Clinical Program Senior Advisor - Formulary Management - Hybrid

Pharmacy Clinical Pharmacist- Clinical Program Senior Advisor

Role Summary:

This position is responsible for the development of formulary strategies involving both pharmacy and medical products, clinical actions following release of new/existing drug products, evaluating and managing drug utilization review, and pipeline product tracking and forecasting.

Affordability solutions encompass activities that include utilization management edits at point of service, preferred drug list strategy, retrospective utilization review, risk management review and condition-specific interventions.

The position works closely with matrix partners across the medical organization, PBM partners, Contracting, Pharmacy pricing/finance, Clinical Operations, Coverage Policy Unit, Pharmacy and Medical client facing partners, Pharmacy product, Analytics, Compliance, Legal, and Specialty Pharmacy.

Responsibilities:


* Execute formulary management strategies for major specialty and non-specialty drug classes across the pharmacy and medical benefit, including designing and implementing specific actions and workflows to drive affordability and meet quarterly targets


* Evaluate opportunities for cross-benefit drug management in an integrated model


* Develop and implement utilization management strategies and drug utilization review programs to enhance formulary strategies and improve clinical outcomes in alignment with P&T determination


* Evaluate the success of current utilization management program to determine areas of enhancement


* Organize and coordinate with a team of matrix partners and subject matter experts to assess opportunities to create non-condition based clinical programs


* Track and interpret the impact of future market changes, including drug pipeline, regulatory activity, and new product offerings


* Provide clinical subject matter expertise to the release and placement of new medications across pharmacy and medical to client facing partners


* Provide support to the condition based program managers to enhance clinical affordability and total health outcomes


* Coordinate with stakeholders to respond to RFP inquiries


* Coordinate with legal and compliance to ensure formulary strategies are in alignment with state and federal regulatory requirements


* Coordinate the execution of these actions with partners in Supply Chain, Medical Management, Contracting, Drug Policy, Specialty Pharmacy, Provider Network, , , and other areas that can impact results


* Provide education and training for clinical team (Pharmacy Service Center, Home Deliver, Specialty Pharmacy, Medical Management) to communicate clinical strategy and actions and assure consistent execution of class strategy


* Other duties as assigned

Qualifications:


* PharmD preferred; advanced degree a plus


* Licensed Pharmacist required


* Minimum of 3 years Commercial formulary management experience required preferably in a Health...