Your Health Experts Advisory Team

Most advisors pick a side. We connect them all.

The only side we're on is yours.

Strategic advisory from operators who now advise. We help manufacturers, PBMs, GPOs, health plans, employers, wholesalers, pharmacies, 340B stakeholders, patient-services organizations, and growth-stage health and wellness brands turn fragmented market complexity into integrated, executable strategy across access, economics, contracting, channel design, and execution.

As trusted advisors, we are committed to helping organizations navigate complex challenges, optimize outcomes, and achieve sustainable growth.

The Six Pillars

Six pillars across the ecosystem. One integrated view.

Across manufacturers, PBMs & GPOs, health plans & employers, trade & distribution, 340B, and patient access, we translate fragmented market signals, payer and PBM behavior, and channel economics into one integrated plan that improves access, economics, compliance, and execution.

We also advise growth-stage digital health and wellness companies on positioning, go-to-market strategy, and the reimbursement landscape they're entering. We bring the same operator-level fluency to earlier-stage brands.

01

Manufacturers

Commercialization, access, launch, value, contracting & channel strategy, from pre-launch through pull-through.

  • Commercialization strategy across access, trade, finance, brand & patient services
  • Pre-launch, launch & post-launch market access planning
  • Payer value story, board-level access materials & stakeholder mapping
  • Gross-to-net, ASP, ANRP, rebate, chargeback & channel-mix modeling
  • Medical vs. pharmacy benefit strategy & site-of-care economics
  • Biosimilar formulary, contracting, interchangeability & channel strategy
  • DTC & patient-access alignment with affordability and payer strategy
  • Manufacturer education on how PBMs, plans, employers & pharmacies decide
02

PBMs & GPOs

Formulary, rebate economics, GPO contracting, network design & vendor accountability.

  • PBM, GPO & health-plan landscape strategy and decision-lever analysis
  • Formulary positioning, exclusion strategy & utilization-management design
  • GPO contracting, aggregation economics, rebate flow & admin-fee structures
  • Rebate-dependency analysis & incentive alignment
  • Contract-language advisory, negotiation strategy & risk scoring
  • Network design, specialty-pharmacy alignment & channel steerage
  • PBM-owned specialty-pharmacy dynamics & performance benchmarking
  • Vendor accountability, reporting & legislative-impact analysis
03

Health Plans & Employers

Payer economics, benefit design, total cost of care & employer-ready strategy.

  • Coverage strategy across commercial, Medicare, Medicaid, exchange & employer-sponsored
  • Health-plan economics, total cost of care & budget-impact modeling
  • ASO employer benefit design, PMPM forecasting & savings attribution
  • PBM / vendor evaluation, program validation & contract benchmarking
  • Utilization management — prior authorization, step therapy & quantity limits
  • Channel steerage across retail, specialty, medical benefit & site-of-care
  • Employer-ready reporting, executive dashboards & plain-language economics
  • AI-powered claims & POS segmentation to surface cost drivers and leakage
04

Wholesalers, Trade & Distribution

Channel design, wholesale economics, specialty-pharmacy networks & site-of-care strategy.

  • Channel design across the pharmacy & medical benefit
  • Wholesale strategy, distribution economics & channel financial implications
  • Specialty-pharmacy network design, optimization & benchmarking
  • Limited-distribution, open-network & hybrid channel models
  • Buy-and-bill vs. specialty-pharmacy modeling
  • Site-of-care & alternate-site-of-care strategy
  • Retail channel implications & retail-to-specialty handoffs
  • Pharmacy feasibility, licensing & ground-up build support, covering everything from the go/no-go business case through staffing, technology, and PBM contracting to go-live
  • Gross-to-net, ASP & reimbursement strategy across the channel
05

340B & Revenue Cycle

340B economics, revenue integrity, compliance risk & policy strategy.

  • 340B opportunity assessment across manufacturers, plans, employers & covered entities
  • Covered-entity (CE) & TPA relationships and contract-pharmacy network design
  • Carve-in / carve-out modeling & duplicate-discount exposure analysis
  • Revenue integrity: split billing, denial management & coding optimization
  • HRSA audit readiness & operational risk mitigation
  • Policy & legislative monitoring: manufacturer restrictions & payer-driven disruption
  • AI risk analytics: duplicate-discount detection & 340B exposure modeling
  • 340B financial dashboards & plain-language economic translation
06

Patient Services, Pharmacy & Access Operations

HUB strategy, affordability, retail pharmacy, access operations & patient-journey design.

