Key takeaways

PBMs and PBM pharmacists aim to improve patient outcomes while minimizing costs, involving roles such as developing prescription benefit plans, handling prior authorizations, and driving clinical programs.
PBM pharmacists typically work in office or call center environments, focusing on tasks like medication therapy management, drug utilization reviews, and negotiating drug prices and rebates.
Becoming a PBM pharmacist requires a Pharm.D. degree, an active pharmacist license, and preferably experience in managed care pharmacy, which can be gained through internships or specialized training.
Pros of being a PBM pharmacist include flexible schedules, work-life balance, and the ability to impact healthcare indirectly, while cons include limited direct patient interaction and extensive desk work.

Working for a pharmacy benefit manager (PBM) is one of the many paths you can take as a pharmacist. With links to almost every aspect of the pharmacy marketplace, PBMs play a central role in balancing optimal outcomes and costs for health insurance plans, pharmaceutical manufacturers, and pharmacies. PBMs manage the prescription drug benefits provided by health plans, employers, Medicare Part D, Medicaid drug plans, and other organizations. In turn, PBMs help patients access the medications they need.

If you’re interested in improving patient outcomes with pharmacy marketplace economics in mind, becoming a PBM pharmacist may be right for you. PBM pharmacists are on the front end of managing and auditing prescription benefit plans and are a valuable asset to improving medication access.

What is a PBM pharmacist?

The primary objective of PBMs and PBM pharmacists is to help improve patient outcomes while driving lower costs. PBM companies can have several different departments that handle different aspects of drug cost control. As a result, a PBM pharmacist can have different roles and responsibilities depending on their work environment.

PBM pharmacists develop prescription benefit plans, adjudicate prescription drug claims, and handle prior authorizations. They might be a part of a Pharmacy and Therapeutics (P&T) Committee that develops, curates, and implements a formulary or preferred drug list. PBM pharmacists also drive clinical programs, such as step therapy programs, medication therapy management, and mail order services. PBM pharmacists may use their research skills to evaluate clinical trials and studies on the most cost-effective medications. Some PBM pharmacists may consult with healthcare providers and patients on low-cost therapeutic alternatives and direct patients to adhere to specific medications before trying more expensive options.

Unlike other pharmacists, PBM pharmacists generally work in an office or call center. They often work at a desk, handling and processing prior authorizations, medication therapy management programs, among other duties. Many PBM pharmacists work in a mail-order pharmacy, performing drug utilization reviews (DURs), verifying prescriptions, and overseeing an automated dispensing process.

In general, the duties of PBM pharmacists include:

Performing utilization management, medication therapy management, and medication reconciliation
Negotiating drug prices, rebates, and reimbursement with drug manufacturers
Adjudicating insurance claims through detailed review and approving or denying drug coverage
Managing formularies and determining copays
Analyzing clinical data and educating clients, patients, or providers on cost-effective medications
Acting as clinical pharmacists that prepare therapeutic reviews for doctors and healthcare providers
Making drug therapy recommendations based on disease management protocols and evidence-based guidelines
Developing or maintaining quality assurance (QA), and fraud, waste, or abuse programs

How to become a PBM pharmacist

Becoming a PBM pharmacist entails several requirements. PBM work is not as common as retail or hospital pharmacy work, so it’s best to prepare for a career in PBM as soon as you develop an interest in it.

Get a Pharm.D. degree

Most PBM pharmacist positions require a Pharm.D. degree earned from an accredited college of pharmacy. Getting a Pharm.D. degree usually takes around six to eight years after completing high school. The length of time it takes to receive a doctorate degree in pharmacy varies based on the pharmacy school program and whether you opt to get a bachelor’s degree before entering pharmacy school.

Become licensed as a pharmacist

Having an active unrestricted license is a requirement to be a PBM pharmacist. You should be licensed according to the licensure requirements of the state you want to work in. Initial licensure requires that you pass the North American Pharmacist Licensure Examination (NAPLEX) and the Multistate Pharmacy Jurisprudence Examination (MPJE).

Gain work experience or complete specialized training

Many PBM pharmacist positions strongly prefer experience in managed care pharmacy. This type of experience can be acquired through an internship in pharmacy school, contract work with a PBM company, or completion of managed care residency training. Some PBMs will hire pharmacists with experience in a hospital, community, or long-term care setting, as many companies prefer that you have some patient care experience.

Pros and cons of PBM pharmacist jobs

There are different pros and cons of being a PBM pharmacist that can vary depending on the role and location of the job. According to an APhA Career Pathway Evaluation Program survey, around 83% of PBM pharmacists are somewhat or extremely satisfied with their jobs.

Pros of PBM pharmacist jobs

Flexible schedules: Some PBM pharmacists work Monday through Friday for around eight hours per day, although many are able to make their own hours. Some PBM pharmacists may work every other weekend or no weekends at all. They may also have the option to work remotely.
Work-life balance: PBM pharmacists have a work schedule that allows them to have more leisure time rather than having to work rotating or unpredictable schedules in a community or hospital pharmacy.
Ability to use clinical knowledge: Pharmacists who work at PBMs are able to use their clinical skills to evaluate studies and make recommendations on cost-effective drugs. They also use their analytical skills to find cost-saving measures for health insurance companies and patients.
Make an impact in health care: PBM pharmacists have an indirect impact on patient outcomes because they generally don’t follow patient care plans as closely as pharmacists in a hospital or community setting. However, PBM pharmacists can help improve patient access to medications and make therapeutic recommendations to prescribers.

Cons of PBM pharmacist jobs

No direct patient or provider contact: Most PBM pharmacists don’t directly interact with patients or providers in person. They also don’t follow patients closely or develop a close clinical relationship with patients. Pharmacists who prefer to directly interact with patients or providers in a community or hospital setting may find PBM work less appealing.
Long hours at a desk: Many PBM pharmacists work at a desk for the majority of their day. Pharmacists who prefer to be on their feet and moving may find this part of the job less desirable. However, some PBM pharmacists may travel to interact with clients.
A lot of administrative work: PBM pharmacists typically have to deal with paperwork and administrative tasks, such as answering emails and creating reports.

How to stand out as a PBM pharmacist

Whether you’re looking for your first PBM job or looking to make a transition to another PBM, you’ll want to make sure you’re a strong candidate for the job. You can stand out as a potential PBM pharmacist in a number of ways.

Complete residency training

One way to stand out as a PBM pharmacist candidate is to complete an ASHP-accredited residency in managed care. Some residency programs may last one to two years. Completing a postgraduate year one (PGY1) or year two (PGY2) pharmacy residency can help boost your qualifications when applying for PBM jobs.

Networking

Building a professional pharmacy network is one of the key ways to break into any career in pharmacy. Connect with PBM pharmacists during pharmacy school by choosing PBM rotations or searching for PBM internships. You can also reach out to PBM pharmacists through sites like LinkedIn or in-person pharmacy conventions.

Develop and showcase your skills

PBM pharmacists have several skills under their belt, including analytical, critical thinking, and clinical skills. Having strong communication and leadership skills, as well as an eagerness and aptitude to learn, can help make you a strong PBM pharmacist. You should also be proficient in Excel and PowerPoint functions as PBM pharmacists need to have strong data analytical skills. Showing that you have an interest or proficiency in pharmacoeconomics and the overall business of health systems can help round out your PBM job application.

Join professional organizations

Think about joining pharmacy organizations that are involved with PBM programs. Professional pharmacy organizations include the Academy of Managed Care Pharmacy (AMCP). You can also follow news and updates from the Pharmaceutical Care Management Association (PCMA), a national association representing PBMs.