CANDIDATE HANDBOOK Pharmacy Benefit Management … 2019 Candidate Handbo… · The Pharmacy Benefit...

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MARCH 4, 2019

CANDIDATE HANDBOOK Pharmacy Benefit Management Technician

Certification Program ni

© 2019 Distance Learning Network, Inc. All Rights Reserved

ContentsCANDIDATE HANDBOOK ......................................................................................................................................... 3

DISTANCE LEARNING NETWORK, INC. ..................................................................................................................... 3

MISSION AND PURPOSE ......................................................................................................................................... 4

OUR LEADERS ........................................................................................................................................................ 5

PHARMACY BENEFIT MANAGEMENT TECHNICIAN CERTIFICATION PROGRAM BOARD OF DIRECTORS ......................................... 5

CODE OF CONDUCT ................................................................................................................................................ 6

NON‐DISCRIMINATION POLICY ............................................................................................................................... 7

MAKING A REPORT OR COMPLAINT OF DISCRIMINATION ................................................................................... 8

PBMCT EXAMINATION ELIGIBILITY REQUIREMENTS ............................................................................................... 9

CRITERIA .............................................................................................................................................................. 9 REQUIREMENTS ....................................................................................................................................................... 9

EXAMINATION FEES ............................................................................................................................................... 9

CANDIDATE APPLICATION .................................................................................................................................... 10

APPLICANT CERTIFICATION AGREEMENT .............................................................................................................. 19

EXAMINATION LOCATIONS ................................................................................................................................... 20

ACCOMMODATION POLICY AND PROCEDURE ....................................................................................................... 21

APPLICABILITY OF POLICY: .................................................................................................................................. 21 REASONABLE ACCOMMODATION INCLUDES: .................................................................................................... 21 REQUESTING A REASONABLE ACCOMMODATION ............................................................................................. 21 DEFINITIONS ...................................................................................................................................................... 22

Disability: .................................................................................................................................................... 22 Reasonable Accommodation: ..................................................................................................................... 22

PREPARING FOR THE PBMCT EXAMINATION ........................................................................................................ 23

FORMAT ............................................................................................................................................................ 23 SAMPLE QUESTIONS .......................................................................................................................................... 26

EXAMINATION DAY .............................................................................................................................................. 28

THE CANDIDATE BRINGS WITH THEM THE FOLLOWING ITEMS: .......................................................................................... 28 EXAMINATION CONDUCT .................................................................................................................................. 29

RESULTS AND SCORE REPORTS ............................................................................................................................. 29

SCORING ............................................................................................................................................................ 29 SCORE REPORT ...................................................................................................................................................... 30

RESCHEDULING OR RETAKING AN EXAMINATION ................................................................................................. 31

RESCHEDULING ...................................................................................................................................................... 31 RETAKING AN EXAMINATION ............................................................................................................................... 31

APPEAL PROCESS FOR ADVERSE DECISIONS .......................................................................................................... 33

© 2019 Distance Learning Network, Inc. All Rights Reserved

OVERVIEW ......................................................................................................................................................... 33 REQUEST FOR RECONSIDERATION ..................................................................................................................... 33 REVIEW BY THE BOARD ...................................................................................................................................... 34 NOTIFICATION OF DECISION .............................................................................................................................. 34

APPROPRIATE USE OF THE PBMCT CREDENTIAL.................................................................................................... 35

CERTIFICATION PERIOD ........................................................................................................................................ 35

RECERTIFICATION ................................................................................................................................................ 36

REQUIREMENTS ..................................................................................................................................................... 36 RATIONALE ........................................................................................................................................................... 36 CEU RECORD MAINTENANCE ................................................................................................................................... 36 RECERTIFICATION APPLICATION ................................................................................................................................. 37 RECERTIFICATION NOTIFICATION AND AUDITING ........................................................................................................... 37 EXPIRED CERTIFICATION ........................................................................................................................................... 37

PBMCT DIRECTORY .............................................................................................................................................. 38

DISCIPLINARY POLICY ........................................................................................................................................... 39

CAUSES FOR DISCIPLINARY ACTION ............................................................................................................................ 39 VIOLATION REPORTS ............................................................................................................................................... 39 VIOLATION REVIEW ................................................................................................................................................ 39 DISCIPLINARY ACTIONS ............................................................................................................................................ 40

WEBSITE ‐ APPLICANT, CANDIDATE AND CERTIFICANT INFORMATION SECURITY .................................................. 40

PERSONAL INFORMATION ........................................................................................................................................ 40 INFORMATION DISCLOSURE ...................................................................................................................................... 40 PERSONAL INFORMATION COLLECTED......................................................................................................................... 40

Cookies and Tracking.................................................................................................................................. 40 CORRECTION, UPDATING, AND REMOVAL OF PERSONAL INFORMATION ............................................................................ 41 PAYMENT CARD INDUSTRY DATA SECURITY STANDARD (PCI DSS) ................................................................................... 41 CHANGE NOTIFICATIONS .......................................................................................................................................... 41

RECORDS RETENTION POLICY ............................................................................................................................... 42

DATA STORAGE ...................................................................................................................................................... 42 DATA RETENTION ................................................................................................................................................... 42

PBMCT.COM TERMS AND CONDITIONS ................................................................................................................ 42

CHANGE OF ADDRESS OR NAME .......................................................................................................................... 43

COMPLAINTS ....................................................................................................................................................... 43

V1.5 Updated 01/08/2019

© 2019 Distance Learning Network, Inc. All Rights Reserved 3

CANDIDATE HANDBOOK This handbook contains complete information about the Pharmacy Benefit Management Technician Certification Program’s Policies and Procedures as they apply to applicants, candidate and certificants, as well as information about applying for, obtaining and maintaining the credential of PBMCT. Applicants, candidates and certificants are expected to have knowledge of, and abide by, the information contained herein.

DISTANCE LEARNING NETWORK, INC. Distance Learning Network, Inc. (DLN) is a business unit of UnitedHealth Group, Inc. committed to offering products and services that promote the quality and safety provided by health care teams worldwide. The Pharmacy Benefit Management Technician Certification Program assesses the abilities of individuals performing the role of PBM technician and confers the designation of PBMCT to those candidates that demonstrate competency in the role by passing the PMBCT Examination.


