Standards

Draft, public comment, redraft, beta reviews, redraft, and approve.

That's the basic sequence for developing a new set of accreditation standards at URAC. While sometimes it seems as though this is a long, slow process (and sometimes it is), there are passages that seem like the Indy 500. In the history of the development of the URAC Pharmacy Benefit Management ("PBM") accreditation standards, now is one such time.

The public comments are in, and the second draft is being worked on. Yet, within a matter of weeks, URAC accreditation reviewers will be showing up on the doorsteps of the companies participating in the "beta" process to conduct their onsite reviews.

So, if you're a PBM that is participating as a beta applicant, some time in the next few days you'll get a copy of the revised standards and need to start gathering documents like crazy to be ready for the knock on your front door that could be as early as mid-March.

Now, of course, the beta process at URAC is different from the normal application process. The normal approach is to submit an application, receive an evaluation of that application from the reviewer(s), respond to that evaluation (called the "Desktop Review Summary") with additional documentation, then submit your organization to an onsite review. In the beta process, you gather your documents together, engage in a more dialogic back-and-forth with the reviews (and sometimes observers) during the onsite review, and then pull your formal application together after the reviewers have left.

Despite this difference faced by beta applicants, there is a big demand for fast action at this phase of the game. Staff training, gap analysis, document assessment and review, revision of P&Ps, mock onsite reviews, and much more, all within the next 30 business days. One of our clients is in this select crew, and we launch our effort tomorrow.

Ladies and gentlemen, start your engines.

After a several-year dormancy, the idea of a URAC Accreditation Program for Pharmacy Benefit Managers (PBMs) has reawakened. URAC announced today that it has formed a committee to develop standards for PBMs. This comes years after the PBM industry first started discussions with all the major managed care accreditation bodies to see who would be interested in developing such standards.

None of the accreditation organizations were ready for the idea in the early part of this decade, when the idea was first floated. I'm guessing that URAC is better prepared to step into this arena since the advent more recently of the Core Standards, which provide a baseline of sound management practices across all types of organizations. This narrows the range of issues to be hammered out, since the "management 101" principles are handled in the Core module.

What will be interesting to see is how the committee handles the fact that non-M.D. pharmacists typically make the UM-like decisions in the drug use management component of PBM operations. I surmise that once that issue has been resolved (if it has not already been resolved), the rest of the issues will go pretty smoothly.