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Covering an array of market access training topics

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A full library of knowledge at your fingertips

ProFusion’s propriety market access training courses provide a foundation of knowledge to build upon. A full spectrum of marketplace topics ensures applicability to your product’s sales environment.

You can select from ProFusion’s off-the-shelf catalog or design custom market access courses to begin constructing your customized training curriculum.

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  • FOUNDATIONAL TOPICS
  • ADVANCED TOPICS
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  • PAYER TEAM

Foundational Topics

The Managed Care Landscape

  • E-Book
  • 45 minutes
View Description
THE MANAGED CARE LANDSCAPE

Appropriate for “level-setting” an entire team on managed care concepts.

Learning Objectives:

  • List the stakeholders in managed care delivery
  • Define the term “risk”
  • Describe how risk is apportioned within the managed care system
  • Understand the design of health care benefits
  • Recognize cost containment strategies
  • Interpret quality metrics applied in the marketplace
  • Follow the flow of dollars through the health care delivery system
  • Understand drug pricing

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    Course of Interest:


    Foundational Topics

    Medicare overview

    • E-module
    • 20 minutes
    View Description
    MEDICARE OVERVIEW

    This module describes various features and benefits offered by the Medicare program

    Learning Objectives:

    • Understand the Medicare program design
    • Identify the basic structure of each of the 4 parts of Medicare
    • Identify Medicare eligibility requirements and common characteristics of the Medicare beneficiary
    • Understand Medicare benefit design and a beneficiary’s cost-share

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      Course of Interest:


      foundational topics

      medicare part d

      • E-module
      • 30 minutes
      View Description
      MEDICARE PART D

      This module describes the standard Part D benefit and how payers deviate from it when designing their own benefit

      Learning Objectives:

      • Understand Medicare Part D benefit design
      • Define a person’s eligibility for Medicare Part D
      • Identify types of Medicare Part D plans
      • Understand a patient’s cost-share in the standard Part D benefit
      • Understand the impact of healthcare reform on the Medicare Part D program

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        Course of Interest:


        foundational topics

        medicare part d low-income subsidy program

        • E-MODULE
        • 15 minutes
        View Description
        MEDICARE PART D LOW-INCOME SUBSIDY PROGRAM

        This module reviews how the Medicare Part D LIS Benefit fits into the overall Medicare Program design

        Learning Objectives:

        • Identify the goal of the low-income subsidy (LIS) program for prescription drug coverage
        • Understand the program requirements for eligibility
        • Distinguish the differences between the dual-eligible benefit design and the LIS program

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          Course of Interest:


          Foundational topics

          medicaid overview

          • E-module
          • 20 minutes
          View Description
          MEDICAID OVERVIEW

          This module describes the features of the Medicaid program and how features may vary between states.

          Learning Objectives:

          • Define the Medicaid program
          • Identify Medicaid eligibility requirements and common characteristics of the Medicaid beneficiary
          • Determine various types of benefits provided under Medicaid
          • Anticipate the impact of Managed Medicaid
          • Identify the impact of healthcare reform on Medicaid

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            Course of Interest:


            foundational topics

            commercial insurance policies

            • E-module
            • 25 minutes
            View Description
            COMMERCIAL INSURANCE POLICIES

            This module reviews the typical design of policies purchased in the commercial space

            Learning Objectives:

            • Describe the characteristics of the basic insurance products available in the market
            • Understand the differences between these insurance products
            • Know which products have the most and least restrictive access to pharmaceuticals
            • Identify important features of consumer-directed health plans

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              Course of Interest:


              FOUNDATIONAL TOPICS​

              buy & bill

              • E-module
              • 15 minutes
              View Description
              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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                Course of Interest:


                FOUNDATIONAL TOPICS​

                cost containment strategies

                • E-module
                • 25 minutes
                View Description
                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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                  Course of Interest:


                  FOUNDATIONAL TOPICS​

                  Pharmacy vs. medical benefit design

                  • E-module
                  • 25 minutes
                  View Description
                  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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                    Course of Interest:


                    FOUNDATIONAL TOPICS​

                    paying for healthcare

                    • E-module
                    • 25 minutes
                    View Description
                    PAYING FOR HEALTHCARE

                    This module is a high-level look at who ultimately pays for healthcare services and drug treatment

                    Learning Objectives:

