PBMI Innovator Robyn Crosson, J.D.

Managed Healthcare Executive and the Pharmacy Benefit Management Institute (PBMI) have selected Robyn S. Crosson, J.D., for this year’s PBMI Innovators Award, recognizing professionals leading innovation in pharmacy benefits. Crosson is vice president of government relations at Navitus Health Solutions.

Crosson's path into the industry started at 17, in a part-time claims customer service job at Golden Rule Insurance, a division of UnitedHealthcare. Fielding calls from members appealing denied claims, she said, taught her both how state benefit mandates worked and how much was riding on the outcome for the person on the phone. She went on to work in Anthem's actuarial department, practice law in New York and Chicago, and serve as Indiana's chief deputy commissioner of insurance under Gov. Mitch Daniels. About a decade ago, as vice chair of the American Bar Association's tax section on employee benefits, she began hearing employers describe frustration with pharmacy benefit manager transparency. When the opportunity came to join Navitus, owned by a nonprofit health system and Costco, its pass-through model was the draw.

Crosson said she has come to see the drug supply chain less as a story of villains and more of misaligned incentives spread across many players, each facing its own outside cost pressures. "I don't think there's a villain in the whole thing. I think there are disincentives stacked in, and that's where transparency really comes in," she said

At Navitus, Crosson pointed to the shift of members from Humira and Stelara to their biosimilars, managed through direct patient outreach and physician coordination that achieved a 98% transfer rate. She also described a growing regulatory burden — state-by-state reporting requirements and short compliance windows — that weighs disproportionately on smaller, transparent PBMs that, unlike larger competitors, have no spread revenue to absorb the added cost.

In this video, Crosson discusses how her path through insurance, law and government shaped her approach to pharmacy benefits, and why she believes patient education is the industry's next frontier.

Read Crosson’s full profile here.

AI assisted in the writing of this summary.