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Accreditation: An Essential Distinction in the Evolving Realm of Pharmacy
Originally published in the March 2011 NABP Newsletter
With its first accreditation program developed more than a decade ago, NABP continues to advocate accreditation as a symbol of excellence in health care and as a means for providing additional support to the regulation of pharmacy. As a process whereby professional associations or nongovernmental agencies grant recognition to health care organizations for demonstrated ability to meet predetermined criteria for established standards, accreditation provides more than just a certificate of recognition or gold star. It creates a culture of health care distinction, promoting quality care and public protection by providing a framework guiding entities as they seek to improve upon their current practices.
Accreditation Outcomes
Entities that undergo the thorough, ongoing reviews associated with accreditation demonstrate their ability to go above and beyond standard requirements, evaluating their operations and services against current and emerging performance standards developed through the collaboration of experts and stakeholders in the health care arena. As part of the accreditation process, these entities are afforded the opportunity to take an in-depth look at all of their patient safety and care delivery processes.
Even after accreditation is granted, accredited entities are continually striving to provide the highest quality services as they are periodically evaluated by NABP to ensure that they uphold the standards set forth by each accreditation program. All of the NABP accreditation programs offer a growing range of quality benchmarking programs and accreditation services to assist pharmacies in keeping abreast of constant changes in pharmacy practice and the health care system as a whole.
The dynamic nature of accreditation calls for constant evolvement as advancements in health care continue to shape the practice of pharmacy. Promoting adoption of current best practices, accreditation can help pharmacies to keep pace with emerging health care advancements more readily than if undertaken by mandates through legislation and regulation. In some cases, accreditation has the ability to advance compliance at less costly and cumbersome rates than more stringent legal and regulatory mandates.
More than just a marketing tool, accreditation can minimize risk for accredited entities by improving communication within the pharmacy. Successful preparation for accreditation and follow-up surveys can assist pharmacists and pharmacy staff by increasing teamwork while boosting their morale and pride in the standard of care they offer.
In the long run, accreditation may be a less onerous and costly option for advancing patient safety than other measures, such as continually imposing more complex legislation or regulations on businesses and pharmacies, as a method of capturing greater levels of compliance within the practice of pharmacy. Entities that obtain accreditation validate their commitment to excellence, quality, and most importantly accountability.
NABP Programs
As a leading national accrediting organization, NABP drives improvements in health care through its six accreditation programs: DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies), VAWDCM (Verified-Accredited Wholesale DistributorsCM), VIPPS® (Verified Internet Pharmacy Practice SitesCM), Vet-VIPPSCM (Veterinary-Verified Internet Pharmacy Practice SitesCM), the NABP e-Advertiser ApprovalCM Program, and newest in development, the community pharmacy accreditation program. Each of these programs was developed to include requirements that ensure patients and beneficiaries receive quality care and services from their DMEPOS, Internet, and community pharmacies, as well as the wholesale distributors who supply them.
Through accreditation, NABP works closely with regulatory agencies and other stakeholders to ensure that quality health care is continually provided. In 2006, the Centers for Medicare & Medicaid Services (CMS) approved NABP as an accrediting organization for suppliers of DMEPOS. As an accreditation program for licensed pharmacies that distribute certain DMEPOS products, the NABP DMEPOS program ensures that accredited suppliers meet all quality standards required in order to obtain or maintain their Medicare billing privileges. DMEPOS-accredited pharmacies undergo an annual participation compliance review and must obtain reaccreditation every three years. Obtaining DMEPOS accreditation holds these suppliers at a defined standard, allowing them to participate in the DMEPOS competitive bidding program, which was implemented by CMS to help reduce out-of-pocket costs and improve the effectiveness of Medicare DMEPOS payments while ensuring beneficiary access to quality items and services.
Additionally, accredited suppliers are viewed as having enhanced credentials when it comes to participating in Medicare Part D. While CMS requires all Part D sponsors to provide Fraud, Waste, and Abuse (FWA) training to all entities they partner with to provide benefits or services in Part D programs, CMS recognizes those pharmacies who have obtained DMEPOS accreditation as having met the FWA requirements.