                    • Define the major payers in the US
                    • Understand the differences between private and public payers
                    • Identify private and public payer populations

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                      Course of Interest:


                      FOUNDATIONAL TOPICS​

                      Health INSURANCE exchanges

                      • E-module
                      • 25 minutes
                      View Description
                      HEALTH INSURANCE EXCHANGES

                      This module explains how health insurance exchanges represent a distinct market for obtaining drug coverage

                      Learning Objectives:

                      • Describe key differences between state-based exchanges and private exchanges
                      • Define the relationship between the exchanges and the markets they serve
                      • Understand the operation of state-based exchanges
                      • Define the characteristics of policies sold on the exchange
                      • Recognize trends in the exchange market

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                        Course of Interest:


                        FOUNDATIONAL TOPICS

                        the healthcare landscape

                        • E-module
                        • 25 minutes
                        View Description
                        THE HEALTHCARE LANDSCAPE

                        This module focuses on the Affordable Care Act and how it continues to impact the healthcare industry

                        Learning Objectives:

                        • Identify how access to health insurance has been expanded through the Affordable Care Act
                        • Describe how health insurance is being restructured
                        • Identify new methods used to pay physicians and hospitals in an effort to control costs

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                          Course of Interest:


                          FOUNDATIONAL TOPICS​

                          how physicians get paid

                          • E-module
                          • 25 minutes
                          View Description
                          HOW PHYSICIANS GET PAID

                          The way physicians are compensated may impact prescribing decisions. This module discusses various compensation models prevalent in today's market.

                          Learning Objectives:

                          • Explain the difference between fee-for-service, salary, bundled, and capitated payment models
                          • Outline the process for physicians to get paid
                          • Describe the implications of physician compensation on pharmaceutical companies, physicians, patients, and payers

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                            Course of Interest:


                            FOUNDATIONAL TOPICS​

                            trends in benefit design

                            • E-module
                            • 20 minutes
                            View Description
                            TRENDS IN BENEFIT DESIGN

                            This module reviews how health insurance policies are structured. It details the medical and pharmacy benefits, the new specialty pharmacy benefit, and other design strategies instituted by payers.

                            Learning Objectives:

                            • Describe several benefit design considerations
                            • List the ways that employers are reacting to the growing cost of healthcare coverage
                            • Describe high deductible health plans, their advantages, and their disadvantages
                            • Outline the implications of evolving benefit design on patients, providers, and pharmaceutical companies

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                              Course of Interest:


                              Healthcare Stakeholders impacting the business of medicine

                              FOUNDATIONAL TOPICS​

                              marketplace pressures

                              • E-book
                              • 45 minutes
                              View Description
                              MARKETPLACE PRESSURES

                              Appropriate for “level-setting” an entire team on how managed care pressures are forcing providers to change their business models

                              Learning Objectives:

                              • Visualize how coordinated care is changing the way health care services are delivered to patients
                              • List the new compensation models and how they make physicians accountable for more than delivering services to patients
                              • Draw the new lines of negotiation that occur between consolidated physician groups and the payers who reimburse them for services
                              • Contrast the traditional business model of a private physician practice with the new model being created by today’s shifting health care marketplace

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                                Course of Interest:


                                FOUNDATIONAL TOPICS​

                                Legislation & Regulation

                                • E-module
                                • 20 minutes
                                View Description
                                LEGISLATION & REGULATION

                                This module contrasts legislation with regulation to describe the tools used by government to shape our healthcare industry

                                Learning Objectives:

                                • Recite the difference between laws and regulations
                                • Outline the processes by which laws and regulations are defined
                                • Recognize examples of some healthcare-related laws and correlate how Rules and Regulations relate to those laws
                                • Map the judicial review process in the federal court system

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                                  Course of Interest:


                                  ADVANCED TOPICS​

                                  the role of group purchasing organizations

                                  • E-module
                                  • 20 minutes
                                  View Description
                                  THE ROLE OF GROUP PURCHASING ORGANIZATIONS

                                  This module provides insight on both Specialty and Hospital GPOs

                                  Learning Objectives:

                                  • Map where GPOs influence drug distribution as your products move from manufacturing sites to hospitals and physician practices
                                  • Distinguish between hospital GPOs and specialty GPOs
                                  • Define the services GPOs offer to their customers
                                  • Predict the influence GPOs may have on their customer’s purchasing decisions

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                                    Course of Interest:


                                    ADVANCED TOPICS​

                                    impact of the 340B program

                                    • E-module
                                    • 30 minutes
                                    View Description
                                    THE IMPACT OF THE 340B PROGRAM

                                    This module describes how the 340B program has fundamentally changed the healthcare landscape.

