Managed Care Pharmacy Resident Q&A

Have you ever wondered what opportunities exist for pharmacists in managed care organizations?

Have you ever wondered what opportunities exist for pharmacists in managed care organizations?

To find out, I spoke with Alex Wiggall, PharmD, a managed care pharmacy resident at Horizon Blue Cross Blue Shield (BCBS) of New Jersey in Newark.

Dr. Wiggall grew up in the Philadelphia area before graduating with his Doctor of Pharmacy degree from University of Maryland School of Pharmacy. After completing his residency, he hopes to find a job at a health plan in the New York City area.

Q: Why did you decide to pursue a managed care residency?

AW: Having been exposed to multiple areas of pharmacy, I realized that managed care was a way to be involved in all of the areas of health care that interested me at once with some great perks, such as a flexible schedule and better work-life balance. Additionally, managed care allows me to expand my role as a pharmacist in patient care from individual patients to large populations.

Q: What is the structure of your residency?

AW: Similar to many managed care residencies, Horizon BCBS is unaccredited with the American Society of Health-System Pharmacists (ASHP), though the program has been around for 20 years. The main difference is that the residency program isn’t rotation-based like accredited residencies.

That said, I work in many different areas of managed care at once. Some of the main ongoing projects I work on include the pharmacy and therapeutics (P&T) committee, monograph presentations, medication therapy management (MTM), clinical programs, answering drug information questions, pharmacy student precepting, a longitudinal research project, and writing medical policies.

P&T meetings meet quarterly, and I along with the other residents evaluate all of the newly FDA-approved drugs that come onto the market. In doing so, I write a drug monograph that is intended to review the drug based on its clinical trials, potential place in therapy, patient outcomes, and many other factors. As a resident, I present our formulary recommendation to the P&T committee.

MTM is a service we provide to certain Medicare Part D members, based on the number of disease states and medications the patient has. I spend time speaking with the member and going through his or her medications, providing counseling, and identifying issues or gaps in care. Then, I provide recommendations to the physician, if needed. This helps keeps our members healthy and allows for effective patient interaction.

Precepting pharmacy students is another valuable component of my residency that I find very rewarding. As a resident, I work with students from Rutgers University on working up members for MTM services, journal club evaluations, weekly presentations, a final case presentation, and demonstrating the pharmacist’s role in managed care.

Although it takes some time to get up to speed, the residency schedule accommodates time for training. It can definitely be hectic trying to balance many different projects and responsibilities at once, but this is more in line with a post-residency work environment, and it helps develop prioritizing and time management skills.

Q: What are your day-to-day tasks?

AW: Every day can be vastly different. Some days are tied up in meetings with specialty pharmacies, pharmacy benefit managers (PBMs), or clinical presentations from pharmaceutical companies. Other days are spent clinically reviewing patient cases for drug approval.

Sometimes, there might be more time to work on larger projects, such as writing monographs for P&T meetings, medical policies, or coordination of community outreach events. Regardless, each day usually involves going over patients with my student, MTM, and balancing time between projects and meetings.

Q: How did you decide that your residency program was the right fit for you?

AW: Fortunately, I had the opportunity to intern where I am currently completing my residency as a pharmacy student, so I had some insight. I knew it would be a great fit because the residents get to work in many areas of managed care with an extremely dedicated clinical team.

One of the main criteria I looked for in a residency program was the ability to focus in many areas as opposed to programs that are focused in one area, such as a residency for a Medicaid plan or a PBM. Although working for a PBM would be similar to a health plan, it doesn’t focus on the whole picture of how pharmacy and medical management is intertwined. Working in government programs is great, too, but I wanted to experience working on a commercial plan since it is regulated very differently.

One of the best aspects of my residency is having the opportunity to work with so many great pharmacists who all specialize in different areas of managed care. Ultimately, a residency should prepare you to be well rounded and have many potential career paths after finishing the program.

Q: What career opportunities does a pharmacy resident have after completing a managed care program?

AW: There are a lot of opportunities within managed care. These include working for a health plan in specialty management or commercial lines of business, or working in government programs such as Medicare and Medicaid.

You can also work for a PBM that does many of the same types of work that is done at a health plan, but is more focused on drug rebates, prior authorizations, and pharmacy cost. Pharmaceutical companies also employ former managed care residents for business insight and other clinically focused positions.

Q: What advice do you have for students looking to pursue a residency in managed care?

AW: Become involved in the Academy of Managed Care Pharmacy, seek out opportunities for internships or rotations in managed care, and do research in a relevant area of pharmacy such as health outcomes. For me, there was limited exposure to managed care in pharmacy school, so seeking out your own opportunities and asking pharmacists you know in the field is necessary to get an idea of whether you think it’s a good fit for you.

Look for programs that interest you and give you experience in multiple areas so your options aren’t limited after leaving the program.

Lastly, don’t be worried about whether a program is unaccredited by ASHP, unless it has lost its accreditation. Many programs choose to stay unaccredited, as the rotation-based environment doesn’t always fit the managed care work environment like it does for other types of residencies.