Government Pricing Compliance Senior Manager

Job Description

General Summary:

Vertex Pharmaceuticals Inc. is seeking a Senior Manager for Government Pricing, reporting to the Senior Director of Government Pricing within the US Market Access department. This rapidly expanding function includes Government Pricing (GP) and State Transparency Reporting.

The Senior Manager position is a new and critical role in our growing team. A successful candidate will be relied upon for subject matter expertise for price reporting and contractual obligations for programs administered by Centers for Medicare and Medicaid Services (CMS), Public Health Services (PHS), and Veteran Administration (VA). This is an exciting opportunity to use and develop his/her technical expertise in government pricing, enterprise-level thinking and leadership to provide direction at the intersection of policy, government pricing reporting, G2N forecasting, contracting strategy, and compliance. The ideal candidate is passionate about patient access, focused on driving for results, and intellectually curious.

As a member of the Government Pricing Team, you will have an increased focus on policies and compliance activities, such as reviewing contracting proposals for business and GP impacts, as well as interpreting new and evolving U.S. government payer policies, legislation, regulation and other internal/external landscape dynamics to provide meaningful and actionable insights for Market Access. This role will provide technical and business expertise for Bona-fide Service Fees (BFSFs) and FMV reviews, provide GP impact analysis for contracting strategy proposals, solve for “what if” type questions from stakeholders, and determining any impact of regulatory changes. This position will also support audit readiness activities and collaborate in the development and enhancements of Government Pricing Reporting policies and methodologies resulting from changes in the business and/or regulatory environment.

This role has the option for remote or hybrid/on-site based in Boston, MA (3 days onsite, 2 days remote weekly).

Key Duties and Responsibilities:

• Key contributor within the Government Pricing Team, with demonstrable knowledge and experience in government pricing calculations and reporting requirements including Medicaid, Medicare, 340B and FSS.

• Supports actionable strategic and tactical recommendations that enable Vertex to adapt rapidly and appropriately evolve for U.S. government payer practices, policies, relevant legislation, regulations, trends and other dynamics.

• Actively monitor government pricing regulations as they relate to payer, IDN, policy, competitor, and market conditions to inform critical decisions and potential impacts to reimbursement as well as Federal pricing helping shape future access strategies.

• Collaborates with Market Access Contracting, Legal and broader Commercial Business Partners on contract reviews, assessing contractual terms, Bona-Fide Service tests (BFSF), FMV, Class of Trade Assessment, and other Government Pricing analysis.

• Leads contract assessments of all BFSF tests, ensuring four-part tests is appropriately analyzed, interpreted and documented, the highest level of compliance.

• Ensures contractual obligations under the Federal Supply Schedule (FSS) contract are met, through continuous monitoring of obligations with Federal Acquisition Regulations (FARs) and the Veterans Health Care Act.

• Establishes and maintains policies, procedures, and standards in support of Sarbanes-Oxley (SOX) requirements, internal/external financial reporting processes, and government regulations and stays abreast of CMS Medicaid rules and guidance changes.

• Collaborate across all internal and external stakeholders (i.e., Market Access Strategy, Contract Operations, GTN, Accounting/Finance, US Public Affairs, Legal, Audit, Commercial leaders, and external Legal and consultants).

Who are you:

• A Bachelor’s degree in Business, Finance, Accounting or Public Policy, and/or equivalent working experience. An MBA or other related graduate-level degree is a plus.

• 4-6 years of experience in pharmaceutical/biotechnology industry or state agency, with experience in Government Pricing, Finance, or other related government payer/program administration experience.

• Strong knowledge/understanding of relevant pricing and drug contracting strategy development, government pricing methodologies, government and commercial customers, and associated distribution channels.

• Demonstrable knowledge of the current policies and guidelines that affect government programs, pricing and payment adjustments (e.g., Final Rule, Pro