The Basics

This standard, which applies only to materials sent to consumers enrolled in the PBM program, requires that your organization monitor those materials for accuracy and changes them where necessary to assure that accuracy.  This ongoing monitoring should be done in connection with information about

• participating pharmacies;
• the formulary; and
• benefits.

This standard makes more specific a general requirement covered by a standard in the Pharm Core module.

So, if changes in your network, formulary, or benefits occur, you'll need to have one or more mechanisms in place inform consumers about those changes in a timely fashion (which often will mean letting them know before the changes go into effect).  

Management Tips

URAC doesn't prescribe the means by which you must let consumers know of changes, but the reviewer will expect that it make sense in the context of your particular organization and the make-up of its client- and consumer-base.

The communications plan (or P&Ps) discussed in the applicable Pharm Core standards should be specific enough to cover the requirements of this standard.  

URAC Accreditation Tips

Each element of this standard carries a weight of 4.  

The AccreditNet submission should include the communications plan/P&Ps and sample communications advising consumers of changes in the formulary or benefit structures.