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New CMS Drug Cost Dashboard Highlights Implications for Specialty Pharmacies

Thursday, February 11th, 2016

New data released by the federal government backs assertions that specialty drugs are accounting for an increasingly larger amount of Medicare spending on pharmaceuticals. As this trend continues and gains more public notice, it shows why pharmacies that dispense specialty drugs owe it to themselves, their customers, and the public to demonstrate the quality of their services.

The Centers for Medicare and Medicaid Services (CMS) recently created a dashboard highlighting the 2014 costs of a select group of prescription drugs. In a blog post announcing the new dashboard, Acting CMS Administrator Andy Slavitt and CMS Chief Data Officer Niall Brennan wrote that its purpose is to “increase the knowledge around drug spending and support efforts that are evaluating whether public dollars are being spent most effectively.”

Selecting 80 drugs – half of which are the highest cost in their categories – CMS based dashboard rankings on high per-user spending, unit cost increases, and overall Medicare spending on those pharmaceuticals.

According to information provided by the CMS Drug Spending Dashboard, over $33.5 billion was spent on these drugs collectively in 2014 – amounting to 33 percent of the total spending on Medicare Part D and 71 percent of Part B-related drugs. Nearly 60 percent of the drugs studied could be classified as being in the specialty drug category.

In late 2015, the U.S. Department of Health and Human Services – of which CMS is a part – sponsored a discussion among stakeholders to discuss “the dual imperatives of encouraging drug development and innovation, while ensuring access and affordability.” Some drug costs borne by consumers are known to have risen as much as 22 percent between 2013 and 2014. Other specialty drugs may cost those who need them in excess of $20,000 in out-of-pocket cost sharing.

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Patients and taxpayers are looking for assurance that these expensive pharmaceuticals are correctly managed by the specialty pharmacies that dispense them. When an error occurs dispensing a specialty drug, the human and economic costs are high. Slavitt and Brennan added in their blog post that “[h]aving this [cost dashboard] information… should inform health care decisions, policy considerations, and encourage collective problem solving around these important issues.”

Part of any conversation on pharmacy and prescription drug-related quality should naturally include the importance of ensuring the functions of specialty pharmacies are validated through an adherence to quality standards set by independent stakeholders.

URAC defines a Specialty Pharmacy as a full-service pharmacy that specializes in filling prescriptions for patients who need certain high-cost biotech and injectable medications. These specialty medications help patients with complex conditions that include multiple sclerosis, rheumatoid arthritis, and certain types of cancer, solid organ transplant, and hemophilia. These drugs can be injected, infused, or taken orally. They typically require special handling and other specialty expertise.

High drug costs, especially when they are being paid for by Medicare, understandably generate scrutiny from the public, policymakers, and regulators. They want assurance that specialty pharmacies are well-managed and can properly handle such drugs as well as dispense them in an efficient and safe manner. With a rapidly-evolving health care landscape and increased public demands for cost containment, many organizations are seeking to differentiate themselves by seeking independent validation of their quality in delivering care. That’s where accreditation from URAC, the leader in the field, can be a valuable resource.

One CMS official, Acting Director of the Medicare Drug Benefit and Part C&D Data Group Amy Larrick, has mentioned the positive benefits of accreditation. In 2015, she suggested that an accreditation of services is among “conditions of participation established by the sponsor related to health and safety or financial integrity” when she issued guidance on participation in Medicare Part D’s “Any Willing Pharmacy” requirements.

URAC pioneered specialty pharmacy accreditation. It makes URAC uniquely positioned to share what we have learned from our review of hundreds of pharmacy organizations.

To ensure specialty pharmacies operate at the highest levels of efficiency and meet established best practices for quality assurance, URAC works with independent leaders within the pharmacy field and health care industry as a whole to create comprehensive accreditation standards. URAC performance expectations include how an organization conducts clinical assessments, addresses unique administration requirements, and provides individualized patient education and monitoring. These standards, and a rigorous review of them in practice, are meant to verify how applicant pharmacies store, handle, and ship their complex products.

URAC’s standards are geared toward making an applicant pharmacy a better organization while seeking a recognition that the organization adheres to quality practices and regulatory requirements. With increasing concern over drug costs, as reported by the new CMS dashboard (at least in public spending), it underscores the importance of being able to demonstrate that quality and integrity is a valuable asset.

With over 400 organizations choosing URAC’s Pharmacy Quality Management® programs to validate their quality, URAC’s specialty pharmacy accreditation is recognized as an industry pioneer and leader. It is yet another way that URAC aims to fulfill its stated mission of promoting continuous improvement in the quality and efficiency of health care management through processes of accreditation, education, and measurement.

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For 25 years, URAC has been the independent leader in promoting health care quality through accreditation, education, and measurement. URAC offers a wide range of quality benchmarking programs that reflect the latest changes in health care and provide a symbol of excellence for organizations to showcase their validated commitment to quality and accountability. URAC’s evidence-based measures and standards are developed through inclusive engagement with a broad range of stakeholders committed to improving the quality of health care.

For more information about URAC, contact us.

Interested in accreditation?
Contact businessdevelopment@urac.org

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