OptumRX to Require VAWD Accreditation for Reimbursements

MIAMI, FL – 08/15/2016 (PRESS RELEASE JET) — In a letter dated August 11, 2016, OptumRX announced that it will require provider pharmacies to limit their purchasing to suppliers who have the private VAWD Accreditation, starting October 1, 2016. After years of declining reimbursements and creative MAC strategies, OptumRX has dealt another blow to the independent retail pharmacy.

Said Sumeet Singh, Director of Pharma Solutions, “This is an unprecedented move that will have a very immediate and detrimental effect on pharmaceutical distribution in the United States. Specifically, this action has the potential to increase drug pricing and create artificial shortages. OptumRX is increasing the pressure on family-run, independent pharmacies and distributors. We plan to investigate the legality of the action immediately.”

There is definitely a business case to push Americans away from independent pharmacies and towards national retail chains. It was only in March that OptumRX announced Walgreens to be its preferred retail pharmacy partner with its own in-house pharmacy to be the preferred mail order pharmacy. In exchange for naming Walgreens a preferred partner, OptumRX enjoys lower drug costs – and higher profits.

Per the letter, pharmacies “MUST purchase ALL medications dispensed for claims being dispensed to OptumRX participants” (emphasis theirs) from a VAWD Accredited distributor. OptumRX has over 65 million covered lives, or almost 25% of insured Americans. This action is most likely enough to convince all independent pharmacies to restrict purchases to those suppliers that have VAWD accreditation.

Based on anecdotal evidence of performance, the NABP takes a minimum of nine months to complete the VAWD Accreditation process. With less than two months’ notice, distributors can expect to have their business severely impacted or brought to a standstill for at least seven months, until they are able to gain VAWD Accreditation.

“It does not make sense for OptumRX to have such a short window before demanding VAWD Accreditation. Dynasty Pharmaceuticals has been faithfully serving the independent pharmacy market for over 6 years. We take pride in achieving best-in-class pricing by sourcing directly from manufacturers and authorized distributors. We are duly licensed in over 25 states, properly registered with the FDA and compliant with all aspects of the Federal DQSA,” added Anton Kozlikin, CEO of Dynasty Pharmaceuticals, Inc.

OptumRX’s extra measures comes on the heels of the Drug Quality Security Act (DQSA) which was implemented in the last two years. The DQSA legislation completely overhauled the nation’s drug pedigree laws to ensure continuity across states, in addition to requiring annual reporting of licensures and other requirements. The law has already helped to cement the transparency and safety of the pharmaceutical supply chain, severely impacting the relevance of VAWD Accreditation.

About Pharma Solutions

Pharma Solutions is a leading pharmaceutical compliance services firm that uses experience, relationships and knowledge to develop custom solutions for their clients. The company provides numerous services including VAWD Accreditation, state Board licensing and federal registration consulting services. Five Rivers helps third-party logistic firms, distributors and manufacturer in the pharmaceutical industry focus on their supply chain while reducing costs, enhancing efficiency and improving quality. Five Rivers is committed to helping their clients thrive and to providing peace of mind.