70% of Americans Receive Their Prescription Medications through PBM Companies; What is Assurance of Quality?

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URAC’s first-ever Pharmacy Benefit Management Accreditation standards now available to the market. More than 52 percent of market included in Beta test.

The standards address key areas for any pharmacy benefit organization, but allow for innovation

Pharmacy benefit management organizations now can seek URAC’s quality seal of approval with the introduction of the first-ever voluntary accreditation standards for the industry. Currently, about 70 percent of Americans receive their prescription medications through pharmacy benefit management companies, but until today there was no comprehensive assurance for consumers and purchasers that quality standards were met for consumer protection and empowerment, appropriate access to drugs and pharmacies, patient safety, and disclosure of pricing and contracting terms.

Pharmacy benefit management is a rapidly growing health care sector. Pharmacy related expenses in the United States were expected to reach $250 billion in 2006, representing an 11.5 percent increase over 2005. The sector saw rapid expansion with the introduction of Medicare Part D prescription drug coverage in 2006, with more than 39 million Medicare beneficiaries (90 percent) now enrolled in that program.

URAC, the Washington, D.C.-based independent accreditor of health care management organizations, announced today the availability of its Pharmacy Benefit Management Accreditation program for health plans and stand alone PBM organizations in the commercial market. The announcement is the culmination of more than a year of standards development and testing, engaging all major stakeholder groups and a field team of expert reviewers in the standards development and standards review process.

Initial standards underwent a public review and comment period, then field testing by a dozen pharmacy benefit management organizations, including United HealthCare’s Prescription Solutions, Inc.; Express Scripts, Inc.; PerformRx; MedImpact HealthCare Systems; Prime Therapeutics LLC; Catalyst Rx; Envision Pharmaceutical Services; AETNA, Inc.; and Navitus Health Solutions, LLC. The group together represents 52 percent of the current lives covered under pharmacy benefit management programs across the nation.

"URAC Pharmacy Benefit Management Accreditation will provide consumers with greater confidence that the companies which are behind the scenes managing their pharmacy benefits are dedicated to quality improvement, and that they have made the necessary investments into the clinical expertise and oversight that is necessary to manage an effective program in today’s environment," said Alan P. Spielman, URAC’s president and chief executive officer. "For purchasers, accredited companies can demonstrate that they clearly disclose their pricing methodologies and offer the services and protections consumers need as they deal with the complex world of pharmacy benefits management."

The pharmacy benefit management industry is relatively young, Spielman said, noting that "the time has come" for voluntary accreditation standards. URAC created the program to promote industry best practices, encourage quality improvement, and protect and empower consumers.

"At a time when employers must judiciously allocate health care dollars, URAC’s Pharmacy Benefit Management accreditation helps significantly in vendor selection," said Marianne Fazen, Ph.D, past chair of the National Business Group on Health, executive director of the Dallas Fort Worth Business Group on Health and URAC board member. "It gives purchasers an additional level of assurance that certain quality standards are met within the organization."

"Accreditation through URAC's Pharmacy Benefit Management program provides companies with assurance that they are receiving high quality products and services from participating vendors," said Cynthia Kirman, R.Ph.,Pharm.D., director of pharmacy, General Motors and member of URAC's Pharmacy Benefit Management Standards Committee.
The standards include modules for organizational quality, customer service, communications, disclosure of pricing policies, pharmaceutical distribution, drug utilization management, and formulary/pharmacy and therapeutics committee.

URAC is also rolling out a separate accreditation for Drug Therapy Management (DTM), a related service provided by a broader range of organizations.

Initial interest in the new accreditation program is high, as demonstrated by the largest field testing group in the history of URAC accreditation programs. Spielman said he expects dozens of organizations to seek accreditation early, as there is already feedback that URAC Pharmacy Benefit Management Accreditation will soon become an industry standard for purchasers and consulting organizations.

"The standards address key areas for any pharmacy benefit organization, but allow for innovation," said John Jones, RPh, JD, chairman of URAC’s PBM Standards Committee and vice president of professional practice and pharmacy policy at Prescription Solutions. "Clinical rigor, such as the qualifications of staff who make decisions about drugs included in a formulary and how those decisions are made, is one notable area. The standards also seek a very sound operational base and address regulatory compliance issues, such as oversight of information disclosure to consumers, providers and pharmacists.

"The accreditation program is really focused on making sure organizations do what is right by the consumer, including standards for appeals procedures and making sure they have access to the drugs they need," Jones added. "I know that regulatory bodies, such as state departments of insurance or state boards of pharmacy, are looking at ways they can consider this accreditation as a proxy for their development of laws and regulations. The states don’t want to be experts in PBM accreditation. They’ve got other work to do."

"URAC’s Pharmacy Benefit Management Accreditation brings a remarkable opportunity for organizations to demonstrate their voluntary commitment to the
highest level of standards for care," Spielman said. "Accreditation makes it easier for purchasers to compare vendors and gives the assurance that when they choose an accredited organization, they are choosing quality."

To read more about the URAC Pharmacy Benefit Management Accreditation program go to http://www.urac.org.

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 stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information, visit http://www.urac.org.

NOTE TO EDITORS: If you would like to speak with Alan P. Spielman, CEO of URAC, contact Katherine Capps at Health2 Resources, 703-319-0957

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
URAC
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