Specialty Pharmacy Accreditation: To Be or Not to Be, That is the Question

Becoming an accredited specialty pharmacy requires a large time investment and a significant commitment to properly record and report specific data.

Defined in the broadest sense, accreditation means the action of officially recognizing someone as having a particular status or being qualified to perform a particular activity. This definition points to the idea that the act of accreditation provides an individual or organization with an official qualification to perform said duty.

Upon accreditation then, it would make sense that the duties must be performed to standard in order to maintain accreditation. I can remember various rules or restrictions that were placed on students in pharmacy school, sometimes in the name of accreditation.

I had always assumed that this accreditation was performed by a single authoritative body to whom all schools answered. In the case of academia, it truly depends on the institution; however, in the (tragic) case of a specialty pharmacy, this is far from the truth. The question is not, to be or not to be accredited. Instead it becomes, how many different accreditations should I get?

The Alphabet Soup of Accreditation

URAC, ACHC, TJC, CPPA: Each of these combinations of letters represent a different accrediting body used by specialty pharmacies. There is not a single authoritative body requesting consistent data reports and patient outcomes that a specialty pharmacy provider (SPP) can utilize. Instead, there is a mix of multiple bodies requesting different kinds and different levels of data.

As such, it is now standard practice for SPPs to have at least 2 accreditations from 1 of these 4 programs. Furthermore, these 4 accrediting bodies do not include other accrediting agencies that most pharmacies will have, such as VIPPS (Verified Internet Pharmacy Practice Sites) for accreditation of online pharmacies and VAWD (Verified-Accredited Wholesale Distributors) for pharmacies that also participate in wholesale distribution practices.

Lining up the letters

In order of their previous listing, the 4 accrediting agencies names are URAC (previously known as Utilization Review Accreditation Commission), Accreditation Commission for Health Care (ACHC), The Joint Commission (TJC), and Center for Pharmacy Practice Accreditation (CPPA). Each of these agencies require the reporting of different information with focuses on the business in different ways.

URAC, for example, is considered the gold standard for specialty pharmacy. This agency emphasizes 5 key measures: drug-drug interactions, call center performance, dispensing accuracy, distribution accuracy, and prescription turnaround time.

ACHC is considered the second most popular accreditation for specialty pharmacies and has slightly different reporting requirements. ACHC focuses on organizational structure, looking at patient care outcomes, but also on areas such as fiscal and human resources management.

ACHC is considered a deeming authority. They determine which facilities meet Medicare and Medicaid certification requirements, and can inspect your pharmacy unannounced.

TJC is not a traditional specialty pharmacy accreditation; however, many pharmacies continue to be accredited by TJC because for many years they were the only accrediting body in town. TJC focuses a lot on hospital or home care, and some of their standards do not pertain to specialty pharmacy.

Nevertheless, they too are a deeming authority and can show up for inspection without prior notice.

CPPA is a new accrediting body and was established by a partnership between the National Association of Boards of Pharmacy, the American Society of Health-System Pharmacists, and the American Pharmacists Association. This accreditation focuses on both clinical and business operations standards.

You must pay to play

As previously mentioned, the industry standard is for most SPPs to have at least 2 accreditations. Becoming accredited takes a large time investment (usually 8 months or more for the initial accreditation) and a large commitment to properly record and report the specific information that each body requires.

Maintaining accreditation can be even more difficult due to the commitment to record and report all necessary requirements; however, it also costs financially for accreditation.

Although the size of the pharmacy and the chosen accrediting body changes the cost for accreditation, it typically costs the pharmacy tens of thousands of dollars each time accreditation is given. And with the growing trend of pharmacies requiring more accreditations, that price is likely to rise.

So what’s the point?

Accreditation allows an objective third party to inspect and validate the processes of the specialty pharmacy. The purpose is to improve patient outcomes and patient care, while encouraging best practices.

However, each passing year the requirements from these bodies get more stringent and reporting requirements grow. Does this put continued burden on SPPs and drive efforts towards maintaining accreditation and away from basic patient care?

Why is it necessary to have at least 4 major accrediting bodies influencing the behavior of specialty pharmacies? Is the next step for pharmacy differentiation to have 3 accreditations?

These are some of the looming questions that many who work in specialty pharmacy have.

About the Author

Alex Toman attended Duquesne University, earning his Doctor of Pharmacy degree in 2011. Alex worked as a retail pharmacist until 2015, at which time he transitioned into a clinical pharmacist role within the specialty pharmacy industry. He 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.