APFM Section 5: CMS Final Rule on Patient Engagement in Managed Care Pharmacy: Putting Policy into Practice
As healthcare decision-making becomes more patient-centric, incorporating patient perspectives is critical for developing meaningful formulary design models. New CMS regulations will require patient representation on P&T committees for plans offering essential health benefits and expand beneficiary engagement across state Medicaid agencies. But will these efforts be sufficient? Informative? If not, what practical actions are needed to ensure that the experiences of patients and beneficiaries can be translated into meaningful and actionable insights? Hear examples from experts that will support individual patients tasked with representing diverse patient populations and health conditions; pair committee membership with more representative, rigorous, and robust patient experience information; and identify policies, processes, and partnerships needed. Together, these practices can shift patient centricity from representation to informative, meaningful, and actionable guidance.
Learning Objectives
At the completion of this activity, participants should be able to:
- Summarize the CMS rules that expand patient representation or advisory engagement for state Medicaid agencies and P&T committees for plans offering essential health benefits.
- Identify actionable strategies to translate these policies into practical actions to meet the CMS patient representative requirements.
Kimberly Lenz, PharmD, MBA, FAMCP
Chief Pharmacy Officer, MassHealth
Massachusetts Medicaid
South Grafton, MA
Emily G. Tsiao, PharmD, BCPS
Medical Policies Clinical Pharmacist
Premera Blue Cross
Federal Way, WA
Joe Vandigo, PhD
Principal Scientist & Director of Value
Applied Patient Experience
Washington, DC
Financial Relationship Disclosures
FACULTY/REVIEWER/PLANNER | REPORTED RELEVANT FINANCIAL RELATIONSHIPS |
Kimberly Lenz, PharmD, MBA, FAMCP Faculty | Disclosed no relevant financial relationships. |
Emily G. Tsiao, PharmD, BCPS Faculty | Premera Blue Cross, Employee |
Joe Vandigo, PhD | Applied Patient Experience: Employee; Novartis Pharmaceuticals: Individual Stocks/Stock Options |
Michelle Aslami, PharmD Reviewer | Disclosed no relevant financial relationships. |
Brooke Whittington, PharmD Planner | 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.
The Academy of Managed Care Pharmacy (AMCP) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
ACPE UAN: 0233-0000-26-001-H04-P • Activity Type: Knowledge-Based
Contact Hours: 0.50
Release Date: January 12, 2026 • Expiration Date: December 31, 2027
Activity Fee: Free for Members and $30 for Non-Members
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 AMCP 2024. 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
- 0.50 ACPEThe Academy of Managed Care Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

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