Matthew Respicio Email & Phone Number

•Review medication coverage requests and assess the medical necessity against the plan’s formulary and policy criteria for pharmacy and medical drugs across multiple lines of business (i.e., commercial, exchange, government)•Complete peer-to-peer interactions with providers to discuss member-specific situations and assess medical necessity based on current clinical guidelines and policies•Precept pharmacy residents in analyzing coverage determination history to make recommendations on medication utilization management improvements to streamline the policies and reviews•Update medication policies based on new indications and clinical guideline changes•Review new medication approvals and provide evidence-based formulary recommendations and management strategies to the pharmacy and therapeutics (P&T) committee•Provide prior authorization (PA) review training for new pharmacists and pharmacy residents on appropriate application of current guidelines, utilization management, and policies when making coverage determinations (i.e., PA, appeals, peer-to-peer) •Assisted the transition between PA review platforms to ensure translatable workflow changes and ongoing feedback to improve system efficiency

• Review stability and excursion information to determine viability of medications outside of manufacturer recommendations and discuss escalated situations with patients and healthcare providers to determine course of action• Created new manufacturer replacement process to reduce loss and reshipments• Communicate with drug manufacturers and insurance plans to facilitate drug replacements on behalf of patients and healthcare providers• Review other departments’ processes and recommend changes to address gaps, optimize efficiency, and notate accountability• Collaborated to establish all standard operating procedures as part of the initial logistics department with aim to decrease unwarranted company loss• Supervise technician specialists on the process of reships, returns and coaching• Document interactions and outcomes in the patient record to ensure continuity of care

• Review patient records and medications to assess appropriate use of therapy• Effectively counsel patients about complex medication therapies, in compliance with clinical program protocols (i.e. REMS programs and pharma contract medications)• Clearly communicate with care team to answer inquiries and obtain necessary information to process prescriptions and address therapeutic concerns• Precept pharmacy students and developed a course outline for student rotation• Obtained additional licensure to allow compliance for provision of pharmacy services outside the state of Oregon

• Effectively address patients’ healthcare related questions and concerns • Optimize care by ensuring individualized patient counseling on new medications• Work in a high-volume pharmacy processing approximately 300 prescriptions daily• Competence in third party billing and troubleshooting of problems