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Pharmacists do not just work in the neighborhood retail pharmacy. In addition to retail pharmacy and hospital settings, the insurance industry also offers job opportunities for pharmacists. Insurance carriers may offer prescription plans to their members or contract with a pharmacy benefit management company (PBM) to provide and manage prescription benefit plans. Pharmacists play several roles in a variety of settings within the insurance company and in the PBM. Education and experience requirements for these positions include a PharmD degree, a current state license and experience in the managed care industry.
Mail Order Pharmacist
One job in the insurance industry for pharmacists is the mail order pharmacy manager. This role may be within a telephonic call center environment, in an office or medication fulfillment center or on-call off-site as needed. The pharmacist is responsible for assisting insurance plan members/patients who have technical questions about their medications such as side effects, content, dosage and mixing medications. The mail order pharmacy manager may also consult with patients’ doctors as needed and document all assistance and interventions completed. As the expert on medications, the pharmacist answers technical questions about prescriptions. According to a survey of pharmacists completed by "Drug Topics" magazine, the average annual salary for a mail order pharmacist was $101,500 in 2007.
Clinical Pharmacy Program Manager
Clinical pharmacy program managers may work for the health plan or PBM in the insurance industry. Pharmacists in this role provide leadership and supervision to the clinical team that manages the prescription benefits. Clinical program managers oversee the mail order prescription team and assure that they meet compliance standards by overseeing frequent audits of these programs. They review claims reports for trends and issues, analyze drug pricing, note major claims costs, review system data for accuracy and develop plans to improve the quality of the mail order and pharmacy programs. Lastly, they may review specific cases involving high costs and make clinical recommendations on medications. According to a survey completed by pharmacists for "Drug Topics" magazine, the average annual salary for a managed care pharmacist was $114,067 in 2007.
Many insurance and health management companies offer disease management programs for their members. The goal of these programs is to help their members better understand and manage their conditions by facilitating education between health professionals and the members. The insurance plan analyzes medical and pharmacy paid claims data to identify those who may benefit from disease management services. Pharmacists and clinicians create algorithms used for this identification. Pharmacy informatics is a specialty field that combines technology with clinical medication and cost knowledge. The pharmacist in informatics has a great understanding of how to analyze medication trends and costs to identify and help patients with specific diseases and improve their medical outcomes. According to a survey in 2008 by the Healthcare Information and Management Systems, the average annual salary for a pharmacist in the informatics field is $109,329.
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