Pharmacy Benefit Management Accreditation

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URAC’s Pharmacy Benefit Management Accreditation standards facilitate transparency by ensuring that accredited organizations have a mechanism for clients to verify that financial disclosures are comprehensive and accurate.

Customer service and communication are key elements of URAC’s standards, which provide for enforcement of ongoing communications (in multiple formats) and communication safeguards. Standards for pharmacy distribution channels address key issues related to access, availability, quality and safety across retail, mail order and specialty pharmacy channels. URAC’s drug use management standards include areas of special interest to consumers and purchasers, including coverage decisions, clinical review criteria, consumer safety process requirements and the appeals process.

URAC’s standards help accredited organizations focus formulary decisions on the safety, efficacy and therapeutic need for drugs first, and focus on cost only after these considerations are met.

The URAC-accredited pharmacy benefit management program:

  • Meets key benchmarks in service quality
  • Has processes to identify consumer safety issues
  • Promotes rational, clinically appropriate, safe and effective drug therapy
  • Ensures the formulary is up to date
  • Includes review of the therapeutic advantages of drugs based on scientific evidence and standards of practice
  • Adheres to standards for P&T committee membership representation, its functions and responsibilities
  • Provides for a formulary appeals process, including peer clinical review
  • And more.

Download our Pharmacy Benefit Management Standards-at-a-Glance and Measures-at-a-Glance.

Who may apply

Pharmacy benefit management companies, health plans, and other healthcare organizations.

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