Module 2: Utilization Management

Module Description

Understanding the evolution of managed care pharmacy is important to understand the current marketplace. This module delves into the history of managed care and its progression to current practices, the different care delivery models and how each one works to provide patient access to care. This includes discussions of health maintenance organizations (HMOs), preferred provider organizations (PPOs), point-of-service plans (POS’s), integrated delivery networks (IDNs), high deductible health plans (HDHPs), and a la carte benefit models.

 

Target Audience

Pharmacists, Pharmacy Technicians, Managed Care Professionals

Learning Objectives

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

  • Summarize the different lines of business for which payers develop and maintain formularies. 

  • Define the process for formulary development. 

  • Review common formulary structure and drug management tools. 

  • Discuss the differences between pharmacy and medical drug management.  

 

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.
Course opens: 
01/01/2025
Course expires: 
06/30/2026
Cost:
$0.00

Faculty:

Joseph DiBiase Jr., CPhT
Director, Clinical Pharmacy Operations, Medicare Part D
Magellan Rx Management

Fred Goldstein
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
Lockwood

Financial Relationship Disclosures:

Faculty/Reviewer/PlannerReported Relevant Financial Relationships
Joseph DiBiase Jr., CPhT
Peer Reviewer		None
Fred Goldstein
Faculty, Planner, Peer Reviewer		None
Tracy McDowd, PharmD, FAMCP
Peer Reviewer		None
Brittany V. Henry, PharmD, MBA
Planner, Peer Reviewer		None
Vimal Reddy, PharmD
Peer Reviewer		None
Ruby Singh, PharmD
Planner, Peer 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:0233-0000-23-026-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.

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.

Price

Cost:
$0.00
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