MISSION AND PURPOSE The primary purpose of the Pharmacy Benefit Management Technician Certification Program (Program) is to evaluate the competency of individuals who provide Pharmacy Benefit Management (PBM) technician services and to confer the credential Pharmacy Benefit Management Certified Technician (PBMCT) to individuals that possess the knowledge, skills, and abilities necessary to provide safe, efficient, and effective PBM technician services for U.S. based prescription drug programs or integrated healthcare systems. In fulfilling this mission, the Program serves PBM employers, individuals seeking employment at these organizations and the general public. The designation of PBMCT provides employers with increased confidence in the competency of certified technicians. The Program also provides a manner in which individuals can demonstrate and receive third party attestation of their competency - thereby increasing their value within the PBM industry. The Program serves the public by validating the competency of PBM technicians that it may encounter when seeking or receiving prescription drug services. By developing a credential specific to the PBM industry, the Program aims to raise awareness of the importance of technicians and their specific skills within the PBM industry. Finally, the Certification Program provides PBMCTs with recertification requirements that provide some structure to their continuing education and professional development.


OUR LEADERS

PHARMACY BENEFIT MANAGEMENT TECHNICIAN CERTIFICATION PROGRAM BOARD OF DIRECTORS

Gary Aaront, Director, Expert Global Solutions

Vickie Chandler, Quality/Training Coordinator, University of Oklahoma

Sherri Cohmer, BS, MBA, Vice President, OptumRx

Darcil Gangoo, MS, Business Process Analyst, UnitedHealthcare

Heidi Leenay, BA, Vice President, Distance Learning Network, Inc.

Jane Lutz, Executive Director, Pharmacy Benefit Management Institute (PBMI)

Jamie Nash, PharmD, Associate Dean, Regis University

Danette Nix, Public Member

Dianna Hyunh, RPH, Pharmacist, Alorica

Justin DeCleene, PBMCT, Quality Specialist, Cigna


CODE OF CONDUCT The PBMCT Code of Conduct highlights the behaviors expected of each participant and to help ensure Program members always strive to do the right thing in their day-to-day activities and long-term decision-making. Every individual certified as a PBMCT and all individuals seeking certification (applicants and candidates) are expected to act with integrity. Acting with integrity begins with understanding and abiding by applicable laws and regulations as well as Program policies and procedures. The Program’s Board has adopted this Code of Conduct in order to officially recognize the expectations of all Program participants. Since the Code of Conduct cannot address every situation an individual may encounter, it is intended to provide a framework of shared values within the Pharmacy Benefit Management (PBM) profession. The Code of Conduct is grounded in fundamental principles including acting responsibly and in an ethical manner. The responsibility of each individual is to aspire to the highest possible standards of conduct and to encourage ethical behavior in all those with whom they work. The Program relies on the applicant’s, candidates and certificant’s, good judgment and values to uphold the spirit and intent of the Code of Conduct. Each individual must comply with this Code of Conduct. Violating this Code of Conduct, Program policies or procedures, or laws and regulations not only has potential legal and regulatory consequences, but also compromises the Program’s reputation. Unethical or illegal acts can never be justified. Violation of this Code of Conduct may result in action by the Board, including, but not limited to, revocation of credential. As an applicant, candidate or certificant you must:

Hold yourself accountable for your decisions and actions Act with integrity Recognize and address conflicts of interest Comply with all informational requests by the Program or its Board of Directors Act responsibility Comply with all Program policies and procedures Comply with all applicable local, State and Federal laws and regulations Report misconduct or unethical behavior


NON‐DISCRIMINATION POLICY The Pharmacy Benefit Management Technician Certification Program (Program) prohibits any kind of improper or illegal discrimination. This policy explains discrimination and what you should do if you feel you are being discriminated against. The Program will not discriminate against any individual based on age, race, gender, color, religion, national origin, ancestry, disability, marital status, covered veteran status, sexual orientation, gender identity and/or expression, genetic information, status with respect to public assistance or any other characteristic protected by state, Federal, or local law. The Program is committed to affirmative action with respect to gender, race, covered veteran status, and disability in its credentialing practices and our employment practices. This policy applies to all applicants, candidates, certificants, Members of the Board of Directors (Board), committee members, volunteers, vendors, consultants and employees of the Program. Discrimination happens when you feel you are treated differently because of your race, sex, religion, national origin, age or other reason protected by the state or Federal government. A complaint of discrimination could happen if you believe you are being treated unfairly because of any of the following demographics:

age ancestry color covered veteran status gender gender identity and/or expression genetic information handicap/disability marital status national origin race religion sexual orientation status with respect to public assistance


MAKING A REPORT OR COMPLAINT OF DISCRIMINATION If you experience or witness any incident or behavior that you believe is discriminatory, you should report that incident or behavior by completing the Discrimination Complaint Form located on the Program’s website at https://pbmct.com/non-discrimination and sending it to the Chair of the PMBCT Board of Directors via confidential Fax at +1 866-354-8687. Alternatively, you can mail the form to the PMB Technician Certification Program at: Distance Learning Network, Inc. 11000 Optum Circle MN101-W800 Eden Prairie, MN 55344 USA


PBMCT EXAMINATION ELIGIBILITY REQUIREMENTS

CRITERIA Applicants are required to meet the following criteria in order to qualify as a candidate for the PBMCT Examination Candidates must: Have a high school diploma or equivalent educational recognition (i.e. GED, foreign diploma) Be at least 18 years of age Have a minimum of 80 hours of work experience in the PBM field -or- 6 months of experience

working in a healthcare or pharmacy related field

REQUIREMENTS To become certified as a PBMCT, Candidates must: Meet the eligibility requirements Submit a completed application including the Applicant Certification Agreement Pay the application fee Agree to comply with all PBM Certified Technician Program’s policies and procedures and

the Program’s Code of Conduct Pass the PBMCT Examination

EXAMINATION FEES Application and Examination $125 Re-Testing Fee $125 Re-Certification Fee $80 Note: Failure to appear for an examination at the scheduled time will result in a forfeiture of fees and a re-testing fee will be applied in order to reschedule another examination.


