There was a significant increase in pharmacy fraud and abuse under the pandemic, analysts at OptumRx say.
The pharmacy benefit manager giant recovered $300 million in fraud, waste and abuse spend in 2020 and documented the largest ever increase in fraudulent claims, which were up 300% compared to 2019.
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.
Tricia 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.
Tricia currently works at 986 Pharmacy in Van Nuys, CA. She is the lead pharmacist for monkeypox vaccine clinics and multiple COVID-19 vaccination sites in collaboration with Los Angeles County. She also precepts intern pharmacists, supervises nurses giving vaccines, checks for conflicts and contraindications for patients getting vaccinated, and counsels patients.
Concurrently, Tricia works at the USC School of Pharmacy, in who’s pioneering COVID-19 vaccine clinic she has served as a lead pharmacist since its inception in 2001. She administers vaccines, maintains CDC compliance as regulations change, and conducts orientation and training for students and medical volunteers. Tricia also worked at CVS Health running vaccination clinics at different in-store locations and verifying prescriptions, dispensing, vaccinating, counseling, and opening/closing the pharmacy.
Tricia is President of the San Gabriel Valley Pharmacists Association, a chapter of the California Pharmacists Association. She is a member of the San Fernando Valley Chapter of CPhA, and of CSHP. Tricia is also a clinical assistant professor of pharmacy practice & administration at Western University of Health Sciences.
Tricia holds an Associate of Science, Advertising Art degree from Glendale Community College in Glendale, CA, Bachelor of Arts, Music and Bachelor of Arts, Biological Sciences degrees from the University of Southern California in Los Angeles, CA, and a Doctor of Pharmacy degree from Western University of Health Sciences, College of Pharmacy in Pomona, CA. She is a licensed pharmacist in the state of California.
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.
Dr. Milgram is a Physician 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.
Dr. Milgram is a board-certified internist and was the Chief Medical Officer of Sharp Community Medical Group (SCMG). Her main roles and responsibilities centered on the Triple Aim of Health plus one. She was responsible for improving the health of the population, the patient experience, bending the cost curve and improving provider engagement and satisfaction. As part of the C-suite, Dr. Milgram sat on the Executive Committee and was part of the team tasked with the goals for the group, including growth and development, improving quality, and controlling costs. She had oversight of all clinical activities including Pharmacy, Care Transitions, and Population Health.
Prior to joining SCMG, Dr. Milgram held the position of Medical Director both with CIGNA of California and United Health Care. While in private practice, Dr. Milgram served as Medical Director of Harbor View Medical Center’s Total Life Care Clinic. She was also one of the founders and the Medical Director of a multi-specialty medical group, Uptown Medical Group, and served on the board of directors as Vice President.
Dr. Milgram has served as Executive Editor and Guest Editor of continuous education programs in the areas of dermatology and oral contraceptives. She has served as a board member of the South Coast Tumor Institute in San Diego. Dr. Milgram has consulted on various advisory boards in the areas of Oncology, Immunology, Neurology, Genomics and Rheumatology. Most recently, she has been on the steering committee for all things COVID at her IDN.
Dr. Milgram earned her undergraduate degree from Queens College of the City University of New York. She completed her MD degree from La Universidad Autonoma de Guadalajara and her MBA degree from San Diego State University.
Christine 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.
She is a self-disciplined, experienced professional with over 25 years of experience in pharmacy, population health, and managed care who is passionate about healthcare and delivers exceptional results through strategic thinking, creative problem-solving, technology, and innovation to improve outcomes to address individual health needs and improve the health of others. She is adept at leveraging excellent communication and interpersonal skills to collaborate with diverse stakeholders at all organization levels.
Christine was recently the Senior Vice President of Operations and Innovation for RxAdvance. During her tenure, she served as the Executive Account Sponsor and Clinical Account Manager for local, regional, and national accounts. She coordinated with other clinical, benefits, and technology stakeholders to ensure operations were performed effectively and efficiently, and assisted with the development of clinical programs and services that aligned with the organization’s strategic goals and initiatives to further growth and innovation, optimize revenue, and mitigate risk.
Prior to her work with RxAdvance, she held positions at Avera Health Plans, DAKOTACARE, Avera McKennan Hospital & University Health Center, Sioux Valley Hospital & Health System, Kaiser Permanente Clinic, and Walgreens. She is a member of the Academy for Managed Care Pharmacy (AMCP), the American College of Clinical Pharmacy (ACCP), the American Society of Health-System Pharmacists (ASHP), and the American Pharmaceutical Association (APhA).
Christine holds a Bachelor of Science in Pharmacy from South Dakota State University and a Doctor of Pharmacy from the University of Minnesota. She recently obtained her Master of Healthcare Administration with Population Health Focus from Colorado State University-Global Campus. She is a registered pharmacist in South Dakota.
