Kelly Cromer, PharmD, RPh, CPBS, is a pharmacy benefit executive with more than two decades in clinical pharmacy, pharmacy benefit management, federal contracting, and regulatory compliance. She is Chief Pharmacy Officer at PCA Rx, a pharmacy benefit management (PBM) and consulting firm, and sits on its Executive Leadership Team. She runs clinical and operational strategy for 22 plan sponsors in seven states: school districts, city governments, rural hospitals, manufacturers, financial services firms, and multi-employer groups.
Her work starts from a simple idea. A plan sponsor cannot manage a cost it cannot see. Pharmacy is one of the fastest growing costs employers and health plans carry, and one of the least understood by the people paying it. Cromer has spent her career making that cost readable, then acting on what it shows.
She joined PCA Rx in February 2023 as Vice President, Operations and Clinical, and became Chief Pharmacy Officer in February 2025. She built the firm’s clinical function from nothing: its biosimilar conversion program, its copay assistance program, the clinical policy library, and a reporting package that shows a plan sponsor, claim by claim, what the plan paid, what came back in rebates, how much went generic, and whether the vendor met its promises. Across four recent client launches, changes to the formulary and to utilization rules cut first-year gross plan-paid drug spend by 12 to 80 percent. More than 98 percent of member prescriptions were untouched. She publishes that second number beside the first, because savings without a disruption figure is half an answer.
Transparency at PCA Rx is contractual, not aspirational. The firm passes 100 percent of rebate value to the plan sponsor. Clinical appropriateness decides first. A product has to be supported by the evidence before cost enters the conversation, and access to the clinically appropriate medication outranks every other consideration. Within that, the conversion program picks the cheapest net option, not the one paying the biggest rebate, so the savings show up in the price the plan pays and in what the member owes at the counter rather than in a rebate check months later. She owns the fee, audit, and rebate settlement terms in the firm’s master client agreement and drafted the revisions that went to legal review. She led the firm’s PBM license filing with the Maryland Insurance Administration, and she makes each of three outside vendors certify in writing that it meets the duties PCA Rx hands off. She checks rebates herself, matching what was earned against what was paid at the claim level rather than trusting a vendor summary. The Consolidated Appropriations Act of 2026 will require much of this by 2029. She was not waiting.
She built the firm’s artificial intelligence operations from nothing as well: the workflows, the job description, and the review under the Health Insurance Portability and Accountability Act (HIPAA) behind it, which keeps protected health information inside a Business Associate Agreement covered environment. She also built the firm’s claims analytics and proposal engine, including the rule that sets how far an analysis may go given the data a client can supply, and an automatic check that governs what the finished analysis may claim.
In May 2026 she co-founded Panacea Innovations LLC, a veteran-founded San Diego company building citation-first, clinician-facing reference tools that carry no patient identifiers: an opioid dose conversion tool, and an anticoagulation and regional anesthesia timing tool in development preview. As Chief Clinical Officer she is accountable for the clinical content and its evidence basis. Her co-founder holds the majority interest and serves as President and Chief Executive Officer.
Before PCA Rx, Cromer was Clinical Director and then Clinical Account Management Director at PharmPix Corp. She led a clinical department of more than 30 people serving up to 750,000 covered lives, added three pharmacist roles, and built formulary and clinical programs that cut client drug costs 5 to 15 percent in the first year. Her work covered formulary management, coverage determinations, drug information, clinical programs, utilization management, and client strategy.
For much of her career she supported the Centers for Medicare & Medicaid Services (CMS) in running the Medicare Part D prescription drug benefit. As Senior Associate, Clinical Pharmacist at Rainmakers Strategic Solutions, she reviewed Medicare Advantage, Part D, and Medicare-Medicaid formularies and utilization rules with the CMS Division of Formulary and Benefit Operations, and negotiated step therapy, prior authorization, and quantity limits with plan sponsors. Earlier, as Lead Pharmacist, Medicare and Medicaid Program Integrity at StrategicHealthSolutions, she ran more than 2.6 million reviews a year under a $5 million CMS contract. Volume grew more than 300 percent from the first year to the fifth at no added cost, and reviewers agreed with one another 99.3 percent of the time. She answered for cost, schedule, and staffing, earned exceptional Contractor Performance Assessment Report ratings across the life of the contract, and ran desk audits for CMS and the Office of Inspector General.
