Course Overview

BUS-403: The Formulary Process—Managing the Pharmacy Benefit (3 Credits)
Program(s): CMR

COURSE CONSULTANTS

SECOND, THIRD, AND FOURTH EDITIONS

Norman V. Carroll, PhD
Professor of Pharmacy Administration
Department of Pharmacy
Medical College of Virginia Branch
Virginia Commonwealth University
Richmond, Virginia

David A. Sclar, BPharm, PhD
Professor of Health Policy
and Administration

Director, Pharmacoeconomics
and Pharmacoepidemiology Research Unit
College of Pharmacy
Washington State University
Pullman, Washington

Graduate Supplement
BUS-5403
To earn graduate-level credit, this supplement and course BUS-403 must be successfully completed.

Click here for more information about graduate-level credit.

Who Should Take This Course:
Sales representatives, managers, and others who would benefit from a knowledge of formularies and how they influence the drug utilization decisions of healthcare administrators, physicians, and pharmacists.

Career Applications/Benefits:
Formularies are important tools used by healthcare organizations to guide rational drug use and efficiently control pharmacy costs. In addition to hospitals, many managed care organizations, government programs such as Medicare and Medicaid, and some health insurance companies, have developed formularies that influence which drugs are prescribed by providers and used by subscribers. This extensive use of formularies to manage and organize drug use both for inpatients and outpatients is redefining the role of healthcare representatives as well as the roles of physicians, pharmacists, and other healthcare professionals. This course will benefit healthcare representatives and others who need to be aware of the specific trends and issues that govern the formulary in different healthcare organizations. The information in this course describes the formulary system, which has a significant impact on physician prescribing decisions and how representatives and others conduct their sales activities.

Course Description:
This course discusses significant developments in the formulary process and pharmacy benefit management, particularly in terms of managed healthcare organizations. It provides an overview of the healthcare institutions that use formularies, the types of formularies that are in place, and the role of the Pharmacy and Therapeutics (P&T) Committee in product approval to the formulary. The course also discusses strategies for managing the pharmacy benefit, including formularies, generic substitution, therapeutic interchange, drug utilization review, clinical practice guidelines, and outcomes research. It concludes by discussing trends among pharmacy benefit management companies (PBMs) and pharmaceutical companies, and the role of healthcare representatives in the formulary decision-making process.

Related Courses:

The Managed Healthcare Market
Contemporary Pharmacoeconomics
The Value of Pharmaceuticals

Chapter Content:

Chapter 1: Overview of the Formulary System
	The Formulary Rationale for the Formulary The Hospital Formulary The Managed Healthcare Formulary Medicare and Medicaid Formularies Open, Closed, and Incented Formularies Managing Formularies to Control Cost The Pharmacy and Therapeutics Committee Structure and F Functions of the Pharmacy and Therapeutics Committee Formulary Approval Process Criteria for Product Approval to the Formulary Formulary Criteria Tools in the Formulary Decision-Making Process
Chapter 2: Managing the Pharmacy Benefit
	Strategies for Managing the Pharmacy Benefit Prior Authorization Generic Substitution and Therapeutic Interchange Drug Utilization Evaluation (DUE) Clinical Practice Guidelines Role of Physicians and Pharmacists in Managing the Pharmacy Benefit Administering the Pharmacy Benefit Role of Prescription Medicines in Healthcare Delivery Pharmacy Benefit Design Pharmacy Benefit Management Companies Financial Risk Management of the Pharmacy Benefit
Chapter 3: Role of the Healthcare Representative
	Trends Among Pharmaceutical Companies Influence of Buying Groups and Negotiated Contracts National Accounts/Managed Care Departments Pharmacoeconomics and Outcomes Research Departments Healthcare Representatives and the Formulary Developing Product Advocates Maintaining Formulary Approval Successful Selling Without Formulary Status

Learning Objectives:
Upon successful completion of this course, the student will be able to describe and differentiate the various types of formularies used within healthcare organizations; discuss the role of the Pharmacy and Therapeutics Committee in formulary development; describe strategies used by healthcare organizations to manage the pharmacy benefit; discuss trends among pharmaceutical companies; and describe the role of healthcare representatives in the formulary decision-making process.