Drug Pricing and Payment Program
Activity Preview
APhA's Drug Pricing and Payment Program is an advanced training program that is designed to provide pharmacists and pharmacy technicians with a better understanding of the complexities, opacities, and eccentricities of drug pricing and payment in the U.S. healthcare system. Comprised of a 17.5 hour webinar series, this activity covers all you need to know from the flow of money through the healthcare system to considerations for contracting.
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Activity Type: Knowledge-based
Target Audience: Pharmacists and pharmacy technicians
Learning Level: Level 1 - No prior knowledge in drug pricing and payment is required.
Initial Release Date: May 2, 2023
Expiration Date: May 2, 2026
Goals and Learning Objectives
- Provide pharmacists and pharmacy technicians with comprehensive knowledge about the drug pricing and payment system in the United States.
- Teach pharmacists and pharmacists nomenclature related to drug pricing and payment as well as how money flows through the system.
- Enhance pharmacists' understanding of PBMs, how they function and practice and alternatives in support of pharmacy reimbursement.
- Introduce concepts related to contracting and considerations for employers
Accreditation Information
The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. The Drug Pricing and Payment program is approved for a total of 17.5 contact hours of continuing pharmacy education (CPE) credit (17.5 CEUs). The ACPE Universal Activity Numbers (UAN) for this activity are listed below.
Learning Objectives, Accreditation Information, Experts and Disclosures
Module 1: Something is Rotten in the State of Denmark
Learning objectives
- Identify key drivers of U.S. Prescription Drug Expenditures
- Compare/contrast U.S. Expenditures with expenditure in other countries
- Describe the role of benefit design in driving expenditures
Approved for 0.5 contact hour (0.05 CEUs) of CPE credit
ACPE UAN(s): 0202-0000-23-220-H04-P/0202-0000-23-221-H04-T
Expert: Antonio Ciaccia
Disclosures: Past consultant: Capital Rx. Current consultant: Mark Cuban Cost Plus Drug Company.
Module 2: The Drug Supply Chain
Learning objectives
- Identify direct and indirect drug supply chain participants
- Describe the role of direct drug supply chain participants
- Discuss the role of indirect drug supply chain participants
Approved for 1 contact hour (0.1 CEUs) of CPE credit
ACPE UAN(s): 0202-0000-23-222-H04-P/0202-0000-23-223-H04-T
Expert: Joey Mattingly, PharmD
Disclosures: Current consultant: PHRMA, Johns Hopkins University, Research grant received: Food and Drug Administration
Module 3: Drug Pricing and Payment Lexicon
Learning objectives
- Describe the most common drug pricing benchmarks
- Discuss the origin and role of most common drug pricing benchmark
- Identify the claim elements necessary to understand total cost of prescription drug
Approved for 2 contact hours (0.2 CEUs) of CPE credit
ACPE UAN(s): 0202-0000-23-224-H04-P/0202-0000-23-225-H04-T
Expert: Benjamin Link, PharmD
Disclosures: Past consultant: Capital Rx. Current consultant: Mark Cuban Cost Plus Drug Company.
Module 4: Follow the Money
Learning objectives
- Identify the role of each drug supply chain participant in setting non-transparent costs
- Review the role of various non-transparent discounts relative to pricing benchmarks
Approved for 2 contact hours (0.2 CEUs) of CPE credit
ACPE UAN(s): 0202-0000-23-226-H04-P/0202-0000-23-227-H04-T
Expert: Benjamin Link, PharmD
Disclosures: Past consultant: Capital Rx. Current consultant: Mark Cuban Cost Plus Drug Company.
Module 5: Why PBMs
Learning objectives
- Describe the origin and role of pharmacy claim transaction and billing standards
- Discuss PBM business functions
Approved for 1 contact hours (0.1 CEUs) of CPE credit
ACPE UAN(s): 0202-0000-23-228-H04-P/0202-0000-23-229-H04-T
Expert: Joshua Golden
Disclosures: Nothing to disclose
Module 6: Large PBMs – A Look Behind the Curtain
Learning objectives
- Describe existing PBM claim processing software functionality
- Discuss existing federal PA requirements within Medicare and Medicaid
- Summarize existing federal provider network requirements within Medicare and Medicaid
- Describe PBM rebate contracting
- Review sample service level agreements (SLAs) from PBMs regarding PBM functions
Approved for 1 contact hours (0.1 CEUs) of CPE credit
ACPE UAN(s): 0202-0000-23-230-H04-P/0202-0000-23-231-H04-T
Expert: Benjamin Link, PharmD
Disclosures: Past consultant: Capital Rx. Current consultant: Mark Cuban Cost Plus Drug Company.
Module 7: PBM Disruptors
Learning objectives
- Identify what PBM functionality is being affected by PBM disruptors
- Discuss new incentives that are created by PBM disruption
Approved for 1.5 contact hours (0.15 CEUs) of CPE credit
ACPE UAN(s): 0202-0000-23-232-H04-P/0202-0000-23-233-H04-T
Expert: Antonio Ciaccia
Disclosures: Past consultant: Capital Rx. Current consultant: Mark Cuban Cost Plus Drug Company.
