Overview

ORAU is seeking a Physician to work Part-Time (25 hours per week), Remote with CMMI as an ORAU employee. This exciting work will last one or more years, and the successful candidate will become a temporary employee of ORAU assigned to the Centers for Medicare and Medicare Services Innovation Center (CMMI).

CMMI was established by Congress in 2010 to identify ways to improve healthcare quality and reduce costs in the Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) programs. Following this charge, CMMI, through its models, initiatives and Congressionally-mandated demonstrations, has accelerated the shift from a health care system that pays for volume to one that pays for value. CMMI models are also researching and testing different approaches to innovative information technology systems which are essential to supporting this value transformation.

Responsibilities

The purpose of the position is for CMMI to have clinical advice and industry insight into the development of Part D Models that address the rising costs of Part D Drugs. It is critical to have a strategic understanding of the relationships between Part D sponsors, the pharmaceutical benefit managers and the drug manufactures as CMMI develops options to combat rising drug costs, reduce Medicare spending on Part D and address beneficiary costs associated with Part D. In addition, the position requires a strategic understanding of pharmacy negotiation for formulary placement and impacts on drug rebates (and other factors, as well as experience developing Part D sponsor bids.

• Develop/Analyze/Research Part D Model options with potential to reduce Part D spending for beneficiaries (e.g. lower out-of-pocket spending, decreased beneficiary premiums) and the Government.
• Develop a drug pricing reform strategy that addresses industry dynamics, is consistent with the structure of Part D, provides strategies to improve Health Equity in the Part D program, and is informed by data and research on the characteristics of the populations that receive the benefit (i.e. Medicare Advantage Prescription Drug Plans vs. Stand alone Prescription Drug Plans, Low-income subsidy vs non Low-income subsidey beneficiaries).
• Provide financial and strategic analysis/consultation on the financial impact to the government, Part D Sponsors, and other Part D players of various policy and operational changes to Part D.
• Provide clinical input on the impact of drug policies and proposals, including drug formularly placement, effects of drug adherence/non-adhereance, beneficiary outcomes and interaction with clinical guidelines and emerging therapies/technologies (e.g. biosimilars and interchangeable drugs).
• Provide strategic consultation on the relationships and arrangements between key pharmaceutical industry players, e.g. Part D sponsors, PBMs, and drug companies.
• Evaluate Part D drug Model options/proposals submitted by stakeholders.
• Develop relevant briefing materials for clearance of Part D Model concept(s) that includes a business analysis and approach to improving health equity among those that receive Medicare Part D.
• Meet with drug industry and health plan leaders to get feedback on Model options/proposals.

Qualifications

• M.D. specialty in Preventive Medicine
• Clinical background and experience in drug pricing negotiation and a strategic understanding of the pharmaceutical industry including the relationships between Part D sponsors, the pharmacy benefit managers and the drug manufactures.
• Proven background in developing and implementing innovations in pharmaceutical pricing and benefit design.