Pharmacy Benefit Management Accreditation

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Top Validation of Excellence

In a dynamic health care marketplace, where providers, payers, and other stakeholders responsibly work to improve patient health, it is important that pharmacy benefit management organizations (PBMs) demonstrate their commitment to consumer protection and transparency. Achieving the highly respected Pharmacy Benefit Management Accreditation from URAC provides this proof.

With this credential, your organization substantiates its commitment to quality care and better patient outcomes. The URAC seal means your programs and processes have been rigorously evaluated by the leading independent accreditor to be at the forefront of best-in-class programs.

URAC industry experts will collaborate with your team to facilitate learning and create a framework for continuous improvement in areas such as:

  • Customer service and communication benchmarks and safeguards
  • Financial disclosures mechanisms
  • Pharmacy distribution channels related to access, availability, and quality and safety across retail, mail order and specialty pharmacy delivery systems
  • Drug use management standards in key areas, to include coverage decisions, clinical review criteria, consumer safety process requirements, and the appeals process

Long-Lasting Benefits

URAC’s stringent standards help accredited PBMs focus formulary decisions on two criteria:  first, the safety, efficacy, and therapeutic need for drugs and, second, once these considerations are met, cost. The process brings numerous benefits, which include:

  • Driving appropriate therapeutic outcomes for consumers and reducing adverse events
  • Promoting safe and effective drug therapy that is rational and clinically appropriate
  • Ensuring an up-to-date formulary, along with an appeals process, peer clinical review and P&T committee standards

In addition, achieving this gold standard credential provides other benefits:

  1. Elevates contracting power, credibility, and differentiation over competitors as payers and stakeholders are assured of organizational competency
  2. Provides a practical roadmap for ongoing improvement with operational and clinical infrastructure, processes, and efficiencies
  3. Delivers risk management peace-of-mind with standards that prevent and manage liabilities
  4. Inspires innovation through a non-prescriptive approach that support your specific business and clinical practices
  5. Validates compliance with all state and federal regulations, licensing, and other regulatory requirements
  6. Helps you stay informed of breaking industry trends

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

What to Expect

In six months or less, URAC will collaborate with your team to create a flexible framework for continuous improvement without prescribing how to meet those standards. URAC’s approach stimulates innovation across the continuum of care through email, conference calls and web conferencing.

Who May Apply

Pharmacy benefit management companies, health plans, and other health care organizations are welcome to apply for this credential.

For Your Contracted Provider Network

PBMs understand the value of an accredited network since accreditation is both a business requirement and indication of excellence. URAC provides an array of relevant accreditations that reassures clients you can be depended on to follow best practices. Applicable accreditations include:

For your subsidiaries and internal services, consider these additional accreditations:

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