Should my practice pursue accreditation for our physician dispensing program?

Many practices are hearing more about accreditation and wondering if they should go through this process. Is it worth it? The short answer is yes. But explaining why you want to obtain accreditation and getting the support needed from your organization is more complex. While accreditation is not a significant expense for most practices, it is very time-consuming and requires commitment, not just from the pharmacy or dispensing program, but from the entire organization.

Physician office practices with point-of-care physician dispensing programs or licensed pharmacies are well aware of the efforts by pharmacy benefit managers (PBMs) to steer prescriptions to their corporate-owned specialty pharmacies. Recently, PBMs have pursued several tactics in an effort to make dispensing less attractive to specialty practices, including restricting or eliminating the ability to fill prescriptions beyond the first fill, revised definitions of network participation, and direct and indirect remuneration (DIR) fees that compromise patient care and financial viability.

In order to preserve the ability of their practices to fill prescriptions, many point-of-care dispensing programs are currently working to demonstrate that they meet all of the same standards as corporate specialty pharmacies. This includes becoming accredited and recognized as a specialty pharmacy. Increasingly, PBMs are signaling that in order to remain in network, dispensaries must be accredited by a recognized agency. In fact, Express Scripts Incorporated (ESI) has implemented an accreditation requirement, stimulating much of the accelerated interest in specialty physician office practices. Pharmaceutical companies have also indicated interest in accreditation as a means to ensure that their products are handled according to the highest standards and that patient outcomes are optimized. This is especially of interest for higher-risk specialty medications.

In the past, the answer was no. Originally, specialty pharmacy accreditation was only available via URAC and only licensed pharmacies could become accredited. Accreditation was very expensive and, as a result, only the largest licensed pharmacies in community oncology decided to pursue accreditation. Another organization, Accreditation Commission for Health Care (ACHC), began offering accreditation in 2004.

In 2016, with support from the Community Oncology Alliance, ACHC launched a new accreditation for specialty pharmacies known as Specialty Distinction in Oncology, which includes both licensed pharmacies and physician dispensing programs. This provides a less expensive and more inclusive pathway for accreditation, and enables practices with oncology-specific patient populations to differentiate their programs. ACHC has now become the preferred pathway for physician office practices.

As practices become familiar with accreditation standards, most will find that they already meet the majority of them. The challenge lies in documentation, or proof of compliance with the standards.  Ensuring that documentation exists for all standards and compiling the materials needed for the survey visit represent the biggest share of effort. In addition, many standards are met by documentation that exists in other departments, such as human resources, finance and business operations. It is very important to obtain executive-level support for the accreditation process and to engage all departments early to ensure they are on board and can complete their portions of the assessment. 

The time for accreditation varies depending on the readiness of the practice and the amount of time that can be devoted to prepare the necessary documentation. Per ACHC, practices should expect the accreditation process to be complete within six months.

The cost for accreditation through ACHC is $10,000 and the accreditation term is three years. For a practice that is accredited as a specialty pharmacy with a Specialty Distinction in Oncology (dual certification), the ACHC accreditation fee would be $15,000 for three years.  Most practices view this as a reasonable investment in the long term viability of their dispensing program.

Prior to beginning the application process, it is a good idea to review the accreditation standards and become familiar with the requirements and begin to assess your practice’s readiness. The process officially starts with filing the initial application with ACHC. The practice will be assigned an ACHC resource to assist throughout the process, and they will receive access to additional online resources such as audit checklists.  Practices should strongly consider working with a certified ACHC consultant experienced in community oncology pharmacy to help guide them through the accreditation process.

Accreditation has evolved from an optional add-on to a critical element of a successful point-of-care dispensing program or licensed pharmacy. Given the current market pressures to limit physician dispensing, practices should take steps now to demonstrate that they meet industry standards in order to preserve their programs for the future. Pursuing ACHC accreditation, with the support of your organization and a certified and experienced consultant, is indeed worthwhile and will help to ensure your patients can continue to access this valuable service.