On a recent trip to Great Britain to learn about the English National Health Service (NHS), we observed how the increasing areas of overlap between the American system of primarily private insurance and the English system of primarily public insurance. Although we do not support nor expect the United States moving to a fully public …
The U.S. spends two to four times as much on healthcare as most other high-income countries, but the health outcomes lag behind, a new Commonwealth Fund study found. “U.S. Healthcare from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes” is an ongoing report by the Commonwealth Fund that compares healthcare spending and outcomes, health status …
US spends most on healthcare but has worse outcomes: 6 report findings Read More »
FORLIMPOPOLI, Italy — There may be no better place to see the future of Italian health care than a small medical center in the town of Forlimpopoli. Until the arrival of the coronavirus, Italians prided themselves on having one of the best national health systems in the world. They told themselves that despite the endemic corruption, …
When smaller is better: Italian health care goes local after pandemic Read More »
The Mediterranean diet originates in the food cultures of ancient civilizations which developed around the Mediterranean Basin and is based on the regular consumption of olive oil (as the main source of added fat), plant foods (cereals, fruits, vegetables, legumes, tree nuts, and seeds), the moderate consumption of fish, seafood, and dairy, and low-to-moderate alcohol …
Prescription drugs were not covered for Medicare beneficiaries before 2006. Now, the top-selling Medicare Part D drugs of all time include Revlimid, Eliquis, Xarelto, Trulicity, and Humira. February 25, 2022 – All Medicare plans must cover a wide range of prescription drugs, including most drugs in certain protected classes. But Medicare Part D plans must …
Top-Selling Medicare Part D Prescription Drugs in Recent Years Read More »
Below is an excerpt from an article posted on ModernHealth.com. A link to the full article on their page appears at the end of the excerpt. For eight years, Beth Joyner Waldron has counted on Eliquis to treat clots in her lungs and legs. In November 2021, she received a letter from CVS Caremark telling …
CVS adds Eliquis, other vital drugs to formulary exclusions Read More »
In Deloitte’s Future of Health vision, the focus will be on prevention over treatment, and care will happen in the home or community. As accessible and trusted health care personnel, pharmacists can play a big role. Executive summary Most people don’t realize that pharmacists can perform a range of complex clinical functions around therapy optimization, …
MOUNTAIN VIEW, Calif., Jan. 6, 2022 /PRNewswire/ — Pack4U, a connected health services company, acquires long-time technology partner Catalyst Healthcare whose patented AdhereNet® platform links pharmacists, patients, and care teams to effectively manage drug complexity and improve medication adherence. “We are dedicated to improving patient outcomes at scale. Bringing this domain knowledge in-house is vital for …
Pack4U acquires leading pharmacy technology company Catalyst Healthcare Read More »
Perry Cohen, Chief Executive Executive of the TPG Family of Companies, recently wrote an article about the next generation of PBMs in Managed Healthcare Executive. The COVID-19 pandemic has had a deep and profound impact on American businesses both large and small. As the country inches back to a “new normal,” business leaders have to …
Steve Violette has more than 25 years of experience in the healthcare industry, including 18 years working within managed care roles for both payers and pharmacy benefit managers. He has held leadership positions in Clinical Management, Product, and Operations, with a consistent focus on Government Programs, including Medicare, Medicaid, and Individual Exchange lines of business.
Prior to joining TPG, Steve was the Senior Vice President of Government Program Operations at Optum Rx with accountability for the accurate and timely delivery of PBM services for more than 30 million lives, including but not limited to benefit readiness, claims processing, formulary management, program audit support, and regulated reporting requirements. He is recognized as an expert in the administration of Medicare pharmacy benefits and led PBM readiness efforts for major legislative initiatives such as implementing Part D changes associated with the Inflation Reduction Act.
Steve was previously the Chief Pharmacy Officer for UnitedHealthcare’s Government Programs team, where he successfully integrated distinct clinical strategy and operations functions to support United’s Medicare, Medicaid, and Individual Exchange populations. Steve participated in the Pharmacy and Therapeutics Committee and chaired the corresponding Formulary Management Committees for each line of business, representing more than $50B in annual drug spend. Steve was a member of the Part D Product team, lending support to the annual design, development, and deployment of Medicare pharmacy benefits. He was accountable for clinical and formulary strategies and deployed medical drug management initiatives that led to more than $300M in plan savings.
