Services
Tier 1 Pharmacy Consulting's services are customized and beneficial for healthcare plans of all shapes and sizes. We can provide the right level of support when you need it most. Explore our core services below to see how we can support your organization.
Expertise That Fits Your Plan
Plans don’t always need another vendor; they need a trusted partner who can step in with proven experience. Tier 1 Pharmacy Consulting works alongside your team to address immediate needs and build long-term stability.
Interim Management
For many health plans, pharmacy leadership is critical but difficult to secure, whether due to size, budget, or a lack of available expertise. I step in to provide fractional executive leadership, working side by side with your team to ensure operations and compliance run smoothly. These partnerships often evolve into multi-year partnerships because they deliver both stability and relief. This also allows other senior executives to focus on their priorities without worrying they’re missing something in pharmacy.
Medicare Application Support
The Medicare Part D application process is complex and often difficult to navigate. Many health plans need pharmacy expertise but aren’t ready to add full-time staff. I partner directly with plans to complete application requirements and provide support with PBM relationships and delegation discussions to ensure every detail is aligned. This approach makes the process more efficient and less stressful, while also helping teams understand what each part of the application means for their health plan.
Regulatory Audit Support
Regulatory audits can be some of the most labor-intensive activities a Medicare plan faces, often lasting for months and demanding extensive attention from staff. CMS oversight spans multiple areas, including program audits, PDE audits, financial audits, formulary administration audits, BID audits, and more.
I partner with plans to prepare for and manage these reviews—validating data, interpreting submissions, identifying potential issues, and supporting responses to CMS inquiries. I also assist with remediation and corrective action planning when findings occur. My goal is to reduce the burden on internal teams by providing the additional bandwidth and expertise needed to navigate these complex audits efficiently and effectively.
Clinical Performance Management
CMS requires all health plans to have substantive policies and procedures in place to ensure proper compliance, including effective P&P for all first-tier downstream delegated entities (FDRs) like the PBM.
Tier 1 supports health plans through maintenance and enhancement to any compliance program that is currently in place for the pharmacy side of the health plan. We review and understand the impact to health plans as it relates to the ever-changing regulatory landscape.
We also support monitoring and audit activities to ensure all obligations and requirements are met. Our team can identify any potential risk areas that may be inadequate or need enhancement to ensure compliance. Many complaints, after all, revolve around prescription benefits. We can help craft responses or generate corrective action if there are gaps. We also can administer an effective FWA program that monitors prescription activity to avoid fraud or abuse.
Part D Clinical Stars Improvement
Performance on Part D Star measures is critical, particularly those tied to adherence, MTM, and statin utilization. I work with health plans to actively monitor their performance and identify where improvements are needed, offering hands-on support to implement initiatives designed to raise scores. This includes helping strengthen adherence programs, supporting vendor relationships, and developing workplans that are practical and results-driven. My focus is on building tailored strategies that improve performance today while putting processes in place for sustained success.
Medicare Part D Training
For many health plans, Medicare Part D can feel overwhelming, especially when the pharmacy team is new to Medicare or has limited experience with the Part D program. I provide customized training that helps teams understand the regulatory requirements, how PBM delegations fit into compliance, and where the plan itself must take ownership.
Training can cover areas such as claim adjudication, formulary requirements, coverage decisions, and benefit design. Whether it’s targeted education for pharmacy staff or broader training for the entire organization, I tailor sessions to ensure teams gain the knowledge they need to effectively manage the Part D benefit.