Available Until 12/31/2023
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Managed Care Carve-In or Fee-for-Service Carve-Out: Exploring Medicaid Pharmacy Program Designs

Course Description:

Carve-in, carve-out, and single PBMs – OH MY! Many state Medicaid programs that contract with managed care entities to provide care to the majority of their members are exploring different pharmacy program designs with the goal of transparency, budget savings, or improved operations. What should a state consider when exploring different pharmacy program design options?

This session will focus on financial and operational advantages and challenges associated with each option, and provide information on best practices for states engaged in a pharmacy program design change.


Learning Objectives:

At the completion of this activity, participants should be able to:
  1. Describe advantages and challenges of a FFS Carve-out pharmacy program design.
  2. Describe advantages and challenges of a Managed Care Carve-in Pharmacy program design.
  3. Identify policy objectives that should be considered as part of a pharmacy program design decision.



Faculty(s)


Sara Drake, RPh, MPH, MBA

Principal

Mercer Government Human Services Consulting

Saint Paul, MN

Bethany Holderread, PharmD

Senior Government Pharmacy Consultant

Mercer

Phoenix, AZ


Moderator(s)

Brenden O'Hara, RPh, BCACP

Team Leader, Provider Engagement Pharmacy Initiatives

Blue Cross NC



Accreditation:

The Academy of Managed Care Pharmacy (AMCP) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

ACPE UAN:0233-0000-22-006-H04-P • Activity Type: Knowledge-Based
Contact Hours: 1.25
Release Date: March 30, 2022 •  Expiration Date: December 31, 2023
Activity Fee: $15 for Members and $30 for Non-Members

Participants should claim continuing pharmacy education (CPE) credit for this home study activity only if they have not claimed credit for the live activity presented at AMCP 2022. 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.

System Technical Requirements/Viewing Requirements:

System Requirements 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 learning activities.

Credit Information

Activity Number Credit Amount Accreditation Period
ACPE UAN #0233-0000-22-006-H04-P 1.25 Contact Hours March 30, 2022 - December 31, 2023