Working for an insurance company

[JWells488]

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After shadowing a couple of pharmacists over the summer, I've noticed something in common between them all. They all report back to or get told what to do by insurance companies. A pharmacist knows whats best for a patient and can have some input on the decision, but it's the insurance company who has the ultimate control here. But there's the issue of how insurance companies determine if a patient can get a medication. They certainly have to employ some hybrid creature that is a drug expert and a businessman (or business woman for the feminists) to do cost-benefit analysis.

So I started researching PBMs (pharmacy benefit managers) like Express Scripts and Humana. But I'm not sure this is exactly what I am interested in. What are pharmacists who work for insurance companies called? and where can I read more about this? Would this be considered industry pharmacy? This really looks what I want to get involved in. Thanks in advance for the info.

 

[pinkyrx]

I think they're called "managed care pharmacists". Check out this link:
http://www.amcp.org/home

 

[rxdotty]

Actually, PBM companies have different names for pharmacist roles, not just one type of pharmacist. I actually work for a PBM on the east coast and they have many different pharmacist functions. The function I'm designated is called a Drug Utilization Review pharmacist where I look at DURs pretty much all day and then if there's any discrepencies about dosing, directions, drug interactions, I make calls to the office to discuss it. In addition to doing DUR, they train us in a specialized area of medicine which might include diabetes, cardiovascular, oncology, HIV, etc. so you are a specialist pharmacist in that area.

In other departments of the company, there are managed care pharmacists that call or fax md offices and ask to switch drugs to another drug in the same class that is cheaper both for the pt and the PBM. Others areas also include formulary pharmacists, clinical pharmacists, and even verification pharmacists (they pretty much verify drugs going out of the facility).

However, I think PBMs are always worth researching and who knows, if you definitely know retail is not what you want, PBMs is definitely an option. You do have a much better quality of life but remember the income is a bit lower as well. It's a bit of a trade-off...

 

[unknown82]

Actually, PBM companies have different names for pharmacist roles, not just one type of pharmacist. I actually work for a PBM on the east coast and they have many different pharmacist functions. The function I'm designated is called a Drug Utilization Review pharmacist where I look at DURs pretty much all day and then if there's any discrepencies about dosing, directions, drug interactions, I make calls to the office to discuss it. In addition to doing DUR, they train us in a specialized area of medicine which might include diabetes, cardiovascular, oncology, HIV, etc. so you are a specialist pharmacist in that area.

In other departments of the company, there are managed care pharmacists that call or fax md offices and ask to switch drugs to another drug in the same class that is cheaper both for the pt and the PBM. Others areas also include formulary pharmacists, clinical pharmacists, and even verification pharmacists (they pretty much verify drugs going out of the facility).

However, I think PBMs are always worth researching and who knows, if you definitely know retail is not what you want, PBMs is definitely an option. You do have a much better quality of life but remember the income is a bit lower as well. It's a bit of a trade-off...

Would Medco be considered a PBM? Also, the company you work for do they have call centers where pharmacists counsel patients and talk to doctors all day like Medco does?

Also, has anyone worked or is currently working at a Medco like call center? How is it like? I am currently looking at working at Humana, Medco, or Express scripts.

Thanks

 

[Allure]

If I want to do an elective rotation in Ohio or Arizona, where do I begin? What are some companies that take students?

 

[Hpower12]

I had my drug info rotation at an insurance company. Two different pharmacists were my preceptors. Not sure exactly what they do but basically come up with the formulary and whats covered and what not. Like they had me make spreadsheets with drugs, MOA, SE, and cost. I really wanted to work there but they had no openings, it was in a really nice office building, chill atmosphere, and I got the idea they made really good money.