Pharmacy Benefits Management Program

R-Pharmacy Benefits Management Program Sources Sought Notice Synopsis: THIS IS A SOURCES SOUGHT ANNOUNCEMENT ONLY FOR PURPOSES OF CONDUCTING MARKET RESEARCH. THERE IS NO SOLICITATION AVAILABLE AT THIS TIME. REQUESTS FOR A SOLICITATION WILL NOT RECEIVE A RESPONSE. Request for information Pharmacy Benefits Management Program Background The United States Department of Agriculture is implementing its first national Pharmacy Benefits Management Program for Workers' Compensation. This program is supported in principle by the Office of Workers' Compensation Programs, U.S. Department of Labor, (OWCP) and builds on a pilot project based upon an inter Agency Agreement with the Unites States Postal Service (USPS) implementing the program on a trial basis. This contract is intended to implement a contract for direct USDA Pharmacy Benefits Management Services for its Workers' compensation program. Objective USDA is seeking a national Pharmacy Benefits Management (PBM) organization, USDA in Federal workers' compensation, to administer the program. This will be a national program for USDA employees who are injured on the job and require prescription medication and durable medical equipment paid from the OWCP Employee Compensation Fund which is then reimbursed by USDA through the OWCP annual Chargeback process. Approximately 12,000 employees currently receive prescription medications monthly. The use of a PBM system will be a voluntary program where employees will have the option of using the approved PBM providers or choosing their own pharmacy provider. Eligibility Two groups of USDA employees will be eligible for coverage under this program. 1. Group 1 is comprised of those who have an existing claim under the Federal Employees Compensation Act (FECA). These employees have fully adjudicated workers' compensation claims and have coverage for all prescriptions that meet the OWCP formulary requirements for their accepted injury. 2. Group 2 is comprised of new FECA claimants. These employees are newly injured of the job and have filed FECA claims pending adjudication by OWCP. USDA requests that the PBM provide a system for first fill prescription coverage for employees who sustain a traumatic injury at work. The PBM will provide a pharmacy card system to these employees as part of the USDA injury packet. Full prescriptions coverage will be provided to all injured employees upon filling a FECA claim for traumatic injury. Pharmacy Benefits Management Program Requirements Please respond to each requirement confirming capability. 1. Pharmacy Benefits Management Services will be at zero cost to USDA. Vendor revenue is generated by negotiating pricing arrangements with pharmacy providers. 2. Contractor must have a minimum of 3 years experience in providing Pharmacy Benefits Management services in conjunction with the Federal Office of Workers' Compensation Programs (OWCP). 3. National access to large pharmacy chains and a majority of other pharmacies with a minimum of 60, 000 network pharmacies during contract term. 4. Ability to electronically transfer, at point of sale, all prescription information between participating network pharmacy, PBM and OWCP. 5. Claims processing conforming to the National Council for Prescription Drug Programs (NCPDP) standards 6. Prescriptions must be billed using the 11 digit NDC #. 7. Must provide a pharmacy authorization method to eligible employee. OWCP requires a method of limiting this program to USDA employees. 8. Mail order program option for employees requesting this service and to include the use of USPS for the delivery. 9. Program to include contacting treating physicians for generic substitution in allowable cases. 10. Formulary Administration with ability to administer and ICD-9 code based formulary in accordance with and as determined by OWCP. 11. Dedicated and Security-cleared customer service representatives for USDA job-injured employees to access 24/7 to provide information regarding denials, claims, drug information, payments, etc. 12. Ability to phase in PBM services to support about employees of which about employees receive prescriptions as a benefit of the workers' compensation program. 13. Provide a fee schedule and savings (Average Wholesale Price (AWP) - discount of x %) for generic and brand drugs. 14. Drug Utilization Review (DUR) Program must include the following: a. Detection of inappropriate or unusual prescription usage patterns by providers or employees b. Screening for drugs or drugs contra-indications, drug and age contra-indications, drug and pregnancy contra-indications c. Duplicate prescriptions d. Therapeutic overlap e. Early refill f. Prospective, concurrent, and retrospective DUR program 15. Must have a single program manager assigned full-time to support the USDA account with a minimum of 5 years Federal PBM workers' compensation program experience. 16. Institute performance metrics to measure the contract effectiveness. 17. Must pass USDA required Security Clearance for the following groups: A. Account management B. Customer service representatives C. Clinical Staff D. Reporting and data analytics E. Information Technology staff (Database administrator, programmers etc.) F. Billing and Accounting staff Interested vendors may submit their capabilities and qualifications regarding the aforementioned requirement electronically to: OPPM, Attn: J. Barnes-Edwards, 300 7th & D. Sts. SW, Reporters' Bldg., Rm 302, Washington, DC. 20024. Vendors are asked to confirm if they are a Service-Disabled Veterans-Owned Small Business (SDVOSB), Veterans Owned Small Business (VOSB), Woman-Owned Small Business or a Small Business. Also, vendors are asked to confirm if they have a GSA Federal Supply Schedule contact.