Emergency Prescription Assistance Program

CMS is conducting market research to identify both large and small firms that are capable of performing the Emergency Prescription Assistance Program (EPAP) as described in the attachment to this posting. CMS is not interested in obtaining the services of an integrator, but is looking for a firm that can meet all the requirements as described in the document attached to this posting. Respondents may submit capability statements of no more than 10 pages (10 pitch, new times roman font) addressing their ability to meet the government's needs under this program. In addition to the 10 page document, interested parties should provide a description of contracts/work they have performed of a similar scope and size to that described in the EPAP attached document. In addition, the following information must accompany any capability statement: (1) Corporate DUNS Number (2) Size Standard (large, small, small disadvantaged...etc) (3) NAICs under which your firm can perform; NAIC for this effort is 624230 (4) Any GSA/Other Government contracts currently held by your organization, including contract number and point of contact (5) Statement that your organization does or does not have a cost accounting system previously audited by a Government entity and deemed acceptable for handling cost type contracts Capability information must be submitted to the following e-mail address no later than April 28, 2008 to: Carol.sevel@cms.hhs.gov Christopher.worrall@cms.hhs.gov Please note that the government does not intend to respond to any questions regarding this posting and does not anticipate contacting any respondents as a result of capability statements. This posting is purely for the purposes of conducting market research. This document does not constitute an obligation of Government funds. Emergency Prescription Assistance Program (EPAP) In the aftermath of hurricane Katrina, community retail pharmacies were ready, willing and able to assist victims and evacuees. In many disaster areas, community pharmacists were on the scene before any other medical professionals providing first aid and prescription drug assistance to victims. Through the coordinating efforts of DHHS/CMS, community pharmacists were able to set up and serve the emergency needs of evacuees from Katrina at hundreds of evacuee sites using the existing private drug distribution system. Conflicting directions from Federal, State, local and private agencies, along with the lack of any established process for enlisting the help from this community resource were among the biggest challenges for these pharmacies. Pharmacies that dispensed medications and some Durable Medical Equipment (DME) to Katrina evacuees found it challenging to settle claims due to a lack of clarity with how to navigate different layers of government to find the appropriate payer of last resort. Prescription drugs and DME are critical first line therapies in treating both acute and chronic conditions. For this reason, assuring an adequate and readily available supply is a priority for emergency planning. As a byproduct of our experience with hurricane Katrina, the federal government established the Emergency Prescription Assistance Program (EPAP) to fully leverage private sector resources for efficient prescription drug distribution. CMS is now conducting market research to determine the availability of vendors such as, but not limited to, prescription drug and DME claims processors who may be capable of administering this critical emergency response program. Requirements for the EPAP claims processor include: - Providing access at any pharmacy in the nation, via either in-network or out of network pharmacy claims, up to a 30-day supply of necessary prescription drugs and limited DME for individuals who were affected by a disaster of national significance and have no other health insurance. - Activating the EPAP upon notification from the CMS Project Officer, and will provide timely reports of EPAP claims to CMS. - Distributing appropriate payer sheets and eligibility information to all network pharmacies, including posting of this information on its website, and examine the feasibility of performing back-end eligibility checks to safeguard the integrity of the EPAP as a payer of last resort. - Making its call center available to participating pharmacies and eligible individuals through a toll-free number. - Communicating with government, charitable organizations and private industry to ensure eligible pharmacy claims can be identified and processed in necessary brick and mortar, mobile and out of area pharmacies. - Examining the feasibility of facilitating a pharmaceutical product donation for drugs dispensed under this program, potentially reducing federal government costs to respond to a disaster. The EPAP claims processor will be reimbursed under a cost reimbursement contract for operational expenses incurred outside of the normal course of business, including paid claims (at existing network rates), EPAP communications, back-end eligibility checks, additional call center staffing and scripts, reports for manufacturer product donations and other operational expenses directly related to the management of the EPAP. The EPAP claims processor will utilize a different reimbursement metric for claims associated with manufacture product donations. CMS cannot reimburse the contractor for any activities prior to activation during a disaster of national significance. While it is impossible to predict on an annual basis how often the EPAP will be activated, we expect EPAP activation to occur very infrequently. It is important to note that, while Presidential Declarations (emergency or major disaster) may average around 50 per year, not every Presidential Declaration would invoke the EPAP. Since 2003, only the following events, with varying levels of exposure, would have potentially activated the EPAP: 2006 - Tropical Storm Ernesto 2005 - Hurricanes Katrina and Rita 2004 - 4 major Hurricanes (in close proximity, by geography and date) 2003 - Hurricane Isabel