How to Be Pharmacy Benefits Analyst - Job Description, Skills, and Interview Questions

Oct 21, 2020 / 6 Minutes Read / By Albert

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The role of a Pharmacy Benefits Analyst is to analyze and review pharmacy benefit plans, provide cost savings strategies, and manage pharmacy services. This requires a great deal of knowledge of the industry and an understanding of different regulations that apply to pharmacy services. As a result, Pharmacy Benefits Analysts are able to identify cost-saving opportunities, develop strategies to improve the quality of service and patient care, and ensure compliance with health care laws.

they help to minimize the cost of medications, develop new drug utilization policies, and provide education to other healthcare professionals. Pharmacy Benefits Analysts play a vital role in the health care industry, as they are able to provide cost-savings solutions and ensure that patients receive the best possible care.

Steps How to Become

Obtain a Bachelor's Degree. A bachelor's degree in healthcare administration, business, economics, finance, or a related field is typically required to become a pharmacy benefits analyst.
Consider Certification. Some employers may prefer to hire pharmacy benefits analysts who have certification in the field. The National Association of Pharmacy Benefit Management (NAPBM) offers the Certified Pharmacy Benefits Analyst (CPBA) certification.
Gain Relevant Work Experience. Many employers prefer to hire pharmacy benefits analysts who have previous experience in the field. Internships, apprenticeships, and entry-level roles in healthcare administration, benefits management, or insurance are great ways to gain experience.
Stay Up-To-Date on Industry Trends. Pharmacy benefits analysts must stay up-to-date on changing industry trends and regulations. Staying abreast of developments in the field can help you stay competitive in the job market and even advance in your career.
Develop Knowledge of Software. Pharmacy benefits analysts often need to be proficient in software used in the field. Becoming familiar with software programs like Microsoft Excel, Access, and other database software can help you stand out to employers.

Staying competent and updated in the field of Pharmacy Benefits Analyst requires a proactive approach. To maintain a competitive edge, it is essential to continuously stay informed of changes in the industry, such as new legislation, regulatory updates, and emerging trends. staying current with the latest technology and techniques is necessary to ensure accuracy in the analysis of benefits and to stay up-to-date on industry trends.

regularly attending professional development seminars, conferences, and webinars can help Pharmacy Benefits Analysts stay up-to-date on the latest developments in the field. Regularly engaging with peers and colleagues through professional organizations or online forums provides an opportunity for collaboration, networking, and information sharing. Finally, it is important to commit to continuous learning by reading industry journals and publications that provide insight on best practices and other trends.

By taking a proactive approach to staying informed and up-to-date, Pharmacy Benefits Analysts can remain competent and successful in their field.

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Job Description

Develop and analyze pharmacy benefit programs to ensure cost-effectiveness and to maximize value for clients.
Monitor pharmacy benefits programs to identify cost-saving opportunities and areas of potential improvement.
Analyze data to identify trends and areas of inefficiency in pharmacy benefit plans.
Develop and implement strategies to improve the efficiency and cost-effectiveness of pharmacy benefit plans.
Develop reports on pharmacy benefit utilization and performance.
Establish quality assurance processes and procedures to ensure that pharmacy benefit plans meet client requirements.
Monitor changes in regulations, legislation, and industry trends that may affect pharmacy benefits programs.
Work closely with clients to ensure that their pharmacy benefit plans are tailored to meet their specific needs.
Negotiate with vendors and suppliers to obtain the best pricing for clients' pharmacy benefit plans.
Educate clients about their pharmacy benefit plans and provide them with materials to help them make informed decisions.

Skills and Competencies to Have

Knowledge of Pharmacy Benefit Management (PBM) rules, coding, and utilization management
Knowledge of pharmacy benefit plan design and pricing/cost-containment strategies
Ability to interpret and analyze PBM agreements, contracts, and clinical policies
Ability to develop, implement and monitor pharmacy benefit programs
Ability to analyze and interpret pharmacy data such as claims, utilization, and cost trends
Ability to identify and recommend strategies for improvement in pharmacy benefit design, cost containment, and patient care
Knowledge of Medicare Part D, Medicaid and other government payer reimbursement requirements
Knowledge of the Affordable Care Act (ACA) regulations related to pharmacy benefits
Ability to collaborate with pharmacy providers and other stakeholders
Ability to develop reports and provide recommendations on pharmacy benefit trends
Knowledge of pharmaceutical formularies, drug classes, and therapeutic alternatives
Ability to create and manage programs that promote the appropriate use of medications
Knowledge of relevant federal and state regulations concerning pharmacy benefits
Knowledge of pharmacy reimbursement models and techniques
Proficiency with Microsoft Office Suite applications, especially Excel

In order to be successful in a career as a Pharmacy Benefits Analyst, having strong organizational and analytical skills is essential. Being able to effectively organize, analyze, and interpret complex data is crucial for this role. the ability to understand and interpret laws, regulations, and insurance policies is also important.

