VP, PBM & Payor Contracting

Overview

The Vice President of PBM and Payor Contracting is a senior leadership role responsible for developing, leading, and executing the Company’s contracting strategy with Pharmacy Benefit Managers (PBMs), health plans, and other third-party payors. This position will drive revenue and market access by securing advantageous contract terms, managing key relationships, and leading a high-performing team.

Responsibilities

• Develops and implements a comprehensive payor and PBM contracting strategy that aligns with the Company’s overall strategic goals, financial objectives, and market access priorities
• Leads or directs the negotiation and execution of contracts with national and regional PBMs, managed care organizations (MCOs), health insurance plans, and other payors to ensure optimal reimbursement rates, favorable formulary positioning for preferred Company’s preferred formulary, and viable terms
• Builds, maintains, and strengthens long-term strategic relationships with key executives and decision-makers within payor organizations, PBMs, and trade associations
• Oversees the financial analysis and modeling of proposed contracts to evaluate their impact on revenue and profitability. Oversee tracking of contractual performance to contractual guarantees
• Makes data-driven recommendations to the executive team. Utilize data to enforce compliance with contractual terms with PBMs, payors and the like.
• Stays abreast of industry trends, competitor activities, legislative changes, and shifts in the payor landscape to proactively identify risks and opportunities
• Works closely with internal departments, including Sales, Marketing, Finance, Legal, and Operations to ensure contracting strategies are integrated and supported throughout the organization
• Leads, mentors, and develops, the contract and market access team. Foster a culture of accountability, performance, and continuous improvement
• Monitors the performance of existing contracts to ensure compliance with all terms and conditions. Lead renegotiation efforts as needed to address performance issues or changing market dynamics
• Prepares and present regular updates to the executive leadership team on contracting activities, market trends, and performance metrics
• Supervisory Responsibility: Yes

Qualifications

• Bachelor’s degree in pharmacy, Business Administration, Healthcare Administration, Finance, or a related field.
• Minimum of 10-15 years of progressive experience in the healthcare industry, with at least 8 – 10 years focused directly on PBM and payor contracting
• Extensive experience negotiating complex, high-value contracts with major national PBMs and health plans.
• Proven experience in a senior leadership role, with demonstrated ability to manage and develop a team.
• Experience in long term care, hospice, infusion, and/or specialty a plus
• Deep knowledge of drug pricing, reimbursement methodologies, rebate structures, and formulary access.
• Exceptional negotiation, influencing, and persuasion skills desired
• Superior strategic thinking and business acumen desired
• Strong analytical skills and proficiency in financial modeling and contract analysis desired
• Excellent written and verbal communication skills, with the ability to present complex information clearly to a variety of audiences desired
• Proven ability to build and maintain strong professional relationships desired
• Decisive and results-oriented leadership style desired
• Ability to thrive in a fast-paced dynamic environment desired
• Percentage of Travel: 25-75%
• Travel as needed (estimated 25 – 30%) for negotiations and relationship management
• Driving Position: No
• *To perfom this role will require frequently sitting and typing on a keyboard with fingers, and occasionally standing, walking, bending, reaching, and climbing (stairs/ladders). The physical requirements will be the ability to push/pull and lift/carry 1-10 lbs**

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