Over the years, Steve has held additional leadership roles within United Healthcare, Bright Health, and Cigna with broad responsibilities, including but not limited to analytics, clinical strategy, health plan operations, organizational transformation, product development, and population health.
Steve earned both his Doctor of Pharmacy and Master of Business Administration from the University of Rhode Island. He practiced as a community and long-term care pharmacist for more than 5 years and remains a licensed pharmacist in the states of Connecticut and Rhode Island. Steve was a visiting lecturer for the University of Minnesota College of Pharmacy, teaching an annual course on Medicare from 2019 through 2024.
Susan is a Senior Consultant for The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
Through collaboration with payers, providers, and manufacturers, Susan has over 40 years of leadership experience driving growth for innovative and cutting-edge programs to enhance quality, improve outcomes, and lower the cost of care. Her accountabilities have included business development, account management, sales enablement, product strategy, and clinical operations. She maintains numerous relationships with national and regional healthcare decision-makers and channel partners across the United States healthcare system.
Most recently, Susan has advanced payer programs related to member engagement, improved Star Ratings and quality measures, and reduced adverse drug events as Area Vice President of Business Development at Tabula Rasa HealthCare. Previously, Susan spent 17 years in various leadership roles, including Managing Director and Vice President, Health Systems and Payer Relations for MedStart, a point-of-care medication adherence platform that originated at MedVantx, Inc. and was later acquired by QPharma, Inc.
A pharmacist by training, Susan held various positions at the UPMC Health System for over 14 years, including Director of Pharmaceutical Services, Director of Therapeutic Services, and Assistant Vice President of Business Development. Susan also served as Executive Director of the Physician Hospital Organization (PHO) for four UPMC Hospitals. The PHO physician membership eventually transitioned to become the provider network when the UPMC Health Plan was launched.
Susan holds a Bachelor of Science in Pharmacy from the University of Pittsburgh, in Pittsburgh, PA, a Master of Public Management from Carnegie Mellon University, in Pittsburgh, PA, and a Sales Growth Certificate from eCornell, in Ithaca, NY.
Dr. John Vazquez is a Physician Consultant with TPG International Health Academy (TPG-IHA). TPG-IHA has hosted educational programs for senior healthcare executives for 25+ years, holding week-long Educational Summits in over 30 countries across the globe. The Academy is powered by three pillars: education, networking, and cultural immersion.
Dr. Vazquez is a Physician Executive with extensive CMO and Healthcare Management experience who has spent his career serving the underserved communities in some of the most industry-challenged healthcare delivery organizations. HIs skills in teamwork, strategy, quality, safety, business development, turnaround, and a commitment to education have led to Dr. Vazquez’s long-term success.
Dr. Vazquez spent the last 17 years at Sinai Health System, Chicago’s largest private healthcare system serving vulnerable communities, and with over $1 billion of revenues. Dr. Vazquez led the physician group through numerous projects and endeavors. He was the physician lead on philanthropy for the system, EMR and telemedicine implementations as well as numerous physician practice acquisitions and a large hospital merger. During his work as a physician leader for Sinai Chicago, the system saw a year-over-year improvement in the bottom line from a loss of $42 million to a profit of $10.7 million and an improved EBIDA from a negative $14.8 million to a positive $33.8 million. Dr. Vazquez assisted to increase philanthropic giving from a baseline of $2.3 million annually to $10.9 million.
Dr. Vazquez is currently Professor of Anesthesia at University of Illinois in Chicago. Besides leadership roles as Chief Medical Officer and Chair of Anesthesia, he has been Medical Director of the anesthesia service line and operating rooms at three hospitals, residency site coordinator for University of Illinois and Program Director for the Midwest School of Nurse Anesthesia. Dr. Vazquez is active in state and national physician organizations and governance bodies. He has built strong teams and strategic relationships with many companies building partners both in and out of healthcare.
Dr. Vazquez has served on several boards. As an entrepreneur at heart, he has helped shepherd companies to growth and acquisition. He is driven by the opportunity to bring innovation while improving health and wellness. On a global scale, Dr. Vazquez has been a US delegate for years with TPG International Health Academy visiting 4 countries to date with the mission to share strategies to improve global healthcare.
Dr. Vazquez holds a Doctor of Medicine degree from University of the Illinois in Chicago, Illinois and Is Board Certified in Anesthesia.
