The Basics

The standard imposes two requirements on the policies and procedures governing the functions of the P&T committee:

• a clearly defined policy regarding consumer use of and access to drugs before their inclusion in the formulary
• other formulary management activities, such as prior authorizations, step therapies, quantity limits generic substitutions, drug utilization, and other functions that address issues of consumer access to drugs.

Management Tips

Not only does this standard explicitly mention "protocols and procedures," but it also imposes a requirement that components of those policies addressing the requirements of the standard be "clearly defined."  In a reference to the issues raised in the standard will be insufficient.

URAC Accreditation Tips

Both elements of this standard are mandatory.

You'll need to submit the applicable policies and procedures for the desktop review, and have available the committee minutes for the on-site review.