Development and Implementation of a Managed Care Rotation in Medical Necessity Review: Exposing Students to New Opportunities

The purpose of this project was to design a rotation for fourth-year PharmD students in managed care through medical necessity review. There are few rotations currently offered in this area, and with the dom-ination of managed care in our healthcare system it is important to show students its opportunities and challenges. The rotation involved working with the Tennessee Department of Health’s TennCare Appeals Unit. Throughout the development process and implementation, the students were exposed to the various aspects of the appeal process, and to the complexity of managed care. This rotation exposes students to the impact pharmacists can have on patients ’ lives within the managed care realm that didactic lectures cannot adequately explain. As a model for professional development, the experience showed the advan-tage of utilizing pharmacists as drug therapy experts in an area where physicians have dominated the practice, and the potential to expand the pharmacy practice environment