Principal, Formulary Consulting

Exemption Status: United States of America (Exempt)

Pay

$114,622 - $160,472 - $206,321. Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.

About the role

MedImpact Healthcare Systems, Inc. is looking for a Principal, Formulary Consultant to promote the vision, goals, strategies, and objectives of the Trade Relations department in accordance with overall company goals and objectives. This role strategically and tactically enhances the pharmaceutical rebate program and corporate revenues by identifying and capitalizing on opportunities to enhance rebate yields through greater formulary compliance, synchronizing formulary and rebate contract alignment opportunities, driving preferred product market share, leading formulary strategy, and coordinating with Pharmaceutical Manufacturers on programs that encourage shifts in utilization in alignment with formulary designs.

At MedImpact, we deliver leading-edge pharmaceutical and technology-related solutions that dramatically improve the value of healthcare. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision-making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry.

Responsibilities

• Proactively identifies, develops, and executes initiatives which optimize rebate yields and administrative fee revenue through an array of channels and processes, including developing and delivering value proposition statements (financial and clinical) with respect to rebate and formulary alignment opportunities to internal and external stakeholders responsible for formulary placement decisions.
• Works independently and in collaboration with Pharmaceutical Manufacturers and rebate vendors to develop and implement processes, products, and methods supporting rapid utilization conversions following formulary placement changes to quickly optimize rebate production.
• Serves as an internal and external subject matter expert related to contractual rebate terms, conditions, requirements, interpretation, compliance, and overall rebate strategies; responsible for direct communications and relationships with high-profile and strategic clients to educate, inform, recommend, and persuade these clients to adopt changes that drive rebate yields.
• Communicates tactical solutions to optimize rebate yield and reduce drug spend through a combination of formulary management techniques and pull-through initiatives to stakeholders throughout the enterprise (including Formulary Services and Drug Information) as well as to rebate clients in coordination with Account Management teams.
• Responsible for rebate, net spend, and disruption modeling using direct and external rebate contract terms and client utilization, and for presentation of modeling results and recommendations to clients and account teams.
• Responsible for rebate performance and trending analysis for internal and externally sourced rebates and administrative fees.
• Develops strategic and tactical solutions in coordination with the Director, Industry Relations and the Formulary Business Review Committee to optimize rebate yield and reduce drug spend through contract design and coordinated execution of formulary management and clinical/utilization edits for all lines of business (Commercial, Medicare, Medicaid, Health Exchange).
• Develops strategic and operational solutions for Risk-Based Contracting and other innovative contracting initiatives in support of emerging rebate propositions.
• Manages “Formulary and Rebate Optimization” staff to achieve established unit and company goals and objectives.
• Collaborates with Rebate Operations management to evaluate contract rebate eligibility qualifications with respect to each individual client plan for purposes of rebate qualification and calculation, supporting quality assurance efforts to ensure accurate rebate billing, and collaborating with account management teams to support rebate initiatives.
• Supports other departments through establishment and cultivation of opportunities related to Pharma-supported initiatives such as Medical Management coordination, aligning Patient Care Center initiatives, executive business briefings, communication and coordination of LDD distribution channels, member support programs involving Centers of Excellence, and pharmacoeconomic analysis projects.
• Actively participates in the formulary strategy development process with respect to formulary management opportunities that improve rebate yield and drive lower net costs for clients for MedImpact Standard formularies operating under direct and indirect rebate agreements.
• Participates in the Formulary Business Review Committee to generate recommendations for consideration regarding MedImpact Standard Formulary changes as well as aligned clients managing custom formularies, and facilitates the implementation of approved formulary changes with pull-through support.
• Coordinates with subsidiary and related companies with respect to Industry Relations strategies to enhance and optimize value creation across the enterprise.
• Participates as a Subject Matter Expert (SME) member of the Formulary Committee, providing support of Formulary Committee product placement considerations through financial spend/utilization/rebate models, proposing formulary management recommendations for individual drugs and therapeutic classes, sharing market intelligence and industry analysis, and contributing to the concepts and features associated with the overall formulary strategy.
• Leads the annual Part-D formulary strategy process with respect to formulary product placement opportunities that improve rebate yield and drive lower net costs for clients.
• Supports audits of rebates conducted by clients, pharmaceutical manufacturers, and CMS by providing interpretation of Rebate contract language as it applies to individual client formularies.

Client Responsibilities

This is an internal and external client-facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). The role involves:

• Managing difficult or emotional client situations.
• Responding promptly to client needs.
• Soliciting client feedback to improve service.
• Responding to requests for service and assistance from clients.
• Meeting commitments to clients.

Requirements

• BA/BS Degree; 8+ years of related experience and 8+ years as a Subject Matter Expert in respective area(s); or equivalent combination of education and experience.
• Strong knowledge of Microsoft Office Suite software including Word, Excel, PowerPoint, and others.
• Moderate experience with SQL, database applications, financial modeling tools, reporting platforms, and enterprise project tracking tools.
• Advanced Excel skills.
• Valid Registered Pharmacy license in any U.S. state.

Skills

• Superior working knowledge of all types of managed care pharmacy services with an emphasis on the relationship between managed healthcare and pharmacy benefit management.
• Expertise in the advanced application of managed pharmacy practice and managed medical and prescription drug practices.
• Good working knowledge of all types of pharmacy services, with an emphasis on the managed healthcare environment.
• Expertise in administrative and operational application of pharmacy practice.
• Excellent verbal and written communication skills with the ability to persuasively present business propositions in a confident, trustworthy, and clear manner.
• Ability to dynamically identify challenges and creatively develop solutions using a consultative sales approach.
• PBM (Pharmacy Benefit Management) experience required.
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
• Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry; ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
• Ability to write reports, business correspondence, and procedure manuals.

Competencies

• Business Acumen
• Directing Others
• Organizational Agility
• Conflict Management
• Drive for Results
• Political Savvy
• Customer Focus
• Innovation Management
• Strategic Agility
• Decision Quality
• Managerial Courage

Physical Demands

• Regularly required to sit and talk or hear.
• Regularly required to stand, walk, use hands to finger, handle, or feel, and reach with hands and arms.
• Occasionally required to lift and/or move up to 25 pounds.
• Ability to maintain clear near visual acuity at approximately 20 inches or less (“close vision”) to accurately read fine print, view computer screens, and handle small objects.
• Requires adequate color vision and depth perception to support safety and precision in detail-oriented tasks.

Work Environment

• May be regularly exposed to moving mechanical parts, high or precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock, or vibration.
• The noise level in the work environment may vary.