CANDIDATE APPLICATION Following are detailed, step-by-step instructions on how to apply to be a candidate and register/schedule to take the PBMCT Examination. Please be sure to review all of the information available on the Program’s website: http://pbmct.com/ prior to applying to become a candidate.

1. Go to dln.certifior.com


2. First time users, click ‘Register’

a. Complete profile form and click ‘Save’

b. Click ‘OK’


c. Receive Email, subject line: ‘Verification Required for PBMCT Examination’

d. Verify Email address; follow the instructions in the Email

e. When prompted, click ‘OK’

3. Existing users, enter username and password and click ‘Sign In’


4. Once logged in, under ‘Candidate Registration’, ‘BOOKING’ choose ‘PBMTC

Examination’ and click ‘Next’

5. Under ‘Candidate Registration’, ‘SCHEDULE’, click ‘Next’ Please note, you will receive this message: “Exam can't be scheduled at this time because it's dependent on another component to be completed and verified. You will be prompted to schedule your exam once the components have been verified. Click ‘Next’ below to proceed with your registration.”

Do not be concerned, click ‘Next’


6. Under ‘Candidate Registration’, ‘CONFIRM’, confirm the examination and click ‘Confirm’

7. Receive Email, subject line: ‘Examination Receipt’


8. Click on the tab ‘Program Status’

9. Under ‘Program Status’, ‘Eligibility Criteria’, verify eligibility and click ‘Submit’

10. Under ‘Program Status’, click on ‘Applicant Agreement’ verify your consent and click

‘Submit’

If the eligibility requirements are not met or the application agreement statement is not


completed, user will be un-able to schedule to take the examination.


Under ‘Program Status’, click on ‘PBMCT Examination’ click ‘Schedule Test’

11. Search for the correct site/location a. Click next to the site/location (a check mark will appear) b. Click ‘Next’

12. Select the appropriate date and time and click ‘Next’


13. Review that the correct date and time have been chosen, click ‘Next’

14. Enter your payment information, click ‘Purchase’

15. Click ‘OK’

16. Receive Email, subject line: ‘Examination Receipt’

17. Close out of internet browser


18. Upon confirmation by the site coordinator ( between 1-7 days after submission), you

will receive Email, subject line: ‘PBMCT Examination Confirmation Email’

19. Follow the instructions within the Email Please note, the ‘PBMCT Examination Confirmation Email’ verifies your acceptance as a candidate and that you are scheduled for the examination. If you do not receive this Email contact us at, http://pbmct.com/contact-us.

APPLICANT CERTIFICATION AGREEMENT All applicants must sign the Applicant Certification Agreement and agree to all policies and procedures and the terms and conditions of the Program prior to being accepted as a candidate. Please see the Program’s website, https://pbmct.com/how-apply , to find all forms related to the Application and Certification process. The Applicant Certification Agreement reads as follows: I hereby apply to become certified as a Pharmacy Benefit Management Certified Technician. I have received a copy of the Pharmacy Benefit Management Technician Certification Program (Program) Candidate Handbook, have read it, understand it and agree to be bound by it and all policies and procedures of the Program. I will review and accept updates and amendments to the Program’s policies and procedures as they are amended including, without limitation, those posted on the Program’s website: www.pbmct.com. I certify that I meet all of the eligibility requirements to become a candidate for certification and I that the information contained in this application has been completed in good faith and is true and complete. I understand that the Program may require additional information and I agree to supply this information if/ when requested. I authorize the Program to contact any organization or person it deems necessary to verify the information I have provided with my application. All materials supplied to the Program, become property of the Program once submitted with my application. I understand that if it is later proven that I do not meet the requirement for certification, my application fee will not be refunded. I certify that I will act in a way that is consistent with the Program’s Code of Conduct and other applicable Program policies. I will report to the Program, any charge, complaint or ethics-related matters in which I am implicated within 30 days of the date of the occurrence. I agree to maintain the confidentiality of all examination materials and agree not to disclose, publish, reproduce, or distribute examination information. I agree to cooperate with any subsequent investigation regarding such matters. I understand that if any information provided by me is later deemed to be false, the Program reserves the right to revoke my certification. I agree to comply with all disciplinary or corrective action decisions of the Program, including suspension or revocation of my certification. If my certification is suspended or revoked, I agree to cease use of the PBMCT certification designation immediately. If appeal of an adverse decision is pursued, per the Policy and Procedures of the Program, I agree to crease use of the PBMCT certification until such time as the Program’s Board of Directors has determined the outcome of this appeal.


I understand that the Program and contracted Program vendors may collect, transmit, transfer, use, save, deliver and otherwise process candidate information for analysis, marketing, or other purpose deemed necessary to operate the Program. I hereby authorize the Program to disclose and share my name as well as any other basic demographic information required to help verify my certification status. I agree to register on the examination site and sign up for an examination location, date and time. I will bring my candidate approval email to the testing center and I will provide a government issued form of identification which exactly matches the name on my candidate approval email. I will complete the accommodation request form if I need special examination accommodation. I agree to act responsibly and with integrity in taking the examination. I understand that if I fail to appear on my scheduled date, time and location take the examination my application fee will be forfeited. I hereby release, discharge, and exonerate the Program, its directors, officers, members, employees, representatives, agents and parent company(ies) from any and all actions, suits (including third-party suites), complaints, losses or damages, liability claims or demands, including attorney fees, arising out of, or related to any aspect of the certification process including examination results or any other decision that may result in a decision to not issue me a certification, or related to my certification, my use of and display of my certification or references to the Program, my activities and services. I understand that the PBMCT Certification does not represent licensure or work authorization.