Furthermore, excellent communication and problem solving skills are needed in order to effectively collaborate with other professionals and provide solutions to challenges. By having these skills, a Pharmacy Benefits Analyst can effectively identify cost savings opportunities, manage pharmacy programs, and ensure the accuracy of claims data.

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Frequent Interview Questions

What experience do you have working with pharmacy benefits programs?
How familiar are you with the regulations and guidelines governing pharmacy benefits?
What challenges have you encountered when developing and managing a pharmacy benefits program?
Describe a pharmacy benefit analysis project you have worked on in the past.
How do you stay up-to-date on the latest pharmacy benefit trends?
What methods do you use to evaluate the effectiveness of new pharmacy benefit programs?
What is your experience with formulary management and preferred drug lists?
How do you handle complex pharmacy benefit claims issues?
What strategies do you use to ensure accuracy and compliance of pharmacy benefits data?
How do you build relationships with key stakeholders, such as providers, insurers, and employers?

Common Tools in Industry

Pharmacy Benefit Manager (PBM). A software system used to manage the cost and coverage of medications. (eg: Express Scripts)
Drug Utilization Review (DUR). A program that evaluates the appropriateness of medication use and identifies potential drug-related problems. (eg: Cerner HealthFacts DUR)
Pharmacy Claims Processor. A software system that processes and adjudicates pharmacy claims. (eg: Infor/Lawson)
Formulary Management Software. Software that allows for the management and analysis of medication formularies. (eg: McKesson Paragon)
Drug Price Comparison Tools. Software that allows for comparison of drug prices from various sources. (eg: GoodRx Price Finder)
Clinical Decision Support Software. Tools that aid clinicians in making the best possible decisions regarding patient care. (eg: UpToDate)
Payment Reconciliation Software. Software used to reconcile payments made to pharmacies. (eg: Change Healthcare Reconciliation Manager)
Pharmacy Benefit Analysis Software. Software used to analyze pharmacy benefit costs and utilization patterns. (eg: MedImpact Insight)

Professional Organizations to Know

Academy of Managed Care Pharmacy
National Association of Chain Drug Stores
National Community Pharmacists Association
National Pharmaceutical Association
American Society of Health-System Pharmacists
American Pharmacists Association
International Society of Pharmacoeconomics and Outcomes Research
American Society of Consultant Pharmacists
National Institute for Pharmaceutical Technology and Education
Health Insurance Association of America

We also have Pharmacy Technician Trainee, Pharmacy Intern, and Pharmacy Data Analyst jobs reports.

Common Important Terms

Pharmacy Benefit Manager (PBM). A third-party administrator of prescription drug programs for commercial health plans, Medicare Part D plans, and other government-sponsored programs. PBMs provide services such as claims processing, formulary management, drug utilization review, and rebate contracting.
Formulary. A list of medications that is approved by a health plan for reimbursement. Pharmacy benefit managers use formularies to control drug costs.
Drug Utilization Review (DUR). A process of evaluating a patients medication use to optimize therapeutic outcomes and prevent potential drug-related problems.
Rebate Contracting. Negotiations between PBMs and drug manufacturers to obtain discounts and rebates on the cost of drugs.
Prescription Drug Program. A program that provides coverage for prescription drugs and other related services.
Pharmacoeconomics. The economic analysis of pharmaceuticals and how they are used in the healthcare system. This includes cost-effectiveness analysis, budget impact analysis, and benefit-risk assessment.

Frequently Asked Questions

What does a Pharmacy Benefits Analyst do?

A Pharmacy Benefits Analyst is responsible for managing and evaluating pharmaceutical benefits plans for employers and insurers. They analyze drug trends and costs, review contracts, recommend strategies to reduce costs, and monitor utilization of prescription medications.

What qualifications are needed to be a Pharmacy Benefits Analyst?

To be a Pharmacy Benefits Analyst, individuals typically need to have a Bachelors degree in pharmacy, health care administration, or a related field. They may also need to have experience working in the pharmacy or insurance field.

What skills are important for a Pharmacy Benefits Analyst?

Pharmacy Benefits Analysts need to have strong analytical and problem-solving skills in order to evaluate and analyze drug trends and costs. They also need to be adept at utilizing various software programs and databases to track utilization and costs of prescription medications.

What are the benefits of being a Pharmacy Benefits Analyst?

Pharmacy Benefits Analysts can enjoy a variety of benefits, including job stability, flexible hours, and the potential for career growth. Additionally, they are able to make an impact on the health care industry by helping to reduce costs and improve outcomes for patients.

How much do Pharmacy Benefits Analysts make?

According to PayScale, the average salary for a Pharmacy Benefits Analyst is $68,660 per year. However, salaries can vary depending on experience and location.