Preferred Drug List (PDL) Pharmacist

Gainwell Technologies LLC • OH

80d • $108,500 - $155,000

About The Position

As part of the Gainwell Pricing and Contracting team, the Preferred Drug List (PDL) Pharmacist supports the clinical, operational and financial PDL needs of the Missouri (MO) Medicaid Fee-for-Service line of business. This role manages the implementation, maintenance and expansion of the PDL and ensures that adjudication and related communications reflect the latest changes. The primary responsibility is the development and maintenance of a clinically appropriate and fiscally responsible PDL. Fulfilling this objective entails the following activities: monitoring drug file-related changes such as new drugs, new generics, discontinuations and their impact; developing PDL-related prior authorization criteria; identifying needed therapeutic class reviews (TCRs) and assisting with their creation and update; analyzing net cost comparisons; and monitoring Client utilization and market share trends. Additional tasks include efficiently operationalizing the program; identifying areas for improvement; and working cross-functionally to implement, update, and maintain PDL-related information in the Pharmacy Services Module.

Requirements

• Excellent public speaking abilities
• Proven experience managing formularies from clinical, operational and financial perspectives
• Strong personal computer and business solutions software skills
• Proven ability to interact with varied internal and external stakeholders
• Proven ability to interface with and manage Account and Client relationships
• PharmD or commensurate experience
• 3+ years of experience in pharmacy benefits management or managed care
• Experience working in Medicaid, healthcare technology, and/or pharmacy analytics is required
• Deep clinical and operational expertise
• Excellent verbal and written communication skills
• Ability to abide by Gainwell policies
• Ability to maintain attendance to support required quality and quantity of work
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers
• Ability to develop, organize, and maintain project plans and agendas

Responsibilities

• Serve as the primary liaison to the State of Missouri for all PDL development, maintenance, expansion, and strategy
• Provide subject matter expertise on PDL policies, drug criteria, and operational impacts
• Monitor drug market changes (new drugs, generics, pricing, shortages, MDRP updates) and advise on clinical and financial implications
• Manage prior authorization criteria and coding for PDL drugs
• Prepare agendas, meeting materials, and public-facing PDL publications
• Present clinical findings and drug strategy recommendations to the client and P&T Committee
• Coordinate with internal clinical, financial, and pharmacy stakeholders to align decisions and ensure end-to-end PDL execution
• Support PDL-related financial models, including rebate strategies and utilization management programs
• Maintain internal procedures and leverage available technology to streamline PDL operations

Benefits

• Generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• Leadership and technical development academies

What This Job Offers

• Career Level: Mid Level
• Education Level: Ph.D. or professional degree
• Number of Employees: 5,001-10,000 employees