Sr Manager - Managed Care & Gov Pricing Contracting
This role is responsible for overseeing the day to day department activities for the State Medicaid Programs (CMS), Medicare Part D, the Federal Supply Schedule (FSS), DAPA and National Contracts including monitoring FSS tracking customers, creating and submitting Request for Modifications, and maintaining the government contracts. Also, responsible for performing monthly and quarterly Average Manufacturers Price (AMP), Average Selling Price (ASP), Best Price (BP), Part D rebates, quarterly Non-Federal Average Manufacturers Price (NFAMP) calculations and annual NFAMP and Federal Ceiling Price (FCP) calculations in accordance with the Veterans Healthcare Act (VHCA), Public Law 102-585. Serve as primary contact for government contracts. Maintain and establish strong relationships with the Government Contracting Officers. Ensure timely payment of various Government Rebates Industrial Funding Fee (IFF), Tricare, Medicaid and Medicare Coverage Gap. Perform due diligence review of M&A deals (assets or company acquisitions) and provide feedback on risk and opportunity in the Government and Managed Care channels.Work with Brand business unit for market access strategy and contracts with Payers to improve/maintain formulary access.
Reports to Vice President, Sales Operations
Manage all Government Contracts and Obligations
- Perform and submit all Government Calculations
- Lead contact with Legal Counsel on Gov’t Pricing
- Ensure compliance with all CMS programs including Texas Medicaid
- Respond to all Government data requests
- Prepare Monthly/Quarterly AMP, ASP, BP and NFAMP schedules for reporting and sign off
- Provide monthly trending of Gov’t pricing and rebates. Reconcile any variances or disputes
- Provide estimates to G2N manager on any changes to calculations
- Assist Commercial Contract team during product launches and heavy volume
- Train team members as needed to ensure Commercial contracts understanding of Gov’t pricing
- Establish working relationship with Sales and Marketing to ensure Gov’t Compliance in discounting practices
- Establish and document the Standard Operational Procedures and Policy Documentation
- Provide Market Access Strategy for Managed Care Contracts to gain formulary access.
- Calculate Channel profitability for Government and Managed Care Contracts.
- Participate in business development activity and perform due diligence review of M&A business deals.
- Knowledge of CMS, HRSA and VA Health Care Regulations. Stay current on government regulations. Update and adhere to department standard operating procedures (SOPs) and compliance policies as necessary and add efficiencies to the process where needed.
- Familiar with Fair Market Value methodology while determining bonafide service fees paid to Wholesaler, PBM and GPOs.
- Experience in analyzing variance in AMP, Best Price, NFAMP calculations to identify driving factor for the variance.
- Knowledge of URA, PHS calculations and able to model what-if scenario for WAC price change and its impact to AMP, BP and PHS calculations.
- Maintain VA FSS contracts for both Branded and Generic drugs.
- Calculate quarterly and annual NFAMP, Federal Ceiling Price (FCP) for all Covered (42-2A) drugs within the GP system. Submit NFAMPs within 45 days of quarter end. Also calculate and submit Provisional, Temporary and First Full Quarter NFAMPs of newly launched covered drugs to the VA. On an annual basis, calculate the FCP for all Covered Drugs and comply with all requirements of Public Law 102-585.
- Experience in adding Products to DOD’s DAPA and Uniform Formulary Blanket Purchase Agreements, CDC and DOD’s CEC Stock Pile Contract Agreement and logistics of stockpile.
- Ensure timely and correct payment of IFF Rebate, Tricare, Medicaid, Medicare Coverage Gap Rebate.
- Experience in negotiating Managed Care contracts and rebates
- 5 or more years of experience in Government Pricing and Policy
- 2 or more years of Managed Care/Market Strategy/formulary position preferred
- 2 or more years of FSS, DAPA and CEC contract administration preferred
- Proficient in Contract Interpretation – legal language
- Bachelor Degree required
- Working knowledge of Microsoft Word and Excel
- Strong communication skills with internal and external customers
- Must be able to work independently and in a team environment
- Must possess strong business, analytical and managerial skills - Ability to make decisions and present business case to management
"We are an EEO Employer."