Pharmacy Benefit Management

Pharmacy benefit managers are third-party pharmaceutical benefit administrators. They’re primary functions are processing and paying for prescribed pharmaceutical drugs. They also secure contracts with pharmacies, create lists of preferred pharmaceuticals called formularies, and make deals with manufacturers. Utilization management programs are implemented by pharmaceutical benefit managers to assure that client treatment is necessary. Utilization management helps observe the medical need for and efficiency of provided care. For example, specialty drugs are very costly and can incur large amounts of money, but with utilization management programs in place, cost can be managed appropriately. Pharmacy benefit management is largely used amongst employers to pay for prescription drug claims. Majority of employers offer their active employees prescription drug coverage. Half of employers offer their retired employees prescription drug coverage. The results of a survey released in June 2011 showed the top reasons employers offered pharmacy benefits to their employees (shrm.org, 2011). Providing pharmacy drug coverage positively affects medical claims. It creates competition amongst other businesses. It also is a way of getting the attention of and retaining essential employees. Lastly it’s simply the right thing to do for employees. The cost to…

Pharmacy Benefit Managers (PBM) had a large market reach as they assisted in a various number of ways in the pharmacy market. Two channels of distribution existed: wholesaler to retailer and mail service pharmacy. Other competitors also engaged in acquisitions of PBMs but did not meet the success of the Merck-Medco acquisition. The Merck-Medco integration can be deemed as a textbook example for its competitors as Merck Pharmaceuticals successfully introduced a channel intermediary that changed…

On October 27, 2015, Walgreens Pharmacy, announced it deal with Rite aid to combine in hopes to boost the industry. This massive deal would combine the second and third largest pharmacy companies to create possible the largest chain. The offer proposed by Walgreens to Rite aid was that it would pay 9$ per share. Wall Street Journal reported Rite aid shares skyrocketed 43% as the deal approached reaching a high $8.67 nonetheless, Walgreens offer was still greater. (Bomey) The total agreed offer…

CVS operates in two segments: Pharmacy Services and Pharmacy Retail. Pharmacy Services provides pharmacy benefit management (or PBM) services to customers, including employers, managed Medicaid plans and health plan sponsors. Pharmacy Retail includes the sale of prescription and OTC (over-the-counter) drugs, beauty and personal care products, and more. There are four segments that compose CVS Health: CVS Pharmacy, CVS Caremark, CVS Minute clinic, and CVS Specialty. CVS Pharmacy offers:…

The career of pharmacy has interested me ever since I was a little girl and this has been one of my passions ever since. Some of the different pharmacy careers that really stood out and interested me are community pharmacy, pharmacy opportunities in rural communities, ambulatory care clinics, and medication therapy management programs. A community pharmacy is a healthcare facility that focuses on providing services to a single specific community within an area. A community pharmacist is…

1. Who are you? A pharmacy student , Pharm D. candidate, 2018, motivated, well organized, and fast learner 2. What are your interests? Medical field Knowledge and pharmacy field specifically. I like any science related to pharmacy. I like music and arts that promote my professional sensitivity with my patients. 3. What are your skills? Leadership and management, I was responsible for a musical quire that helped me to gain leadership and management skills, with people of different ages. Also I…

Interview a Pharmacist With exceptional significance, pharmacists are preventing prescription errors and any consequential risks to patients. I interviewed Lester I. Wilson, PharmD, currently employed full time at CVS Health, Pharmacy Benefit Management and part time at Phoenix Children’s Hospital, both here in Phoenix, AZ. Now having a deeper respect and understanding of the valuable involvement pharmacists play in interprofessional collaboration between prescribers and pharmacists, I look…

increasingly showing more interest in integrating pharmacy services within their organization due to the shift from fee-for-service to fee-for-value compensation model and the increased demand for care coordination in the post-acute space (Fox, 2016). In actuality, there are many benefits to opening up a pharmacy connected to the hospital and can often times outweigh steep costs that can affect the bottom line. For the last 10 years, Centers for Medicare and Medicaid have set guidelines around…

noon. This was my first time behind the pharmacy viewing a practicing community pharmacist. Many of her tasks for the day included immunizations, reviewing medications orders, counseling patients, and when orders became backed up she aided the pharmacy technician when available. There was an audit that day for immunization from the corporate level to make sure that all procedures and vaccines were being stored correctly. The corporate employee who was also a licensed pharmacist and allowed me…

How to get internal stakeholders (clinical and non-clinical) to buy into a new pharmacy? Stakeholders should be involved during each stage of new pharmacy to build support for it, provide suggestions for its design, and participate in evaluation and continuous quality improvement activities. Involving stakeholders during all stages of the company can lead to an early buy in, successful program design, and establishment of long-term support for the company (Caleb, 2015). Implementing…