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Drug Pricing and Payment Program

Drug Pricing and Payment Program

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.

Pricing

Member Price: $149
Nonmember Price: $249

If your company or organization is interested in offering this program to your pharmacists or student pharmacists, please contact Chris McKerrow.

Learning Objectives & Module Details

This course contains the following contents:

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Drug Pricing and Payment Program Description
Something is Rotten in the State of Denmark Slides, Activity, and Assessment
The Drug Supply Chain Slides, Activity, and Assessment
Follow the Money Slides, Activity, and Assessment
Why PBMs Slides, Activity, and Assessment
Large PBMs Slides, Activity, and Assessment
PBM Disruptors Slides, Activity, and Assessment
PBM Pricing Slides, Activity, and Assessment
Pharmacy Discount Pricing Slides, Activity, and Assessment
Impact on Payers Slides, Activity, and Assessment
The Role of Pharmacy Service Administration Organizations Slides, Activity, and Assessment
Contract Considerations for Employers Slides, Activity, and Assessment
PBM Contracting Considerations for Employers Slides, Activity, and Assessment
Drug Pricing and Payment Certificate of Achievement

Module 1: Something is Rotten in the State of Denmark

At the completion of this Knowledge-Based activity, participants will be able to:

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 expenditure

Module 2: The Drug Supply Chain

At the completion of this Knowledge-Based activity, participants will be able to:

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

Module 3: Drug Pricing and Payment Lexicon

At the completion of this Knowledge-Based activity, participants will be able to:

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

Module 4: Follow the Money

At the completion of this Knowledge-Based activity, participants will be able to:

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

Module 5: Why PBMs

At the completion of this Knowledge-Based activity, participants will be able to:

Describe the origin and role of pharmacy claim transaction and billing standards
Discuss PBM business functions

Module 6: Large PBMs – A Look Behind the Curtain

At the completion of this Knowledge-Based activity, participants will be able to:

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

Module 7: PBM Disruptors

At the completion of this Knowledge-Based activity, participants will be able to:

Identify what PBM functionality is being affected by PBM disruptors
Discuss new incentives that are created by PBM disruption

Module 8: PBM Pricing

At the completion of this Knowledge-Based activity, participants will be able to:

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

Module 9: Pharmacy Drug Pricing

At the completion of this Knowledge-Based activity, participants will be able to:

Describe pharmacy usual & customary (U&C) price setting process
Summarize the impact of PBM reimbursement practices on pharmacy U&C prices

Module 10: Drug Discount Programs

At the completion of this Knowledge-Based activity, participants will be able to:

Describe business operations of top drug discount card programs
Discuss drug manufacturer coupon programs
Identify copayment accumulators and maximizers impact of pharmacy benefits

Module 11: Impact on Payers

At the completion of this Knowledge-Based activity, participants will be able to:

Discuss the impact of drug supply chain payments on benefit design structure of pharmacy benefits
Identify barriers to changes within current model

Module 12: The Role of Pharmacy Services Administrative Organizations (PSAOs)

At the completion of this Knowledge-Based activity, participants will be able to:

Identify PSAO service offerings
Summarize the role of PSAOs in “true up” of pharmacy claim payments

Module 13: Contracting Considerations for Employers

At the completion of this Knowledge-Based activity, participants will be able to:

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.)

Module 14: PBM Contracting Considerations for Employers

At the completion of this Knowledge-Based activity, participants will be able to:

Discuss PBM incentives within contracting with employer groups
Summarize how properly designed incentives can drive outcomes
Identify best practices in PBM contracting

How to Obtain a Certificate of Completion

Complete 14 self-study modules, each of which consists of an interactive eLearning module, an assessment, and a module evaluation.
Achieve a passing grade of 70% or higher on each module assessment.
Credit must be claimed for each module to obtain credit.
Participants 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 all 14 module activities on the participant's My Training page.
APhA continuing pharmacy education policy provides you with two opportunities to successfully complete a continuing pharmacy education assessment. Please note that you will not be permitted to submit an 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 is intended to maintain the integrity of the CPE activity and the assessment.

Accreditation Information

ACPE logo

The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. APhA's Drug Pricing and Payment Program is approved for a total of 17.5 contact hours of continuing pharmacy education (CPE) credit (1.75 CEUs). The ACPE Universal Activity Numbers (UAN) for individual activities are listed below.

