The Basics

This standard deals with the situation in which your organization contracts with an intermediary organization that then, in turn, contracts with the participating pharmacy.  The standard requires that your contract with the intermediary makes it clear that the intermediary must bind the participating pharmacies with which it contracts to the terms of your agreement with the intermediary.  The purpose of the standard is to make sure that the fact that there is an organization between your organization and the participating pharmacy does not let the participating pharmacy off the hook for compliance with the previous standard's requirements for a participating pharmacy agreement.

Management Tips

In addition to making sure that your pharmacy intermediary agreements contain the subcontracting clause required by this standard, binding downstream pharmacies to the terms of the intermediary agreement, it will be imperative that your pharmacy provider manual and/or applicable policies and procedures also address this issue.  Beyond that, it would be advisable to make sure your policies and procedures and/or manual establish a mechanism for tracking these relationships, as they are of particular concern to reviewers.

URAC Accreditation Tips

This is a mandatory standard.

The initial documentation is simple: submit your contracting policy and procedure and a template agreement containing the required language.

The on-site review will involve an examination of your contracts with pharmacy intermediaries, as well as an interview with network management staff to make sure that they understand this important requirement.