Director, Payer Access & Reimbursement

Gamida Cell Ltd.; Northern (KY); Hybrid; USD 180,000 - 240,000; Full time

Benefits offered by this job

Travel 50%

Job summary

Gamida Cell, Inc. is seeking a Director, Payer Access & Reimbursement to lead payer strategy and secure timely access for Gamida Cell therapies in the US market. You will partner with medical affairs, account management, and operations to educate payers and hospital administrators on coverage, reimbursement and coding.

Travel is expected up to 50%, and you will report to the AVP, Head of Market Access. The role requires 10+ years biotech/pharma experience with payer access and government

Qualifications

• 5–7+ years with national, regional or government payers in a biotech/pharma setting.
• 10+ years total biotech/pharma commercial experience.
• Experience with payer access, reimbursement and hospital formulary concepts.

Responsibilities

• Obtain positive coverage for Gamida Cell products with national, regional, and government payers.
• Educate hospital administrators on formulary access, coverage, coding and payment methods.
• Negotiate trade agreements with treatment centers as needed.
• Support patient access journey from physician order to reimbursement and appeals.
• Build relationships with payers, KOLs, and health plan leaders.
• Develop payer account level business plans and contribute to hospital plans.
• Represent product education with health economic information to customers.

Skills

Strategic thinking

Business acumen

Cross-functional leadership

Communication skills

Relationship management

Problem solving

Urgency & initiative

Leadership without authority

Education

B.S. degree

Master’s degree preferred

Job description

Director, Payer Access & Reimbursement

• Company Gamida Cell, Inc.
• Posting Title: Director, Payer Access & Reimbursement
• Function: Market Access, Commercial

Gamida-Cell Inc., an Ayrmid Pharma Ltd. company, is amid a period of transformational growth with a focus on commercializing novel treatments for rare, specialty, and oncological diseases with high unmet need. In support of this evolution, Gamida-Cell is seeking to bring people into the company who have a passion for both helping patients and building corporate capabilities. Are you ready to assist us on that journey? Join us and be instrumental in our growth!

Gamida Cell is a leader in advanced cellular therapies and hematopoietic stem cell transplants, with two FDA approved therapies, Omisirge ® (omidubicel-onlv) and APHEXDA ® (motixafortide). Omisirge® is the first and only FDA approved cell therapy for allogeneic stem cell transplant. APHEXDA® is a stem cell mobilization agent indicated for autologous transplantation for patients with multiple myeloma.

General Scope and Summary

The Director, Payer Access & Reimbursement plays an important role in securing timely access to therapies for patients and will collaborate cross functionally with the medical affairs, account management, and cell therapy operations teams to support transplant centers. The core function of the role is to operationalize the overall payer and hospital administrator strategy to ensure appropriate patient access to therapies. The Director, Payer Access & Reimbursement will ensure coverage and access at the payer level as well as educate hospital administrators on appropriately accessing Gamida Cell’s therapies and on relevant coverage and reimbursement policies.

The Director, Payer Access & Reimbursement will report to AVP, Head of Market Access.

Roles and Responsibilities

• Obtain positive coverage and access for Gamida Cell products with national, regional and government payers within assigned region
• Educate hospital administrators (C- suite level, billing and reimbursement personnel, chargemaster personnel) on appropriate formulary, access, coverage, coding requirements and payment methodology for Gamida Cell products to build reimbursement confidence
• Negotiate trade agreements with Treatment Centers as needed
• Provide assistance supporting the entire patient access journey, from physician order to reimbursement, including payer policy development, prior authorization to appeals/denials requirements and procedures, and appropriate coding and billing support
• Build proactive relationships with organizations/KOLs whose experience and expertise are relied on by payers
• Assess payer and state policy landscape to understand potential impact to coverage of Gamida Cell’s products for Commercial, Medicare and Medicaid patients
• Develop and implement payer account level business plans and contribute to overall hospital account business plans
• Responsible and accountable for the successful implementation within region of the strategic and tactical market access plan
• Present / provide approved product education and health economic information to key customers and communicate the value proposition of Gamida Cell’s products
• Partner with internal and external stakeholders, including business solutions, Gamida Cell Assist and other partners to onboard sites, address access related inquiries and execute on strategic account plans
• Identify and mitigate potential challenges that may hinder access
• Establish critical relationships with a variety of stakeholders within geography: key transplant centers, Medicare CMDs, health plan medical directors and state Medicaid directors

Experience, Education and Specialized Knowledge and Skills

• Demonstrated successful experience with National, Regional and/or Government payers (5-7 years minimum required); 10+ years total biotech/pharmaceutical experience in a commercial setting.
• Demonstrated experience with provider access and reimbursement with a medical benefit product or inpatient therapy (5-7 years required)
• Cell therapy, gene therapy, or transplant market access and economic experience with existing transplant center and payer relationships strongly preferred
• Launch experience with new specialty biologics preferred
• A./B.S. degree required; Master’s Degree preferred but not required.

Skills:

• Outstanding written and verbal communication skills with the ability to effectively present to and engage with a wide range of audiences.
• Excellent strategic and business acumen skills, with demonstrated ability to successfully partner with payers.
• Strong ability to work collaboratively and cross-functionally to ensure goals are achieved.
• Proven ability to think strategically and prioritize.
• Exceptional problem-solving skills.
• Exhibits initiative, flexibility, tenacity, and dependability.
• Ability to lead without authority
• Possess a willingness and ability to work hands-on and with a sense of urgency, in a fast-paced, entrepreneurial environment.

Travel: 50%

Reports to: AVP, Head of Market Access

Base Salary Range: Gamida Cell considers a range of factors when determining base compensation and therefore the final compensation will vary depending on experience level.

Gamida-Cell is deeply committed to fostering an environment where diversity and inclusion are not only valued but prioritized. Gamida-Cell is proud to be an equal opportunity employer, seeking to create a welcoming and diverse environment. All applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other applicable legally protected characteristics.