Marketplace Profitability: Adding Prescription Drug Data to the Risk Adjustment Model

ACPE UAN #:  0233-0000-17-033-H04-P

Release Date: March 29, 2017

Expiration Date:  March 29, 2020

Activity Type:    Knowledge-based

Contact Hours:  1.25

Activity Fee:  Member:  $15        Non-Member: $30

Target Audience: Pharmacists who practice in managed care settings.

Activity Overview

Until the Centers for Medicare & Medicaid Services issued the proposed 2018 Notice of Bene_ t and Payment Parameters, risk adjustment was not an area of focus for Marketplace pharmacy directors, pharmacy bene_ t managers or pharmaceutical manufacturers. Beginning in January 2018, drug prescribing data will be used to identify high-risk conditions missed by the current risk adjustment model, and to establish the severity of the high-risk conditions.  This session will discuss how drug use varies on factors unrelated to risk, such as access to pharmacies or high cost-sharing. In addition the session will explore the impact of prescription drug data on the complexity of the model and physician overprescribing.

Learning Objectives:  

At the completion of this activity, participants should be able to:

1. Outline the implications of risk adjustment on the ­ scal stability of Marketplace plans.

2. Summarize the impact of the addition of prescription drug data to the Centers for Medicare and Medicaid Services’ risk adjustment model on Marketplace health plans, pharmacy bene­ t managers and pharmaceutical manufacturers.

3. Relate the use of prescription drug categories and the impact on hierarchical condition categories.

4. Describe challenges and concerns related to the use of prescription drug data in the risk adjustment model.

5. Discuss a health plan’s experience with risk adjustment to date and how upcoming changes will impact its operations. 

Schedule of Educational Activity

This activity consists of an audio recording, pre-test assessment questions (not required to pass or continue), post-test questions (required to pass with a score of 70% or higher) and a specific activity evaluation. 

CPE Requirements:   

Participants should claim continuing pharmacy education (CPE) credit for this home study activity only if they have not claimed credit for the live activity presented at the AMCP Annual Meeting 2017. 

CPE credit will be processed through the AMCP Learn portal and reported directly to CPE Monitor.  Please allow 72 hours for processing and posting in your NABP account.

To receive credit for an online activity you must:

  • Review the full content of the activity.
  • Successfully complete the post-test (required to pass with a score of 70% or higher, it may be taken a maximum of three times).
  • Complete a specific activity evaluation.

System Technical Requirements/Viewing Requirements: System Requirements Courses and learning activities are delivered via your Web browser and Acrobat PDF. For all activities you should have a basic comfort level using a computer and navigating web sites.  View the minimum technical and system requirements for continuing education online learning activities.

As an accredited provider, AMCP strictly adheres to the ACPE Standards for Commercial Support and other relevant guidelines and standards to ensure the independence of continuing pharmacy education (CPE) activities.  It is AMCP’s intent that all CPE activities be independent, objective, balanced, evidence-based and free of any commercial bias.


Stephen George,PharmD, MS | Consultant | Milliman | Tampa, Florida

Credit Information

Activity Number Credit Amount Accreditation Period
ACPE UAN #0233-0000-17-033-H04-P 1.25 Contact Hours March 29, 2017 - March 29, 2020