Jim is Senior Consultant with The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
With extensive experience in the managed care industry, he has served as Director of Ancillary Clinical Services and Manager of Pharmacy Services for Univera Health Care, and Director of Managed Care Programs/Research & Development for Centrus, an Albany-based prescription benefit management company.
In 2000, Jim founded and grew CSS Health into one of the nation’s three largest medication therapy management software and service providers. At CSS Health, Jim was the product visionary for MTMPath a unique medication management SaaS software platform that has been used in over 120 health plans, self-insured employer groups, PBMs and ACOs to manage drug utilization at a population level.
Throughout his career, Jim’s career has been focused on small to medium sized venture and private funded start-ups in the health tech space.
Jim is a graduate of Albany College of Pharmacy; he holds a Master’s degree in health administration from Union College and a PhD in Operations Research from the University of North Carolina at Chapel Hill. He is a licensed pharmacist in both New York and North Carolina.
Dan is a senior consultant for The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
With over 20 years of management of associations at the highest levels Dan Leonard has had a unique 360-degree view of the healthcare ecosystem in America from the payor, innovative and generic pharma, and patient perspectives. Leonard is the founder of Granite Capitol Consulting where he works with corporations, nonprofit associations, and professional societies in the healthcare space on strategic planning, advocacy, policy, and public affairs.
From 2020 to 2022 Leonard served as the President and Chief Executive Officer of the Association for Accessible Medicines (AAM), the nation’s trade association for the makers of generic and biosimilar medicines which fill 9 out of 10 prescriptions in the United States. Prior to joining AAM, Leonard served as President and Chief Executive Officer of the National Pharmaceutical Council (NPC), which sponsors and conducts research on a number of critical health policy issues. During his 12 years as CEO, NPC played a leadership role in the evolving areas of pharmaceutical value assessment, value-based contracting, and the importance of maintaining a robust innovation ecosystem.
Prior to his time in the pharmaceutical space, Leonard was an executive responsible for Public Affairs and Advocacy at one of the nation’s leading payor organizations America’s Health Insurance Plans (AHIP), the trade association representing companies providing health insurance coverage in the United States. He also served for six years on the Board of Directors of the National Health Council, whose core membership includes the nation’s leading patient organizations.
Before entering the Washington association community Leonard developed significant experience in politics and government, including time spent in presidential campaigns, leading communications at the National Republican Congressional Committee (NRCC) and serving as a Chief of Staff for a member of the Congressional leadership. Early in his career, Leonard worked as a television news reporter covering presidential primary politics in his home state of New Hampshire. He also worked in newsrooms in Boston, Pittsburgh, and Vermont.
Leonard has a bachelor’s degree in journalism from Marietta College in Marietta, Ohio, where he currently serves on the Board of Trustees, and he received a master’s degree in Government from the Johns Hopkins University.
Michael is a Senior Consultant with The Pharmacy Group (TPG). TPG provides consulting services to healthcare, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
He is a results-driven sales professional with experience in developing new sales programs and promotional strategies. He has over 25 years of extensive healthcare experience and is recognized for developing multi-unit operations. Michael also has a working knowledge of many aspects of the healthcare system.
During his career, Michael has worked for several healthcare companies. Consulting to independent pharmacies to generate new revenue streams. New business development and account management for a group purchasing organization (Innovatix, LLC). Pharmaceutical sales to physicians for Takeda Pharmaceuticals, Sanofi-Aventis and Bayer Pharmaceuticals. He also managed sales for closed-door and community pharmacies. Lastly, he generated new business for a drug wholesaler (AmerisourceBergen Company).
Michael holds a Bachelor of Science, Business Management degree and Master of Business Administration degree from the California Lutheran University of California. He also has a Executive Juris Doctorate from Concord Law School/Purdue University Global.
Dr. Susan Ito is Senior Consultant with The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
Dr. Ito is an accomplished healthcare executive and pharmacist with over 30 years of experience in client relations management and clinical pharmacy serving a diverse portfolio of managed care organizations, commercial employer clients, health plans, and pharmacy benefit management consultants. She is currently a partner with Swenson Pharmacy Advisors and a consultant for SH Advisors. Her focus is on pharmacy benefit management, clinical pharmacy services, health, and wellness.