Module 1: Something is Rotten in the State of Denmark is approved for 0.5 hour (0.5 CEU) of CPE credit. ACPE UAN 0202-0000-23-220-H04-P/0202-0000-23-221-H04-T
Module 2: The Drug Supply Chain is approved for 1.0 hour (0.1 CEU) of CPE credit. ACPE UAN(s): 0202-0000-23-222-H04-P/0202-0000-23-223-H04-T
Module 3: Drug Pricing and Payment Lexicon is approved for 2.0 hours (0.2 CEU) of CPE credit. ACPE UAN(s): 0202-0000-23-224-H04-P/0202-0000-23-225-H04-T
Module 4: Follow the Money is approved for 2.0 hours (0.2 CEU) of CPE credit. ACPE UAN(s): 0202-0000-23-226-H04-P/0202-0000-23-227-H04-T
Module 5: Why PBMs is approved for 1.0 hour (0.1 CEU) of CPE credit. ACPE UAN(s): 0202-0000-23-228-H04-P/0202-0000-23-229-H04-T
Module 6: Large PBMs – A Look Behind the Curtain is approved for 1.0 hour (0.1 CEU) of CPE credit. ACPE UAN(s): 0202-0000-23-230-H04-P/0202-0000-23-231-H04-T
Module 7: PBM Disruptors is approved for 1.5 hours (0.15 CEU) of CPE credit. ACPE UAN(s): 0202-0000-23-232-H04-P/0202-0000-23-233-H04-T
Module 8: PBM Pricing is approved for 2.0 hours (0.2 CEU) of CPE credit. ACPE UAN(s): 0202-0000-23-234-H04-P/0202-0000-23-235-H04-T
Module 9: Pharmacy Drug Pricing is approved for 0.5 hour (0.05 CEU) of CPE credit. ACPE UAN(s): 0202-0000-23-236-H04-P/0202-0000-23-237-H04-T
Module 10: Drug Discount Programs is approved for 1.0 hour (0.1 CEU) of CPE credit. ACPE UAN(s): 0202-0000-23-238-H04-P/0202-0000-23-239-H04-T
Module 11: Impact on Payers is approved for 0.5 hour (0.05 CEU) of CPE credit. ACPE UAN(s): 0202-0000-23-240-H04-P/0202-0000-23-241-H04-T
Module 12: The Role of Pharmacy Services Administrative Organizations (PSAOs) is approved for 1.0 hour (0.1 CEU) of CPE credit. ACPE UAN(s): 0202-0000-23-242-H04-P/0202-0000-23-243-H04-T
Module 13: Contracting Considerations for Employers is approved for 1.5 hours (0.15 CEU) of CPE credit. ACPE UAN(s): 0202-0000-23-244-H04-P/0202-0000-23-245-H04-T
Module 14: PBM Contracting Considerations for Employers is approved for 1.5 hours (0.15 CEU) of CPE credit. ACPE UAN(s): 0202-0000-23-246-H04-P/0202-0000-23-247-H04-T
Target Audience: Pharmacists and Pharmacy Technicians
Release Date: May 2, 2023
Expiration Date: May 2, 2026 - PLEASE NOTE: NO Home Study credit granted after this date.

Technology Requirements and Tips

Computer and Internet access are required to complete this activity. If you experience technical difficulties, try a different web browser.

Please be aware that if the system detects no activity for an extended amount of time while the screen is open in the interactive activity, the Next button may freeze, and you will need to Restart that activity again.

The recommendation is that if you cannot complete the activity within one sitting and need to step away, close the activity so that your place is bookmarked.

If you continue to experience difficulties, please reach out to education@aphanet.org with the name of course, details of your experience, which web browser(s) used and if possible, screenshots.

Faculty

Erin L. Albert, MBA, PharmD, JD, DASPL

Vice President, Pharmacy Relations & Chief Privacy Officer
Mark Cuban Cost Plus Drug Company, PBC
Dallas, TX

Disclosure: Current Employment: Mark Cuban Cost Plus Drug Company, PBC

Antonio Ciaccia, RPh

Chief Executive Officer
46brooklyn Research
Dayton, OH

Disclosures: Past consultant: Capital Rx; Current consultant: Mark Cuban Cost Plus Drug Company, PBC

Matt Gibbs, PharmD

Pharmacy Transformation Leader
Blue Shield of California
Chicago, IL

Disclosure: Author has nothing to disclose

Joshua Golden

Senior Vice President of Strategy
Capital Rx
Atlanta, GA

Disclosure: Author has nothing to disclose

Dae Y. Lee, PharmD, Esq, CPBS

Partner
Frier Levitt
Fort Lee, NJ

Disclosure: Author has nothing to disclose

Benjamin Link, PharmD

President
46brooklyn Research
Columbus, OH

Disclosures: Past consultant: Capital Rx; Current consultant: Mark Cuban Cost Plus Drug Company, PBC

Joey Mattingly, PharmD

Associate Professor & Vice Chair of Research
University of Utah College of Pharmacy
Salt Lake City, UT

Disclosures: Current consultant: PHRMA, Johns Hopkins University; Research grant received: Food and Drug Administration

Scott Pace, PharmD, JD

Co-Owner
Kavanaugh Pharmacy
Little Rock, AR

Disclosures: Current consultant: Healthcare Distribution Alliance

Development

Drug Pricing and Payment Program was developed by the American Pharmacists Association. Copyright © 2023 by the American Pharmacists Association.

APhA's Education staff involved in the review of this content declare no conflict of interest or financial interest in any product or service mentioned, including grants, employment, gifts, stock holdings, and honoraria. For a full listing of APhA Staff Disclosures, please see the APhA Disclosure Statement webpage at APhA Staff Disclosures.

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