SECTION I: INTRODUCTION - New Hampshire



21945606032500State of New HampshireREQUEST FOR PROPOSALForPHARMACY BENEFIT MANAGEMENT SERVICESRFP # 2018-203RESPONSE DUE BY:January 19, 2018 at 2:00 PM Eastern Time (ET)Department of Administrative ServicesRisk Management UnitTable of Contents TOC \h \z \t "Heading 1,1,Heading 2,2" SECTION I: INTRODUCTION PAGEREF _Toc501031940 \h 4A.Background PAGEREF _Toc501031941 \h 4B.Objective PAGEREF _Toc501031942 \h 4SECTION II: BIDDING INSTRUCTIONS AND CONDITIONS PAGEREF _Toc501031943 \h 7A.Proposal Conditions for The State of New Hampshire, Department of Administrative Services, Risk Management Unit PAGEREF _Toc501031944 \h 7B.Estimated RFP Timetable PAGEREF _Toc501031945 \h 12C.Evaluation Process PAGEREF _Toc501031946 \h 12D.Subcontracting PAGEREF _Toc501031947 \h 16E.Vendor Contacts PAGEREF _Toc501031948 \h 16SECTION III: REQUIRED PLAN DESIGNS, SERVICES AND PROGRAMS PAGEREF _Toc501031949 \h 17A.Plan Design PAGEREF _Toc501031950 \h 17B.General Services PAGEREF _Toc501031951 \h 17C.Clinical and Other Programs PAGEREF _Toc501031952 \h 20D.Implementation PAGEREF _Toc501031953 \h 23SECTION IV: REQUESTED CONTRACTUAL TERMS PAGEREF _Toc501031954 \h 24SECTION V: FINANCIAL PAGEREF _Toc501031955 \h 35SECTION VI: PERFORMANCE GUARANTEES PAGEREF _Toc501031956 \h 46SECTION VII: REQUIRED PROTECTION OF CONFIDENTIAL INFORMATION AND DATA SECURITY PAGEREF _Toc501031957 \h 52SECTION VIII: TECHNICAL QUESTIONNAIRE PAGEREF _Toc501031958 \h ANIZATIONAL STABILITY & EXPERIENCE PAGEREF _Toc501031959 \h 55B.ADMINISTRATIVE, MEMBER & CLAIM PAYING SERVICES PAGEREF _Toc501031960 \h 56C.REPORTING, IT & DATA INTEGRATION PAGEREF _Toc501031961 \h 59D.FORMULARY MANAGEMENT & REBATES PAGEREF _Toc501031962 \h 60E.DRUG UTILIZATION REVIEW PAGEREF _Toc501031963 \h WORK MANAGEMENT & QUALITY ASSESSMENT PAGEREF _Toc501031964 \h 64G.MAIL ORDER PAGEREF _Toc501031965 \h 65H.SPECIALTY PHARMACY PROGRAM PAGEREF _Toc501031966 \h 66I.MEDICARE PART D EGWP PROGRAM PAGEREF _Toc501031967 \h 67SECTION IX: NETWORK DISRUPTION PAGEREF _Toc501031968 \h 70SECTION X: CLIENT REFERENCES PAGEREF _Toc501031969 \h 71APPENDICES: GROUP INFORMATION PAGEREF _Toc501031970 \h 72APPENDIX A PAGEREF _Toc501031971 \h 73APPENDIX B PAGEREF _Toc501031972 \h 74APPENDIX C PAGEREF _Toc501031973 \h 75APPENDIX D PAGEREF _Toc501031974 \h 76APPENDIX E PAGEREF _Toc501031975 \h 77APPENDIX F PAGEREF _Toc501031976 \h 78APPENDIX G PAGEREF _Toc501031977 \h 83APPENDIX H PAGEREF _Toc501031978 \h 91SECTION I: INTRODUCTIONThis Request for Proposal (“RFP”) is issued by the Department of Administrative Services, acting through the Risk Management Unit, for a contract for pharmacy benefits manager (PBM) services as described herein.BackgroundThe State of New Hampshire (“State”) provides prescription drug benefits through its Employee and Retiree Health Benefit Plan (HBP) for approximately 37,100 covered lives. The covered population consists of approximately 24,700 active employees/dependents located throughout the country although primarily in New Hampshire. . Included in the active enrollment is a “Special Group” of approximately 300 subscribers and their dependents from other organizations that have been either legislatively or traditionally offered coverage under the State’s HBP. In addition, the State provides prescription drug benefits to approximately 2,800 non-Medicare retirees/dependents and to 9,600 Medicare retirees. Retirees are located throughout the country as well. The chart below outlines the October 2017 enrollment by population and type of plan:SubscribersDependentsTotal MembersActive Plan9,78414,94424,728Non-Medicare Retiree Plan2,1136842,797Medicare Retiree Plan9,566N/A9,566Total All Plans21,46315,62837,091Express Scripts, Inc. has been the State’s PBM since January 1, 2014 and transitioned the Medicare population to an EGWP effective January 1, 2015.Every two years, the State collectively bargains employee health benefits, including plan design, health promotion programs and employee-facing initiatives, with the State’s unions. There are five unions represented including the New Hampshire State Employees’ Association of New Hampshire, SEIU 1984 (SEA), the New Hampshire Trooper’s Association (NHTA), NHTA – Command Staff, Teamsters Local 633 and the New England Police Benevolent Association (NEPBA) with multiple Locals. At this time, all unions have agreed to the same Active Plan design and programs. The legislature has exclusive authority to change retiree health benefits for both the Non-Medicare and Medicare State of New Hampshire Retiree Plans. Plan design changes for the Non-Medicare Plan can be implemented mid-year. Plan design changes for the Medicare Plan (EGWP) are subject to CMS requirements for notification of change. Currently, the Non-Medicare and Medicare Plans have similar plan designs.ObjectiveThe State is seeking proposals to provide PBM services for its Employee and Retiree Health Benefit Plan (HBP), including the services and programs described in Section III of this document. As mentioned above, all unions have independently agreed to the same Active Plan design and programs. Due to the existence of collective bargaining agreements (for the Active Plan) and required legislative authorization (for the Retiree Plans), the State requires vendors to duplicate the current Active and Retiree Plans’ copayments, maximum out-of-pockets, retail (31-day) and mail (90-day) supply limits, and mandatory mail order (with opt-out). The State also requires vendors to offer clinical and other programs similar to those outlined within Section III. The State must be notified of any deviations from the current clinical and other programs. If no deviations from the current clinical and other programs are identified within your response, the State will assume the prescription drug plan can be duplicated exactly. It is important to note that the State is currently participating in collective bargaining and negotiations with all of the unions. The PBM is expected to implement changes if and when negotiated. The State’s contract with a PBM requires the PBM implement any changes in plan design or coverage to the Active Plan resulting from collective bargaining throughout the term of the contract. In addition, the PBM shall provide financial modeling to assist the State with consideration of plan changes. It is possible for the State to be required to manage multiple plan designs to comply with each of the collectively bargained units. The