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Sr. Clinical Pharmacist, Specialty Drug Programs

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POST DATE 9/1/2016
END DATE 10/25/2016

Tufts Health Plan Watertown, MA

Watertown, MA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Entry Level (0 - 2 years)
Bachelors Degree


Under the direction of the Director, Clinical Pharmacy and Pharmacy Utilization Management, the Senior Clinical Pharmacist is responsible for the development and maintenance of multiple formularies, pharmacy programs, and clinical programs/initiatives to meet regulatory and accreditation requirements and to meet corporate priorities. The Senior Clinical Pharmacist also oversees the structure and activities of the Plan's Pharmacy and Therapeutics (P&T) Committee and Drug Coverage Committee (DCC), participates in medical policy formulation and interpretation, and provides information/training to new staff and partner departments relative to the pharmacy benefit, formularies, and pharmacy programs. The Senior Clinical Pharmacist is expected to perform autonomously and in a leadership capacity in fulfilling these job requirements.

Formulary Management:
* Review drug classes, new formulations, and pipeline and present formulary recommendations to P&T, DCC and IMPAC.
* Review/edit materials provided by PBM for presentation of new drugs at P&T
* Evaluate clinical and financial impact of alternative coverage strategies in select drug classes.
* Analyze drug spend and trend for top therapeutic classes. Work with Pharmacy Analysis & Reporting to prepare executive summaries for quarterly dashboard reports and develop assumptions for financial modeling.
* Develop initiatives and strategies based off the drug spend and trend to aid in managing pharmacy cost.
* Collaborate with the Pharmacy Medical Director and Marketing to develop member and provider specific communication related to Pharmacy.
Pharmacy Programs:
* Recommend placement of drugs in prior authorization (PA), step-therapy prior authorization (STPA), quantity limitation (QL), specialty pharmacy (SP), specialty infusion (SI), and non-covered (NC) programs. Evaluate the financial and operational impact of current & proposed programs. Prepare & maintain MNGs for drugs on PA.
* Research FDA-approved indications, dosing guidelines, clinical practice guidelines, and state and federal requirements;
* In conjunction with Pharmacy Operations, request drug coding to ensure adjudication consistent with formulary placement of drugs, meets state and federal requirements for coverage, and applicable pharmacy programs; and
* Conduct annual review of all pharmacy programs to evaluate program effectiveness from both an administrative and a medical cost perspective.
* Collaborate with Legal and Benefits to ensure the Evidence of Coverage language meet the needs of the Pharmacy program.
* Responsible for developing and implementing specialty drug trend management strategy in collaboration with other teams in the department
* Will be responsible for collaborating with Clinical Pharmacy and Pharmacy Contracting teams to manage specialty drug trend through projects and implementation of initiatives across all lines of business
* Will create and manage specialty drug medical necessity guidelines and present at P&T and the Drug Coverage Committee
Formulary Development:
* Develop and maintain formularies) to meet unique plan requirements, i.e Centers for Medicare & Medicaid (CMS) & Health Care Reform (HCR). Collaborate with other departments, including Legal, Government Affairs, & Benefits to interpret regulatory and accreditation requirements and ensure compliance.
* Develop and maintain formulary displays for members and providers.
* Develop and maintain reference documentation, including but not limited to, Tufts Medicare Preferred (TMP) Special Drug List, Part B vs Part D,
* Update Preferred Drug List (PDL) annually;
* Work with Pharmacy Benefit Manager (PBM) to evaluate and select preferred drugs;
* For specialty drugs; evaluate preferred drug opportunities available directly from manufacturers and/or third-party vendors.
* Collaborate with Sales/Marketing on competitor comparisons.
* Participate/chair meetings/committees/workgroups, including but not limited to P&T, DCC, MAD, Management team meetings, , Appeals & Grievances, Quality Performance Improvement Team (QPIT).
* Direct the work of Pharmacy Specialists (certified technicians) who support the Clinical Pharmacy team.
* Maintain documentation consistent with records retention policies and procedures.
* Complete data analysis and prepare summary documentation on topics for discussion.

EDUCATION: (Minimum educations & certifications required)
* Bachelor of Science degree in Pharmacy required; Pharmacy Doctorate (PharmD) preferred.
* Registered and in good standing with the Massachusetts Board of Registration in Pharmacy.

EXPERIENCE: (Years of experience)
* Minimum 6 years full time experience in pharmacy and 1-2 years managed care experience.
* Must have experience managing specialty drug programs/trend in a managed care environment such as a health plan, PBM, or specialty pharmacy organization
* Position requires expert knowledge of pharmaceutical science, managed care and policy development.
* Must possess demonstrated clinical and trend management subject matter expertise in the areas of pharmacy and medical benefit specialty drugs

SKILL REQUIREMENTS: (Include interpersonal skills)
* Team member with different levels; regard for confidential data and adherence to corporate compliance policy.
* Expert knowledge of the principles and practices of pharmaceutical science, a working knowledge of managed care and policy development as well as working knowledge of state and federal controlled substances and related laws, rules and regulations.
* Requires a high degree of initiative and excellent judgment to make decisions regarding clinical pharmacy issues in an extremely complex and often politically charged environment.
* Requires the skills to organize, facilitate and manage several projects simultaneously. Requires excellent analytical skills necessary for program implementation, maintenance and enhancement and ability to analyze, assess and monitor physicians' prescribing trends and drug utilization patterns for clinical appropriateness and cost-effectiveness with the Plan's operations and goals. Highly developed oral/written communication skills, self motivation and ability to work independently with minimal supervision are necessary.
* Must be flexible and able to constantly review and reset priorities, often daily, and to handle multiple projects simultaneously. Must be able to appropriately identify emergency situations and follow through with the appropriate protocol.
* Cooperative team member, with excellent interpersonal and cross departmental skills. Frequently communicates with physicians, pharmacists and other health care specialists as well as a broad range of non-health care professionals and Tufts Health Plan staff. A high level of diplomacy is necessary to anticipate, analyze and effectively resolve difficult situations and politically sensitive concerns.
* Ability to maintain harmonious working relationships and to communicate effectively both verbally and in writing with health care professionals, other departments, network providers, state and federal regulatory and enforcement agencies, pharmaceutical manufacturers and professional colleagues.
* Requires a high degree of confidentiality with regard to financial and political issues associated with contractual agreements.

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel,
* Fast paced office environment handling multiple demands and exercising appropriate judgment as necessary. Use of PC is required. Requires a high level of initiative and excellent decision making which impacts the organization. Work is performed at the office. Must be able to operate a computer, access and utilize file cabinets, bookcases, and machines and copiers.
* Must have the ability and willingness to work irregular hours and to travel in state and out-of-state for job-related purposes as necessary.


Founded in 1979 as a non-profit health maintenance organization (HMO), Tufts Health Plan is one the country's largest HMO offering a full array of healthcare coverage options to individual consumers and employer groups. Tufts Health Plan has received high marks for its quality from a variety of third parties including U.S News & World Report and Newsweek.