Kathleen 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. As a trained pharmacist, health economist, and outcomes researcher, Kathleen brings three decades of diverse experience and leadership in delivering new products, programs, and services to market within the global healthcare sector.
She is an experienced professional who has demonstrated ability in overcoming complex challenges across biopharma manufacturer, molecular insights, diagnostics, healthcare provider, and payer organizations. She has an intimate understanding of stakeholders’ needs and motivations to affect change by aligning organizational objectives. Kathleen has broad understanding of healthcare outcomes research and analytics, business intelligence applications, and user adoption. She is a passionate leader who has led large and small strategic, customer-focused, operational, and technically focused teams. With a calm, collaborative, and supportive leadership style, Kathleen brings a sense of urgency and focus to developing and implementing solutions with demonstrable results.
Kathleen has had many key career experiences that have shaped her tenure in healthcare. She has experiences across various organizations in developing and launching new products, programs, and services based on evolving market and customer needs. She has led large scale strategic, cultural, and operational transformation for a global team, with significant internal, cross-functional, and external stakeholder impacts. She’s led large patient, provider, and customer support teams across multiple products, producing continual operational efficiencies, meeting, or exceeding budget commitments, and addressing evolving quality and compliance requirements.
Kathleen has had an impressive 30-year career and most recently served as the Chief Commercial Officer, AI for Foundation Medicine. She previously held positions at Roche, Genentech, AmerisourceBergen Specialty Group, Lash Group, Aetna, Inc., and Prudential HealthCare. Ms. Kaa served on the Board of Directors for the Academy of Managed Care Pharmacy, the Board of Trustees for the AMCP Foundation and held the role of President for the Managed Care Network.
Kathleen holds a Bachelor of Science degree in Pharmacy from the University of Washington in Seattle, Washington and a PhD in Pharmacy Administration, Economics from the University of South Carolina in Columbia, South Carolina.
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.
Brian 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.
Brian Butler serves as Vice President, Business Development for OneOme and has over 22 years of experience in the healthcare industry with a primary focus in managed care, drug pricing, pharmacy benefits, and pharmaceutical value chain consulting. Brian works with employers, consultants, and channel partners as a trusted advisor to improve return on pharmacy benefit investments, consult on lowering total cost of care, and advise on healthcare innovation. Brian is known as a collaborator, change agent, and is particularly passionate about people. In his role at OneOme, Brian promotes personalized medicine through OneOme’s RightMed family of pharmacogenomics solutions.
Prior to his work at OneOme Brian served as the Vice President, Client Development at Flipt where he executed client and channel partner sales strategies leading to revenue growth exceeding $5M. He monitored industry trends, shared competitive intelligence, and facilitated the overall sales process. He also held leadership positions at Cardinal Health, Cigna, CVS Health, and Wellmark BCBS. At Cigna, Brian managed national account clients with total organizational revenue of $2.5B across 1.5M commercial members.
Brian currently volunteers with the Junior Achievement of Iowa. He was a member of Cigna’s Gold Circle for two years and was awarded the Dale Carnegie Highest Award for Achievement.
Brian holds a PharmD and a Master of Business Administration from Drake University in Des Moines, IA.
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.
K.C. is 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.
She is a creative, confident, and high performing pharmaceutical professional with over 20 years of experience building and maintaining relationships, developing new markets, driving revenue growth, and improving aggressive market positioning. She has proficiency in all areas of account management —vision through strategies, tactical plans, communication, protocols, market knowledge, and successful negotiations. K.C. shows solid leadership competencies with particular strengths in overall team involvement, leading without authority, and customer service for both internal and external stakeholders.
K.C. is in her sixth year with Xcenda as the Director, Outsourced Market Access Account Executive where she represents pharmaceutical companies as their Market Access Account Executive and supports development and execution of client market access strategy for initial drug launch, new indication, and/or post-launch account management and drives medical policy and reimbursement discussions with the payer community. Her previous roles with Xcenda include Customer Success Manager for FormularyDecisions and On-Call Market Access Strategic Account Executive Consultant.
Prior to her work with Xcenda, K.C. has held positions at Bristol Myers-Squibb, Boehringer Ingelheim, Daiichi Sankyo, Genzyme Biosurgery, GlaxoSmithKline, and Diversified Pharmaceutical Services.
K.C. holds a Bachelor of Science degree in Business Management from Cardinal Stritch College in Milwaukee, Wisconsin.
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.
Kari Ratkevich is a consultant with The Pharmacy Group (TPG). Kari’s broad range of pharmacy experience spans over 29 years. Kari has a proven track record for successful sales increases, inventory and purchasing, and minimizing pharmacy expenses and operational costs in retail pharmacy.
