Fellow of the Academy of Managed Care Pharmacy FAMCP Application Packet.Pharmacy Pay-for-Performance Principles.Inflation Reduction Act (IRA) Workshop Series.Diversity, Equity & Inclusion (DEI) Glossary.Student Pharmacist Webinars & Recordings.Managed Care Internships & APPE/IPPE Programs.Roadmap to a Career in Managed Care Pharmacy.Tips on Applying for a Residency or Fellowship.Substance Use Disorder Advisory Group: A Focus on Prescription Drug Use.Biosimilars Operational Readiness Initiative.Addressing Barriers to Value-Based Payment Models in Integrated Delivery Networks Advisory Group.Drug Product Pipeline Portal (Member View).Drug Product Pipeline Portal (Limited View).Medication Use Quality Continuing Education Program.Managed Care Pharmacy PowerPoint Presentations.Jim worked closely with plan finance and actuaries to validate pharmacy spend and utilization trend assumptions during the health plan BID and rate validation processes. Responsibilities included PBM oversight, pharmacy financial forecasting, utilization trend review, P&T meeting presentations, savings initiatives development and member and provider quality outreach programs to improve HEDIS measures and maintain NCQA accreditation. Most recently Jim was Senior Director of Pharmacy for a Managed Care plan serving over 300 thousand Medicaid, ACA Marketplace and Medicare beneficiaries where he was directly responsible for operational, financial and quality oversight of the pharmacy benefit. In past work experience, Jim was instrumental in providing CMS and State Medicaid Agencies guidance on reimbursement policy and payment methodologies including the use of acquisition cost based reimbursement and the 340B program. Jim is a pharmacist with over 15 years’ experience across multiple settings including retail, hospital clinical pharmacy, pharmacy reimbursement analytics and consulting, and pharmacy managed care administration. Describe the challenges of using value frameworks for a health plan’s clinical and actuarial teams.Be familiar with how value frameworks like ICER could be used to augment the current formulary process.Describe the benefit of value frameworks to a health plan’s clinical and actuarial teams.Select relevant AMCP Dossier information for actuarial modeling.Describe the purpose of the AMCP Dossier and the types of information included.At the conclusion of this session, attendees will be able to: There will be focus on what the value frameworks can help with today, and what questions still remain about the utility of the frameworks in the formulary decision making and health plan budgeting process. The intent of this session is to improve actuaries' understanding of valuable information contained in the AMCP Dossier and introduce relevant value frameworks and illustrate how they can help to inform actuaries and payer coverage decisions through value assessment. There are two useful tools that can help stakeholders plan for and manage this increased risk: the Academy of Managed Care (AMCP) Format for Formulary Submissions (known as the AMCP Dossier) and value frameworks. The availability of new drugs at increasing prices have increased pharmacy PMPM cost risk. A significant number of drug approvals have occurred in the past few years.
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