Medical Benefits Training- Life Sciences Version

Pricing: $699 for members and $799 for non-members

Course Description

AMCP’s Medical Benefit Medication Management is an 8-part series built specifically for members of Life Science companies.  This self-paced e-Learning training program is designed to fit into a busy schedule and delivers the foundational concepts of medical medication management within 40-minute modules. 


Target Audience

This program is designed for brand and payer marketers, account executives, field and HQ-based HEOR leads, payer medical leads

Learning Objectives

  1. Describe the foundational components of medical and pharmacy benefits and market trends impacting medical and pharmacy benefits
  2. Identify employer benefit design and coverage processes and discuss health plan versus PBM medical and pharmacy coverage
  3. Describe medical benefit medication contracting and integration and payer rules of engagement
  4. Discuss medical policies and utilization management techniques
  5. Describe pre-certification versus prior authorization and other medical benefit utilization management techniques and approval and denial management
  6. Identify buy and bill methodology, and medication distribution models
  7. Discuss medical benefit reimbursement and claims, including reimbursement billing overview and coding for medical benefit billing
  8. Provide overview of patient support services, HUB services, patient assistance and provider reimbursement support services
  9. Discuss field team support roles and review case studies
Course summary
Course opens: 
Course expires: 

Part 1:   Medical and Pharmacy Benefits Overview

  • Medical and pharmacy benefits comparison
  • Foundational components of medical and pharmacy benefits
  • Market trends impacting medical and pharmacy benefits


Part 2:   Medical Benefit Overview

  • Employer benefit design and coverage process
  • Health plan versus PBM medical and pharmacy coverage
  • Medical benefit medication contracting and integration


Part 3: Medical Benefit Management

  • Payer Rules of Engagement
  • Medical Policies
  • Utilization management techniques


Part 4: Medical Benefit Medication Approval

  • Pre-certification versus prior authorization
  • Other medical benefit utilization management techniques
  • Approval and denial management


Part 5: Medical Benefit Medication Acquisition

  • Buy and bill methodology
  • Specialty pharmacy overview
  • Distribution models


Part 6:   Reimbursement: Billing and Coding

  • Reimbursement billing overview
  • Coding for medical benefit billing
  • Medical benefit reimbursement and claims


Part 7:   Patient Services for Medical Benefit Medication

  • Patient support services overview
  • HUB services
  • Patient assistance
  • Provider reimbursement support services


Part 8: Organizational Engagement for Medical Benefit Medication

  • Field team support roles
  • Case scenarios


Fred Goldstein, AMCP Faculty Member

Accountable Health, LLCGraduate Faculty, John. D. Bower School of Population Health, University of Mississippi Medical Center

Please note that this session is not accredited for continuing pharmacy education credit.


Please login or register to take this course.

Required Hardware/software

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.