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URAC’s Specialty Pharmacy Accreditation Incorporates Best Practices for Treating Chronic Conditions

Tuesday, April 24th, 2012

Washington, DC – The specialty pharmacy market is relatively new and is growing rapidly, fueled by the increasing number of complex chronic conditions that require more of the latest highly engineered pharmaceuticals. Specialty pharmacies offer a high-touch, comprehensive care system of pharmacological care wherein patients with chronic illnesses and complex disease states receive expert therapy management and support tailored to their individual needs. Medications that health plans and other payers classify as specialty pharmaceuticals may vary and evolve over time. URAC developed a specialty pharmacy accreditation program because it is one of the key distribution channels for pharmacy benefit management, and it extends URAC’s consumer protection and empowerment efforts in managed care pharmacy.

As part of its Part D drug benefit, the Centers for Medicare and Medicaid Services (CMS) define a specialty drug as one that costs more than $600 per month1. Other sources2,3 consider a “specialty” drug one that must fall into five of the following eight categories:

  • Treats specific, mainly chronic, and often rare conditions;
  • Usage initiates with a specialist;
  • Typically not administered orally;
  • Requires special handling;
  • Involves unique distribution and administration channels, such as special distribution management and specialized paperwork;
  • Is costly, ranging from $6,000-$750,000 per year;
  • Requires high degrees of patient management, like increased supervision of counseling; and
  • Results in patients requiring reimbursement assistance.

The URAC accreditation program design for Specialty Pharmacy includes five modules:  Core Organizational Quality Standards; Customer Service, Communications and Disclosure Standards; Specialty Drug Management Standards; Pharmacy Operations Standards and Patient Management.

“The increased desire for discrete quality management strategies are a good marker of the shift toward better coordinated care,” said Alan P. Spielman, President and CEO of URAC. “This industry-wide movement is cemented by payers’ preference that specialty pharmacies achieve third-party accreditation as a way to confirm their commitment to quality, cost containment and proper utilization.”

Specialty Pharmacy Best Practices

URAC recently recognized Medco Health Solutions, Inc., as recipient of a 2011 Best Practices in Health Care Consumer Protection and Empowerment Awards.  Medco’s Specialist Pharmacist Care Model for Improving Medication Adherence program demonstrates how the company’s pharmacy practice for patients with chronic and complex conditions – such as diabetes, cardiovascular disease and cancer – improves patient safety, affordability and medication adherence with essential medications. Medco specialist pharmacists are trained in a particular disease and supported by proprietary information systems that enable review of patient-level data and evidence-based clinical protocols to effectively identify and address clinically significant gaps in care, including adherence to essential medication and omissions of essential medications or testing.

Specialty pharmacies with URAC accreditation or that are in-process include:

  • Accredo Health Group, Inc.
  • Acro Pharmaceutical Services
  • Apothecary Shop of Deer Valley, Inc (Arizona Corporation), and Greater Sacramento Pharmacy, Inc. (California Corporation).
  • ASAP Pharmacy
  • Axium Healthcare Pharmacy, Inc
  • Biologics, Inc.
  • BioPlus Specialty Pharmacy Services, Inc.
  • BioScrip, Inc.
  • Brame Huie Pharmacy
  • Burman’s Specialty Pharmacy, LLC
  • Caremark Rx, LLC
  • Centric Health Resources
  • Commcare Pharmacy
  • Coram RX
  • CuraScript
  • Cystic Fibrosis Services
  • Diplomat Pharmacy, Inc.
  • Drugco Pharmacies
  • Fairview Pharmacy Services
  • Fast Access Specialty Therapeutics
  • Fresenius Medical Care Rx LLC
  • Giannotto’s Pharmacy
  • ICORE Healthcare
  • Josefs Pharmacy LLC
  • JVJ Pharmacists, Inc. dba University Chemists
  • KCC, Inc. dba Vital Care Rx
  • Kerr Health LLC
  • Kings Pharmacy LLC
  • Livingston Infusion Care, Inc., dba Discover Rx Infusion & Specialty Pharmacy
  • Longs Drugs of Lexington, SC Inc.
  • Main Street Pharmacy
  • Mast Drug Company, Inc.
  • MedCart Specialty Pharmacy
  • MedfusionRx, LLC
  • MEDIC SPECIALTY PHARMACY
  • Medicine Shoppe Pharmacy
  • MedPro Rx Inc.
  • OncologyRx Care Advantage
  • OncoSource Rx
  • OptumRx, Inc.
  • Orchard Pharmaceutical Services, Inc.
  • Pharmaceutical Specialties, Inc.
  • Pharmacy Advantage
  • Piedmont Hematology and Oncology Associates
  • Portland Professional Pharmacy Associates dba Ascend SpecialtyRx
  • Premier Kids Care, Inc.
  • Prime Aid Pharmacy, Inc
  • Tyro Family Pharmacy
  • US Bioservices – An Amerisource Bergen Specialty Company
  • Value Specialty Pharmacy
  • Village Fertility Pharmacy
  • Walgreens Specialty Pharmacy LLC
  • Wal-Mart Specialty Pharmacy

1 Centers for Disease Control and Prevention. Adult Obesity. www.cdc.gov/obesity/data/adult.html. Accessed September 13, 2011.
2 EMD Serono. EMD Serono Specialty Digest, 7th Edition. 2011; 18.
3 Sauerwald, Pamela Leigh. Changing the Channel: Developments in U.S. Specialty Pharmaceutical Distribution. Pharmaceutical Commerce. 2009; reprint.

Also available: The Patient-Centered Outgrowth of Specialty Pharmacy: URAC Specialty Pharmacy White Paper

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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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