The Basics

This standard requires that your organization's policies and procedures regarding formulary envy P&T committee specifically address how it interfaces with both the drug utilization management and quality management programs.

Management Tips

A mere reference to quality of health care for utilization management is likely to be insufficient in the eyes of URAC.  Rather, your policy and procedure should address, overtly, the mechanisms by which the three programs (DrUM, QM, and PTFD) interact.  Such mechanisms could include a requirement of inter-program communications and/or a review of the formulary program by the quality management committee.

URAC Accreditation Tips

The single element of the standard has a weight of 2.

The applicable policy and procedures the sole documentation required for initial submission for this standard.

The on-site reviewer will examine quality management committee minutes for evidence of inter-program interaction.  He/she also may look for other documented indicators of inter-program interaction (e.g., reports).