  • HUB design: benefits verification, prior auth, affordability, adherence & field reimbursement
  • Patient-journey mapping & access-friction reduction
  • Time-to-therapy optimization & abandonment reduction
  • Copay, foundation & financial-assistance strategy
  • Retail-pharmacy operations & retail-to-specialty handoffs
  • Independent commercial growth strategy for owned or captive-payer pharmacies, clearing competitive-access objections and opening non-captive revenue
  • Vendor strategy, selection, performance management & accountability
  • AI-enabled adherence prediction & access-barrier identification
  • Specialty-pharmacy network design aligned to payer coverage

About

Operators who now advise.

OmniHealthRx Solutions is your health experts advisory team, led by executives who have sat in every seat at the table. We don't just study the system; we've run it.

Roxanne Schwans, MBA — Founder & Chief Executive Officer

Roxanne Schwans, MBA

Founder & Chief Executive Officer

I have sat in every seat at the table: as a PBM executive, a health plan economist, a manufacturer general manager, a retail pharmacy COO, and a health system strategist. I understand how each party thinks, what they optimize for, and where the real economic levers are.

Roxanne brings 30+ years of lived operating experience across every node of the U.S. healthcare ecosystem. That includes PBM and health plan economics, manufacturer strategy, 340B, biosimilar access, HUB patient services, and health systems.

Prime Therapeutics

SVP, Supply Chain & Industry Relations

Walgreens & Rite Aid

SVP / Group VP

Johnson & Johnson

SVP, VP, RBD

Amgen, Horizon, Sanofi

Senior leadership roles

Deep expertise

PBM economicsHealth plan economicsFormulary management340B programsBiosimilar accessHUB & patient servicesSpecialty pharmacyMarket accessRebate strategyHealth system economics

Core Team

Senior operators across commercial strategy and operations — each bringing decades inside the payer, provider, and pharmacy ecosystems they now advise.

Megan Butterfield, Chief Operating Officer

Megan Butterfield

Chief Operating Officer

I have spent 20 years inside the payer, provider, and pharmacy ecosystems, not advising from the outside, but operating from within. I know where the margin goes, why it goes there, and how to get it back.

Megan is a commercial strategy executive with 20+ years of experience optimizing value across the payer, provider, and pharmacy ecosystems. She specializes in specialty pharmacy economics, channel optimization, and data-driven go-to-market strategy. She translates complex financial pressure into clear, defensible commercial decisions. Previously serving as VP at Walgreens, Optum, Diplomat, and MedAdvisor, Megan bridges clinical intent and financial performance for pharmaceutical manufacturers navigating competitive specialty markets.

Optum

VP

Walgreens

VP

Diplomat

VP

MedAdvisor

VP, Commercial Strategy

Deep expertise

Specialty pharmacy economicsChannel optimizationPBM strategyNet revenue analyticsCopay & GTN modelingSpecialty drug market accessCommercial contractingData-driven go-to-marketASP protectionPricing strategy
George Kowalski, Operations & Project Management Lead

George Kowalski

Operations & Project Management Lead

I bring a unique dual perspective from having worked on both the service-provider and vendor sides. This enables me to anticipate challenges and connect strategy with on-the-ground execution.

George is an operations-focused leader with deep experience optimizing performance, driving execution, and building scalable systems across healthcare, retail, and service industries. He has held VP, Director of Operations, and General Manager roles. He led turnarounds that delivered double-digit gains in profitability and employee retention, and stood up data-driven performance tracking across multi-site healthcare operations. His consulting work spans managed care, discount-card and PAP programs, and operational-excellence initiatives. He stabilizes workflows and optimizes contracting and reimbursement strategy.

Multiple Business Lines

Vice President

Multi-Site Healthcare

Director of Operations

Retail Operations

General Manager

Managed Care & PAP

Consultant & Project Manager

Published

  • Best Practices for Payer Contracting
  • Pharmacy Returns Policies

Deep expertise

Operational turnaroundsMulti-site operationsManaged careDiscount card & PAP programsPayer contractingReimbursement strategyProcess optimizationPerformance tracking & KPIsP&L improvementTeam building & retention
Matthew Loftus, MBA, Head of Product & Innovation

Matthew Loftus, MBA

Head of Product & Innovation

Every good product idea in this industry has a target segment and a discrete pain point to address. I've spent over 15 years at health plans and PBMs building the pricing model, winning the capital, and getting it to market, so I know exactly where that gap is and how to close it.

