Fundamentals of Managed Care Pharmacy | 2nd Edition

The Fundamentals of Managed Care Pharmacy Certificate Program 2nd  edition provides a refined and updated introduction to basic concepts in managed care pharmacy. Previously presented live at AMCP meetings, with the help of key thought-leaders.   Learners will explore key aspects of managed care pharmacy, including focused content areas: Medicare Part D, Medicaid, Specialty Pharmacy, and Quality Ratings.  Pharmacists can earn a maximum of 9 contact hours (9.0 CEUs) of CPE credit for the Fundamentals of Managed Care Pharmacy Certificate online program

Target Audience

This program is designed for pharmacists, managed care/managed markets team members, and other individuals who are interested in expanding their understanding of managed prescription drug benefits.

Activity Fee:      AMCP Member:  $399       Non-Member: $499

Evolution and Principles of Managed Care

ACPE UAN #:   0233-0000-19-001-H04-P

Release Date:  February 1, 2019

Expiration Date:  02/01/2022

Activity Type:  Knowledge-based  

Contact Hours:  0.75 contact hours

Activity Overview

Understanding the evolution of managed care pharmacy is important in order to understand the current marketplace. This module delves into the history of managed care and its progression to current practices, the different care delivery models and how each one works to provide patient access to care. This includes discussions of health maintenance organizations (HMOs), preferred provider organizations (PPOs), point-of-service plans (POS’s), integrated delivery networks (IDNs), high deductible health plans (HDHPs), carve outs, and a la carte benefit models

Learning Objectives

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

  1.  Outline the evolution of managed care in the United States.
  2.  Describe the different types of delivery models and how each impacts patient health care access.
  3.  Distinguish between medical and pharmacy benefits and what services fall under each benefit type.
 Pharmacy Benefit Management Toolkit

ACPE UAN #:   0233-0000-19-002-H04-P

Release Date:  February 1, 2019

Expiration Date:  02/01/2022

Activity Type:  Knowledge-based  

Contact Hours:  0.75 contact hours

Activity Overview

How do pharmacy benefits meet the demands of balancing safety, effectiveness and accessibility of drug products while also ensuring that the most cost-effective treatment options are used appropriately in the service of optimal health outcomes? This module discusses various management strategies and tools used in the management of pharmacy benefits.

Learning Objectives

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

  1.  Discuss common strategies used to manage the cost of medications and demand for medications in a pharmacy benefit
  2. Recognize how various drug cost and utilization management strategies can be combined to design a customized pharmacy benefit.  
Behind the Scenes: Getting Medications to Patients through the Pharmacy Benefit

ACPE UAN #:    0233-0000-19-003-H04-P

Release Date:  February 1, 2019

Expiration Date:  02/01/2022

Activity Type:  Knowledge-based  

Contact Hours:  0.75 contact hours

Activity Overview

This module explores the behind the scenes coverage, prescribing, claims and adjudication processes. Participants will learn about the invisible steps and data exchange that culminate into a filled prescription, ready for pick up. Differences between traditional and electronic prescribing, use of claims analysis and edits, and importance of data exchange and reporting are some of the concepts discussed in this module.

Learning Objectives

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

  1. Summarize the difference between traditional paper prescribing and electronic prescribing.
  2. List the steps involved in adjudicating a prescription drug claim.

Developing and Managing the Drug Formulary

ACPE UAN #:    0233-0000-19-004-H04-P

Release Date:  February 1, 2019

Expiration Date:  02/01/2022

Activity Type:  Knowledge-based  

Contact Hours:  0.75 contact hours

Activity Overview

The drug formulary, or preferred drug list, is a listing of drugs covered by a payer such as health plan or pharmacy benefits manager - and is the backbone to understanding managed care pharmacy. There is extensive work done to prepare and review each medication added to the formulary. This module will detail what a formulary is and how a Pharmacy and Therapeutics Committee develops and maintains a formulary.

