Corporate Pharmacist

at  Bupa

ABOUT THE OPPORTUNITY

Bupa is Australia’s largest health insurer and is committed to helping people live longer, healthier and happier lives in a better world. It supports the health and wellbeing needs of more than 4.7 million health insurance customers. Bupa has embarked on a global transition from Health Insurer to a Healthcaring company with the goal of becoming the world’s most customer centric organisation.
This role will report into the General Manager of Claims Integrity and Provider Capability Transformation and will be a member of the CI&PCT Leadership Team. It plays a critical role in ensuring the safe, effective, and cost-efficient delivery of pharmaceutical benefits within Bupa Health Insurance. This position is responsible for overseeing the implementation of pharmacy policies and practices that align with regulatory requirements and company goals, while contributing to the development of health insurance products.
This role works closely with internal teams and stakeholders to optimise pharmaceutical benefits, manage medication-related risks, and maintain the drug database to ensure accurate payment for member benefits in compliance with Bupa policies and regulations. Additionally, the role involves providing guidance and approval for high-cost drug requests in accordance with hospital contract obligations and supporting initiatives aimed at improving health outcomes and controlling pharmacy-related costs.
Through strategic leadership and expert pharmaceutical guidance, the Corporate Pharmacist helps enhance the overall value of health insurance offerings, ensuring that members have access to the most appropriate and affordable medications.

The is an exciting newly created role and will have the following responsibilities:

• Manage and coordinate the maintenance of the Drug Database, and relevant collateral, ensuring that medications listed for reimbursement are in line with the Pharmacy and Product Policies.
• Provider advice to the product team by offering expertise on pharmaceutical benefits and ensuring alignment with private health insurance legislation and regulations
• Ensure that Bupa adheres to Australian regulations regarding drug coverage, such as PBS listing and private health insurance standards, and ensure compliance with the Therapeutic Goods Administration (TGA) and other relevant authorities.
• Review high-cost drug claims to ensure they align with the relevant hospital agreements and health insurance policies.
• Analyse pharmaceutical data to identify patterns that may indicate claims leakage, such as inappropriate claims for medications or discrepancies in the use of pharmaceutical benefits.
• Provide advice to the hospital contracting team on high-cost drug clauses during contract negotiations by offering insights into drug pricing, reimbursement models, and regulatory requirements.