Managed Care/Payor

Managed care/payer pharmacists work in managed care, insurance, or pharmacy benefit management (PBM) organizations, focusing on formulary management, prior authorizations, utilization review, and cost-effective medication access. They apply clinical expertise to evaluate therapies, develop coverage policies, and support value-based care decisions. These roles offer the opportunity to influence medication use on a population level, improve affordability, and shape the intersection of pharmacy and health care policy.