State reserves the right within any contract awarded under this RFP to re-negotiate elements of the contract as required under collective bargaining agreements. The State’s contract with a PBM requires the PBM to implement any changes in plan design or coverage to the Retiree Plans resulting from legislative authorization throughout the term of the contract. The PBM shall provide financial modeling to assist the State with consideration of plan changes. The State reserves the right within any contract awarded under this RFP to re-negotiate elements of the contract as required by legislative changes.It is essential that the Vendor “duplicate” plan design, and provide similarity in cost management and clinical programs, services and access to plan members. See Section III and Appendix A for details about plan design, services, and programs for both the Active and Retiree Plans. The following is an excerpt from the 2015 – 2017 collective bargaining agreements pertaining to pharmacy benefits for the Active Plan. The current collective bargaining agreements authorize:Prescription Drugs – The prescription drug plan shall include the following:Mandatory Mail Order for Maintenance Drugs after three (3) retail purchases per prescription, with employee opt-out.Mandatory Generic Substitution with DAW 2 (i.e., the only exception is physician ordered “Dispense as Written”)Co-payments:Retail Co-payments - $10 for each generic medicine/ $25 for each preferred brand name medicine/$40 for each non-preferred brand name medicine.Mail Order Co Payments - $1 for each generic medicine/ $40 for each preferred brand name medicine/$70 for each non-preferred brand name medicine.Exclusive Specialty PharmacyTraditional Generic Step TherapyQuantity LimitsPharmacy AdvisorMaximum out of pocket expenses shall be $750.00 per individual per calendar year and $1,500.00 per family per calendar year.Contract Length & SpecificsThe State seeks to contract with a qualified Vendor commencing upon approval from the Governor and Executive Council and ending on December 31, 2021 with the option to extend for up to two additional years as mutually agreed and approved by the Governor and Executive Council. The administrative services outlined in this RFP shall commence on January 1, 2019. Implementation activities shall commence within seven days of Governor and Executive Council (G&C) approval but in no event earlier than July 1, 2018. Payments for contractual services shall commence January 1, 2019 and shall not be made during the implementation period. SECTION II: BIDDING INSTRUCTIONS AND CONDITIONSProposal Conditions for The State of New Hampshire, Department of Administrative Services, Risk Management UnitRFP ScopeThe Department of Administrative Services, Risk Management Unit, is soliciting proposals for Pharmacy Benefit Management (PBM) Services as described in these procurement documents.Mandatory Instructions for VendorsIt is required that you complete all sections of the RFP and provide your proposal by the stated proposal submission deadline. Do not alter any parts of this RFP, to include the questions and the question numbering. Failure to follow these instructions may be grounds for rejection of your RFP response.Point of ContactPurchasing Agent, Danielle Bishop, or her designee, shall be the single point of contact for this RFP, whether verbal or written. RFP InquiriesThe State will host an Instructions and Conditions conference call on December 14, 2017 at 3pm (Call-in number 1-415-655-0001, access code 738 430 249). The purpose of the call is to answer any procedural questions related to submitting a bid. Questions related to specifications contained herein or the services requested will not be addressed during this call.All technical questions regarding this RFP, including questions related to the form contract P-37, must be submitted to Danielle Bishop at Danielle.Bishop@. All questions must be submitted in writing prior to the deadline for Vendor Inquiries and/or Requests for Clarification deadline of December 22, 2017 at 3:00PM ET. The questions will be consolidated and/or paraphrased and responded to via a written addendum, or addenda that will be posted online on or before January 5, 2018.The Vendor must include complete contact information including the Vendor’s name, telephone number, and e-mail address. The State shall attempt to provide any assistance or additional information of a reasonable nature, which might be required by interested Vendors. RFP inquiries must be submitted by an individual authorized to commit the organization to provide the services necessary to meet the requirements of this RFP.Appendix H is a Data Request Form which must be completed and emailed to Danielle.Bishop@ to obtain data referred to in Appendices B and C.AddendaIn the event it becomes necessary to add to or revise any part of this RFP prior to the scheduled proposal submittal deadline, the Risk Management Unit shall post any Addenda on the State’s vendor website. Before your submission and periodically prior to the RFP closing, check the website for any addenda or other materials that may have been issued affecting the RFP. The web site address is . VENDOR CertificationsAll Vendors must be duly registered as a vendor authorized to conduct business in the State of New Hampshire. Vendors shall comply with the certifications below at the time of submission and through the term of any contract which results from said proposal. Failure to comply shall be grounds for disqualification of proposal and/or the termination of any resultant contract. STATE OF NEW HAMPSHIRE VENDOR APPLICATION: Prior to bid award, Vendors must have a completed Vendor Application Package on file with the NH Bureau of Purchase and Property. See the following website for information on obtaining and filing the required forms (no fee): NEW HAMPSHIRE SECRETARY OF STATE REGISTRATION:?? A bid award, in the form of a contract(s), will ONLY be awarded to a Vendor who is registered to do business AND in good standing with the State of New Hampshire.? Please visit the following website to find out more about the requirements for registration with the NH Secretary of State: CONFIDENTIALITY & CRIMINAL RECORD: If Applicable, by the using agency, the Vendor shall have signed by each of employees or its approved sub-contractor(s), if any, working in the office or externally with the State of New Hampshire records a Confidentiality form and Criminal Record Authorization