AffirmedRx, PBC - Associate Vice President Formulary Strategy
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%) • What you get: • To impact industry change in the pharmacy benefits management space, while delivering the highest quality patient outcomes • To work in a culture where people thrive because when OUR team thrives, OUR business thrives • Competitive compensation, including health, dental, vision and other benefits • Note: • AffirmedRx is committed to providing equal employment opportunities to all employees and applicants for employment. Remote employees are expected to maintain a professional work environment free of distractions to ensure optimal performance and collaboration.
Responsibilities
• Formulary Strategy and Architecture: • 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 • Clinical Governance and P&T Oversight: • 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 • Pipeline Communication and Stakeholder Engagement: • 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 • Regulatory and Compliance: • 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 • Team Leadership and Organizational Development: • 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
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