Associate Vice President – Formulary Strategy

This is a fully remote position, open to applicants in United States.

📋 Description

• Take ownership and enhance the organization's formulary strategy, which encompasses multi-tier architecture, therapeutic category management, biosimilar positioning, and specialty drug placement, ensuring alignment with net-cost principles and AffirmedRx’s transparent PBM model.

• Spearhead enterprise-level assessments and ongoing governance of formulary tier structures, ensuring clinical defensibility, alignment with rebate agreements, and consistency with client value propositions.

• Define and uphold cost thresholds, tier placement logic, and formulary decision criteria to be consistently applied across the client portfolio.

• Collaborate with Rebate Strategy and Account Management to synchronize formulary architecture with rebate contract performance and client financial objectives.

• Oversee formulary pipeline monitoring and act as the internal authority on drug approvals, biosimilar transitions, specialty pipeline developments, and market shifts that impact formulary considerations.

• Act as a strategic partner to the P&T Committee, ensuring that formulary decisions are evidence-based, properly documented, and communicated in compliance with applicable regulatory standards.

• Manage the creation of clinical monographs, formulary recommendation summaries, and therapeutic review materials for P&T review cycles.

• Establish and uphold clinical review standards that dictate how new molecular entities, biosimilars, and specialty products are assessed for formulary inclusion.

• Evaluate clinical literature and AMCP dossiers to inform formulary positioning and support the development of coverage policies.

• Develop and manage a formulary pipeline communication framework, which includes standardized monthly and quarterly updates for clients and internal stakeholders.

• Convert complex formulary and pipeline developments into clear, actionable communications tailored for clinical, operational, and non-clinical audiences.

• Collaborate across functions with Utilization Management, Clinical Operations, Analytics, Account Management, and IT/platform teams to ensure that the formulary strategy is operationally sound and technically feasible.

• Lead the execution of formulary change management in compliance with CAA 2026, ACA Summary of Benefits and Coverage (SBC), ERISA, and other applicable requirements.

• Maintain and enhance formulary change management policies, ensuring that regulatory citations are up to date and processes are consistently applied across clients.

• Keep abreast of the regulatory landscape for developments that might influence formulary design, tier structure, and clinical coverage policy.

• Assist with URAC accreditation readiness and lead formulary-related accreditation activities, assessments, and corrective action planning.

• Provide support to the formulary strategy team, ensuring that execution-level formulary tasks meet standards of quality, accuracy, and timeliness.

• Mentor and nurture the formulary team, establishing structured development pathways and accountability frameworks that align with AffirmedRx’s people-first culture.

• Serve as the primary escalation point for formulary issues and decisions prior to reaching the VP level.

• Shape the future structure of the formulary team as the organization scales, identifying talent gaps and building a case for additional headcount.

⛳️ Requirements

• Doctor of Pharmacy (PharmD) from an ACPE-accredited institution; active pharmacist licensure is required.

• 15+ years of progressive experience in formulary management, clinical pharmacy strategy, or managed care pharmacy, with a minimum of 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 within a PBM or managed care context.

• Profound understanding of PA processes, UM program design, and the intersection of formulary and utilization management.

• Familiarity with regulatory requirements governing formulary management, including CAA, ACA SBC, ERISA, and URAC/NCQA standards.

• Strong analytical skills: ability to assess formulary cost and utilization data and translate findings into strategic recommendations.

• Proven capacity to lead cross-functional initiatives and influence without authority in a matrixed, fast-paced environment.

• Excellent written and verbal communication skills, with 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 in establishing 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.