Her experience was garnered in leadership positions that included two major pharmacy benefit managers – OptumRx and Express Scripts. Her responsibilities included strategic development, account management, client/consultant education for formulary management, utilization management, pharmacy trend management, and specialty benefit management. Prior to her pharmacy benefit management service, Susan held positions with Blue Cross of California. She also served in both the retail and hospital practice settings prior to moving into corporate healthcare management roles.
Susan received her Doctor of Pharmacy degree from the University of Southern California (USC). She completed a postdoctoral American Society of Health-System Pharmacists (ASHP) accredited residency in Ambulatory Care at USC in conjunction with the United States Department of Veterans Affairs. She is a member of the Academy of Managed Care Pharmacy (AMCP) and served as Chairman for the AMCP Public Policy Committee from 2022 – 2023. She currently serves on the Legislative and Regulatory Action Committee for AMCP. In 2023, Dr. Ito was awarded the AMCP Advocate of the Year Award. Dr. Ito is based in Gainesville, Florida.
Gaston is a Senior Consultant with The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
He is an accomplished c-suite healthcare executive with experience in client management, market access, product development, contracting and business development. He has over 30 years of broad healthcare experience and is recognized for developing long-term relationships with internal and external customers built on exceptional service and execution. Gaston also has a working knowledge of medical and pharmacy benefits, pharmaceutical trade relations and employer programs.
During his career, Gaston has worked for several pharmacy benefit management companies (e.g., NDC/HealthTrans, ProVantage, Rescription, ValueRX, Welldyne), specialty pharmacies (e.g., CoramRx, Eversana, HealthDyne, ivpcare specialty pharmacy, priority healthcare), specialty infusion companies (e.g., Soleo Health, Coram Healthcare and Amerita Specialty Infusion) and pharmaceutical companies (e.g., Schering-Plough, William H. Rorer)
Gaston holds a Bachelor of Science degree from the University of California at Irvine and Master of Business Administration degree from the University of Southern California.
Michelle is a Senior Consultant for The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
Michelle is an executive leader with deep experience in business development, client service and operations. She builds strong partnerships with internal and external resources to develop and implement market driven business solutions. She has demonstrated ability to develop markets, drive net new sales and retain customers profitably. Michelle is an excellent communicator and negotiator known for influencing and engaging others, as well as for building highly effective teams focused on customer satisfaction and achieving results.
Michelle recently retired from Cigna where she was the Senior Vice President, Go To Market Lead. She was responsible for the overall segment-specific product, marketing, sales, distribution and account management strategies and implementation for Cigna Pharmacy Management’s 9.1 million customers in commercial business. During her time at Cigna, her work contributed to membership growth, earnings growth and retention strategies, and client guarantee creation and delivery have driven over $1.4B in additional earnings in the past 8 years, an annual growth rate of 22%.
Prior to her work with Cigna, Michelle was the CEO at Pharmacy First – Wholesale Alliance, a Senior Vice President at Medco Health Solutions, working with regional health plans, mid-market and large market employers and resellers. Michelle began her career at Aetna Pharmacy Management focused on system and benefit set up and maintenance.
Michelle is heavily involved in the healthcare industry. She is a member of Women Business Leaders in Health Care and Global Leadership Program. She is on the Board of Directors for the National Council of Prescription Drug Programs Foundation, and ChoicePays, a patient financing company.
Michelle holds a Bachelor of Science degree in Business Management from Minnesota State University and a Financial Instruction Certificate from the Wharton School of Business.
Sue is a senior consultant for The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
Sue is an executive in the PBM industry with deep experience representing some of the largest US payors. Leadership roles have included accountability for the entire scope of manufacturer relationships including rebate competitiveness, supply chain strategies and optimizing overall value. She is passionate about affordability, value-based outcomes and building capabilities to execute strategies leading to better health outcomes and lower cost of care.
Sue brings expertise in rebate and innovative contracting, including value-based or outcomes agreements. Most recent experience in bidding and pricing optics brings significant value as they are critical components in formulary strategies and achieving growth targets. Recognized as a strategic thinker, she has an in-depth understanding of formulary development, pricing strategies, and innovative contracts that leads to effective total cost of care management, minimal patient disruption, and a competitive edge.
Sue’s areas of expertise include working collaboratively with pharmaceutical manufacturers on market access strategies – offering a payor perspective on value-based agreements, and innovative contracting.
