What Do PBM Pharmacists Do?
Since pharmacy benefit manager jobs are relatively rare, most pharmacists don't know what it's like to work for one.
The majority of pharmacists practice in either a retail pharmacy or a hospital setting, according to the US Bureau of Labor Statistics. Since pharmacy benefit manager (PBM) jobs are relatively rare, most pharmacists don’t know what it’s like to work for one.
In a 2013 American Pharmacists Association survey, pharmacists employed by PBMs found the following job aspects most appealing: client interaction, constantly changing issues and challenges, flexible schedule, researching and evaluating clinical studies and peer-reviewed literature, and the opportunity to change pharmacy to a provider profession.
These same PBM pharmacists found the following job aspects least appealing: sitting at a desk for 8 to 10 hours a day and day-to-day functions such as answering emails, statistics, and paper work. Another frequent concern that these pharmacists had was a lack of direct patient contact.
In my experience, this is the best-known aspect of PBM jobs. Many employers require their employees to use mandatory 90-day mail-order services for their chronic medications. Mail-order pharmacies account for about 19% of the total outpatient prescriptions filled in the United States.
Mail-order pharmacists typically work in large centers and translate scanned pictures of prescriptions into the ordering system. These prescriptions are then filled by automated dispensing systems. Mail-order pharmacists perform drug utilization review (DUR) and call prescribers to clarify prescriptions.
In my opinion, one of the hardest things about filling mail-order prescriptions is the lack of context. You are filling a prescription that was written by a prescriber you don’t know for a patient you’ve never met.
Pharmacists working in a call center perform a variety of functions such as calling prescribers, medication therapy management (MTM), disease management programs, and patient consultation. Call centers also handle and process prior authorization requests.
A number of PBM pharmacist positions are performed in an office setting. Here is a brief list of possible roles:
- Formulary management
- DUR (prospective, concurrent, retrospective)
- Drug information
- Fraud and abuse programs
- Utilization management (prior authorization, step therapy, limits, post-limits)
- Quality assurance
Client support/account management
These pharmacists work directly with clients to discuss client plan benefit design (formulary, utilization management, etc). They allow their clients to customize clinical and reporting requirements to meet their individual population needs and assess the appropriateness of new medications.
This role may require frequent travel in order to meet with clients and attend business meetings.
1. Channel Distribution by U.S. Dispensed Prescriptions. IMS Health, February 23, 2012.
2. Roles of Pharmacists in Managed Health Care Organizations. Academy of Managed Care Pharmacy.