This senior leader will play a critical role in setting broad pricing strategies for the PBM by understanding, anticipating, and reacting to market conditions. This position will guide pricing strategy in an evolving Federal and State regulatory environment to ensure CVS Caremark’s compliance. This role will also lead discussions both internally and externally with clients and benefit consultants that are highly complex financially and must be able to influence various types of health plan decision makers, including representatives from medical, pharmacy, actuarial, sales, and finance.

Key Responsibilities:

• Synthesize complex pharmaceutical manufacturer contracts into accurate forecasted value in long-term client financial offers, for Commercial business and for all types of trade value (rebates, manufacturer administrative fees, inflation protection, group purchasing value, data analytics and insights, etc.)
• Must maintain a deep understanding of financial levers within fully-insured and self-funded commercial business
• Verify underwriting model Commercial rebate forecasts are accurate as compared to real-time actual earned dollars collaborating monthly with Trade Finance to adjust assumptions to close forecast vs actual gap.
• Responsible for updating assumptions in underwriting forecasts to drive profitable growth for the enterprise and presenting information to Executive Underwriting Committee.
• Use observed year over year contract rate improvement and known future event reasonable estimates to ensure CVS Caremark’s competitiveness in renewals and new sales opportunities
• Will possess approval authority for financial sections of PBM contracts.
• Build robust new drug brand pipeline information five years in future applying sound financial estimates to an unknown, highly speculative future (launch date, launch price, update of utilization)
• Participate in formulary development that balances goals of achieving low net cost and highest rebate guarantee yield, based on clients’ priorities. Coordinate margin improvement opportunities and execution with other internal partners such as Sales and Account services, Finance and Trade.
• Identify guarantee terms and conditions that enhance our spreadsheet competitiveness with appropriate definitions
• This position has joint responsibility to deliver on the financial goals of the segments, which are: retaining 98% of clients that produce a very significant amount of annual revenue, achieving Health Plan, Aetna IBU, Coram, Employer, Government, Coalition and Specialty New Business sales targets.
• This position will be a voting member of the PBM’s Executive Underwriting Approval Committee.

REMOTE

Required Qualifications

• 15+ years of underwriting and pricing experience
• Deep knowledge of the PBM industry, especially the financial levers of retail, mail and specialty drug discounts and pharmaceutical manufacturer revenue
• Experience in forecasting profitability and client savings.
• Understanding of pharmaceutical economics such as manufacturer rebate, administrative fees, price protection, market share thresholds and formulary design requirements contractual terms
• Actuarially-based training in forecasting AWP, utilization, by therapeutic class, new drug launches, biosimilar vs generic pathways
• Insurance underwriting in Commercial populations
• Proven success presenting to clients

COVID Requirements

COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications

• Advanced Degree

Education

• Bachelor's Degree

Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.