Prescription Drugs

Lesson 1: Introduction to Managing Pharmacy Benefits

1. Marketplace and financial trends
2. Brief history of prescription drug benefits
3. The value of pharmacy benefits

Lesson 2: Introduction to Managing Pharmacy Benefits (Purchasing and Contracting Issues)

1. Managing Pharmacy Benefits
   1. The Purchase of Prescription Drugs
   2. Prescription Drug Manufacturer
   3. Other Intermediate Organizations
2. What Makes Some Prescription Drugs So Costly?
   1. Cost-Containment Versus Cost-Effectiveness
3. What Is Pharmacy Benefits Management?
   1. What Are PBMs?

Lesson 3: The Evolution of Pharmacy Benefits Management

1. The Evolution of Pharmacy Benefits Management
   1. Stage 1: Direct Pay
   2. Stage 2: Access-Oriented Third-Party Administrators (TPAs) and Administrative Service Organizations (ASOs)
   3. Stage 3: Price-Conscious Third-Party Administrators (TPAs) ) and Administrative Service Organizations (ASOs)
   4. Stage 4: Influencing the Drug Use Process (PBMs)
   5. Stage 5: Managing Diseases (PBMs)

Lesson 4: Health Management and Formularies

1. Overview of Healthcare and Health Management
   1. Disease State Management and Wellness
2. Developing and Using Practice Guidelines
   1. Practice Guidelines
   2. The Process of Developing Practice Policies
   3. Types of Practice Policies

Lesson 5 - Health Management Programs

1. Managing Large Groups for Healthier Results
   1. Population Health Management
   2. Health Management Programs
   3. Obstacles to Implementing Health Management Programs
   4. Medication Therapy Management Services (MTMS)
2. Health and Pharmacy Economic Analyses
3. Outcomes Research: The Basis of Real-World Change

Lesson 6: Pharmacy Benefit Plan Design

1. Characteristics of an Effective Pharmacy Benefit
   1. Definition and description
   2. Basic steps
2. Basic Elements of the Pharmacy Benefit Plan
   1. Member cost sharing
   2. Pharmacy reimbursement
   3. Limitations, restrictions and exclusions
   4. Provider network
   5. Claims processing and administration
   6. Communication
3. Specialty and Biotechnology Medications
   1. Definition
   2. Strategy

Lesson 7: Drug Utilization Review

1. Overview of Drug Utilization Review
   1. Types and Timing of Drug Utilization Review
   2. Areas of Focus
   3. Advantages and Disadvantages of Drug Utilization Review
2. Utilization Reports

Lesson 8: Pharmacy Networks

1. Delivery Options for Outpatient Pharmacy Services
2. Pharmacy Reimbursement
3. Point of Sale Technology

Lesson 9: Evaluation and Selection of a PBM

1. Evaluation and Selection of a PBM
2. Basic Questions
3. PBM Evaluation

Lesson 10: Current Trends and Pharmacy Innovation

1. Health and wellness current trends
2. Chronic Disease and Health Technologies
3. Harnessing Pharmaceutical Products for Healthier Members