The Basics

This standard requires that your organization implement a pharmacy relations program for your participating pharmacies.  It sets forth several components that are required of this pharmacy relations program:

• a communications plan that addresses new pharmacy orientation, updating network activities, notice of changes in contract provisions, advising pharmacies on how to obtain information about benefits, eligibility, formularies, and appeals, and mechanisms for obtaining participating pharmacy manuals;
• help for pharmacies and their staffs on various network issues; and
• processes for receiving suggestions from participating pharmacies on how your organization can best serve its consumers.

Management Tips

Our recommendation is that you prepare a comprehensive document that embraces all of your provider relations issues.  At the very least, we suggest that you have a clearly-identified communications plan to guide your communications with participating pharmacies.  That communications plan should address all the various means of communicating with providers, including newsletters, online medications, "blast faxes", and telephone services.  

It also will be important to be able to document how you receive feedback from participating pharmacies, whether through a formal survey mechanism or through a solicitation of less-formal suggestions.

URAC Accreditation Tips

Seven of this standard's eight elements are weighted 4, while the element about receiving suggestions and guidance from pharmacies is weighted 3.

The initial documentation submissions should include not only your governing policies and procedures and communications plan, but also a few examples of your mechanisms for communication, such as newsletters, screenshots of provider-facing webpages, etc.

In addition to the network-management interview, the on-site review will focus on an examination of any recent notices sent to pharmacies regarding changes in contract or fees, as well as a complaint log that tracks pharmacy complaints.