Vice President, National Payer Accounts

Vice President, Head of National Payer Accounts

Key Accountabilities

• Own national payer account strategy across commercial, Medicare (incl. MACs), and Medicaid for a buy-and-bill Part B retina product
• Senior relationship owner for top national/regional payers and PBMs; lead direct negotiations on coverage policy, contracting, and value-based arrangements
• Build and lead the national accounts team and trade/distribution role as the business scales post-launch ("player-coach" in year one)
• Own government pricing and contract operations for the retina portfolio (ASP reporting, 340B, contract compliance) with Finance/Legal; partner as Trade/Distribution executes chargebacks and contract price administration

Launch Execution

• Lead payer-facing launch readiness: coverage policy, prior authorization criteria, and claims/billing pathways through the J-code transition
• Partner with Trade & Distribution, Reimbursement/HUB, and Medical Affairs for coordinated provider/payer launch
• Collaborate with patient support/HUB and co-pay assistance; ensure SD/SP capacity and product availability for buy-and-bill onboarding
• Develop and defend the payer value story (clinical, economic, HEOR)

Cross-Functional & Executive Engagement

• Represent payer strategy/account status to CCO, executives, and Board as needed
• Partner with Sales leadership to align field access/reimbursement support with national account strategy
• Provide input to pricing, contracting, and gross-to-net strategy based on payer intelligence

Market & Policy Monitoring & Engagement

• Track evolving Part B policy landscape; translate into account strategy/forecasting
• Maintain fluency in IRA provisions relevant to Part B/Part D and downstream pricing/access impacts
• Engage in health policy activities (e.g., CMS comment letters)
• Monitor competitive payer coverage and contracting across retina category

Qualifications

Required

• 15+ years in pharma/biotech market access, national accounts, or payer strategy; 3+ years at VP/senior leadership with direct payer negotiation ownership
• Experience launching Medicare Part B buy-and-bill product; navigate miscellaneous J-code to permanent coding
• Retina or broader ophthalmology experience strongly preferred
• Demonstrated success building payer strategy pre-launch and leading through launch/post-launch growth (ideally from scratch in a small/mid-cap biotech)
• Expert knowledge of Part B reimbursement mechanics (ASP methodology, buy-and-bill economics, site-of-care, specialty pharmacy/distribution)
• Working knowledge of IRA provisions and impact on pricing/access/contracting
• Proven senior-level negotiation track record with national payers/PBMs
• Experience building/leads national accounts team; comfortable as "player-coach" during build-out
• Bachelor's degree required; MBA/healthcare-related degree a plus

Preferred

• Small/mid-cap biotech experience during first-in-class/category launch
• Existing relationships across major national payers and specialty distributors for retina/buy-and-bill
• Familiarity with evolving MFN/Part B pricing policy landscape