                                    Learning Objectives:

                                    • Cite the goals and intent of the 340B program
                                    • Define the pricing advantages available to “Covered Entities”
                                    • Describe how health systems become qualified as Covered Entities
                                    • Identify patients eligible to receive 340B medications
                                    • Understand how the 340B program impacts a hospital’s entire pharmacy management strategy, including:
                                      • Contract pharmacies
                                      • In-house pharmacies
                                      • Formularies/pathways

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                                      Course of Interest:


                                      ADVANCED TOPICS​

                                      biosimilars

                                      • E-module
                                      • 25 minutes
                                      View Description
                                      BIOSIMILARS

                                      This module describes the introduction of biosimilars into the drug market, including the FDA approval process and payer coverage decisions

                                      Learning Objectives:

                                      • The difference between innovator biologic drugs and biosimilar drugs
                                      • How laws are driving the potential impact of biosimilar drugs on the healthcare industry
                                      • Considerations being weighed by various stakeholders in the healthcare market

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                                        Course of Interest:


                                        ADVANCED TOPICS​

                                        following the healthcare dollar

                                        • E-module
                                        • 30 minutes
                                        View Description
                                        FOLLOWING THE HEALTHCARE DOLLAR

                                        There are many stakeholders involved in delivering treatments to patients. This module describes each stakeholder's role and how money flows between them

                                        Learning Objectives:

                                        • Describe the services provided by various types of stakeholders along the drug supply chain
                                        • How each player makes money within the healthcare market
                                        • Recognize important healthcare trends currently influencing the landscape and business opportunities for various sectors within the healthcare system
                                        • Understand the nuances between medical and pharmacy benefit
                                        • Learn how specialty pharmacy providers can play a role in both medical and pharmacy benefit distribution

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                                          Course of Interest:


                                          ADVANCED TOPICS​

                                          the physician practice business review

                                          • E-book
                                          • 45 minutes
                                          View Description
                                          THE PHYSICIAN PRACTICE BUSINESS REVIEW

                                          Understanding the work flows of a physician office will help representatives address hidden objections to their product that are not related to its clinical benefit

                                          Learning Objectives:

                                          • List the various business processes prevalent in a typical physician practice
                                          • Describe how those processes impact the practice from a business perspective

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                                            Course of Interest:


                                            ADVANCED TOPICS​

                                            the integrated delivery network business model

                                            • E-book
                                            • 45 minutes
                                            View Description
                                            THE INTEGRATED DELIVERY NETWORK BUSINESS MODEL

                                            The business operations of IDNs are becoming more sophisticated. This module describes how those business operations can impact product access.

                                            Learning Objectives:

                                            • Recognize and define the business models of your integrated delivery system customers
                                            • Analyze the impact the customer’s business model may have on their perception of your products
                                            • Begin to adjust your account strategies based on the customer’s business model

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                                              Course of Interest:


                                              ADVANCED TOPICS​

                                              accountable care organizations

                                              • E-module
                                              • 25 minutes
                                              View Description
                                              ACCOUNTABLE CARE ORGANIZATIONS

                                              This module describes the role of the ACO in moving from volume to value. It also describes how patients and the prescribing of drugs are impacted by ACOs.

                                              Learning Objectives:

                                              • Recognize how the U.S. healthcare system is moving from “volume to value”
                                              • Define the role of the ACO as a tool in the movement towards “value”
                                              • Draw distinctions and similarities between typical ACO contracts
                                              • Explain how the prescribing of drugs may be impacted by ACOs
                                              • Describe how a patient may be impacted when treated in the ACO setting

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                                                Course of Interest:


                                                ADVANCED TOPICS​

                                                the oncology care model

                                                • E-module
                                                • 25 minutes
                                                View Description
                                                THE ONCOLOGY CARE MODEL

                                                This module discusses the structure of the OCM and how it may impact physician practices

                                                Learning Objectives:

