Pharmacy Benefits & PBM Mastery
Pharmacy Benefits & PBM Mastery
Pharmacy Benefits & PBM Mastery is the definitive course for benefits professionals who want to master the most complex and fastest-growing component of employer healthcare costs. Across 16 modules, you will learn how the drug pricing system really works, how PBMs profit at plan sponsors' expense, and how to implement every major pharmacy cost management strategy — from transparent PBM contracting and biosimilar adoption to international drug sourcing and pharmacogenomics. Built for advisors who want to deliver measurable pharmacy savings and build a differentiated advisory practice.
What You Will Learn
Learning objectives for this course.
Who This Course Is For
This course is designed for the following roles.
Course Modules
16 modules · 80 lessons
The US Drug Pricing System: How It Really Works
Decode the opaque drug pricing ecosystem — from manufacturer list prices to what employers actually pay.
5 lessons · 45 min
The PBM Business Model: Revenue Streams and Conflicts
Understand every way PBMs make money — and why most of it comes at the plan's expense.
5 lessons · 45 min
PBM Contract Audit: Finding Hidden Costs
A systematic framework for auditing PBM contracts and quantifying what the plan is actually paying.
5 lessons · 50 min
Transparent PBM Models: Pass-Through and Fiduciary PBMs
Evaluate pass-through and fiduciary PBM models and understand when they deliver real savings.
5 lessons · 45 min
Formulary Design: Driving Clinical and Financial Outcomes
Design formularies that reduce costs without compromising member health outcomes.
5 lessons · 45 min
Specialty Drug Management: The Largest Cost Driver
Master the strategies that control specialty drug spend — the fastest-growing segment of pharmacy costs.
5 lessons · 50 min
Biosimilars: The Biggest Near-Term Savings Opportunity
Capitalize on the biosimilar wave — especially adalimumab biosimilars — to deliver immediate plan savings.
5 lessons · 45 min
GLP-1 Drugs: Managing the Fastest-Growing Pharmacy Cost
Navigate the GLP-1 coverage decision with a framework that balances clinical value and financial sustainability.
5 lessons · 50 min
Mail Order and Specialty Pharmacy Optimization
Maximize savings through mail order mandates, specialty pharmacy networks, and 90-day supply programs.
5 lessons · 45 min
Prior Authorization and Pharmacy Utilization Management
Design a utilization management program that reduces waste without creating barriers to necessary care.
5 lessons · 45 min
Pharmacy Benefit Analytics: Reading Your Pharmacy Data
Interpret pharmacy claims data to identify cost drivers, waste, and intervention opportunities.
5 lessons · 45 min
PBM RFP and Selection: Finding the Right Partner
Run a rigorous PBM RFP process that surfaces true costs and selects the best partner for your client.
5 lessons · 50 min
Drug Coupons and Patient Assistance Programs: Opportunities and Risks
Navigate manufacturer coupons, patient assistance programs, and the copay accumulator controversy.
5 lessons · 45 min
Pharmacy Member Communication: Driving Adherence and Smart Choices
Design member communication programs that improve medication adherence and drive cost-effective pharmacy behavior.
5 lessons · 45 min
The Future of Pharmacy Benefits: Trends and Emerging Strategies
Prepare for the next wave of pharmacy innovation — from cell and gene therapies to AI-driven formulary management.
5 lessons · 45 min
Building a PBM Advisory Practice: Positioning and Pricing
Position yourself as a PBM and pharmacy benefits expert and build a practice that commands premium fees.
5 lessons · 45 min
Earn Your Certificate
Complete all modules, pass the module quizzes, and score 80% or higher on the 50-question final exam to earn your certificate of completion and 5.5 certificate hours.