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What is Managed Care Pharmacy? PowerPoint Presentation

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Description : This presentation on Managed Care Pharmacy was developed by AMCP Membership Committee 2019-20. This presentation on Managed Care Pharmacy gives and introduction to the Academy of Managed Care Pharmacy (AMCP), Managed Care Pharmacy overview and roles of pharmacists in Managed Care Pharmacy.

Tags : Managed Care Pharmacy, healthcare, Academy of Managed Care Pharmacy, pharmacists

Published on : Jul 01, 2020 | Views : 1342 | Downloads : 0

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Slide 1-

What is Managed Care Pharmacy? Developed by AMCP Membership Committee 2019-20 Updated September 2019
Slide 2-

Agenda Introduction to AMCP Managed Care Pharmacy Overview Roles of Pharmacists in Managed Care Pharmacy AMCP Student Pharmacist Membership
Slide 3-

Introduction to AMCP
Slide 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
Slide 5-

Mission Statement To improve patient health by ensuring access to high-quality, cost-effective medications and other therapies.
Slide 6-

Managed Care Pharmacy Overview
Slide 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
Slide 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.
Slide 9-

The Players in Managed Care Pharmacy
Slide 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
Slide 11-

Roles of pharmacists in managed care organizations
Slide 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
Slide 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
Slide 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
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
Slide 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
Slide 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
Slide 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
Slide 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
Slide 20-

Examples of Pharmacists in Managed Care
Slide 21-

AMCP Student Pharmacist Membership
Slide 22-

Membership Advantages General Membership Benefits Valuable Resources Access to the Journal of Managed Care & Specialty Pharmacy (JMCP) www.jmcp.org, and AMCP Publications Section www.amcp.org/resource-center/publications/ Daily Dose email 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: www.amcp.org/resource-center/group-resources/student-pharmacist-center Not yet a member? Join at www.amcp.org/become-member
Slide 23-

Opportunities with your local chapter
Slide 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
Slide 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: http://amcplearn.org/products/1578/fundamentals-of-managed-care-pharmacy-certificate-program-2nd-edition-student-version
Slide 26-

Managed Care Residency/Fellowship Residency 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. Fellowship Generally research-based and typically two years in length. Sometimes completed after a PGY1 and/or PGY2 residency (or instead of one).
Slide 27-

Residency Timeline
Slide 28-

Fellowship Timeline
Slide 29-

How to Make the Most of Your Membership Be There! Network Network Network Volunteer Start collecting business cards! Build a relationship with your local AMCP Diplomat Join AMCP’s LinkedIn, Facebook,& Twitter Contact local managed care pharmacy professionals AMCP Nexus (National Harbor 10.29.19-11.1.19) – www.amcpmeetings.org AMCP Managed Care & Specialty Pharmacy Annual Meeting (Houston 4.21.20-4.24.20) AMCP’s Conference Buddy Mentoring Program Student-specific educational sessions and webinars Local student pharmacist run conferences AMCP chapter opportunities No chapter? Create one! National AMCP volunteer and committee opportunities
Slide 30-

Thank You for your participation! The 2019-2020 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
Slide 31-

To improve patient health by ensuring access to high-quality, cost-effective medications and other therapies. Mission
Slide 32-

Connect with Us www.amcp.org @amcporg

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