EXAMINATION LOCATIONS The (PBMCT) Examination is administered via computer-based testing at proctored test centers across the U.S. and in select international locations. The examination is offered, upon request, continuously throughout the year during normal business hours. A list of PBMCT Examination locations can be found here: http://www.assess.com/proctoring-security/


ACCOMMODATION POLICY AND PROCEDURE It is the Pharmacy Benefit Management Technician Certification Program’s policy not to discriminate against individuals with disabilities. While many individuals with disabilities can function without accommodation, others may face limitations or barriers without the accommodation process. It is the policy of the Program to reasonably accommodate qualified individuals with disabilities unless the accommodation would impose an undue hardship on the Program. In accordance with the Americans with Disabilities Act and other Federal and State laws, accommodation will be provided to qualified individuals with disabilities when such accommodation are directly related to their interaction with the Program.

APPLICABILITY OF POLICY: All applicants, candidates and certificants are eligible to request reasonable accommodation in relation to the PBMCT Examination.

REASONABLE ACCOMMODATION INCLUDES: Ensuring equal access to the Program’s application process. Enabling a qualified individual with a documented disability to take the PBMCT

examination. Enabling an applicant, candidate or certificant with a disability to enjoy the same access to

the examination as that of other applicants, candidates or certificants. Documentation by a licensed health care provider who specializes in evaluating and treating the specific disability for which the accommodation is being requested is required in order to understand the nature and extent of the disability and to provide the reasonable accommodation. Accommodation will be provided at no cost to the candidate. The Program is free to choose among equally effective accommodation and may choose the one that is easier to provide and less expensive. The accommodation will not compromise the examination’s ability to test the knowledge and skills it is measuring. The accommodation will not compromise the integrity of the work produced for the Program by the individual requesting accommodation.

REQUESTING A REASONABLE ACCOMMODATION Individuals should request reasonable accommodation using the Accommodation Request Form located on the Program’s website at https://pbmct.com/request-for-accommodation . An individual is required to p r o v i d e documentation of their disability upon request of reasonable accommodation. The Board will provide a decision to the individual within a reasonable amount of time regarding the request for accommodation. Arrangements for accommodation will commence upon approval of the request. If an accommodation cannot overcome the existing limitations or if the accommodation would cause an undue hardship on the operation of the Program, the individual shall work together with the Program to determine appropriate accommodation.


DEFINITIONS

Disability: For purposes of determining eligibility for reasonable accommodation, a person with a disability is one who: has a physical or mental impairment that substantially limits one or more major life activities (such as walking, seeing, hearing, or learning); has a record of such impairment; or is regarded as having such impairment.

Reasonable Accommodation: Reasonable accommodation for individuals with documented disabilities who demonstrate a need for accommodation will be made in accordance with the Americans with Disability Act. The Program does not discriminate against individuals with a disability in providing access to the examination or to work on or with the Program.


PREPARING FOR THE PBMCT EXAMINATION

FORMAT Candidates are provided with two hours (120 minutes) to complete the examination which consists of 120 multiple choice questions (100 scored, 20 non-scored), These questions have been developed to address the four main categories of job responsibilities identified through the Job Task Analysis Study and survey and the sub-task categories as shown below.

I. Support Pharmaceutical Plan Members (31%) a. Authenticate pharmaceutical plan members according to HIPAA regulations (2%)

b. Enter and process medication orders (10%)

i. Accurately interpret the prescription

ii. Verify that the medication is accurately prescribed to the correct member

iii. Verify that the member is eligible to receive the medication

iv. Enter and process drug Utilization Reviews (URs)

v. Determine if clarification is needed from provider

vi. Dispense and fill prescription according to state and federal guidelines

vii. Provide correct packaging for use

viii. Ship medication to member

c. Explain plan benefits to pharmaceutical plan members (9%)

i. Explain periods of coverage

ii. Explain premiums

iii. Explain true out of pocket

iv. Explain coverage gap

v. Explain deductibles

vi. Explain copays

vii. Explain pay alternatives (In-network and out-of-network pharmacies)

viii. Explain formularies

d. Troubleshoot adjudicated claims (10%)

i. Analyze the error code

ii. Verify that the medication is on the formulary

iii. Ensure that the copay is correct

iv. Verify that the claim is submitted for the correct pharmacy

v. Provide the correct override or edit


II. Respond to Provider Queries (30%) a. Authenticate providers according to HIPAA regulations (2%)

b. Route provider requests through the appropriate process and personnel (6%)

c. Provide information about alternative therapeutic medications (5%)

i. Identify and communicate appropriate drug classes and subclasses

ii. Verify that the alternative medication is on the formulary

d. Explain plan benefits to providers (6%)

i. Explain formularies

ii. Identify appropriate pharmacy

iii. Explain relevant Medicare rules

iv. Provide explanation for prior authorization denial

v. Provide appeals process information

e. Enter and process drug Utilization Reviews (URs) (6%)

i. Accurately enter information provided to support drug Utilization Review request

ii. Determine correct review type

iii. Obtain the ICD-10 codes, and/or disease state or diagnosis name/acronym, and relevant clinical information necessary to process the drug Utilization Review

iv. Determine if requested drug utilization aligns with documented disease state or diagnosis name/acronym

v. Monitor Service Level Agreement (SLA) with prior authorization to ensure compliance with Medicare and state regulations

vi. Notify provider of Utilization Review decision

f. Remediate escalated prior authorizations (5%)

i. Determine if escalation request is appropriate

ii. Explain processing time in Service Level Agreement (SLA)

iii. Query provider for additional information


III. Support Pharmaceutical Plan Insurers (22%) a. Authenticate pharmaceutical plan insurers according to HIPAA regulations (1%)

b. Enter and maintain member information (8%)

c. Build and maintain plan information (7%)

i. Build and maintain formulary information

ii. Load the plan information

iii. Ensure that the plan information is available and accessible

d. Track and record claims adjudication information (6%)

IV. Support Corporate Clients (17%) a. Authenticate corporate clients according to HIPAA regulations (1%)

b. Process claim overrides (5%)

c. Remediate escalated issues (6%)

d. Support corporate client audits (5%)


The following are sample questions similar to what may be found on the PBMCT examination.

