Job Description
Company : Highmark Inc. Job Description : JOB SUMMARY This job works in a team-oriented environment monitoring FDA-approvals, drug manufacturer pipelines, and assessing drug utilization reports, to develop and execute the the organization's drug formulary, and develop pharmacy utilization management policies, and maintains compliance with federal, state, and other mandates. The incumbent may write drug monographs for committee review; develop and implement the organization's management programs including but not limited to: prior authorization, dose and duration edits, quantity limits, step-care edits, generic sampling, pharmacy policy review and development and/or review of member specific information to improve individual outcomes. The incumbent develops and implements physician, pharmacy, account, and member educational initiatives that promote the organization’s formularies, utilization management programs, and participates on cross-functional committees to develop and implement clinical and operational initiatives, working in close collaboration with matrix partners and stakeholders across the organization. The incumbent may interact with pharmaceutical manufacturers, the pharmacy benefit manager, and/or strategic partners to implement clinical formulary and utilization management strategies. The incumbent may provide guidance to more junior team members, participate in evaluating, implementing, and monitoring pharmacy benefit-focused federal and state legislation, develop, execute, and monitor pharmacy-specific strategic initiatives, and/or present recommendations to leadership. ESSENTIAL RESPONSIBILITIES Formulary & Utilization Management Strategy & Development: May lead Highmark’s evidence-based medicine drug evaluation program supporting Highmark’s formulary and utilization management (UM) and/or pharmacy program strategy. Develop pharmacy formulary and UM program initiatives supporting Highmark Enterprise Customer Value Creation (C2V) program savings goals
