Q517--FY21: Emergent First Fill Prescription Services Base plus four (4) Twelve (12) Month Option Years

Pre-Solicitation Notice The C. W. Bill Young VA Medical Center has a requirement for VISN 08 Emergent First Fill Pharmacy Prescription Services for the Veterans Health Administration. For purposes of this document, VISN 08 Emergent First Fill Pharmacy Prescription Services defined as: Emergent First Fill and Emergency pharmaceutical benefits management products and services to Veterans Affairs (VA) beneficiaries in the Veterans Integrated Service Network (VISN 8) as follows: a. Prescriptions may only be filled from an authorized VA provider employed by the Department of Veterans Affairs under this contract. The contractor must review all prescriptions to ensure that the prescriber is a VA authorized provider. Prescriptions from non-VA authorized providers may not be filled under the contract and will not be reimbursed. b. Only new prescriptions shall be filled. In rare instances where refills may be necessary, there shall be a pre-authorization by the Chief, Pharmacy Service at the responsible Veteran Affairs Medical Center (VAMC) and so noted on the invoice. c. Pharmacy Benefit Management services provided under this contract shall be provided by the contractor Monday through Sunday (7 days a week) to include all federal holidays and weekends. Hours of operation (0000hrs to 2400hrs) daily. d. The contractor shall provide VA with an after-hours point of contact and phone number in the event of an emergency or the provider needing to authorize a non-formulary approval for an emergent prescription. e. The contractor will have an emergent enrollment process to assist patients, VA staff and contract pharmacies 24 hours per day, 7 days per week and 365 days per year. f. The Community Based Outpatient Clinics (CBOC s) normal operating hours are Monday Friday 8:00am to 5:00pm, (excluding federal holidays). Some locations have extended hours of operation. A full list of locations and hours of operation are included in attachment A. g. The VISN 8 Clinical Contact Center (CCC) provides twenty-four (24) hour coverage for all veteran beneficiaries within VISN 8. The VISN 8 Clinical Contact Center operates twenty-four (24) hours a day, including all ten federal holidays (365 days per year). h. Prescriptions filled will be in written form provided by authorized VA providers and shall be identified with the name and address of each CBOC or VISN 8 VAMC location. (VA Form 10-2577F, Security Prescription Form). Prescriptions may also be faxed or telephoned into the pharmacies at the discretion of each VAMC. When available prescriptions may be electronically written by authorized VA providers and electronically transmitted (outbound e-RX prescribing) to the contracted retail pharmacies at the discretion of the VAMCs. i. Unless otherwise pre-authorized, prescription fills shall be limited to a maximum of a ten (10) day supply. The balance of the patients prescribed medication shall be mailed from the VA Mail-Out Pharmacy. Each VA Medical Center may independently choose a shorter day limit if so desired. j. Prescriptions shall be filled for legend drugs only according to the authorized Emergency Medication Formulary List , a small subset derived from medications on the VA National Formulary determined and approved by VISN 8 PBM VPE and/or designee. There shall be a mechanism in place, provided by the contractor to provide real-time messaging and hard edits to the pharmacies to prevent any drug outside of the approved list being dispensed without prior authorization. Prior authorization shall be required for any medication outside of the approved list including all medications on VA National Formulary, a Non-Formulary or any medication considered restricted. k. Prescriptions filled under this contract shall be, to the extent permitted by law, the least expensive drug product the pharmacy has in stock. l. Generic (AB rated) shall be dispensed whenever possible. A product is not considered a generic equivalent unless the strength, quantity and dosage are the same as the brand name. The generic name shall be displayed on all labels for all medication. All generic products used shall comply with Federal and State regulations. m. All prescriptions are to be picked up