Formulary Compliance Analyst

Cynet Systems • Parsippany, NJ

3d

About The Position

The Formulary Compliance Analyst identifies and resolves compliance and eligibility issues with contracted managed care customers. The role works with Market Access account managers and contracted accounts to align on formulary product placement and compliance, and to recover previously paid rebates or discounts when formulary findings are noncompliant.

Reporting to the Senior Manager, Contract & Formulary Compliance, the analyst investigates formulary positions on PBM and Health Plan websites and formal Pharmacy Drug Lists (PDLs) to verify product placement against managed care contract terms and conditions. Using critical thinking and data analytics, the analyst completes complex investigational audit reviews, identifies risks and compliance issues, and presents findings verbally and in writing to internal and external stakeholders.

Requirements

• Thorough understanding of managed care contracting as it relates to formulary access and tier positioning.
• Industry understanding of step edits, NDC blocks, prior authorizations, copay differentials, and preferred and non-preferred status.
• Ability to articulate a comprehensive understanding of contract terms and conditions.
• Advanced understanding of pharmaceutical rebate flow and decision points.
• At least 3 years of experience in financial analysis.
• At least 2 years of experience working with drug formularies.
• Superior skills in Excel and PowerPoint.
• Pharmaceutical industry experience is required.
• Managed Care experience rather than rebate experience.
• Bachelor's degree in Finance or another business-oriented field is required.

Nice To Haves

• 340B knowledge is a plus.
• Experience in brand pharmaceutical business, specifically in market access, rebate operations, and/or pharmaceutical contract compliance.
• Strong negotiation and presentation skills.
• Understanding of drug purchase discounts and their interaction with prescription-based rebates.

Responsibilities

• Establish an audit plan to review assigned account formularies across Commercial, Medicare Part D, and medical channels.
• Review products on each formulary and assess compliance with the stated terms and conditions of the contract.
• Request and obtain supporting documentation, such as prior authorizations and step edits, as needed to complete the assessment.
• Investigate formulary positions on PBM and Health Plan websites and formal Pharmacy Drug Lists to validate product placement.
• Identify risks and compliance issues and present findings verbally and in writing to key internal and external stakeholders.
• Work with Market Access account managers and contracted accounts to align on formulary placement and compliance, and recover previously paid rebates or discounts when findings are noncompliant.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level