I recently had the pleasure of taking a break from my normal day job to shadow a validation review. Given that my everyday tasks don’t really overlap with the review process, I was excited to get the chance to observe our reviewers in action. I regularly interact with product development, so I have a general understanding of how our standards are developed/revised, but this was a great opportunity to see our standards come to life, for lack of better words.

To give some background, I observed a specialty pharmacy client up for reaccreditation in New York City. They referred to themselves as something akin to a Mom and Pop 2.0 in that they are a small, independent pharmacy, but they have more than one location. I was actually surprised to see how much business they do.

Here’s what I learned:

1. Our reviewers are rock stars
2. REVIEWERS. ARE. ROCK STARS.

Honestly the amount of work the reviewers do is quite impressive, and my hat goes off to all of them.

Okay now that we’ve gotten that out of the way – here are the top 5 things I discovered during my validation experience:

1. Clients really do recognize the value in URAC (this client noted at the outset that URAC is the “highest standard” in specialty pharmacy accreditation)
2. The documentation review portion is the area in which most issues arise, especially if a client has had employee turnover
3. URAC aims to avoid being punitive
4. The intent of our standards is not always construed correctly by the client (this occurred more than once and was a minor source of frustration)
5. Clients up for reaccreditation don’t have an easier process because they must have proof that they kept up with the URAC standards over the previous 3 years

The item that really hit home for me was the discrepancy between the intent of our standards and how the client interpreted them. It was even noted by the client that the standards are basically nothing without the guide because the guide is where the interpretive information is found – and – even the guide information is not always enough. In discussion with Bruce Karns and Troy Reese (the awesome reviewers I got to tag along with!) I discovered that it isn’t uncommon for clients to point this out.

All in all, I had a great time and encourage anyone who hasn’t been on a review to shadow one if you have the opportunity.

I do want to acknowledge Heather, Karen and the entire review staff who travel near and far to conduct these exhaustive reviews. Most importantly, I want to give a big thank you to Bruce and Troy for letting me shadow them, all the insight they provided me with, and for making me feel like part of the team. Lastly, thank you to Aaron (and Heather again) for setting this in motion. It really was an invaluable experience.

Lastly, I’d be remiss to not give my update on all things government and policy:  

There are currently two proposed rules under review at the Office of Management and Budget (OMB) related to the Trump Administration’s Drug Pricing Blueprint released in May. One will require drug companies to disclose their prices in advertisements and the other will remove the safe harbor protection for rebates given to health plans/PBMs.