SOURCES SOUGHT
R -- Conduct Part D Formulary & Benefits Review 2007
- Notice Date
- 3/12/2007
- Notice Type
- Sources Sought
- NAICS
- 541611
— Administrative Management and General Management Consulting Services
- Contracting Office
- Department of Health and Human Services, Centers for Medicare & Medicaid Services, Office of Acquisition and Grants Management, 7500 Security Blvd. C2-21-15, Baltimore, MD, 21244-1850, UNITED STATES
- ZIP Code
- 00000
- Solicitation Number
- CMS-2007-70142
- Response Due
- 3/23/2007
- Archive Date
- 4/7/2007
- Description
- THIS IS NOT A FORMAL REQUEST FOR PROPOSAL (RFP) AND DOES NOT COMMIT THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) TO AWARD A CONTRACT NOW OR IN THE FUTURE. Review Part D Plan Formularies and Benefits INTRODUCTION This announcement constitutes a Sources Sought Synopsis in support of the Centers for Medicare and Medicaid Services (CMS), Center for Beneficiary Choices (CBC). CMS is seeking capability statements from small and minority business firms (e.g., 8(a), service-disabled veteran owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business, and women-owned small business) that are qualified to support CMS in reviewing plan formularies and benefits related to the Medicare prescription drug program. This initiative will assist CMS in achieving its objective of reviewing plan formularies and benefits to ensure compliance with the guidelines outlined in the CMS Strategy for Reviewing Prescription Drug Plan Formularies and Procedures for Affordable Access to Needed Drugs Covered under MMA: Guidelines for Reviewing Prescription Drug Plan Formularies and Procedures (referred to as Formulary Guidelines), available at: http://www.cms.hhs.gov/PrescriptionDrugCovContra/03_RxContracting_FormularyGuidance.asp#TopOfPage and to ensure compliance with CMS? benefit guidelines. HISTORY In January 2005 the Centers for Medicare & Medicaid Services (CMS) issued the final rule on the Medicare prescription drug benefit. This new voluntary prescription drug benefit program was enacted into law on December 8, 2003, in Section 101 of the Medicare Prescription Drug, Improvement, and Modernization act of 2003 (MMA). The addition of a prescription drug benefit to Medicare represents a landmark change to the Medicare program that will significantly improve the health care coverage available to millions of Medicare beneficiaries. The MMA specified that the prescription drug benefit program would be available to beneficiaries beginning on January 1, 2006. The drug benefit is offered to Medicare beneficiaries through Medicare Advantage drug plans (MA-PDs), stand-alone prescription drug plans (PDPs), or fallback plans. The MMA requires CMS to review Prescription Drug Plans formularies to ensure beneficiaries have access to a broad range of medically appropriate drugs to treat all disease states and the formulary?s design does not discriminate or substantially discourage enrollment of certain groups of beneficiaries. The primary focus of the formulary review is to ensure the inclusion of a broad distribution of therapeutic categories and classes, utilize reasonable benchmarks to check that drug lists are non-discriminatory, review tiering and utilization management strategies, identify potential outliers at each review step for further CMS investigation, and obtain clinical justification when outliers are determined to be potentially discriminatory. The MMA requires CMS to review Prescription Drug Plans benefit packages to ensure nondiscriminatory benefit designs. In addition CMS reviews the benefit packages to ensure there are no discrepancies between the plans formulary and benefit submissions. TASK DESCRIPTION Formulary Review Under the North American Industry Classification System (NAICS) (formerly known as the SIC code): 541611 ? (Size Standard: $6.5 million. Additional information on NAICS codes can be found at www.sba.gov), the Contractor shall review plan formularies to ensure they meet the standards outlined in the CMS formulary guidance documents. All reviews must be done by licensed pharmacists. The pharmacist reviewers will utilize reports generated by Health Plan Management System (HPMS) to review plan formularies against CMS? standards. This review will consist of reports that contain ?potential issues? listed for the pharmacist to review for discrimination, access or clinical issues. The review will include, but is not limited to, the following areas: ? Discrimination Review. Formularies will be reviewed for inclusion of drugs to check for formulary robustness and breadth of covered drugs. ? Formulary Classification Review. The categories and classes will be reviewed for all submitted formularies. Additionally, all formularies will be reviewed to ensure inclusion of at least two drugs in each of the plans? categories and classes. ? Common Medicare Drugs Review. Formularies will be reviewed to ensure inclusion of those drugs or drug classes that are most commonly utilized by the Medicare population. ? Drug Classes of Clinical Concern. Submitted formularies must be reviewed to ensure coverage of all or substantially all drugs in recognized classes of special clinical concern. ? Treatment Guideline Review. Drugs or drug classes specifically identified in widely accepted treatment guidelines will be identified. Formulary submissions will be reviewed for these drugs or drug classes. ? Tier Placement Review. A tier review will be performed for all Part D formulary submissions to ensure adequate coverage of drug classes in preferred formulary tiers. ? Utilization Management Review. Applicable utilization management tools will be reviewed for clinical appropriateness, as well as to ensure that there are no discriminatory practices. In addition to the identification of potential formulary issues, the review will require the coordination and completion of following processes: ? Communication of potential formulary issues identified during the initial formulary review. ? Review of plan-submitted clinical justifications in response to outlier communication. ? Participation in formulary negotiations with plan sponsors ? Secondary formulary reviews. ? Review of monthly formulary updates. ? Tests and analyses to assure review consistency (e.g., 95% of the materials reviewed by a second reviewer result in the same finding as for the original review). ? The estimated number of formularies to be reviewed is 600 initial formulary submissions and 450 monthly updates. Benefit Review The Contractor shall