1. What is Managed Care Pharmacy?
Developed by AMCP Membership Committee
Updated September 2019

2. Agenda Introduction to AMCP Managed Care Pharmacy Overview
Roles of Pharmacists in Managed Care Pharmacy
AMCP Student Pharmacist Membership

3. Introduction to AMCP

4. Managed Care Pharmacy
AMCP has over 8,000 pharmacists and other practitioners who manage medication therapies for the 270 million Americans with insurance.
Ensure the pharmacy (and sometimes medical) benefit plan provides individual patients with medications that are:
Clinically appropriate
Cost-effective
Delivered through the appropriate channel
AMCP has over 8,000 members from across the country that includes pharmacists, physicians, nurses, student pharmacists and other’s who work or are interested in managed care pharmacy
AMCP works to keep our members informed of the issues that are important to managed care pharmacy and advocates at the state, federal and regulatory level to determine policy affecting managed care pharmacy.
AMCP CEO Susan A. Cantrell, RPh, CAE

5. Mission Statement
To improve patient health by ensuring access to high-quality, cost-effective medications and other therapies.
Our mission is (from slide)
More information on what AMCP does can be found at

6. Managed Care Pharmacy Overview

7. Goals of Managed Care Prevention of disease
Focus on wellness and enhanced quality of life
Improved clinical outcomes
Quality and accessibility of health care
The right therapy at the right time for the right member
Provide cost effective treatment options
Goals differ from indemnity. Healthcare resources are not unlimited. Must have prudent use of available resources.

8. What is Managed Care Pharmacy?
Managed Care Pharmacy is the practice of developing and applying evidence-based medication use strategies that enhance member and population health outcomes while optimizing health care resources.
Managed care pharmacy organizations cover populations of people – pharmacists in managed care pharmacy have the ability to impact the care of millions of members.

9. The Players in Managed Care Pharmacy
The process of a medication getting from the manufacturer to the end-user (the patient) often encounters the various players of managed care. While the physical product travels along the left-hand side of the graphic (from manufacturer to distributor, then retailer and patient) a variety of services and interactions occur to facilitate that process.
JAMA
Image from:

10. Managed Care Pharmacy Tools
Formulary development with P & T Committees
Clinical Programs
Medication Therapy Management
Prescription Drug Monitoring programs
Drug Utilization Review
Utilization management: prior authorizations, quantity limitations, and step therapy
Appropriate channel management
Preferred & exclusive networks
Mail order pharmacy
Specialty pharmacy
There are various tools in Managed Care Pharmacy to ensure appropriate access to medications to improve patient outcomes.
Those tools range from establishing a set of clinically sound options through the creation of a formulary by a pharmacy and therapeutics committee, to clinical programs aimed at improving patient’s use of those medications through medication therapy management, drug utilization review and utilization management.
Additional tools include ensuring high quality, and cost-effective access to the medications through the use of preferred/exclusive networks and specialty pharmacies.

11. Roles of pharmacists in managed care organizations

12. Plan Benefit Design
Pharmacists collaborate with other healthcare professionals to design effective benefit structures that serve a population’s* needs:
Formulary
Plan Design
Pharmacy network
Utilization management
Member cost share
Use of generic drugs
*Population examples: commercial, Medicare, Medicaid

13. Pharmacy and Therapeutics Committee (P&T)
P&T committee may include
Pharmacists, physicians and other providers, administrators, quality improvement managers and member advocates
Formularies are designed to optimize patient care and therapy management
Evidence based medicine
Updated list of drugs available
Reflect judgment of the medical and pharmacy staff
Encouraging providers to prescribe cost effective treatments
Pharmacists often lead pharmacy and therapeutics committees by serving as the medication experts in evaluating the evidence of new drug therapies. These P&T committees are often multidisciplinary, featuring pharmacists, physicians and other providers.

