FOUNDATIONAL TOPICS
buy & bill
- E-module
- 15 minutes
BUY & BILL
This module describes standard buy & bill processes, including benefit investigation, product acquisition, product administration, and claims adjudication
Learning Objectives:
- List the steps in the buy and bill process
- Explain how specialty drugs are acquired
- Describe the implications of buy and bill for providers, pharmaceutical companies, payers, specialty pharmacies, and patients
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FOUNDATIONAL TOPICS
cost containment strategies
- E-module
- 25 minutes
COST CONTAINMENT STRATEGIES
This module reviews the tools employed by payers to control healthcare costs, including PAs, Step Edits, and more
Learning Objectives:
- Identify cost containment strategies used to manage the Pharmacy Benefit
- Identify cost containment strategies used to manage the Medical Benefit
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FOUNDATIONAL TOPICS
Pharmacy vs. medical benefit design
- E-module
- 25 minutes
PHARMACY VS. MEDICAL BENEFIT DESIGN
This module compares and contrasts the two primary benefit designs found in most insurance policies
Learning Objectives:
- Understand the basic structure of pharmacy and medical benefits
- Compare and contrast features of pharmacy and medical benefits as they relate to:
- Drug acquisition, drug administration, and site of care
- Stakeholders at financial risk for the cost of drugs
- Medical and pharmacy costs to patients
- Coverage guidance and drug utilization management
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