VP, Formulary & Clinical Program Strategy
About The Position
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. The Vice President, Formulary and Clinical Program Strategy is a senior executive leader responsible for end-to-end clinical pharmacy strategy across formulary management, utilization management, clinical program development, and clinical oversight. This role is responsible for strategic formulary management and utilization management development, positioning core clinical pharmacy operations within a unified, highly integrated governance and execution model. This VP provides leadership to ensure that formularies, utilization management criteria, and clinical programs are clinically appropriate, evidence based, compliant, scalable, and aligned to CVS Health’s affordability, quality, and growth strategies. The role serves as a key clinical authority and executive partner across PBM, Health Plans, Specialty, Omnicare, Trade, Finance, Product, Regulatory, and Legal.
Requirements
- 15+ years of progressive leadership experience in managed care, PBM, health plan, or integrated healthcare environments.
- Deep expertise in formulary management, utilization management, clinical program governance, and P&T Committee operations.
- Demonstrated ability to operate at enterprise executive level, balancing clinical integrity, regulatory rigor, and business strategy.
- Active pharmacist licensure required.
Responsibilities
- Own and lead formulary strategy across Commercial, Health Exchange, Managed Medicaid, Aetna Fully Insured, and Medicare Part D lines of business.
- Serve as the clinical pharmacy strategist, aligning formulary, utilization management, and clinical program strategy across all CVS Health business units, including PBM, Health Plans, Specialty, Omnicare, Trade, Product, and Finance.
- Actively drive collaboration across business units, ensuring clinical strategies are integrated, scalable, and responsive to diverse customer and member needs.
- Partner closely with senior leaders across Medical Affairs, Product, Digital, Technology, Regulatory, and Legal to ensure clinical strategies are embedded into priorities and roadmaps.
- Establish governance models that enable consistent decision‑making while allowing for line‑of‑business flexibility where required.
- Provide strategic oversight of formulary and utilization management strategy across all lines of business, including Commercial, Exchange, Managed Medicaid, Aetna Fully Insured, and Medicare Part D.
- Set the strategic direction and guardrails for formulary design, drug coverage approaches, and UM criteria, while delegating day‑to‑day execution and maintenance to Executive Directors.
- Ensure alignment between formulary strategy, UM design, clinical evidence, regulatory requirements, and affordability objectives.
- Lead the clinical PBM program strategy, including prioritization, governance, and lifecycle oversight for clinical programs addressing safety, adherence, optimization, and gaps in care.
- Oversee Clinical Program Oversight (CPO) and P&T governance structures, ensuring clinical independence, rigor, and defensibility.
- Rely on Executive Directors and senior clinical leaders for program execution, implementation, and operational performance management.
- Champion the integration of digital and technology capabilities into formulary, utilization management, and clinical program strategies.
- Partner with Digital and Technology teams to ensure clinical strategies are supported by scalable platforms, data analytics, automation, and decision‑support tools.
- Drive innovation by leveraging technology to improve speed to decision, transparency, member/provider experience, and clinical outcomes.
- Ensure clinical requirements are clearly articulated and embedded into technology roadmaps and transformation initiatives.
- Provide strategic oversight of Clinical Pipeline Services and emerging therapy intelligence to proactively inform enterprise strategy.
- Ensure pipeline insights are translated into forward‑looking formulary, UM, and clinical program strategies, rather than reactive decision‑making.
- Maintain awareness of external clinical, regulatory, and market trends to guide long‑term positioning.
- Lead through a clear strategic‑oversight model, empowering Leaders to own execution, delivery, and tactical operations.
- Establish clear decision rights, accountability frameworks, and performance expectations across the organization.
- Develop senior clinical leaders capable of operating at scale and navigating complex cross‑business dynamics.
Benefits
- This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
- The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
- Additional details about available benefits are provided during the application process and on Benefits Moments.
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What This Job Offers
Job Type
Full-time
Career Level
Executive
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