Form. These forms shall be returned to the individual using agency prior to the start of any work.PUBLIC DISCLOSUREIntroduction Pursuant to RSA 21-G:37, all responses to this RFP shall be considered confidential until the award of a contract. At the time of receipt of proposals, the Agency will post the number of responses received with no further information. No later than five (5) business days prior to submission of a contract to Governor & Executive Council pursuant to this RFP, the Agency will post the name, rank or score of each Vendor. The State of New Hampshire has made it a priority through the Right-to-Know law (RSA 91-A), the TransparentNH initiative, and other statutes and practices to ensure that government activity is open and transparent. In general, these requirements allow for public review, disclosure and posting of government and public records. As such, the State is obligated to make public the information submitted in response to this RFP, any resulting contract, and information provided during the contractual relationship. The Right-to-Know law obligates the State to conduct an independent analysis of the confidentiality of the information submitted, regardless of whether it is marked confidential.In addition, the Governor and Executive Council (G&C) contract approval process more specifically requires that pricing be made public and that any contract reaching the G&C agenda for approval be posted online.Disclosure of Information Submitted in Response to RFPInformation submitted in response to this request for proposal (RFP) is subject to public disclosure under the Right-to-Know law after a contract is actually awarded by G&C. Notwithstanding the Right-to-Know law, no information concerning the contracting process, including but not limited to information related to proposals, communications between the parties or contract negotiations, shall be available until a contract is actually awarded by G&C. Confidential, commercial or financial information may be exempt from public disclosure under RSA 91-A:5, IV. If you believe any information submitted in response to this request for proposal should be kept confidential, you must specifically identify that information where it appears in your submission in a manner that draws attention to the designation. You must also provide a letter to the person listed as the point of contact for this RFP, identifying the specific page number and section of the information you consider to be confidential, commercial or financial and providing your rationale for each designation. Marking or designating an entire proposal, attachment or section as confidential shall neither be accepted nor honored by the State.Pricing and other information that relates to your contractual obligations in your proposal or any subsequently awarded contract shall be subject to public disclosure regardless of whether it is marked as confidential.Notwithstanding a Vendor’s designations, the State is obligated by the Right-to-Know law to conduct an independent analysis of the confidentiality of the information submitted in a proposal. If a request is made to the State by any person or entity to view or receive copies of any portion of your proposal, the State shall first assess what information it is obligated to release. It will then notify you that a request has been made, indicate what, if any, information the State has assessed is confidential and will not be released, and specify the planned release date of the remaining portions of the proposal. To halt the release of information by the State, a Vendor must obtain and provide to the State, prior to the date specified in the notice, a court order valid and enforceable in the State of New Hampshire, at its sole expense, enjoining the release of the requested information.By submitting a proposal, you acknowledge and agree that:The State may disclose any and all portions of the proposal or related materials which are not marked as confidential and/or which have not been specifically explained in the letter to the person identified as the point of contact for this RFP; The State is not obligated to comply with your designations regarding confidentiality and must conduct an independent analysis to assess the confidentiality of the information submitted in your proposal; and The State may, unless otherwise prohibited by court order, release the information on the date specified in the notice described above without any liability to you. Bidder(s) may submit a redacted copy of their RFP in accordance with this section. This redacted copy shall be subject to review and analysis as referenced above.Electronic Posting of Resulting ContractRSA 91-A obligates disclosure of contracts resulting from responses to RFPs. As such, the Secretary of State provides to the public any document submitted to G&C for approval, and posts those documents, including the contract, on its website. Further, RSA 9-F:1 requires that contracts stemming from RFPs be posted online. By submitting a proposal you acknowledge and agree that, in accordance with the above mentioned statutes and policies, (and regardless of whether any specific request is made to view any document relating to this RFP), any contract resulting from this RFP will be made accessible to the public online via the State’s website without any redaction whatsoever. Terms of SubmissionThe State assumes no responsibility for understandings or representations concerning conditions made by its officers or employees prior to and in the event of the execution of a contract, unless such understanding or representations are specifically incorporated into this RFP. Verbal discussions pertaining to modifications or clarifications of this RFP shall not be considered part of this RFP unless confirmed in writing. Any information provided by the Vendor verbally shall not be considered part of that Vendor’s response. By submitting a Proposal, a Vendor agrees that in no event shall the Agency be either responsible for or held liable for any costs incurred by a Vendor in the preparation of or in connection with the Proposal, or for Work performed prior to the Effective Date of a resulting Contract.SUBMISSION FORMATInstructions, formats, and approaches for the development of RFP information contained within the RFP are designed to ensure that the submission of data essential to the understanding of the Vendor’s response is received in a consistent and comparable format. Your RFP