Lora Ertmoed, PharmD, BCGP
Senior Consultant
Lora Ertmoed, PharmD, BCGP, is a pharmacist and Senior Health Plan Services Consultant at BluePeak Advisors, a division of Gallagher Benefit Services, Inc. With over 15 years of experience in Medicare, she specializes in Part D and Part C clinical operations, including coverage determinations, organizational determinations, appeals, overutilization management system (OMS)/drug management program (DMP) oversight, formulary administration, and regulatory compliance.
Before joining BluePeak Advisors, Lora served as Managing Director of Clinical Pharmacy Operations at a managed care organization, where she led pharmacy operations across all lines of business. Her responsibilities included formulary administration, P&T (Pharmacy and Therapeutics) Committee, clinical policy development, coverage determinations, appeals, organizational determinations, and pharmacy compliance. She previously worked as a Medicare pharmacist for a regional health plan. Across these roles, she successfully completed multiple Medicare audits (program, timeliness, transition, and desk audits), transitioned Medicare coverage determinations and appeals from the PBM to the health plan, and implemented a CMS compliant opioid overutilization program.
At BluePeak, Lora serves as a subject matter expert (SME) on Medicare Part D, Medicaid, commercial and Exchange plan questions and issues. In addition, she has expertise in helping plans with their P&T committees and Data Validation Audits.
Lora holds a Doctor of Pharmacy degree from Purdue University and is board certified in geriatric pharmacy. She also earned a bachelor’s degree in biology from Indiana University. She is a registered pharmacist in Indiana.