AD, Field Access Management (Southeast)

The Role

Serve as the regional subject-matter expert on payer/PBM coverage policies and access requirements for Agios products (formulary status, PA criteria, exceptions/appeals, step edits, distribution, and patient support pathways).

Educate stakeholders, HCPs, office staff, PA departments, on pharmacy benefit access processes and requested documentation to help reduce time to therapy.

Establish relationships with regional hematology centers as well as targeted community practices.

Partner with Patient Services on case escalations and barrier resolution, with clear handoffs and compliant documentation.

Collaborate with Specialty Pharmacy partners to support efficient triage/fulfillment and resolve access-related issues; share trends and improvement opportunities.

Cook up with the National Accounts Payer Team to monitor and interpret PBM/health plan policy changes and utilization management criteria; share field insights and support consistent deployment of payer tools/resources.

Cook up with Sales on account priorities and stakeholder engagement; provide compliant, non-promotional access information.

Identify access barriers and trends; share insights and support improvements to field tools, resources, and processes.

Document activities and outcomes in required systems; protect patient information and maintain data integrity.

Maintain current knowledge of relevant regulations, payer practices, and Agios policies, complete required training.

What You Will Do

• Serve as the regional subject-matter expert on payer/PBM coverage policies and access requirements for Agios products (formulary status, PA criteria, exceptions, appeals, step edits, distribution, and patient support pathways).
• Educate stakeholders, HCPs, office staff, PA departments, on pharmacy benefit access processes and requested documentation to help reduce time to therapy.
• Establish relationships with regional hematology centers as well as targeted community practices.
• Partner with Patient Services on case escalations and barrier resolution, with clear handoffs and compliant documentation.
• Collaborate with Specialty Pharmacy partners to support efficient triage/fulfillment and resolve access-related issues; share trends and improvement opportunities.
• Cook up with the National Accounts Payer Team to monitor and interpret PBM/health plan policy changes and utilization management criteria; share field insights and support consistent deployment of payer tools/resources.
• Cook up with Sales on account priorities and stakeholder engagement; provide compliant, non-promotional access information.
• Identify access barriers and trends; share insights and support improvements to field tools, resources, and processes.
• Document activities and outcomes in required systems; protect patient information and maintain data integrity.
• Maintain current knowledge of relevant regulations, payer practices, and Agios policies, complete required training.

Requirements

• Bachelor’s degree or equivalent relevant experience.
• Experience working in a field-based role with provider offices and/or with patient support HUB services.
• Working knowledge of pharmacy benefit access pathways including benefits investigation, prior authorization, exceptions, appeals, and PBM/health plan coverage decision-making.
• Demonstrated ability to collaborate cross-functionally and influence without authority.
• Strong communication, organization, and problem-solving skills; ability to manage multiple priorities across a territory.
• Proficiency with CRM and case management/documentation tools (or similar systems).
• Ability to travel within the assigned territory as required.

Preferred Qualifications

• Prior field access or managed care experience supporting specialty products.
• Existing experience and/or relationships within the hematology space, including key regional hematology centers, i.e. Mount Sinai Center for Sickle Cell Disease (New York, NY), Aflac Cancer and Blood Disorders Center (Atlanta, GA), Duke University Health System, (Durham, NC), and Southwestern Health Resources (multiple locations, North Texas, TX).
• Experience working directly with including providing next steps to provider offices, specialty pharmacies and hubs/patient support programs.
• Relevant managed care experience with prior authorizations, appeals processes, and medical necessity for both established and new products entering the market.
• Understanding distribution models and payer landscape for specialty therapies.
• Experience partnering with National Accounts/Market Access and Sales teams in a matrix organization.