The Basics

This standard, which applies only if your organization is contracted to provide post-enrollment consumer information, requires your organization to have the capacity to let your consumers know about a variety of resources, both information and customer assistance.  The list of resources you are required to provide include:

• Provider directory (including network, specialty, and mail order pharmacies)
• Information about benefits (which categories are covered, which categories are not covered)
• The consumers' financial responsibilities (e.g., deductibles, co-pays, etc.)
• Options the consumer might have regarding prescription benefits
• Evidence-based information regarding common ailments and their treatments
• Information to help consumers in a variety of interactions, like how to factor finances into pharmacy benefit decisions
• How to get help via email, telephone, or in-person.

Management Tips

URAC doesn't tell you how to deliver the information, but your mechanisms for delivering that information should be appropriate to your audience.  Don't worry about communication "upstream" to the employer/plan/purchaser of your PBM's services.  This standard is all about your consumers and the information you provide to them.

You should have policies and procedures which specifically outline how your organization will get the required information to consumers.  Remember, it is not sufficient that your organization does all these things, but also that you have a P&P that describes how you are going to do it.

We also recommend standardizing your documentation of consumer communication, such as template consumer letters and standard post-enrollment consumer informaction packets.

URAC Accreditation Tips

Each subsection of this standard is weighted 4.  

For the document submission, submit:

• The applicable P&Ps
• A portion of your provider directory
• A screen-shot of a consumer information page from your website
• Any employee training materials covering consumer communications
• Template letter to consumers

For the onsite review, in addition to interviewing your customer service representatives, the reviewer will look at your printed and online consumer information materials.