URAC develops voluntary standards for PBMs

WASHINGTON--Nonprofit health care accreditation organization URAC has developed voluntary quality accreditation standards for the pharmacy benefit management industry.

URAC has launched a program for health plans and stand-alone PBMs in the commercial market to receive accreditation that they have met quality standards set by the Washington-based nonprofit for consumer protection and empowerment, appropriate access to drugs and pharmacies, patient safety, and disclosure of pricing and contracting terms, according to a statement.

Health care purchasers can benefit from the program because "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," Alan P. Spielman, URAC's president and chief executive officer, said in the statement.

The accreditation program will examine numerous PBM practices, including the qualifications of staff deciding which drugs to include in a formulary and how those decisions are made as well as the PBM's appeals procedures and the oversight of information disclosure to consumers, providers and pharmacists.

A dozen PBM's tested the program, including United HealthCare's Prescription Solutions Inc., Express Scripts Inc., PerformRx, MedImpact HealthCare Systems, Prime Therapeutics L.L.C., Catalyst Rx, Envision Pharmaceutical Services, Aetna Inc. and Navitus Health Solutions L.L.C.

The PBMs, which represent 52% of U.S. lives covered under PBM programs, are still going through the program and have not yet received accreditation, a URAC spokesman said.

URAC expects dozens of organizations to seek accreditation amid feedback that the new program will become the industry standard for purchasers and consultants, according to the statement.

A spokesman for the Pharmaceutical Care Management Assn., the organization representing PBMs, said it "has been involved and supportive of this effort and believes the new voluntary accreditation standards provide an additional information source for payers when making health care purchasing decisions."

URAC is also rolling out separate accreditation for drug therapy management, a related service provided by a broader range of organizations. The program will be launched in August, the URAC spokesman said.