Role of pharmacy services in accountable care organizations

The accountable care organization (ACO) model being adopted across the United States aims to improve patient care and reduce costs. Little is known about whether commercial ACO contracts include accountability for prescription drug spending or how ACOs are engaging outpatient pharmacies and managing prescription drug use.

To explore how ACOs are addressing drug spending and pharmacy services-a potentially important determinant of quality and total spending.

We used data from 2 waves of the National Survey of Accountable Care Organizations (N = 270), a survey completed by ACOs that were established prior to July 2013. ACO executives were asked about ACO engagement of pharmacy services, pharmacy-related health information technology capabilities, and ACO accountability for prescription drug spending.

Among ACOs with commercial contracts, 77% reported being held responsible for prescription spending by their largest contract. Considering all ACOs (Medicare, Medicaid, and/or commercial contracts), 45% reported at least 1 contract included prescription drug spending responsibility. Nearly half of ACOs reported a formal relationship with a pharmacy; 26% included a pharmacy within the ACO; and 19% had contracted pharmacy services. On average, compared with those that do not, ACOs that engage pharmacies have a broader range of services and provider types, commercial and public contracts, and greater experience with payment reform.

Management of pharmacy services and prescription spending will likely influence commercial ACO contract success. Given the broad potential impact of prescription use on overall spending and quality, payers might encourage integration of pharmacy services in ACOs through prescribing quality and prescription spending performance measures.