Administering the Pharmacy Benefit
This module begins with a discussion of the role of prescription drugs in the delivery of healthcare services and what is meant by the pharmacy benefit. It then discusses the role of PBMs in managing the pharmacy benefit and how financial risk is influencing the pharmacy benefit.
Criteria for Product Approval to the Formulary
This module focuses on the formulary approval process in both managed care organizations and hospitals, and how decisions are made regarding which drugs are approved for formulary inclusion.
This module describes three major formulary design concepts: open, closed, and incented or multi-tier, and discusses the emerging approach to formulary structure, and value-based formulary design.
Hospital and Managed Care Formularies
This module discusses the use of formularies in hospital and managed care/organized customer settings.
Medicare and Medicaid Formularies
This module explores the role of formularies in controlling healthcare costs under two major public programs--Medicare and Medicaid.
Role of Clinicians and Pharmacists in Managing the Pharmacy Benefit
This module focuses on the role of clinicians and pharmacists in pharmacy benefit management.
Selling in the Formulary Environment
This module discusses how pharmaceutical companies have responded to and are succeeding in a formulary environment.
Strategies for Managing the Pharmacy Benefit
This module describes the key methods used by health plans, insurers, and hospitals to manage the pharmacy benefit. These methods include: cost sharing through tiered formularies and higher copays, influencing prescribers' medication choices, implementing formulary control measures such as prior authorization and generic and therapeutic substitution, conducting periodic drug utilization evaluation (DUE) for specific products or entire classes, and implementing clinical practice guidelines, step therapy, and disease management programs to optimize pharmacological therapy. The module concludes by considering the possible effects on an insurer or MCO of managing a pharmacy benefit and formulary too restrictively.
The Managed Care Pharmacy
This module discusses current strategies for managing pharmacy coverage, the changing role of the pharmacist, and the role of pharmacy benefit management (PBM) companies.
The Pharmacy and Therapeutics Committee
This module focuses on the role of the P&T Committee in the formulary system. It describes the structure and functions of the P&T Committee and explains the actual drug approval process and the restrictions and limitations that might be imposed on a drug once it is approved. In addition, this module describes the criteria that are used to determine whether a drug is accepted for the formulary or rejected.
This module discusses the rationale behind formularies and considers the advantages and disadvantages that come with their use.
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