Senior Pharmacy Technician, Formulary Management

Job Description

A bit about this role: 

As a Senior Pharmacy Technician on the Formulary Management Team, you will own the oversight of various Part D formularies, provide expertise on drug evaluations, coverage recommendations, and utilization management. You will monitor new drug releases, analyze utilization trends, and conduct comprehensive regulatory research to ensure CMS compliance. You will also serve as a subject matter expert for clinical pharmacy operations, supporting cross-functional teams and helping ensure that our members understand their pharmacy and formulary benefits.

Embracing technology and innovation, our dynamic team navigates Medicare rules and regulations while prioritizing exceptional member care. We are seeking a certified pharmacy technician with direct managed care experience in Part D/MAPD, including PBM collaboration on the administration of Part D and Part B pharmacy claims. Candidates should have strong drug knowledge, advanced analytical skills, and proficiency with data and business intelligence tools to drive formulary accuracy, compliance, and operational efficiency. Experience supporting Medicare Part D bid development is highly valued.

At Devoted Health, we're dedicated to providing personalized, coordinated care to every Medicare-eligible member, aligning with the care and support we'd want for our own families.  

Responsibilities & Impact will include:

• Lead the development, implementation, maintenance, and evaluation of formularies, ensuring adherence to CMS rules and state-specific regulations.

• Drive cross-functional decision-making on formulary strategy, including tier placement, utilization management criteria, and excluded drug determinations, in partnership with Actuarial, Finance, Compliance, and PBM stakeholders.

• Conduct comprehensive clinical and financial analyses supporting formulary decision-making.

• Serve as the pharmacy subject matter expert for the pharmacy components of the Medicare Part D bid, partnering closely with the Product team and Actuarial to inform benefit design, pricing assumptions, and formulary strategy.

• Own HPMS formulary submissions and related CMS filings, ensuring accuracy, timeliness, and alignment with bid strategy.

• Manage formulary change governance processes, including required member and stakeholder notifications.

• Provide expert-level guidance to internal teams and external partners, serving as a go-to resource and escalation point for complex formulary-related inquiries.

• Support the creation and ongoing enhancement of the online formulary search tool, ensuring alignment between formulary intent, member experience, and system functionality.

• Ensure accuracy and integrity of formulary files, drug databases, claims testing outputs, and published formulary materials (print and web), implementing quality assurance controls as needed.

• Develop, implement, and maintain standard operating procedures to drive operational excellence and mitigate compliance risk.

• Serve as the formulary Subject Matter Expert (SME) for regulatory documents, including Evidence of Coverage (EOC), Summary of Benefits, ANOC, LIS Riders, and related materials.

• Maintain internal knowledge resources and serve as a key escalation point for complex formulary inquiries.

• Lead or contribute to high-impact departmental and enterprise initiatives related to Part D operations.

Required skills and experience: 

• Nationally Certified Pharmacy Technician (CPhT) in good standing.

• 5+ years of experience in Medicare Part D operations within a Health Plan and/or PBM, with deep expertise in at least one of the following areas: formulary management, Part D implementation, or utilization management.

• Demonstrated expertise in formulary strategy and administration, including formulary builds, CMS file submissions (e.g., HPMS), drug classification, prior authorization criteria, step therapy programs, and member impact analysis.

• Strong working knowledge of CMS Part D regulations and compliance requirements, with experience interpreting guidance and translating it into operational processes.

• Advanced proficiency in Excel or Google Sheets (e.g., complex formulas, pivot tables, data modeling); experience working with large, messy datasets.

• Experience using business intelligence and data vi