Who is Prescryptive?

Prescryptive Health is a healthcare technology company delivering solutions that empower consumers. Prescryptive’s secure, mobile-first products connect consumers, pharmacists, and employers, ultimately providing people with the information they need to make informed decisions and take control of their health. To learn more about Prescryptive Health, visit Prescryptive.com.

About this role

We're seeking a strategic and experienced Formulary Management Clinical Pharmacist to design, own, and optimize our clinical programs and formulary operations. This role goes beyond traditional formulary maintenance—you'll be the clinical authority driving program development, policy creation, and system automation that directly impacts cost, quality, and member outcomes. The ideal candidate brings deep PBM experience and thrives in building systematic quality assurance into clinical operations from the ground up.

What you will do

Clinical Program Ownership & Development

• Design and own comprehensive clinical programs (e.g., GLP-1 weight loss management, opioid management, fraud/waste/abuse detection) including program objectives, clinical guardrails, and success metrics
• Define clinical policy and intent behind prior authorization criteria and utilization management controls
• Serve as the internal clinical authority and point of contact for complex clinical questions and policy decisions
• Translate clinical guidelines and evidence into actionable interventions that balance member access with cost management

Formulary Strategy & Management

• Design, implement, and maintain drug formularies that balance clinical efficacy, safety, and cost-effectiveness with lowest net cost strategies
• Conduct therapeutic class reviews and drug evaluations using evidence-based clinical criteria, considering rebate compliance, market trends, and clinical literature
• Manage formulary updates in response to new drug approvals, pipeline changes, and evolving clinical evidence
• Ensure accurate implementation of Limited Distribution Drug (LDD) classifications and specialty medication criteria
• Monitor and ensure formulary compliance with regulatory requirements across the Prescryptive book of business

Prior Authorization & Utilization Management

• Develop and manage PA criteria that are clinically sound, medication-specific, and operationally effective
• Interpret and restructure vendor criteria (e.g., MCG, InterQual) into Prescryptive-specific logic for initial builds and major program changes
• Provide clinical direction for PA content in Formulary Navigator and downstream adjudication systems
• Create utilization management tools including step therapy protocols, quantity limits, and clinical edits that support program goals

System Integration & Automation

• Lead Formulary Navigator buildout and drive automation of drug list processes
• Ensure formulary data accuracy across multiple platforms through systematic testing and quality assurance initiatives
• Collaborate with technical teams to translate clinical requirements into system configurations
• Validate implementation of formulary changes in adjudication systems

Analytics & Data-Driven Decision Making

• Partner with Analytics team on targeting logic, intervention design, and performance dashboards
• Analyze claims data to identify trends, cost savings opportunities, and program effectiveness
• Translate data insights into clinical interventions and program refinements
• Establish and monitor metrics for clinical program success

Client & Stakeholder Collaboration

• Support client-facing clinical discussions and explain coverage rationale with clinical credibility
• Approve and guide client-specific clinical customizations and formulary solutions
• Develop project plans to ensure appropriate implementation of client program requirements
• Coordinate Pharmacy & Therapeutics (P&T) committee activities and drug evaluation processes
• Communicate formulary changes and program updates to internal and external partners
• Create and update clinical marketing materials

Quality Assurance & Compliance

• Build quality assurance into formulary design from inception, emphasizing prevention over inspection
• Ensure compliance with federal and state regulations, including ERISA requirements where applicable
• Maintain documentation supporting formulary decisions for audit and regulatory purposes
• Monitor pharmacy benefit legislation and policy changes that impact formulary management

What you will bring

• PharmD from an ACPE-accredited college of pharmacy
• Active pharmacist license
• Minimum 5 years of PBM experience with demonstrated expertise in formulary management and utilization management
• Proven track record of designing and implementing clinical programs with measurable outcomes
• Strong understanding of pharmacy benefit design, drug utilization management, and clinical guidelines
• Experience with specialty pharmaceuticals, biosimilars, and limited distribution drugs
• Knowledge of rebate compliance, contracting, and lowest net cost strategies
• Proficiency with pharmacy claims adjudication platforms and NCPDP standards
• Experience translating vendor clinical criteria into operational logic
• Advanced analytical skills with ability to interpret claims data and identify trends
• Excellent project management capabilities with ability to manage multiple priorities

Ideally you will also have

• Board certification (BCPS, BCACP, or relevant specialty)
• Experience with Formulary Navigator or similar formulary management systems
• Hands-on experience with First DataBank (FDB) and/or Medispan drug files
• Background in clinical program development for GLP-1/weight loss management and/or opioid management
• Experience in startup or high-growth healthcare technology environments
• Familiarity with transparent pricing models and value-based pharmacy benefits
• Experience with fraud, waste, and abuse (FWA) detection programs
• Understanding of pharmacy network operations, BIN/PCN routing, and Surescripts protocols
• Advanced proficiency with MS Office, particularly Excel and Access
• Experience coordinating P&T committees

What we have to offer

• The opportunity to grow alongside an early-stage company shaking up a big, old-fashioned industry
• Flexible time off, including 12 paid holidays
• 401k match plus 100% employer paid medical, dental, and vision premiums
• Company contribution to Health Savings Account
• Stock options

Prescryptive is committed to fair pay practices. The projected annual salary for this position is $158k to $195k. When preparing an offer, we consider the candidates resume, experience, interview feedback, internal equity, and location.

Prescryptive is an Equal Opportunity Employer. Prescryptive does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. All employment is decided on the basis of qualifications, merit, and business need.