response must be clearly sectioned and tabbed as outlined within this RFP document. (e.g. Section II. Step 1, Step 2, etc.) There is no intent to limit the content of the responses in other than the Vendor’s favor, only to assist the evaluation committee in reviewing each response. PROPOSAL SUBMISSION DEADLINEAll RFP submissions must be received at the Bureau of Purchase and Property no later than 2:00 PM ET on Friday, January 19, 2018. Submissions received after the date and time specified will be marked as late and will not be considered. All offers shall remain valid from the proposal submission deadline until the contract award. A Vendor’s disclosure or distribution of proposals other than to the Department of Administrative Services, Bureau of Purchase and Property, shall be grounds for disqualification. No more than one (1) proposal per respondent shall be submitted. Vendors shall submit their proposal to:State of New Hampshire C/O Danielle Bishop, Administrative ServicesNew Hampshire Bureau of Purchase and Property25 Capitol StreetConcord, NH 03301-6312(603) 271-3290Proposal responses shall be marked as: State of New Hampshire, RFP # 2018-203Due Date: January 19, 2018 @ 2:00 PM ETAdministration of Medical BenefitsRFP DELIVERYYour RFP response must conform to the following criteria in order to be considered for evaluation:RFP submissions shall be hard copies.RFP responses shall be addressed as described in Item 10 above Exterior of the package shall be permanently marked identifying the submitting party’s name and address. Package shall be sealed (tape, glue etc.). RFP submissions may be hand delivered, mailed, or sent via package delivery service (UPS, FedEx, courier). In all cases, the Bureau of Purchase and Property must receive your submission no later than the due date and time.Vendors are encouraged to confirm delivery of their submissions by calling 603-271-2201 or by emailing prchweb@.RFP responses must include:One (1) original (clearly identified as such) of your RFP responses to Sections II to X, including Appendix C (Enrollment and Top 100 Brand workbook file), Appendix D (Plan Deviations Form), and any Addenda in numerical sequence and signed; Eight (8) conforming copies (clearly identified as a copy) of your RFP responses; One (1) redacted copy of your RFP response, including a letter identifying confidential information, as referenced in 7.b. above; andTwo (2) electronic* copies of your RFP responses on secure thumb drives.?The two (2) electronic copies of your RFP shall include responses to all questions in Sections II to X of this RFP document in MS Word format. DO NOT PDF your response.The two (2) electronic copies of your RFP shall also include the Appendix C “Enrollment and Top 100 Brand” workbook file in MS Excel format. DO NOT PDF your response.The original RFP response must include Appendix E, State of NH Transmittal Letter, signed by a person authorized to bind the company to all commitments made in the RFP response. Failure to submit the Transmittal Letter with your response will result in rejection of your response.RFP responses transmitted by facsimile or e-mail shall not be accepted or reviewed.* In the event of a discrepancy between a proposal response received in paper and electronic copy, the paper copy identified as the ‘original’ shall prevail.The State shall not be held liable for any costs incurred by the Vendor in preparing or submitting an RFP response. Any and all damage, which may occur due to shipping, is the Vendor’s responsibility. ADDITIONAL INFORMATIONThe State reserves the right to:Make a request for additional information in writing from a Vendor to assist in understanding or clarifying a proposal response;Waive minor or immaterial deviations from the RFP requirements, if determined to be in the best interest of the State; Omit any planned evaluation step if, in the Agency’s view, the step is not needed;Reject any and all proposals, or any part thereof. RIGHT TO CONSIDER AVAILABLE INFORMATIONThe State reserves the right to consider available information regarding the Vendor, whether gained from the Vendor’s proposal, question and answer conferences, references, or any other source during the evaluation process. This may include, but is not limited to, information from the New Hampshire Department of Insurance, as well as any other state or federal regulatory entity.RESTRICTION OF CONTACT WITH STATE EMPLOYEESFrom the release date of this RFP, all contact with personnel employed by or under contract with the State related to this RFP, except the point of contact specifically mentioned in this Section II, Item 3 of this RFP, is prohibited. Improper contact is grounds for rejection of your response.CANCELLATIONThe State reserves the right to cancel all or any part of this RFP at any time. Cancellation of this RFP, in whole or in part, shall not bar the State from issuing an RFP for the same services or from purchasing the same services through other means.ETHICAL REQUIREMENTSFrom the time this RFP is published until a contract is awarded, no Vendor shall offer or give, directly or indirectly, any gift, expense reimbursement, or honorarium, as defined by RSA 15-B, to any elected official, public official, public employee, constitutional official, or family member of any such official or employee who will or has selected, evaluated, or awarded an RFP, or similar submission. Any Vendor that violates RSA 21-G:38 shall be subject to prosecution for an offense under RSA 640:2. Any Vendor who has been convicted of an offense based on conduct in violation of this section, which has not been annulled, or who is subject to a pending criminal charge for such an offense, shall be disqualified from bidding on the RFP, or similar request for submission and every such Vendor shall be disqualified from bidding on any RFP or similar request for submission issued by any state agency.REQUIRED CONTRACT TERMS AND CONDITIONSThe form contract P-37 (attached hereto as Appendix F) shall form the basis for any resulting contract. The successful Vendor and the State, following notification of award, shall promptly execute the P-37 contract, as amended by the parties to incorporate the service requirements of this RFP, price conditions established by the Vendor’s offer, and any other reasonable administrative practices and services. The form contract Business Associate Agreement (attached hereto as Appendix G), is required to comply with the Health Insurance