Learning Objectives

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

  1. Explain what a drug formulary is and how it is developed and maintained.
  2. State the composition, role, and responsibilities of a Pharmacy and Therapeutics (P&T) Committee.
  3. Summarize the process that begins with the identification of a likely new drug approval and culminates in a formulary decision about the drug.
Trading Partners and Flow of Money in Managed Care Pharmacy

ACPE UAN #:    0233-0000-19-005-H04-P

Release Date:  February 1, 2019

Expiration Date:  02/01/2022

Activity Type:  Knowledge-based  

Contact Hours:  0.75 contact hours

Activity Overview

The health care of the United States is both unique and complex. It has both state and federal oversight, and many stakeholders that must work together to ensure the systems work to get medications to patients. This module also explains the “flow of money” between these stakeholders and how specific fees are calculated.

Learning Objectives

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

  1. Identify the various stakeholders involved with the prescription drug benefit.
  2. Explain how managed care organizations determine pharmacy reimbursement for drug products and associated dispensing fees.
Understanding Pharmaceutical Manufacturer Discounts and Rebates

ACPE UAN #:    0233-0000-19-006-H04-P

Release Date:  February 1, 2019

Expiration Date:  02/01/2022

Activity Type:  Knowledge-based  

Contact Hours:  0.75 contact hours

Activity Overview

Managed care organizations and pharmaceutical manufacturers work very closely to negotiate drug prices. There are a few different types of price concessions that can help both organizations in the long run. This module will discuss this close relationship and how it all works.

Learning Objectives

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

  1. Discuss the structure and impact of rebate contracts offered by pharmaceutical manufacturers.
  2.  Explain how rebates and formulary decision-making can be related.

Managed Care Pharmacy Clinical and Educational Programs

ACPE UAN #:    0233-0000-19-007-H04-P

Release Date:  February 1, 2019

Expiration Date:  02/01/2022

Activity Type:  Knowledge-based  

Contact Hours:  0.75 contact hours

Activity Overview

The overall goals of provider and member clinical and educational programs in managed care pharmacy are to maintain a high quality of care and reduce overall health care costs.This module discussesthe role and use of clinical and educational programs pharmacy for providers and patients.

Learning Objectives

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

  1. Name types of pharmacy clinical and education programs that may contribute to ensuring optimal medication use by managed care plan members.
  2. Analyze the factors contributing to medication adherence challenges.
Medication Therapy Management

ACPE UAN #:    0233-0000-19-008-H04-P

Release Date:  February 1, 2019

Expiration Date:  02/01/2022

Activity Type:  Knowledge-based  

Contact Hours:  0.75 contact hours

Learning Objectives

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

  1. Define medication therapy management (MTM) and its key components. 
  2. Discuss the benefits of MTM for patients, health systems, and payers.Summarize the impact of government and healthcare quality improvement mandates on the demand for pharmacist-conducted MTM. 
  3. Describe patient eligibility for MTM services under Medicare Part D, and the types of patients most likely to benefit from non-Medicare MTM services.
Introduction to Specialty Pharmacy

ACPE UAN #:    0233-0000-19-009-H04-P

Release Date:  February 1, 2019

Expiration Date:  02/01/2022

Activity Type:  Knowledge-based  

Contact Hours:  0.75 contact hours

Learning Objectives

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

  1.  Outline the evolution of managed care in the United States.
  2.  Describe the different types of delivery models and how each impacts patient health care access.
  3.  Distinguish between medical and pharmacy benefits and what services fall under each benefit type.

Medicare and Managed Care Pharmacy

ACPE UAN #:   0233-0000-19-010-H04-P

Release Date:  February 1 2019

Expiration Date:  02/01/2022

Activity Type:  Knowledge-based  

Contact Hours:  0.75 contact hours

Learning Objectives

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

  1.  Outline the evolution of managed care in the United States.
  2.  Describe the different types of delivery models and how each impacts patient health care access.
  3.  Distinguish between medical and pharmacy benefits and what services fall under each benefit type.
Medicaid and Managed Care Pharmacy

ACPE UAN #:   0233-0000-19-011-H04-P

Release Date:  February 1 2019

Expiration Date:  02/01/2022

Activity Type:  Knowledge-based  

Contact Hours:  0.75 contact hours

Learning Objectives

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

  1.  Outline the evolution of managed care in the United States.
  2.  Describe the different types of delivery models and how each impacts patient health care access.
  3.  Distinguish between medical and pharmacy benefits and what services fall under each benefit type.
The ABC's and Stars of Quality Measures

ACPE UAN #:    0233-0000-19-012-H04-P

Release Date:  February 1 2019

Expiration Date:  02/01/2022

Activity Type:  Knowledge-based  

Contact Hours:  0.75 contact hours

Learning Objectives

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

  1.  Outline the evolution of managed care in the United States.
  2.  Describe the different types of delivery models and how each impacts patient health care access.
  3.  Distinguish between medical and pharmacy benefits and what services fall under each benefit type.

