Defense Supply Center Philadelphia, Directorate of Medical Materiel, Bldg 6, 700 Robbins Ave., Philadelphia, PA 19111

65 -- REQUEST FOR INFORMATION "PHARMACY BENEFIT MANAGER" DUE 033100 POC Vincent Valinotti, K.O.(215)737-4149 or Paul Vasquez, Sr. K.O.(215)737-5759 E-MAIL: Click here to contact the Contracting Officer via, pvasquez@dscp.dla.mil. The Department Of Defense Is Seeking the Help of the Pharmacy Benefit Management, Pharmaceutical Wholesaler, and Pharmaceutical Manufacturer Industries. The Department of Defense is seeking the help of all interested parties in developing its strategy to provide the next generation of pharmacy benefits to its population of approximately 8.3 million beneficiaries. This benefit will include a national network of retail pharmacies, as well as a mail order pharmacy option that will include beneficiaries who live both stateside and abroad. DoD is considering contracting with a Pharmacy Benefit Manager (PBM) that will manage both the national retail pharmacy network and the National Mail Order Pharmacy Phase II (NMOP II) program. A solicitation has already been issued for the NMOP II program (Solicitation # SP0200-99-R-1009, dated 12 Nov, 1999). This solicitation has been put on hold pending review of comments submitted in response to this RFI and a Departmental determination on establishment of a PBM. To request a copy of the NMOP II Solicitation and Statement of Work, you may contact Vincent Valinotti at the Defense Supply Center Philadelphia, at (215) 737-4149, or email vvalinotti@dscp.dla.mil. The successful PBM will be expected to perform the following functions for the Department of Defense: Claims Processing -- for prescriptions filled either in the network or out of network. Approximately 10M adjudicated from the retail network Less than 1M adjudicated as paper claims Collection of co-payments from either a transaction or a claim Be the central repository of all transaction data for prescriptions filled within the Military Health System. The contractor must also accept and store transactions from prescriptions filled at Military Treatment Facilities (MTFs). Even though the contractor will not fill these prescriptions, it must store the data in its system so it may be used for Prospective Drug Utilization Review against the patient's entire drug profile. The contractor must also be prepared to accept, store, and use the existing database of previous prescriptions filled at the point it begins service to DoD. (All new transactions and those in the existing database will be NCPDP compliant.) IM/IT capability to handle the expected volume of claims and transactions. In Fiscal Year 1999 DoD processed approximately 61 million pharmacy transactions; 50M of these were at MTFs, 10M in the Managed Care Support Contractors' retail networks, and 1.3M in the National Mail Order Pharmacy program. Ability to interface with DEERS (Defense Enrollment Eligibility Reporting System) for eligibility determination. Chargeback/Rebate procedures with pharmaceutical manufacturers. The pharmaceuticals used in the NMOP II portion of the contract will be procured at best federal pricing (using the DSCP-awarded National Pharmaceutical Wholesaler contract) on a replenishment basis. The retail pharmacy network may or may not have access to best federal pricing. However, if this pricing is not available, it will still be the responsibility of DoD to negotiate pricing with the pharmaceutical manufacturers and control the pharmaceutical acquisition process. The contractor shall assist DoD in implementing procedures under either or both scenarios. Provide a Pharmacy Benefit card to each beneficiary enrolled in the program. Customer Service -- provide toll-free access and act as the first line of contact for all patient inquiries. Marketing -- to beneficiaries, military and contracted medical providers, Health Services Regional Offices, and military base commanders and staffs. Reporting -- provide data in agreed-upon formats to DoD; perform Retrospective Drug Utilization Review. Implement Formulary decisions made by DoD. Support the DoD P&T Committee, providing administrative and clinical assistance. Utilization Management -- assist DoD in UM Plan development, Prior Authorization program and/or tiered co-payments, etc. DoD also requests respondents to investigate and provide comment on the possibility of processing refillsfor prescriptions that were originally filled at a Military Treatment Facility. The refill requests would be transmitted electronically (in NCPDP-compliant format) to a mail order facility from any of the 105 CHCS Host Sites within the Military Health System. Any prescription received by the PBM through this CHCS link will have already been screened for eligibility and Drug Utilization Review, and the contractor will not be responsible for performing these functions. The PBM would be responsible for processing the refill (correct drug, correct patient, correct mailing address) and delivering by mail the prescription to the beneficiary. All clinical responsibility would be the responsibility of the MTF Pharmacy. This service could be a separately priced line item to the mail order portion of the contract. In addition to these known requirements, DoD would also like to receive information from the PBM industry on the following topics. Interested parties may submit the following data for DoD to consider: Provide information on your Disease Management programs. Provide information on the network density of your existing retail pharmacy networks. Provide information on your overpayment recovery/reconciliation programs. Provide information on your audit capability for the pharmacies in your network. Provide information on your reporting capability -- standard and customized reporting you do for other clients. Provide information on your ability to establish a robust national retail network under the constraints of this design. DoD also requests experts in the Pharmaceutical Wholesaler, Pharmacy Benefits Management and Pharmaceutical Manufacturer industries provide recommendations on best procedures for the following functions: Rebate and Chargeback procedures for managing this program. Distribution Channels -- will the program require any deviations from existing commercial practices? Business relationships between PBM and retail network; types and cost. It is worth noting that while DoD will remain fiscally responsible, it is a non-profit organization wishing to ensure quality healthcare in the most expeditious manner possible given the restraints of the market place. Although DoD is considering a contract with a PBM to establish and maintain the retail pharmacy network and NMOP II, DoD would maintain the management and control functions over the entire program. The following functions would remain under control of DoD: Management/ Control. Policy Development. Formulary Development. Edits/ Business Rules for Prospective Drug Utilization Review. Developing criteria for Prior Authorizations. Awarding and administering the National Pharmaceutical Wholesaler contract. All transaction, claims, and utilization data remain the property of the DoD and can not be shared, transferred, or sold to a third party All interested parties shall provide information to the following address: Defense Supply Center Philadelphia ATTN: DSCP-MGAC (Paul Vasquez) 700 Robbins Avenue Philadelphia, PA 19111-5096 You may also email information to Mr. Vasquez at pvasquez@dscp.dla.mil. DSCP must receive all information by 31 March 2000 to be considered. If you do not want to provide information at this time, but you would like to receive a copy of any solicitation once it is issued, you may also respond to Mr. Vasquez at the address above. Posted 02/18/00 (W-SN426888). 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