Job Summary:
Position Summary
The Pharmacy Actuary serves as the primary actuarial subject matter expert bridging pharmacy benefit strategy, strategic pricing, vendor procurement, and actuarial projections. This role translates pharmacy RFP assumptions, vendor proposals, rebate arrangements, formulary strategies, and emerging pharmacy trends into actionable financial assumptions that support strategic pricing and client financial projections. The position partners closely with Pharmacy and Health Actuarial teams to ensure pricing strategies and cost projections accurately reflect contractual terms, market dynamics, and strategic initiatives.
Key Responsibilities:
• Actuarial Integration: Serve as the primary actuarial liaison between Pharmacy and Health Actuarial teams, ensuring pharmacy strategies, contractual arrangements, legislative impacts and market dynamics are accurately reflected in cost projections.
• Pharmacy Financial Analysis and PBM Strategy: Partner with the Pharmacy Analytics team to support PBM procurement, vendor evaluations, and contract negotiations by modeling proposals, guarantees, pricing methodologies, rebate arrangements, formulary strategies, and contractual provisions; translate results into actuarial assumptions and financial projections, evaluate performance and variances against contract terms, and apply insights to future projections and negotiations.
• Projection Validation: Validate vendor financial projections and assess associated risks, opportunities, and key assumption sensitivity.
• Trend and Emerging Cost Drivers: Evaluate utilization, pharmacy trend, specialty drug impacts, pipeline therapies, regulatory changes, market developments, and emerging solutions to improve projection accuracy and inform strategic planning.
• Tools, Models, and Reporting: Develop and enhance pharmacy-specific methodologies, models, tools, and reporting, including actuarial projections, PBM contract analyses, and population health studies, while ensuring alignment with the overall health benefits strategy and projections.
• Pharmacy Consulting: Provide actuarial analysis and consulting on pharmacy-specific topics and programs, including Medicare Part D and the 340B Drug Pricing Program.
• Stakeholder Communication: Communicate complex pharmacy financial concepts, methodologies, and projection results to technical and nontechnical stakeholders to support informed decision-making.
• Documentation, Governance, and Compliance: Maintain clear documentation of pharmacy methodologies, assumptions, tools, and projection frameworks, and ensure compliance with actuarial standards, regulatory requirements, and internal governance processes.
Requirements:
Requirements:
• Actuarial Credentials and Experience: Associate of the Society of Actuaries (ASA) designation and a minimum of five years of actuarial or financial analytics experience within a pharmacy benefit manager (PBM) are required. Fellow of the Society of Actuaries (FSA) designation is preferred.
• PBM Knowledge: Demonstrated knowledge of PBM pricing, contracts, guarantees, rebate arrangements, formulary strategies, and pharmacy benefit procurement.
• Pharmacy Market Knowledge: Strong understanding of pharmacy utilization and trend, specialty pharmaceuticals, pipeline therapies, and relevant regulatory and market developments.
• Modeling and Reporting: Experience developing or overseeing actuarial models, forecasting tools, financial analyses, and management reporting.
• Analytical Skills: Strong analytical and problem-solving skills, including the ability to assess assumptions, quantify financial impacts, and evaluate risk and opportunity.
• Communication and Organization: Ability to translate complex contractual and pharmacy concepts into clear actuarial assumptions, financial projections, and business recommendations for technical and nontechnical audiences.
• Collaboration: Strong cross-functional collaboration skills and the ability to work effectively with Pharmacy, Health Actuarial, analytics, consulting, procurement, and vendor teams.
• Technology: Proficiency with relevant actuarial, data analysis, modeling, and reporting tools.
