URAC is in the process of revising three accreditation
programs in its Pharmacy Quality
Management® suite of products: (1) Mail Service
Pharmacy (2) Specialty Pharmacy and (3) Workers’
Comp PBM. These are the first revisions of the Mail
Service and Specialty Pharmacy standards to include
proposed performance measures, such as dispensing
accuracy, medication possession ratios, generic
dispensing rates, prescription turnaround time, and
overall consumer satisfaction. The measures are specifically
designed to collect data on Mail Service and
Specialty Pharmacy processes and outcomes considered
critical for the evolution of professional practices
in these areas.
The revised programs were developed by URAC’s
Pharmacy Accreditation Advisory Group and
Performance Measures Focus Groups. These groups
are comprised of a wide range of stakeholders including
employers, consumers, pharmacy consultants,
health plans, independent retail pharmacies, pharmacy
benefit management organizations, pharmacy
professional organizations, labor organizations, and
large public purchasing groups. As part of the standards
revision and measures development processes,
URAC continues to enhance its programs following
the principles promoted by the U.S. Department of
Health and Human Services “Four Cornerstones” for
health care improvement and value-based purchasing
concepts. Specifically, URAC added new standards to
the pharmacy programs, since information and education
are key to empowering consumers.
URAC is committed to having the broadest possible
input into its standards development process.
URAC strives to ensure that its accreditation is
meaningful across the health care spectrum, including
consumers, purchasers, providers, regulators, and
the industry. Therefore, the proposed modifications
were available for public comment on any section of
the pharmacy standards and measures from February
5 through March 23, 2010.
The proposed revised Mail Service Pharmacy,
Specialty Pharmacy and Workers’ Comp PBM v2.0
accreditation guides include PHARM Core v3.0 and
other pharmacy modules. The new standards and
measures include:
New Standards:
PHARM Core v3.0
Note: PHARM Core v3.0 is the same module in the PBM and Drug Therapy Management (DTM) v2.0 accreditation programs. There were no new standards added to PHARM Core v3.0 since approval by URAC’s Board in July 2009.
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- Emergency management and business continuity
- Employment background screening
- Client satisfaction
- Information confidentiality and security
- Coordination with external entities
- Consumer rights and responsibilities
- Employment background screening
Mail Service Pharmacy, Specialty Pharmacy
and Workers’ Comp PBM
- Integration and coordination with existing benefits
- Communication process
- Electronic prescribing (e-prescribing)
Specialty Pharmacy—Patient Management
Module
- Patient management periodic reassessment process
- At-risk patient identification and recruitment
- Periodic consumer reassessment process
- Evidence-based research and practices—Promote
goals established for consumers, including health
outcomes
- Customize education materials and counseling
- Information regarding other resources and providers
- Program evaluation process and outcomes (3 standards)
New Performance Measures:
Newly proposed performance measures are being considered
for the first revisions of the Mail Service and Specialty
Pharmacy standards as part of the accreditation. The
measures are designed to collect data on Mail Service and
Specialty Pharmacy processes and outcomes considered critical
for the evolution of professional practices in these areas.
To date, each measurement effort has identified a
conceptual framework of measurement domains. The
pharmacy measurement conceptual domains include:
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