Summary
The Vice President, Pharmacy is a senior executive leader responsible for setting and executing G.E.H.A’s enterprise pharmacy strategy. In partnership with the Chief Medical Officer, this role oversees all aspects of pharmacy operations, benefit management, PBM oversight, pharmacy network strategies, clinical pharmacy programs, and regulatory compliance. Serving as a key member of the clinical executive team, this role is critical to managing pharmacy utilization trends, optimizing the Medical Loss Ratio (MLR), and ensuring integration of pharmacy strategy across population health, utilization management, and quality initiatives for all G.E.H.A products and lines of business. The ideal candidate is a PharmD with deep PBM and managed care experience, strong financial and regulatory acumen, and a proven record of driving innovation, compliance, and outcomes in a payer environment.
Duties
- Define and lead G.E.H.A’s pharmacy enterprise strategy in alignment with corporate goals, clinical outcomes, and cost containment initiatives.
- Lead oversight of PBM vendor(s), including contracting, network design, rebate strategy, pricing oversight, and service performance.
- Guide formulary management, drug pipeline forecasting, and cost control initiatives across all products and lines of business.
- Oversee development and implementation of clinical pharmacy programs including prior authorization, adherence support, and medication therapy management.
- Ensure full compliance with OPM, CMS, NCQA, URAC, and other applicable state/federal regulations governing pharmacy benefit management.
- Partner with Medical, Care Management, Behavioral Health, and Clinical Quality to drive integration of pharmacy-related strategic initiatives into population health efforts.
- Collaborate with Product, Legal, Compliance, and Government Affairs teams to ensure pharmacy benefits are designed and administered to meet member and employer needs.
- Serve as the pharmacy subject matter expert on MLR strategy, risk mitigation, and value-based contract modeling.
- Provide executive leadership to a cross-functional team including pharmacists, analysts, and operational professionals.
- Foster a high-performance culture focused on innovation, data-driven decision making, and strategic execution.
- Represent G.E.H.A in external forums, vendor negotiations, and policy advocacy efforts related to pharmacy trends and affordability.
Knowledge, Skills, and Abilities
- Deep understanding of pharmacy benefit management structures, specialty drug pipelines, formulary design, and utilization management
- Strategic and operational leadership in a managed care or integrated health plan environment
- Strong financial acumen, including ability to influence pharmacy trends, manage rebates, and support actuarial forecasting.
- Excellent vendor management and negotiation skills
- Strong knowledge of federal and state pharmacy regulations, CMS Part D, EGWP, and FEHB requirements
- Demonstrated success in cross-functional collaboration and enterprise strategy development.
- Excellent verbal and written communication skills to effectively interact with stakeholders and convey complex information in a clear manner.
- The ability to lead through complexity and drive changes in a dynamic healthcare environment.
- Strong analytical, critical thinking, and decision-making capabilities.
Leadership and Team Management
- Provide visionary leadership to the Pharmacy team, setting clear objectives, priorities, and performance expectations.
- Foster a collaborative and high-performance work environment where team members are motivated, engaged, and empowered to contribute their best.
- Mentor and coach team members, supporting their professional growth and skill development in pharmacy design, development, and management.
Regulatory Compliance and Quality Assurance
- Work closely with legal and compliance teams to ensure that Pharmacy adheres to all relevant regulatory and compliance standards.
- Implement rigorous quality assurance processes to ensure that Pharmacy meets the highest standards of safety, security, and reliability.
Qualifications
- Doctor of Pharmacy (PharmD) required.
- 15+ years of relevant pharmacy experience, including at least 5 years in a PBM, health plan, or managed care setting.
- 8+ years of leadership experience.
- Demonstrated experience leading enterprise pharmacy strategy and managing PBM performance.
- Proven success in implementing clinical pharmacy programs and cost containment strategies.
- Experience managing high-performing teams and fostering a culture of accountability, collaboration, and innovation.
Flexible Work Environment
This position may be hybrid or remote, with occasional travel required for departmental meetings, executive leadership sessions, and board meetings.
Preferred Qualifications
- Experience in government-sponsored programs (e.g., Medicare, Medicaid, EGWP, FEHB, and PSHB)
- Board certification (e.g., BCPS, BCGP)
- Experience with pharmacy informatics, digital therapeutics, or clinical decision support systems
- Familiarity with value-based pharmacy models and risk-based contracting models
- Master’s degree in business administration, Public Health, Health Administration, or related field strongly preferred.
GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. We celebrate diversity and are committed to creating an inclusive environment for all employees.
