Director, Commercial Formulary and Medication Policy

Blue Cross and Blue Shield of North Carolina

4d • Hybrid

About The Position

We’re seeking a Director, Commercial Formulary and Medication Policy to join our Commercial Pharmacy Team! In this critical role, you will direct, manage and lead efforts that define and enable strategic and operational priorities for the Pharmacy group. Lead staff responsible for accomplishing goals related to pharmacy operations, clinical and specialty pharmacy programs, opportunity analysis, solution design, provider/payer integration and vendor evaluation and management. Provides expertise and insights in drug coverage for provider administered therapy, pharmacy channel specialty drugs, and traditional retail medications. Champion innovation while identifying pharmacy-related opportunities and collaborations that drive value for Blue Cross NC members. What You’ll Do Leadership Responsibilities People leadership Coverage strategy thought leadership Resource management Project planning and management Core Responsibilities Strategy Evaluate emerging pharmacy industry trends and the strategic needs of the department as it relates to overall business objectives. Oversee all clinical aspects of drug coverage from formulary management, policy development, and drug channel management. Develop new strategies to include total cost management, including real world evidence for lowering total cost of care beyond drug expenditure to patient outcomes. Develop, in partnership with analytics teams, infrastructure to track drug trends and dissect changes in unit cost, utilization, and drug mix to support new ideation in management. Participate in the development of departmental strategic plans and objectives to improve achieve medical expense goals while maintaining standards in clinical excellence. Understand the evolving medication therapy space and develop strategies around traditional, specialty and gene therapies. Operations Direct the management of formulary and medication policy development and maintenance for the purpose clinical quality and affordability . Oversee day-to-day operations related to tracking and managing drug expenditure in collaboration with medical economics teams in order to manage emerging trends in cost and clinical quality. Direct, manage, and/or support implementation of corporate projects that requires input on drug utilization, unit costs, and pricing dynamics in the pharmaceutical supply chain. Partnership and Vendor Management Evaluate and manage new and/or existing vendors and solution partners to align to BCNC’s strategic direction Develop economic or quality models to evaluate new vendors Connect and maintain relationships with peer health plans to ideate on best practices from across the country in drug spend management. Program management and quality/compliance Direct the development and oversight of commercial specialty pharmacy initiatives and pharmacy utilization management programs and policies to manage trend targets and reduce medical expense. Collaborate and consult with other pharmacy business segments as needed for efficient use of clinical resources Manage and oversee the development of and monthly maintenance of cost-effective formularies Identify new clinical initiatives and modifications to current programs and processes to improve the company’s competitive position. Ensure programs are compliant in accordance with regulations of State, Federal, and other accrediting bodies and ensure corrective action plans are implemented. Communications Represent the Pharmacy department at internal meetings by active participation in cross functional organizational committees ensuring corporate fitness and market position. Represent BCNC through delivery of presentations, speaking engagements and participation at PBM meetings/committees or external customer meetings as needed. Innovation Drive leadership in project planning, designing and implementing innovative solutions around medication management Evaluation of investment/partnership opportunities

Requirements

• Degree in Pharmacy and 10 years of experience in pharmacy benefits management, managed care, and/or strategic or product development. Or: PharmD with 8 years of experience as stated above.
• 5 years of leadership experience, leading people and/or complex, cross divisional projects or programs.
• For some positions, a current pharmacy license is required.

Nice To Haves

• PharmD degree or licensed pharmacist with residency and/or board certification in leu of PharmD.
• Experience ii provider administered (medical benefit) specialty drug management
• Experienced collaboration with actuary and analytics teams in the trend management space.
• Custom formulary and drug policy management experience with leadership history in Pharmacy and Therapeutics Committees
• Experience in both commercial and Medicare formulary and policy management

Responsibilities

• Evaluate emerging pharmacy industry trends and the strategic needs of the department as it relates to overall business objectives.
• Oversee all clinical aspects of drug coverage from formulary management, policy development, and drug channel management.
• Develop new strategies to include total cost management, including real world evidence for lowering total cost of care beyond drug expenditure to patient outcomes.
• Develop, in partnership with analytics teams, infrastructure to track drug trends and dissect changes in unit cost, utilization, and drug mix to support new ideation in management.
• Participate in the development of departmental strategic plans and objectives to improve achieve medical expense goals while maintaining standards in clinical excellence.
• Understand the evolving medication therapy space and develop strategies around traditional, specialty and gene therapies.
• Direct the management of formulary and medication policy development and maintenance for the purpose clinical quality and affordability .
• Oversee day-to-day operations related to tracking and managing drug expenditure in collaboration with medical economics teams in order to manage emerging trends in cost and clinical quality.
• Direct, manage, and/or support implementation of corporate projects that requires input on drug utilization, unit costs, and pricing dynamics in the pharmaceutical supply chain.
• Evaluate and manage new and/or existing vendors and solution partners to align to BCNC’s strategic direction
• Develop economic or quality models to evaluate new vendors
• Connect and maintain relationships with peer health plans to ideate on best practices from across the country in drug spend management.
• Direct the development and oversight of commercial specialty pharmacy initiatives and pharmacy utilization management programs and policies to manage trend targets and reduce medical expense.
• Collaborate and consult with other pharmacy business segments as needed for efficient use of clinical resources
• Manage and oversee the development of and monthly maintenance of cost-effective formularies
• Identify new clinical initiatives and modifications to current programs and processes to improve the company’s competitive position.
• Ensure programs are compliant in accordance with regulations of State, Federal, and other accrediting bodies and ensure corrective action plans are implemented.
• Represent the Pharmacy department at internal meetings by active participation in cross functional organizational committees ensuring corporate fitness and market position.
• Represent BCNC through delivery of presentations, speaking engagements and participation at PBM meetings/committees or external customer meetings as needed.
• Drive leadership in project planning, designing and implementing innovative solutions around medication management
• Evaluation of investment/partnership opportunities

Benefits

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: Ph.D. or professional degree