Sue currently works at Scheid Services, LLC as the founder and principal. Past roles have included Vice President, Trade Relations at Prime Therapeutics and the Head of Manufacturer Relations at Aetna.
Sue has her Bachelor of Science degree in Biology from the University of Minnesota.
Gayle is a Senior Consultant with TPG Data Services (TPG-DS). TPG-DS and our team of senior healthcare and clinical consultants are transforming the way providers and payors monitor healthcare information to control costs and enhance efficiencies.
Gayle is an innovative, caring, and pragmatic clinician who leverages business acumen and strategic vision to create realistic solutions that optimize member care and improve outcomes while also delivering an ROI. She has been effective in working with both internal and external stakeholders to build consensus and create long-term strategies that are both practical and pioneering at the same time. Gayle’s expertise in government programs (Medicare including duals, and Managed Medicaid) allows her to effectively incorporate regulatory requirements into processes without losing site of the goal. She has a special interest in transitions of care, medication concordance, care management, value-based contracting, elderly care, and behavioral health.
Gayle most recently served at the Vice President of Integrated Care Strategies at Neighborhood Health Plan of Rhode Island (NHPRI). In this role, she created the clinical strategy that aligned with the plan’s 5-year strategic plan which was integral to answering the Medicaid RFI. She also served as a clinical lead for care management, creating a comprehensive review with recommendations and managed the relationship with the Medicaid accountable care organizations, enabling them to both meet state requirements and successfully navigate their risk contracts.
Gayle has been a trail blazer in the managed care pharmacy world. In addition to successfully building and then running the pharmacy departments for several health plans, Gayle worked with CMS and her MTM provider to initiate a medication synchronization program (then a new concept) that was coordinated with MTM and specialized packaging (services widely used and accepted today). Gayle served on then RI Governor Raimondo’s committee to improve the use of opioids as well as Rhode Island’s Utilization Review Board. Gayle was also part of a successful academic detailing program and has spent time in the PBM space, long-term care pharmacy, and has extensive experience in the retail pharmacy business.
She has held senior leadership positions at Superior Health Plan, Core Health, LLC/Health Alliance Connect, Senior Whole Health, BMC Healthnet Plan, Bridgeview Pharmacy, Merck-Medco Managed Care, and Insta-care Pharmacy Services. She has been active with the Association of Managed Care Pharmacy (AMCP) and served as a preceptor Northeastern University School of Pharmacy.
Gayle holds a BA in Psychology and Sociology from Brandeis University, a BS in Pharmacy from Massachusetts College of Pharmacy and Allied Health, and an MBA in Marketing from Bentley College. She has a current pharmacy license in Massachusetts and Rhode Island.
Nancy is a Senior Vice President with The Pharmacy Group, responsible for all financial aspects of the TPG Family of Companies, as well as operational matters. She joined The Pharmacy Group in March 2012, in addition to performing the overall financial management she evaluates project profitability and pricing, manages cash flow, analyzes financial performance, and makes financial recommendations. Additionally, she handles HR functions, and frequently is involved in client contracting.
Prior to her career in finance, she spent over a decade in the Information Technology department at The Travelers Insurance Company during the 80’s. During her tenure, she held multiple technical and analytical positions, including software design, development, and implementation.
Nancy received her BS in Business Administration from the University of Connecticut. She currently resides in South Glastonbury, Connecticut with her husband, and enjoys spending time with her three grandchildren. Her hobbies include spending time with her family at their cottage in Rhode Island, boating, walking, gardening, and reading.
Jeff joined The Pharmacy Group (TPG) in August 2008 to support its administrative functions. Over the years he has taken on additional responsibilities including marketing initiatives, client communications, and general web support. As a vice president Jeff is primarily responsible for attendee recruitment for all TPG activities, from the planning and strategy of recruitment to the execution and oversight of those initiatives.
Jeff also handles administrative functions for TPG International Health Academy (TPG-IHA) and TPG National Payor Roundtable (TPG-NPRT). He works in several areas of the TPG Family of companies including registration and attendee administration, hotel and audio-visual coordination, on-site meeting management, publications, website maintenance and graphic design, grant research and writing and budgeting.
