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The Measure of a Quality Pharmacy Benefit Management Program: Accreditation

March 26, 2020

According to the Centers for Disease Control and Prevention (CDC), six in 10 adults in the U.S. have a chronic disease, and with the rising cost of prescription drugs, payers need to ensure they are providing their members with quality prescription benefits.[1] Payers have a choice of pharmacy benefit managers (PBMs), but how can you determine if they offer a quality program? Accreditation from the National Committee for Quality Assurance (NCQA), a private, nonprofit organization dedicated to improving healthcare quality that accredits and certifies a wide range of healthcare organizations, can provide payers with confidence that their members will receive the care they need.

Accred_UM (1)EnvisionRx has received Accreditation in Utilization Management from NCQA and is one of only three organizations to earn Health Information Products Certification for Pharmacy Benefits Information. These designations are in addition to being one of 27 organizations accredited by URAC for Pharmacy Benefit Management and one of only four organizations accredited by URAC for Drug Therapy Management. We have held our URAC accreditations since 2007. Additionally, our pharmacies hold accreditations from URAC for Mail Order and Specialty Pharmacy Services, from the Accreditation Commission for Health Care (ACHC) for Specialty Pharmacy Services, and from the National Association of Boards of Pharmacy® (NABP®) for Verified Internet Pharmacy Practice Sites® (VIPPS®) for mail pharmacy.

Accreditation Doesn’t Come Easy

Accreditation is earned by demonstrating your dedication to quality care. The NCQA certification and accreditation processes involved rigorous evaluations conducted by a team of healthcare professionals. A national oversight committee of physicians analyzed the team’s findings and determined certification and accreditation based on EnvisionRx’s compliance with NCQA standards.

Quality is extremely important when it comes to utilization management tactics, as not all approaches are equal. While it may seem that denying drugs would save the plan money, the lack of necessary medication could lead to undesirable health outcomes and even more complications. On the other hand, allowing more drugs without assessing appropriateness could needlessly drive up spend. EnvisionRx’s balanced approach ensures patients receive the right medication, at the right time and for the right price. Our utilization management programs offer clinically sound solutions based on indication, effectiveness, safety and adherence to drive improved health outcomes for members.

The NCQA Utilization Management Accreditation is a quality assessment program that focuses on consumer protection and improvement in service to customers. Standards recognize that organizations that apply for accreditation have open access networks, and can improve service quality and utilize customized structures to meet purchaser needs. EnvisionRx earned a three-year Accreditation in Utilization Management, which demonstrates that our services and clinical quality meet the highest consumer protection and quality improvement requirements.

44_HIP_Pharmacy_Benefit_Info_RGB (1)The NCQA Health Information Products (HIP) Certification for Pharmacy Benefits Information is a quality assessment program that health plans can use to assess organizations that develop and provide content, tools and services in pharmacy benefits. The process of earning this certification included evaluation of EnvisionRx’s management of various aspects of our data collection and systems operation, and the process we use to continuously improve the services we provide.

With pharmacy benefits becoming increasingly and unnecessarily complex, EnvisionRx strives to do things differently, aligning our interests with those of our clients and their members. The Pharmacy Benefits Information Certification proves that we are helping to simplify pharmacy benefits for our clients and improve the quality of care for patients.

Focus on Continuous Improvement and Quality Healthcare

As part of maintaining our accreditations, EnvisionRx continuously monitors and updates our processes to ensure we continue to deliver the best possible pharmacy care experience. Our NCQA certification and accreditation, in addition to our other accreditations, demonstrate our commitment to quality healthcare and accountability based on rigorous national standards.

[1] Centers for Disease Control and Prevention. Chronic Disease in America.