Formulary Analyst (Internal Only)

MotivHealth is seeking a detail-oriented Formulary Analyst to support the development, maintenance, and administration of pharmacy formularies for our health plans. This role plays a key part in ensuring formulary accuracy, cost-effectiveness, and compliance, while supporting plan sponsors, members, and internal teams with pharmacy benefit design.

 HOW YOU’LL MAKE AN IMPACT:

• Build, maintain, and update pharmacy formularies in alignment with plan design and client specifications


• Analyze drug utilization trends, pricing, and rebate data to support formulary decision-making


• Collaborate with PBMs (Pharmacy Benefit Managers) to ensure accurate formulary loading and claims adjudication


• Review and process prior authorization, step therapy, and quantity limit criteria within formulary structures


• Monitor drug pipeline updates, new FDA approvals, and generic/biosimilar releases to recommend formulary changes


• Partner with underwriting, account management, and client services teams to communicate formulary structures and plan-specific pharmacy benefits


• Ensure formulary compliance with ACA, ERISA, and other applicable regulatory requirements


• Assist in resolving member and provider inquiries related to formulary coverage and exceptions


• Maintain accurate documentation of formulary changes, rationale, and version history

WHAT YOU BRING:

• 2 + years of experience in formulary management, pharmacy benefits, or PBM operations


• Familiarity with pharmacy claims systems and formulary management tools


• Strong understanding of drug classifications, tiering structures, and utilization management criteria


• Excellent analytical skills with the ability to interpret pharmacy utilization and pricing data


• Strong communication skills, with the ability to explain formulary decisions to both technical and non-technical stakeholders


• Detail-oriented with strong organizational and documentation skills

MotivHealth is a dynamic and mission-driven health insurance company dedicated to disrupting the status quo by making healthcare simpler and more affordable for our members. We believe in empowering our members to take control of their health and financial well-being. Our innovative approach requires a team of passionate, talented individuals who aren't afraid to challenge conventional thinking and build solutions that truly make a difference. If you're looking to contribute your skills to a company that values innovation and positive impact, MotivHealth is the place for you.