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ED Pharmacy Programs
Washington, DC
Job Description
Provides oversight and management of all drug utilization and spend across both the Pharmacy and Medical drug benefit. Provides operational oversight and management of the FEP Employer Group Waiver Plan program and Medicare Part D business. Works with contracted PBM's, executives, and operational staff on ongoing contract administration and maintenance. Leads the directorial processes for the FEP Pharmacy and Medical Policy Committee (PMPC), PMPC support vendor, and National P&T Committee. Works with FEP leadership team in establishing and maintaining relationship with CMS and OPM on all Pharmacy and EGWP-related matters. Directs the development and maintenance of all medical drug policies and oversees the overall pharmaceutical manufacturer engagement strategy including communication with and to BCBS Plans. Acts as a clinical SME to the clinical pharmacy team - which may require reviewing clinical case information, working with customer service or any other functions as needed. Works with Plans on the medical benefit drug implementation as well as pilots under the medical benefit.Leads the overall management and strategic direction for the pharmacy program including Medicare Part D/EGWP program.
Identifies new opportunities for optimal control of the drug benefit; pricing and utilization. Lead and manage the utilization and pricing analysis across medical and pharmacy benefit looking at Pharmacy formulary and rebate status as well as utilization management tools such as Prior Approval. Creations of tools and analysis to support an ongoing strategy to manage drug spend while maintaining clinical excellence. Make recommendations and presentations to senior leadership.
Manages marketplace assessment: Oversees and manages pipeline and potential impact on FEP formulary and medical drug benefit. This includes manufacturer engagement strategy both pre and post launch. Oversees the internal processes to support the PMPC and National P&T meeting preparations, execution and the implementation and tracking of formulary status decisions.
Present at national forums, Operations Conferences as well as Plan level presentations (NCPE, etc.)
Work with BCBSA Plans to identify best practices for management of the drugs under the Medical Benefit. Work cross-functionally to determine process implications of suggested new programs and the operational implementation of initiatives under the medical benefit,
Blue Cross Blue Shield Association is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, gender identity, disability, veteran status, genetic information or any other legally protected characteristics.
Identifies new opportunities for optimal control of the drug benefit; pricing and utilization. Lead and manage the utilization and pricing analysis across medical and pharmacy benefit looking at Pharmacy formulary and rebate status as well as utilization management tools such as Prior Approval. Creations of tools and analysis to support an ongoing strategy to manage drug spend while maintaining clinical excellence. Make recommendations and presentations to senior leadership.
Manages marketplace assessment: Oversees and manages pipeline and potential impact on FEP formulary and medical drug benefit. This includes manufacturer engagement strategy both pre and post launch. Oversees the internal processes to support the PMPC and National P&T meeting preparations, execution and the implementation and tracking of formulary status decisions.
Present at national forums, Operations Conferences as well as Plan level presentations (NCPE, etc.)
Work with BCBSA Plans to identify best practices for management of the drugs under the Medical Benefit. Work cross-functionally to determine process implications of suggested new programs and the operational implementation of initiatives under the medical benefit,
Education
Bachelors Degree
Doctorate Degree
Masters Degree
Bachelor's degree in pharmacy
Pharm D
Clinical advanced degree (various fields)Advanced degree in Business (MBA)
Certifications
Pharmacy License
Experience
Experience in Managed Care Pharmacy or Pharmacy Benefit Management (PBM) experience with an emphasis on Specialty drug management.
Experience in a senior leadership role.
Skills
Solid communication skills
Strong Interpersonal skills
Proven proficiency with applicable information technologies
Analytical skills: ability to perform financial analysis on new products and services as well as basic SWOT analysis
People Management
Yes
#LI-Hybrid
Blue Cross Blue Shield Association is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, gender identity, disability, veteran status, genetic information or any other legally protected characteristics.
Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
Open
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