It’s been a busy year thus far in many state houses and the effort to regulate pharmacy benefit managers (PBMs) hasn’t slowed down. Several state legislatures have considered bills to regulate PBMs’ business operations. As part of this effort, many PBM reform bills include language that prohibits PBMs or health insurance issuers from requiring pharmacies to be accredited for network contracting purposes. URAC has gone on the record in noting that we do not have a public position on whether and how PBMs should be regulated, but we do strongly oppose the ongoing effort to prohibit the use of accreditation as we feel it is a vital quality tool.
In the state of Texas, HB 1763, one of several bills the legislature considered relating to PBMs, was recently enacted. This bill includes a provision that would prohibit health plan issuers and PBMs from requiring specialty pharmacy accreditation. While URAC is opposed to any blanket prohibition on accreditation, we do recognize that some of the complaints associated with how accreditation may be misused as a barrier to market entry are valid.
The most common complaint regarding accreditation is cost. To help address this concern, URAC launched a reduced price offering designed to accommodate smaller, independent community pharmacies handling specialty medications. This program was created nearly two years ago in large part due to feedback about the cost of accreditation being burdensome for smaller pharmacies with less resources. “Cost alone should never prevent a high performing organization from being able to serve their community”, said Dr. Shawn Griffin, President and CEO of URAC. “From my background as a rural family physician, I know how important pharmacies are to their communities, especially underserved areas, both rural and urban.”
Heather Bonome, PharmD, Director of Pharmacy at URAC added, “We have seen all shapes and sizes of pharmacies achieve URAC specialty accreditation. The key is that accreditation ensures that the pharmacy, regardless of the size or business model, is providing the critical services that specialty patients need.”
One of our accredited clients in Texas, ReCept Pharmacy, wrote a letter to the Texas legislature highlighting the positive impact accreditation has had on their organization. ReCept has long been accredited by URAC and have been providing high-quality specialty care for over four decades. Many of their patients have complex chronic conditions such as cancer, HIV, hepatitis, and others. Quite simply, the medications they dispense and patient management they provide are invaluable to their community. In her letter, Kathleen Rand, Corporate Director of Quality Assurance and Training, noted, “Accreditation provided the framework for us to enhance our commitment to on-going innovation and improvement. Our solid, data-driven story demonstrates strong patient outcomes based on the optimal use of therapy, and hence it can be inferred that our management of therapies and patient outcomes are saving the overall healthcare system money, preventing side effects, and reducing hospital readmissions.”
To read more about ReCept and how accreditation has improved their organization, click here.
Brittany McCullough, Manager, Health Policy and Government Programs.
Brittany McCullough, URAC’s Manager of Health Policy and Government Programs, tracks and analyzes legislation and regulations of importance to URAC stakeholders. She also helps manage URAC’s public policy external affairs portfolio and oversees compliance with government deemed programs. Most of her policy and research work has been related to the ACA, Medicaid managed care, Part D, telehealth and mental health parity. She holds a B.S. in Neuroscience and a Master of Health Administration.
Views, thoughts and opinions expressed in my articles belong solely to me, and not necessarily to my employer.