• Sisco-Law

Insurer demands wholesale pharmaceutical distributors to obtain VAWD accreditation

Recently Optum Rx, a large pharmacy benefits manager, imposed an unreasonable and unnecessary requirement on pharmacy providers seeking to submit claims by Optum insureds. Effective October 1, 2016 Optum Rx required that its insureds prescriptions be filled only with medications purchased from a wholesale distributor with Verified Accredited Wholesale Distributor (VAWD) accreditation by the National Association of Boards of Pharmacy (NABP). The demand is unreasonable because the NABP takes months to process applications, the cost is prohibitive for smaller distributors, and VAWD accreditation provides no benefit to Optum Rx insureds because the VAWD criteria are already subsumed by existing regulatory requirements.

Numerous pharmacy professional associations (American Pharmacists Association; National Alliance of State Pharmacy Associations; National Association of Specialty Pharmacy; National Community Pharmacists Association)have voiced their criticism of Optum's actions, demonstrating the requirement is not practical and does not further patient safety or supply chain security. Wholesalers must already comply with the Drug Supply Chain Security Act (DSCSA) which requires the FDA to issue regulations regarding wholesale distributor and third-party logistics provider licensure.

The greatest impact of this action will be on individuals covered by Optum's programs and independent pharmacies.

Independent pharmacies often rely upon small, local distributors who provide better pricing and services than are available tot hem elsewhere. The plan participants will be forced to fill prescriptions at the large chain pharmacies, even though in many instances they obtain better service and appreciate the personalized care offered by the independents. Since Optum's website claims they manage more than 66 million customers and process over a billion claims annually, the impact of this action is unreasonable and unnecessary.

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