Position Summary
The Pharmacy Actuary serves as the primary actuarial subject matter expert bridging pharmacy benefit strategy, strategic pricing, vendor procurement, and actuarial projections. This role translates pharmacy RFP assumptions, vendor proposals, rebate arrangements, formulary strategies, and emerging pharmacy trends into actionable financial assumptions that support strategic pricing and client financial projections. The position partners closely with Pharmacy and Health Actuarial teams to ensure pricing strategies and cost projections accurately reflect contractual terms, market dynamics, and strategic initiatives.
Key Responsibilities:
- Actuarial Integration: Serve as the primary actuarial liaison between Pharmacy and Health Actuarial teams, ensuring pharmacy strategies, contractual arrangements, legislative impacts and market dynamics are accurately reflected in cost projections.
- Pharmacy Financial Analysis and PBM Strategy: Partner with the Pharmacy Analytics team to support PBM procurement, vendor evaluations, and contract negotiations by modeling proposals, guarantees, pricing methodologies, rebate arrangements, formulary strategies, and contractual provisions; translate results into actuarial assumptions and financial projections, evaluate performance and variances against contract terms, and apply insights to future projections and negotiations.
- Projection Validation: Validate vendor financial projections and assess associated risks, opportunities, and key assumption sensitivity.
- Trend and Emerging Cost Drivers: Evaluate utilization, pharmacy trend, specialty drug impacts, pipeline therapies, regulatory changes, market developments, and emerging solutions to improve projection accuracy and inform strategic planning.
- Tools, Models, and Reporting: Develop and enhance pharmacy-specific methodologies, models, tools, and reporting, including actuarial projections, PBM contract analyses, and population health studies, while ensuring alignment with the overall health benefits strategy and projections.
- Pharmacy Consulting: Provide actuarial analysis and consulting on pharmacy-specific topics and programs, including Medicare Part D and the 340B Drug Pricing Program.
- Stakeholder Communication: Communicate complex pharmacy financial concepts, methodologies, and projection results to technical and nontechnical stakeholders to support informed decision-making.
- Documentation, Governance, and Compliance: Maintain clear documentation of pharmacy methodologies, assumptions, tools, and projection frameworks, and ensure compliance with actuarial standards, regulatory requirements, and internal governance processes.