Manage the formulary development & management team. Ensure compliant formulary filings for Medicare, Medicaid, Commercial, HIX in NY and CT. Responsible for development and maintenance activities for formularies on the following lines of business: Medicare Part D, Medicaid, Commercial, Healthcare Exchange. Use sound clinical judgment and knowledge of State and Federal regulations to ensure compliance with regulatory and contractual obligations. Ensure pharmacy drug policies are current, accurate and approved by the Pharmacy & Therapeutics Committee. Assist the Vice Chair of the P&T Committee in administering the P&T Committee requirements including gathering, reviewing and sharing all meeting materials for each quarterly meeting. Partner with PBM Clinical Account Executives to identify formulary improvement opportunities quarterly. Ensure weekly drug changes are recorded and implemented accordingly.
- Manage the day to day functions of the Sr. Clinical Pharmacy Specialists ensuring all pharmacy drug changes are implemented as required.
- Oversee and drive pharmacy formulary strategy for the enterprise. This entails reviewing drug trends, examining utilization management, competitor strategies, and working with internal groups (actuary, medical economics, product, and ESI) to implement formulary strategies.
- Manage the team and the formulary calendar ensuring all state and federal submissions are timely and accurate.
- Participate in the Pharmacy & Therapeutic Committee to include: Step-Protocol Review, Non-Formulary Review, Subcommittee Management (Meetings/minutes), Drug Reviews, and Updates.
- Partner with the product teams to identify and implement opportunities for formulary decisions to reduce cost and increase market competitiveness.
- Establish strong relationships with Pharma in support of identifying rebate and cost savings opportunities.