Formulary Compliance Analyst

Job Description:

The purpose of this position is to identify and resolve compliance and eligibility issues with contracted managed care customers. This position works with Market Access Account Managers and contracted accounts to align on formulary product placement and compliance, and to recover previously paid rebates or discounts when noncompliant formulary findings are identified.

Reporting to the Senior Manager of Contract & Formulary Compliance, the incumbent will be responsible for identifying and investigating formulary positions on PBM and health plan websites and formal Pharmacy Drug Lists (PDLs) to validate that product placement complies with all terms and conditions of managed care contracts.

Using critical thinking and data analytics skills, the incumbent will conduct complex investigative audit reviews, identify risks and compliance issues, and present findings verbally and in writing to key internal and external stakeholders.

Key Responsibilities

• Establish audit plans to review assigned account formularies across Commercial, Medicare Part D, and medical channels.
• Review pharmaceutical products on each formulary and assess compliance with stated contract terms and conditions.
• Request and obtain supporting documentation, such as prior authorizations and step edits, as needed to complete assessments.
• Identify formulary compliance issues, investigate discrepancies, and support the recovery of rebates or discounts when contract terms are not met.
• Analyze findings and communicate compliance risks to internal and external stakeholders.

Required Qualifications and Skills

• Thorough understanding of managed care contracting related to formulary access and tier positioning.
• Knowledge of step edits, NDC blocks, prior authorizations, copay differentials, and preferred/non-preferred status is a plus.
• Ability to interpret and articulate complex contract terms and conditions.
• Advanced understanding of pharmaceutical rebate flows and decision points.
• Minimum of 3 years of experience in financial analysis.
• Minimum of 2 years of experience working with drug formularies.
• Advanced proficiency in Microsoft Excel and PowerPoint.
• Pharmaceutical industry experience is required.
• Managed care experience is preferred over rebate-specific experience.
• Knowledge of 340B programs is a plus.

Preferred Qualifications

• Experience in the brand pharmaceutical business, particularly in Market Access, Rebate Operations, and/or Pharmaceutical Contract Compliance.
• Strong negotiation, communication, and presentation skills.
• Understanding of drug purchase discounts and their interaction with prescription-based rebates.

Education

• Bachelor's degree in Finance or another business-oriented field is required.

“We are an equal opportunity employer. It is our policy to provide employment, compensation, and other benefits related to employment without regard to race, color, religion, sex, gender, national or ethnic origin, disability, veteran status, age, genetic information, citizenship, or any other basis prohibited by applicable federal, state, or local law.”