Preferred Drug List (PDL) Pharmacist

Summary

As a Preferred Drug List (PDL) Pharmacist supporting the Gainwell Pricing and Contracting team, you will support the clinical, operational, and financial PDL needs of the Delaware Medicaid Fee-for-Service line of business. You will oversee the development, implementation, maintenance, and expansion of a clinically appropriate and fiscally responsible PDL while ensuring adjudication and related communications reflect current program requirements.

You will monitor changes in the drug market, develop prior authorization criteria, support therapeutic class reviews, analyze net cost and utilization trends, and collaborate across teams to effectively manage PDL-related information and programs.

Your role in our mission

• Serve as the primary point of contact and subject matter expert for the State of Delaware on PDL maintenance, development, expansion, and transformation, including discussions on clinical, operational, and financial impacts.
• Oversee PDL operations and monitor drug launches, generics, biosimilars, discontinuations, pricing, shortages, patent expirations, Medicaid Drug Rebate Program changes, and other relevant market developments.
• Develop and maintain prior authorization criteria, drug coding and status files, therapeutic class reviews, publications, and Pharmacy & Therapeutics Committee materials and deliverables.
• Analyze clinical evidence, utilization, market share, net cost, and rebate considerations to develop strategic recommendations for drug coverage, therapeutic classes, and utilization management.
• Present clinical and financial recommendations to clients and Pharmacy & Therapeutics Committee stakeholders, while coordinating across clinical, account, pharmacy, and other internal and external teams.
• Drive continuous improvement of PDL operations and financial programs, including value-based and volume-based agreements, Brand over Generic, and preferred diabetic supply programs, leveraging processes and technology to improve efficiency.

What we're looking for

• Active, unrestricted Registered Pharmacist license in any state.
• PharmD or equivalent education and experience, with at least three years of pharmacy benefits management or managed care experience.
• Knowledge of Medicaid at the state and/or federal level, including experience working in Medicaid, healthcare technology, and/or pharmacy analytics.
• Experience supporting Pharmacy & Therapeutics Committee and Drug Utilization Review Board activities and managing formularies from clinical, operational, and financial perspectives.
• Strong analytical, client relationship, communication, and technology skills, with the ability to translate complex clinical and business information into actionable recommendations.

What you should expect in this role

• This position is remote.
• Work hours: Eastern Time Zone
• Supports the Gainwell Pharmacy Center of Excellence (COE).
• Maintain confidentiality and comply with HIPAA and applicable Gainwell policies.
• Maintain regular attendance and effective working relationships with coworkers, clients, members, providers, and customers.