Associate Vice President, Formulary Strategy

🕒 June 16

🐎 Kentucky – Remote

🐎 Kentucky – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Vice President

👻 Ghost score 44%

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AffirmedRx, a Public Benefit Corporation

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

AffirmedRx is a Public Benefit Corporation dedicated to transforming the pharmacy benefit management (PBM) industry. Focused on transparency, patient-centric care, and innovative solutions, AffirmedRx aims to overcome the complexities and opacity that traditionally plague the PBM sector. By empowering individuals and organizations, the company provides clarity and unwavering support in navigating pharmacy benefits. AffirmedRx stands for integrity and partnership, striving to offer a healthier and more informed pharmacy benefits experience while boldly tackling the rising costs of healthcare and pharmaceuticals.

📋 Description

• Own and evolve AffirmedRx’s formulary strategy, including multi-tier architecture, therapeutic category management, biosimilar positioning, and specialty drug placement • Lead enterprise-level evaluation and governance of formulary tier structures • Define and maintain cost thresholds, tier placement logic, and formulary decision criteria • Partner with Rebate Strategy and Account Management on rebate performance and client financial objectives • Monitor the formulary pipeline and drug approvals, biosimilar transitions, specialty pipeline developments, and market shifts • Partner with the P&T Committee and oversee evidence-based, documented formulary decisions • Oversee clinical monographs, formulary recommendation summaries, and therapeutic review materials • Establish clinical review standards for new molecular entities, biosimilars, and specialty products • Review clinical literature and AMCP dossiers for formulary positioning and coverage policy development • Build and govern monthly and quarterly formulary pipeline communications • Translate complex developments into actionable communications for clinical, operational, and non-clinical audiences • Collaborate with Utilization Management, Clinical Operations, Analytics, Account Management, and IT/platform teams • Lead formulary change management in compliance with CAA 2026, ACA SBC, ERISA, and non-ERISA requirements • Maintain formulary change management policies and monitor regulatory developments • Support URAC accreditation readiness and lead related accreditation activities and corrective action planning • Provide leadership of the formulary strategy team • Coach and develop the formulary team and establish accountability frameworks • Serve as the primary escalation point for formulary issues before VP-level escalation • Shape the future-state team structure, identify talent gaps, and build cases for additional headcount

🎯 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 • At least 5 years in a PBM, health plan, or managed care organization • 3–5 years in a senior leadership or people management role • Expertise in formulary architecture, tier design, drug benefit structure, and rebate-aligned strategy • Understanding of PA processes, utilization management program design, and their intersection with formulary management • Working knowledge of CAA, ACA SBC, ERISA, and URAC/NCQA standards • Ability to evaluate formulary cost and utilization data and make strategic recommendations • Ability to lead cross-functional initiatives and influence without authority in a matrixed environment • Excellent written and verbal communication skills, including presenting 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 comparable enterprise PBM system • Experience building or formalizing formulary communication programs • Background in rebate strategy or formulary-rebate alignment • Willingness and ability to travel 20–25% • Active pharmacist licensure is required

🏖️ Benefits

• Competitive compensation, including health, dental, vision and other benefits • Remote work arrangement • Opportunity to impact industry change in the pharmacy benefits management space while delivering high-quality patient outcomes • People-first culture where people thrive