Pharmacy Benefits & PBM

You manage the formulary: drug tier placement (generic, preferred brand, non-preferred, specialty), prior authorization criteria for non-formulary and high-cost drugs, step therapy protocols (try this cheaper drug first), quantity limits, and clinical exceptions. Prospective DUR runs at point of sale: checking for drug-drug interactions, therapeutic duplication, age/gender contraindications, and dose limits. Retrospective DUR analyzes utilization patterns across the population. P&T committee governance drives formulary decisions. Biosimilar management and specialty drug pipeline monitoring are increasing areas of focus.