T Brown

At UnitedHealth Group, I adjudicate complex pharmacy appeals across Medicare Part D, Medicaid, and Commercial plans, applying clinical evidence, coverage policy, and P&T-approved criteria to timely coverage determinations.

Previously at Capital Rx and CVS Health, I evaluated prior authorization, step therapy, formulary exception, and quantity-limit requests while translating drug information, utilization trends, and formulary changes into practical guidance for providers, members, clients, and internal teams.

My work spans prospective and retrospective drug utilization review, medication safety, peer-to-peer coordination, therapeutic alternatives, and audit-ready documentation under CMS, URAC, and NCQA standards.

I'm also completing HEOR/RWE work in budget impact, cost-effectiveness, claims analytics, and real-world evidence, bringing payer-focused analysis into therapeutic class reviews and formulary decision support.