VP Pharmacy Services Greater Jacksonville, FL Area

The VP Pharmacy Services is the senior-most pharmacy executive for the enterprise and reports to the Chief Operating Officer, Health Services. This transformational leader articulates a clear and compelling vision for pharmacy, drives innovation, inspires others, and sets high expectations for achievement within and beyond the pharmacy organization. The role serves as the trusted pharmacy advisor to the executive leadership team and the Board.

This position holds strategic, operational, and financial accountability for all Commercial and Medicare pharmacy and specialty pharmacy programs at a Blue plan with approximately $30 billion in annual revenue. Accountabilities include enterprise pharmacy cost of care and multi-year trend, benefit and formulary strategy, Pharmacy Benefit Manager (PBM) performance, Medicare Part D and Commercial regulatory compliance, and clinical quality outcomes. The role is accountable for achieving and sustaining Part D Star Ratings of 4.5 stars or higher across the organization’s Medicare Advantage prescription drug and stand-alone Part D contracts; for delivering pharmacy savings as a core contributor to total cost of care and affordability goals, with specialty and medical-benefit drug trend as a primary focus; and for leading the renegotiation and restructuring of PBM and specialty pharmacy arrangements while building a strong pharmacy operations organization that manages vendors and clinical programs.

Integrating pharmacy and medical strategy is essential to improving quality and controlling total cost of care. The VP Pharmacy Services leads the integration of clinical and operational solutions across the pharmacy and medical benefits to deliver innovative, cross-functional, and compliant programs. This executive aligns team operational and budget goals with organizational directives, acts as a change leader within and beyond Pharmacy and Health Services, and provides organization-wide direction for project and functional resources inside and outside the reporting structure. Additional responsibilities include applying rigorous controls and oversight to the PBM and other strategic vendors across Pharmacy and Health Services to ensure compliance with all contractual terms and all State and Federal regulations.

Key Responsibilities:

Pharmacy Strategy and Operations:

• Build, develop, and lead a diverse, high-performing pharmacy leadership team and organization that applies individual expertise to collectively achieve organizational goals and objectives
• Set the enterprise pharmacy vision and multi-year strategy for Commercial (individual, small group, large group, and ASO) and Medicare lines of business, delivering a coordinated, comprehensive pharmacy program that supports member care and aligns with the company’s vision and strategic imperatives
• Own pharmacy cost of care for the enterprise, including multi-year pharmacy trend forecasting, budget accountability for multi-billion-dollar pharmacy spend, and delivery of net-cost and rebate targets, and accountable for annual pharmacy savings targets as a core contributor to enterprise total cost of care and affordability goals, with savings validated using enterprise methodology and reported separately as realized versus avoided
• Lead the annual goal, budget, and financial planning process, ensuring goals are timely, measurable, and executed
• Monitor pharmacy cost and trend continuously to identify operational improvement and savings opportunities
• Direct PBM strategy and governance, including RFP and market-check activities, contract negotiation, pricing, rebate and performance guarantee terms, transparency and audit rights, and ongoing performance management to secure best-in-market net cost and member experience, with specific accountability to lead the renegotiation of PBM agreements informed by independent market-check results and the design and execution of restructured specialty pharmacy arrangements, including carve-out and multi-vendor models, ensuring seamless member transition, data integration, and protection of rebate and performance guarantees
• Oversee the PBM and other pharmacy vendors across Commercial and Medicare to ensure contractual performance and achievement of the organization’s strategic imperatives, using scorecards and governance that cover performance guarantees, claims pricing accuracy, audit findings closure, rebate guarantee attainment and collection, and service levels, and pursuing financial remedies for non-performance
• Lead pharmacy operations across the full operating cycle, including formulary and clinical policy administration, pharmacy coverage determinations and appeals, medical-benefit drug management (prior authorization, dose optimization, wastage, and infusion site of care), dispensing channel and network strategy, claims pricing and payment accuracy, and rebate invoicing, collection, and reconciliation
• Lead pharmacy clinical programs, including adherence, Medication Therapy Management, medication safety, and prescriber engagement, and the outreach vendors that support them, ensuring each program has defined objectives and measured ROI
• Set formulary, benefit design, and clinical pharmacy program strategy, including oversight of the Pharmacy and Therapeutics (P&T) process, to balance clinical outcomes, affordability, and member access
• Lead specialty drug strategy across the pharmacy and medical benefits, including site-of-care, biosimilar adoption, specialty network and vendor strategy, and management of emerging high-cost therapies such as GLP‑1s and cell and gene therapies, with accountability for specialty and medical-benefit drug trend, including exclusive specialty network utilization, infusion site of care, dose optimization and wastage reduction, and rebate capture
• Direct Medicare Part D strategy and operations in partnership with Actuary and Medicare leadership, including annual bid development, formulary and network adequacy, Medication Therapy Management, and readiness for Inflation Reduction Act requirements, including the Medicare Prescription Payment Plan and Maximum Fair Price
• Own Part D Star Ratings performance, with a goal of 4.5 stars or higher for each Medicare Advantage prescription drug (HMO and PPO) contract and stand-alone Part D contract, including medication adherence, statin use in persons with diabetes, Medication Therapy Management comprehensive medication reviews, and medication safety measures, in partnership with Quality and Medicare leadership
• Integrate Commercial and Medicare pharmacy programs with medical strategy to reduce total cost of care while achieving quality outcomes
• Build and deliver a pipeline of pharmacy affordability initiatives (for example, formulary and tiering, alternative sourcing, site of care, and manufacturer agreements), partnering with Healthcare Economics, Analytics, and Finance to quantify and validate savings
• Lead pharmacy innovation, including manufacturer value-based agreements, digital and point-of-care pharmacy solutions, and alternative sourcing and pricing models, and evaluate their impact on total cost of care and member experience
• Partner with Product and Actuary to deliver competitive, innovative Commercial and Medicare pharmacy product offerings in the marketplace
• Support targeted ASO efforts to ensure competitiveness, growth, and financially positive outcomes
• Lead the design and implementation of targeted interventions to improve pharmacy trend and support membership growth while minimizing disenrollment
• Partner with Analytics and Healthcare Economics to build pharmacy performance reporting, forecasting, and drug trend analytics that inform executive decision-making
• Establish and own pharmacy operations and clinical KPI scorecards, with leading and lagging indicators reported through the Health Services management rhythm
• Apply data, automation, and AI (such as electronic prior authorization and predictive adherence and cost-risk modeling) to improve turnaround, outcomes, and efficiency
• Lead the transformation of Commercial, Medicare, and specialty pharmacy to support future and changing health care models Executive Leadership and Enterprise Representation:
• Serve as the enterprise pharmacy executive, advising the executive leadership team and Board on pharmacy strategy, drug trend, and regulatory developments, and partnering with BCBSA, peer Blue plans, manufacturers, and industry coalitions
• Represent Florida Blue and Health Care Services, both internally and externally, on pharmacy and related regulatory matters, including BCBSA activity and proposed State and Federal legislation, leveraging key relationships and professional organizations to influence policy and industry peers
• Lead team operational efforts to minimize risk and ensure compliance with all Commercial and Medicare pharmacy State and Federal regulations, including coverage determination and appeal turnaround, CMS program audit readiness, Part C and Part D reporting requirements, and evolving federal PBM transparency requirements
• Continuously evaluate internal and external factors that pose pharmacy-related risk to Florida Blue, and develop and implement controls and operational processes to mitigate that risk
• Provide ongoing support, input, and oversight to Health Care Services (HCS) strategic partnerships
• Lead the development and implementation of Healthcare Solutions through key initiatives, including High-Value initiatives pursued with Network and through IMM Governance
• Develop effective partnerships with key leaders in Sales/Marketing, Compliance, Medical Operations, Care Management, Service Organization, Network, Product, and Legal
• Remain current on issues affecting the pharmacy industry and integrate best practices to manage them effectively
• Lead diverse, multi-disciplinary, cross-functional teams to support organizational goals and directives, providing direct and indirect leadership to GuideWell Health Solutions by leveraging individual and team expertise Clinical Support and Oversight:
• Oversee pharmacy-related committees, including Pharmacy and Therapeutics and pharmacy policy, and ensure alignment with medical policy for drugs covered under the medical benefit
• Oversee the review and implementation of selected enabling technologies, tools, and initiatives, using organizational SMEs and support staff, that promote quality, administrative efficiency, and medical cost goals
• Provide clinical oversight of pharmacy and drug-related medical policies to ensure clinical integration and alignment, and provide leadership and direction to achieve effective clinical programs and operational excellence, with a focus on member outcomes

