The Basics

The standard imposes a requirement on your organization that it informs prescribers, patients, and payers about the various factors that go into formulary decisions.  The organization also must provide information about how to obtain non-formulary drugs and information about drug compliance.  The standard also requires that the organization's consumer education program explains how the organization makes its decision about inclusion in and exclusion from the formulary, as well as what is expected of the consumer.  Finally, consumers and providers must be able to readily access copy of the formulary.

Management Tips

In all such consumer and provider notification standards, URAC requires multiple methods of delivering information, as much as not everybody has access to the Internet.  Therefore, mere access to a formulary web page will not meet the intent of the standard.

URAC Accreditation Tips

Three of the elements of the standard are weighted 3, while the others weigh 4 each.

The submission requirement for the desktop review is the applicable policy and procedure as well as a comprehensive communication plan.

The on-site review will involve an examination of the formulary, probably on the website.  The reviewer also is likely to request a sample of notifications to prescribers, pharmacies, and consumers of any recent changes in the formulary.  It is therefore a best practice to have recent notifications of changes on hand during the on-site review.