What is Managed Care Pharmacy?

Health care practitioners in managed care pharmacy design and implement drug benefits for the more than 200 million Americans covered by health insurance. Drug benefits ensure broad access to needed medications and include programs and incentives that improve patient health while keeping costs under control. Managed care pharmacy helps to ensure that those drug benefits are delivered in a safe and cost-effective manner and that patients receive the most appropriate medications.   

Managed care pharmacy professionals — including pharmacists, physicians and nurses — perform many functions. Among other things, they:     

  • Monitor the safety and effectiveness of new drugs on the market;    
  • Alert patients to potentially dangerous drug interactions;    
  • Use medication therapy management practices to ensure patients receive the most appropriate therapies;    
  • Develop and implement programs to improve medication adherence;    
  • Ensure “medical-necessity” guidelines for the pharmacy benefits are consistent with evidence-based medicine and that exceptions are based on sound medical judgment;    
  • Provide ongoing patient education and care coordination of medication therapy; and    
  • Use various evidence-based tools and incentives to keep the costs of prescription drugs under control.   

 All of these practices, and more, aim to ensure that all patients have access to the pharmaceuticals they need and that the medications they take are improving their lives.  AMCP knows that our members have many stories illustrating the positive impact of managed care pharmacy on both communities and individuals.   

Careers for Pharmacists in Managed Health Care Organizations

Managed Care Pharmacy - an overview of managed care pharmacy and the tools it uses

Pharmacists' Patient Care Process 

Managed Care Pharmacy Stories from AMCP Members 

 

 

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