14. Utilization Management Tools
Prior Authorization (PA or “Prior Auth.”)
Approval process to encourage proper use of medications. Right Drug Right Patient
Step Therapy
Use of a product required before an alternative can be chosen
Age
Check for member age to ensure safe use
Quantity Limit (QL)
Align approval with FDA approved dosing
Additional roles are related to the creation and maintenance of utilization management tools. These additional limitations placed on formulary medications can lead to reduced improper utilization of medications. Examples of such tools include (see slide)

15. Clinical Program Development
To enhance patient care, particularly for those with chronic conditions, pharmacists design clinical programs to:
Use evidence-based research data to create disease-management and medication therapy management programs
Encourage appropriate prescribing and proper use of medications
Promote use of cost effective therapies to benefit both patients and payers
Improve health and quality of life for population under their care
Using data to identify adherence and non-adherence
Pharmacists also play a critical role in the development and completion of clinical programs aimed at enhancing patient care.
These programs are patient-centric and typically aimed at chronic conditions where the evidence is clear that improved adherence and appropriate utilization of medications can reduce long-term complications. These programs may be intended to educate the patient, the provider, or both.

16. Outreach Opportunities
Pharmacists design and use communication protocols to facilitate exchange of necessary information:
Notify prescribers of drug safety alerts and prior authorization requirements, and best practices
Educate members on their disease state and medications
Provide pharmacies information regarding benefit parameters
Other areas of opportunity include non-patient specific communication of drug information. This happens in a variety of different ways, often aimed at giving providers better information to take care of patients.
Examples may include:
a pharmacist for a pharmaceutical manufacturer sharing new clinical information regarding specific therapies
A pharmacist for a health plan providing evidence-based education to providers that frequently treats its members or sharing updated parameters regarding it’s pharmacy benefit

17. Member Safety Opportunities
Drug Utilization Review (DUR) programs identify potential prescription-related problems
Drug/drug interactions
Duplication of therapy
Known allergies
Under- or overdosing
Potentially inappropriate therapy
Fraud and Abuse Programs
Review key drug classes
Monitor for patterns of inappropriate use

18. Business Management
Pharmacists contract with employer and health plan clients, pharmacies, and manufacturers to structure business arrangements that:
Negotiate with manufacturers for discounts on drug prices
Outcomes-based risk agreements
Establish networks of pharmacies
Pharmacists also play a variety of non-clinical roles in managed care organizations. Examples include rebate contract negotiations between a third party payor and a manufacturer or establishing reimbursement rates between network pharmacies and third party payors.

19. Pharmacy Network Management
Managed Care Organizations (MCOs) provide broad-based networks of participating pharmacies and manage their services to ensure quality.
May own or contract with:
Retail Pharmacies
Mail Order Pharmacies
Specialty Pharmacies
Managed Care Organization Operated Pharmacies
In-house pharmacies owned by the managed care organization
As referenced in the previous slide, pharmacists can also play a role with the management of pharmacy networks.
Pharmacists can also work within various pharmacy channels that are often owned by managed care organizations. An example is a specialty pharmacy that focuses on complex therapies for patients. Due to the complexity and cost of these medications these pharmacies provide a higher level of interaction and education to ensure safe and appropriate utilization.

20. Examples of Pharmacists in Managed Care
Drug Information
Medication Therapy Management / Clinical Programs
Product Development
Client relations / Account Management
Industry Relations/ Market Access / Managed Care MSLs
Health Economics & Outcomes Research
Formulary Management / Prior Authorizations
Government Programs
Specialty Pharmacy
As you’ll have noticed, there are so many different roles that pharmacists can play in managed care and we haven’t even covered them all.

21. AMCP Student Pharmacist Membership

22. Membership Advantages
General Membership Benefits
Valuable Resources
Access to the Journal of Managed Care & Specialty Pharmacy (JMCP) and AMCP Publications Section
Daily Dose news briefings
AMCP webinar series
AMCP Nexus and AMCP Managed Care & Specialty Pharmacy Annual Meeting
Student Pharmacist Benefits
Student pharmacist-specific programming
Conferences
Webinars
AMCP Managed Care Pharmacy Residency and Fellowship Showcase
Student Pharmacist Resource Center:
As a student member of AMCP there are so many great resources to learn more about managed care. There is student pharmacist-specific programing at conferences, webinars like this one, and the residency/fellowship showcase every fall at the AMCP Nexus meeting.
Not yet a member? Join at

23. Opportunities with your local chapter
Get involved with your AMCP Student Pharmacist chapter!!
Participate in chapter programs, activities, and committees
AMCP Foundation P&T Competition
Networking and Professional Events
Chapter specific events
Serve as an elected chapter officer
Plenty of opportunities to get involved at a local, student chapter level. In particular, the national AMCP Foundation P&T competition offers students a great opportunity to
If they don’t have a chapter – contact AMCP about forming one

