stakeholders, including employers, consumers, purchasers, providers, regulators, and the pharmacy benefits management industry. The deadline for public comment is December 1, 2006.

ìAccreditation sets industry-wide clinical and operational standards and brings a recognizable seal of quality to accredited organizations,î said Alan P. Spielman, URACís president and chief executive officer. ìURACís goal in developing accreditation standards is not to dictate the business relationships between PBMs and their customers. Rather, accreditation can provide the assurance that, notwithstanding different business models, the content of what is provided to clients and their members meets acceptable standards.î

The initial set of standards is designed for the commercially insured population. Proposed standards for the Medicare population are expected to be released for comment in January, 2007. The standards were developed by URACís 38-member Pharmacy Benefits Management Advisory Committee, which includes a wide range of stakeholders: employers, consumers, pharmacy consultants, health plans, independent retail pharmacy, pharmacy benefits management organizations, pharmacy professional organizations, labor, and large public purchasing groups.

ìThe pharmacy benefits management industry recognizes that this is the right time for industry-wide standards,î said John D. Jones, RPh, JD, vice president of government affairs and pharmacy policy for Prescription Solutions and chairman of URACís Pharmacy Benefits Management Advisory Committee. ìThe PBM industry wants to identify and use best practices. URAC PBM accreditation standards will provide a uniform approach that PBM organizations can use to demonstrate best practices across the board.î

URACís pharmacy benefits management standards address a wide range of industry practices across seven modules:

ï Organizational Integrity
ï Customer Service/Communications/Disclosure
ï Pharmacy Distribution Channels
ï Drug Use Management
ï Formulary/P and T
ï Medication Therapy Management
ï Benefit Design/ Administration

The draft standards are available for review at www.urac.org. Comments are welcome on any section of the draft standards. URAC prefers to receive comments through the online comment form available at www.urac.org. Alternately, comments may be submitted by email (comments@urac.org with the subject line ìComments ñ Pharmacy Benefit Management Standardsî); by mail (URAC, Attn: Public Comments ñ DM Standards, 1220 L Street, NW, Suite 400, Washington, DC 20005); or may be faxed to comments to (202) 216-9006.

ìOver the last three months of development, we have enjoyed robust discussion from the Pharmacy Benefits Management Advisory Committee,î John P. DuMoulin, MS, CAE, URACís vice president of government relations and product development. ìWe welcome and expect significant input during this comment period.î