Portability and Accountability Act, Public Law 104-191 and with the Standards for Privacy and Security of Individually Identifiable Health Information, 45 CFR Parts 160 and 164 and those parts of the HITECH Act applicable to business associates,?shall be promptly executed by the?successful Vendor?and State, following notification of contract award.Estimated RFP TimetableActionDue Date (Eastern Time)RFP ReleasedDecember 8, 2017Vendor Conference Call for Procedural QuestionsDecember 14, 20173:00 PM ETCall-In Number: 1-415-655-0001Access Code: 738 430 249Deadline for Vendor Inquiries and/or Requests for Clarification and Proposed Specification Changes December 22, 2017at 3:00 PM ETResponse to Vendor Inquiries and/or Requests for Clarification and Proposed Specification ChangesNo later than January 5, 2018Proposal Submission Deadline January 19, 2018at 2:00 PM ETContract Effective DateWednesday, July 1, 2018 or Upon Governor & Executive Council (G&C) approvalContract Implementation PeriodG&C Approval through December 31, 2018TPA Effective Date January 1, 2019Evaluation ProcessSegal Consulting has been retained by the State to assist in the evaluation of each Vendor’s responses for completeness and responsiveness to the RFP and to assist in the review of such responses. The State’s designated evaluation team will review and score Vendor responses and select the highest-ranking proposal. All proposals will be evaluated in accordance with the State procedures set forth in Steps #1 through #4 below. STEP #1: MINIMUM QUALIFICATIONSEach proposal shall be evaluated initially to determine compliance with the State of New Hampshire’s Minimum Qualifications. Any proposal that fails to meet one (1) or more of the following eight (8) qualifications shall be eliminated from further consideration for this contract. Any proposal that meets all of the minimum qualifications shall be further evaluated in accordance with the State’s selection criteria. Therefore, to receive further consideration, a proposal must check “YES” to each of the following questions and comply fully with the “Submission Requirement(s)” for each such qualification.Is the Vendor able and willing to demonstrate its financial stability?[ ] YES [ ] NOSubmission Requirements: a) Vendor’s most recent financial report; b) most recent independent auditor’s report; and c) SSAE 16, SAS-70, or equivalent external audit of Vendor’s operations. Attach to proposal.Has the Vendor provided as part of its proposal the contractual terms and fee and cost information requested in Sections IV and V?[ ] YES [ ] NOSubmission Requirements: Full and complete responses to the Section IV (Requested Contractual Terms) and Section V (Financial) of this RFP.3.Has the Vendor responded to the performance guarantees set forth in the Performance Guarantees Section VI of the RFP and placed at least $400,000 at-risk annually? [ ] YES [ ] NOSubmission Requirement: Provide an annual at-risk amount of at least $400,000 and provide a complete response to the Performance Guarantees Section VI. 4.Has the Vendor provided as part of its proposal all information requested in this RFP including all information requested in the Technical Questionnaire Section VIII?[ ] YES [ ] NOSubmission Requirements: Full and complete responses to all of the information requests made in Section VIII of this RFP.5.Has the vendor a sufficient retail network that minimizes disruption for the State’s membership? Vendor must meet the following retail network match: 95% or greater of the retail scripts dispensed to the State’s members during November 1, 2016 through October 31, 2017, must have been from pharmacies currently in vendor’s retail network. [ ] YES [ ] NOSubmission Requirement(s): A full and complete response to Section IX – Network Disruption will allow the State to confirm this minimum qualification.6.Has the Vendor provided as part of its proposal complete client reference information requested in the Client References Section X?[ ] YES [ ] NOSubmission Requirements: Full and complete responses to all of the information requested in Section X.7.Does the vendor have experience working with a minimum of five (5) states, large municipalities, or other governmental entities similar to the State? [ ] YES [ ] NOSubmission Requirement(s): Demonstrate such experience by providing the total number of public entity clients with at least 25,000 members.8.Does the vendor have experience servicing a client with at least 37,000 members with plans and services similar to those currently offered by the State? [ ] YES [ ] NOSubmission Requirement(s): Demonstrate such experience by providing the total number of clients with at least 37,000 members. If a bid includes a separate contractor (partner, subsidiary, etc.) for EGWP services, the separate contractor must also demonstrate its experience by providing its total number of clients with at least 9,000 members.STEP #2: FINANCIAL SCORING (60 Total Points)The financial proposals (Section V) will be scored based on the total projected costs (TPC) (i.e., claims and administrative costs) as determined by the State for the three-year period from January 1, 2019 to December 31, 2021. The lowest cost proposal will receive 100% of the 60 points allocated for the Financial Score. All other financial proposals will be scored on a sliding scale where the vendor’s score will be reduced by 2 points for every percentage point it is higher than the lowest cost proposal. As the scale is sliding, scores will be adjusted for partial percentage differences.The following exhibit illustrates how the financial score will be calculated from the 60 points available:FormulaExample, where:Lowest Bid TPC = $1,000 and Vendor TPC = $1,025ACost Difference= (Vendor’s TPC / Lowest Bid TPC) – 1($1,025 / $1,000) – 1 = 0.025 BConvert Decimal to Percent Value= A x 1000.025 x 100 = 2.5C2 Point Reduction per Percentage Higher= 2 x B2 x 2.5 = 5.0Vendor’s TPC Score= 60 - C60 – 5.0 = 55.0STEP #3: NON-FINANCIAL SCORING (40 Total Points)The Vendor’s response to information requested in Sections IV, VI, and VIII of the RFP will be evaluated based on the extent to which the Vendor documents conformance with specifications, as well as the completeness, soundness, and creativity of the Vendor’s response, all as evaluated by the State.The State will evaluate proposals based on technical criteria, including:Requested Contractual Terms Score – the extent to which the Vendor demonstrates a willingness to