SAMPLE QUESTIONS

1. What is the route of administration if a medication is applied to the skin? a. sublingual b. oral c. topical d. sub-dermal

2. How many fluid ounces equal 3 pints? a. 48 b. 36 c. 1.42 d. 6

3. The abbreviations: PO, IN, SL, BUCC, PR, are all what? a. fields of medical practice b. drug classifications c. formulary alternatives d. common routes of medication administration

4. What would the second letter of a DEA number assigned to John Smith M.D. be? a. B b. J c. S d. M

5. A prescription dispense quantity is written in roman numerals as “CCXL” What is the correct amount of medication to dispense?

a. 250 b. 260 c. 240 d. 255 6. What does the acronym LIS stand for in relation to PBM practice? a. Low Income Subsidy b. License Is Sufficient c. Low Income State d. Licensed Insurance Provider

7. Which of the following is true about Medicaid? a. Funded solely at the federal level b. Only available to individuals 65 years of age or older c. Is managed by states d. Is only available to people with certain disabilities


8. What is the generic name for Prozac? a. fluoxetine b. sertraline c. citalopram d. pantoprazole

9. Which of the following is an NSAID? a. amoxicillin b. ibuprofen c. omeprazole d. lisinopril

10. The direction for use on a prescription reads “prn”. What does this mean? a. Take per Registered Nurse instructions b. Take every evening c. Take every morning d. Take as needed

ANSWERS

1-C, 2-A, 3-D, 4-C, 5-C, 6-A, 7-C, 8-A, 9-B, 10-D


EXAMINATION DAY At the scheduled date and time, the candidate should arrive at the testing center at least 15 minutes prior to their scheduled examination time. Any candidate who arrives after the scheduled examination time may not be permitted to take the examination and may forfeit their registration fee.

THE CANDIDATE BRINGS WITH THEM THE FOLLOWING ITEMS: E-mail confirmation with candidate and exam IDs (required) An approved form of identification which can include: (required) Driver's license (not temporary or learner's license) Certificate of Naturalization or Certificate of Citizenship Previous or current U.S. passport book or Previous or current U.S. passport card or

Military identification Federal, state, or municipal government employee identification card.

Temporary or altered documents are not acceptable.

A pencil One piece of 8 1/2 x 11 scratch paper (dated and signed)

All cell phones, papers, books and other electronics must be secured outside of the examination room. Once they have entered the testing site, the candidate must sign the testing log at the testing center. The name on the candidate’s e-mail confirmation must exactly match the candidates name on the identification. No candidate will be admitted to the examination center if the names do not match or if the government identification has expired. The candidate will not be permitted to bring any belonging to the seating area where the testing will take place.


EXAMINATION CONDUCT The Program requires appropriate conduct before, during and after the examination session. The examination room is monitored at all times by a trained examination Proctor. If, at any time during the examination period, the Proctor identifies a candidate exhibiting inappropriate conduct they will be dismissed from the examination and the examination will be terminated. Examples of inappropriate conduct include, but are not limited to: Falsifying information or identification required for admission to the examination; Copying answers from another candidate’s examination; Communicating or attempting to communicate with anyone except an examination Proctor during testing. Providing or receiving unauthorized information before or during the examination Removing or reproducing examination materials Disruptive or disrespectful activity during an examination Use of materials that are not on the approved items list If an emergency requires a candidate to leave the examination room, they will be allowed to step out of the examination area but will not be allowed to access personal belonging, speak to others or use a cell phone. The examination time will not be stopped. If a candidate needs to use a cell phone or speak to others, their examination will be terminated. There are no refunds for terminated exams.

RESULTS AND SCORE REPORTS

SCORING At the end of the examination, the system will score the examination and provide pass or fail status. An e-mail will also be sent to the e-mail address provided upon registration. It will include examination pass or fail status. If a candidate has passed the examination, a certificate will also be sent at this time. If the candidate has failed the examination, the email it will include their score report. They may re-apply to take the examination 30 days after the date of their initial examination date.


SCORE REPORT Candidate who did not pass the PBMCT Examination are provided scores presented on a scale of 100 to 300. Subscores are also provided and present information regarding a candidate’s performance on each of the main categories covered in the PBMCT examination. This allows candidates to gauge areas in which they under-performed or out-performed relative to the total score. Subscores are reported on the same scale as the total score. Total Score: %SCORE% Pass-Fail Cut Score: xxx Pass-Fail Outcome: FAIL Subscores*

Domain Scaled Score 1. Support Pharmaceutical Plan Members 171.0 2. Respond to Provider Queries 171.0 3. Support Pharmaceutical Plan Insurers 171.0 4. Support Corporate Clients 171.0 * By putting all scores onto a common scale, differences in difficulty of the examination forms can be adjusted. This is standard practice for professional certification exams as well as for large-scale exams in areas such as K-12 education and higher education. While subscores from categories with fewer items might be less accurate than categories with more items, subscores can still provide valuable information with which you can evaluate your performance. Candidates may re-apply to take the PBMCT examination 30 days after the date of their initial or previous exam.


RESCHEDULING OR RETAKING AN EXAMINATION

RESCHEDULING There is no charge to reschedule an examination provided it is done at least 2-days before the scheduled examination date. Candidates should follow these steps to reschedule an existing PBMCT Exam in instances where they have a conflict or emergency that requires a date change. Failure to appear for your examination or reschedule within 2-days prior to your scheduled examination will result in forfeiture of the examination fee.

1. Go to https://dln.certifior.com/ 2. Enter your username and password; Click ‘Sign In’ 3. Under ‘Booking’ click on the examination name 4. Click on the ‘Reschedule Exam’ button and reschedule the exam 5. Upon confirmation by the site coordinator ( ~1-7 days after submission), you will receive

and Email, subject line: ‘PBMCT Examination Confirmation Email’ with your updated examination date and time

6. Follow the instructions within the Email Please note, the ‘PBMCT Examination Confirmation Email’ verifies your acceptance as a candidate and that you are scheduled for the examination. If you do not receive this Email contact us at, http://pbmct.com/contact-us . Complete information about rescheduling the PMBCT examination can be found on the Program’s website at: https://pbmct.com/reschedule-examination

RETAKING AN EXAMINATION In the event a candidate does not pass the PBMCT examination and would like to retake the examination, they may do so after a 30-day waiting period from the date of the original exam. In order to retake an examination the application and scheduling process must be completed again using the User-ID and Password that was established during the original examination scheduling process, minus the need for the attestation form. The fee for retaking the examination is $125. The application and scheduling process is as follows:

