The quality initiatives that are commonplace in the medical arena are now being adopted by pharmacy. Multiple stakeholders have been establishing standards to evaluate and improve quality in pharmacy benefit programs, drug therapy management, and community pharmacy.

Performance at the Individual Pharmacy Level
Pharmacy Quality Alliance (PQA), a membership organization of stakeholders, has established measures to evaluate how well pharmacies help to improve patient safety and compliance. PQA launched five demonstration projects in July 2008 to test the feasibility of a system to monitor pharmacy performance using its new measures.

Twenty organizations, including health plans, pharmacies, health information exchanges, and academic institutions, are partnering with PQA to test models for data integration, report generation, and quality improvement. The PQA-endorsed pharmacy performance measures include metrics for patient adherence in seven classes of drugs used to treat diabetes, high cholesterol, hypertension, and heart disease. Other metrics focus on dosing and therapy for diabetes and asthma. Pharmacy claims data will be used for measurement.

In addition to providing performance information to health care decision-makers, the monitoring system can help drive internal pharmacy improvements and identify patient education and intervention opportunities. A long-term goal of PQA is to develop and test pay-for-performance models for ambulatory pharmacy.

Health Plan Performance on Pharmacy
Through its Healthcare Effectiveness Data and Information Set (HEDIS), the National Committee for Quality Assurance (NCQA) provides patient-level data to measure health plan performance on pharmacy quality. There are HEDIS measures for appropriate medication use for chronic conditions, monitoring of patients on persistent medications, monitoring for use of high-risk medications in the elderly, and appropriate use of antibiotics. NCQA continues to refine pharmacy quality measures and publishes HEDIS scores annually in its Quality Compass.

Through its eValue8™ initiative, the National Business Coalition on Health and participating employers assess how well health plans manage pharmacy care. eValue8 is an evidence-based request for information (RFI) tool to collect performance data from health plans on many aspects of care. Following data collection, employers visit health plans onsite to discuss eValue8 results and areas for improvement. Health plans are evaluated on efficient use of pharmaceuticals, quality, and safety. eValue8 findings help employers promote quality improvement, negotiate contract provisions, and implement value-based purchasing.

Improvements to Medication Therapy Management
Over the past few years, Medicare Quality Improvement Organizations (QIOs) have partnered with Medicare Part D plan sponsors, community pharmacists, pharmacy schools, and other stakeholders to pilot projects designed to improve safety and quality in drug therapy. QIOs are private organizations that contract with Medicare to provide technical assistance to Medicare providers. Most projects focus on increasing enrollment and improving services of medication therapy management (MTM) programs. The improvement projects will be evaluated for larger scale implementation beginning in late 2008.

National Therapeutic Drug Management Standards
The National Quality Forum (NQF) is developing consensus standards for reporting therapeutic drug management quality. NQF is a non-profit membership organization created to develop and implement a national strategy for health care quality measurement and reporting. In its first six years, NQF endorsed more than 200 standards. In the pharmacy area, NQF has nearly completed its formal process for adopting standards that can be used across all health care settings to evaluate and improve therapeutic drug management.

Quality in PBM, DTM Operations
Quality processes and services in pharmacy benefit management (PBM) and drug therapy management (DTM) are recognized through URAC accreditation programs launched in 2007. URAC is a nonprofit organization that offers accreditation and certification programs to promote quality initiatives.

URAC accreditation indicates that a PBM company or DTM service provider has undergone a rigorous evaluation process and met industry-established quality standards. As of September 2008, 17 PBMs and 11 DTMs have received URAC accreditation or are in the process.

In August 2008, URAC approved two new pharmacy quality accreditation programs: specialty pharmacy and mail-service pharmacy. Seven companies are involved in beta testing to receive accreditation for one or both programs.