DEBORAH TOGA
Pasadena,CA
Summary
Patient access and field reimbursement leader with a background in guiding cross-functional teams, improving access processes, and supporting rare disease therapies. Known for building strong provider, hub, and payer relationships, managing prior authorizations and appeals, and helping teams deliver faster treatment access across multiple products.
Overview
1
1
Certification
29
29
years of professional experience
Work History
Director of Patient Access and Field Reimbursement
BIOMARIN – RARE DISEASE
01.2016 - Current
- Coordinated with SP partners and managed care team to support patient access, retention, and disease awareness for BioMarin products. Worked with clinical nurse educator team to support patient compliance. Led clinic education and conducted field visits to review prior authorizations and medical documentation. Served as subject matter expert for FRM team and partnered with external vendors to manage day-to-day business.
- Supported 5 field reimbursement managers across 6 BioMarin products, addressing barriers to payer coverage and access through a player-coach role.
- Partnered with external hub management to gather accurate, timely data. Provided internal and external support for reimbursement, billing, coding, and buy-and-bill processes. Worked closely with sales, managed care, and hub case managers to address access issues, appeals, and denials.
- Managed patient assistance programs, conducted field visits to institutions and sites of care for site readiness and reimbursement planning, and developed SOPs to streamline reimbursement strategy across products. Trained hub team members to build capability and support growth.
CLINICAL NURSE EDUCATOR – CONSULTANT
RETROPHIN-RARE DISEASE
08.2015 - 12.2016
- Developed and implemented educational programs for clinical staff, enhancing knowledge and skills in rare disease management.
- Oversaw HUB case managers in St. Louis, identifying pull-through and problem-solving strategies to enhance patient adherence for rare disease treatment.
- Educated patients on kidney disease treatment, offering resources for disease management and medication adherence, while clarifying reimbursement and patient support services.
Associate Director – Patient Access Manager
Shire Therapeutics -Rare Disease
05.2006 - 07.2015
- Created and developed PAM role at Shire.
- Supported annual $38MM top-performing territory serving patients with Gaucher disease, Hunter syndrome, and HAE, managing 600+ patients.
- Trained new PAM hires, partnered with case managers to identify 501c3 foundations, planned patient services strategy with dotted-line leadership to case management, and ranked #1 and #2 territory nationwide across all products, patient compliance, and new starts.
- Delivered field support to healthcare providers and hospitals, enhancing patient care and access to treatments.
- Advocated for patients within multidisciplinary teams, coordinating SP timelines and hub activities to expedite access to treatment.
- Served as strategic liaison among stakeholders, payors, and hub resources to support timely treatment.
- Provided personalized care coordination through multidisciplinary team support and built patient assistance program for uninsured and underinsured patients.
- Built and ran patient programs at regional and national levels to strengthen patient relationships.
- Trained patient ambassadors for all products, improving outreach and support for patients.
- Reduced start-to-ship time and cut 5-day appeal to approval status.
- Received Q1 2015 Recognizing Excellence Award.
Independent Healthcare Consultant- Expert Witness
CALIFORNIA STATE BOARD OF NURSING
01.2007 - 01.2011
- Reviewed documentation from Enforcement Office of State Board of Nursing; provided expert witness reports after thorough analysis of case-related documents on alcohol and drug abuse; testified at Administrative Hearings.
- Reviewed healthcare cases for nursing practice standards and policy alignment.
- Advised state nursing board staff on licensure and regulatory compliance requirements.
- Collaborated with stakeholders to assess nursing education program effectiveness, identifying areas for improvement.
- Interpreted statutes, regulations, and board procedures for internal guidance.
Senior Case Manager Specialist III
Genzyme Therapeutics
10.1997 - 05.2006
- Senior Case Management Specialist managing an annual $48MM business for enzyme replacement therapies in California, Nevada, and Hawaii. Site Coordinator for Tower Hematology-Oncology Treatment Center in Beverly Hills, which managed the needs of the Gaucher and Fabry patient population.
- Liaised with Patient Access Network Foundation to monitor access needs for Gaucher population, supported Myozyme product launch, collaborated with sales and managed markets to ensure patient access, identified home infusion and health agencies for patient service, and educated healthcare providers to navigate access processes.
- Escalated payor issues to regional account managers for resolution, coordinated with specialty pharmacies on dispensing, benefit investigations and troubleshooting distribution issues.
Education
Master of Science - Health Care Administration
California Coast University
Orange, CABachelor of Science Degree -
Board of Regents – University of the State of NY
Registered Nurse AD -
Deaconess College of Nursing
St. Louis, MissouriSkills
- Reimbursement processes
- Prior authorization
- Billing procedures
- Patient access
- Payer appeals
- Specialty pharmacy
- Managed care
- Operations management
- Project coordination
- Strategic planning
- Decision-making
- Communication skills
- Relationship building
Accomplishments
- Patient Access Leadership
- Onboarding
- Education & Awareness
- Reimbursement
- Patient Service Programs
- Field Reimbursement
- Institutional Readiness/Misc J code experience
- Team Leadership & Coaching
- Onboarding and Access
- Process Optimization & Improvement
- HUB Pull-Through
- Case Management Expertise
- Cross-Functional Collaboration
- Hospital & Specialty Pharmacy
- REMS
- Commercial / Government Reimbursement
- Injectable & Infusion Therapies
- HOPD / Home / HCP Infusion
- Medicare Expertise
- PBM/Limited Distribution
- Optimal Turn-Around Times
- Patient Advocacy / 501c3 Education
- PACS Certified
Affiliations
- State Board of Nursing Expert Witness Program
- American Psychiatric Nursing Association Standards Committee
- Occupational Health Nurses Association
- Deaconess College of Nursing Alumni Association
- Medical Services Volunteer, American Red Cross
Certification
PACS-Certified
Work History
01-2016
Languages
English
Timeline
Director of Patient Access and Field Reimbursement
BIOMARIN – RARE DISEASE
01.2016 - Current
CLINICAL NURSE EDUCATOR – CONSULTANT
RETROPHIN-RARE DISEASE
08.2015 - 12.2016
Independent Healthcare Consultant- Expert Witness
CALIFORNIA STATE BOARD OF NURSING
01.2007 - 01.2011
Associate Director – Patient Access Manager
Shire Therapeutics -Rare Disease
05.2006 - 07.2015
Senior Case Manager Specialist III
Genzyme Therapeutics
10.1997 - 05.2006
Master of Science - Health Care Administration
California Coast University
Bachelor of Science Degree -
Board of Regents – University of the State of NY
Registered Nurse AD -
Deaconess College of Nursing