Rachel A. Alexander

Rachel Alexander is a partner in the Health Care Practice at Wiley where she counsels clients on regulatory, transactional, and litigation matters involving managed care with an emphasis on advising health plans and third-party administrators on drug pricing, Pharmacy Benefit Manager (PBM) contracting and dispute resolution, and general pharmacy benefit administration for commercial and government health care programs (e.g., Medicare, Medicaid, and the Federal Employees Health Benefits Program).

Prior to entering the legal profession, Rachel spent over a decade in health care administration, primarily in contract negotiations and administration, working for industry-leading managed care organizations and providers. Rachel’s expertise with both health plan operations and health care law allows her to rapidly respond and nimbly navigate clients through complex and factually intense matters involving regulatory compliance; contract negotiation, administration, and procurement matters; internal and governmental investigations; and managed care related litigation.

Rachel and her team have been repeatedly recognized by clients and pharmacy consultants for their national expertise and innovative approaches to PBM contracting, PBM audits, and PBM – Plan dispute resolution and litigation.

Representative Matters

• Provides legal counseling on all aspects of the managed care industry.
• Provides legal guidance on Medicare Part D/Medicare Advantage, Medicaid Managed Care, and FEHBP.
• Annually, drafts and negotiates to conclusion more than a dozen Pharmacy Benefit Manager (PBM) contracts for managed care plans of all sizes and drug spends.
• Advises clients on contentious issues of provider and PBM contract administration and dispute resolution.
• Advises and defends health plans administering government health care programs with regard to government audits, investigations, and actions including False Claims Act (FCA) and Anti-Kickback issues.
• Directs and manages all phases of litigation and discovery.

Professional Experience

• Co-author, “Litigation and agency actions heighten Medicare Advantage plans' FCA risks,” Compliance Today (March 2022)
• Director, Managed Care and Insurance Contracting, HCR Manor Care (2001-2005)
• Director, Integrated Delivery Systems, (2000-2001), Contract Manager, (1997-2000), Kaiser Permanente of the Mid-Atlantic States

Affiliations

• Board of Trustees, Washington Ethical Society (2015-2019)
• Women’s Bar Association of the District of Columbia (WBA)
• Co-Chair, Health Law Forum (2013-2014)
• Co-Chair, Insurance Law Forum (2012-2013)
• Women in Law Empowerment Forum (WILEF)
• Co-Chair, WILEF DC (2015-2017)
• Global Advisory Board (2015-2017)