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First Managed Care Pharmacy Course at the University of Illinois at Chicago

In spring 1997, in response to student demands for more curricular involvement in managed care pharmacy, Professor J. Warren Salmon, Ph.D., launched the first elective course devoted entirely to managed care at the University of Illinois at Chicago (UIC). This three-hour spring elective for second- and third-year Pharm.D. students ran for 14 weeks and awarded three hours of credit.

The course was a logical follow-up to aspects of managed care that students were learning in other coursework in the required Pharmacy Administration course sequence. The managed care emphasis was a direct result of Dr. Salmon's leadership as department head.

In both freshman Roles and Environments and third-year Services and Reimbursements courses, students heard lectures from managed care pharmacists explaining topics of policy and practical relevance. A previous elective course in Pharmaceutical Marketing, initially taught by Joann Stubbings, a pharmaceutical industry consultant, was picked up by new adjunct faculty members Lionel Graveline, Kathleen Olsen, and Bruce Trebbin, all local practicing managed care pharmacists.

The structure of the course consisted of presentations by outside experts, supplemented by numerous journal and news articles, as well as the Foundation of Managed Care Pharmacy's (FMCP) book, The Pharmacist Guide: The Principles and Practices of Managed Care Pharmacy. The emphasis on managed care in the curriculum got students enthused about beginning the first AMCP student chapter at UIC, specifically a group of 50-60 students who had been sufficiently introduced to the concepts and principles of managed care pharmacy to join AMCP and who seek to specialize in this area of pharmacy practice. The course was, of course, situated in the context of the AMCP student chapter activities and finished up with most students heading down to New Orleans for the AMCP annual meeting.

As with the UIC Managed Care Pharmacy Residency Program and other activities, the course benefited greatly from the multiple contributions of national and local AMCP members who have formed personal relationships with some of our students and have presented phenomenal substance in their classroom presentations and informal chats. The Diplomats, a group of professional ambassadors organized by the AMCP Schools of Pharmacy Relations Committee, should be thoroughly utilized as a resource by other academics seeking to introduce more managed care content into the curriculum. These dedicated professionals were an endless source of enthusiasm and support. They brought up-to-the-minute techniques and practices to the students-all on a volunteer basis. As their compensation, the AMCP representatives took away a wealth of satisfaction from their encounters with our students. We know they thought it was well worth the effort.

A few observations about the UIC students are warranted. As mentioned above, most knew the fundamentals of managed care pharmacy, so they were open to consideration of career paths in this specialty. Most students, however, did not have much exposure to the breadth of managed care activities. By course's end, it was apparent from student self-evaluations that the additional opportunities for learning and the insights gained had strengthened their interest in managed care.

As is often the case, participants would have appreciated more class time devoted to exploring the details of the mammoth number of readings and would have benefited from lengthier classroom discussions. Those sessions where they broke into teams to discuss issues and come up with solutions to real-world problems were rated very highly by students, who also appreciated hearing how presenters' own careers developed. Students were interested in the opportunities available to pharmacists in managed care organizations, pharmacy benefit management firms (PBMs), and pharmaceutical companies.

Since our College of Pharmacy has not offered much course content about the subject of pharmacoeconomics, a course presented by two people trained in this discipline was of special interest to many students.

Two trips to local pharmaceutical manufacturers-Abbott Laboratories and Amersham Health Care-were very meaningful and very much enjoyed. The staffs at these two firms went out of their way to respond to the interests and concerns of all the students. Both companies, we think, recognized the good will engendered among these future pharmacy leaders. That good will is likely to pay many dividends in years to come. Historically, certain manufacturers have reached out to Colleges of Pharmacy, and the UIC activities have been enhanced greatly by interpersonal and financial assistance from the managed care divisions within several pharmaceutical firms.

The guest presenters were all personal friends of Dr. Salmon. When asking each person to take time out of his or her busy schedule to prepare for a two- or three-hour class, he knew ahead of time there would be willingness, enthusiasm, and quality preparation. He probably did not realize how well almost all would relate to these second- and third-year students. Again, for other academics contemplating such courses and/or lectures for pharmacy students, local Diplomats and other AMCP members find significant enjoyment in such exchanges and easily justify such use of their time.

Students had three weeks to complete an ambitious and challenging final examination, part of the method for evaluating the students. Each student was asked to write a six- to eight-page self-evaluation, along several criteria, of his or her efforts and learning in the course. It is often said that pharmacy students do not get opportunities to learn how to communicate, but these students prepared res-ponses that reflected their high level of motivation and their appreciation of the benefits from the course. Students were required to write three or four key learnings from each class session. These key learnings were important in our own assessment of just how much learning took place.

The last element of the final examination required the students to critique the FMCP book. This publication, now three years old, was prepared as a textbook for students and other newcomers to the field. Dr. Arthur Shinn is currently chairing an AMCP Special Projects Committee gathering feedback for a possible revision of the textbook. When it was first published, the FMCP book filled a real need, and it continues to do so. The field, however, is changing rapidly, and some aspects of the book are now outdated. Our students' critiques have been relayed to the committee. Our collective views on what constitutes a primer in managed care pharmacy are expanding exponentially. Students took the time to consider each chapter and relayed what they would like to see in a revision, based on all the input they received from individuals in the field and what they have absorbed at various AMCP meetings.

In addition to updated information, the book was found to need additional chapters on ethical issues in managed care, drug policy development, and PBM firms (an example of the rapid change in just the last three years).

One element missing from the UIC course, according to students, was the lack of opportunity to travel to a real-life PBM setting. This fall, Jay Messeroff, senior vice president of Caremark, has invited our AMCP student chapter to visit Caremark's facilities in Deerfield, Illinois. Students want to cultivate increased interaction with pharmaceutical industry representatives.

UIC currently lacks sufficient clinical and administrative research rotations for fourth-year pharmacy students to gain practical experience in managed care organizations and the pharmaceutical industry. This is mostly because our emphasis in the past has been on clinical specialty preparation. Given student pressures, faculty are working to remedy this situation so that students have a chance to put into practice much of what they have learned in this managed care pharmacy course. The course conducted last spring resulted in numerous avenues opening up for 19 students who are planning careers in the managed care and pharmaceutical industries. This Managed Care Pharmacy elective became a success, not only because of the high motivation levels of all the students but also because several AMCP members graciously gave of their time and talents to aid the students' in-depth learning.

J. Warren Salmon, Ph.D.
Professor of Pharmacy
Administration

Swu-Jane Lin, MPH
Graduate Teaching Assistant and Doctoral Student
in Pharmacy Administration
University of Illinois at Chicago