Key Requirements:

• Doctor of Pharmacy (PharmD) or related PhD or additional equivalent senior executive experience considered
• 15+ years’ of progressive related work experience in health care, health plan, or PBM leadership
• Health Plan/PBM senior leadership Executive leadership of enterprise pharmacy operations
• 10+ years of progressive management experience, including leading managers and senior leaders
• Pharmacist License - current Florida pharmacy license or able to obtain
• Deep knowledge of the health care and insurance industry and of managed care products, benefits, and programs, including Commercial and Medicare
• Exceptional verbal and written communication skills, including executive and Board-level presentation
• Proven record of delivering measurable pharmacy cost, quality, and member experience results at enterprise scale
• Demonstrated ability to build productive, collaborative working relationships with key internal and external stakeholders
• Demonstrated knowledge and application of the Florida Blue Management System
• Demonstrated knowledge and application of the profession of pharmacy, including clinical pharmacy, Florida pharmacy law, and the process flow for prescription drug services in Florida
• Demonstrated success improving Medicare Part D Star Ratings, including medication adherence, Medication Therapy Management, and medication safety measures
• Experience leading PBM RFPs and negotiating PBM and specialty pharmacy contracts, including pricing, guarantees, and rebates
• Experience managing specialty drug trends and specialty pharmacy models, including carve-out or multi-vendor arrangements
• Experience overseeing pharmacy operations and vendor performance at scale, including prior authorization, claims accuracy, and rebate management

Preferred:

• MBA, MHA, or comparable advanced degree
• Prior experience leading pharmacy at a Blue plan or health plan of comparable size and complexity.
• Direct experience with Medicare Part D and Medicare Advantage pharmacy, including bid development
• Experience leading a PBM transition or specialty pharmacy carve-out, and negotiating manufacturer value-based agreements
• Demonstrated executive presence and experience presenting to senior executives and Board

General Physical Demands

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities

Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally

What We Offer:

As a Florida Blue employee, you will be at the heart of GuideWell’s vision – to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance;
• Income protection benefits: life insurance, short- and long-term disability programs;
• Leave programs to support personal circumstances;
• Retirement Savings Plan including employer match;
• Paid time off, volunteer time off, 10 holidays and 2 well-being days;
• Additional voluntary benefits available; and
• A comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.