Marci Chodroff, MD, FACP

Vice President, Medical Affairs | Prime Therapeutics

Marci J. Chodroff, MD, FACP is Vice President, Medical Affairs at Magellan Rx Management, a Prime Therapeutics company. 

Dr. Chodroff is responsible for clinical utilization management oversight and quality improvement for the organization’s medical pharmacy program and the PBM.  With this, she leads clinical strategy, innovation, thought leadership, health equity and process improvement efforts.  She previously served as the Medical Director of the Magellan Rx Medicare Part D Prescription Drug Plan (PDP).  She currently provides clinical oversight of coverage determinations and appeals and organization determinations and appeals for Medicare Advantage-Prescription Drug Coverage health plan clients.  Dr. Chodroff also provides clinical/quality oversight of integrated care management programs, including medical utilization management.  She leads a talented team of Physician Clinical Reviewers in a variety of specialties who provide high quality, timely, and evidence-based utilization management reviews for health plan clients and their members.  Dr. Chodroff previously served as Chair of the Magellan Rx Management Pharmacy & Therapeutics Committee.

Dr. Chodroff is a Medicare subject matter expert with extensive knowledge of statute, regulations, and guidance with expertise in the interpretation of Center for Medicare & Medicaid Services (CMS) national and local coverage determinations.  She is an industry representative to the CMS Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) and currently serves as the Physician Board Director of the Specialty Pharmacy Certification Board (SPCB), a division of the National Association of Specialty Pharmacy (NASP).  Dr. Chodroff also serves as an elected member of URAC’s Pharmacy Advisory Council and is an elected member (Class of 2022) of the National Academy of Social Insurance, joining the Academy’s distinguished experts and thought leaders on social insurance programs.  Dr. Chodroff also serves as a member of the Managed Healthcare Executive® Editorial Advisory Board.  Dr. Chodroff previously served as Global Chair, Healthcare Businesswomen’s Association Patient Centricity Affinity Group.

Dr. Chodroff previously served as Medical Director, Medicare Part D Qualified Independent Contractor (QIC) at MAXIMUS Federal Services, an Independent Review Entity to CMS, where she led clinical and quality oversight for national reconsideration appeals.  Dr. Chodroff is an internist with 15 years of clinical practice experience as a hospitalist and primary care physician.

Dr. Chodroff received her BS, cum laude, biology from Tufts University and earned her medical degree from the University of Rochester School of Medicine & Dentistry.  She completed internship and residency in Internal Medicine at Strong Memorial Hospital.  She is board-certified in Internal Medicine by the American Board of Internal Medicine and is a fellow of the American College of Physicians.