By reaching out to other accreditation and industry stakeholders to ensure quality standards are uniform nationally, NABP recognizes that the realm of responsibility to successfully implement quality standards is a collaborative effort among the industry and regulators. In one instance, NABP provided a $50,000 grant to the National Community Pharmacists Association (NCPA) for consulting services and assistance in developing the DMEPOS program with awareness of the unique practices and needs of independent pharmacies.
In an effort to combat the growing presence of counterfeit drugs, two years prior to the launch of the DMEPOS program, in 2004 NABP developed the VAWD program. Creation of this program came about after the Food and Drug Administration’s Counterfeit Drug Task Force recommended that NABP update its Model Rules for the Licensure of Wholesale Distributors to assist states in updating requirements for licensure for wholesale distributors and further secure business practices that affect the ability to deter and detect counterfeit drugs. As a means to help protect the public from the threat of counterfeit drugs infiltrating the United States medication supply, VAWD verifies suppliers’ compliance with state and federal laws for wholesale distributors. As another benefit, the VAWD program relieves these suppliers of the burden of seller-to-buyer due diligence as may be required by law. According to the 2011 NABP Survey of Pharmacy Law, 20 states now recognize the VAWD program.
Also recognized by several states, the VIPPS program, developed by NABP in 1999 as the Association’s first accreditation program, identifies to the public those online pharmacy practice sites that are appropriately licensed, are legitimately operating via the Internet, and that have successfully completed a thorough criteria review and survey. According to the 2011 Survey of Pharmacy Law, 16 states now recognize the VIPPS program. In Texas, for example, a pharmacy located in the state that maintains a generally accessible Web site or sells and/or distributes prescription drugs through the site is required to post certain information about the pharmacy; however, if this pharmacy has been awarded VIPPS accreditation, it is considered to be in compliance with these posting requirements by displaying the VIPPS Seal on its Web site.
Additionally, the VIPPS program serves as a model for regulations in some states as an alternative to developing new rules and laws pertaining to Internet pharmacy practice sites. In Virginia, §54.1-3434.1 requires that nonresident pharmacies that dispense more than 50% of their total prescription volume pursuant to an original prescription order received as a result of solicitation on the Internet, including by electronic mail, be accredited by the VIPPS program or a similar program as approved by the Virginia Board of Pharmacy.
As patients’ use of the Internet to obtain prescription medications continues to increase, NABP consistently reviews the VIPPS program standards to keep pace with these technological advancements in medication access.
Developed from the VIPPS program and launched in 2009, the Vet-VIPPS program was created in response to public and regulatory agency concerns regarding the safety of veterinary drugs sold over the Internet. Similar to VIPPS, Vet-VIPPS provides a means for the public to distinguish between legitimate and illegitimate online veterinary pharmacy practice sites. US-based online pharmacies that dispense prescription drugs and devices for companion and non-food producing animals receive Vet-VIPPS accreditation only after successfully completing a thorough criteria review and on-site survey.
Also related to the VIPPS program, in 2010, the Association developed the NABP e-Advertiser Approval Program. Because the VIPPS accreditation program is structured to address licensed pharmacies engaged in the practice of pharmacy and a full range of defined business activities online, NABP developed the NABP e-Advertiser Approval Program as a complementary program to identify Internet advertisers that offer only limited pharmacy services or other prescription drug-related services online. In March 2010, Google announced that it would began accepting advertisements from only those Internet pharmacies in the US that are accredited through the VIPPS program, making it more difficult for rogue Internet drug outlets to advertise and demonstrating the search engine’s commitment to patient safety. Yahoo! and Microsoft’s Bing followed suit soon after. Approval through the NABP e-Advertiser Approval Program will allow advertisers who do not qualify for VIPPS to advertise on Google.
The community pharmacy accreditation program, one of the newest programs under development, is currently in the piloting stages and will assess, among other things, how pharmacists and pharmacy staff effectively use continuous quality improvement to improve patient care. Completely voluntary, this accreditation program will challenge pharmacies and pharmacists to maintain rigorous accreditation criteria with the sole purpose of improving patient safety and patient outcomes.
More information on the NABP accreditation programs can be found under Accreditation in the Programs section of the NABP Web site.
