Kristen Fetzer
Summary
Strategic leader with extensive experience in managed care across Commercial, Healthcare Reform/Exchange, Medicaid, and Medicare segments. Expert in developing clinical strategies and pharmacy programs to address stakeholder needs. Skilled in team leadership, project execution, and collaborative problem-solving.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Manager, Pharmacy Programs (Commercial/ACA)
Highmark Inc.
03.2021 - Current
- Leads an interdisciplinary team in the deployment of pharmacy program solutions, from pilot initiatives to full-scale implementation, ensuring program capabilities support market differentiation, enhance customer satisfaction, drive strong financial performance, and maintain compliance with all applicable state and federal regulations.
- Collaborates with cross-functional business leaders to align program goals with strategic objectives.
- Accountable for a diverse portfolio of pharmacy programs, encompassing areas such as formulary and network management, drug adherence programs, and patient copay assistance initiatives.
- Manages pharmacy vendor contracts, including the pharmacy benefit manager (PBM) agreement.
- Mentors organizational leaders through professional development initiatives.
Manager, Medication Benefits
BlueCross BlueShield of Western New York
(Now Highmark Inc.)
11.2020 - 03.2021
- Led pharmacy team in developing and managing custom drug formularies, clinical programs, client benefit setup, clinical policies, Pharmacy & Therapeutics (P&T), rebate contracts, sales messaging, and internal pharmacy fraud, waste, and abuse initiatives.
- Spearheaded strategic alignment and integration efforts between the plan and Highmark.
Clinical Strategy Pharmacist
BlueCross BlueShield of Western New York
(Now Highmark Inc.)
01.2018 - 11.2020
- Collaborated with data analytics to develop algorithms for systematic identification of suspected fraudulent pharmacy activity. Developed and implemented management strategies, in conjunction with the Clinical Pharmacy team, for drugs frequently targeted by fraud schemes.
- Proactively researched novel investigational drugs to enable timely development of clinical management strategies in anticipation of FDA approval. Provided clinical insights on high-cost and high-impact drugs to the Trend & Analytics team to support budget projections and financial modeling.
- Collaborated with Express Scripts to develop over 450 criteria sets, based on plan policies, for use in C360/OnePA to expedite and standardize utilization management reviews.
- Developed and maintained evidence-based policies for new and existing FDA-approved drugs. Coordinated quarterly Pharmacy and Therapeutics (P&T) Committee meetings to support formulary and prior authorization strategies.
Staff Pharmacist
Fidelis Care New York
11.2013 - 01.2018
- Performed utilization management reviews for Medicaid, CHIP, Medicare, and Healthcare Exchange lines of business, ensuring clinical, formulary, and financial appropriateness.
- Developed internal procedures to expedite case processing within the new pharmacy case review system (CAS).
- Prepared investigative reports on behalf of the pharmacy department in response to state complaints.
Supervising Pharmacist
Target Pharmacy
09.2013 - 11.2013
- Oversaw the pharmacy team, comprising pharmacists, interns, and technicians, within a high-volume pharmacy setting.
- Managed drug and supply inventory valued at over $400,000.
- Dispensed medications, provided counseling to patients and caregivers on prescription and over-the-counter medications, administered influenza vaccinations, and communicated with prescribers regarding drug therapy adjustments.
Executive Float Pharmacist: Buffalo/Rochester
Target Pharmacy
07.2012 - 09.2013
Education
Doctor of Pharmacy - Pharmacy Practice
University At Buffalo School of Pharmacy And Pharmaceutical Sciences
Bachelors of Science - Biological Sciences: Molecular Genetics
University of Rochester
Skills
- Clinical program development
- Formulary management
- Strategic planning
- Cross-functional leadership
- Problem solving
- Project management
- Healthcare policy compliance
- Financial analysis
- Vendor relationship management
- Performance monitoring
Certification
Licensed and Registered Pharmacist, New York, 056882
Timeline
Manager, Pharmacy Programs (Commercial/ACA)
Highmark Inc.
03.2021 - Current
Manager, Medication Benefits
BlueCross BlueShield of Western New York
11.2020 - 03.2021
Clinical Strategy Pharmacist
BlueCross BlueShield of Western New York
01.2018 - 11.2020
Staff Pharmacist
Fidelis Care New York
11.2013 - 01.2018
Supervising Pharmacist
Target Pharmacy
09.2013 - 11.2013
Executive Float Pharmacist: Buffalo/Rochester
Target Pharmacy
07.2012 - 09.2013
Doctor of Pharmacy - Pharmacy Practice
University At Buffalo School of Pharmacy And Pharmaceutical Sciences
Bachelors of Science - Biological Sciences: Molecular Genetics
University of Rochester