APFM Section 2 Module 4: Utilization Management and Coverage Decision

Module Description

This module will discuss the various utilization management tools used in the formulary development stage and their strengths and weaknesses. It will also summarize the different components of a coverage decision and how utilization management strategies are used in this decision-making process.

 

Target Audience

This program is designed for mid-level managed care pharmacists and managed care professionals working in formulary management or considering a transition to formulary management. 

Learning Objectives

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

  • Discuss best practices of implementing utilization management tools.
  • Summarize the benefits and challenges of common utilization management tools.
  • Review the components of a coverage decision.
  • Discuss utilization management strategies used in coverage decision-making.

 

Course summary
Available credit: 
  • 0.75 ACPE
    ACPE The Academy of Managed Care Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
  • 0.75 Certificate of Completion
Course opens: 
12/13/2024
Course expires: 
12/13/2027
Cost:
$0.00
Part of: 
Advanced Principles of Formulary Management

Faculty/Authors:

Jennifer Cashman, PharmD
Director, Drug Use Management
Kaiser Permanente

Ann Tran-Pugh, PharmD, FCSHP
Residency Program Directory PGY-2 Drug Information
Pharmacy Project Manager III
Kaiser Permanente

Advisory Board

Shawn Barger, PharmD
Lead Director, Medicare Formulary Development and Management
Password

Aimee Loucks, PharmD, BCPS
Director Clinical Pharmacy Services
Kaiser Permanente Washington

Lisa Mahan, PharmD, MS, MTM
Clinical Program Senior Manager
Cigna Healthcare

Kristen Patti, PharmD
Manager, Clinical Drug Evaluation & Policy
Blue Cross Blue Shield of Michigan

Reviewers

Steve Kheloussi, PharmD, MBA, FAMCP
Director, Professional Affairs
AMCP

Katherine Tieu, PharmD
Clinical Account Manager
Capital Rx

Drake Reiter, PharmD
Director, Pharmacy Operations
Priority Health

Financial Relationship Disclosures:

Faculty/Reviewer/PlannerReported Relevant Financial Relationships
Jennifer Cashman, PharmD
Faculty		None
Anne Tran-Pugh, PharmD, FCSHP
Faculty		None
Shawn Barger, PharmD
Planner		None
Aimee Louckes, PharmD, BCPS
Planner

None

Lisa Mahan, PharmD, MS, MTM
Planner		None
Kristen Patti, PharmD
Planner		IngenioRx
Steve Kheloussi, PharmD, MBA
Reviewer		None
Drake Reiter, PharmD
Reviewer		None
Katherine Tieu, PharmD
Reviewer		None
  • AMCP Staff have disclosed no relevant financial relationships.
  • If applicable, relevant financial relationships have been mitigated and documented.
  • Content has undergone a peer review to ensure content validity.

Accreditation:

ACPE UAN:0233-0000-23-4-073-H04-P • Activity Type: Knowledge-Based
Contact Hours: 0.75
Release Date: December 13, 2024 •  Expiration Date: December 13, 2027

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.

Available Credit

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

Price

Cost:
$0.00
Please login or register to take this course.