ANISH PATEL
Oakland Gardens,NY
Summary
Managed care pharmacy strategy executive with deep PBM, trade, formulary, and rebate expertise and a proven record of identifying growth opportunities, building data-backed business cases, and shepherding new initiatives to in-market launch. Combines supply-side fluency in manufacturer contracting, rebate strategy, biosimilar conversion, and formulary innovation with the financial and analytical rigor to design self-sourced analyses, quantify value, and present clearly-articulated business cases to senior enterprise stakeholders. Adept at ‘seeing around corners' on market and drug-trend shifts, influencing cross-functional partners, and producing executive thought leadership within complex, matrixed healthcare organizations.
Overview
14
14
years of professional experience
Work History
Director of Pharmacy
Fidelis Care / Centene Corporation
New York, NY
03.2018 - 02.2026
- Led trade, formulary, financial, and growth strategy for New York market pharmacy operations across Medicare, Medicaid, Marketplace, and Child Health Plus — spanning manufacturer and PBM strategy, rebate and biosimilar programs, business case development, cross-functional launches, and executive thought leadership within a large matrixed enterprise.
- Identified, built business cases for, and launched new formulary and trade initiatives across Medicare, Medicaid, Marketplace, and Child Health Plus — self-sourcing data through trend analysis, custom data pulls, and stakeholder input to back each case with clearly-articulated assumptions and quantified value.
- Produced executive-ready monthly KPI and financial performance reviews for the Health Plan CEO, VP of Finance, and Plan CFO, and prepared thought-leadership responses for senior enterprise stakeholders — translating drug trend, trend drivers, PA volume, and utilization patterns into actionable strategy and 'see-around-corners' market insight.
- Exceeded 2021 pharmacy savings target by $9M, delivering $41M against a $32M goal, and increased projected savings from $25.5M to $42.8M by prioritizing and executing additional high-impact formulary and trade opportunities.
- Built and defended data-driven formulary business cases, including a generic ICS/LABA strategy generating $4.36M, designing the supporting analyses in Excel and presenting recommendations to leadership in PowerPoint.
- Delivered $5M favorable Medicare pharmacy financial performance for the New York market by monitoring trend, utilization, vendor performance, and cost drivers in partnership with market and enterprise stakeholders.
- Developed and scaled preferred biosimilar trade strategies for Avastin, Herceptin, Rituxan, infliximab, and Humira, growing market-specific initiatives into broader enterprise programs that generated $10M+ in savings with targeted biosimilar uptake above 70%.
- Negotiated and evaluated manufacturer rebate opportunities, biosimilar conversions, and preferred-product strategies, aligning trade economics with clinical access, operational feasibility, and regulatory requirements.
- Partnered with Centene Pharmacy Services to incubate a Child Health Plus formulary strategy — Humira brand removal and biosimilar conversion — generating an estimated $1M in annual savings.
- Resolved a critical Semglee supply disruption by engaging manufacturer and wholesaler partners directly to restore inventory within one week, preserving $1.5M in monthly conversion savings.
- Advanced site-of-care strategy across lines of business, transitioning eligible infusions to home infusion and specialty channels — increasing home infusion utilization 30% and reducing drug costs 20%.
- Chaired Pharmacy & Therapeutics Committee governance, including therapeutic class reviews, criteria updates, and NCQA-compliant formulary and utilization management oversight.
- Incubated and launched new growth programs end-to-end — including the Conversio COPD care management program (vendor contracting, IT security, CMS-approved communications, implementation) projected to save $9M annually — by influencing cross-functional partners and driving project management to in-market launch.
- Engineered pharmacy integration for the New Century Health oncology platform launch, mapping 120+ HCPCS/J-codes within Facets to enable prior authorization, case routing, and operational readiness.
- Oversaw PBM governance and Express Scripts vendor management, maintaining service levels above 99% through quarterly business reviews and cross-functional escalation resolution.
- Reduced claims processing errors 80% during the New York market PBM transition from CVS to Express Scripts by coordinating stabilization, coding corrections, and escalation resolution.
- Led Centene integration and blueprinting, transitioning 80 pharmacists and 35 technicians to a centralized MHK shared-services model while aligning workflows and controls across markets.
- Directed WellCare Medicaid integration onto the Fidelis platform, executing grandfathering and formulary comparisons that prevented disruption for 8,000+ members and converted 5,000+ seamlessly.
- Built and led pharmacy teams, managing daily activities, goals, and priorities while mentoring 34 direct and indirect reports and scaling operations from 12 to 225+ employees across clinical, quality, operational, and financial workstreams.
- Founded and led Fidelis Care's Managed Care Pharmacy Residency Program (2012–2024), building a structured talent pipeline across 8 rotations and integrating it into Centene's national residency structure in 2025.
- Directed New York market quality strategy across Medicare Stars and Part D adherence — implementing RxAnte and RxEffect programs that improved adherence measures and contributed to a 4-star overall contract rating.
- Developed strategic initiatives to optimize formulary management and reduce costs.
Clinical Pharmacy Manager
Fidelis Care of New York
Rego Park, NY
03.2012 - 02.2018
- Managed clinical pharmacy operations, formulary strategy, rebate negotiation, utilization management, and cost-savings initiatives across Medicaid and Medicare.
- Managed a monthly pharmacy budget exceeding $150M, supporting financial planning, trend analysis, and executive reporting.
- Negotiated rebate opportunities generating $6M in annual savings and built a specialized HIV/Hepatitis C clinical pharmacy team delivering $20M in annual savings.
- Reduced Medicaid pharmacy PMPM by $5.46 within 30 days through targeted formulary redesign and cost-containment interventions.
- Improved the Medicare rheumatoid arthritis Star measure to 5 stars in 2016 and advanced adherence measures to 4 stars, supporting a 4-star overall rating and $40M in CMS Quality Bonus Payments.
Education
Doctor of Pharmacy -
Philadelphia College of Pharmacy And Science
Philadelphia, PABachelor of Science - Pharmacy
Philadelphia College of Pharmacy And Science
Philadelphia, PASkills
- Trade Strategy
- Formulary Innovation
- Growth Strategy & New Venture Launch
- Business Case Development
- Manufacturer Contracting & Trade Relations
- Rebate & Market Access Strategy
- PBM Strategy & Governance
- Pharmacy Financial Strategy
- Drug Trend & Market Insights
- Self-Sourced Analytics & Custom Data Pulls
- Specialty & Biosimilar Strategy
- Site-of-Care Strategy
- Cross-Functional Execution & Project Management
- Executive Presentations & Thought Leadership
- Microsoft Excel
- Microsoft PowerPoint
- Team Leadership & Talent Development
- Medicare Part D
- Medicaid
- Marketplace/ACA Exchange
- Drug utilization review
- Pharmacy benefit management
- Problem-solving
Personal Information
Title: PharmD, BCPS
Academic And Professional Affiliations
- Assistant Clinical Professor of Pharmacy Practice, Arnold & Marie Schwartz College of Pharmacy, 2004–2026
- Managed Care APPE Preceptor, St. John's University, 2004–2026
- Academy of Managed Care Pharmacy (AMCP)
- American Society of Health-System Pharmacists (ASHP)
Timeline
Director of Pharmacy
Fidelis Care / Centene Corporation
03.2018 - 02.2026
Clinical Pharmacy Manager
Fidelis Care of New York
03.2012 - 02.2018
Doctor of Pharmacy -
Philadelphia College of Pharmacy And Science
Bachelor of Science - Pharmacy
Philadelphia College of Pharmacy And Science