Senior Pharmacy Manager of Utilization Management
Devoted Health Plan
Boston, MA
Adam Hoye-Simek is the Senior Pharmacy Manager of Utilization Management for Devoted Health Plan. Devoted Health provides innovative Medicare Advantage plans in 13 states across the country and has been the fastest growing Medicare Advantage plan in the country for multiple years. Adam oversees the organization’s pharmacy related benefits that fall under Part B. He leads clinical strategy, CMS auditing, appeals, and manages the day to day operations for the department. He has exclusively written and maintained the department's library of over 50 coverage policies. He led the company’s implementation of biosimilar focused step therapy and continues to lead preferred drug and durable medical equipment strategies. Adam is the company's subject matter expert for the billing and coding of medical drugs and related devices and oversees the external relationships with third party vendors. Adam is currently serving as a key stakeholder in his organization's implementation of the Inflation Reduction Act of 2022 and all other legislative changes. He is also heavily involved in cross benefit (medical and pharmacy) strategy and proper benefit adjudication.
Adam has served on AMCP's Format for Formulary Submissions Committee since early 2022 and is on the Digital Therapeutics subcommittee. In April of 2024, he will because the chair for the Format for Formulary Submissions Committee. Adam also participate in AMCP’s Biologics and Biosimilars Collective Intelligence Consortium as a volunteer research assistant.
(R1) 5.0…and Beyond! The Evolution of the AMCP Format for Formulary Submissions
Tuesday, April 16, 2024
8:30 AM – 9:45 AM CT