By usr@qconsult

April 30, 2022

Is Specialty Pharmacy Accreditation Worth the Cost & Effort – Post2

The answer: It depends

As more hospitals and health systems move into the specialty pharmacy business, the discussion on whether or not to go through the expense and effort of accreditation arises.

In its most simple form, the decision really lies around whether the pharmacy wants to have access to limited-distribution drugs, and depending upon the state, the ability to dispense specialty medications to non-Medicare patients. However, if the focus of the specialty pharmacy is more focused on those with open-distribution (of which there are many, including the 3 biggest sellers), and is happy with just catering to Medicare patients, then they might accreditation to be worth the investment.

One large hospital that we have worked has made a decision (at this time) to avoid the accreditation process. They can fill about 55% of all the prescriptions that they see with payers (mostly Medicare) and then can fill about 90% of those with open-distribution specialty drugs (e.g. Humira, Enbrel, Copaxone). The main reason they have held off on accreditation is because they do not have the approval to add the one or two FTE’s that they think will needed to manage the accreditation process, which many describe as ‘grueling.’ On top of this, is the approximate $50,00 in costs for accreditation.

On the flip side, hospitals like Vanderbilt University Medical Center are further down the specialty pharmacy path. Like many hospitals, they grew their specialty pharmacy business out of their outpatient pharmacy operation, and while the pharmacists knew how to dispense medication and manage the protocols of a patient on a specialty medication, they did not have the necessary documentation in place. Jerry Buller, the director of specialty pharmacy services at the medical center cited two essential doors that accreditation opened: The first was access to limited distribution drugs, and the second was access to payer contracts. Dr. Buller commented that “Meeting all the performance requirements for URAC and ACHC has raised the bar and allowed us to be in the conversation with large national payers.”

Most hospitals that we work with choose to open a specialty pharmacy and wait for a year or two before even considering specialty pharmacy accreditation – the most common of which is URAC as a first step.

If you have any questions about the value of specialty accreditation and if it is right for your hospital, then please do not hesitate to contact us about the options available.