at the filling pharmacy by the Veteran patient or designee with ample identification. Veteran patients must present a valid photo ID and sign for all prescriptions upon pickup. n. Contractor shall provide a minimum of three licensed pharmacies accepting its plan within approximately 5 miles or less from each VA facility, CBOC, Outpatient Clinic (OPC) and Community Based Clinic (CBC) except for the US Virgin Islands where at least two licensed pharmacy within a 10-mile radius or less is acceptable. Facilities located in each of the following cities: Bay Pines, Cape Coral, Sarasota, St. Petersburg, Port Charlotte, Naples, Bradenton, Palm Harbor, Sebring, Miami, Deerfield Beach, Pembroke Pines, Hollywood, Homestead, Key Largo, Key West, Sunrise City, West Palm Beach, Boca Raton, Delray Beach, Ft. Pierce, Okeechobee, Stuart, Vero Beach, Moore Haven, Clewiston, Port Saint Lucie Gainesville, Lake City, Ocala, Waycross (GA), Jacksonville, Valdosta (GA), Saint Augustine, Tallahassee, The Villages, Saint Mary s (GA), Marianna, Palatka, Perry, San Juan, Arecibo, Ceiba, Comerio, Guayama, Kings Hill (St. Croix), Mayaguez, Ponce, Saint Thomas (VI), Utuado, Vieques, Tampa, Brooksville, Lakeland, Lecanto, New Port Richey, South Hillsborough and Zephyrhills, Lake Nona, Orlando, Viera, Daytona Beach, Kissimmee, Deltona, Tavares and Clermont The cognizant Pharmacy Service for these areas are associated with the station listed below and further detailed in Attachment A. 1) Bay Pines Bay Pines, Cape Coral, Sarasota, St. Petersburg, Port Charlotte, Naples, Bradenton, Palm Harbor and Sebring 2) Miami Miami, Deerfield Beach, Pembroke Pines, Hollywood, Homestead, Key Largo, Key West and Sunrise City 3) West Palm West Palm Beach, Boca Raton, Delray Beach, Ft. Pierce, Okeechobee, Stuart, Vero Beach, Moore Haven, Clewiston and Port Saint Lucie 4) North Florida/South Georgia - Gainesville, Lake City, Ocala, Waycross (GA), Jacksonville, Valdosta (GA), Saint Augustine, Tallahassee, The Villages, Saint Mary s (GA), Marianna, Middleburg, Palatka and Perry 5) Puerto Rico San Juan, Arecibo, Ceiba, Comerio, Guayama, Kings Hill (St. Croix), Mayaguez, Ponce, Saint Thomas (VI), Utuado and Vieques 6) Tampa Tampa, Brooksville, Lakeland, Lecanto, New Port Richey, South Hillsborough and Zephyrhills 7) Orlando Lake Nona, Orlando, Viera, Daytona Beach, Kissimmee, Deltona, Tavares and Clermont 8) Clinical Contact Center provides twenty-four (24) coverage for all locations within the VISN 8 network. o. Contractor shall not mail filled prescriptions to the patient. Contractor shall not deliver prescriptions to patient. p. Pharmacies authorized to fill prescriptions under the contractor s plan shall agree to the following conditions: 1) All information concerning VA beneficiaries shall be kept confidential and shall not be disclosed to any person, except as authorized in writing and according to all applicable laws. The contractors should complete VA privacy training. 2) Representatives of the VA are authorized to visit the premises of any pharmacy filling VA prescriptions under the contractor s plan during business hours. The purpose of reviewing VA information including auditing and evaluation, which may include the inspection of clinical records. 3) All adverse drug events reported to the contractor s pharmacies by beneficiaries of the VA shall be reported to cognizant Pharmacy Service. Adverse drug events include dispensing errors, drug allergies, and adverse drug reactions. 4) Pharmaceutical care provided to beneficiaries under this contract shall meet all standards applicable to Medicaid recipients in the State where the services are provided for Ambulatory Care/Pharmaceutical Services. 5) Payments made by the Department of Veterans Affairs under this contractor shall constitute the total costs of services provided by the Contractor. Contractor hereby agrees that in no event shall contractor bill, charge, collect deposit from, seek compensation, remuneration or reimbursement from, or have any resource against the beneficiary, the beneficiary s family, private insurer, Medicare or any other entity acting on the beneficiary s behalf, for services provided pursuant to this contract. 