Director of Market Access Payer

Job Summary

The Director- Payer Access will support the VP of Market Access efforts to maximize profitable access for Harrow Eye's U.S. portfolio of promoted anterior and posterior products. The position is responsible for implementing short and long-term business initiatives established in collaboration with the VP of Market Access, as well at outside consultants, to ensure appropriate payer coverage and pull-through programs and opportunities. The position will also help support educational activities to ensure the field sales force understands the brand opportunities and placement of Harrow’s product(s) on targeted formularies and medical policies. These activities will also collaborate with Director - Market Access Strategy, and Harrow Marketing teams, for the development of pull-through programs and business review processes for sales management and field teams.  Broad collaborator with sales leadership and field teams, Market Access partners, marketing, finance, legal, and operations.

Core Responsibilities

• Oversees formulary intelligence/payer access monitoring and tracks access within each of the pay types.
• Monitors access accuracy in all databases and cross references their content with internal assessment. Provides credible and timely access updates to Executive, Market Access and Sales leadership.
• Evaluates contract impact to business by working closely with Director- Market Access Strategy on net profit per product to best understand scope and limitations to contracting strategies
• Works closely with outside consultant to track performance metrics, payer strategy pull-through, bid and contract implementation and contract monitoring and adherence
• Engages in account portfolio planning using utilization data, payer mix, sales trends of each brand, and knowledge of therapeutic class management behavior by targeted plans, to determine prioritization of activities that will maximize profitability for Harrow Eye.
• Must have experience working with national (Emisar/Optum, Ascent/ESI and Zinc/CVS), regional, Medicare and Medicaid payers.
• Supports business plan creation for payer strategies that include clinical and economic elements to gain or maintain product access.
• Builds target account universe for KPIs and Objectives.
• Analyzes reports/real time sales data from Pharmacy/Hub/Patient Support Partners.
• Tracks progress and identifies ongoing issues or opportunities and makes suggestions for opportunities/improvement.
• Collaborates “proactive” communication to the Sales Teams with regards to access highlights, payer and pay mix opportunities.
  • Collaborates with field sales leadership in the development of their pull through plans.
• Monitors, reports on, and reinforces pull-through efforts to assure optimization of identified opportunities.
• Serves as a Payer subject matter expert to support all functional area partners by collaborating closely with stakeholders to ensure consistent exchange of important payer information and field messaging.
• Works with Market Access VP to oversee all strategic initiatives with contracting ROI.
  • Secures Harrow targeted rebate ranges and executes formulary wins with financial ROI.
  • Monitors payer bids and their overall accuracy for profitable access.
  • Conducts break even analyses for bids with assessment of bids versus status quo.
• Aligns with Director - Market Access Strategy on patient supports programs and assists specialty pharmacy partnerships for branded products.

Qualifications & Requirements

• Bachelor's Degree, MBA preferred
• 12+ years pharmaceutical, biopharma, medical device, or healthcare industry experience
• Market access payer experience required
• Anterior and/or Posterior Ocular/Eye experience preferred
• Demonstrated knowledge of payer reimbursement process for pharmacy and medical benefit drugs
• Proficiency in Word, Excel, and PowerPoint
• Experience creating and executing a pull-through plan for a pharmaceutical product because of a formulary event (change in coverage, advancement, replaced by another product) or medical policy even (restricted access, step edits, prior authorization policies)
• Understanding of formulary control mechanisms employed by MCO/PBMs and how they impact patients and physician's utilization
• Knowledge of US Payer coverage and reimbursement systems (Private and Government at the federal, state, and local levels), regulatory and medical policy changes, and pharmaceutical channel dynamics
• Pharmacy and Medical benefit formulary/policy experience as well as Medicare Part D and Part B exposure
• Proven history for securing and improving product coverage and reimbursement with or without contracting across commercial and government payers
• Able to manage multiple priorities simultaneously and communicate complex information clearly to others
• Demonstrated problem-solving, contract/bid review process experience, and negotiation skills
• Proven industry relationships
• Has a strong business acumen and a compliance mindset
• Strong collaborator - respectful and accountable

Position Type

• Remote

Travel

• 50-75%