New Quality Standards To Measure Value Of Pharmacy Benefit Programs

Armen Hareyan's picture

Pharmacy Benefit Programs

Employer purchasers will discover how URAC's new Pharmacy Benefit Management Accreditation standards apply to their efforts towards value-based purchasing at an educational session during the 12th Annual Conference of the National Business Coalition on Health (NBCH), set for Nov. 11-13 at the Westin Kierland Resort & Spa in Scottsdale, Ariz.

"The New Quality Yardstick for Pharmacy Benefit Management Programs" will be presented at a Nov. 12 session by Alan P. Spielman, URAC's president and CEO, and Christopher V. Goff, CEO and general counsel of the Employers Health Coalition of Ohio.

Goff, a seasoned expert in pharmacy benefit management procurement, will address the challenges relating to contracting these services and will explain the complicated nature of how pharmacy benefits management organizations operate. Spielman will outline the genesis and development of URAC's new Pharmacy Benefit Management and Drug Therapy Management Accreditation standards and how employer purchasers can use the guidelines for contracting and vendor selection.

"Value-based purchasing is a function of both cost and quality, and employers need to know whether potential vendors meet industry-wide standards for organizational excellence and quality of the service they deliver," 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."


URAC's introduced the first-of-its-kind Pharmacy Benefit Management Accreditation in July 2007. Ten companies have already earned the accreditation, representing 52 percent of the current lives covered under pharmacy benefit management programs. URAC introduced a separate Drug Therapy Management Accreditation at the same time, and four organizations have already earned this accreditation. The Drug Therapy Management Accreditation is applicable to a broader range of health management organizations--pharmacy benefit management companies, or care management companies with oversight of a clinical Drug Therapy Management program.

The Pharmacy Benefit and Drug Therapy Management programs include standard definitions of key industry terms, standards for core organizational quality, and quality standards for consumer protection and empowerment, appropriate access to drugs and pharmacies and patient safety. The Pharmacy Benefit Management Accreditation also includes standards for disclosure of pricing and contracting terms.

"Just having a standardized approach to definitions makes a difference in this industry--more so than in others," Goff said. "Pharmacy benefit management tends to use a lot of acronyms and key definitions that are specific to the industry. By putting all that on a level playing field, it should make it easier for customers to interact with accredited plans."

NBCH's annual conference attracts business leaders across the country interested in improving the value of health care benefits to their companies. This year's conference theme, "Buying Right: Strategies for Purchasing Health Care that Delivers," will continue the organization's ongoing focus on successful value-based purchasing strategies.

Goff said URAC's Pharmacy Benefit Management Accreditation is a baseline for organizations to do business. "The standards were developed by a multi-stakeholder group--including plan sponsors, pharmacy benefit management organizations, consumer groups and health plans--and that lends them credibility," Goff said. "Having this accreditation gives plan sponsors a degree of confidence that the organization with which it is contracting adheres to a level of standards that is accepted as industry-wide practice."


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