Rotation 8: Managed Care – Health Alliance Plan of Michigan, Detroit, MI

Posted by Jennifer at Tuesday, April 29, 2014

For this rotation, I was able to see a different aspect of a pharmacy at Health Alliance Plan of Michigan (HAP).  HAP is a not-for-profit health plan that provides health coverage for patients, either individually or through their employer.  HAP is also related to the Henry Ford Health System. 

Certain pharmacists at HAP are assigned to analyze medication requests that come into a computer queue.  Some medications require a prior authorization.  This means that some drugs are flagged for the pharmacist to review the medication for appropriateness for the specific patient before HAP will provide coverage.  HAP has a formulary with criteria for eligibility usage for specific drugs that is based upon evidence based medicine, and this is one resource that assists the pharmacists in determining whether or not a prior authorization should be approved.  Prior authorizations help to mitigate inappropriate use of medications to make sure that the safest and most cost effective therapy is used.

Generally during the day I would work on projects.  These projects mainly involved assembling detailed documents for new medications to be reviewed by the Pharmacy and Therapeutics Committee.  The purpose of the review was to help the P&T Committee to determine whether to add the drug as formulary or non-formulary and to decide if there should be specific criteria that must be met in order for HAP to approve the use of a drug for a patient.

I also discussed prior authorization cases with the pharmacists and participated in determining whether to approve or deny a request based upon the formulary as well as research that I sometimes needed to conduct. Throughout the day, sometimes I assisted the pharmacists in answering drug questions, which required me to complete research regarding specific prior authorization cases that the pharmacists were working on.  For example, sometimes a medication was requested for an off-label use, so I would look for any research supporting the off-label use.

I enjoyed seeing the role of pharmacists in the managed care setting.  Pharmacists in this area encounter a wide variety of medications and need a solid overall drug knowledge base.  I enjoyed working with all of the pharmacists at HAP and am very glad to have had this experience!