Medical Benefits Training - Provider & Health Plan Version

Title:      Medical Benefits Medication Management Series

Target Audience: Brand and payer marketers, account executives, field and HQ-based HEOR leads, payer medical leads.

Activity Fee
Member cost: $399.00
Non-Member cost: $499.00

Preview: Click here to watch a preview

AMCP’s Medical Benefit Medication Management is an 8-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. 

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


Program Goals:

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


Requirements: This online self-paced program with a certificate based on completion of pre and post-test requirements.



Fred Goldstein, AMCP Faculty Member

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

About AMCP Corporate Training:

AMCP is the professional association leading the way to help patients get the medications they need at a cost they can afford. Creating real-world, relevant training for life science companies - we build your healthcare business acumen so you can step out in confidence, equipped for customer engagements that drive positive patient outcomes. We’ve shaped our learning forums to connect you with thought leaders and experts. This, plus AMCP tools and resources, fast-tracks you to what’s relevant and keeps you informed about the newest insights. We’ll help you learn about the healthcare reforms that are most meaningful to you, your account teams and your clients – guiding you to customer-targeted solutions.


Contact Us:  Email or call 703 684 2600