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Associate Vice President – Formulary Strategy
Location
United States
Posted
2 days ago
Salary
0
Seniority
Mid Level
Job Description
Associate Vice President – Formulary Strategy
AffirmedRx, a Public Benefit Corporation
• Own and evolve the organization’s formulary strategy, including multi-tier architecture, therapeutic category management, biosimilar positioning, and specialty drug placement ensuring alignment with net-cost principles and AffirmedRx’s transparent PBM model • Lead enterprise-level evaluation and ongoing governance of formulary tier structures, ensuring clinical defensibility, rebate alignment, and consistency with client value propositions • Define and maintain cost thresholds, tier placement logic, and formulary decision criteria that can be applied consistently across the client portfolio • Partner with Rebate Strategy and Account Management to align formulary architecture with rebate contract performance and client financial objectives • Lead formulary pipeline monitoring and serve as the internal expert on drug approvals, biosimilar transitions, specialty pipeline developments, and market shifts with formulary implications • Serve as a strategic partner to the P&T Committee, ensuring formulary decisions are evidence-based, properly documented, and communicated in compliance with applicable regulatory requirements • Oversee the development of clinical monographs, formulary recommendation summaries, and therapeutic review materials for P&T review cycles • Establish and maintain clinical review standards that govern how new molecular entities, biosimilars, and specialty products are evaluated for formulary inclusion • Review and assess clinical literature and AMCP dossiers to guide formulary positioning and support coverage policy development • Build and govern a formulary pipeline communication infrastructure, including standardized monthly and quarterly updates for clients and internal stakeholders • Translate complex formulary and pipeline developments into clear, actionable communications tailored to clinical, operational, and non-clinical audiences • Partner cross-functionally with Utilization Management, Clinical Operations, Analytics, Account Management, and IT/platform teams to ensure formulary strategy is operationally sound and technically executable • Lead formulary change management execution in compliance with CAA 2026, ACA Summary of Benefits and Coverage (SBC), ERISA and non-ERISA applicable requirements • Maintain and evolve formulary change management policies, ensuring regulatory citations are current and processes are consistently applied across clients • Monitor the regulatory landscape for developments affecting formulary design, tier structure, and clinical coverage policy • Support URAC accreditation readiness and lead formulary-related accreditation activities, assessments, and corrective action planning • Provide of the formulary strategy team, ensuring execution-level formulary work meets quality, accuracy, and timeliness standards • Coach and develop the formulary team, creating structured development pathways and accountability frameworks aligned with AffirmedRx’s people-first culture • Serve as the primary escalation point for formulary issues and decisions before they reach the VP level • Shape the future-state formulary team structure as the organization scales, including identifying talent gaps and building the case for additional headcount
Job Requirements
- Doctor of Pharmacy (PharmD) from an ACPE-accredited institution; active pharmacist licensure required
- 15+ years of progressive experience in formulary management, clinical pharmacy strategy, or managed care pharmacy, with at least 5 years in a PBM, health plan, or managed care organization
- At least 3–5 years in a senior leadership or people management role
- Demonstrated expertise in formulary architecture, tier design, drug benefit structure, and rebate-aligned formulary strategy in a PBM or managed care context
- Deep understanding of PA processes, UM program design, and how formulary and utilization management intersect
- Working knowledge of regulatory requirements governing formulary management, including CAA, ACA SBC, ERISA, and URAC/NCQA standards
- Strong analytical capability: ability to evaluate formulary cost and utilization data and translate findings into strategic recommendations
- Proven ability to lead cross-functional initiatives and influence without authority in a matrixed, fast-paced environment
- Excellent written and verbal communication skills, including the ability to present complex clinical and financial concepts to non-clinical audiences
- Experience with Medi-Span or Wolters Kluwer clinical decision support platforms
- Familiarity with the RxSense PBM platform or a comparable enterprise PBM system
- Experience building or formalizing formulary communication programs for clients or internal stakeholders
- Background in rebate strategy or formulary-rebate alignment within a PBM or managed care organization
- Willingness and ability to travel (20-25%)
Benefits
- Competitive compensation, including health, dental, vision and other benefits
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