FMCP Module 3: Behind the Scenes: Getting Medications to Patients through the Pharmacy Benefit
This module explores the behind-the-scenes of 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, the use of claims analysis and edits, and the importance of data exchange and reporting are some of the concepts discussed in this module.
Pharmacists, Pharmacy Technicians, Managed Care Professionals
At the completion of this activity, participants should be able to:
- Describe the insurance coverage and benefits and its various components and participants.
- Summarize the difference between traditional paper prescribing and electronic prescribing.
- List the steps involved in adjudicating a prescription drug claim.
Joseph DiBiase Jr., CPhT
Director, Clinical Pharmacy Operations, Medicare Part D
Magellan Rx Management
President and Founder
Accountable Health, LLC
Tracy McDowd, PharmD, FAMCP
Manager, Clinical Pharmacy
BlueCross BlueShield of Tennessee
Vimal V. Reddy, PharmD
VP, Payer Strategy, Market Access
Financial Relationship Disclosures:
|Reported Relevant Financial Relationships
|Joseph DiBiase Jr., CPhT
Faculty, Planner, Peer Reviewer
|Tracy McDowd, PharmD, FAMCP
|Brittany V. Henry, PharmD, MBA
Planner, Peer Reviewer
|Vimal Reddy, PharmD
|Ruby Singh, PharmD
Planner, Peer Reviewer
- 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.
ACPE UAN:0233-0000-23-028-H04-P • Activity Type: Knowledge-Based
Contact Hours: 0.75
Release Date: August 04, 2023 • Expiration Date: July 31, 2026
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.
- 0.75 ACPEThe Academy of Managed Care Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.