Business Owners
You would knock on this BO's door for RxClaim capabilities, including compounds and COB, and anything related to RxClaim adjudication enhancements.
Who is: Marty Mangin
This lawyer handles PA/Appeals inquiries. She also was a former colleague within RA.
Vielka Velazquez
New legislation prohibits plans from invoicing drug manufacturers. What functional area would you engage?
What is: Rebates
This HAW behavior focuses on what matters the most to our customers, and empowers those colleagues closest to the work to make the right call.
What is: Create Simplicity
This 2022 implementation highlighted the need for an enhanced, cross-functional workstream, to ensure claims only paid for registered pharmacies and prescribers.
What is: NY Roster
This BO handles UM Development related requests. She works with the P&T committee and drafts criteria.
Who is: Jessica Kubilius
This lawyer is our go-to for all Anti-Steerage aka Restricted Network Mandates.
Who is: Missy Taylor.
A new requirement for a public posting of drug criteria. What functional business area would this fall to?
What is: Digital
This HAW behavior allows colleagues to work across teams to provide the best care possible.
What is: Join Forces
These states passed legislation to move to a Single PBM in 2022.
Who are: LA and OH
This BO recently replaced Michael Brodeur, and is RA's new POC for Mental Health Parity Reporting.
Who is: Reina Natero
This lawyer's specialty includes: pharmacy contracting, provider manuals, and specialty. He also has the most epic out-of-office replies within the company.
Who is: Michael Mone
A requirement asks that no other pharmacies, hospitals, or providers are listed on a member's plan documents (including ID cards). What functional area would you engage?
Who is: Marketing
This HAW behavior focuses on being customer obsessed.
What is: Put People First
These states passed legislation last year, which required CVSC to update EOB capabilities.
Who are: NY, CT, and CA.
We would engage this BO when dealing with language within our Exchange or Commercial PBM contracts.
Who is: Matt Oesterle
This lawyer is the star of our PAC call.
Who is: Tara Lynn Danforth
Who is: Networks/ Geo Access
This HAW behavior requires colleagues to act swiftly and adapt to feedback, to take smart risks, and be innovative.
What is: Rise to the Challenge
This 2022 implementation picked up from an older 2019 implementation, but now impacting ERISA plans.
What is: OK 2632 Mulready
These 2 BO's were introduced to us in 2022, and handle all things UW related, including: client pricing and network changes.
Who are: Cherylanne Kolmin and Roselyn Shuey
This lawyer is our Medicaid legal expert. Note: has never played Catwoman.
Who is: Christine Pfeiffer
True or False: Clients can customize our template formulary.
What is: False
(this would make client custom, resulting in financial impact)
This HAW focuses on doing the right thing, even when it's hard.
What is: Inspire Trust
True or False: Our team completed 332 records in 2022.
What is: TRUE