Medical Benefits Training- Provider & Health Plan Version

Pricing: $399 for members and $499 for non-members

Course Description

AMCP’s Medical Benefit Medication Management is a 7-part series.  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 individuals who are managing or support products reimbursed under medical benefits

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
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


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.