Thomas Kaye Email & Phone Number

Louisville, Kentucky Area

Directed pharmacy benefits and served as contact for the state Medicaid contract for Caresoruce. Provided strategic involvement in pharmacy deployment, operations and financial planning.

Louisville

management and deployment of strategic initiatives as required in the acquisition of Coventry health care of Kentucky to become Aetna better healthcare. Functioned in a multidimensional collaborative system with actions for formulary, PBM management and executive staff communications. Provided collaborative compliance as point person for the state department of medicaid. Past assignments have included 25 years of broad experiences with the Blues, Humana, Centene, Caremark and Optioncare .

Kentucky. State Regional

Humana Pharmacy Benefits

Dr. Thomas Kaye has over 30 years’ experience in pharmacy with the last 20 years specializing in Managed care pharmacy operations and management. Medicaid plans under the CMS waiver systems (1115b & 1915’s). Past engagements have been with the Blue cross and Blue Shield, Humana and other insurance like programs with base experiences in hospital, institutional and infusion pharmacy. Dr. Kaye has been involved with several areas of plan operations including; medical management, actuary, disease management, billing, operations, 340b, specialty pharmacy PBM sales /contracting, data analytics and benefit design. He has designed and implemented programs that affect the positive outcomes of high risk pregnancy, substance abuse and mental health utilization with lower overall costs.Populations served includes, self-insured accounts, large union, small employers and individual markets. PSO, PPO, HMO Medicaid and Medicare parts, A, B, C and D with Duals and non-dual SSI populations. As an author and contributor to several healthcare magazines the topics have been published in many national healthcare publications and digests that cover management topics, utilization monitoring and measures for improved outcomes. Dr. Kaye is a sought after consultant for operations, payments and distribution of pharmacy services in the USA and European markets.Dr. Kaye is knowledgably regarding both PBM operations, specialty pharmacy and medically managed pharmaceuticals. He has designed and implemented several programs that enable the use of decision making choices, benefit designs while maintaining the cost structure mitigation to the plan or group. He had implemented programs for enhanced provider reimbursement and is currently engaged with several areas surrounding state exchanges and Accountable care models for strategically alignment with financial risk sharing among the variable partner’s.

Louisville, Ky

• Strategic consulting for pharmacy benefit design and deployment• Competitive intelligence in pharmacy for new product ideas• Team lead for utilization measures, measure and analytical report design• Group consultation, benefit determination and projections of financial outcomes• Client facing and discussions for benefit decision and deployment• Participant with HRSA in development and deployment of RoOp registry concept ( A federal registry program funded by NIH)• Strategic consultant for Humana’s account executives with pharmacy services• Pharmacy and therapeutics member

Lexington, Kentucky Area

This position provides guidance and strategy to end user accounts and purchasers of pharmacy products for the insured benefit. Based in the concept of consumer empowerment, offers unique and cost effective solutions for benefits.

 Chaired two P and T committees &, member of the national Medicare P& T  Projects costs and department financial performance Demonstrates financial accountability, trends and forecasts Evaluates budgets, new technology, medication, therapies Creative problem solving solutions and innovative approaches to problems• Direct reports-with facultative staffing for support• Responsible for budget attainment and plan savings for pharmacy• Collaborate in financial outcomes expectations with the CFO• Prepare algorithms for step and prior authorizations • Performs utilization analysis, financial trending and development of programs for cost avoidance• Local development for Medicare Part D project (MA-PDP/SNP- process engagement• Experience with processes for compliance with CMS, financial needs (Plan to Plan) and actuarial requirements (PDE’s) in association with the PBM. • Chair of the Fraud wasted and abuse committee to monitor and approach requirements

 Chaired two P and T committees &, member of the national Medicare P& T  Projects costs and department financial performance Demonstrates financial accountability, trends and forecasts Evaluates budgets, new technology, medication, therapies Creative problem solving solutions and innovative approaches to problems• Direct reports-with facultative staffing for support• Responsible for budget attainment and plan savings for pharmacy• Collaborate in financial outcomes expectations with the CFO• Prepare algorithms for step and prior authorizations • Performs utilization analysis, financial trending and development of programs for cost avoidance• Local development for Medicare Part D project (MA-PDP/SNP- process engagement• Experience with processes for compliance with CMS, financial needs (Plan to Plan) and actuarial requirements (PDE’s) in association with the PBM. • Chair of the Fraud wasted and abuse committee to monitor and approach requirements

• Management of the pharmacy benefit program for all lines of business (Commercial, Managed Medicaid, Managed Medicare, Medicare supplemental plans, consulted for self insured and Worker comp). • Co-chair to the Pharmacy and Therapeutics committee• Actively participate with sales and marketing to assist in benefit structures design, co-pay ranges, provide structural / actuarial information for utilization and pharmacy consultation. • Projects management for the successful for implementation of a new pharmacy benefits management service; Home IV care contract design, and development of a three-tier pharmacy co-pay benefit using fixed co-payment and co-insurance characteristics.• Interfaced with state regulatory officials as needed.• Implemented two transitions with new PBM’s - selection, validation, operations and concordances were achieved.

• Management of the pharmacy benefit program for all lines of business (Commercial, Managed Medicaid, Managed Medicare, Medicare supplemental plans, consulted for self insured and Worker comp). • Co-chair to the Pharmacy and Therapeutics committee• Actively participate with sales and marketing to assist in benefit structures design, co-pay ranges, provide structural / actuarial information for utilization and pharmacy consultation. • Projects management for the successful for implementation of a new pharmacy benefits management service; Home IV care contract design, and development of a three-tier pharmacy co-pay benefit using fixed co-payment and co-insurance characteristics.• Interfaced with state regulatory officials as needed.• Implemented two transitions with new PBM’s - selection, validation, operations and concordances were achieved.

Bachelor Of Science (Bs)/ Doctor Of Pharmacy Licensure In Several States, Pharmacy Administration With Mba For Marketing And Finance

Activities and Societies: International marketing and operational characteristics of organizations

Bachelor'S Degree, Biology And Pharmacy