Babette S. Edgar, Pharm.D., MBA, FAMCP is a Principal at BluePeak Advisors (BPA). Babette has been in the managed care industry for over 25 years and advises health plans, pharmacy benefit management companies and pharmaceutical companies on Medicare and managed care strategies, operational and compliance issues. Throughout her tenure, Babette has conducted and supported numerous audits with her primary expertise in Part D Coverage Determinations, Appeals and Grievances (CDAG).
Prior to starting her own firm, Babette worked at CatalystRx, where she was President, Government Services and ran the Medicare business for the fourth largest PBM. Babette was the Director of the Division of Finance and Operations for the Medicare Drug Benefit Group at the Centers for Medicare and Medicaid (CMS), where she directed building and implementing the formulary and benefit design review processes for the Part D drug benefit. She oversaw the CMS Part D team that developed the agency’s marketing guidelines and marketing models, and conducted oversight of the marketing review process. Babette also directed CMS operations for reviewing and monitoring the licensure and solvency of Part D plan sponsors, assisted in developing transition guidance for Part D plans with patients migrating from Medicaid or other benefits; and provided input into the Part D regulations and other subregulatory guidance from a managed care pharmacy perspective.
Previous to her term at CMS, Babette was Vice President, Clinical Business Development at Caremark/AdvancePCS, where she directed sales, account management and product development for a multi-million-dollar disease management product line. She oversaw 16 premier accounts, including Blue Cross plans, managed health plans, Medicare/Medicaid, third party administrators and large and small employers. Babette previously served as Director of Clinical Services for Advance Paradigm, where she ran the P and T process, developed physician and patient education materials, performed academic detailing, and managed the clinical team responsible for developing clinical content and clinical strategy. She also performed business development for specialty services in the Theracom division.
Babette has authored many articles in peer-reviewed journals, and has been a speaker at many national meetings, conferences and symposia. She is the Immediate Past President of the Academy of Managed Care Pharmacy and is a national thought leader in topics related to managed care pharmacy, Medicare strategy and value-based pharmaceutical care.