Head of US Market Access, Contract Operations

Job Description

Vertex is hiring a Head of USMA Contract Operations reporting to the Vice President US Market Access. The team includes Contract Operations supporting Payer Trade and GPO field teams and accounts Chargebacks & Memberships US and Canada Rebate Operations and 340B Compliance. Spanning disease areas customer and contract types this team will support timely and broad access to Vertex medicines in the US and Canada ensuring compliance to contract terms and alignment to access strategy while ensuring accuracy in payments. This is an exciting opportunity for a leader that applies an enterprise-level mindset people management and technical expertise at the intersection of data process optimization automation and innovation.

Vertex is a biotechnology company with commercialized medicines for Cystic Fibrosis Sickle Cell Disease Transfusion Depended Beta-thalassemia and Acute Pain. Vertex also has a robust pipeline with programs in Type 1 Diabetes and targeted kidney diseases in phase 3 clinical trials as well as several programs in phase 2 development. This opportunity is unique in the breadth of disease areas in scope as well as the product modalities which span small molecule gene therapy cell therapy subcutaneous injection and mRNA therapy each requiring unique and innovative access and distribution strategies.

In support of Vertexs evolving commercial business and in preparation for potential future launches this role will be tasked with the continued building of the Market Access Contract Operations team. This includes identifying hiring and onboarding talent as well as streamlining and building new capabilities processes systems and governance. The incumbent will collaborate closely with the Market Access Strategy team the Access Operations & Analytics team and the Field Accounts team. They will build strong cross-functional working relationships across Accounting Accounts Payable the Vertex Canada team Compliance Finance Data and Technology the Pain Strategic Accounts team Tax and Legal.

This senior leader will possess the highest professional integrity exemplary leadership skills and relevant experience across the areas of oversight:

• Contract Operations: Ensure efficient governance and SOX compliant processes in place for contract intake review and execution. Build and deliver pre-deal analytics to support field business cases for use at deal councils and pricing committees. Ensure consistent pull through and adherence to Access Strategy and grants of authority. Serve as business escalation point with decision making authority on complex terms and financial materiality. Build strong relationships with Field leaders and key accounts; supports complex negotiations at senior levels with external stakeholders. Ensure alignment of implementation ability and timing across Government Price Reporting Trade Operations and Gross-to-Net forecasting. Serve on Vertex Enterprise Contracting Steering Committee advocate for and support implementation of resource system enhancements.

• Rebate Operations: Accountable for ensuring compliant set-up of US commercial federal and state Medicaid and Canadian Private and Provincial financial and operational contract terms in Model N/Revitas. Lead team in building innovative approaches for processing outcomes-based agreement(s). Decision maker on interpretation of medical policies formularies prior authorizations benefit plans reimbursements and pathways for Vertex products and competitors where applicable. Serve as leadership escalation point for rebate disputes. Ensure timely and accurate monthly and quarterly reporting of contractual payment activities dashboards and trends support forecasting analyses and ad-hoc requests.

• Chargeback Operations: Ensure system capabilities and resources match business needs for in-house processing of 340B FSS and hospital GPO chargebacks. Timely verification of eligible members and/or plans and processing of chargebacks. Serve as leadership escalation point for chargeback disputes.

• 340B Compliance: Guide the development implementation and performance tracking of Vertex 340B policies. Serve as escalation point for targeted data supported disputes and resolutions. Track 340B state and federal policy evolution and develop operational response. Partner closely with US Public Affairs leadership. Lead build-out of function as business needs dictate.

Additional Responsibilities:

• Serve as operational lead and Chair of the North America Pricing Committee (NAPC). Develop and implement governance and organizational awareness and education across US and Canadian stakeholders. Ensure compliant business cases with supportive deal analyses for Committee review. Document decisions and actions. As required produce next-level Global Pricing & Reimbursement Committee (C-Suite) materials for review.
• With ED Market Access Strategy co-lead development of contracting strategies across inline and pipeline assets.
• Build lead and motivate the team prioritizing and allocating work across team members to ensure the highest levels of performanceand commitment to their professional development.

• Work with internal functions and external vendors to understand market trends and implications. Stay current with all promulgated and proposed federal regulations that impact contract terms rebate and/or chargeback adjudications.

• Connect and understand customers and closely partner with stakeholders (internally and externally) to develop the strategic direction of the department including people end-to-end processes data and technology within budget to deliver the highest value outcomes.

• Lead training efforts and development of departmental standard operating procedures (SOPs) that reduces process variation and drives process flexibility efficiency and effectiveness.
• Hold team accountable to compliance training(s) and Vertex Code of Conduct.

• Own and maximize team budget; approve invoices and payments.

• Ensure all SOX controls are met and supported with appropriate documentation. Participate in and support SOX-related internal and external audits.

Education and Experience:

• Bachelors degree
• 12 years US pharmaceutical industry or adjacent experience with increasing responsibilities
• Excellent understanding of Payer Agreements Rebates Chargebacks and State Medicaid rebate processes; prior contract operations responsibilities
• Contracting strategy
• Minimum 5 years of supervisory experience

Location: Vertex Boston Headquarters on a hybrid schedule (3 days a week)

Preferred Qualifications:

• MBA MPH or a Masters in a relevant discipline (Business Public Health Law)
• Experience in Trade Contracting (Full line wholesaler Specialty Pharmacy/Distributor and Hospital GPO)

• US product launch experience including cell and gene therapies

• Value based contract strategy development and implementation experience
• Led or served on a Pricing Committee body

Pay Range:

Disclosure Statement:

Flex Designation:

Flex Eligibility Status:

In this Hybrid-Eligible role you can choose to be designated as:
1. Hybrid: work remotely up to two days per week; or select
2. On-Site: work five days per week on-site with ad hoc flexibility.

Note: The Flex status for this position is subject to Vertexs Policy on Flex @ Vertex Program and may be changed at any time.

Company Information

Vertex is a global biotechnology company that invests in scientific innovation.

Vertex is committed to equal employment opportunity and non-discrimination for all employees and qualified applicants without regard to a persons race color sex gender identity or expression age religion national origin ancestry ethnicity disability veteran status genetic information sexual orientation marital status or any characteristic protected under applicable law. Vertex is an E-Verify Employer in the United States. Vertex will make reasonable accommodations for qualified individuals with known disabilities in accordance with applicable law.

Any applicant requiring an accommodation in connection with the hiring process and/or to perform the essential functions of the position for which the applicant has applied should make a request to the recruiter or hiring manager or contact Talent Acquisition at