How do I get PBM experience?

As a PBM pharmacist, you fill prescriptions on behalf of a pharmacy benefit manager, a person or organization that helps administer a program to deliver prescription pharmaceuticals to a group of people, often employees of a single firm. In this capacity, you may assist in negotiating costs with pharmaceutical producers, assess contracts, and supply medication by mail or by specialized couriers. In certain instances, you may even operate in the same building as your clients; although this is uncommon, several large hospice firms have on-site pharmacy managed by a Hospice PBM. This job title refers to a pharmacist who works for a pharmacy benefit manager and should not be confused with the position of pharmacy benefit manager.

How Do I Obtain Employment as a PBM Pharmacist?

The essential requirements for becoming a PBM pharmacist are a valid pharmacist license and some pharmacy work experience. The prerequisites for obtaining a license vary by state. Still, they often include a bachelor’s degree in a related discipline, completing two tests successfully, and submitting personal information. Many states also provide reciprocity or license transfers, so you may not need to take tests in the state where you intend to work, although it is prudent to confirm this beforehand. A PBM pharmacist’s responsibilities and tasks need attention to detail, communication skills, research abilities, and occasionally the ability to function in an environment with minimal or no patient interaction.

Pharmacy Benefit Managers (PBMs) are businesses that considerably impact how much health plans pay for drugs. PBMs administer prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, major employers, and a variety of other payers. They serve as the intermediary between the direct firms that negotiate pricing, rebates, and reimbursement with drug makers and pharmacies to limit the total amount of money spent on drugs by all parties. Three major PBMs account for around 78 percent of the market: Express Scripts, CVS Caremark, and OptumRx. United Health, Blue Cross Blue Shield, Anthem, and Duane Reade retail are among the most prevalent organizations employing pharmacy benefit managers. Depending on the pharmacist’s job within the PBM, the typical workday for a PBM pharmacist can vary significantly.

For instance, a consultant pharmacist may contact patient daily. Writing prescription reports and discussing them with patients comprises a significant portion of this pharmacist’s daily duties. Some additional pharmacists work in the prior authorization or appeals department, analyzing the whole patient case file to determine if a drug request should be denied or approved based on an ever-changing formulary and set of criteria, as well as consultation with Medical Directors. Some pharmacists provide patients with information regarding drug interactions. Other pharmacists may develop utilization management recommendations, construct and maintain formularies. Develop new drug monographs, participate in pharmacy and therapeutics meetings, or serve in administrative or communication positions.

Qualifications of a PBM Pharmacist

A valid PharmD in the state of licensure is necessary. Or the equivalent of four years of client-facing or account management experience in a healthcare or Pharmacy Benefits Management (PBM) setting. Some employers may require completion of a Managed Care Pharmacy Residency recognized by the American Society of Health-System Pharmacists (ASHP). Some pharmacists have completed board certification and postgraduate year two (PGY2) pharmacy residency training. Comprehensive knowledge of healthcare analytics is desired but not needed. Many pharmacists begin their careers as independent contractors before being hired full-time after a trial. A managed care residency is preferable, but pharmacists can win roles in managed care by displaying a wide understanding of the insurance industry and a talent for numbers, business, and finance.

Compensation of a PBM Pharmacist

The average salary for PBM positions in the United States is $92,240 annually. Depending on their pay grade, pharmacists may be paid hourly or on a salary. PBM occupations range from $58,000, part of the 25th percentile, to $119,500. Near the top of the 75th percentile for base pay in the United States. There are several prospects for promotion depending on skill level and improved compensation based on location and experience. In addition, some pharmacy benefit managers may provide their staff with annual bonuses that are partially dependent on the company’s profitability and partially on the employee’s performance.

Positives and Negatives of Being a PBM Pharmacist

Pros:

• The Pharmaceutical Care Management Association (PCMA) asserts that pharmacist roles have increased and are growing continuously due to the need for PBMs to deliver cost-saving solutions.
• However, job stability is contingent on demand and experience.
• Generally, there is a healthy work-life balance. Monday through Friday consists of eight-hour workdays. Additionally, occasional or alternating weekends may be available.
• Numerous PBM roles are remote, particularly during the pandemic and post-covid eras.
• primarily with other pharmacists, medical directors, and techs

Opportunity to experience a variety of tasks, even within the same organization. The possibility of advancement to subject matter expert, supervisor, manager, and director.

Cons:

• It is feasible but uncommon for Pharmacy Benefits Management professionals to travel up to 25 percent of the time.
• During the first quarter of the year, which is considered a busy season, overtime may be necessary. It may also be required when onboarding new clients or formularies or in other situations requiring “all hands on deck.”
• A particular case rate may be demanded of pharmacists.
• Many pharmacists begin their careers as independent contractors before being employed full-time, which may not appeal to some individuals.

How to Differentiate Yourself as a PBM Pharmacist

Candidate Before beginning their PBM pharmacy careers, several pharmacists have pursued a range of professions. Here are some ways to stand out when applying for PBM jobs:

• Without prior work experience, completing a managed care residency may be the ideal way to begin a career in PBM pharmacy.
• Utilize professional pharmacy groups to build your network. Keep in mind that securing your first PBM position is frequently the most difficult.
• Academy of Managed Care Pharmacy (AMCP) is a valuable organization for meeting new people and gaining new skills; consider joining.
• Participate in workshops and national conventions to learn about various elements of PBMs (e.g., AMCP Nexus).
• Demonstrate your critical thinking, multitasking, time management skills, and ability to adapt and learn new programs quickly.
• Demonstrate your willingness and eagerness to grow in the PBM job, and emphasize your leadership skills.

Develop as much proficiency as possible using Excel functions such as pivot tables, lookups, graphs, and tables.

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