Prior to joining TPG, Kari worked at a CVS/Target Pharmacy in Irvine, CA as a Pharmacy Manager for 15 years. While there, Kari managed daily operations of the pharmacy that generated $1,800,000 in annual revenue. Daily operations included: sales, budgeting, dispensing prescriptions, ordering, inventory control, administration, recruiting, loss prevention, workflow management, quality assurance, patient safety, and regulatory compliance. Kari also counseled patients and implemented vaccination clinics.
Before working with CVS/Target, Kari spent 14 years with Longs Drug in Tustin, CA as a Pharmacy Manager. While with Longs, Kari coordinated a growth project at 27 Longs Drug locations that emphasized patient loyalty to build business. She was in charge of daily operations of the pharmacy with $800,000 in annual revenue. Kari also acted as a liaison between patients and their healthcare providers by offering patient counseling.
Kari also served on the California State Board of Pharmacy Competency Committee for 7 years.
Kari earned her Doctor of Pharmacy degree from The University of Southern California. She completed clerkships in psychopharmacy, community pharmacy, medicine, antimicrobial medicine, ambulatory care, and home healthcare. Kari is a licensed pharmacist in the state of California.
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.
Dr. Kaufman 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.
Dr. Kaufman is an established, trusted advisor, licensed medical professional, and senior executive with a career’s worth of experience successfully navigating the complexities of healthcare frameworks in clinical, corporate, and customer-centric spaces—building, leading, and driving high performing teams that consistently deliver notable bottom-line results.
He has been a senior health care executive for over 25 years. He began his executive career as the inhouse counsel for Hawthorne Community Medical Group, at the time the 5th largest medical group in the US and the owner of Maxicare, where he also practiced pediatrics. Subsequently he has served as the Chief Medical Officer of Harvard Pilgrim Health Care, WellPoint Health Network, PacifiCare, Private Health Management and Alameda Alliance. In these roles, he has had extensive experience with Medicare Advantage, MediCal, and commercial lines of business and was accountable for medical management, quality of care, regulatory compliance, population health, behavioral health, pharmacy, and healthcare data analytics
He has most recently served as the Chief Medical Officer for Astitva Health where he was responsible for setting up and overseeing the Medical Services Department, establishing and fostering an integrated relationship with its Pharmacy Benefit Manager (PBM), and developing a Chronic Condition Special Needs Plan (C-SNPs) initiative that promotes health plan inclusivity and expands its reach to individuals facing specific severe or disabling conditions.
Dr. Kaufman currently holds his medical license in the state of California and is a member of The American Academy of Pediatrics and The California Bar Association.
Dr. Kaufman received his Bachelor of Arts from Columbia University. He received his Doctor of Medicine from Yale University Medical School and his Juris Doctor from Harvard Law School.
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.
Helen is a Senior Consultant with TPG Healthcare Consulting (TPG-HC). She has a track record of developing successful businesses and teams and advancing effective use of medications. She has over 25 years of healthcare experience as a practicing pharmacist, clinician, consultant, and healthcare services leader. She has represented billions of dollars in pharmaceutical purchasing decisions for Fortune 50 companies, international employers, federal and state funded programs, health plan associations, healthcare systems, health plans, and a US intelligence agency. Helen is a visionary with experience in strategic planning and implementation, including startup companies; she is a published international speaker and instructor on the US healthcare system and pharmaceutical market access.
Most recently, Helen was the Executive Vice President & Chief Pharmacy Officer of WithMe Health in San Mateo, California. While there, Helen was a key officer with the startup medication guidance company (an alternative to traditional pharmacy benefit mangers) building modern technology to personalize medication use. She developed and lead contracting, underwriting, pricing analytics, and an evidence-based clinical program model for startup personalized medication guidance service.
Other relevant work experience includes seven years at Solid Benefit Guidance/Arthur J. Gallagher & Co (AJG) in Montvale, New Jersey as the Senior Vice President & Chief Pharmacy Officer, Pharmacy Consulting. She spent 16 years at RegenceRx/Cambia in Portland, Oregon in several leadership roles and co-founded the RegenceRx, Cambia 250 employee captive pharmacy benefit manager that served over two million Cambia members, Blue Cross Blue Shield of Michigan, BlueCross BlueShield Federal Employees Program, and several PBMs and generated $1.2 billion in annual revenue.
Helen was an instructor for ISPOR (International Professional Society for Health Economics and Outcomes Research). Also, heavily involved with AMCP (Academy of Managed Care Pharmacy) where she is a member, on the Education Affairs Committee, and on the formulary format Committee. She is also a member of BCBSA (Blue Cross Blue Shield Association and NCPE (National Council for Physician and Pharmacist Executives).
Helen is a licensed pharmacist in the state of Oregon. She received her Bachelor of Science in Pharmacy from Oregon State University and her Doctor of Pharmacy from Purdue University. She completed her Pharmacy Residency Certificate at Legacy Good Samaritan Hospital & Medical Center and her Pharmacy Fellowship Certificate at the State University of New York.
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.
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.