1. Go to dln.certifior.com 2. Enter username and password and click ‘Sign In’ 3. Once signed in, Under ‘Candidate Registration’, ‘BOOKING’ choose ‘PBMTC Program’

and click ‘Next’ 4. Under ‘Candidate Registration’, ‘SCHEDULE’, click ‘Next’ 5. Under ‘Candidate Registration’, ‘CONFIRM’, confirm the examination and click ‘Next” 6. Receive Email, subject line: ‘Examination Receipt’ 7. Under ‘Program Status’, verify candidate eligibility requirements and complete the

application agreement statement 8. If the eligibility requirements are not met or the application agreement statement is not

completed, user will be un-able to schedule to take the examination


9. Once you have verified your eligibility and agreed to the application agreement, under ‘Candidate Registration’, ‘SCHEDULE’, schedule and pay for the examination

10. Receive Email, subject line: ‘Examination Receipt’ 11. Upon confirmation of the site coordinator ( approximately 1-7 days after submission),

receive Email, subject line: ‘PBMCT Examination Confirmation Email’ 12. Follow the instructions outlined in the confirmation email 13. If you have any questions or concerns, please contact us.

Information regarding retaking the PBMCT examination can also be found on the Program’s website at: https://pbmct.com/retake-examination


APPEAL PROCESS FOR ADVERSE DECISIONS

OVERVIEW The following adverse decisions affecting certification by the Pharmacy Benefit Management Technician Certification Program are subject to appeal:

Rejection of credentials for candidacy to sit for a Pharmacy Benefit Management Certified Technician Examination;

Denial of certification or recertification. No appeal may be taken from an adverse decision based on an individual's receipt of a failing grade on a PBMCT examination unless extraordinary circumstances exist as determined solely by the Program’s Board of Directors. The procedures set forth below for the review and appeal of adverse decisions affecting certification or recertification may be subject to an expedited schedule when deemed necessary by the Board.

REQUEST FOR RECONSIDERATION An individual who has received an adverse decision will be given prompt written notice of the decision. The notice will state the reason(s) for the adverse decision and will inform the individual that they have the right to seek review of the adverse decision by filing a timely written Request for Appeal of an Adverse Decision (Appeal) with the Chair of the Board. To be valid, the Appeal must be received by the Chair within 30 calendar days of receipt by the individual of notice of the adverse decision. The request must contain a statement of why the individual believes that the adverse decision was improper and must include any supporting documentation that the individual wishes to have considered as part of the reconsideration. The request must be accompanied by a check or money order made payable to Distance Learning Network, Inc. in the amount of $75.00 to cover administrative costs associated with the appeal process. This fee will not be refunded, regardless of the outcome of the appeal.


REVIEW BY THE BOARD The adverse decision will be reviewed by the Board. The Board may review any information it deems pertinent and may request additional information from the individual. The Board may, at its discretion, take one of the following actions:

Affirm the adverse decision; or Recommend that the adverse decision be reversed or modified. Recommend a hearing of the appeal by the Board

NOTIFICATION OF DECISION The Chair of the Board will notify the individual in writing of its action, including the reasons for these actions, within 60 calendar days after receipt of the request for reconsideration. An individual who has been notified that the adverse decision has been confirmed by the Board cannot make additional appeals regarding this adverse decision. Information about the appeals process for adverse decisions can also be found on the Program’s website at: https://pbmct.com/appeal-process-adverse-decisions


APPROPRIATE USE OF THE PBMCT CREDENTIAL A credential is one mechanism used to help employers and the public readily identify individuals who have proven that they possess a specific knowledge or skill set. In the case of the PBM Technician Certification Program (Program), these are the knowledge, skills, and abilities necessary to provide safe, efficient, and effective Pharmacy Benefit Management (PBM) technician services for U.S. based prescription drug programs or integrated healthcare systems. The inappropriate use or misuse of a credential may undermine the purpose of this designation by making it difficult for the public to determine whether a person does or does not possess this knowledge or skill set. Candidates who have received a passing score on the Pharmacy Benefit Management Certified Technician Examination are awarded the credential of Pharmacy Benefit Management Certified Technician (PBMCT). This credential may be used in conjunction with the recipient’s name as long at the certificant remains in good standing with the Program. A certificant in good standing is one who is currently certified and who is not undergoing a disciplinary action initiated by the Program.

Example of appropriate credential use: John Doe, PBMCT

Examples of inappropriate use of credential: John Doe, Pharmacy Benefit Management Certified Technician John Doe, PBM Certified Technician

CERTIFICATION PERIOD The PBMCT certification is valid for a period of two (2) years from the date of issue. Recertification is required after this two year period. Recertification of PBMCT’s is one way to help assure that the specific skills and industry knowledge that are needed to provide safe, efficient and effective services to the public are being maintained. The continuing education requirements that are included in re-certification promote continual learning in a rapidly changing field, and help enhance skills that are essential in PBM technician practice.


RECERTIFICATION

REQUIREMENTS In order to recertify and an active PBMCT, individuals must complete a minimum of fifteen (15) contact hours of ACPE-approved Continuing Education Units (1.5 CEUs) during each two (2) year recertification cycle. A fee of $80 must also be paid as part of the recertification application process.

RATIONALE ACPE-approved content is required for recertification, as the ACPE promotes meaningful professional learning activities that focus on quality assurance and advancement of pharmacy education. In 2015 the ACPE Board of Directors adopted a revised Definition of Continuing Education for the Profession of Pharmacy:

[a Continuing Pharmacy Education (CPE) is] a structured educational activity designed or intended to support the continuing development of pharmacists and/or pharmacy technicians to maintain and enhance their competence. Continuing pharmacy education (CPE) should promote problem-solving and critical thinking and be applicable to the practice of pharmacy.