                                                • Describe the purpose of the OCM model
                                                • Detail who is participating and what types of cancer are included in OCM
                                                • Identify the different OCM practice requirements
                                                • Explain the two-part payment approach for OCM Fee-for-Service:
                                                  • Per-beneficiary-per month payment
                                                  • Performance-based payment

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                                                  Course of Interest:


                                                  ADVANCED TOPICS​

                                                  Drug pricing and rebating

                                                  • E-module
                                                  • 25 minutes
                                                  View Description
                                                  DRUG PRICING AND REBATING

                                                  This module provides a foundational understanding of specific price points. It also discusses the impact of rebates on those price points

                                                  Learning Objectives:

                                                  • Define various drug price points
                                                  • Track the flow of dollars as drugs move through the drug distribution process
                                                  • Calculate the impact of rebating on a drug’s gross-to-net results
                                                  • Relate changes in rebate amounts to their impact on other price points, such as Best Price and 340B ceiling price

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                                                    Course of Interest:


                                                    ADVANCED TOPICS

                                                    ACCESS AND REIMBURSEMENT IN THE ELDERLY CARE SETTING

                                                    • E-module
                                                    • 30 minutes
                                                    View Description
                                                    ACCESS & REIMBURSEMENT IN THE ELDERLY CARE SETTING

                                                    This module reviews how drug coverage and reimbursement varies according to the sites of care that treat elderly patients

                                                    Learning Objectives:

                                                    • Map the general flow of prescriptions, drugs and claims
                                                    • Identify payers that cover drugs at each site of care
                                                    • Track changes in drug coverage as patients move between sites of care
                                                    • Understand how the product access environment may impact branded products

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                                                      Course of Interest:


                                                      ADVANCED TOPICS

                                                      REIMBURSEMENT ENVIRONMENT FOR MEDICAL BENEFIT DRUGS

                                                      • E-module
                                                      • 30 minutes
                                                      View Description
                                                      REIMBURSEMENT ENVIRONMENT FOR MEDICAL BENEFIT DRUGS

                                                      This module reviews how payers cover and reimburse for drugs under the medical benefit

                                                      Learning Objectives:

                                                      • Describe the impact of various product access acquisition channels on reimbursement
                                                      • Map the claims process and its impact on reimbursement
                                                      • Assess the influence of managed care organizations on reimbursement

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                                                        Course of Interest:


                                                        ADVANCED TOPICS​

                                                        Pharmacy Benefit Managers

                                                        • E-module
                                                        • 25 minutes
                                                        View Description
                                                        PHARMACY BENEFIT MANAGERS

                                                        This module describes the market-driven changes to the PBM business model

                                                        Learning Objectives:

                                                        • Review the current PBM business model
                                                        • List the market-dominant PBMs
                                                        • Describe how PBMs earn revenue
                                                        • Describe the consolidation of PBMs with Payers and Specialty Pharmacies
                                                        • Review the pressures PBMs face to change their business model

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                                                          Course of Interest:


                                                          ADVANCED TOPICS​

                                                          CARING FOR THE ELDERLY: A pATIENT'S JOURNEY

                                                          • E-module
                                                          • 25 minutes
                                                          View Description
                                                          CARING FOR THE ELDERLY: A PATIENT'S JOURNEY

                                                          This module describes a patient's transition through sites of care dedicated to treating the elderly

                                                          Learning Objectives:

                                                          • List the sites of care treating elderly patients
                                                          • Describe the clinical profile of the patient population at each site
                                                          • Identify clinicians that typically provide healthcare services at each site
                                                          • Map a typical patient’s journey through the different sites of care

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                                                            Course of Interest:


                                                            ADVANCED TOPICS​

                                                            THE EVOLVING PAYER BUSINESS MODEL

                                                            • E-module
                                                            • 25 minutes
                                                            View Description
                                                            THE EVOLVING PAYER BUSINESS MODEL​

                                                            Payers are adapting to the evolving healthcare landscape. This module compares the old payer business model to how they operate in today's environment

                                                            Learning Objectives:

                                                            • Understand how risk‐based contracts with providers are becoming more prevalent
                                                            • Describe the new stakeholder category created by consolidation with PBMs and Specialty Pharmacies
                                                            • Explain the impact of healthcare reform laws and regulations on payers

                                                            Fill out below to learn more about accessing this course