Consultant/Associate Principal, Pharmacy Policy

Avalere Health is seeking a Consultant or Associate Principal with pharmacy policy expertise to join our Policy practice.

Avalere Health is a strategic advisory company whose core purpose is to create innovative solutions to complex healthcare problems. Based in Washington, DC, the firm delivers actionable insights, business intelligence tools, and custom analytics for leaders in healthcare business and policy. Avalere’s experts span 230 staff drawn from Fortune 500 healthcare companies, the federal government (e.g., CMS, OMB, CBO, and the Congress), top consultancies, and nonprofits. The firm offers deep substance on the full range of healthcare business issues affecting the Fortune 500 healthcare companies. As an Inovalon company (Nasdaq: INOV), Avalere’s focus on strategy is supported by outstanding data analytics that generate unique insights and meaningful business improvement. Through events, publications, and interactive programs, Avalere insights are accessible to a broad range of customers. For more information, visit, or follow us on Twitter @avalerehealth.

Avalere Health is seeking a Consultant or Associate Principal with pharmacy policy expertise to join our Policy practice. The practice focuses on a range of issues including:

  • Ongoing federal and state health reform
  • Medicare reform policies and regulations
  • Medicaid and other state health policies
  • Drug pricing
  • Evolving benefit designs in public and private payers
  • Medicare Advantage and Part D policy and payment
  • Federal budget and deficit reduction issues

We rely on deep subject-matter expertise and understanding of the business issues facing our clients to assess how this changing policy landscape impacts the pharmaceutical industry, managed care plans, providers, pharmacies, and consumers. We provide analytic support and advisory services, including legislative strategy, regulatory analysis, and quantitative modeling of proposed and enacted policies to a wide range of clients across the healthcare industry.

Job Description

  • Serve as a key subject-matter expert on pharmacy policy-related issues impacting retail, specialty, and mail-order pharmacies; other entities in the pharmaceutical supply chain; and other stakeholders
  • Work with teams within the Policy practice and across the firm to solve complex client problems and engage clients with novel solutions and ideas
  • Create both strategic and tactical recommendations for clients depending on their policy and business needs
  • Help generate business with new clients and grow business with existing clients
  • Manage a portfolio of clients to identify and deliver on business opportunities and projects that dovetail with Avalere’s expertise and offerings, particularly around policies impacting pharmacy reimbursement and other pharmacy business operations
  • Manage multiple clients, as well as short- and long-term deliverables, to ensure that all of Avalere’s knowledge and expertise are available to meet client needs
  • Solve complex client issues in a timely and appropriate manner with minimal management oversight and attention to resources
  • Conceptualize, design, and execute—from start to finish—a broad range of client projects involving diverse, cross-functional, cross-practice teams
  • Train, supervise, and mentor staff members within the practice and across the firm
  • All candidates to comply with all security policies/procedures

Skills, Experience, and Other Job-Related Requirements

Education Requirements

  • A graduate degree in health policy, public policy, healthcare management, public health, public administration, health economics, business administration or a relevant discipline. A combination of bachelor’s degree and in-depth relevant work experience is also acceptable.

Skill Requirements

  • Expertise in federal health care programs’ policies and commercial practices that impact pharmacy reimbursement and finances, pharmacy-PBM contracting, and other business operations
  • Understanding of Medicare Part D payment and bidding process, as well as familiarity with Direct and Indirect Renumeration (DIR), plan sponsor reimbursement to pharmacies, and calculation of negotiated price
  • Knowledgeable of policies related to pharmacy access, including general access requirements, any willing pharmacy requirements and preferred pharmacy networks
  • Understanding of Medicaid pharmacy reimbursement policies, including state calculation of acquisition costs and dispensing fees, the federal upper limit (FUL), and state maximum allowable cost (MAC) lists
  • Familiar with proposals that would allow pharmacists to be granted provider status under Medicare
  • Significant experience analyzing policy proposals, legislation, and/or regulation and conveying findings to clients and the public
  • Sophisticated understanding of the policy issues impacting the healthcare sector, business dynamics in the marketplace, and how federal and state policy impacts industry
  • Experience overseeing and directing the work of staff members
  • Proven situational leadership skills and the ability to motivate and generate enthusiasm with individuals across all levels of the organization
  • Exemplary interpersonal skills that translate into positive relationships with colleagues and clients
  • Commitment to working in a team environment with an emphasis on collaboration and maintaining positive relationships with colleagues and clients
  • Solid communication skills (written and verbal) including the ability to concisely explain complicated concepts to executives within and outside of the firm
  • High level of initiative coupled with quick learning ability.

Experience Requirements

  • 5–10 years of relevant work experience, which could include employment by a health insurance company, pharmacy or pharmacy benefit manager, relevant trade group, or advocacy organization. Industry experience is preferred
  • Prior experience in the government, the financial services industry, or a professional services firm thinking critically about and/or working on behalf of the healthcare industry is an appropriate substitute for direct industry experience
  • In particular, experience should be focused on pharmacy policy and payment , especially under the Medicare and Medicaid programs
*Avalere is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.