Furthermore – the ACPE requires of its accredited providers (those that develop and offer ACPE-accredited CEUs) that:

The mission, goals, and activities must be related to the vision and educational needs of the profession of pharmacy to better serve society. As recommended by the Institute of Medicine for all health care professionals, pharmacists and pharmacy technicians must be educated to deliver patient-centered care as members of an interprofessional team, emphasizing evidence-based practice, quality improvement approaches, and informatics. (Accreditation Council for Pharmacy Education Accreditation Standards for Continuing Pharmacy Education, Version 2: Released March, 2014)

The number of contact hours required for reaccreditation is aligned as a percentage of the contact hours required for licensed pharmacists practicing in the U.S. as based on State CEU requirements for Licensed Pharmacists. (medscape.org/public/pharmcestaterequirements 2014)

CEU RECORD MAINTENANCE CEUs completed before initial certification is granted will not be eligible to satisfy recertification requirements. CEUs can only be applied to the recertification cycle in which they are completed and will not be attributed to future certification periods. PBMCTs must maintain their own records of CEUs earned during each recertification period, and are responsible for maintaining these records for at least two (2) years after the certification cycle ends. Verification of attendance must be uploaded to the certificant’s account on dln.certifior.com.


RECERTIFICATION APPLICATION All applications for recertification must be submitted before the expiration date of certification. In order to apply for recertification, please visit the Program’s website at: https://pbmct.com/recertification-application or follow the steps listed below:

1. Go to dln.certifior.com

2. Enter username and password and click ‘Sign In’

3. Once signed in, Under ‘Candidate Registration’, ‘BOOKING’ choose ‘PBMTC Program

Recertification’ and click ‘Next’

4. Follow the system instructions to validate your requirements and pay for your recertification

If you have any questions or concerns, please contact us.

RECERTIFICATION NOTIFICATION AND AUDITING Recertification applications are reviewed in the order they are received. If the application for recertification is approved, an updated certification will be issued. The Program reserves the right to audit any PBMCT at any time. Audits of reaccreditation requirements are conducted on a regular and random basis. If requested by the Program, a PBMCT is required to comply with audit instructions and requirements and may be asked to provide additional information regarding their CEUs. All materials supplied to the Program, become property of the Program once submitted. Failure to comply with audit requirements will result in certification being revoked.

EXPIRED CERTIFICATION Certificants will be decertified upon the expiration date of their certification if they fail to apply for recertification and meet recertification criteria. Certificants are encouraged to apply for recertification and pay the re-certification fee at least ninety (90) days prior to the expiration of their certification. Certificants who become decertified must stop using the PBMCT credential immediately. In order to regain certification after a lapse in certification, an individual must re-apply and re-take a PBMCT Examination by following the Application instructions in this Manual or on the Program’s website at: https://pbmct.com/application - “existing users.”


PBMCT DIRECTORY The PBMCT directory is a searchable database that can be used to verify active status of a certified PBMCT. The directory verifies Active Status only for PMBCTs along with the certificant’s first name, middle name, last name, city, state/province, country, certification date and certification expiration date. The PBMCT Directory can be found on the Program’s website under “Who Are PBMCTs” at: https://pbmct.com/directory Individuals are offered an option to opt-out of inclusion in the online directory by following the instructions found in the Security Policy in the footer of the Program’s website (http://pbmct.com/privacy-policy) The PBM Technician Certification Program makes all reasonable effort to ensure that certification directory information is reported and published in an accurate and complete manner. Questions or concerns regarding the information provided can be sent to [email protected].


DISCIPLINARY POLICY The following policy and procedure has been developed to help ensure an approved, fair and documented process is followed should any individual holding the credential of PBMCT be in alleged violation of the Program’s Code of Ethics, or be reported to have breached a Program Policy or Procedure related to attaining, maintaining or appropriately using their PBMCT credential. The Disciplinary Policy can also be found on the Program’s Website at: https://pbmct.com/disciplinary-policy

CAUSES FOR DISCIPLINARY ACTION (This list is not exclusive, and there may be other acts or omissions related to unprofessional conduct that could be considered grounds for discipline.)

1. Any act or omission that violates the State, Federal or International laws of the location where a certificant resides or is employed.

2. Any act or omission that violates the policies and/or procedures for obtaining, maintaining or properly using the PBMCT credential.

3. Any act that is a direct or indirect, but known violation of the Program’s Code of Ethics.

VIOLATION REPORTS Upon written receipt of an alleged ethics violation or policy breach, the Program will make an initial determination as to the feasibility of a response or action in regards to the allegation. If the individual in question is no longer a certificant or if the allegation is deemed to be a non-actionable violation, it will not be reviewed.

VIOLATION REVIEW If a review of the alleged violation is deemed to be warranted, the individual in question will be contacted, in writing, based on their profile address in their pmbct.com or dln.certifior.com account, and a summary statement of the alleged violation will be provided. At that time, that individual will have 30 days to respond, in writing, to the alleged violation. If no response is received within 30 days, the original written complaint and the Program’s summary of the violation will be provided to the Board of Directors (Board) for review. If a written response is received by the individual, that response, as well as the original written complaint and the Program’s summary of the violation will be provided to the Board for review. At that time, the Board will deliberate on the violation and take one of the following two actions:

1. No action will be taken – the alleged violation is closed and the person making the complaint and the individual with the alleged violation will be informed of this decision in writing.

2. The Board determines that the complaint is warranted and, depending on the severity of violation, disciplinary action is determined and communicated to the individual in violation and well as the person who has filed the complaint.


DISCIPLINARY ACTIONS If the Board determines that disciplinary action is warranted, one of the following actions is chosen based on the severity of the violation:

1. A written violation warning letter. A second violation letter will result in revocation of the PBMCT credential.

2. Suspensions of the right to use the PBMCT credential a period of 6 months’ time. 3. Permanent revocation of the PBMCT certification.

WEBSITE ‐ APPLICANT, CANDIDATE AND CERTIFICANT INFORMATION SECURITY

PERSONAL INFORMATION Precautionary measures are taken to make all information received from online visitors secure against unauthorized access and use. Appropriate security measures are in place in our physical facilities to protect against the loss, misuse, or alteration of information that we have collected from the pmbct.com site or at a testing location. The Program’s website security policy can be found on the Program’s website footer at: https://pbmct.com/privacy-policy

INFORMATION DISCLOSURE The Program does not sell or share personal or identifiable information to companies outside of Distance Learning Network, Inc.