Module 8: PBM Pricing
Learning objectives
- Compare and contrast PBM drug reimbursement to other commodity markets (i.e. oil)
- Describe the PBM MAC rate setting process
- Discuss the PBM effective rate setting process
Approved for 2 contact hours (0.2 CEUs) of CPE credit
ACPE UAN(s): 0202-0000-23-234-H04-P/0202-0000-23-235-H04-T
Expert: Matt Gibbs
Disclosures: Nothing to disclose
Module 9: Pharmacy Drug Pricing
Learning objectives
- Describe pharmacy usual & customary (U&C) price setting process
- Summarize the impact of PBM reimbursement practices on pharmacy U&C prices
Approved for 0.5 contact hour (0.05 CEUs) of CPE credit
ACPE UAN(s): 0202-0000-23-236-H04-P/0202-0000-23-237-H04-T
Expert: Benjamin Link, PharmD
Disclosures: Past consultant: Capital Rx. Current consultant: Mark Cuban Cost Plus Drug Company.
Module 10: Drug Discount Programs
Learning objectives
- Describe business operations of top drug discount card programs
- Discuss drug manufacturer coupon programs
- Identify copayment accumulators and maximizers impact of pharmacy benefits
Approved for 1 contact hour (0.1 CEUs) of CPE credit
ACPE UAN(s): 0202-0000-23-238-H04-P/0202-0000-23-239-H04-T
Expert: Erin L. Albert, PharmD, MBA, JD
Disclosures: Current Employment: Mark Cuban Cost Plus Drug Company, PBC
Module 11: Impact on Payers
Learning objectives
- Discuss the impact of drug supply chain payments on benefit design structure of pharmacy benefits
- Identify barriers to changes within current model
Approved for 0.5 contact hour (0.05 CEUs) of CPE credit
ACPE UAN(s): 0202-0000-23-240-H04-P/0202-0000-23-241-H04-T
Expert: Benjamin Link, PharmD
Disclosures: Past consultant: Capital Rx. Current consultant: Mark Cuban Cost Plus Drug Company.
Module 12: The Role of Pharmacy Services Administrative Organizations (PSAOs)
Learning objectives
- Identify PSAO service offerings
- Summarize the role of PSAOs in “true up” of pharmacy claim payments
Approved for 1 contact hour (0.1 CEUs) of CPE credit
ACPE UAN(s): 0202-0000-23-242-H04-P/0202-0000-23-243-H04-T
Expert: Scott Pace, PharmD
Disclosures: Current consultant: Healthcare Distribution Alliance
Module 13: Contracting Considerations for Employers
Learning objectives
- Describe the role of benefit brokers within PBM contracting
- Discuss contracting provision standards with PBMs
- Summarize PBM contracting mechanisms (request for proposals, reverse auction, etc.).
Approved for 1.5 contact hour (0.15 CEUs) of CPE credit
ACPE UAN(s): 0202-0000-23-244-H04-P/0202-0000-23-245-H04-T
Expert: Dae Y Lee, PharmD, Esq, CPBS
Disclosures: Nothing to disclose
Module 14: PBM Contracting Considerations for Employers
Learning objectives
- Discuss PBM incentives within contracting with employer groups
- Summarize how properly designed incentives can drive outcomes
- Identify best practices in PBM contracting
Approved for 1.5 contact hour (0.15 CEUs) of CPE credit
ACPE UAN(s): 0202-0000-23-246-H04-P/0202-0000-23-247-H04-T
Expert: Benjamin Link, PharmD
Disclosures: Past consultant: Capital Rx. Current consultant: Mark Cuban Cost Plus Drug Company.
To obtain 17.5 contact hours of CPE credit (1.75 CEUs) for APhA's Drug Pricing and Payment advanced training program, the learner must successfully complete all components listed above, and CLAIM credit for each component. Learners will need to have a valid APhA (pharmacist.com) username and password, as well as a CPE Monitor account to claim credit. After credit has been claimed, please visit CPE monitor for your transcript. The Certificate of Completion will be available online upon successful completion of the necessary activity requirements on the learner’s My Training page on www.pharmacist.com.
APhA's continuing pharmacy education policy provides you with two opportunities to successfully complete the continuing pharmacy education assessment. Please note that you will not be permitted to submit the assessment a third time. The current policy of the APhA Education Department is not to release the correct answers to any of our CPE tests. This policy is intended to maintain the integrity of the CPE activity and the assessment.
Acknowledgements
Advisory Board
- Antonio Ciaccia
President, 3 Axis Advisors
CEO and co-founder of 46Brooklyn Research
- Benjamin Link, PharmD
Vice President of Pharmacy, 3 Axis Advisors
President of 46Brooklyn Research
APhA Staff Members
- Katie Meyer, PharmD, BCPS, BCGP
Director, Content Creation
- Misty Knack
Associate Director, Advanced Training
System Requirements
Computer and Internet access is required to complete this activity. Please visit our website to view the Technology System Requirements to have a positive learning experience.