Magazine article Drug Topics

Is an Accreditation Program Needed for PBMs?

Magazine article Drug Topics

Is an Accreditation Program Needed for PBMs?

Article excerpt

Should pharmacy benefit management programs meet quality standards? URAC, a Washington, D.C.-based healthcare quality group, has formed a Pharmacy Benefit Management Standards Committee to look into this matter. Its goal is to develop an accreditation program for PBMs and health plans alike.

Heading up the 34-member committee is John Jones, R.Ph., JD, VP of government affairs and pharmacy policy at Prescription Solutions, a PBM based in Irvine, Calif., and part of Ovations Pharmacy Solutions, representing a wide range of players in the PBM field. The committee has met twice and will meet again in December to review the initial draft of the standards, which is expected to be out for public comment this month. It will create standards for four related accreditation programs for health plans and PBMs providing services to both Medicare and commercially insured populations.

URAC's goal is to complete the development process and launch the accreditation programs by mid2007 following live beta testing, which is scheduled to begin after the first of the year.

"This is something whose time has come," said Jones. "At one point there were competing organizations looking at it, and ultimately, URAC felt it was time that this industry had a quality accreditation program developed for it. The industry is maturing, and there are several groups that would like to see standards in this area."

Under the committee heading, two subcommittees have been formed to study quality gaps and medical management in PBM programs and to evaluate consumer empowerment through these programs. These two separate work groups initiated efforts to create standards falling within two broad categories. The Operations Work Group has discussed standards for operational integrity, communications, customer service and disclosure, and pharmacy network. The Clinical Work Group has discussed drug use management, benefit design administration, patient safety, formulary development, and medication therapy management.

"We want to create an accreditation program for both the commercial and the Medicare markets that promotes industry best practices, encourages quality improvement, and protects and empowers consumers," said Alan Spielman, president and CEO of URAC. …

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