But first, a quick recap of the PQM^® program changes made in 2018.

With the release of Community Pharmacy v2.0 in August 2018, all pharmacy programs now include a version of the Core module.Community Pharmacy v2.0 was released with Core v4.0, a strategic decision designed to test this latest version of Core in a pharmacy program without impacting existing clients. Our one Community Pharmacy client (i.e., CVS) had no issues with Core v4.0 and as such were receptive to the changes made, which include moving each standard into one of four focus areas covering important yet familiar topics:

• Risk Management
• Consumer Protection and Empowerment
• Operations and Infrastructure
• Performance Monitoring and Improvement

In August 2018, all other PQM® programs were updated with PHARM Core v3.2. The changes made for this version of PHARM Core were limited to the delegation section, which is covered in a supplemental guide. This supplemental guide, along with an existing program guide, constitute the new program guide until Product Development republishes the guides later this year. A schedule for the release of these combined program publications will be shared in next month’s newsletter – I know you can’t wait!

Why focus on the PQM^® programs?

The pharmacy programs represent a significant part of URAC’s portfolio. In 2018, they represented 81% of new business contract value and 58% of reaccreditation contract value. While this is down from prior years, the PQM^® programs remain an important piece of URAC’s portfolio and we must ensure that our programs reflect current market trends.

What’s in store for the PQM^® programs in 2019?

In 2019, URAC plans to launch revisions of the following pharmacy programs: 

• Specialty Pharmacy
• Mail Service Pharmacy
• Drug Therapy Management
• Pharmacy Benefit Management
• Workers’ Compensation Pharmacy Benefit Management

 These revisions will follow our usual revision process of gathering input from Advisory Groups comprised of clients, industry leaders, and subject matter experts. The proposed revisions will be available for public comment before presentation to the URAC Board of Directors for final approval.

Specialty Pharmacy and Mail Service Pharmacy

The revisions for Specialty Pharmacy and Mail Service Pharmacy will be addressed together and will inform changes to the Drug Therapy Management accreditation as well. Revisions to these programs will focus on:

• Targeted focus on current practices in Patient Management documentation and Temperature Management.
• Aligning applicable standards with the Community Pharmacy Program v2.0.
• Identifying new areas of practice that should be reflected within these programs.
• Eliminating standards that do not reflect current practice.
• Streamlining the standard language into the “new” URAC standard format.
• Eliminating duplication within the standards.

Pharmacy Benefit Management and Workers’ Compensation Pharmacy Benefit Management