Provides executive leadership, strategic direction, and decision making for Program wide Pharmacy Benefits Plan including - Medicare Part D, Commercial Benefits, Self-Funding, Exchanges, and Medicaid. Responsible for Pharmacy Benefit Management (PBM) Vendor Management, Pharmacy Service Center, and National Pharmacy Fee Schedule. Positions pharmacy as a growth enabler and market differentiator by delivering integrated benefit solutions that support acquisition, retention, and enterprise brand value. Lead strategist for development and management of pharmacy benefit offerings that meet customer requirements, maintain an appropriate risk pool, promote quality, and achieve financial targets. Provides leadership and oversight to program wide Pharmacy Benefit Community of Practice. Serves as program wide Pharmacy Leader for Medicare Part D Drug Benefit. Manages program wide Pharmacy Benefit Management functions including PBM contracts, network management, customer service, benefit design, utilization management and reporting across all lines of business (Medicare, Medicaid, individual, ACA, self-funded, and commercial). Provides leadership and oversight to the National Pharmacy Fee Schedule for outpatient, clinic, and inpatient medications. Collaborates with Health Plan Product Development, Sales, and Marketing to ensure alignment with KFHP benefits, marketing strategies and sales tactics. Collaborates with Regional Pharmacy Leadership in the management of drug benefits in KP-owned and operated pharmacies. Provides program wide consultation and expertise in the identification, dissemination and implementation of drug benefit best practices and opportunities. Assists the SVP, Chief Pharmacy Officer of National Pharmacy in the development and execution of a national strategy for the delivery of pharmaceutical care across the program. Builds strong collaborative relationships with National Pharmacy Service Line Leaders and other Pharmacy Market Leaders of the program to ensure alignment of resources and efficiency of operations. Collaborates with peers within the National Pharmacy Leadership Executive Team to ensure optimal delivery of pharmaceutical care and implementation of best practices.

Executive Leadership & Strategy 

• Provides executive leadership and oversight to over 80 departmental staff including pharmacists, benefit analysts, information technology, and finance personnel to meet internal and external customer needs.
• Expected to lead, serve, and participate on various committees at the senior leadership level.
• Assures appropriate design and execution of the pharmacy benefits plan to meet operational, clinical, regulatory, and financial objectives, in primary collaboration with pharmacy executives.
• Plays a key role in aligning pharmacy strategy with market growth, enterprise performance goals, and health plan product development.
• Defines and leads governance structures for pharmacy benefit decision-making-ensuring transparency, shared accountability, and alignment with enterprise priorities.
• Leads through influence in a highly matrixed environment-navigating market variability, aligning diverse stakeholders, and building consensus for transformative change.
• Champions the voice of the customer (members, purchasers, and brokers) to ensure pharmacy benefits meet evolving expectations and drive satisfaction, retention, and sales.
• Serves as executive pharmacy sponsor or co-sponsor for health plan initiatives and projects impacting pharmacy.
• Provides strategic support for applicable pharmacy initiatives with Risant.

Pharmacy Benefit Design & Management

• Leads the design, development, and implementation of new pharmacy benefits and modifications to current benefits. Effectively collaborates with relevant KFHP departments (Product Development, Sales, Member Services, and Benefits) in development and implementation of new pharmacy benefits.
• Manages program-wide PBM functions including contracts, service level agreements, program management, eligibility and benefit loads and testing, software changes, and compliance. Leads PBM RFPs and market checks.
• Leads strategy, development, and implementation of pharmacy-related requirements for the Medicare Part D drug benefit across the program. Owner of Part D drug tiering strategy through iMPacT Implementation Committee (IIC) as co-chair.
• Collaborates with Pharmacy Informatics and KPIT to ensure the successfulprogramming and implementation of new benefits through claims processing vendors.
• Coordinates and liaisons with Pharmacy Care Delivery teams to ensure new or modified benefits are effectively implemented.
• Leads program-wide development, implementation, and maintenance of the National Pharmacy Fee Schedule for outpatient drugs. Lead pharmacy executive on the Fee Schedule Oversight Tech Team.
• Partnering with KPIC executives, leads program-wide pharmacy support for KFHP Self-Funding, Deductible, and Consumer-Directed Health Care benefits.
• Provides strategic consultation to health plan operations leadership on design, development, and implementation of new pharmacy programs impacting PBM benefits configurations.
• Provides oversight and verification of PBM invoice accuracy and approvals for payment.
• Acts as business sponsor for the Accredo relationship and national agreement. Participates in a Health plan oversight steering committee. 

Market Analysis & Customer Experience

• Utilizes KP market research and competitive intelligence to: 
  • Ensure that KP Pharmacy is positioned in the marketplace to exploit areas of competitive advantage.
  • Ensure that KP Pharmacy benefits meet customer requirements and promote quality.
  • Effectively track, trend, and anticipate new products from KP competitors.
• Ensures communication and interpretation to internal and external customers regarding new or modified pharmacy benefits. Customers include HP administration and marketing staffs, pharmacy managers and staff, employers and group representatives, and community and other external groups.
• Supports member experience for pharmacy benefits (e.g., improving access, service consistency, and satisfaction scores).
• Serves as enterprise spokesperson on pharmacy value; leads development of compelling, data-backed narratives for customers, brokers, and regulators.
• Partners with Digital and IT teams to advance digital pharmacy experience and innovation, ensuring seamless access, personalization, and real-time benefit support for members.
• Serves as primary enterprise pharmacy contact to pharmacy marketing team and advises on external-facing proof points to showcase the competitive value of KP-s pharmacy model.
• Serves as a subject matter expert for sales and account management training and customer presentations.
• Advises KP Sales and Account Management for customer RFPs, performance guarantees, and pricing.

Financial Oversight & Vendor Management

• Provides executive oversight and sponsorship of various enterprise-wide programs including manufacturer copay assistance and national payor agreements.
• Oversees/sponsors medical pharmacy rebate program with external vendors and outpatient rebates received from PBMs.

Regulatory & Compliance

• Ensures that pharmacy benefits are compliant with applicable new laws, regulations, and accreditation agency requirements.
• Responsible for impact assessment of benefit changes and new technology on key business parameters such as prescription utilization and cost, as well as key quality parameters such as medication compliance.
• Provides executive oversight of regulatory, compliance, and PBM audits impacting pharmacy benefits.
• Ensures regulatory and member financial assistance data submissions are provided as required, including providing attestations.
• Responsible for meeting external pharmacy network access requirements and external specialty pharmacy oversight.
• Responsible for member experience related to pharmacy benefits including CAHPS scores and STARS.
• Provides subject matter expertise to Government Relations for proposed federal and state bills impacting pharmacy benefits.
• Provides subject matter expertise to health plan regulatory services for proposed state regulations and evidence of coverage filings to state regulators.
• Provides oversight of pharmacy help desk for SCAL/NCAL.