Accreditation: The Specialty Pharmacy 'Report Card'


With new specialty pharmacies emerging and existing pharmacies evolving, accreditation has become more important.

In our current health care landscape, it has become more important than ever for specialty pharmacies to focus on quality and value-based care. The increased costs surrounding specialty medications, paired with the payer shift toward outcomes-based reimbursement models, have made tracking and reporting pharmacy data—as well as decreasing costs through quality and efficiency measures—critical to our success.

To secure payer and pharma contracts necessary for continued growth in the marketplace, specialty pharmacies must continually improve operational procedures and invest in increasingly complex technology. With new specialty pharmacies arriving on the scene and existing pharmacies continually evolving, how is it possible for payers and pharma to see each pharmacy’s “report card,” so to speak, to ensure they are a viable partner? The answer, of course, is specialty pharmacy accreditation.

There are many accrediting bodies for specialty pharmacies. According to URAC, their accreditation programs are considered the premier choice in the industry. URAC is also 1 of only 2 approved accreditations for health plans as part of the Affordable Care Act.1 However, URAC isn’t the only game in town when it comes to specialty pharmacy accreditation.

The Accreditation Commission for Health Care, The Joint Commission, Center for Pharmacy Practice Accreditation, and Community Health Accreditation Program are also very commonly utilized for accreditation by specialty pharmacies.

In order to show payers and pharmaceutical manufacturers that your pharmacy is dedicated to quality, controlling costs, and documenting positive patient outcomes, accreditation is now all but mandatory, if not truly mandatory, when competing for contracts. It is now considered part of the cost of doing the business of specialty pharmacy. Accreditation has become so commonplace in our current landscape that many contracts are now requiring not only 1, but 2 specialty pharmacy accreditations.

If accreditation is so common, and pharmacies now need multiple accreditations to be competitive, the accreditation process must be fairly simple, right? Wrong.

The accreditation process is extremely complex and each accrediting body has a slightly different focus and, therefore, different expectations. For this discussion, let’s focus on URAC accreditation.

According to the URAC website, a specialty pharmacy with URAC accreditation:

· Has policies and procedures in place to ensure consumers have access to appropriate drugs/medications.

· Maintains methods to measure customer satisfaction.

· Protects consumer health information.

· Has policies and procedures that ensure adherence to drug safety protocols.

· Follows a logical blueprint for quality management, maintenance, and reporting.

· Meets rigorous performance measures for accuracy and turnaround time of dispensed prescriptions.

· Has a patient-centered strategy for its patient management program that includes coordination of care, communication and education, patient rights and responsibilities.

· Ensures the timeliness and performance of customer service center operations, including time to answer telephone inquiries.

· Reports mandatory performance measures to URAC.2

These attributes of a URAC-accredited pharmacy are anchored on 4 elements of specialty accreditation. The first element is customer service, communications, and disclosure. The quality measures included for this element are all related to patient satisfaction metrics and patient privacy. It is always of the utmost importance that patients are satisfied with their pharmacy services, and it becomes increasingly important with specialty patients.

In the world of retail pharmacy, many patients are utilizing pharmacy services on an acute or temporary basis. Most specialty patients will require service through a specialty pharmacy for their entire lives.

The second element of URAC accreditation is Specialty Drug Management. We must track quality data when dispensing specialty medications to ensure proper resolution and documentation of any quality errors that may occur to demonstrate adherence to quality standards. According to Aaron Turner-Pifer, URAC’s director of government relations and policy, “This quality data can and should be used as a competitive tool that exhibits a specialty pharmacy’s expertise.”3

URAC also adds a sixth right to the “Five Rights” of medication administration, which includes right patient, right drug, right dose, right time, and right route. The sixth right that URAC includes is “the right result for the patient,” in demonstrating the importance of tracking patient outcomes.

This falls under the third element for accreditation: patient management. Tracking and reporting patient outcomes is increasingly important as CMS regulations are following outcome-based reimbursement models, as mentioned above.

The final element of specialty accreditation through URAC is pharmacy operations. The goal of tracking operations metrics is to ensure adherence to key performance indicators such as turnaround time and average speed of answer, and to identify opportunities to gain efficiencies where possible.

Tracking and working to decrease the average speed of answer, which is the average time that it takes a representative to answer an inbound call, is critical to patient satisfaction. The turnaround time is directly related to the speed with which patients can gain access to their specialty medication. When managing complex disease states, including HIV and cancer, a small decrease in turnaround time can significantly improve patient outcomes.

These examples of quality and service metrics are just a snapshot of the increasingly complex expectations for specialty pharmacy accreditation. To gain the competitive advantage to win business in the current marketplace and to ensure that patients are achieving the best possible outcomes, it is critical to get a passing grade on our accreditation report card.





About the Author

Kimberly Firtz earned her Doctor of Pharmacy degree from Duquesne University and is currently enrolled in the Masters of Science in Pharmacy Business Administration (MSPBA) program at the University of Pittsburgh, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines. Kimberly has spent the last 5 years working in Specialty Pharmacy, initially as a clinical pharmacist and most recently working on a variety of high profile Specialty Operations Projects. Her current role is working with the Process Innovation team on an effort to transform Specialty Operations and optimize the stakeholder experience.

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