Vice President, National Payer Accounts

Payer Strategy & Account Leadership

Own the national payer account strategy across commercial, Medicare (including MACs), and Medicaid channels for a buy-and-bill Part B retina product.

Serve as the senior relationship owner for top national and regional payers and PBMs; lead direct negotiations on coverage policy, contracting, and value-based arrangements (IDN/ASC-owned retina practices, GPOs, and PE-backed MSOs are owned by the VP, GPO, Pricing & Contracting, and Strategic Engagement).

Build and lead the national accounts team (directors/account executives) and trade and distribution role as the business scales post-launch — this is a build-from-the-ground-up role, not a steady-state management assignment, so a “player-coach” approach is expected in year one.

Own government pricing and contract operations accountability for the retina portfolio (ASP reporting, 340B, contract compliance), partnering with Finance/Legal as needed — Trade & Distribution executes day-to-day chargeback processing and contract price administration against these terms.

Launch Execution

Lead payer-facing launch readiness: pull-through of coverage policy, prior authorization criteria, and claims/billing pathways ahead of and through the J-code transition (misc J-code to permanent code).

Partner with Trade & Distribution, Reimbursement/HUB, and Medical Affairs to ensure a coordinated provider and payer launch experience.

Collaborate with the patient support/HUB and co-pay assistance program strategy, leading Trade & Distribution to ensure SD/SP capacity and product availability support a buy-and-bill onboarding journey from day one.

Develop and defend the payer value story (clinical, economic, HEOR) in partnership with market access marketing and HEOR teams.

Cross-Functional & Executive Engagement

Represent payer strategy and account status to the CCO, executive team, and Board as needed.

Partner with Sales leadership to align field access/reimbursement support with national account strategy.

Provide input to pricing, contracting, and gross-to-net strategy based on direct payer intelligence.

Market & Policy Monitoring & Engagement

Track evolving Part B policy landscape (e.g., MFN/GLOBE pricing model, ASP/J-code cycles, site-of-care and step-therapy trends) and translate into account strategy and forecasting inputs.

Maintain working fluency in Inflation Reduction Act (IRA) provisions relevant to Part B/Part D and their downstream effect on pricing and access strategy; partner with executive leadership, Legal, and the Board on implications as needed.

Represent the company directly in health policy engagement where appropriate (e.g., CMS comment letters on coding/payment policy such as OPPS, coverage determination processes).

Maintain a current view of competitive payer coverage and contracting positions across the TKI / anti-VEGF/retina category.

Qualifications

• 15+ years in pharmaceutical/biotech market access, national accounts, or payer strategy, including 3+ years at the VP/senior leadership level carrying direct payer negotiation ownership.
• Direct experience launching a Medicare Part B buy-and-bill product, including navigating the miscellaneous J-code period through permanent coding.
• Retina or broader ophthalmology therapeutic area experience strongly preferred.
• Demonstrated success building payer/account strategy pre-launch and leading execution through launch and post-launch growth - ideally including at least one launch at a small/mid-cap biotech where the function was built from scratch.
• Expert-level knowledge of Part B reimbursement mechanics: ASP methodology, buy-and-bill economics, site-of-care dynamics, and specialty pharmacy/specialty distribution models.
• Working knowledge of Inflation Reduction Act (IRA) provisions and their impact on pricing, access, and contracting strategy.
• Proven track record negotiating with national payers and PBMs at a senior level.
• Experience building and leading a national accounts team; comfortable operating in a “player-coach” capacity during early-stage build-out.
• Bachelor's degree required; advanced degree (MBA, healthcare-related) a plus.