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Managed Care Pharmacy Systems

Managed Care Pharmacy Systems Track

The managed care track offers students an in-depth understanding of managed care principles, structure, financing, and program management strategies common in all health insurance programs. Track coursework examines prescription drug benefit management of Medicare, Medicaid, employer, commercial, and the Insurance Exchanges, as well as emerging delivery and reimbursement systems, such as Accountable Care Organizations.

Coursework covers subjects such as benefit design, pharmacoeconomics, drug comparative effectiveness, formulary management, pharmacy distribution channels, pharmaceutical contracting, quality and drug safety, specialty pharmacy management, public policy, and benefit trends and costs.

The managed care track is ideal for a variety of students, including:

  • Pharmacists who are interested in learning about, or joining a health plan or PBM (pharmacy benefit manager) with employer commercial, Medicare, Medicaid, or Exchange programs
  • Pharmacists or non-pharmacists in pharmaceutical manufacturers, including MSLs, who wish to learn more about health plan and PBM customers, or who may want to join managed markets department with a manufacturer.
  • Health services researchers who wish to understand structure and outcomes measurement of managed healthcare
  • Attorneys or paralegals engaged in healthcare law practice
  • Federal or state agency individuals who interface with insurer, health plan, or PBM prescription drug programs
  • Students who simply wish to understand managed prescription drug benefit programs.

What is Managed Care?

Managed care implies a defined structure and process of designing and delivering covered healthcare benefits that include risk-sharing, price and utilization controls, and quality assurance. These principles are found in all private and public health insurance programs delivered by insurance companies, health plans, pharmacy benefit managers (PBMs), and new programs from the PPACA, including Insurance Exchanges and Accountable Care Organizations.

Pharmacy Benefit Management

The Affordable Care Act or PPACA defines prescription drug benefits as Essential Health Benefits required in every Qualified Health Plan benefit. Pharmacy benefits management components are specifically designed for each type of insured program to optimize clinical and economic outcomes. Each program defines covered and excluded benefits, covered benefit access rules, drug formularies, and pharmacy program quality assurance and outcomes measurement. All health care organizations and systems, including pharmacy provider networks, pharmaceutical manufacturers, and plan sponsor benefit purchasers, providers, and patients all share in financial risk and program management.

Curriculum

Sample Plans of Study – MS and Certificate

Career Options

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At a Glance