24. Student Involvement
Attend events hosted by your AMCP student pharmacist chapter and AMCP regional/local affiliates
Volunteer for an AMCP Chapter committee
Run for chapter officer
Apply for Managed Care Summer Internships
Participate in the AMCP Foundation P&T Competition
Apply for national AMCP Committees
Attend AMCP Nexus Managed Care Pharmacy Residency and Fellowship Showcase to find a managed care residency program
Be proactive, volunteer for committees

25. Fundamentals of Managed Care Pharmacy Certificate Program
Previously presented live at AMCP meetings, it has been updated and is now available as an online certificate program.
Explore key aspects of managed care pharmacy, including core fundamental modules and four focused content areas: Medicare Part D, Medicaid, Affordable Care Act, and Quality Ratings.
Watch a preview video of the Student version at this link:
The Fundamentals of Managed Care Pharmacy Certificate Program provides a comprehensive introduction to basic concepts in managed care pharmacy.
Previously presented live at AMCP meetings, it has been updated and repurposed as an online certificate program, with the help of key thought-leaders.
Learners will explore key aspects of managed care pharmacy, including core fundamental modules and four focused content areas: Medicare Part D, Medicaid, Affordable Care Act, and Quality Ratings.
Member $199.00
Non-Member $249.00

26. Managed Care Residency/Fellowship
Year long post-PharmD intensive learning and skills-building experience in a managed care pharmacy environment.
To be accredited by ASHP the program must meet standards that are developed by the Commission on Credentialing with input from AMCP members.
Generally research-based and typically two years in length.
Sometimes completed after a PGY1 and/or PGY2 residency (or instead of one).
For students interested in pursuing a career in managed care, a residency or industry fellowship are great opportunities to gain additional experience after graduation. It’s important to understand some key differences between the two types of post graduate training as their timelines vary.
*Some programs are not accredited because they are new, others choose not to be accredited since they want to focus on different aspects than ASHP and AMCP

27. Residency Timeline Apr Mar Feb Jan Dec Nov Oct Match phase II
Match results released
Mar
Interview with programs
Submit program rank for the Match
Feb
Jan
Attend the Residency Showcase at ASHP Midyear
Register for the Match
Dec
Register for PhORCAS
Identify faculty/preceptors/mentors willing to provide letters of recommendation
Nov
Attend the Residency Showcase at AMCP Nexus
Oct
As a final-year student pharmacist here is an outline of key dates and events to keep in mind when pursuing a residency.

28. Fellowship Timeline Jan Dec Oct-Nov Sept On-site interviews
Final selection of candidates
Jan
Participate in PPS at ASHP Midyear
Final application materials due
Dec
Attend the Fellowship Showcase at AMCP Nexus
Register for PPS and schedule interviews at PPS
Oct-Nov
Identify faculty/ preceptors/mentors willing to provide letters of recommendation
Sept
As you may notice the timeline for fellowships are slightly altered. Some key differences include the faster timeline for applying to fellowships and the lack of a match process.

29. How to Make the Most of Your Membership
Network
Start collecting business cards!
Build a relationship with your local AMCP Diplomat
Join AMCP’s LinkedIn, Facebook,& Twitter
Contact local managed care pharmacy professionals
Be There!
AMCP Nexus (National Harbor ) –
AMCP Managed Care & Specialty Pharmacy Annual Meeting (Houston )
AMCP’s Conference Buddy Mentoring Program
Student-specific educational sessions and webinars
Local student pharmacist run conferences
Volunteer
In conclusion, being a member of AMCP is a great start to learning more about a career in managed care but don’t just stop there. To make the most of your membership it’s important to network with managed care professionals and peers interested in managed care.
AMCP chapter opportunities
No chapter? Create one!
National AMCP volunteer and committee opportunities

30. Thank You for your participation!
The AMCP Membership Committee: Marti Groeneweg (Chair), Hosain Aghamoosa (Vice Chair), Janetta Bekman, Donna Bell, Donna Chiefari, Brianne Chin, Sean Chitwood, Tasmina Hydery, Brent Milovac, Ryan Morris, Victoria Nazarov, Vijay Patel, Geoff Traeger, Yanina Vignoni, Thomas Walters, Debra Minich (Board Liaison) and Staff Liaisons Betty Whitaker and Susan Noell

31. Mission To improve patient health by ensuring access to
high-quality, cost-effective medications and other therapies.

32. Connect with Us
@amcporg