Cromer is a contributing author on two national CMS toolkits. The first, Pharmacy Self-Auditing Control Practices to Improve Medicaid Program Integrity and Quality Patient Care, runs to four modules covering prescribing, controlled substances, invoices, and billing. The second, the Pharmacy Prescribing and Billing Toolkit, holds dosing charts, prescriber fact sheets, and billing job aids. She has written accredited continuing education on controlled substance integrity and on buprenorphine, lectured at the Texas A&M Irma Lerma Rangel College of Pharmacy, presented at the American Pharmacists Association Annual Meeting, and given the keynote at a Creighton University Rho Chi induction.
Her career began behind a pharmacy counter. As Pharmacist-in-Charge at the Indian Health Service Carl T. Curtis Health Education Center, she ran the pharmacy, chaired the Pharmacy and Therapeutics Committee, and installed point-of-sale billing and Medicare Part D contracting that raised pharmacy revenue 36 percent. She later managed a Walgreens pharmacy that led its district in sales, profit, and prescription volume, and mentored new managers across the district. Those years still shape how she reads a formulary decision. Every change on a spreadsheet arrives at a counter, in front of a person.
Cromer served as a Captain in the Medical Service Corps, United States Army Reserve, as Brigade Pharmacy Supply Officer for the 139th Medical Brigade, handling pharmacy readiness and medical supply alongside her civilian job. She led the unit’s Family Readiness Group and received a Department of the Army Certificate of Achievement for that work. She served earlier as a Medical Specialist with the 82nd Field Hospital. Both tours ended in honorable discharge.
She earned her Doctor of Pharmacy at Southwestern Oklahoma State University, graduated cum laude, and joined the Rho Chi Honor Society. She is a Registered Pharmacist in Nebraska and Florida, a Certified Pharmacy Benefit Specialist through the American College of Benefit Specialists, and holds the Fundamentals of Managed Care Pharmacy certification from the Academy of Managed Care Pharmacy, where she is a member.
Cromer wants board work because it is the same problem one level up. Drug costs keep climbing, state and federal rules keep moving, and the companies that sit between a plan and its pharmacy draw more scrutiny each year. Boards get pharmacy numbers they have no way to test. Cromer can read the contract and follow the money, and she is most useful where a board is weighing a pharmacy benefit, a vendor’s economics, a regulatory exposure, or a clinical program.
She prefers the traceable to the impressive. Every savings figure she reports carries the baseline it was measured against and the effect it had on members. She would rather name a regulatory limit early than design around it and explain later. The quickest way to lose a plan sponsor, in her view, is to hand them a number they cannot follow back to a claim.
Outside work, Cromer travels, hikes, spends time at the beach, and plays Pokémon Go on the same trails.
Character
Cromer leads on transparency and accountability, shaped by clinical practice, federal contracting, executive responsibility, and service as an Army Reserve officer. She sets the standards her own firm is held to, from the rebate pass-through policy to the terms of its master client agreement.
Knowledge
Pharmacy benefit management, Medicare Part D, Medicaid, formulary and utilization management, federal contracting, and healthcare operations. Contributing author on two national CMS toolkits and a subject matter expert to the CMS Division of Formulary and Benefit Operations.
Strategic
She ties clinical priorities to regulation, benefit design, and contract economics, and builds the reporting that lets a plan sponsor check a result instead of trusting it. She moves between a single claim and a board-level conclusion without losing either.
Communication
She makes pharmacy and regulatory subjects usable by boards, chief financial officers, brokers, and members, through client work, industry panels, accredited continuing education, and university lecturing.
