URAC, the accreditation body that seems to be into every aspect of managed care, is now looking to certify PBMs. In a presentation at the PBMI conference in Phoenix last week, a representative provided an overview of the process, modules, timing and certification levels contemplated by URAC.
While the process is only for health lines today, URAC is seriously looking into accrediting WC PBMs…
Brace yourselves.
URAC currently has 16 different accreditation programs for such areas as HIPAA, Utilization Revew (group and workers comp), case management, consumer directed health, and health care call centers. While the organization’s standards are well-known, tend to support high-quality operations and service delivery, and in some states satisfy state certification requirements, the process can be onerous, expensive, and of uncertain benefit.
In what I’d characterize as a (very) soft sell, the presenter spent a good deal of time reviewing the benefits of URAC accreditation.
The modules include organizational integrity, pharmacy distribution channels, drug utilization management, formulary/P&T and others.
Given the lax P&T process that has resulted in listing of drugs like Lyrica on many formularies, the PT/formulary process alone may be quite valuable.
There are also stringent requirements for financial disclosure of rebate and admin fees. When one considers the confusion and consternation and outright frustration among buyers attempting to understand PBM pricing it’s clear there is a need for some universal standard.
So far, so good. Personally, I’ve been less than overwhelmed by a few of the entities accredited by URAC. My professional experience includes quite a few audits of managed care suppliers, several with URAC accreditation. Among the URAC accredited there are more than one that, by any measure, are low performers.
What does this mean for you?
URAC certification means the organization spent a whole lot of time and money getting a “seal of approval”. It may, or may not, mean the certified vendor is actually good at what it does.
PBMs, already pressured on the price front by buyers, may well find those same buyers requesting they spend time, money, and resources gaining certification. Whether those buyers will actually pay more to work with a URAC-accredited vendor is a doubtful proposition.
Joe, I have also audited several Magaged care companies that are URAC accredited and have found that the results are among the lowest peformers in the Industry. In addition if a confidential survey of Managed Care vendors was peformed I believe 90% of them would agree it is a shake down.