The New Medicaid Managed Care Rule: Implications for Pharmacy Programs

ACPE UAN #:  0233-0000-16-062-H04-P 

Release Date:  October 5, 2016

Expiration Date:  October 5, 2019

Activity Type:    Knowledge-based

Contact Hours:  1.5

Activity Fee:  Member:  Free        Non-Member: $30

Target Audience: Pharmacists who practice in managed care settings.

Activity Overview

In late April 2016, the Centers for Medicare & Medicaid Services (CMS) issued a major final rule that represents the first overhaul of Medicaid managed care regulations since 2002. Although the new rule does not focus on pharmacy specifically, many of the changes and requirements will affect state Medicaid pharmacy programs in important ways. Do you know everything you should about the provisions of this final rule, and how to comply? For example, do recent communications from CMS signal a new alignment of formulary strategies among a state’s pharmacy benefit programs?

This session will provide practical perspectives on the Medicaid managed care final rule from multiple vantage points. In addition to learning about the new requirements, you will discover emerging trends and opportunities for clinical and business collaboration.

Learning Objectives:  

At the completion of this activity, participants should be able to:

  1. Describe the scope and penetration of the current managed Medicaid market.
  2. Explain the sections of the new CMS rule on managed Medicaid and their implications for managed care pharmacy.
  3. List various options managed care plans may exercise to comply with the new rule.
  4. Discuss possible changes to the managed care pharmacy market as a result of the new rule.

Schedule of Educational Activity

This activity consists of an audio recording, pre-test assessment questions (not required to pass or continue), post-test questions (required to pass with a score of 70% or higher) and a specific activity evaluation. 

CPE Requirements:   

Participants should claim continuing pharmacy education (CPE) credit for this home study activity only if they have not claimed credit for the live activity presented at AMCP Nexus 2016.  CPE credit will be processed through the AMCP Learn portal and reported directly to CPE Monitor.  Please allow 72 hours for processing and posting in your NABP account.

To receive credit for an online activity you must:

  • Review the full content of the activity.
  • Successfully complete the post-test (required to pass with a score of 70% or higher, it may be taken a maximum of three times).
  • Complete a specific activity evaluation.

System Technical Requirements/Viewing Requirements: System Requirements Courses and learning activities are delivered via your Web browser and Acrobat PDF. For all activities you should have a basic comfort level using a computer and navigating web sites.  View the minimum technical and system requirements for continuing education online learning activities.

As an accredited provider, AMCP strictly adheres to the ACPE Standards for Commercial Support and other relevant guidelines and standards to ensure the independence of continuing pharmacy education (CPE) activities.  It is AMCP’s intent that all CPE activities be independent, objective, balanced, evidence-based and free of any commercial bias.

Brian Mischel, RPh, MBA
Director, Medicaid Innovation
Express Scripts
St. Louis, Missouri

Credit Information

Activity Number Credit Amount Accreditation Period
ACPE UAN #0233-0000-16-062-H04-P 1.5 Contact Hours October 05, 2016 - October 05, 2019