Director of Payer Access
The salary range for this position is between $200K and $245K
Actual salary at the time of hire may vary and may be above or below the range based on various factors, including, but not limited to, the candidate’s relevant qualifications, skills, and experience. The company also currently offers a Long-Term Incentive Plan (cash plan) of 25% base salary, annual performance bonus target of 25% base salary (subject to meeting plan requirements).
Position Overview
The Director, Payer Access is a field-based strategic role responsible for shaping and executing payer access initiatives across national and regional health plans, PBMs, and GPOs. This role focuses on improving clinical utilization management policies, securing favorable formulary access, and driving business strategies that expand patient access for key brands. The Director collaborates closely with cross-functional partners—including Sales, Marketing, Medical Affairs, and Market Access leadership—to ensure alignment and effective execution of payer strategies. This position reports to the National Director, Payer Access.
Key Responsibilities
- Lead formulary negotiations and secure positive coverage, reimbursement, and access across assigned payer accounts.
- Influence and shape clinical policy and utilization management criteria in collaboration with key payer decision-makers.
- Develop comprehensive business plans for priority accounts, identifying opportunities to enhance formulary status and pull-through.
- Build and maintain strategic relationships with senior leaders at national and regional payers, PBMs, and GPOs.
- Prepare and lead timely, accurate, and compelling RFP responses representing the payer value proposition for the product portfolio.
- Partner with internal stakeholders to ensure aligned messaging and integrated execution of market access strategies.
- Analyze contract performance and leverage insights to optimize negotiation strategies and business outcomes.
- Present payer value propositions and health economics information to support access discussions.
- Represent the organization at major industry and payer conferences (e.g., AMCP, PCMA, Asembia).
- Ensure all activities are executed in full compliance with laws, regulations, and company policies
Strategic Impact & Key Interfaces
The Director, Payer Access directly impacts reimbursement, patient access, and overall brand performance by securing and maintaining favorable payer coverage. The role acts as a key external ambassador to payer organizations and a critical internal partner who aligns payer insights with brand and organizational strategy. Primary interfaces include Market Access Leadership, Sales, Marketing, Medical Affairs, Legal, Compliance, Finance, and Patient Services.
Required Qualifications & Experience
- Bachelor’s degree required; advanced degree preferred (MBA, MPH, or related field).
- 10+ years of progressive experience in the pharmaceutical or biotech industry.
- Minimum 5 years of direct market access experience engaging national and regional payers.
- Demonstrated success negotiating formulary access, UM criteria, contract terms, and payer RFPs.
- Proven experience shaping clinical policy and driving access outcomes within payer accounts.
- Strong analytical capability with experience evaluating contract performance and business impact.
- Established relationships with key payer decision-makers.
- Solid proficiency with Microsoft Office (PowerPoint, Excel, Word).
- Proven track record in business planning and leading strategies that expand market share and improve access.
Core Competencies & Behaviors
- Strategic account leadership and influence
- Skilled negotiator with strong analytical decision-making
- Executive level communication and presentation skills
- Cross-functional collaboration and stakeholder management
- High integrity, ethical judgment, and compliance mindset
- Ability to operate autonomously and manage multiple priorities
- Strong problem-solving and critical thinking skills
- Adaptability in a dynamic payer and healthcare environment
Key Success Factors
- Strengthened payer relationships built on credibility and value
- Improved formulary access and clinical policy outcomes
- Effective alignment between payer account strategy and brand priorities
- High-quality RFP responses and strong contract performance
- Clear communication of payer insights to internal teams
- Consistent compliance with all regulatory and company standards
Ethics & Compliance
- Demonstrates the highest level of ethics, integrity, and professionalism.
- Ensures all payer interactions and negotiations adhere to legal, regulatory, and company policies.
- Maintains accountability for compliant behavior and promotes a culture of transparency and trust.
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