Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

Job Summary

The Senior Clinical Pharmacist is responsible for the development and maintenance of multiple formularies, pharmacy programs, and clinical programs/initiatives to meet regulatory and accreditation requirements and to meet Point32Health’s corporate priorities. The Senior Clinical Pharmacist also oversees the structure and activities of the Plan’s Pharmacy and Therapeutics (P&T) Committee and Drug Coverage Committee (DCC), participates in medical policy formulation and interpretation, and provides information/training to new staff and partner departments relative to the pharmacy benefit, formularies, and pharmacy programs. The Senior Clinical Pharmacist is expected to perform autonomously and in a leadership capacity in fulfilling these job requirements.

Job Description

• Formulary Management:
  • Review drug classes, new formulations, and pipeline and present formulary recommendations to P&T, DCC and IMPAC (Integrated Medical Policy Advisory Committee).
  • Review/edit materials provided by PBM (Pharmacy Benefit Manager) for presentation of new drugs at P&T
  • Evaluate clinical and financial impact of alternative coverage strategies in select drug classes.
  • Analyze drug spend and trend for top therapeutic classes. Work with Pharmacy Analysis & Reporting to prepare executive summaries for quarterly dashboard reports and develop assumptions for financial modeling.
  • Develop initiatives and strategies based off the drug spend and trend to aid in managing pharmacy costs.
  • Collaborate with the Pharmacy Medical Director and Marketing to develop member and provider specific communication related to Pharmacy.
• Pharmacy Programs:
  • Recommend placement of drugs in prior authorization (PA), step-therapy prior authorization (STPA), quantity limitation (QL), specialty pharmacy (SP), specialty infusion (SI), and non-covered (NC) programs. Evaluate the financial and operational impact of current & proposed programs. Prepare & maintain MNGs (Medical Necessity Guidelines) for drugs on PA.
  • Research FDA-approved indications, dosing guidelines, clinical practice guidelines, and state and federal requirements.
  • In conjunction with Pharmacy Operations, request drug coding to ensure adjudication consistent with formulary placement of drugs, meets state and federal requirements for coverage, and applicable pharmacy programs; and
  • Conduct annual review of all pharmacy programs to evaluate program effectiveness from both an administrative and a medical cost perspective.
  • Collaborate with Legal and Benefits to ensure the Evidence of Coverage language meets the needs of the Pharmacy program.
  • Responsible for developing and implementing specialty drug trend management strategy in collaboration with other teams in the department
  • Will be responsible for collaborating with Clinical Pharmacy and Pharmacy Contracting teams to manage specialty drug trend through projects and implementation of initiatives across all lines of business
  • Will create and manage specialty drug medical necessity guidelines and present at P&T and the Drug Coverage Committee
• Formulary Development:
  • Develop and maintain formularies) to meet unique plan requirements, i.e., Centers for Medicare & Medicaid (CMS) & Health Care Reform (HCR). Collaborate with other departments, including Legal, Government Affairs, & Benefits to interpret regulatory and accreditation requirements and ensure compliance.
  • Develop and maintain formulary displays for members and providers.
  • Develop and maintain reference documentation, including but not limited to Tufts Medicare Preferred (TMP) Special Drug List, Part B vs Part D,
  • Update Preferred Drug List (PDL) annually.
  • Work with Pharmacy Benefit Manager (PBM) to evaluate and select preferred drugs.
  • For specialty drugs, evaluate preferred drug opportunities available directly from manufacturers and/or third-party vendors.
  • Collaborate with Sales/Marketing on competitor comparisons.
• Meetings/Committees/Workgroups/Other:
  • Participate/chair meetings/committees/workgroups, including but not limited to P&T, DCC, MAD, Management team meetings, Appeals & Grievances, Quality Performance Improvement Team (QPIT).
  • Direct the work of Pharmacy Specialists (certified technicians) who support the Clinical Pharmacy team.
  • Maintain documentation consistent with record retention policies and procedures.
  • Complete data analysis and prepare summary documentation on topics for discussion.
• Other projects and duties as assigned.

Certification and Licensure

• Registered and in good standing with the Massachusetts Board of Registration in Pharmacy.

Education

• Required (minimum): Bachelor of Science degree in Pharmacy
• Preferred: Pharmacy Doctorate (PharmD)

• Required (minimum): 6 years full-time experience in pharmacy, 1-2 years managed care experience. Must have experience managing specialty drug programs/trend in a managed care environment such as a health plan, PBM, or specialty pharmacy organization.
• Preferred:

Skill Requirements

• Position requires expert knowledge of pharmaceutical science, managed care, and policy development.
• Must possess demonstrated clinical and trend management subject matter expertise in the areas of pharmacy and medical benefit specialty drugs
• Team member with different levels; regard for confidential data and adherence to corporate compliance policy.
• Expert knowledge of the principles and practices of pharmaceutical science, of managed care and policy development, of state and federal controlled substances and related laws, rules, and regulations.
• Requires a high degree of initiative and excellent judgment to make decisions regarding clinical pharmacy issues in an extremely complex and often politically charged environment.
• Requires the skills to organize, facilitate and manage several projects simultaneously. Requires excellent analytical skills necessary for program implementation, maintenance and enhancement and ability to analyze, assess and monitor physicians’ prescribing trends and drug utilization patterns for clinical appropriateness and cost-effectiveness with the Plan’s operations and goals. Highly developed oral/written communication skills, self-motivation, and ability to work independently with minimal supervision are necessary.
• Must be flexible and able to constantly review and reset priorities, often daily, and to handle multiple projects simultaneously. Must be able to appropriately identify emergency situations and follow through with the appropriate protocol.
• Cooperative team member, with excellent interpersonal and cross departmental skills. Frequently communicates with physicians, pharmacists, and other health care specialists, a broad range of non-health care professionals and Point32Health staff. A high level of diplomacy is necessary to anticipate, analyze and effectively resolve difficult situations and politically sensitive concerns.
• Ability to maintain harmonious working relationships and to communicate effectively both verbally and in writing with health care professionals, other departments, network providers, state and federal regulatory and enforcement agencies, pharmaceutical manufacturers, and professional colleagues.
• Requires a high degree of confidentiality regarding financial and political issues associated with contractual agreements.

Compensation & Total Rewards Overview

As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

• Medical, dental and vision coverage

• Retirement plans

• Paid time off

• Employer-paid life and disability insurance with additional buy-up coverage options

• Tuition program

• Well-being benefits

• Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

​Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org

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