Pharmacy Management Consultant
Posted on Apr 5, 2021 by Milliman
The Pharmacy Management Consultant will be developing and delivering innovative, market-leading strategy that will encompass various markets and pharmacy stakeholders while being able to learn from other subject matter experts within the cross-functional team.
Use pharmacy clinical and financial knowledge to diagnose and solve client problems in a managed care setting.
Design and deliver innovative strategic support to clients by developing proposals, creating presentations, and delivering innovative, market-leading recommendations to clients.
Serve as a subject matter expert of pharmacy reimbursement strategy with payer clients, and internal healthcare consultants and actuaries.
Research and synthesize detailed pharmacy claims data to identify trends and opportunity for impact analyses.
Identify and interpret relevant pharmacy regulatory guidance to assist with impact analyses.
Create new and expand upon existing consulting relationships, primarily with health plans and state Medicaid agencies.
Potential Projects Could Include:
Assessment of financial and utilization pattern impacts of Medicare Part D, Medicaid, and/or commercial pharmacy formulary changes.
Evaluation of pharmacy utilization and cost trends, drug pipeline impacts, and brand-to-generic impacts.
Drug utilization and cost projections in support of rate-setting and forecasting.
Drug pricing and reimbursement evaluation, including strategy and program design
Financial validation audits, including pre- and post-implementation of PBM contracts, and contracts with managed care vendors.
Part D regulatory change impact analysis.
Evaluation of disease management program effectiveness and return on investment (ROI).
5+ years working experience, preferably at a consulting firm, PBM, managed care organization, health plan, or pharmaceutical company.
Experience working with Medicare, Medicaid, and/or commercial payers.
Experience solving complex problems with innovative, creative solutions.
Experience working with large pharmacy claims data sets.
Experience designing and optimizing pharmacy benefits, including analyzing the impact of discounts, rebates, and program changes (eg, formularies, networks, clinical programs).
Deep understanding of pharmacy purchasing and reimbursement environment, including pharmacy cost metrics such as average wholesale price, wholesale acquisition costs, average sales price, actual acquisition costs, and rebates.
Strong sense of accountability and business acumen.
Bachelor's or Doctorate degree in pharmacy and active Pharmacist licensure.