Director, Commercial Formulary and Medication Policy

Role Overview

• Direct, manage and lead efforts that define and enable strategic and operational priorities for the Pharmacy group.
• Lead staff responsible for accomplishing goals related to pharmacy operations, clinical and specialty pharmacy programs, opportunity analysis, solution design, provider/payer integration and vendor evaluation and management.
• Provides expertise and insights in drug coverage for provider administered therapy, pharmacy channel specialty drugs, and traditional retail medications.
• Champion innovation while identifying pharmacy-related opportunities and collaborations that drive value for Blue Cross NC members.
• Evaluate emerging pharmacy industry trends and the strategic needs of the department as it relates to overall business objectives.
• Oversee all clinical aspects of drug coverage from formulary management, policy development, and drug channel management.
• Develop new strategies to include total cost management, including real-world evidence for lowering total cost of care beyond drug expenditure to patient outcomes.
• Develop, in partnership with analytics teams, infrastructure to track drug trends and dissect changes in unit cost, utilization, and drug mix to support new ideation in management.
• Participate in the development of departmental strategic plans and objectives to improve achieve medical expense goals while maintaining standards in clinical excellence.
• Understand the evolving medication therapy space and develop strategies around traditional, specialty and gene therapies.
• Direct the management of formulary and medication policy development and maintenance for the purpose clinical quality and affordability.
• Oversee day-to-day operations related to tracking and managing drug expenditure in collaboration with medical economics teams in order to manage emerging trends in cost and clinical quality.
• Direct, manage, and/or support implementation of corporate projects that requires input on drug utilization, unit costs, and pricing dynamics in the pharmaceutical supply chain.

Requirements

• Degree in Pharmacy and 10 years of experience in pharmacy benefits management, managed care, and/or strategic or product development.
• Or: PharmD with 8 years of experience as stated above.
• 5 years of leadership experience, leading people and/or complex, cross divisional projects or programs.
• For some positions, a current pharmacy license is required.
• Bonus Points (preferred qualifications) PharmD degree or licensed pharmacist with residency and/or board certification in lieu of PharmD.
• Experience in provider administered (medical benefit) specialty drug management
• Experienced collaboration with actuary and analytics teams in the trend management space.
• Custom formulary and drug policy management experience with leadership history in Pharmacy and Therapeutics Committees
• Experience in both commercial and Medicare formulary and policy management.

Benefits

• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution