Kelly Makay
Senior Consultant
Kelly K Makay, RPh MBA is a Pharmacist and Senior Health Plan Services Consultant at BluePeak Advisors, a division of Gallagher Benefit Services, Inc. With 15 years of Medicare experience, Kelly’s expertise is in Part D pharmacy and clinical operations, specifically coverage determinations, appeals, and grievances (CDAG), medication therapy management (MTM), overutilization management system (OMS)/drug management program (DMP), formulary administration (FA) and regulatory oversight activities.
Prior to joining BluePeak Advisors, Kelly was vice president of Medicare operations at a pharmacy benefit management company where she was responsible for the strategic direction of the Medicare product offering and initiatives. In her role, she successfully integrated Medicare clients across multiple platforms into a single platform creating fully integrated solutions and developed initiatives to ensure compliance to CMS regulations through internal auditing as well as external vendor oversight. Additionally, she spearheaded enterprise-wide quality process improvements that enhanced both client and member experiences including formulary implementation and maintenance initiatives, HPMS report integration and automation, support of data validation audits for all Medicare clients as well as continual refinement of best practices across all business units leveraging technology with operational improvements. Prior to her experience in the Medicare team, Kelly was vice president of PBM operations with experience in client implementations, eligibility, benefit design and analytics. Additionally, in that role, she led several acquisitions integration teams integrating software platforms and operational processes always focused on best practices and financial gains.
At BluePeak, Kelly serves as a subject matter expert (SME) on Part D Medicare, Medicaid, commercial and Exchange plan issues. Kelly is the primary account manager and contact for multiple health plan and PBM clients of varying sizes with focus on pharmacy-related operational, clinical, and benefit-management related issues. Kelly serves as a primary SME for CMS audit support for Part D clients, in the areas of formulary administration (FA) and Part D coverage determinations, appeals, and grievances (CDAG). Kelly has also supported health plans implementing a Medicare product offering as well as led several PBM migrations with a focus on operational and quality-related initiatives.
Kelly holds a master’s degree in business from Benedictine University and a bachelor’s degree in pharmacy from the University of Pittsburgh. She is a licensed, registered pharmacist in Pennsylvania.