Provide consulting and market research activities to pharmaceutical industry, Health plans, PBMs, agencies of record and others in the areas of benefit design, disease management, risk assumption, contracting, specialty pharmacy, formulary process, and pharmaceutical cost containment strategies in Commercial and Medicare populations.

Actively participated in the operational and clinical activities of the IDN System Pharmacy Services with a focus on identifying opportunities to improve pharmaceutical use and management across the integrated delivery network to enhance care, enhance patient safety and reduce overall costs of care. Responsibilities included coordination of specialty medication use between IDN medical groups and IDN owned specialty pharmacy, review emerging medications, negotiation and evaluation of pharmaceutical manufacturer contracts, development of pharmaceutical use guidelines for specialty medications, participation in system formulary processes and participation in pharmacy related population health initiatives. Led initiatives for biosimilar adoption across IDN, worked closely with the system managed
care contracting in negotiations with health plan payers, developed budget impact models and cost savings models for system pharmaceutical initiatives.
● Voting member of System, Health Plan and

Development and implementation of cost effective managed care pharmacy program for network model HMO within an integrated delivery network servicing commercial, exchange and MA-PD enrollees. Oversight of Rx benefit design, formularies, and prior authorization processes. Responsible for implementation of programs to ensure pharmaceutical quality and safety, including maintaining a 90th percentile score on pharmacy related HEDIS and CMS 5-star metrics. Responsible for adherence to all state and federal regulations impacting the pharmacy benefit and delivery of pharmaceutical services. Part of team to coordinated and integrate pharmacy services and programs across the IDN including the use of 340b pricing and biosimilars where appropriate.

Accountable for all pharmacy services administration for the IPA model medical group within the Sharp Healthcare system. Responsible for bringing value to more than 160K patients and 700 physicians such that patients receive the highest service in their pharmaceutical benefit while maintaining the highest efficiencies and standards for the mutual success of health plans, physicians, and patients. This includes but is not limited to coordination of pharmacy benefits and closing gaps in pharmaceutical care for patients and physicians as it relates to each commercial and senior HMO or Pioneer ACO members, integration with hospital pharmacy programs, technical and operational expert to all state and federal regulations, guideline and research
protocols for the medical groups and finally to serve as the liaison and pharmaceutical content expert for the medical group in their relationship with health plans, state associations, Centers for Medicare and Medicaid Services, pharmaceutical compa

Establishment of independent, multi-employee managed care consulting firm, providing services focused on pharmaceutical benefit design and management in HMO, PPO, PBM and employer group settings. Specializing in the management of prescription benefit and specialty pharmaceutical programs for commercial, managed Medicaid and Medicare Advantage plans and enrollees. Also provided consulting services and market research activities to pharmaceutical industry and others in the areas of disease management, pharmacy risk assumption, rebate contracting, pharmaceutical product market strategy, and Medicare Part
● benefit management and audit readiness.

Initial development and ongoing management of pharmacy benefit management (PBM) company subsidiary servicing more than 4.0 million lives and with gross revenues approaching $500 million annually. Company serviced both internal health plan and external customers, housed full claims and reporting capabilities, owned and operated a mail service facility and 3 stand alone pharmacies, coordinated generic sampling and couponing programs, operated open and closed formulary systems and maintained all manufacturer contract relationships. Largest Medicare Part
● manager in the country at that time.

Development and implementation of cost effective managed care pharmacy and vision benefit management program for network model HMO servicing both commercial and Medicare Part
● enrollees.

Responsibilities included:
• Revision and maintenance of outpatient prescription drug program in IPA model HMO to assure quality services and cost effectiveness.
• Solicitation for and implementation of sole source capitated regional laboratory service contracts.
• Solicitation and implementation of contracts for Home Health Care, Cardiac centers of excellence.

Management of pharmacy services on mixed staff and IPA model HMO including both owned and contracted pharmacy sites.

Responsibilities included:
• Expansion of an established program for the provision of clinical pharmacy services in an ambulatory care setting.
• Direct patient monitoring.
• Participant in AB717 Health Manpower Act Pilot Project through the University of California School of Pharmacy, allowing for the expanded role of pharmacists as prescribers.
● TEACHING EXPERIENCE