CVS adds Eliquis, other vital drugs to formulary exclusions

Mike 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.

Mike has over 25 years of strategic, operational and investment experience in the healthcare technology and services sectors. He has extensive experience in bringing solutions to the healthcare marketplace (payers and providers) through his expertise in marketing, sales, partnerships and product management.

He has a proven record driving growth and market leadership for venture-backed, privately funded and public organizations while building and leading highly effective teams. Mike has served organizations in the areas of care management, digital health, patient experience, clinical operations, AI/NLP, medical devices and data analytics, among others.

Most recently, Mike was Chief Growth Officer of Toney Healthcare, a management consulting and clinical operations firm, that he successfully led through a private equity acquisition. He remains an Executive Advisor to the firm while serving other companies as an advisor and consultant.

While at Health Integrated, a health management company (acquired by EXL Service), Mike held executive leadership roles in marketing, business development, product management, growth operations and strategic partnerships. Mike also had key positions at Guidant Corporation (a cardiovascular technology company acquired by Boston Scientific and Abbott Labs) and as a consultant with Accenture.

Mike has an MBA from the University of Chicago Booth School of Business and a BSE in biomedical and electrical engineering from Duke University. As an engineer by training, he is passionate about finding solutions at the intersection of healthcare and technology.

Susie is a 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 over 17 years of sales leadership experience in the healthcare and medical field, Susie has a proven track record of building high-performing sales teams and optimizing sales strategies for both B2C and B2B companies.

Throughout her career, Susie has played a pivotal role in leading sales organizations through start-up, turnaround, and expansion phases. She has worked extensively with companies to develop sustainable sales processes that increase market share and profitability. Her ability to align sales strategy with corporate growth objectives has resulted in significant revenue improvements and value creation for companies she has partnered with.

Prior to consulting for growth oriented companies, Susie spent over two decades in executive roles leading corporate growth initiatives for multi-billion dollar companies, including spearheading a start-up sales organization in the medical field where she helped scale the company to over $2 billion before its acquisition. She has also led sales transformation efforts, working with independent pharmacies, national retailers, and private businesses to implement revenue-generating strategies. Her expertise in sales enablement, business development, and channel partnerships has made her a sought-after consultant in the industry.

Susie holds a BA from California State University, Northridge, and has completed executive education programs at Carnegie Mellon University’s Tepper School of Business and the Sorbonne University in Paris, France. Recognized as a strategic thinker and problem solver, she is often called “the voice of reason” by clients who rely on her insights to navigate complex sales challenges and unlock new growth opportunities.

Henry 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.

Loubet’s extensive background is rooted in managed care and public companies. He was the former Western Region CEO of United Healthcare (1996-2000) where he was responsible for 1.6 million members across 10 western states from California to Colorado. This included Commercial and Medicare Advantage. He had full P&L and M&A responsibility. Loubet served as President of Health Net (1989-1996) where he led health plan growth to 750,000 members and $1 billion in revenue. This included Commercial, Medicare Advantage and Medicaid with full P&L responsibilities. He was General Manager and President of Maxicare Health Plans (1986-1989), increased growth by 300%. He created and ran Valley Health Plan in Santa Clara County, a Commercial and Medi-Cal Health Plan.

Loubet was Chief Strategy Officer for Keenan (2003-2016), one of the nation’s top 20 largest Consultants/Brokers/TPAs, now owned by Assured Partners. In this role he was responsible for strategy, business development and innovation, and developed a PBM coalition with Express Scripts covering 550,000 members across 30 states, led the Kennan TPA as well as the Covered California exchange program. Loubet also served as Executive Advisor to Paladin Healthcare in 2016 where he applied his expertise to develop a managed care platform, including health insurance/physician strategy for a safety net hospital company.

In addition, Loubet was also Director of Patient Business Services at Santa Clara Valley Medical Center, affiliated with Stanford University Healthcare. Loubet was the Vice Chairman of Ohio-based Drug Emporium and DrugEmporium.com, a publicly traded pharmacy and internet company acquired by Rite Aid. Loubet also led the sale of DrugEmporium to Rite Aid.

Stephanie is a consultant with The Pharmacy Group (TPG). TPG provides consulting services to healthcare services, information technology, and pharmaceutical companies to support revenue growth and improve the financial performance of their products and services.