Matt is a healthcare product and commercial strategy executive with 15+ years across pharmacy benefits, health plans, and provider technology. He's led teams of product directors and managers with full P&L accountability, from development capital through pricing to margin, and he has a consistent record of hitting gross-margin goals. At Prime Therapeutics he owned a product roadmap through 2029, stewarding $5.5M in development capital against $140M of three-year margin contribution, and he commercialized health-plan offerings across GLP-1, specialty, and affordability programs for BCBS plans and their employer groups. At OptumRx he led the portfolio of cash market/DTC and specialty products and developed the Medicare Prescription Payment Plan solution to meet 2025 CMS requirements. Matt turns employer and health-plan needs into benefit designs that actually hold up economically. That means formulary strategy and utilization management. It means specialty management and affordability levers. And it means packaging all of it with the pricing assumptions, operational requirements, and success metrics that make it sellable.

Prime Therapeutics

AVP, Product Development & Innovation

Optum Rx

Sr. Director, Specialty Product Development

Blue Cross Blue Shield of Nebraska

Sr. Manager, Product Strategy & Development

UnitedHealth Group

Director, Product Operations

Epic Systems

Manager, Implementation & Operations Consulting

Deep expertise

PBM product strategySpecialty & risk-bearing constructsMedicare & CMS complianceEmployer benefit designProduct P&L & pricingFormulary & utilization managementHealth-plan economicsMarket AccessCommercialization & sales enablementProduct lifecycle & stage-gate governanceGLP-1 & affordability programs
Elena Moraitis, Consultant

Elena Moraitis

Consultant

Pricing and contracting in the pharmaceutical space comes down to one thing: understanding how every decision ripples through revenue. I've spent 20 years in those details. I know where gross-to-net erodes, why it happens, and how to build the frameworks that protect it.

Elena is a strategic Pricing & Contracting leader with 20 years of progressive pharmaceutical industry experience spanning government price reporting, gross-to-net optimization, and enterprise contracting strategy across commercial and government channels. She has led pricing and contracting functions through product launches, acquisitions, and lifecycle management, building scalable operations along the way. With a strong track record of advising C-suite and senior leadership on competitive positioning and commercial effectiveness, Elena translates complex regulatory and financial pressure into pricing strategy that leadership can actually defend, in front of a board or an auditor.

Amgen

Pricing & Contracting

Horizon Therapeutics

Pricing & Contracting

AbbVie

Pricing & Contracting

Deep expertise

Government price reportingGross-to-net optimizationEnterprise contracting strategyCommercial & government channelsLaunch pricing strategyLifecycle managementPricing through M&APrice-reporting complianceCompetitive positioningC-suite pricing advisory
Elizabeth Southerlan, Healthcare Systems Transformation Lead

Elizabeth Southerlan

Healthcare Systems Transformation Lead

Most operational problems in healthcare don't live inside a department. They live in the handoff between two departments, where information gets lost and nobody's quite accountable. I find those gaps and fix them.

Elizabeth is a healthcare consultant with 20+ years of experience applying systems engineering to operational transformation. Trained in Industrial and Systems Engineering at Penn State and MIT, she has led strategy, operations, and digital innovation work at Accenture, Oliver Wyman, and West Monroe, across hospitals, health insurers, PBMs, and public health agencies. Her approach treats healthcare operations as a solvable system: find where the connections between teams break down and redesign them so information, accountability, and care flow the way they're supposed to.

Accenture

Strategy & Operations

Oliver Wyman

Strategy & Operations

West Monroe

Digital Innovation

Threadwell

Founder

Deep expertise

Systems engineeringOperational transformationCross-functional process redesignHospital operationsHealth insurer operationsPBM operationsDigital innovation strategyChange managementPublic health systemsHealthcare workflow design
Helaine Gregory, JD, Healthcare Attorney & Market Access Advisor

Helaine Gregory, JD

Healthcare Attorney & Market Access Advisor

Thirty years in this business taught me one thing above the rest: a client trusts you the moment you're willing to tell them no. My job has always been to give people the real answer, not the easy one.

