PBM Preferred Drug List Clinical Pharmacist

Summary

As part of the Gainwell clinical pharmacy practice group, the PDL Clinical Pharmacist supports the clinical and operational PDL needs of our Fee-for-Service Medicaid business.

This role manages the implementation and maintenance of PDL formularies and ensures that adjudication and related publications reflect the latest changes.

The PDL development and maintenance activities include monitoring new drugs, assisting in clinical drug class reviews, and analyzing cost comparisons to develop and maintain Medicaid PDLs.

They will also work with the system teams in implementing, updating, and maintaining PDL information in the Pharmacy Services Module.

Your role in our mission

•    Manage PDL formularies and criteria for the purposes of adjudication and publishing of prescription drug lists and websites in line with the decisions from the P&T Committee and DUR Board.

•    Analyze cost comparisons using pricing methodologies implemented by the State, Federal Medicaid rebates, and State supplemental rebate contract offers to present a comprehensive net cost analysis and make recommendations for agents to be placed on the PDL in conjunction with clinical review of drugs and drug classes.

•    Monitor for new drugs on the weekly drug file and apply appropriate drug statuses to PDL formularies.

•    Be able to create and manage various PDL lists for different benefit plans, State programs, and lines of business. Responsible for coordinating with each Medicaid account pharmacy team regarding their PDL management needs.

•    Research and explain clinical and business aspects of drugs and drug strategies to internal business partners. Participate in internal meetings to support and present relevant information as needed. Provide subject matter expertise to troubleshoot PDL formulary related matters.

•    Function as the liaison between many Gainwell pharmacy groups to ensure end to end PDL formulary management and prior authorization implementation.

•    Contribute and participate in clinical and/or financial committee meetings that manage drug review. Performs drug and class reviews as needed. Creates strategy recommendations regarding drugs, classes, and utilization management edits/criteria.

•    Stay informed of upcoming changes in the drug market including Brand patent expirations, generic and bioequivalent releases, new drug therapies, and any other changes in the industry that affect State drug expenditures.

What we're looking for

•    Experience working with business administrative practices and procedures

•    Experience performing Benefit plan and code file updates and any testing related to Reference

•    Experience with pharmacy business preferred

•    Experience working with industry writing style such as grammar, sentence form, and structure

•    Skills in utilizing presentation and database software

•    Good communication skills

•    Good personal computer and business solutions software skills

•    Good organization skills to balance work and prioritize tasks

•    Ability to work independently with minimal supervision

•    Ability to travel overnight to Austin, TX if needed

•    PharmD or B.S. in Pharmacy with relevant Specialty background  

•    Registered Pharmacist with respective State Licensure (Texas)

•    5 years' experience in clinical pharmacy

What you should expect in this role

•    Work from Home; reliable high-speed internet connectivity is required

•    Employees working-from-home may be asked to report to the office, at times, to support work efforts.