agree to the requested terms. (15 Points; Section IV)Performance Guarantees Score – the extent to which the Vendor demonstrates a willingness to agree to the requested performance guarantees and the proposed dollar amount at risk. (5 Points; Section VI)Technical Questionnaire Score – the extent to which the Vendor demonstrates itsexperience and ability to provide the requested services and reporting (5 points; Section VIII.A,B,C)ability to manage its formulary and retail and mail network pharmacies, and to provide drug utilization review (5 points; Section VIII.D,E,F,G)commitment to manage the specialty drug program and its costs (5 points; Section VIII.H)its ability to administer the Medicare Part D EGWP program (5 points; Section VIII.I)STEP #4: CONTRACT AWARDThe State shall award a contract, if at all, to the Vendor submitting the highest ranked proposal. Formal and final selection of the Vendor, however, is contingent upon the successful negotiation and the proper execution of all contract documents (acceptable to the State) and the approval of the Governor and Executive Council. If the State is unable to reach agreement with the Vendor, the State may, at its sole discretion and at any time and without liability to the Vendor, immediately terminate such contract discussions with the Vendor and undertake discussion with the Vendor submitting the next highest ranked proposal, and so on. Evaluation of the proposals shall include the criteria below. Vendors will receive scores up to the maximum points allocated to each item outlined below.CriteriaPointsSection(s)FINANCIAL*?60VRequested Contractual Terms15IVPerformance Guarantees5VITECHNICAL QUESTIONNAIRE?20?Organizational Stability & ExperienceAdministrative, Member, & Claim Paying ServicesReporting, IT, & Data Integration5?VIII.A, VIII.B and VIII.CFormulary Management & RebatesDrug Utilization ReviewNetwork Management & Quality AssessmentMail Order5?VIII.D, VIII.E, VIII.F, and VIII.G,Specialty Pharmacy Program5?VIII.HMedicare Part D – EGWP Program5VIII.ITOTAL POINTS?100?* All fees to be assumed by the State for all the requested services shall be included in the financial section of this RFP.SubcontractingSubcontracting of services shall require prior approval by the State. If your organization plans to utilize subcontractors for any portion of the services identified in this RFP, please include the subcontractor information, to include an outline of the services or functions in which you would plan to subcontract, the length of your relationship with the subcontractor, and a brief company profile. Vendor shall be accountable for the performance of all subcontractors and shall be responsible for all performance guarantee penalties (See Section VI) that may result from underperformance of the subcontractor. Vendor ContactsDesignate the individual(s) with the following responsibilities:The individual(s) representing your company during the RFP process:Representative Name:______________________ Phone #:______________ Email: ___________________The individual(s) responsible for day-to-day service (if different): Representative Name:______________________ Phone #:______________ Email: ___________________SECTION III: REQUIRED PLAN DESIGNS, SERVICES AND PROGRAMSPlan DesignDue to the existence of collective bargaining agreements and required legislative authorization, the State requires Vendors to duplicate the active and retiree plan designs.Please review the attached Summaries of Benefits in Appendix A and complete the “Plan Deviations Form” located in Appendix D. If no deviations are provided on this form, it will be assumed that your organization can administer the current plan designs exactly as written in the following attached Summary of mercial PlansSONH Rx - Active Summary.pdfSONH Rx – Non-Medicare Retiree Summary.pdfSONH Rx - Mandatory Mail Order - Opt Out.pdfMedicare PlanSONH Rx – EGWP BenefitOverview.pdfPlease see Section C below for requested clinical and cost management programs.General ServicesTo be eligible to receive a score for the Technical Questionnaire in Section VIII, Vendors are required to offer comprehensive PBM services with a full range of customer (client and member) service including, but not limited to:Indicate the name and address of the legal entity providing any of the services below, if different than the bidding entity.Claims AdjudicationMember Enrollment and Eligibility MaintenanceIntegration of PBM services with the State’s other vendors/programs (e.g., medical, wellness)Patient and Provider EducationSystematic Prospective, Concurrent and Retroactive Drug Utilization ReviewNetwork Pharmacy ManagementMail Service Pharmacy (Mandatory Mail after 3 refills, with opt-out)Exclusive Specialty Pharmacy ProgramClinical and Cost Management Programs (including, but not limited to Traditional Generic Step Therapy, Drug Quantity Limits, and Mandatory Generic Substitution with DAW2)Formulary Management and Rebate SharingData Sharing* and Reporting (standard and ad-hoc reporting)Distribution of ID CardsAccess to Pharmacy DirectoriesMember Services (including website, portal, and mobile app)Online systems for the State, and its designee(s)EGWP Administration / Subsidy Support Services* NOTE: For the purpose of this analysis, “Data Sharing” is referenced in relation to requests for data and reports from either party (the State or the selected PBM). The State currently shares data between the PBM and medical administrator, University System of New Hampshire and may, over the course of the contract term, add other vendors, including, but not limited to a data-warehousing vendor if retained by the State.The requirements set forth below shall be minimum service requirements to be provided by the successful Vendor:The State requires that the Vendor administer run-out claims for 12 months following termination of the contract. The cost of run-out administration must be included in your proposed administration fees.The State requires that Vendor agree to accept payment of claims and administrative expense invoices via Electronic Funds Transfer. The State requires a minimum of 23 group breakouts for purposes of reporting. In addition, a lesser number of COBRA breakouts will be required. The State requires that the Vendor work with the State’s eligibility systems. The State utilizes the Global Human Resources and Human Resources Management modules of the Infor/Lawson ERP (enterprise resource planning) software for human resources, benefits