Helaine has spent more than three decades moving between law, compliance, and healthcare operations, and for the past 24 years she's run her own business out of San Juan. Her consultancy focuses on getting specialty biopharma products to market: launch strategy, market access, and managed care contracting across the US and Puerto Rico. Her client list reads like a who's who of biopharma (Amgen, Genzyme, Alexion, Novartis, Gilead, dozens more), and most of them found her through word of mouth and never left. Before she went independent, she ran the Puerto Rico region for Fresenius Kidney Care with full P&L over 27 dialysis clinics, did forensic and litigation work at KPMG, and headed compliance for a 1,400-person division at UnitedHealth Group. She started out as an attorney at two Blue Cross Blue Shield plans and put in two decades with the Army JAG Corps Reserve on the side. JD from Boston University, AB from Harvard, licensed in Texas and several federal jurisdictions.

Helaine Gregory LLC

President

Fresenius Kidney Care

VP, Operations (Puerto Rico Region)

KPMG

Director, Forensic & Litigation Services (NY | CT)

UnitedHealth Group

Director, Business Practices (Compliance | CT)

Deep expertise

Specialty biopharma market accessManaged care contractingProduct launch strategyUS and Puerto Rico market entryRegulatory compliancePBM bid & formulary strategyGovernment affairs
Kara Jaehnert, Value-Based Strategy & Payment Innovation Advisor

Kara Jaehnert

Value-Based Strategy & Payment Innovation Advisor

I've built my career in places with no roadmap, just the challenge of creating one. I bring the right people to the table, align them around a shared vision, and build a practical path toward meaningful, measurable outcomes.

Kara is a healthcare executive and entrepreneur with deep expertise in value-based care, payment innovation, provider strategy, and healthcare transformation. During her 13 years at Humana, she built and implemented provider engagement strategies to help organizations succeed in value-based care, and later led the development and implementation of value-based strategies and payment models across Medicare, Medicaid, and Commercial populations. Her work brought together health plans, health systems, providers, and cross-functional teams to translate strategy into measurable clinical, financial, and patient outcomes. She later founded TrioEffect, a patent-pending digital health platform designed to connect personalized health and nutrition with healthcare, grocery retail, and philanthropy. Today, Kara advises healthcare organizations and executive teams on value-based strategy, payment innovation, partnerships, growth, and the development of new solutions where an established roadmap doesn't yet exist.

Humana

Executive Leader, Value-Based Strategy & Payment Innovation

TrioEffect

Founder & CEO

Deep expertise

Value-based care strategyPayment model design and innovationProvider engagement and performanceProvider and health system partnershipsProvider network strategyMedicare/Medicaid/CommercialStrategic partnershipsDigital health innovationGrowth strategyCross-functional alignmentHealthcare transformation
Todd Helmink, Strategic Sales + Partnerships Executive

Todd Helmink

Strategic Sales + Partnerships Executive

Most healthcare technology doesn't fail because the product is wrong. It fails because the go-to-market and channel strategy never caught up to it. That's the gap I work in.

Todd is a strategic sales and partnerships executive with 25+ years across healthcare IT, digital health, and life sciences, including Free Market Health, DrFirst, Atlas Health, ConnectiveRx, and Allscripts. He specializes in partner-led distribution, go-to-market and channel strategy, and post-acquisition integration. He has particular depth in electronic prior authorization (ePA), EHR-embedded patient and HCP messaging, and AI vendor vetting for specialty hub and pharmacy technology.

Free Market Health

SVP, Business Development

DrFirst

SVP, Business Development

ConnectiveRx

GM- Provider Network

Allscripts

SVP, Corporate Business Development

Atlas Health

SVP, Life Sciences Business Development

Deep expertise

GTM strategy & channel developmentPartner-led distribution (payer, provider, pharma, EHR, eRx, AI/ML)Fractional Head of PartnershipsPharma-sponsored patient/HCP messaging in EHR workflowsAI vendor vettingSpecialty HUB/SP vertical entryPatient financial assistanceCopayHUB lightRx & medical ePA monetization

Let's build your strategy together.

A focused conversation, no generic frameworks, just real-world context from day one. Tell us where you're headed and we'll show you how OmniHealthRx becomes an extension of your team.

Send us a message

Tell us where you're headed and we'll follow up.

Roxanne@omnihealthrx.com · Roxanne Schwans, Founder & Chief Executive Officer