BusinessPolicy & Law

Hot Off the Presses: URAC Specialty Pharmacy Updates

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URAC Specialty PharmacyURAC accreditationURAC Specialty PharmacyURAC accreditation is highly coveted, especially when it comes to Specialty Pharmacy. As such, URAC recently released Revised Specialty Pharmacy Accreditation standards!

Highlights of these latest URAC Specialty Pharmacy updates include:

  • Updated performance measures for Specialty Pharmacy and Mail Service Pharmacy
  • Clarified the circumstances under which disclosure of the pharmacy service pricing structure is required
  • Made it mandatory for organizations to be able to handle clinical issues 24/7, while eliminating the requirement to respond to claims-related inquiries
  • Updated and enhanced telephone performance monitoring to align with current industry standards, including average blockage rates
  • Expanded consumer safety requirements, including validation of the cold chain distribution process
  • Enhanced quality management program design to include quarterly reporting to a quality management or other appropriate committee
  • For the “Patient Management” section of Specialty Pharmacy:
    • Identified all instances where medication reconciliation needs to be addressed
    • Require active facilitation of participation for “at risk” individuals
    • Specified communication and documentation requirements for coordination of care
    • Clarified the areas to address to demonstrate Patient Management program value

One major topic of discussion is that of mail-order pharmacy. Advisory group chairman, Kim Caldwell, RPh, said of the changes, “It is vitally important for any pharmacy in the specialty drug business to invest in the infrastructure to support the unique requirements necessary to dispense, monitor, and manage specialty medications with their patients, their health plans, and pharmacy benefit management (PBM) partners. These proposed standards are designed to align the specialty and mail order pharmacy best practices with the growth of the specialty drug boom to improve patient outcomes, reduce adverse drug events, increase medication adherence, and minimize medication waste.”

5 Steps to URAC Specialty Pharmacy Accreditation

Through accreditation, a pharmacy can exemplify to third-party payers and manufacturers that they have the resources and dedication to abide by their preset standards. Most contract agreements now require URAC Specialty Pharmacy Accreditation as part of their relationship with pharmacies, so getting accredited opens up the doors for a pharmacy to more business relationships.

Below are five steps to achieving and maintaining URAC Specialty Pharmacy Accreditation.

  1. A pharmacy’s relationship begins with URAC when the business enters an agreement and pays the necessary fees for accreditation.
  2. At this point, the business submits documentation of their current state of adherence to standards. They may be ready for accreditation, or, they may need to make a few adjustments first.
  3. In the third step, the accrediting body responds by evaluating how well the business is currently meeting the standards and what they need to do to improve. They may also request more information on which to base their decision, and this information needs to be sent within a predetermined time frame in order to qualify.
  4. The accrediting body is now ready to do an onsite evaluation. During this time, they will assess the business’s adherence to current policy and procedures.
  5. Finally, the accreditation decision is made. If the business becomes accredited, they will require periodic reviews by the accrediting body to maintain. If they are not ready to become accredited, they can make the necessary changes and submit again.
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