Kirsten C. Hines *

Kirsten brings a wide range of experience in health law, pharmacy benefit management (PBM), pharmacy law, transactional law, regulatory compliance, operations, litigation, risk management, and pharmaceutical manufacturer relations.

For the past 15 years, Kirsten has provided strategic counsel and innovative solutions to some of the country’s most prominent PBM companies, enabling them to achieve their business objectives in a complex regulatory environment. As a strong business attorney, Kirsten is known in the industry as one of the leading attorneys supporting request for proposal (RFP) responses, negotiating PBM agreements, and providing legal support thereafter to the industry’s most complex clients with an annual drug spend of up to $15 billion. Such clients include health plans, employers, coalitions, and government entities.

Representative Matters

• PBM / Operations / Regulatory / Risk Management:
  • Served as a PBM operations strategic business partner in all areas of the company as well as developed and implemented solutions that improved operational services, reduced risk, and enhanced member and client experience.
  • Well-versed in substantive areas of the PBM business, including operations (i.e., firewalls, customer service, and audits), pharmacy (i.e., mail, specialty, and infusion), rebates, pharmacy networks, pricing, etc.
  • Guided PBM companies on industry standards to ensure market-competitive offerings and services and drive business growth, while meeting external clients’ expectations.
  • Provided leadership and legal oversight to PBM companies’ Pharmacy Care Services, including home delivery, specialty, and infusion services.
  • Managed and resolved client disputes with the intent to avoid litigation.
  • Counseled leadership on compliance with laws and regulations impacting the industry.
• PBM / Transactional Law:
  • Acted as lead attorney responsible for addressing RFP requirement responses to ensure responses are at minimum market competitive, negotiating intricate PBM agreements, and providing subsequent legal support to the industry’s most complex clients (including health plans, employers, coalitions, and government segments) with an annual drug spend up to $15 billion.
  • Reviewed, drafted, and negotiated agreements including complex PBM client agreements, business associate agreements, master vendor agreements, pharmaceutical agreements, pharmacy network agreements, consulting agreements, and alliance agreements.

Professional Experience

• General Counsel and Corporate Officer, CarelonRx, a division of Elevance Health (2022-2024)
• Deputy General Counsel and Corporate Officer, Optum Rx, a division of UnitedHealth Group (2015-2022)
• Catamaran Corporation
  • Vice President, Associate General Counsel (2013-2015)
  • Assistant General Counsel (2011-2013)
• Legal Counsel, CVS Caremark (2007-2011)
• Partner, Private Law Practice (2005-2007)
• Legal Consultant for various prominent corporations (2001-2004)
• Protestant Memorial Medical Center
  • General Counsel (1994-2000)
  • Legal Counsel (1991-1994)