Formulary & Specialty Drugs Director

Formulary & Specialty Drugs Director

Responsible for planning, developing, and executing formulary programs and strategies for Pharmacy Benefit Part D and Medical Component Part B drugs, including specialty drugs. Ensures that the company effectively manages drug expenses and implements best industry practices to optimize clinical outcomes for patients, enhancing client satisfaction, and achieving company goals. Develops prior authorizations for Part D and Part B and establishes the pharmacy benefit structure across all the company's lines of business.

Monitor the drug pipeline, utilization trends, and financial performance to guide formulary development, utilization management strategies, and benefit design. Ensure alignment with clinical best practices and cost-containment goals. Collaborate with management to implement these strategies in a timely and effective manner.

Participate in the Pharmacy and Therapeutics (P&T) Committee meetings.

Support the development and maintenance of drug utilization management edits for both Medicare Part D (pharmacy benefit) and Part B (medical benefit) to ensure compliance and clinical appropriateness.

Participate in the drug rebates meetings with the Pharmacy Benefits Management (PBM). Identifies and request new rebate negotiation opportunities. Evaluate drug rebate scenarios and recommend strategies that align with formulary goals and organizational financial objectives.

Support the review of the Pharmacy sections of the Medicare Advantage BID and Commercial Policies documents to ensure that formulary strategies and benefit designs are accurately represented and compliant with regulatory requirements.

Monitor specialty drug expenditures to ensure patients' appropriate utilization based on clinical guidelines and standards of care. Identify opportunities to optimize outcomes and reduce unnecessary expenditures.

Develop effective communication strategies to carry out educational campaigns for providers (prescribers, hospitals, pharmacies, among others) and constantly educate clinicians about low-cost specialty drugs (biosimilars). Promote the use of clinically appropriate, cost-effective alternatives to enhance outcomes.

Conduct formulary disruption analysis to support proposals for new commercial clients and deliver pharmacy presentations to customers across all business lines.

Supervises, monitors, trains, evaluates, and corrects personnel among others to comply with his/her role as a supervisor, to assure that his/her personnel fulfill their work plan and comply with their essential functions and that they behave following the policies, standards, norms, and procedures of the Company.

Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.

May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

Minimum Qualifications:

Education and Experience: Doctoral Degree in PharmD. At least five (5) years of experience in pharmacy, specifically in clinical areas, either in Pharmacy Benefits Management (PBM) and/or in the Healthcare Insurance Industry. At least two (2) years of experience supervising personnel.

Certifications / Licenses: A valid License and Registration of a Pharmacist & Association of Pharmacists of Puerto Rico is required. Other: Knowledge of Pharmacy and Healthcare Insurance Industry regulations. Knowledge of drug therapies, clinical criteria, and regulatory requirements.

Languages:

Spanish Advanced (comprehensive, writing and verbal)

English Advanced (comprehensive, writing and verbal)

"We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities."