Pharmacy Benefits Manager

Question 1

Define managed care

Answer 1

terms that refers to the organizations, groups and activities designed to ensure appropriate healthcare services in a cost-efficient manner

Question 2

What is the goal of a managed care pharmacy

Answer 2

managing of medications for populations of people that is both clinically appropriate and cost-effective

Question 3

What is a Pharmacy Benefit Manager

Answer 3

directs prescription drug programs and processes prescription claims by negotiating with manufacturers and pharmacies

Question 4

What is the pharmacists’ role within a PBM

Answer 4

1. drug information
2. formulary management
3. utilization management
4. client management
5. industry relations and contacting
6. provider services
7. population health
8. government programs

Question 5

What is drug information

Answer 5

the timely and accurate research and evaluation of literature
*drug class reviews
*clinical significances
*study limitations

Question 6

What is a formulary?

Answer 6

list of prescription medications that have been evaluated by a committee and decided that the drugs offer the greatest value clinically and financially to patients

Question 7

What is the purpose of a formulary

Answer 7

try to control medication costs while still providing best care for patients

Question 8

What is utilization management

Answer 8

set of techniques used in the PBM industry to encourage safe, effective, and economical medication use
*i.e. prior authorizations, quantity limits, step therapies

Question 9

What is client management?

Answer 9

management and coordination of the clinical relationship with existing clients
works to improve the quality of care while controlling/decreasing overall health care costs

Question 10

What is the pharmacists role in client management?

Answer 10

-recommend, implement, and evaluate clinical programs and services
-responsible for the account relationship and ultimate retention of the account and growth of the business

Question 11

what is industry relations and contracting?

Answer 11

entails pharmacoeconomic activities and rebate contracting with manufacturers
handles contracting strategies and management, financial decision making, economic modeling, and budget imapact analysis

Question 12

What is the pharmacist’s role in industry relations and contracting

Answer 12

responsible for establishing, maintaining and enhancing effective relationships with pharmaceutical manufacturers and negotiating contracts
provide formulary decision support through appropriate cost modeling, rebate forecasting and budget impact analysis

Question 13

What are provider services

Answer 13

the development, monitoring and maintenance of retail, mail and specialty pharmacy networks
*may include, broad, limited, preferred and/or client custom networks

Question 14

What is population health

Answer 14

the health outcomes of a group of individuals, including the distribution of such outcomes withing the group
the approach to health that aims to improve the health of an entire population

Question 15

How do we manage population health

Answer 15

design, implement and monitor outcomes of population-based clinical programs
-using Drug Utilization Reviews

Question 16

What are government programs

Answer 16

-entails pharmacy benefit management in the government setting and the meeting of Medicare and Medicaid requirements

Question 17

What is the pharmacist role in government programs

Answer 17

-Medicare benefits is highly regulated and has strict
-The centers for Medicare and Medicaid Services (CMS) strives to make regular improvements to the Medicare program
i.e. medication assisted treatments, safe use of opioids, medication adherence, compounding.