US Payer Strategy & Engagement:
- Develop and execute Skyhawk's national US payer strategy across Commercial, Medicare, and Medicaid channels, including payer segmentation, tiering, and call-prioritization frameworks that reflect coverage policy, formulary timing, and covered-lives concentration.
- Build and personally lead relationships with national and regional MCOs, PBMs, IDN's and specialty pharmacy/hub partners — this role is expected to be in the room for the organization's highest-value payer conversations, not solely directing others.
- Design and lead the account-planning and workload model for the payer-facing field team as it's built out, including geographic/territory design and prioritization logic.
- Own the strategy and execution for pre-approval payer engagement (e.g., health care economic information exchange), in close coordination with Legal/Compliance, ensuring all activity stays within applicable regulatory guardrails.
Value-Based & Innovative Contracting:
- Lead the evaluation, design, and negotiation of value-based agreements and other innovative contracting models with payers, where appropriate for SKY-0515 and future assets.
- Partner with HEOR, Pricing, Medical Affairs, Finance, Marketing and Legal to structure outcomes-based terms, rebate architecture, and risk-sharing mechanisms that are operationally feasible to track and administer.
- Evaluate managed access and alternative reimbursement pathways (e.g., ex-US precedents such as outcomes-based pilots) for applicability to the US market where relevant.
Government Programs — Medicare & Medicaid:
- Own Skyhawk's Medicare (PDP and MA) and Medicaid (state and managed) access strategy, including formulary review timing, prior authorization/step-therapy criteria, and rebate/pricing program compliance (e.g., 340B, Medicaid Drug Rebate Program).
- Monitor and plan for the practical impact of evolving CMS policy — including Inflation Reduction Act provisions, Medicare drug price negotiation, and related rulemaking — on launch and lifecycle strategy.
Launch Readiness & Commercial Execution:
- Serve as the market access lead on the cross-functional launch team, ensuring payer, distribution, and patient-access workstreams are sequenced and resourced correctly ahead of approval.
- Partner with Distribution/Trade and 3PL partners on channel strategy, contracting, and operational readiness (order-to-cash, chargebacks, data flows) as they affect payer access.
- Work with Patient Services to design hub and patient-support program eligibility criteria, ensuring alignment between payer coverage realities and the support patients receive.
Cross-Functional Leadership:
- Partner closely with Marketing to ensure payer and patient messaging are aligned and mutually reinforcing across the launch narrative.
- Partner with HEOR to translate clinical and real-world evidence into payer-relevant value communications, dossiers, and pre-approval information exchange materials.
- Partner with Commercial Operations on data, reporting, and CRM/account-management infrastructure needed to run a payer-facing team effectively.
- Represent market access considerations in pricing, forecasting, and portfolio discussions with Finance and executive leadership, including board- and investor-facing materials.
Policy & Environmental Monitoring:
- Maintain a current, working understanding of the US health policy environment — CMS rulemaking, state legislative activity, PBM and 340B reform efforts, and payer/PBM consolidation trends — and translate implications into actionable strategy shifts.
- Represent Skyhawk, as appropriate, with trade associations and policy-adjacent industry forums relevant to rare disease and orphan drug access.