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Independent Pharmacy Reviewers (Pharmacists)

Active

State & Local

Response Deadline09/15/2026, 06:00:00 PM UTC

Contract Overview

Solicitation details, issuing organization, response deadlines, documents, and interested companies for this government contract opportunity.

AI Contract Overview

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This subcontract opportunity is for licensed Pharmacists, holding either a PharmD or RPh credential, to serve as independent third-party pharmacy reviewers for prime contractors supporting the Kentucky Department of Medicaid Services. The selected professionals will be responsible for evaluating pharmacy claims and medication requests to assess medical necessity and the appropriateness of pharmaceutical interventions, ultimately providing formal decisions and determination reports for pharmacy-related administrative reviews. The solicitation is categorized under NAICS code 621391 and was posted on August 7, 2026, with a response deadline of September 15, 2026. Interested parties can find further details and submission guidelines through the Kentucky state vendor portal.

General Info

Licensed Pharmacists to review pharmacy claims for Kentucky Department of Medicaid Services.

Agency

Kentucky → 275 E. Main StreetView Agency

NAICS

621391 - Offices of PodiatristsView NAICS

Place of Performance

Other, KY, USA

Set-Aside

NONE

Documents

This scope was carved out of RFP 746 2700000006.

The full solicitation package (7 documents), including the RFP, is on the prime solicitation, not on this scope.

View the prime solicitation

RFP-746-2700000006-1 | External Independent Third-Party Review (C6102)

AI Contract Breakdown

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No contract breakdown available.

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Timeline

PostedAug 7

subcontract

Response DeadlineSep 15

Submission deadline

Response Deadline

09/15/2026, 06:00:00 PM UTCin 9 days

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Organization & Contact Information

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AgencyKentucky → 275 E. Main Street

ContactsNo contacts available

OfficeN/A

Organization / Agency

Kentucky → 275 E. Main Street

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Office AddressN/A

ContactsNo contact information available

Full Description

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Performs independent third-party pharmacy reviews for prime contractors on Kentucky Department of Medicaid Services (DMS) projects. Reviews pharmacy claims and medication requests to determine medical necessity or appropriateness of pharmaceutical interventions and renders formal decisions on pharmacy-related administrative reviews. Requires licensed Pharmacists (PharmD or RPh). Delivers a rendered decision/determination report for pharmacy review cases.

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More opportunities from Kentucky → 275 E. Main Street

Same awarding agency

RFP-746-2700000006-1 | External Independent Third-Party Review (C6102)

Solicitation # RFP 746 2700000006

The Commonwealth of Kentucky Cabinet for Health and Family Services, Department for Medicaid Services, has issued solicitation RFP-746-2700000006-1 for a Personal Service Contract to provide External Independent Third-Party Reviews (EITPR). The selected contractor will assist the Department of Medicaid Services by performing timely and accurate reviews of adverse final decisions made by Managed Care Organizations regarding Medicaid provider appeals. The scope of work includes making medical necessity, administrative, and pharmacy determinations, developing a formal process for credentialing qualified clinicians, and ensuring all reviewers are free of conflicts of interest. Key deliverables include issuing final decisions within specific timeframes—30 calendar days for administrative reviews, 3 calendar days for pharmacy reviews, and 24 hours for expedited or urgent cases—as well as providing comprehensive review summaries and regular reporting. Proposals must be submitted electronically via the Kentucky Vendor Self Service System by September 15, 2026, at 2:00 PM Eastern Time. Submissions must be divided into three distinct parts: a Technical Proposal, a Cost Proposal, and Proprietary Information, with each part limited to a single attachment not exceeding 65,000 KB. The evaluation process will rank proposals based on technical merit and cost, with the lowest-priced proposal receiving maximum points for the cost component. The contractor is required to maintain strict HIPAA compliance as a Business Associate, implement robust data security via encryption or secure FTP, and hold cyber insurance or a performance bond for the full contract amount. Additionally, the contractor must comply with various Kentucky statutes, non-discrimination laws, and federal regulations, including prohibitions on using certain specified telecommunications and surveillance equipment.

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