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Scott DunhamScott Dunham, PharmD

Senior Consultant

Scott Dunham, RPh, PharmD is a Pharmacist and Senior Health Plan Services Consultant at BluePeak Advisors, a division of Gallagher Benefit Services, Inc. With 20 years of Managed Care experience, Scott’s expertise is in Medicare Part D pharmacy and clinical operations, specifically plan and PBM operations, formulary administration (FA), coverage determinations, appeals, and grievances (CDAG), medication therapy management (MTM), overutilization management system (OMS)/drug management program (DMP), and compliance and regulatory oversight activities.

Prior to joining BluePeak Advisors, Scott was Vice President of a Prescription Drug Plan where he was responsible for the operations and strategic direction of the Medicare product offering and initiatives. In his role, he successfully managed and grew the Medicare business while ensuring compliance with CMS regulations through internal auditing as well as external vendor oversight.  Additionally, he has managed clinical operations for a large PBM across multiple clients and lines of business implementing process improvements that enhanced both client and member experiences including plan implementations, bid submissions, formulary development and maintenance initiatives, coverage determinations and appeals operations and system development, reporting integration and automation, support of data validation audits as well as continual refinement of best practices across clinical business units leveraging technology with operational improvements.

At BluePeak, Scott serves as a subject matter expert (SME) on Medicare Part D, Medicaid, commercial and Exchange plan questions and issues. Scott has served in interim staffing roles as Pharmacy Director for multiple plans and serves as a contact for multiple health plan, PBM clients and vendors of varying sizes with focus on pharmacy-related operational, clinical, and benefit-management related issues. Scott is 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). Scott has also supported health plans implementing Exchange and Medicare product offering with a focus on operational, clinical, and quality-related initiatives.

Scott holds a Doctor of Pharmacy degree from the University of Arkansas and a bachelor’s degree in pharmacy from the University of Pittsburgh. He is a licensed, registered pharmacist in Georgia and Pennsylvania.

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