Director, Market Access

About Milestone Pharmaceuticals

Milestone Pharmaceuticals Inc. (Nasdaq: MIST) is a biopharmaceutical company focused on the development and commercialization of innovative cardiovascular medicines. Cardamyst™ (etripamil nasal spray) is the company’s first commercial product — a first-in-class, self-administered treatment for paroxysmal supraventricular tachycardia (PSVT) in adults, approved by the FDA in December 2025 and launched through retail pharmacies in Q1 2026.

Position Overview

The Director, Market Access is a hands-on operational leadership role responsible for executing market access functions supporting the Cardamyst commercial launch and ongoing lifecycle management. This person will serve as the primary point of contact for all market access vendors and will manage the day-to-day execution of payer contracting support, GTN/accruals analytics, pull-through materials, patient support programs, government pricing operations and state compliance reporting.
The ideal candidate is someone who thrives in a small-company environment and will be involved in every aspect of market access — from reviewing government price calculations to troubleshooting a patient’s copay issue to preparing a formulary negotiation model. The role requires a willingness and ability to operate at both the strategic and tactical level.

Essential Duties and Responsibilities

Patient Support Program Operations

• Serve as the primary vendor relationship owner for all patient support partners including copay card (UBC), eVoucher/denial conversion (CoverMyMeds, Relay Health), prior authorization support (CoverMyMeds PA+), patient support call center, and any future programs
• Monitor and optimize patient journey metrics across dispensing options: PA submission through approval, pharmacy adjudication, copay program utilization, fill rates, and abandonment
• Proactively identify and troubleshoot access barriers throughout the patient journey; develop action plans to address issues surfaced through data, vendor feedback, or field intelligence
• Manage program compliance, including copay card accumulators/maximizers, cash-pay restrictions, and coordination of benefits between programs
• Lead patient support reporting and analytics, including copay card capture rates, average buydown amounts, out-of-pocket costs, eVoucher utilization, and denial conversion rates

Government Pricing and Compliance

• Manage government pricing operations through regular standing meetings with the contracted government pricing vendor (CGPV), ensuring timely and accurate calculation submissions and resolving any open items
• Execute initial review and approval of government price calculations on a recurring basis; provide initial review of quarterly and monthly submissions prepared by the CGPV
• Maintain Medicaid state portal registrations, federal contract registrations, and ensure ongoing compliance with federal and state pricing programs (Medicaid Drug Rebate Program, 340B, TRICARE, VA/FSS)
• Own state price transparency report generation, registration maintenance, and submission tracking across all applicable states
• Support government pricing audits, information requests, and legislative/regulatory change impact assessments as they arise
• Serve as operational liaison to Finance for rebate invoice approvals, payment coordination, and reconciliation of contracted terms against actual payments

Payer Contracting and Formulary Access

• Support GPO and PBM contract negotiations by preparing financial models, scenario analyses, and recommendation decks for Pricing Committee review
• Maintain and update the formulary coverage tracker across commercial, Medicare Part D, and Medicaid channels using claims data and Fingertip/Clarivate DRG sources
• Track contract performance against negotiated terms; flag variances and coordinate with Finance and external partners to resolve discrepancies
• Support payer bid submissions, rebate rate negotiations, and contract amendment processes across GPOs (Ascent, EMISAR, Zinc) and direct payer arrangements
• Prepare payer engagement materials including coverage status updates, value proposition summaries, and formulary decision support content

GTN / Accruals and Analytics

• Support GTN forecasting and accrual processes by maintaining data inputs, running scenario models, and reconciling forecast-to-actual variances
• Produce and distribute regular market access reporting: TRx trends, 867 sell-through, payer mix, rebate accruals, and copay program economics
• Closely collaborate with Finance to ensure GTN models reflect current contract terms, payer mix shifts, and patient program utilization trends
• Build and maintain ad hoc analyses as needed to support executive decision-making, board reporting, and commercial forecasting

Pull-Through and Field Access Support

• Support the development of, and maintain payer-facing and field-facing materials including coverage status tools, representative leave-behinds, reimbursement guides, and access messaging
• Coordinate with Marketing, Medical, Regulatory, and Legal on promotional review committee (PRC) submissions for all market access materials
• Build and communicate formulary coverage updates to field teams to support pull-through efforts and prescriber education on access pathways
• Support the development and execution of payer advisory boards, market research, and field access training content

Cross-Functional Collaboration

• Partner with Commercial Operations, Sales, and Marketing to align market access initiatives with broader commercial strategy
• Collaborate with Medical Affairs on evidence generation priorities and HEOR data needs for payer engagements
• Support distribution and trade operations as needed, including coordination with retail pharmacy and wholesale distribution partners
• Contribute to forecast adjustments and launch planning discussions with a market access perspective on demand drivers and barriers

Required Qualifications

• Bachelor’s degree required; MBA or advanced degree preferred
• 8+ years of pharmaceutical industry experience with progressive responsibility in market access, pricing, contracting, or patient services
• Direct experience in at least three of the following: payer/PBM contracting, government pricing operations, patient support/hub program management, GTN/accruals, or formulary access strategy
• Demonstrated experience managing external vendors and holding partners accountable to deliverables, timelines, and quality standards
• Working knowledge of government pricing programs (Medicaid rebate, 340B, TRICARE/VA, Medicare Part D) and state price transparency requirements
• Proficiency in Excel-based financial modeling, scenario analysis, and data-driven decision making
• Experience in a small-company or launch environment where individuals are expected to operate across functional boundaries
• Strong written and verbal communication skills with the ability to synthesize complex information into clear, actionable deliverables for senior leadership

Preferred Qualifications

• Experience supporting a retail pharmacy-distributed product
• Familiarity with copay card program design and economics, eVoucher platforms, and denial conversion programs
• Prior experience supporting a product launch where payer education and formulary access required proactive market shaping
• Knowledge of cardiovascular, CNS, or acute/episodic therapeutic areas
• Experience with data sources including IQVIA, Clarivate/DRG Fingertip, CoverMyMeds, and claims-level analytics
• Comfort working directly with Finance on accrual methodologies, balance sheet impacts, and audit-ready documentation

Location

This is a remote position. Periodic travel may be required for payer meetings, vendor summits, and industry conferences.

COVID-19 VACCINATION POLICY: All Milestone employees, regardless of work location, must be fully vaccinated for COVID-19. This requirement includes a booster dose once eligible. Requests for exemption for medical or sincerely held religious beliefs will be considered.

EEOC STATEMENT: Milestone believes in a diverse environment and is committed to equal employment opportunities for all its employees and qualified applicants. We do not discriminate in recruitment, hiring, training, promotion or any other employment practices for race, color, religion, gender, national origin, age, sexual orientation, marital or veteran status, disability, or any other legally protected status. Milestone will make reasonable accommodations for qualified individuals with known disabilities in accordance with applicable law.