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 how PBMs make money and why their revenue model creates conflicts with employer interests.
5 lessons · 50 min
PBM Contract Audit: Finding Hidden Costs
Conduct a systematic PBM contract audit to identify hidden costs, contract violations, and savings opportunities.
5 lessons · 50 min
Transparent PBM Models: Pass-Through and Fiduciary PBMs
Evaluate transparent and fiduciary PBM models that align incentives with employer interests.
5 lessons · 50 min
Formulary Design: Driving Clinical and Financial Outcomes
Design a formulary that promotes evidence-based prescribing, drives generic utilization, and manages specialty drug costs.
5 lessons · 50 min
Specialty Drug Management: The Largest Cost Driver
Master the strategies for managing specialty drug costs — the fastest-growing and most expensive component of the pharmacy benefit.
5 lessons · 50 min
Biosimilars: The Biggest Near-Term Savings Opportunity
Capture the significant savings available from biosimilar adoption — the most actionable near-term pharmacy cost management opportunity.
5 lessons · 50 min
GLP-1 Drugs: Managing the Fastest-Growing Pharmacy Cost
Develop a comprehensive GLP-1 coverage and management strategy that balances access with cost sustainability.
5 lessons · 50 min
Mail Order and Specialty Pharmacy Optimization
Optimize mail order and specialty pharmacy programs to reduce costs and improve medication adherence.
5 lessons · 50 min
Prior Authorization and Pharmacy Utilization Management
Design and manage pharmacy prior authorization and utilization management programs that balance cost control with appropriate access.
5 lessons · 50 min
Pharmacy Benefit Analytics: Reading Your Pharmacy Data
Use pharmacy claims data to identify cost drivers, measure program effectiveness, and drive cost management decisions.
5 lessons · 50 min
PBM RFP and Selection: Finding the Right Partner
Conduct a rigorous PBM RFP process that identifies the best partner for your plan's specific needs.
5 lessons · 50 min
Drug Coupons and Patient Assistance Programs: Opportunities and Risks
Navigate the complex landscape of manufacturer drug coupons and patient assistance programs — and their impact on plan costs.
5 lessons · 50 min
Pharmacy Member Communication: Driving Adherence and Smart Choices
Design pharmacy member communication programs that improve adherence, drive generic utilization, and reduce costs.
5 lessons · 50 min
The Future of Pharmacy Benefits: Trends and Emerging Strategies
Understand the macro trends reshaping pharmacy benefits and position your practice for the opportunities ahead.
5 lessons · 50 min
Building a PBM Advisory Practice: Positioning and Pricing
Build a differentiated PBM advisory practice that commands premium fees and delivers measurable client value.
5 lessons · 50 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 13.0 certificate hours.