The Role of Pharmacy Benefit Managers in Population Health

Module Description

Sky rocketing drug prices are in the news. Clinicians are increasingly confronted with the clinical aspects of prescribing complex drug regimens for patients at the same time they need to navigate the administrative aspects of prior authorization, step therapy, and prohibitively high cost drugs. This module provides an overview of the pharmacy supply chain and the role of pharmacy benefit managers (PBMs) in clinical care. The module explores insights and strategies for effectively working with PBMs to enhance access to appropriate drug therapy and improve care outcomes.

Intended Audience

This course is designed for physicians as well as nurse practitioners, physician assistants, and allied health professionals who are working toward population health management, especially in safety-net settings.

Duration and Fee

Estimated Time to Complete: 1 hour

Registration Fee: $20

CME Credits

This Enduring Material activity, Population Health in the Safety Net, has been reviewed and is acceptable for up to 12.00 Prescribed credit(s) by the American Academy of Family Physicians. AAFP certification begins 10/01/2018. Term of approval is for one year from this date. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


Prior to joining HMA, Anne Winter served as senior director of Medicaid for CVS Caremark where she focused on ensuring Caremark’s ongoing regulatory compliance with state and federal laws, regulations and policies. Anne now brings her extensive expertise to this presentation to explain the relationship between payers, pharmacy benefits managers, and providers.  As drug therapy becomes increasingly complex and drug cost growth continues to accelerate, health systems will need to address pharmacy benefit management more aggressively.  This module will equip clinicians in leading efforts to manage pharmacy benefits.

Anne Winter discloses that she is an employee of Health Management Associates, a national research and consulting firm providing technical assistance to a diverse group of healthcare clients.

Learning Objectives

At the completion of the course, attendees will be able to:

  • Describe the role of pharmacy benefit managers (PBMs) in the pharmacy supply chain
  • Describe the key functions of PBMs
  • Compare and contrast key differences on how pharmacy is managed and regulated in government programs versus commercial and self-insured payers
  • Describe how PBMs and/or payers may interact with prescribers and impact clinical care
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