Accreditation: The Specialty Pharmacy 'Report Card'

In our current health care landscape, it has become more important than ever for specialty pharmacies to focus on quality and value-based care. The increased costs surrounding specialty medications, paired with the payer shift toward outcomes-based reimbursement models, have made tracking and reporting pharmacy data—as well as decreasing costs through quality and efficiency measures—critical to our success.

To secure payer and pharma contracts necessary for continued growth in the marketplace, specialty pharmacies must continually improve operational procedures and invest in increasingly complex technology. With new specialty pharmacies arriving on the scene and existing pharmacies continually evolving, how is it possible for payers and pharma to see each pharmacy’s “report card,” so to speak, to ensure they are a viable partner? The answer, of course, is specialty pharmacy accreditation.

There are many accrediting bodies for specialty pharmacies. According to URAC, their accreditation programs are considered the premier choice in the industry. URAC is also 1 of only 2 approved accreditations for health plans as part of the Affordable Care Act.1 However, URAC isn’t the only game in town when it comes to specialty pharmacy accreditation.

The Accreditation Commission for Health Care, The Joint Commission, Center for Pharmacy Practice Accreditation, and Community Health Accreditation Program are also very commonly utilized for accreditation by specialty pharmacies.

In order to show payers and pharmaceutical manufacturers that your pharmacy is dedicated to quality, controlling costs, and documenting positive patient outcomes, accreditation is now all but mandatory, if not truly mandatory, when competing for contracts. It is now considered part of the cost of doing the business of specialty pharmacy. Accreditation has become so commonplace in our current landscape that many contracts are now requiring not only 1, but 2 specialty pharmacy accreditations.

If accreditation is so common, and pharmacies now need multiple accreditations to be competitive, the accreditation process must be fairly simple, right? Wrong.

The accreditation process is extremely complex and each accrediting body has a slightly different focus and, therefore, different expectations. For this discussion, let’s focus on URAC accreditation.

According to the URAC website, a specialty pharmacy with URAC accreditation:
·       Has policies and procedures in place to ensure consumers have access to appropriate drugs/medications.
·       Maintains methods to measure customer satisfaction.
·       Protects consumer health information.
·       Has policies and procedures that ensure adherence to drug safety protocols.
·       Follows a logical blueprint for quality management, maintenance, and reporting.
·       Meets rigorous performance measures for accuracy and turnaround time of dispensed prescriptions.
·       Has a patient-centered strategy for its patient management program that includes coordination of care, communication and education, patient rights and responsibilities.
·       Ensures the timeliness and performance of customer service center operations, including time to answer telephone inquiries.
·       Reports mandatory performance measures to URAC.2
These attributes of a URAC-accredited pharmacy are anchored on 4 elements of specialty accreditation. The first element is customer service, communications, and disclosure. The quality measures included for this element are all related to patient satisfaction metrics and patient privacy. It is always of the utmost importance that patients are satisfied with their pharmacy services, and it becomes increasingly important with specialty patients.

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