review the cost sharing structure for each formulary tier to ensure plans do not have a benefit structure that is discriminatory. The analyst will utilize data generated by HPMS to review cost sharing per tier against the standards set forth by CMS. This review will consist of data analysis that focuses on ?outliers? to review for potential discrimination. The review will require the coordination and completion of the following processes: ? Maintain a spreadsheet of the outcomes of the benefits review. ? Participate in benefit negotiations with plan sponsors ? Secondary benefit review ? Tests and analyses to assure review consistency (e.g., 95% of the materials reviewed by a second reviewer result in the same finding as for the original review). ? The estimated number of plan benefit packages to be reviewed is 2500. A. REQUIRED DEMONSTRATED KNOWLEDGE, EXPERIENCE, OR THE ABILITY TO PROVIDE 1) Demonstrated specialized knowledge and an operational understanding of Section 101 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). a) Provide an algorithm of review procedures to determine if a medication qualifies as a Part D covered medication. 2) Research on drug indications and specialized information using the compendia specified in the regulation. (42CFR Section 423.100) 3) The review of prior authorization criteria. 4) The review of quantity limits. 5) The review of step therapy protocols. 6) Working with FDA databases to identify DESI and LTE drugs. 7) Demonstrated experience conducting review of prescription drug plan formularies including all review elements listed in A2 through A6 above. 8) Evaluation of clinical justifications for formulary exceptions. 9) Knowledge of the Medicare Part D plan benefit models. 10) Evaluation of plan benefit packages for acceptable cost shares. 11) Preparing technical and analytical reports and databases including, but not limited to meeting minutes, letters, formulary review results, and presentation slides. 12) Provide both sufficient personnel and appropriately skilled professionals (licensed pharmacists for formulary review) knowledgeable and experienced in conducting review of formularies including prior authorization criteria, quantity limits, step therapy protocols, and clinical justifications for formulary outliers/exceptions and review of plan benefit packages. 13) Staff should be knowledgeable about the Medicare Part D program, the definition of a covered Part D drug, and the Part D plan benefit models. a) Number of staff (licensed pharmacists for formulary review) to support this effort available (this cannot include staff who are currently performing Part D related work for Medicare Prescription Drug Plans under contract with CMS or staff who work for pharmacy benefit managers that are under contract to Part D plan sponsors.) b) Confirmation the contractor understands that staff performing Part D related work for Medicare Prescription Drug Plans under contract with CMS or staff who work for pharmacy benefit managers under contract to Part D plan sponsors will not review formularies or benefit packages under this task. 14) Ability to secure locations in which to maintain and store confidential and proprietary information (i.e., paper and electronic versions) and ability to shred confidential documents as instructed by CMS. 15) Maintaining and storing electronic data in a HIPAA-compliant environment throughout and after the conclusion of the project. 16) Specific corporate experience directly related to our requirements; include references (point of contact and phone number). B. BUSINESS INFORMATION Please provide the following: a. DUNS: b. Company Name c. Company Address d. Current GSA MOBIS Schedules appropriate to this Sources Sought. (This may or may not be a GSA procurement) e. Do you have a Government approved accounting system? If so, please identify the agency that approved the system. f. Type of Company (i.e., small business, 8(a), woman owned, veteran owned, etc.) as validated via the Central Contractor Registration (CCR). All offerors must register on the CCR located at http://www.ccr.gov/index.asp. g. Company Point of Contact, Phone and Email address. h. Point of Contact, Phone and Email address of individuals who can verify the demonstrated capabilities identified in the responses. It is essential that the contractor be free of all perceive, potential or actual conflicts. Specifically, the contractor must not have any relationships or arrangements through its business operations or its employees that could be considered as possibly lessening the company?s objectivity concerning any aspect of this work. If such relationships or arrangements exist, contractors shall be required, during the procurement process, to identify potential conflicts of interest and discuss how the conflicts will be addressed and mitigated. The synopsis is for information and planning purposes and is not to be construed as a commitment by the Government. This is not a solicitation announcement for proposals and no contract will be awarded from this announcement. No reimbursement will be made for any costs associated with providing information in response to this announcement and any follow-up information requests. Respondents will not be notified of the results of the evaluation. All information submitted in response to this announcement must arrive on or before the closing date. Small and minority businesses interested in documenting their capabilities should address A & B above to perform in the functional areas provided herein. Responses to this sources sought announcement should be sent as soon as possible, but no later than March 23, 2007. Capability statements shall be limited to ten (10) pages and no more than ten (10) pages of attachments, and shall include any/all teaming arrangements. Documentation should be sent to: Centers for Medicare & Medicaid Services Attn: Chip Farmer, Contract Specialist Office of Acquisitions and Grants Management Acquisitions and Grants Group Division of Beneficiary Support Contracts Mailstop: C2-21-15 7500 Security Boulevard Baltimore, MD 21244 Questions may be referred to Chip Farmer at 410-786-1997. Point of Contact Chip Farmer, Contract Specialist, Phone 410-786-1997, Fax 410-786-9088, Email ? edward.farmer@cms.hhs.gov
- Place of Performance
- Address: The Contractor's Site
- Zip Code: 21244
- Country: UNITED STATES
- Zip Code: 21244
- Record
- SN01248830-W 20070314/070312220129 (fbodaily.com)
- Source
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