I have over five years of experience working with PBM systems, including designing and implementing strategies to optimize drug formularies and reduce costs. I am proficient in using tools like Express Scripts and CVS Caremark to analyze claims data, identify trends, and recommend cost-effective solutions. My expertise also includes collaborating with stakeholders to ensure compliance with regulatory requirements and improving patient outcomes through tailored benefit designs.

I regularly attend industry conferences, participate in webinars, and subscribe to newsletters from organizations like the National Association of Specialty Pharmacy (NASP) and the Academy of Managed Care Pharmacy (AMCP). Additionally, I network with peers and engage in continuous learning through certifications and online courses to ensure I remain informed about evolving regulations, drug pricing trends, and advancements in pharmacy benefit management.

In my previous role, I identified inefficiencies in a client’s drug formulary and recommended switching to therapeutic alternatives with lower costs but similar efficacy. By negotiating with manufacturers and implementing step therapy protocols, I reduced their annual pharmacy spend by 15%. This approach not only saved costs but also maintained high-quality patient care, demonstrating my ability to balance financial and clinical outcomes effectively.

I prioritize open communication and transparency when resolving conflicts. I start by thoroughly understanding the client’s concerns and the PBM’s perspective, then analyze data to identify the root cause. By presenting evidence-based solutions and facilitating collaborative discussions, I help both parties reach a mutually beneficial resolution. My goal is to maintain trust and ensure the client’s pharmacy benefit goals are met while addressing the PBM’s operational constraints.

I implement a proactive approach by conducting regular audits, staying informed about regulatory updates, and collaborating with legal and compliance teams. I also develop clear policies and training programs for stakeholders to ensure adherence to regulations like HIPAA and ERISA. By leveraging technology to monitor compliance and address potential risks early, I help organizations avoid penalties and maintain ethical pharmacy benefit practices.