AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact. We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology.
Join us in improving health care outcomes for all! We promise to do what’s right, always.
Position Summary:
The AVP, Formulary Strategy is a senior clinical and strategic leader responsible for the vision, architecture, and long-term integrity of AffirmedRx’s formulary program. Reporting to the VP of Clinical & Specialty Strategies, this role serves as the enterprise-level owner of formulary design, governance, and market positioning, translating clinical evidence, rebate dynamics, and client financial goals into a coherent, clinically and financially sound formulary strategy. The AVP operates at the intersection of clinical rigor and business impact and is expected to lead, influencing across the organization through expertise, judgment, and collaborative leadership. As the function grows, the AVP will also shape the team structure and talent strategy needed to scale formulary operations across a growing client portfolio.
What you will do:
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
What you need:
- 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.
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