The Advanced Principles of Formulary Management training program provides pharmacists with the essential skills and best practices needed to optimize drug formularies. In 16 interactive modules, learners will explore key elements of formulary management, operations, and maintenance, including regulatory and legal considerations, value assessment, clinical evaluation, and much more.
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Section 1: Formulary Management Overview
Formulary Management is a tool used to optimize patient access, manage costs, and improve overall health care outcomes. This section provides an overview of the necessary tools and considerations used in formulary management such as the basics of utilization management, regulatory and legal considerations, and the role of PBMs and rebates.
- Module 1: Formulary Overview
This module begins the Advanced Principles of Formulary Management training program. It provides an overview of formulary management's basics and key business lines and will briefly introduce benefit design. Additionally, learners will explore the general structures and common management tools used within drug formularies.
- Module 2: Utilization Management
Utilization management is a key strategy used in formulary management to ensure medications are used safely, appropriately, and cost-effectively. This module dives into the different utilization management tools and strategies, such as step therapy, prior authorization and quantity limits, and how they are applied in practice. This module will also discuss the principles of cross-benefit management and its place in formulary management.
- Module 3: PBM
Pharmacy Benefit Managers, or PBMs, play a large role in the health care system, and more specifically in formulary management. This module will review the different core functions of a PBM as well as the benefits and challenges of utilizing rebates.
- Module 4: Regulatory and Legal Considerations
Understanding regulatory and legal considerations is a large part of developing and maintaining a formulary. This module will explore the FDA approval process, patents, and how various regulatory bodies impact different lines of business. In addition, this module will review the regulatory landscape and legislative mandates and considerations for ensuring compliance and mitigating risks associated with formulary decisions.
Section 2: Formulary Development
This section will examine the various considerations for formulary development. Participants will learn about P&T committees, value assessment, clinical evaluation, coverage decision, and utilization management. Lastly, special considerations and hot topics will be discussed, including various FDA approval pathways, health disparities, incorporating the patient voice, and more.
- Module 1: P&T Committee
This module will focus on Pharmacy and Therapeutics (P&T) Committees, their management, regulation, and best practices for prepping and leading a meeting. Learners will review the essential components of a P&T charter and learn how to identify potential conflicts of interest from potential committee members.
- Module 2: Clinical Evaluation
Clinical evaluation is crucial in formulary management to ensure formulary decisions are based on scientific evidence, optimizing patient outcomes. Participants will learn how to identify important components within a clinical trial’s design and how to interpret and evaluate a study’s outcomes and endpoints. In addition, this module will discuss key attributes and strategies to objectively review the quality of clinical guidelines. Lastly, learners will review considerations for designing a non-inferiority study using an interactive case.
- Module 3: Value Assessment
Value assessment plays an essential role in helping payers make informed decisions about how they develop their formularies. By the end of this module, learners will be able to define the key components of a value assessment and how to compare the different types of value assessment. Participants will also learn about the different resources used for value assessment and each of their strengths and weaknesses.
- Module 4: Utilization Management and Coverage Decision
This module will discuss the various utilization management tools used in the formulary development stage and their strengths and weaknesses. It will also summarize the different components of a coverage decision and how utilization management strategies are used in this decision-making process.
- Module 5: Special Considerations and Hot Topics
Managed care is an ever-evolving landscape with new ideas, products, and innovations. This module will review various special considerations and hot topics that many formulary management pharmacists will encounter. It includes topics such as various FDA accelerated approval pathways, biosimilars, digital therapeutics, and high-investment therapies and their implications on formulary management. It will also review health disparities and how patient perspectives may be incorporated into decision-making. Lastly, this module will summarize value-based care modules and their impact on outcomes-based reimbursement and population health management.
Section 3: Formulary Operations
After all the clinical decisions have been made by the formulary development teams, the formulary operations team puts the formulary into action. Various steps are taken to ensure that the formulary is programmed and executed correctly to ensure the patient has appropriate access to their medications. This section will provide an overview of formulary operations, best practices for formulary communication and education, and utilization management administration.
- Module 1: Overview of Formulary Operations
This module will provide an overview of formulary operations and how they impact payer organizations’ workflows. It will take learners through the process of submitting a formulary for regulatory and client approval, as well as discuss key components of formulary operations and logistics.
- Module 2: Utilization Management
Communication and education are essential for operating a successful formulary to ensure patients are getting access to the right medication at the right time. Formulary changes can be disruptive to patients, so it is essential to recognize the importance of timely and effective communication to both patients and providers. This module will help learners identify different approaches to engage and educate patients and providers about changes to the formulary. In addition, this module will review the regulatory and compliance considerations for formulary changes.
- Module 3: Utilization Management Administration
Utilization management can be resource-intensive and require significant administrative operations. This module will explore electronic prior authorization and gold carding and their significance in utilization management operations. Learners will be able to identify sources of administrative burden and strategies to address them. Lastly, this module will identify the different types of smart logic systems along with their benefits and challenges in utilization management operations.
Section 4: Formulary Maintenance
Maintaining and updating formularies is a continual process to ensure they remain current, effective, and aligned with the latest clinical evidence, safety information, and cost considerations. Formulary maintenance requires regular review, evaluation, monitoring, and assessment to remain dynamic and promote safe and effective medication use.
- Module 1: Classification Systems
Classification systems are essential tools for organizing medications, which ensures there is adequate coverage for various medical conditions and supports formulary decisions. This module will summarize the role and function of classification systems and discuss how health care organizations leverage these tools in the maintenance of formularies.
- Module 2: Formulary Maintenance Considerations
Drug withdrawals, safety recalls, drug shortages, and discontinuations are some of the many unforeseen circumstances that may disrupt patient care and access. This module will identify the implications of these circumstances on a payer’s formulary. This module will discuss the considerations and impact of limiting NDCs, limited distribution, new FDA approvals, and criteria management will have on formulary decision-makers.
- Module 3: Strategies for Monitoring the Formulary
Monitoring the formulary is crucial to anticipating any events, such as a new FDA-approved product or drug recall, that may affect the formulary and patient access. This module will describe the various methods and channels for collecting feedback as well as key metrics and trends for monitoring the formulary.
- Module 4: Best Practices for Utilizing Formulary Resources
There are various resources and best practices to ensure optimal formulary management. By proactively monitoring and assessing pipeline drugs and utilizing pricing tools, it can inform formulary management decisions to get ahead of high-cost and impact medications. This module will discuss formulary lookup resources to access accurate and up-to-date formulary information as well as benchmark resources for comparing formulary performance and metrics.
Target Audience
This program is designed for mid-level managed care pharmacists and managed care professionals working in formulary management or considering a transition to formulary management.
- $499 for Members or $399 through Jan. 31, 2025
- $549 for Non-Members
Bulk Pricing Available
Contact amcplearn@amcp.org for more information.
This training program will be accredited for Continuing Pharmacy Education
