Specialty Pharmacy: New Accreditation Program, Same Value(s)

August 12, 2021 · Matt Brock

These are exciting times at NCQA. First, last week’s release of HEDIS® 2022. Now, new products that apply NCQA’s values of measurement, accountability and transparency to new sectors of the expansive health care system. NCQA now offers  Specialty Pharmacy Accreditation, a service to help distinguish quality leaders and support value-based contracting in the rapidly growing field of specialty pharmacy.

“Specialty Pharmacy Accreditation addresses intersecting needs,” said Brad Ryan, MD, Chief Product Officer of NCQA. “Specialty pharmacies want to showcase their quality to stand out from peers so they can gain access to networks and pharmaceutical products. Drug manufacturers want to trust a specialty pharmacy can manage their products appropriately. And payers want to trust a specialty pharmacy can provide quality care to their members.”

“Specialty Pharmacy Accreditation helps organizations reach all those goals.”

In addition to helping pharmacies demonstrate their commitment to quality improvement and show they can be strong partners for value-based contracts, the new program helps pharmacies identify barriers to therapy initiation and adherence.

Organizations interested in NCQA Specialty Pharmacy Accreditation also stand to make meaningful improvements and contributions to quality by participating in a first-of-its-kind Measurement Lab.

The NCQA Specialty Pharmacy Measurement Lab is a collaborative working group composed of quality leaders from specialty pharmacies, health plans, pharmacy benefit managers, manufacturers and other industry stakeholders. Measurement Lab members learn best practices, pilot performance measures and influence the creation of digital measures as benchmarking and performance-based accreditation evolve.

Diverse organizations like those comprising the Measurement Lab helped design the new accreditation program. Organizations NCQA consulted include 11 specialty pharmacies, 9 health plans, 9 drug manufacturers, 6 pharmacy benefit managers and 3 patient advocacy groups. A 14-member Advisory Committee representing those industries—plus academia and CMS—developed the accreditation standards.

Specialty Pharmacy: The NCQA Standards

Pharmacies meet standards in four areas to earn Specialty Pharmacy Accreditation:

• Patient Programs standards evaluate how well pharmacies support patients through the script journey—how patient-centered a pharmacy is and how it ensures patients experience their medications’ intended benefits.
• Organization, Administration and Compliance standards evaluate how pharmacies train their staff and align with regulators and other stakeholders.
• Specialty Pharmacy Operations standards consider how well pharmacies procure, secure, dispense and ship products to ensure product integrity.
• Quality and Performance Improvement standards unify and build on the previous three standards to assess how pharmacies organize and measure continuous improvement.

Eligible organizations are licensed pharmacies that contract with drug manufacturers, health plans or pharmaceutical benefits managers to dispense specialty medications and provide supporting services.

Accreditation surveys, which may be virtual or in-person, will begin in early 2022. NCQA determines accreditation status within 34 days after a survey. Specialty Pharmacy Accreditation lasts three years.