Method and CE Requirements:   

Pharmacists can claim continuing pharmacy education (CPE) credit for this certificate program once Module 12 is completed. Important: All continuing pharmacy education (CPE) credit(s) must be claimed within 60 days of enrolling in an online activity.   Learn More Learning activities are available for a specific time after the activity has been accessed or opened. Be sure to know the close date of your activities. Each activity shows a "Close Date" in the far right side next to the activity title listed in the "My Learning Activities" tab. All activities must be completed before the close date or they will expire and you will not be able to claim CPE credit.  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 CPE Monitor account.

Pharmacists interested in obtaining CPE credit must:

  • Successfully view the 12 recorded videos (approximately 9 hours total viewing time).
  • Complete a Post-Test which requires a passing score of 70% or higher for each module.  You will be allowed three attempts to pass the post-test.
  • Complete a specific evaluation for the entire program.

To print your certificate of completion: 

  • After you complete the Module 12 Post-Test a   button will appear on the bottom left-hand corner. Click and print your certificate of completion.

Please note: Certificates of Completion are only for showing completion of the online program and do not reflect any earned credits or hours.

System Technical and Internet 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 websites.  View the minimum technical and system requirements for continuing education online activities. For assistance please Contact US.

Faculty Relevant Financial Relationships Disclosure: 

AMCP asks everyone who is in a position to control the content of a continuing pharmacy education activity to disclose all relevant financial relationships with commercial interests. If AMCP determines that a conflict of interest exists as a result of a financial relationship you have (or that your spouse/partner has), we will need to take appropriate steps to resolve the conflict of interest.

Robert Navarro reports having no conflict of interest in the past 12 months.
Douglas S. Bourgoyne is the Principal at Coorperative Benefits Group, LLC. He was previously employed by Magellan Rx Management. He has also consulted for Spark health and Xcenda
Debbie Stern is employed by eviCore healthcare.

Mary Jo Carden reports having no conflict of interest in the past 12 months.
Cindy J. Pigg is employed by Cardinal Health.
Tracy McDowd is employed by OptumRx.

The Academy of Managed Care Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 

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. 

Copyright

Permission has been obtained to use copyrighted materials for the Fundamentals of Managed Care Pharmacy Certificate Program. Sources for all images

Credit Information

Activity Number Credit Amount Accreditation Period
ACPE UAN #0233-0000-19-001-H04-P 0.75 Contact Hours February 01, 2019 - February 01, 2022
ACPE UAN #0233-0000-19-002-H04-P 0.75 Contact Hours February 01, 2019 - February 01, 2022
ACPE UAN #0233-0000-19-003-H04-P 0.75 Contact Hours February 01, 2019 - February 01, 2022
ACPE UAN #0233-0000-19-004-H04-P 0.75 Contact Hours February 01, 2019 - February 01, 2022
ACPE UAN #0233-0000-19-005-H04-P 0.75 Contact Hours February 01, 2019 - February 01, 2022
ACPE UAN #0233-0000-19-006-H04-P 0.75 Contact Hours February 01, 2019 - February 01, 2022
ACPE UAN #0233-0000-19-007-H04-P 0.75 Contact Hours February 01, 2019 - February 01, 2022
ACPE UAN #0233-0000-19-008-H04-P 0.5 Contact Hours February 01, 2019 - February 01, 2022
ACPE UAN #0233-0000-19-009-H04-P 0.75 Contact Hours February 01, 2019 - February 01, 2022
ACPE UAN #0233-0000-19-010-H04-P 0.75 Contact Hours February 01, 2019 - February 01, 2022
ACPE UAN #0233-0000-19-011-H04-P 0.75 Contact Hours February 01, 2019 - February 01, 2022
ACPE UAN #0233-0000-19-012-H04-P 0.75 Contact Hours February 01, 2019 - February 01, 2022