PBMI
 

 

 

PBM 101 White Paper Series 

 

If you need some basic training on how to work with your pharmacy benefit manager and get the most value from your organization’s drug benefit plan, this white paper series is invaluable. It’s perfect for anyone new to the drug benefit arena. It will help employee benefits generalists for whom the drug benefit is only a small part of their total responsibilities. Each of these reader-friendly white papers includes schematics to illustrate major concepts, a glossary of need-to-know terms, and links to electronic resources for additional learning.

 

Evolution of Drug Benefit Management

Pharmacy Benefit Manager (PBM) Business Models

Simple Approach to Understanding PBM pricing

Drug Rebate Programs

Working Effectively with PBMs

 

Defining Generic Drugs

Tracking Generic Savings Opportunities
Getting to the Lowest Net Cost Drug

  --  MAC Pricing  

  --  Plan Design and Other Incentives
  --  Member and Prescriber Education
Impact of Generics on Medication Compliance
Strategizing Around Health Conditions
 
 Managing Drug Mix Through Effective Plan Design
Cost Sharing Strategies
Economic Tools
Utilization Management Tools
 

Defining Specialty Pharmacy

Growth in Specialty Drug Marketplace

Cost Management Strategies

  --  Rx & Medical Claims Analysis 

  --  Best Drug Pricing 

  --  Optimal Dispensing Channel 

Utilization Management Strategies

  --  Clinical Tools 

  --  Member Cost Share 

  --  Preferred Products 

Clinical Care Management Strategies

  --  High-touch Patient Services 

  --  Medication Adherence

Choosing a Specialty Pharmacy Provider

Measuring Success

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Industry Overview: Drug Benefit Stakeholders

Industry Stakeholders and Their Roles

Relationships Among Stakeholders

Customer Corridor for Pharmacy Benefit Management

Major Industry Achievements: 1995-2009

Challenges Ahead

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