URAC Sets Standards For Pharmacy Benefit Management Programs

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New Standards Aimed At Ensuring Patient Safety, Consumer Protection

Today URAC announced it has formed a Pharmacy Benefit Management Standards Committee to advise the organization on the creation of requirements for the first-ever accreditation programs addressing pharmacy benefits management in the Medicare, commercial insurance and health plan arenas. URAC is the independent, nonprofit health care accrediting organization well-known as a leader in promoting health care quality through its accreditation and certification programs.

“One out of every five health care dollars is spent on prescription drugs, and there is presently no independent accreditation program ensuring quality in pharmacy benefits management,” said Alan Spielman, URAC’s president and chief executive officer. “The potential to enhance patient safety, assure timely access to prescription medications and to improve medication therapy management in this area is enormous.”

Currently, pharmacy benefit management companies (PBMs) contract with 95 percent of retail pharmacies nationwide (1). With the introduction of the Medicare Part D prescription drug benefit this year, the number of Americans enrolled in PBM programs is expected to grow dramatically. Currently more than 38 million Medicare beneficiaries are enrolled in a prescription drug program (2). Medicare prescription drug spending alone over the next 10 years is projected to reach between $500 billion and $1.2 trillion (3). Prior to implementation of the Medicare Part D program, only 70 percent of adults with chronic conditions received recommended medications (4).

Understandably, such large expenditures are attracting the attention of lawmakers, regulators and business purchasers. Most PBMs are working to meet or exceed customer expectations regarding transparency in their contracting practices and by providing more information to consumers about the price and value of medications. But as the number of Americans covered by pharmacy benefit management programs grows, the need to establish quality standards that support informed consumer choice increases.

As a third party, independent voice informed by multiple stakeholders, URAC has a long history of establishing standards for best practices in the care management sector. Accreditation programs that align standards with industry best practices offer purchasers and consumers the confidence that accredited organizations meet or exceed those standards.

The pharmacy benefit management accreditations will include standards relating to organizational integrity, clinical quality and benefits management programs, pharmacy network access, and consumer education and support.

“From the employer perspective, it is important to have assurances that pharmacy benefit managers deliver on promises for customer service, savings and fair pricing structures,” said Marianne Fazen, director of the Dallas-Fort Worth Business Group on Health, chair of the National Business Coalition on Health and a member of URAC’s board of directors. “Employers have seen instances where certain vendors haven’t lived up to those promises. URAC accreditation can offer trusted, third-party assurance that pharmacy benefit management programs deliver better quality in organizational, contracting and communication areas.”

URAC also announced that is has named John D. Jones, RPh, JD, to chair its Pharmacy Benefit Management Standards Committee. Jones is vice president of government affairs and pharmacy policy at Prescription Solutions, a PBM based in Irvine, Calif.,part of Ovations Pharmacy Solutions. Jones is both a pharmacist and an attorney with experience in managed health care regulation, health care contracting and interstate regulatory compliance for PBMs and health plans.

“John brings more than 30 years of expertise and the respect of his colleagues to this task,” Spielman said. “He will be joined by a committee of health care stakeholders to recommend standards, including purchasers, regulators, consumers, health plans, PBMs and other expert voices in pharmacy management.”

”Many in the industry are already working to find ways to better educate those buying prescription drug benefits on the value of programs such as managed formularies, disease management, and mail-order pharmacy,” Jones said. “A third-party accreditation program that sets industry-wide standards will assure purchasers that accredited PBMs and health plans are organizationally working to improve quality, increase satisfaction, and lower costs.”

Under the Pharmacy Benefit Management Standards Committee, two subcommittees will also be formed to study quality gaps and medical management in PBM programs and to evaluate consumer empowerment through these programs.

The Pharmacy Benefit Management Standards Committee will create standards for four related accreditation programs for health plans and PBMs providing services to both Medicare and commercially insured populations. The committee will begin meeting this summer and will seek additional input through public comment opportunities. URAC's goal is to complete the development process and launch the accreditation programs in 2007.

(1) Congressional testimony of Mark Merritt, May 23, 2006.

(2) CMS, May 16, 2006

(3) “Medicare Drug Benefit May Cost $1.2 Trillion,” Washington Post, Feb, 9, 2005.

(4) The Quality of Health Care Delivered to Adults in the United States, McGlynn E. A., Asch S. M., Adams J., Keesey J., Hicks J., DeCristofaro A., Kerr E. A., N Engl J Med 2003; 348:2635-2645, Jun 26, 2003.

About URAC

URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation and certification programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all key stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information, visit http://www.urac.org

This press release was distributed through eMediawire by Human Resources Marketer (HR Marketer: http://www.HRmarketer.com) on behalf of the company listed above.

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Karla Hurter