Third Party Administrator (TPA) for the Medicare Part D

This is a SOURCES SOUGHT NOTICE issued for the purpose of planning and market research. This is NOT a solicitation for proposals, proposal abstracts, or quotations and does not obligate the Centers for Medicare & Medicaid Service (CMS) to award a contract. The purpose of this notice is to obtain information regarding the availability and capability of qualified small businesses only (including 8(a), service-disabled veteran owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business, and women-owned small business) that can provide the requisite IT and non-IT services solution in support of the CMS requirements. These services include, but are not limited to, the development, testing, implementation, operation, maintenance, and customer service necessary to meet the needs of CMS, pharmaceutical manufacturers, Part D sponsors, and contracted CMS personnel involved with the operation and administration of the Medicare Part D Coverage Gap Discount Program (CGDP), in accordance with the provisions of the legislation listed in this notice. Prior to engaging in procurement activity to acquire a Third Party Administrator (TPA) contractor for the Medicare Part D CGDP, the CMS is issuing this Sources Sought Notice. The potential small businesses will need to demonstrate the ability to provide the services defined in this notice under Requirements. REQUIREMENTS 1. The contractor shall have the necessary infrastructure support to effectively interface with all stakeholders. This includes CMS, pharmaceutical manufacturers, Part D sponsors, and contracted CMS personnel involved with the operation and administration of the Medicare Coverage Gap Discount Program. 2. The work that will be addressed under the future contract will require the contractor to have advanced knowledge of the Medicare Part D program, Coverage Gap Discount Program, Prescription Drug Event (PDE) file data, and be able to develop and maintain a transparent electronic, web based, financial automated clearing house (ACH) payment process system that is fully operational to meet the CMS Part D Coverage Gap Discount Program scheduled operations deadlines. 3. The contractor shall have the capabilities and infrastructure sufficient to meet all CMS IT Systems Security compliance requirements including, but not limited to, experience with ARS Controls, ACT, FISMA, A-123, CFO, OIG, and GAO audits and to comply with National Automated Clearing House Association (Nacha) guidelines. 4. The contractor shall have the ability to communicate timely, accurately and reliably, both internally and externally, to ensure open and effective dissemination and coordination of information to all affected parties involved in the Discount Program operations. These parties include, but are not limited to: CMS staff, pharmaceutical manufacturers and their third party vendors, Part D sponsors, CGDP program auditors, the Drug Data Processing System (DDPS) contractor, and other CMS data analysis contractors, as applicable. 5. The TPA shall serve as the single point of contact for all pharmaceutical manufacturer and Part D sponsor plan questions concerning TPA functions, invoices, disputes, audits and data associated with the CGDP. The contractor shall facilitate payment between parties to ensure invoiced amounts are paid. The contractor shall respond to pharmaceutical manufacturer and Part D sponsor telephone, written, and e-mail inquiries regarding third party administrator transactions or transaction processing requirements and provide answers, recommended remedies and/or appropriate system intervention. 6. The TPA contractor shall provide the physical facilities, technology, customer contact and data analysis staff and the IT and management personnel to operate and manage a customer service and support operation center that receives inquiries from pharmaceutical manufacturers and Part D sponsors. The contractor shall provide expert Medicare Customer Service Representatives (CSRs) during all hours of operation, sufficient to handle projected volumes of telephone, e-mail, and written correspondence. 7. The contractor shall maintain ongoing communication with all CGDP participants to ensure proper coordination of activities and dissemination of relevant CGDP information. Communication may include List Serve email broadcasts, targeted telephone and email communication and other outreach projects as required. To aid in the process of communication with manufacturers and plan sponsors, the contractor shall participate in training webinars as requested by CMS. The contractor shall take a leadership role in the development and presentation of training webinars and their content. THIS IS STRICTLY MARKET RESEARCH. CMS WILL NOT ENTERTAIN QUESTIONS REGARDING THE RESULTS OF THIS MARKET RESEARCH.