Certified Pharmacy Benefits Pharmacist (CPBP)

CPBP (PBP-001) Exam Objectives

This exam certifies that the candidate has the strategic, financial, and analytical knowledge to manage an employer-sponsored pharmacy benefit to maximize value and ensure quality.

Domain 1: PBM Contracting and Network Management (35%)

• PBM Contracts: Analyze the key financial and operational terms within a PBM contract, including definitions of brand/generic, rebates, and pricing methodologies (e.g., AWP, WAC, MAC).
• Contract Negotiation: Understand the principles of PBM contract negotiation to secure favorable terms for a plan sponsor.
• Pharmacy Networks: Differentiate between network types (e.g., open, preferred, limited) and understand the fundamentals of network management.
• PBM Business Models: Describe the different PBM business models (e.g., traditional, transparent, pass-through).

Domain 2: Formulary and Utilization Management Strategy (30%)

• Formulary Design: Design a cost-effective formulary, including tier structures and co-pay/coinsurance strategies.
• Utilization Management (UM): Develop and evaluate the impact of UM programs (e.g., prior authorization, step therapy, quantity limits) from a plan sponsor perspective.
• Rebate Impact: Analyze the relationship between formulary placement, market share, and pharmaceutical rebates.
• Specialty Pharmacy Management: Develop strategies to manage the high cost of specialty drugs.

Domain 3: Financial Analysis and Claims Auditing (25%)

• Data Analysis: Analyze pharmacy claims data to identify cost drivers, utilization trends, and opportunities for intervention.
• Claims Auditing: Develop and manage a program for auditing PBM claims to ensure contractual and pricing compliance.
• Financial Performance: Evaluate the overall financial performance of the pharmacy benefit plan against benchmarks and budget.

Domain 4: Clinical Program and Vendor Management (10%)

• Clinical Programs: Evaluate the clinical and financial value of PBM-offered clinical programs (e.g., adherence programs, MTM).
• Vendor Oversight: Manage the ongoing relationship with the PBM and other vendors to ensure performance guarantees are met.

Eligibility Requirements

To be eligible to sit for a CPS certification exam, candidates must meet the criteria outlined in one of the two pathways below.

Pathway 1: For U.S. Licensed Pharmacists

This pathway is for pharmacists licensed to practice within the United States, regardless of country of graduation.

• Hold an active and unrestricted pharmacist license in any state or territory of the United States.
• Meet educational requirements by being a graduate of an ACPE-accredited school of pharmacy or holding a Foreign Pharmacy Graduate Examination Committee® (FPGEC) Certificate.
• Fulfill the specialty experience requirement as outlined below.

Pathway 2: For International Pharmacists (Non-U.S. Licensed)

This pathway is for pharmacists who practice outside of the United States.

• Hold an active and unrestricted license to practice pharmacy in their country of practice. A certified English translation of the license must be provided if the original is not in English.
• Hold a professional degree in pharmacy equivalent to a U.S. pharmacy degree, such as a Bachelor’s degree (BPharm), Master’s degree in Pharmacy Practice (MPharm), or Doctor of Pharmacy degree (PharmD).
• Fulfill the specialty experience requirement as outlined below.

Specialty Experience Requirement (for all pathways)

To ensure candidates have foundational knowledge in the specialty, one of the following criteria must be met:

• Standard Pathway:
  Completion of at least one year of professional experience in a practice setting directly related to the certification area.
• Certificate Pathway:
  The one-year specialty experience requirement is waived for candidates who hold an active certificate of completion from a nationally recognized provider in a related subject matter. This includes, but is not limited to, the completion of a relevant PGY residency, fellowship, certificate/training program, or a relevant graduate degree (e.g., a Master's degree in the specialty field). Recognized providers of certificate programs include, but are not limited to:
  • American Society of Health-System Pharmacists (ASHP)
  • American Pharmacists Association (APhA)
  • American College of Clinical Pharmacy (ACCP)
  • American Society of Consultant Pharmacists (ASCP)

Career Path for CPBP Professionals

The CPBP certification is for pharmacists in the specialized field of employee benefits consulting and corporate health management. It is ideal for professionals working for large employers, benefits consulting firms, health coalitions, or unions.

Target Candidates

• Pharmacists working for employee benefits consulting firms.
• Pharmacists who manage pharmacy benefits for a large self-funded employer.
• PBM account executives who wish to demonstrate deeper client-side expertise.
• Pharmacists working for health coalitions or trusts.

Primary Job Roles:

• Pharmacy Benefits Consultant
• Corporate Pharmacy Benefits Manager
• Clinical Account Executive (Consulting)
• Director of Pharmacy (for a large employer or trust)

Career Advancement:

A CPBP is positioned for senior leadership roles in the employee benefits industry. They can advance to become a Senior Partner at a benefits consulting firm, a Vice President of Total Rewards or Benefits for a Fortune 500 company, or a national leader in pharmacy benefit design and strategy.

Study Resources

Prepare for your CPBP exam with resources focused on the strategic management of pharmacy benefits from the plan sponsor perspective.