In addition to his business career, Jeff has over 15 years of teaching experience in martial arts schools around Connecticut. He was the program manager for the state’s top performance martial arts school where he was responsible for student enrollments, curriculum design, and class management on a daily basis. He also had the honor of competing on the nation’s #1 ranked martial arts team for three years. He also founded central Connecticut’s premiere fitness kickboxing school where he designed classes, created social media content and marketing initiatives, and helped manage employee training.
Jeff attended the University of Connecticut and graduated in 2007 with a BA in English. He currently resides in Bolivia, North Carolina. His hobbies include rock climbing, rucking, reading, writing, and supporting Arsenal FC.
Chris is a Senior Consultant for The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
Through collaboration with C-suite executives and general managers of major business segments (commercial group, individual, Medicaid, and Medicare) Chris delivers exceptional financial and service results all the while focusing on the triple aim (improve customer service, improve quality, and reduce costs). This civic-minded Senior Operations and Strategic Professional has achieved a 25-year track record of success in developing one of the largest health insurance providers in the state of Arizona. In the mid-90’s, he leveraged the competencies acquired through completion of an MBA, as well as a background in developing a Pharmacy Benefit Manager (PBM) for United Drugs and accepted the role as the first Vice President of Pharmacy at Blue Cross Blue Shield of Arizona. Accordingly, he executed on the organizational priorities to successfully achieve the goals of BCBSAZ’s strategic plan. Accountabilities included overseeing vendor contract negotiations, financial planning, business development, clinical policy, and all legislative and compliance issues relevant to public policy and the health insurance markets.
For 25 years, Chris was the Vice President & Chief Pharmacy Officer at Blue Cross Blue Shield of Arizona, Phoenix, AZ. Throughout his tenure he accomplished positive results in the areas of health insurance/pharmacy administration, contract negotiations, clinical pharmacy policy, and human resources including a focus on Diversity.
In 2018, Chris won the CEO Award from BlueCross Blue Shield Arizona for improved PBM contracting. He is a member of the Academy of Managed Care Pharmacy, the Arizona Pharmacy Association, and the National Council for Prescription Drug Programs. He is a licensed pharmacist in Arizona and California.
He holds a Bachelor of Science degree in Pharmacy from the University of Arizona in Tucson, AZ, a Master of Business Administration from the University of Phoenix in Phoenix, AZ, and a Graduate Certificate in Non-Profit Leadership and Management from Arizona state University in Tempe, AZ.
Mr. Brook has over 30 years in health care industry management and consulting. He has managed medical and health economic educational programs, convention activities, and promotional product support as both an employee and a consultant. He has worked on market access programs with the National Payor Roundtable since the organization formed in 2005, (as the National Managed Care Roundtable). He managed the daily operation of a pharmacy benefit manager’s formulary programs and was instrumental in the development and implementation of over 20 custom formularies. Mr. Brook has worked with state and federal agencies in refining the diagnosis-related-group system, in developing the resource-utilization-group system—part of the U.S. Federal Long-Term-Care Minimum Data Set, and in developing a mental health classification and reimbursement system. Mr. Brook has taken an active role in the developing and reporting the results of the National Payor Roundtable advisor survey. He reviews for several journals including the American Journal of Managed Care and Current Medical Research and Opinion. He has a variety of therapeutic experience with marketed and developmental products and holds several degrees from Rensselaer Polytechnic Institute, including an M.S. in operations research and statistics, an M.B.A. in health systems finance, and a B.S. in management information systems.
Dr. Sax is co-founder and President of The Pharmacy Group LLC in Glastonbury, Connecticut where he provides marketing services to healthcare service providers; pharmaceutical, biotech, and medical device clients; and information technology and companies to grow revenue and improve the financial performance of their products and services.
My pharmacy experience in community, hospital, and managed care spans 45 years. Over the years, I have developed relationships with hundreds of decision-makers in the United States healthcare system, and have assisted more than 200 companies in selling their products and services to payors. Capabilities includes developing and implementing coverage and reimbursement strategies related to current market payor perspectives; provide strategic and tactical reimbursement support to clients; apply for codes specific to new products or procedures necessary to establish coverage policies and payment rates; planning, developing, and managing clinical pharmacy programs; developing innovative and effective programs and systems to maintain rational pharmacy utilization; optimizing drug therapy; promoting rational prescribing and management of prescription costs; product uptake as well as increased profitability, market share, and competitive advantage.
