Parixit Modi

About Parixit Modi

With a robust background in pharmacy operations and healthcare management, my role at Optum has been to drive strategic initiatives and implement process efficiencies that enhance Medicare and commercial clinical pharmacy programs. We\'ve achieved departmental goals with over 99% accuracy in prior authorization reviews and effectively contained IREs.As a pharmacy consultant, I leverage my industry expertise to guide pharmaceutical industries, independent research firms, and healthcare providers through the market launching pricing strategies including PA criteria, rebates, and contracting. My contributions to market surveys and cost-benefit analyses have yielded meaningful outcomes for pharmaceutical manufacturers, reflecting my commitment to elevating healthcare standards.As a PBM & Market Access Strategy Consultant, I:* Help pharmaceutical manufacturers and investors understand PBM decision-making, optimize formulary positioning, and develop effective market access strategies.* Provide an insider\'s perspective on PBM formulary committee operations, rebate negotiations, utilization management tactics (prior authorization, step therapy), and network design.* Discuss Payer Strategy such as Formulary Tiering, Rebate Contracting, Value-Based Agreements.* Highlight Utilization Management such as PA Criteria Development, Step-Edit Logic, Medical vs. Pharmacy Benefit Dynamics.* Build Go-to-Market/Launch Strategy surrounding Payer-Centric Value Propositions, Pre-Launch Payer Engagement, Pricing & Reimbursement Analysis.* Provide competitive intelligence on PBM response to new drug entities, biosimilar interchangeability, and formulary defense strategies.* Offer Real-World Evidence (RWE) of Payer Perspectives on RWE Study Design and Data Requirements for Formulary Inclusion.Check my resume here: https://gemini.google.com/share/70e5718d5829

Experience

1. Executive Leader, Pbm Operations

   Optum

   Apr 2021 — Present · AZ, US

   Provided strategic and operational oversight for all aspects of UHC\'s Medicare clinical pharmacy programs, including Part D, Part B, and stand-alone prescription drug plans• Design and develop core PBM functions, including claims processing, formulary management, drug utilization review, and clinical programs• Participated in and provided strategic insights to the Pharmacy and Therapeutics (P&T) Committee, contributing to formulary decisions and ensuring alignment with clinical guidelines and overall program goals.• Directed the planning, development, and implementation of clinical initiatives targeting IRE reduction, drug utilization management, and quality improvement, consistently exceeding departmental goals of 99% accuracy in prior authorization reviews and containing the IREs to below the allowed limit• Hiring, supervising, and leading 40 pharmacists, overseeing training, quality, morale, and performance, ensuring the highest standards of work experience with career growth, life and work balance, and work ethics, maintaining job satisfaction and intent to stay rate of perfect 100%• Educating medical directors, auditors, and other personnel regularly, increasing understanding and alignment that positively and consistently enhances program efficiency by more than 20%• Serving as a liaison between the operational staff and various teams that design formulary and clinical guidelines, ensuring a flawless transition and compliance with government regulations, maintaining PGs• Developing action plans to mitigate risks in decision making while improving profitability using data science, for example, restructured pharmacist log monitoring process that reduced costs by 80%• Serving as a subject matter expert and partnering with managers, supervisors, and directors to obtain URAC accreditation and resolve complex prior authorization issues• Review forecasts, presenting them to the Medical team for staffing needs and account Management for approval

Education

• West Texas A&M University

  Master of Business Administration - MBA, Health/Health Care Administration/Management

  2017 — 2021

• Oakton College

  pre-pharmacy, Pre-Pharmacy Studies

  2001 — 2003

• University of Illinois Chicago

  Doctor of Pharmacy (Pharm.D.), Pharmacy

  2003 — 2007

Skills

• Writing
• Patient Counseling
• Team Leadership
• Compounding
• Cpr Certified
• Acting
• Pharmaceutics
• Immunization
• Leadership
• Management
• Community Pharmacy
• Prescription
• Certified Immunizer
• Diabetes
• Patient Safety
• Customer Satisfaction
• Training
• Medication Reconciliation
• Infectious Diseases
• Mail Order Pharmacy
• Pharmaceutical Care
• Inventory Management
• Medicare Part D
• Pharmaceutical Industry
• Dance
• Anticoagulation
• Pharmacy Benefit Management
• Drug Interactions
• Customer Service
• Pharmacy
• Medicare
• Medication Adherence
• Healthcare
• Pharmacists
• Pharmacy Practice
• Medicaid
• Quality Assurance