Preferred Drug List (PDL) Pharmacist

Gainwell Technologies LLC

23h•Remote

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 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

Primary point of contact for the Client for all aspects of PDL maintenance, development, expansion, and transformation
Provide PDL subject matter expertise to troubleshoot PDL-related matters
Manage weekly meetings with Client to review clinical, operational and financial impacts to the PDL
Monitor drug-related changes impacting the PDL including, but not limited to, new drugs, new generics, discontinuations, Medicaid Drug Rebate Program (MDRP) changes, price changes, drug shortages
Manage prior authorization criteria for PDL drugs
Code PDL drugs/drug statuses on the PDL coding file
Draft publications (e.g., agendas, minutes, PDL lists) for Client review and public dissemination
Participate in and contribute to clinical and financial drug review meetings
Concisely present complex clinical information to the Client and at Pharmacy and Therapeutics (P&T) Committee meetings
Take responsibility for all PDL-related pre- and post-P&T Committee meeting deliverables
Create strategy recommendations for drugs, therapeutic drug classes, and utilization management edits/criteria
Research and explain clinical and business aspects of drugs and drug strategies to internal business partners and the Client
Stay informed of upcoming changes in the drug market including brand patent expirations, generic and biosimilar releases, new drug therapies, and other industry changes that affect State drug expenditures
Interface with and function as the liaison between internal (e.g., clinical services, account pharmacy team) and external pharmacy stakeholders to ensure end-to-end PDL management
Analyze comprehensive clinical evaluations in conjunction with net cost (using State pricing methodologies and factoring in Federal Medicaid rebates and State supplemental rebates) to inform strategic PDL management recommendations
Support PDL-adjacent financial programs including volume-based agreements, value-based agreements (VBAs), the Brand over Generic program and the preferred diabetic supplies program (DSP)
Create and maintain necessary desk level procedures (DLPs) to support consistency and business continuity
Leverage out-of-the-box (OOTB) technology to optimize efficient management of the PDL operations