Michael has widely published in medical and pharmaceutical journals. He has lectured and written extensively on the role of pharmacy benefit management in healthcare. He is affiliated with a number of organizations, including the Academy of Managed Care Pharmacy, and is a TMAC Advisor.
Dr. Sax received a Doctor of Pharmacy degree from the University of Southern California School of Pharmacy, and completed a postgraduate residency in ambulatory care at the Veterans Administration and the University of Southern California.
Jim is President of TPG National Payor Roundtable (TPG-NPRT), an educational company that brings healthcare industry product and service offerings to managed care decision makers. Education and access are the key attributes TPG-NPRT offers client customers and payor medical decision makers leading to improved adoption and reimbursement for products and services.
He is the former executive director of the National Association of Specialty Pharmacy (NASP). He is also a founder of the Center for Pharmacoeconomic Studies at the University of Texas College of Pharmacy. His research interests are in applied pharmacoeconomics, digital health, systems integration, and managed care. Over the past 48 years, his practice orientation has been in hospital pharmacy, clinical services design, home infusion therapy, managed care services, drug development, pharmaceutical marketing, and disease management. He has authored more that 85 peer-reviewed publications and has given hundreds of presentations.
Within Professional organizations, Jim has served at the state, national, and global level. He is an original founder of the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) and their third president. ISPOR now exceeds 50,000 members with chapters on every continent and within all major countries.
He has worked with all major pharmaceutical companies. He is the founder and president of Indication Biosciences an early-stage drug discovery company that is examining the use of CBD with statin agents to safely lower lipid anomalies. He was the Executive Vice President and founder of Engaged Media, a technology driven patient engagement solution, used in multiple pharmaceutical copay programs that was purchased in May of 2018. He is also active in other Cannabis-based Medicines (CBM) and research as a founder of CannaPharma Rx and Member of the BOD of Allied Health (ALID), as well as Vice President of Pharmacy and Chief Scientific Officer.
Jim has a pharmacy degree from the University of Buffalo and an MBA from the University of Texas.
Mark is a Senior Consultant for The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
After holding growth and P&L leadership positions with payors such as Aetna and Principal Health Care, Mark pivoted to help suppliers connect and grow within the payor segment. This included holding the position of SVP, Specialty Networks for Optum, SVP, Sales & Distribution for Vitality, and VP, Sales & Marketing for Home Access Health, an at-home laboratory testing company. Just prior to consulting with TPG, Mark was the Senior Vice President of Business Development for VillageMD where he led a team that secured new contracts with physicians looking to expand into a value-based care/DCE/risk-bearing model.
Mark has also spent time as a marketing lecturer for the UCLA and USC Master of Public Health programs, being a board member for the Illinois HMO Association, and as a member of the Finance Committee for the Illinois Guarantee Fund.
Before launching his over 20-year career in the healthcare field, Mark secured a Bachelor of Science degree in Marketing, with an accounting emphasis, from the University of Wisconsin.
Perry is co-founder and Chief Executive Officer of The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.
Perry has more than 40 years of experience with managed care, and during that time has worked for local, regional, and national health plans. A pharmacist by training, he created a pharmacy benefit management (PBM) company for Aetna in the early 1990s. Over the years he has developed relationships with hundreds of decision-makers in the United States healthcare system and has assisted more than 200 companies in selling their products and services to payors.
Additionally, Perry practiced in community, hospital, and long-term care pharmacy in California and oversaw the operations of 50 community pharmacies in nine states. Perry is a co-founder, past president, and fellow of the Academy of Managed Care Pharmacy (AMCP), a member of the Drug Topics, Editorial Advisory Board, Managed Healthcare Executive Editorial Advisory Board, and the University of Arizona College of Pharmacy National Advisory Board. He has lectured and written extensively on the role of pharmacy benefit management in healthcare.
Perry holds a Bachelor of Science degree in Pharmacy and a Doctor of Pharmacy degree from University of the Pacific in Stockton, California. He completed an administrative clerkship at the Food and Drug Administration in Rockville, Maryland. His clinical training was performed at Tripler Army Medical Center in Honolulu, Hawaii.
Rich Balest has served as a health industry consultant utilizing over 25 years of experience in data mining, data modeling, data warehousing, and information delivery. Rich has comprehensive experience analyzing detailed claims and eligibility from CMS, insurance companies, and managed care organizations including prescription benefit managers (PBM), and account and medical record detailed patient data from hospital patient accounting systems, clinical ancillary systems, and professional and institutional billing systems.