PERSONAL INFORMATION COLLECTED The Program’s registration form requires users to provide contact information and some demographic information. Information is password-protected to prevent access by other users as described in this security policy.

Cookies and Tracking The Company will use various technologies, which may include “cookie” technology, to gather information from our website visitors such as pages visited and how often they are visited, and to enable certain features on the website. “Cookies” are small text files that may be placed on computers when a website or a URL is visited. Cookies may include “single-session cookies” which generally record information during only a single visit to a website and then are erased, and “persistent” cookies, which are generally stored on a computer unless or until they are deleted or are set to expire. The Program may also allow third party service providers to use cookies and other technologies to collect information and to track browsing activity over time and across third party websites such as web browsers used to read our websites, which websites are referring traffic or linking to our websites, and to deliver targeted advertisements to users. We do not control these third party technologies and their use is governed by the privacy policies of third parties using such technologies. For more information about third party advertising networks and similar entities that use these technologies, see http://www.aboutads.info/consumers. The Program refers users who wish to opt-out of their ad networks’ and services’ advertising practices, to www.aboutads.info/choices.


CORRECTION, UPDATING, AND REMOVAL OF PERSONAL INFORMATION This Site will give users the following options for opting out of receiving information from the Program, updating and removing personal information they have provided, being listed in the PBMCT Directory and changing preferences with respect to receiving future communications:

Individuals may correct, update, or remove personal information from the Distance Learning Network, Inc. tools that collect and store data by going back to the specific tool, logging-in and making the desired changes;

Individuals can contact the Program at [email protected] and request correction, updating, or removal of personal information;

Individuals can log onto our system and manage their profile settings through the "My Account"; or, can send mail to the following postal address and request correction, updating, or removal of personal information:

Customer Service Distance Learning Network, Inc. 11000 Optum Circle, MN101-W800 Eden Prairie, MN 55344, USA

If personal information is removed or not supplied to the Program, users may be unable to access or fully use the functionality of some of pbmct.com's features. Individuals should also be aware that if the Program corrects, updates, or removes information we will do so from our active databases, but it will not be feasible or possible to do so from our back-up media, nor is it technologically possible to remove each and every record of the information that may have been provided to the Program.

PAYMENT CARD INDUSTRY DATA SECURITY STANDARD (PCI DSS) The Payment Card Industry Data Security Standard (PCI DSS) is a proprietary information security standard for organizations that handle branded credit cards. The PCI Standard is mandated by the card brands and administered by the Payment Card Industry Security Standards Council. The standard was created to increase controls around cardholder data to reduce credit card fraud. Validation of compliance is performed annually, either by an external Qualified Security Assessor (QSA) that creates a Report on Compliance (ROC) for organizations handling large volumes of transactions, or by Self-Assessment Questionnaire (SAQ) for companies handling smaller volumes. The Program requires compliance to PCI DSS standards for all Vendors taking payment on behalf of the Program.

CHANGE NOTIFICATIONS Distance Learning Network, Inc. may modify the Website Privacy and Security Policy at any time in its discretion. In the event of a material change in the Privacy Policy regarding the use of personally identifiable information, the Program will attempt to notify users at the e-mail address provided, and post it prominently on the PMBCT.com Site. Continued use of the Program will indicate acceptance of any such material change, or users may opt-out of continuing to use the Site. Distance Learning Network, Inc. may make non-material changes to the Privacy Policy that do not affect personal information. For these instances, we may not notify users of such non-material changes, collect, how we use it, and under what circumstances, if any, we disclose it.


RECORDS RETENTION POLICY Data includes all data and documents obtained, created and/or maintained electronically or physically for the operations of the Pharmacy Benefit Management Technician Certification Program (Program) and stored by or on behalf of Distance Learning Network, Inc. as well as our vendors, and contractors.

DATA STORAGE All data and documentation for the Program is stored on a firewalled and password-protected, private, secured server accessible only to individuals associated with the program based on their role within the Program. Information includes but is not limited to:

Current and historic certificant information Personal information Examination results Examination data Examination reports

DATA RETENTION The retention for all data and documents is 7 years or the duration and time required to meet federal and/or state legal requirements. At the end of the retention schedule, obsolete documents are disposed/destroyed in a secured manner. Content created for the Program will be maintained according to this Policy and may be subject to third parties in the event of litigation.

PBMCT.COM TERMS AND CONDITIONS PLEASE READ THE TERMS AND CONDITIONS CAREFULLY BEFORE USING THE PMBCT.COM Website. The Terms and Conditions of the pbmct.com website, managed by Distance Learning Network, Inc., as well as the Distance Learning Network's Privacy and Security Policy describe the terms and conditions under which we offer you access to our services. By using these services, you signify your agreement to these Terms. If you do not agree to these Terms, please do not use these services. Distance Learning Network may revise and update these Terms at any time. Your continued use of the pbmct.com website will mean you accept those changes.

The Terms and Conditions for the PBMCT.com website can be found on the footer of the Website and are located here: https://pbmct.com/terms


CHANGE OF ADDRESS OR NAME The Program maintains on file the name, e-mail and mailing address of each applicant/candidate/certificant as is it submitted. It is the responsibility of the applicant/candidate/certificant to inform the Program of any change of name, e-mail or mailing address and effective date, as soon as a change is known to be taking place. All name, e-mail and mailing address changes must be made via the applicant/candidate/ certificant’s account on dln.certifior.com. The Program will not be responsible for mistakes in updating information or for missed or lost communications due to failure by the applicant/candidate/certificant to provide and update their current contact information.

COMPLAINTS To file a complaint or concern regarding the Pharmacy Benefit Management Certified Technician Program, the PBMCT Examination, Proctors, Vendors or other individuals associated with the Program, please contact the Program at the address below or via the “contact us” link on the Program’s website: https://pbmct.com/contact-us Your feedback will be addressed by a member of the Program within 7 working days of receipt. Address complaints to: Customer Service Distance Learning Network, Inc. 11000 Optum Circle MN101-W800 Eden Prairie, MN 55347

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