6) A pharmacist consistent with Omnibus Budget Reconciliation Act (OBRA) 1990 requirement to ensure appropriate use and optimal outcomes from drug therapy shall offer all patients counseling. Counseling at a minimum shall include the following information: a. Name, description and use of the medication b. Dose, dosage form and route c. Special directions and precautions d. Common side effects and action required if they occur e. Techniques for self-monitoring drug therapy f. Action to be taken if a dose is missed g. Proper storage h. What the patient can expect from the medication i. Food-drug interactions A pharmacist shall be available to answer any drug related questions that a patient may have after the prescription is filled. In addition, include documentation (include patient refusal), demonstration of patient understanding, or any other pertinent issue such as provided to care-giver . q. The contractor shall bill the cognizant VA Hospital monthly for services rendered. The VA will audit all billings. Pharmacies accepting payment through the contractor shall make records available to the auditor in a timely manner at the location where dispensed. All invoices shall reference the following information: 1) Contract number 2) Patient name 3) Patient s social security number 4) Prescription number 5) Name and NDC number of the medication dispensed 6) Quantity dispensed 7) RX Cost 8) Average Wholesaler Price (AWP) 9) Brand or Generic identifier 10) Pharmacy Name/location 11) Doctor s Name 12) Contractor s charge fee r. Contractor shall provide VISN 8 a listing of licensed pharmacies that will accept its plan. s. Records maintained by the contractor should have a definite time for retention and a clear method of disposal. t. The contractor must complete the Contractor Security Control Assessment (CSCA) within 30 days of contract approval and yearly on exercise of any options. u. Any disclosure of records to any third party must have an accounting of release of disclosure. v. Offeror shall quote the most favorable discount from the latest edition of an officially recognized US drug database (i.e. First Databank, MediSpan, Multum, Redbook, etc.) or Maximum Allowable Cost (MAC), the most favorable dispensing fee and administration fee and shall meet the requirements as stated in the solicitation. w. In the event of an emergency or special situation such as any manmade or natural disaster, other National Emergency, temporary closing of a VISN 8 facility, interruption of mail services or where prescription delivery services are impaired, the contractor may be authorized to provide prescription services to veteran patients ordered by authorized VA staff. Under the emergency disaster activation, the VA Chief of Pharmacy may authorize a refill on an active prescription. A Veteran patient with a valid ID may take an active VA prescription bottle last filled within 180 days with remaining refills to a participating retail pharmacy to be filled, excluding all controlled substances. The contractor shall provide prescription services for the disruption of normal VA pharmacy prescription filling by VISN 8 or CMOP pharmacy for designated VISN 8 VA patients or where mail delivery, USPO or UPS delivery of VA filled prescriptions is impaired, prevented or otherwise interrupted. x. The emergency disruption clause can only be implemented with the approval of the VISN 8 Chief Medical Officer, Chief Operations Officer, Network Director or, if unavailable due to circumstances, the VAMC Medical Center Director, Associate Director, or Chief of Staff. The Network or VAMC would determine the start and stop date of this service. Prescription status and prescription quantity from the normal ten days supply up to a maximum of ninety days (all VA Formulary without prior approval or limited) will be established when the emergency/special situation necessitates the activation of this provision. y. The contractor shall have a mechanism in place to notify retail pharmacies the emergency disaster plan has been activated to include VA location (s), start/stop date, authorized days supply, restricted or VHA National Formulary and provide the retail pharmacy with contractor contact information for assistance with a VA prescription or billing questions in accordance with VA National policies, directives, DEA, Federal and State laws. The RFQ shall be posted as within the next five days.