Pharmacy Technician, Pharmacy Benefits Management

CVS Health

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Individual state requirements may vary. Please contact your local apprenticeship office to ensure this version is suitable to your state’s requirements.

Work Process Schedule

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On the Job Training

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Skills

Pharmacy Benefit Management (PBM) Structure and Organization

The apprentice demonstrates an appropriate working knowledge and understanding of the pharmacy benefit manager, its role and organization: a. Understand the organization of the PBM b. Understand the relationships and duties of the pharmacists, technicians and support personnel c. Understand the relationships and supervisory structure of the PBM d. Understand how to comply with PBM guidelines and work place ethics e. Maintain patient and client confidentiality and explain the implications of any violation

PBM Structure and Operations

The apprentice demonstrates an appropriate knowledge and understanding of the duties and responsibilities of his/her position including standards of ethics governing practice a. Understand how to comply with federal, state, and local laws related to pharmacy benefits management b. Understand the primary job responsibilities and duties of the pharmacist c. Understand the primary job responsibilities and duties of the technician d. Understand the relationship of the duties between the pharmacist and the technician e. Understand the relationships of the pharmacy benefit manager including pharmacist with doctor, patient and technician, and technician with pharmacist, doctor and patient f. Differentiate clearly when "a decision requiring a pharmacist's judgment" is needed g. Communicate accurately, efficiently, and appropriately with patients and medical personnel on the telephone h. Communicate clearly in writing i. Demonstrate basic computer and keyboarding skills and the ability to learn PBM software

Technical Vocabulary

The apprentice demonstrates an appropriate knowledge and understanding of pharmaceuticalmedical terms, abbreviations, and symbols commonly used in the administration of pharmacy benefits a. Identify and classify drugs correctly b. Abbreviate and spell medical and pharmaceutical terms accurately c. Demonstrate a working knowledge of researching information regarding medications

Knowledge of Drugs and Medications

The apprentice demonstrates a working knowledge of drugs and drug classes evaluated in the prior authorization and appeals processes. a. Demonstrate a working knowledge of the top drugs requiring prior authorization b. Differentiate accurately between generic and brand name drugs

Computation Skills

The apprentice demonstrates the ability to carry out the calculations required for accurately identifying insurance parameters for medications. a. Translate between the apothecary, metric and household measurements accurately b. Demonstrate a working knowledge of addition, subtraction, multiplication and division in the metric and apothecary systems c. Calculate billing prices accurately using test claim functions

Drug Dosage, Administration, and Forms

The apprentice demonstrates a working knowledge of drug dosages, rules of administration and dosage forms as necessary for understanding and researching insurance plan adjudication a. Identify standard drug dosages for various drug classes b. Recognize various forms of drugs differentiated in adjudication including tablets, capsules, solutions, suspensions, ointments, powders, injections, and suppositories c. Recognize the rationales for drug use in prior authorization criteria, including preventive, curative, restorative and limiting disease processes d. Recognize the relationships between patient variables and drug therapy e. Understand how to explain the various routes of administration including oral, sublingual, buccal, inhalation, and rectal f. Demonstrate a working knowledge of needle and syringe sizes and uses

Prescription Research

The apprentice demonstrates the ability to perform the manipulative and record-keeping functions associated with initiating and working prior authorizations and appeals. a. Demonstrate proficiency in accessing and maintaining records electronically b. Demonstrate satisfactory customer skills such as the ability to listen and interpret internal and external customers’ needs c. Communicate accurately with customers and demonstrate empathy

Workplace Behaviors

The apprentice must demonstrate workplace behaviors that contribute to his/her success and that of the PBM. a. Apply classroom instruction to PBM operations b. Demonstrate an ability to learn and apply new concepts c. Take initiative in seeking to contribute to the work of the PBM and increase his/her learning opportunities d. Exhibit quality meeting minimum expectations e. Produce quantity of work meeting minimum expectations f. Maintain his/her schedule in timely manner g. Demonstrate good communication skills h. Demonstrate good judgment i. Exhibit a positive and cooperative attitude

Related Instruction Outline

Pharmacy Technician, Pharmacy Benefits Management

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