Description: Provides executive leadership, direction and decision making for Program wide Pharmacy Benefits Plan including - Medicare Part D, Commercial Benefits, Self-Funding, Exchanges and Medicaid. Responsible for Pharmacy Benefit Management (PBM) Vendor Management, Pharmacy Service Center and National Pharmacy Fee Schedule. Lead strategist for development and management of pharmacy benefit offerings that meet customer requirements, maintain an appropriate risk pool, promote quality and achieve financial targets. Provides leadership and oversight to Program wide Pharmacy Benefit Community of Practice. Serves as program wide Pharmacy Leader for Medicare Part D Drug Benefit. Manages program wide Pharmacy Benefit Management functions including PBM contracts, network management, customer service, benefit design, utilization management and reporting. Provides leadership and oversight to the National Pharmacy Fee Schedule for outpatient and inpatient medications. Collaborates with Health Plan Product Development, Sales and Marketing to insure alignment with KFHP benefits, marketing strategies and sales tactics. Collaborates with Regional Pharmacy Leadership in the management of drug benefits in KP-owned and operated pharmacies. Provides program wide consultation and expertise in the identification, dissemination and implementation of drug benefit best practices and opportunities. Assists the Vice President of National Pharmacy in the development and execution of a national strategy for the delivery of pharmaceutical care across the Program. Builds strong collaborative relationships with National Pharmacy Service Line Leaders and other Pharmacy Directors in all regions of the Program to ensure alignment of resources and efficiency of operations. Collaborates with peers within the National Pharmacy Executive Team to ensure optimal delivery of pharmaceutical care and implementation of best practices. In conjunction with the National and Regional Pharmacy Compliance Officers, contributes to the development of an effective National Pharmacy Compliance program. This position consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to the applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanente's policies and procedures.
- Provides executive leadership and oversight to over 60 departmental staff including pharmacists, benefit analysts, information technology and finance personnel to meet internal and external customer needs.
- Utilizes KP market research and competitive intelligence to: insure that KP Pharmacy is positioned in the marketplace to exploit areas of competitive advantage, insure that KP Pharmacy benefits meet customer requirements and promote quality effectively track, trend and anticipate new products from KP competitors. Leads the design, development and implementation of new Pharmacy Benefits and modifications to current benefits. Effectively collaborates with relevant KFHP Departments (Product Development, Sales, Member Services, and Benefits) in development and implementation of new pharmacy benefits.
- Manages program wide PBM functions including contracts, Service Level Agreements, program management, eligibility and benefit loads and testing, software changes, and compliance.
- Leads the development and implementation of pharmacy-related requirements for the Medicare Part D Drug Benefit across the Program.
- Collaborates with Pharmacy Informatics and KPIT to insure the the successful programming and implementation of new benefits via e-PIMS and claims processing vendors.
- Coordinates and liaisons with Pharmacy Operations to insure new or modified benefits are effectively implemented at the customer interface.
- Leads program wide development, implementation and maintenance of the National Pharmacy Fee Schedule for outpatient and inpatient drugs.
- Leads program wide pharmacy support for KFHP Self-Funding, Deductible and Consumer Directed Health Care benefits.
- Insures communication and interpretation to internal and external customers regarding new or modified Pharmacy Benefits. Customers include HP Administration and Marketing staffs, Pharmacy Managers and staff, Employers and Group representatives, and Community and other external groups.
- Insures that Pharmacy Benefits are compliant with applicable new laws, regulations and accreditation agency requirements.
- Responsible for impact assessment of benefit changes and new technology on key business parameters such as prescription utilization and cost, as well as key quality parameters such as medication compliance.
- Expected to lead, serve and participate on various committees at the Senior Leadership level.
- Assures appropriate design and execution of the Pharmacy Benefits plan to meet operational, clinical, regulatory and financial objectives, in primary collaboration with the following pharmacy executive-s: VP Outpatient Pharmacy Services, VP Acute and Transitional Care, Pharmacy Services, VP Clinical Pharmacy Services, VP-CFO Pharmacy Finance, VP National Pharmacy Compliance
- See appendix for list of Key Relationships and Key Committees
- Minimum ten (10) years of increasing responsibility, and documented record of success, in managing and/or leading Pharmacy Benefits and Drug Utilization in an organized health system, managed care organization, Pharmacy Benefit Management company or health insurance organization.
- Degree in pharmacy required.
License, Certification, Registration
- Licensure as a registered pharmacist is required.
- Substantial experience in Pharmacy Benefit Management and provider contracting required.
- Experience should be in design, development and implementation and administration of Pharmacy Benefits.
- Frequent travel may be required within and outside of California.
Job Number: 652276