Managed Care Pharmacist

Managed care is designed to help lower costs while maintaining a high level of care for both members of the managed care system and its subscribers. A managed care pharmacist works in this setting.

A managed care pharmacist typically works for a health plan or pharmacy benefit management (PBM) company. Pharmacy schools may not adequately train those interested in his area, and additional training may be necessary.

According to the Academy of Managed Care Pharmacists, AMCP, managed care pharmacists function within the following areas:

  • Drug Distribution and Dispensing-Like other pharmacists, managed care pharmacists work with health-care providers to ensure the appropriateness of prescribed pharmaceutical therapy. Managed care pharmacists are also responsible for making sure that prescribed drugs are covered by the patient’s insurance and that the patient is using the lower-cost generic medication wherever available.
  • Patient Care-Managed care pharmacists may evaluate claims data to make sure medications are used appropriately and not abused. These drug utilization programs also help ensure that adverse reactions are avoided. These pharmacists also manage pre-authorizations for medications, which are in place to help prevent the prescribing of inappropriate therapies for patients.
  • Clinical Program Development-In order to make sure that patients receive the most appropriate medications, managed care pharmacists evaluate clinical data on emerging drugs. They study their efficacy in a particular patient population and devise management plans based on this information. Managed care pharmacists may also conduct outcomes-based research on drug therapies.
  • Communication with Patients, Providers, and Pharmacists-The managed care pharmacist is in contact with both physicians and patients and is responsible for educating these groups about medication management plans.
  • Plan Benefit Design-Managed care pharmacists help managed care organizations make decisions regarding whether a formulary should be used and, if one is utilized, whether it should be open or restricted. These pharmacists also help decide whether a network of pharmacies should be created and, if so, how extensive this list should be.
  • Business Management-As discussed above, managed care pharmacists are responsible for creating a network of pharmacies and also for negotiating discounts for medications.
  • Cost Management-Managed care pharmacists help lower costs by encouraging physicians to prescribe lower-cost medications.

The managed care pharmacist works within a managed care organization setting to provide high quality service at a low cost.

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