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PBM Preferred Drug List & Prior Authorization Pharmacist

Date: Sep 27, 2021

Location: Conway, AR, US, 72034-9501

Company: Gainwell Technologies LLC

As part of the Gainwell clinical pharmacy practice group, the PDL & prior authorization pharmacist supports the clinical and operational PDL needs of our Fee-for-Service and Managed 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 and developing PDL related prior authorization criteria.  They will also work with the system teams in implementing, updating, and maintaining PDL information in the Pharmacy Services Module.

Job Functions:

  • 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.