and payroll functions to manage the State Plan’s eligibility.The State requires that the Vendor’s system(s) shall be able to give credit for charges applied to out-of-pocket maximums that accumulated with a prior carrier.The State requires that the Vendor provide the State quarterly reports detailing plan performance and address account and member service issues, federal and state PBM and pharmacy legislation and legislative trends and development in the market. The State requires that the Vendor attend a mid-year and annual plan performance review for each plan year in person. Additionally, the State requires an annual performance or “stewardship” meeting within 90 days after contract year-end at which time the Contractor will, as directed by the State, summarize activities and performance for the year ended.The State requires the assignment of a dedicated Account Executive and Clinical Account Executive. Both shall be accountable to the State for proactive management of all aspects of the Vendor’s performance to the State and its members. The Account Executive and Clinical Account Executive shall remain constant, within the Contractor’s control, for at least the first 18 months of the contact period. The Vendor shall not change assignment of the Account Executive and Clinical Account Executive without written notice provided to the State with a minimum of fourteen (14) days prior to such change. The State reserves the right to request assignment of a new Account Executive and/or Clinical Account Executive and the Vendor shall make such change within 30 days of receipt of written notice from the State. The State requires the Vendor to attend annual open enrollment meetings as needed. Currently the State requests that the PBM attend only one annual enrollment meeting. The Vendor shall attend other meetings as required by the State. The State expects the Vendor to have the ability to produce ID cards and/or temporary proof of benefit letters in “real time”.The State requires that the Vendor provide a designated customer service toll-free phone number to be answered by a live person in the United States. The State requires 24/7 customer services hours.The State requires that the Vendor provide automated services, which are available 24/7.The State requires the Vendor provide members access to EOB statements at no cost to the State.The State requires that the Vendor have the ability to have an independent audit performed of your claim operation at no cost to the State. The State requires that Vendors guarantee adherence to New Hampshire RSA 420-J:8-a regarding prompt pay. The law mandates timeframes for all claims [15 days electronic, 30 days paper claims, overdue (interest payment required if timeframes are not met), denied and pended (inform providers within 15 days (electronic claims) or 30 days (paper claims) and adjudicate with 45 days of receipt of additional]. The State requires you provide dedicated staff in the following specialties:Implementation ManagerAccount ExecutivePharmacist Account ExecutiveAccount ManagerFinancial AnalystCustomer Service ManagerClinical and Other ProgramsThe State requires that the Vendor administer the following programs. Any additional fees associated with these programs must be provided in your response to the Financial Section of this document. The Vendor is also required to outline EGWP clinical utilization management programs separately from the commercial programs.Confirm that you are proposing to administer the State’s clinical and other programs as outlined in the following charts. Please specify if any additional fees apply in your response below and in your response to the Financial Section of this document.DIRECTED GENERICVENDOR RESPONSEWhen a generic equivalent is available but the pharmacy dispenses the brand-name medication for any reason other than a doctor’s “dispense as written” or equivalent instructions, the member pays the generic copayment plus the difference in cost between the brand-name and generic.CLINICAL PROGRAMSVENDOR RESPONSEPrior AuthorizationSee prior authorization lists included in files provided in Appendix A Active Plan“SONH Rx - Active Summary.pdf”“SONH Rx - Active Booklet.pdf”Non-Medicare Retiree Plan“SONH Rx – Non-Medicare Retiree Summary.pdf”“SONH Rx – Non-Medicare Retiree Booklet.pdf”Traditional Generic Step TherapyApplies edits to drugs in specific therapeutic classes at the point of sale.Coverage for back-up therapies (second/third step) is determined at the patient level based on the presence or absence of front-line drugs or other automated factors in the patient’s claims history.Systems support automatic concurrent review of patients’ claims profile for use of front-line alternativesOnly claims for patients whose histories do not show use of first-step products are rejected for payment at the point of sale.Drug Quantity Management/Limits ProgramManages prescription costs by ensuring that the quantity of units supplied for each copayment are consistent with clinical dosing guidelines.Designed to support safe, effective, and economic use of drugs while giving patients access to quality care.Clinicians maintain a list of quantity limit drugs, which is based upon manufacturer-recommended guidelines and medical literature.Online edits help make sure optimal quantities of medication are dispensed per copayment and per days’ supply.Cholesterol ProgramTargets PCSK9 inhibitorsPrior authorizationSpecialist pharmacist support and patient engagementTotal cost guaranteeDiabetes ProgramTotal cost guaranteePreferred pharmacy network for 90-day supplyResources and support centerHepatitis ProgramSpecialized through exclusive specialty pharmacyPrior Authorization Compound Management Solution Morphine Milligram Equivalent DosingProvide other clinical utilization management programs that you offer that could assist the State with managing drug trend.drug utilization review (dur) PROGRAMSVENDOR RESPONSEAlerts to physicians and pharmacists:Severe drug interactionsDrug interactionDrug allergyDrug diseaseTherapy duplicationExcessive daily dosingExcessive duration of therapySub-therapeutic dosingGeneral contraindicationsRefill-too-soonRefill-too-latePotential drug name confusionAlerts for special populationsSeniors (Excessive daily dosing, Drug age contraindications, Drug disease, Drug interactions)Pediatrics (Drug age contraindications, Excessive daily dosing)Women’s health (Drug pregnancy, Oral contraceptives, Fertility