R--Pharmacy Benefits Management Program Sources Sought Notice

THIS IS A SOURCES SOURGHT 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 (RFI) VA101-11-RI-0055, VA Pharmacy Benefits Management Program Background The United States Department of Veterans Affairs (VA) 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 United States Postal Service (USPS) implementing the program on a trial basis. This contract is intended to replace the IAA and contract for direct VA Pharmacy Benefits Management Services for its workers' compensation program. Objective VA is seeking a national Pharmacy Benefits Management (PBM) organization, specializing in Federal workers' compensation, to administer the program. This will be a national program for VA 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 VA through the OWCP annual Chargeback process. Approximately 16,000 employees currently receive prescription medications monthly. These prescriptions result in approximately 88,000 prescription-related medical bills paid annually. 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 VA 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 on the job and have filed FECA claims pending adjudication by OWCP. VA 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 VA injury packet. Full prescriptions coverage will be provided to all injured employees upon filing 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 provided at zero cost to VA. 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 employees. OWCP requires a method of limiting this program to VA 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 an ICD-9 code based formulary in accordance with and as determined by OWCP. 11- Dedicated and Security-cleared customer service representatives for VA 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 240,000 employees of which about 16,000 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 drug or drug 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 VA 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 VA 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 Priscilla Lee at contact@example.gov by 3:00 PM EST March 29, 2011. Vendors are asked to confirm if they are a Service-Disabled Veterans-Owned Small Business (SDVOSB), Veterans Owned Small Business (VOSB), Women-Owned Small Business or a Small Business. Also, vendors are asked to confirm if they have a GSA Federal Supply Schedule contract.