Pharmacy Students' Views of Managed Care Pharmacy and PBMs: Should There Be More Exposure to Managed Care in the Pharmacy Curriculum?

BACKGROUND: New accreditation standards implemented in 2007 have required schools of pharmacy to evaluate their existing curricula. An issue frequently encountered is the limited amount of content in the pharmacy curriculum specific to managed care and the role and function of pharmacy benefit management companies (PBMs). OBJECTIVES: To determine pharmacy student knowledge and opinions about managed care pharmacy, including the function of PBMs in the delivery of health care, in a college of pharmacy, and to explore tendencies in communication between pharmacy interns and patients in the community setting. METHODS: Students from all 4 PharmD years (n = 663) in 1 college of pharmacy were invited to complete an online survey consisting of 19 questions on demographics, students' views and understanding of PBMs, and interest in working at a PBM in their career. Follow-up in-person and online focus group sessions with representatives from each pharmacy class year were conducted to collect information from students regarding views and understanding of managed care pharmacy. Focus group data were analyzed using a constant comparative method by 2 independent researchers. RESULTS: Of 374 respondents, 332 (88.8%) answered all of the survey questions and were included in the analysis. Most students (72.0%) indicated that they understand little or nothing about the functions of PBMs; 84.3% rated the amount that they had been taught about PBMs in pharmacy school as inadequate or very inadequate; and 45.2% indicated little or no interest in a PBM career. Yet, 34.7% (99 of 285) of students with past or current community pharmacy work experience rated the percentage of time that PBMs directly affected their practice worksite during a shift at 50% or greater. Focus group emerging themes confirmed survey data findings that students feel uninformed about managed care but regularly communicate with patients about managed care issues. Focus group findings also suggest that students may perceive managed care to be a masculine, uncaring field. CONCLUSIONS: In an exploratory survey conducted at 1 pharmacy school, students perceived themselves as generally uninformed about managed care issues, yet more than one-third believed that dealing with PBMs constituted a significant portion of their work day as community-based pharmacy interns. Managed care understanding is necessary for all pharmacy students because most graduates will practice in community settings. Patients are exposed to managed care and their pharmacy benefit primarily at the point of medication procurement and medication counseling. As a result, pharmacists provide many patients with managed care and pharmacy benefit education. Schools of pharmacy may wish to evaluate and consider increasing the amount of curriculum content specific to managed care and PBMs.