Stephanie brings over a decade of experience in marketing, communications, and sales support, with a strong background in CRM administration, content development, and campaign execution. She is highly detail-oriented and organized, with a proven ability to manage multiple projects, timelines, and priorities in fast-paced environments. At TPG, she supports sales and marketing initiatives while maintaining accurate, actionable sales data to drive business development efforts.

Her experience includes managing CRM and contact data, maintaining opportunity pipelines, generating reports, and supporting proposals and agreements. She also executes marketing initiatives such as email campaigns, digital marketing initiatives, newsletters, website updates, and development of marketing collateral.

Stephanie has worked closely with sales teams across multiple industries, ensuring materials, data, and communications are accurate, timely, and aligned with organizational goals. Her background spans healthcare, media, real estate, and association management, allowing her to bring a flexible and adaptable approach to client and consultant support.

Stephanie holds a Bachelor of Science in Marketing Management from Grove City College. Known for her strong organizational skills, attention to detail, and proactive approach, she is a trusted partner to consultants and clients alike.

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.

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.

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.

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.

Winston Wong 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.

Winston Wong, PharmD, is the President of the W-Squared Group. The W-Squared Group is committed to assist healthcare innovators develop their value statement and launching their technology in the government and commercial marketplace. Dr. Wong is also the current Editor-In-Chief for the Journal of Clinical Pathways, a journal committed to providing high-quality educational and informational articles as well as presenting original health economic outcomes research data to an audience of interested in utilizing clinical pathways as a tool to move towards value-based care.

Throughout his 30-year career in the pharmacy industry, he has been repeatedly recognized for his
clinical and business innovations. Dr. Wong’s accomplishments start with his leading of two separate
hospital pharmacy departments “out of the basement”, to having a more active clinical role in patient care areas. This new role of the hospital pharmacist was then implemented on a regional basis through his work accomplished at the Southern New England Region of VHA, then the largest Group Purchasing Organization in the United States. His entry into managed care was in 1994, joining United HealthCare, where he developed the first Senior Prescription Benefit offering, which was in place until the CMS Medicare Part D benefit was implemented in 2006.

As the Associate Vice President of Pharmacy Management at CareFirst BlueCross BlueShield, Dr. Wong was responsible for the development, implementation, and administration of the prescription benefit, including formulary development, contracting, including the Medicare Part D prescription benefit. He was instrumental in the development and implementation of a pharmacist driven Medication Therapy Management (MTM) program that has been recognized by CMS, and many national organizations in the Part D benefit. Dr. Wong implemented one of the first successful network-based oncology clinical pathway program where oncologists collaborated with the health plan to develop and maintain clinical pathways for common cancer types. The model was expanded into rheumatology and gastroenterology, as well as serving as a model for many oncology managements programs today.

Dr. Wong was named as one of the Top 100 Healthcare Leaders in 2018 in June 2019, and one of the Top 100 Healthcare Visionaries in 2020 in January 2021 by the International Forum on Advancement in Healthcare.

He earned his PharmD degree in 1981 from the University of the Pacific in Stockton, California, and completed a General Residency at the University of Nebraska Hospital and Clinics in Omaha, Nebraska.

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) 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.

Nancy Dickau

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.

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

BS, Economics, Pennsylvania State University

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

BS, University of Nebraska Medical Center College of Pharmacy
MS, University of Missouri at Kansas City

Professional Affiliations and Accomplishments

Member, Academy of Managed Care Pharmacy
Member, American Society of Health-System Pharmacists
Prepared dossiers using the Academy of Managed Care Pharmacy Format for Formulary Submissions

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

Advisor to the Management Game Board, Tepper School of Business at Carnegie Mellon University
Board Member, Squirrel Hill Urban Coalition

Education and Training

BS, Political Science and Psychology, Reed College, Portland, OR
MBA, Tepper School of Business at Carnegie Mellon University, Pittsburgh, PA
Continuing Education Online Courses, Healthcare Infomatics
Professional Culinary Certificate from L’Academie de Cuisine, Washington, DC

Published Works
Leon has been published in several periodicals, including Managed Healthcare Executive.

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 45 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 and Managed Healthcare Executive Editorial 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.