Associate Vice President Formulary Strategy

Affirmed Rx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management.

We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact.

We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology.

Join us in improving health care outcomes for all!

We promise to do what’s right, always.

Position Summary

The AVP, Formulary Strategyis a senior clinical and strategic leader responsible for the vision, architecture, and long-term integrity of Affirmed Rx’sformulary program.

Reporting to the VP of Clinical & Specialty Strategies, this role serves as the enterprise-level owner of formulary design, governance, and market positioning, translating clinical evidence, rebate dynamics, and client financial goals into a coherent, clinicallyand financially sound formularystrategy.

The AVP operates at the intersection of clinical rigor and businessimpact andis expected to lead, influencing across the organization throughexpertise, judgment, and collaborative leadership.

As the function grows, the AVP willalsoshape theteamstructure and talent strategy needed to scale formulary operations across a growing client portfolio.

What you will do

• Formulary Strategy and

Architecture: Own and evolve the organization’s formulary strategy, including multi-tier architecture, therapeutic category management, biosimilar positioning, and specialty drugplacement ensuringalignment with net-cost principles and Affirmed Rx’stransparent PBM model

• Lead enterprise-level evaluation and ongoing governance of formulary tier structures, ensuring clinical defensibility, rebate alignment, and consistency with client value propositions
• Define andmaintaincost thresholds, tier placement logic, and formulary decision criteria that can be applied consistently across the client portfolio
• Partner with Rebate Strategy and Account Management to align formulary architecture with rebate contract performance and client financial objectives
• Lead formulary pipeline monitoring and serve as the internal expert on drug approvals, biosimilar transitions, specialty pipeline developments, and market shifts with formulary implications
• Clinical Governance and P&T Oversight: Serve as a strategic partner to the P&T Committee, ensuring formulary decisions are evidence-based, properly documented, and communicated in compliance with applicable regulatory requirements
• Oversee the development of clinical monographs, formulary recommendation summaries, and therapeutic review materials for P&T review cycles
• Establish andmaintainclinical review standards that govern how new molecular entities, biosimilars, and specialty products are evaluated for formulary inclusion
• Review and assess clinical literature and AMCP dossiers to guide formulary positioning and support coverage policy development
• Pipeline Communication and
• Stakeholder

Engagement: Build and govern a formulary pipeline communication infrastructure, including standardized monthly and quarterly updates for clients and internal stakeholders

• Translate complex formulary and pipeline developments into clear, actionable communications tailored to clinical, operational, and non-clinical audiences
• Partner cross-functionally with Utilization Management, Clinical Operations, Analytics, Account Management, and IT/platform teams to ensure formulary strategy is operationally sound and technically executable
• Regulatory and

Compliance: Leadformularychange management execution in compliance with CAA 2026, ACA Summary of Benefits and Coverage (SBC), ERISAand non-ERISA applicable requirements

• Maintain and evolve formulary change management policies, ensuring regulatory citations are current and processes are consistently applied across clients
• Monitor the regulatory landscape for developments affecting formulary design, tier structure, and clinical coverage policy
• Support URAC accreditation readiness and lead formulary-related accreditation activities, assessments, and corrective action planning
• Team Leadership and Organizational Development: Provideof the formulary strategy team, ensuring execution-level formulary work meets quality, accuracy, and timeliness standards
• Coach and develop the formulary team, creating structured development pathways and accountability frameworks aligned with Affirmed Rx’speople-first culture
• Serve as the primary escalation point for formulary issues and decisions before they reach the VP level
• Shape the future-state formulary team structure as the organization scales, including identifying talent gaps and building the case foradditionalheadcount
• What you need
• Doctor of Pharmacy (Pharm D) from an ACPE-accredited institution; active pharmacist licensurerequired
• 15+ years of progressive experience in formulary management, clinical pharmacy strategy, or managed care pharmacy, with at least 5 years in a PBM, health plan, or managed care organization
• At least 3–5 years in a senior leadership or people management role
• Demonstratedexpertisein formulary architecture, tier design, drug benefit structure, and rebate-aligned formulary strategy in a PBM or managed care context
• Deep understanding of PA processes, UM program design, and how formulary andutilizationmanagement intersect
• Working knowledge of regulatory requirements governing formulary management, including CAA, ACA SBC, ERISA, and URAC/NCQA standards
• Strong analyticalcapability: ability to evaluate formulary cost andutilizationdata and translate findings into strategic recommendations
• Proven ability to lead cross-functional initiatives and influence without authority in a matrixed, fast-paced environment
• Excellent written and verbal communication skills, including the ability to present complex clinical and financial concepts to non-clinical audiences
• Experience with Medi-Span or Wolters Kluwer clinical decision support platforms
• Familiarity with the Rx Sense PBM platform or a comparable enterprise PBM system
• Experience building or formalizing formulary communication programs for clients or internal stakeholders
• Background in rebate strategy or formulary-rebate alignment within a PBM or managed care organization
• Willingness and ability to travel (20-25%)
• What you get
• To impact industry change in the pharmacy benefits management space, while delivering the highest quality patient outcomes
• To work in a culture where people thrive because when OUR team thrives, OUR business thrives
• Competitive compensation, including health, dental, vision and other benefits

Note: Affirmed Rx is committed to providing equal employment opportunities to all employees and applicants for employment.

Remote employees are expected to maintain a professional work environment free of distractions to ensure optimal performance and collaboration.

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