What Is Managed Care Pharmacy?
The information on this pages gives a broad overview of what managed care pharmacy is and the tools we use. Other resources that may be useful are our "What Is Managed Care Pharmacy?" webinar and Managed Care Glossary.
Managed Care Pharmacy Primer Series
What Is Managed Care Pharmacy?
The managed care pharmacy practice applies clinical and scientific evidence to support the appropriate use of medications to enhance patient and population health outcomes while optimizing the use of limited healthcare resources.
Managed care pharmacy professionals develop strategies for patients, health plans, and providers across five key areas:
Pharmacy Benefit Design & Implementation
- Ensuring access by defining where care is available.
- Determining which treatments are covered based on individual and population needs.
Formulary and Medication Utilization Management
- Identifying which medications to include in the formulary.
- Introducing and applying new and existing drug management strategies and tools.
- Tracking new and developing medications.
Clinical Programs
- Managing coordinated care programs.
- Conducting drug utilization reviews.
- Implementing initiatives to address health disparities.
- Completing medication therapy management.
Quality & Safety Program Management
- Assessing and reporting on quality measures.
- Reporting Medicare Part-D “star rating” measures.
- Managing drug shortage & safety programs.
Promoting Affordability
- Reducing risk for individuals, employers, and other public payers by managing overall cost.
- Protecting against misuse, overuse, and fraud.
- Promoting value-based care.