Rich has supported the actuarial departments of health plans projecting the impact on provider payments resulting from amended contracts, measuring prescription drug trends, preparing Medicare Part D bids, and developing process specifications for the actuarial analytic platform.
On behalf of several consulting firms, Rich has supported the pharmacy practices on client engagements measuring the administrative and financial performance of employer sponsored prescription drug benefit plans as defined by the contractual arrangements with the PBMs. For PBM clients, Rich completed Medicare Part D process assessments and specialty network assessments.
Education
Sarah is a Vice President of Business Development for The Pharmacy Group (TPG). Her primary responsibility is coordinating business growth across the various LLCs in the TPG Family of Companies. She joined The Pharmacy Group in February 2015— initially to augment the organization’s business development and administrative activities. In the years since she has worked on marketing initiatives, client communications, general web support, and program development.
In 2017, she took on the additional role as marketing coordinator for the TPG Family of Companies. She was responsible for the overhaul for all five LLC websites, the lead for redesigning all LLC logos, and charged with giving TPG a more cohesive marketing message. She currently maintains all websites, sends all TPG communications, and prepares all marketing documents.
Sarah supports delegate, advisor, and sponsor recruitment efforts for TPG International Health Academy (TPG-IHA) and TPG National Payor Roundtable (TPG-NPRT).
She graduated from The University of Connecticut in May 2015 with a Bachelor of Science degree in Healthcare Management from the School of Business and a Bachelor of Arts degree in Human Development & Family Studies.
Sarah currently resides in Meriden, Connecticut. She volunteers with One More Dog Rescue which coordinates the fostering and adoption of dogs from both Connecticut and Chicago and with The Run for the Fallen CT which honors fallen CT veterans with an annual commemorative run in September. Her hobbies include skiing, crafting, reading, and traveling.
Marjorie Pestel Zimmerman, MS, BS Pharm, is a registered pharmacist with diverse experience in the healthcare industry. During her practice in a large tertiary care center, she held numerous positions, including decentralized clinical pharmacist and Assistant Director of Operations within the pharmacy department. As a consultant for a psychiatric hospital, she performed medical staff drug usage evaluations and led patient medication groups.
Marjorie has experience as the Director of Pharmacy for a home-infusion company that managed a broad range of diseases and has multiple-years’ experience in the medical communications/education industry. At a managed care communications company, she researched, designed and developed products, including sales training, advisory boards, symposia, disease state management, and communications programs.
After focusing on managed care, Marjorie joined a medical education company, where she held various positions within account services and new business development. Her responsibilities included developing and managing educational plans that included publications and advocacy development as well as promotional and CME programs.
Marjorie served as editor of a business strategy publication that focused on devices, diagnostics and drugs in development. Researching and writing about new drugs in development including biosimilars is an area of interest. Additionally she has worked with several health plans and employer groups distributing and evaluating RFPS for PBM selections as well as determining PBM performance relative to the existing contracts.
Education
Professional Affiliations and Accomplishments
In August 2015, Leon Edelsack became the President of TPG Healthcare Consulting (TPG-HC) and also serves as the president of TPG-HC’s sister company, TPG Data Services (TPG-DS), a position he has held since 2009.
With over 30 years of extensive business experience, including six years managing TPG-DS, Leon brings a well-rounded background to the company. As the president of TPG-DS, he led account management efforts and successfully maintained the client base. He also was instrumental in the development of new data analytic products/services geared to effectively meet the needs of today’s health plans.
Leon’s previous professional experience includes in-depth expertise in information technology (IT), sales and marketing at Fortune 500 companies and new start-ups. During his career, Leon has held management positions in sales, account management, market/product development, strategic planning/business development, mergers and acquisitions and venture capital investing. His IT experience encompasses a number of industries, including manufacturing, government, professional services, broadcasting, insurance and healthcare.
Prior to joining TPG Data Services, Leon was the President and Founder of a state-of-the-art multimedia gaming company. He also spent 20 years with Westinghouse, growing his division into a global communications solutions provider with over $100 million in annual revenue. Additional experience includes overseeing the operations of three data centers for a company providing business process outsourcing services to Fortune 500 clients.
Board and Advisor Appointments
Education and Training
Published Works
Leon has been published in several periodicals, including Managed Healthcare Executive.