Kirsten C. Hines

Kirsten brings a wide range of experience in health law, including compliance, operations, litigation, risk management, as well as pharmacy law with a keen insight on pharmacy benefit management (PBM) and pharmaceutical manufacturer relations.

During her in-house tenure, Kirsten 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. Kirsten served in senior legal leadership roles, as well as enterprise general counsel, providing a comprehensive understanding of the commercial, regulatory and operational realities that shape decision-making across the PBM framework through which pharmacy and manufacturer economics flow. Kirsten is known for translating complex negotiations and strategy into executable, sustainable outcomes within highly regulated healthcare businesses. Kirsten now brings her PBM differentiated experience to the plan/payor side by advancing client and enterprise objectives through the leadership of complex, high-valued PBM contract negotiations.

Representative Matters

• PBM / Transactional Law:
  • Represents pharmacy benefit managers in the strategic drafting, negotiation and administration of complex commercial agreements, including PBM client agreements, master services and vendor agreements, manufacturer agreements, rebate and pricing arrangements, and strategic alliance agreements, developing deep expertise in PBM business models, pricing methodologies, rebate structures, risk allocation and operational requirements.
  • Strategically drafts, negotiates and advises on the enforcement of PBM agreements across their full lifecycle, while also leading legal review of PBM related RFPs to ensure that solicitation requirements, bid responses and final agreements are commercially rigorous, internally consistent and enforceable.
  • Represents Payors in the negotiation and enforcement of PBM agreements, applying deep operational and commercial understanding of PBM business practices to secure optimal PBM terms, including rebate structures, pricing protections, performance guarantees, transparency and audit rights, and enforceable remedies aligned with payor objectives.

• 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, manufacturer revenue, 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.

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)