agents)Cancer patients (Lethal course of chemotherapy)Therapeutic Intervention ProgramVENDOR RESPONSEIntervention when prescriptions written for non-formulary products pass program-specific screening criteria. The prescriber is contacted (via phone or fax) and PBM submits a request to use the Drug List product. If the prescriber agrees to use the Drug List alternate, it is dispensed to the plan participant replacing the original, non-formulary product. A letter explaining that the plan participant's physician was contacted will accompany the Drug List medication when shipped. Additional "value-added" materials, offering educational information on the Drug List product, are sent to the plan participant.PBM provides physicians with a toll-free number that will connect them directly to a registered pharmacist who is available to answer any questions regarding PBM's Drug List. ImplementationImplementation activities shall commence after Governor and Executive Council (G&C) approval but in no event earlier than July 1, 2018. The Vendor shall provide a preliminary implementation plan and timeline for commercial and EGWP in its bid and identify its implementation team members, as well as the State resources required for the implementation. The timeline shall include a pre-implementation readiness audit to be performed by the State’s designee (See Section V for the requested allowance.) No later than one week after Governor & Executive Council approval, the Vendor shall submit a more detailed implementation plan and timeline for the commercial and EGWP plans to meet the State’s needs and subject to the State’s approval that will include but not be limited to the following:Key implementation team member(s), including their contact information. Must include a dedicated EGWP implementation lead.Development of eligibility and enrollment interface between Vendor and State system, including all special campaigns per the collective bargaining agreements Import and testing of existing enrollment data from State and current Medical TPA, as neededSuccessful test of claims adjudicationReceive at least 12 months of claims history, including open refill file for mail claims and current plan overridesTesting of Rx data transfer from the State’s current PBMDevelopment of process for ongoing data transfer between the State’s claims data management system (when determined and in place) and the VendorEstablish process for data and reporting access by the StateDevelopment of a Comprehensive Communication plan with defined targeted audiences to include but not be limited to DAS, employees, retirees, state agencies, providers and other plan participants Support of the State’s October/November 2018 Open Enrollment for 2019 Plan YearInclude examples of proposed employee communications newsletters, posters, etc.Delivery of prescription drug benefit program information and ID cards to plan participants prior to 1/1/2019Access to the Vendor’s online client and member portals as directed by the State The project plan shall be updated thereafter as the State and Vendor mutually agree. Implementation activities shall be conducted in close collaboration and with the approval of the DAS. SECTION IV: REQUESTED CONTRACTUAL TERMSThe State requests the following contractual terms. You are required to respond to each contractual term and indicate your organization’s willingness to comply by having an authorized representative of your organization provide his/her initials next to each contractual term. Electronic initials shall be accepted. Any requests for changes to the Requested Contractual Terms shall be part of this proposal and the basis for contract discussions. Your response to this Section is mandatory. Any requested contractual term left unanswered shall be considered a no response.IMPORTANT NOTE: The items identified with a “+” are preferred by the State. If a vendor does not agree to provide the preferred contractual terms, it will be adversely reflected in their score. These are item numbers: 6,12b-f, 13a-k, 14, 26, 28, 30, 31, 33, 38, 39, 40, 44, and 54.GENERAL TERMSYESNOPBM agrees to a three-year contract term (plus implementation months) that may be renewed for up to two additional years upon terms and conditions as the parties may mutually agree and upon the approval of the Governor and Executive Council. PBM agrees to a mid-contract term market check, that may start as soon as the second quarter of the second contract year, conducted by an independent third party (of the State’s choosing) to ensure the State is receiving appropriate current pricing terms competitive with the industry (as compared to other PBMs) based on its volume and membership, and will improve pricing in the event that the State’s contract terms are less than current. The State will have the right to terminate without penalty if the pricing terms are not industry competitive.PBM agrees to implement new pricing within 90 days of completion of the market check or signature of contract. Acceptance of the new pricing will apply for the remainder of the Initial Term and will NOT result in extension of the contract, unless requested by the State. The financial guarantees for any partial contractual year that results from the implementation of new pricing will still be guaranteed, reconciled and the PBM will still make payments for any shortfalls for those partial contractual years with less than 12 months and those contractual years with over 12 months.PBM contract will provide 120-days advance notice of renewal rates, which shall then be subject to negotiation and written agreement between the parties. PBM agrees to provide a signature ready (meaning non-executed) contract incorporating all agreed upon provisions within this RFP including, but not limited to the form contract P-37 (attached hereto as Appendix F). The contract document will be submitted along with the proposal response. Following notification, the parties shall negotiate any outstanding provisions or changes to the proposed provisions and incorporate them accordingly into the referenced Exhibits A, B and C (Scope of Services, (“Services”), Contract Price/Price Limitation/Payment, and Special Provisions) as outlined in the form P-37.+PBM agrees to mid-year and annual face-to-face meetings with the State to discuss plan performance, present utilization and financial results, etc. at PBM’s expense and provide quarterly reports electronically. At a minimum, the State expects that the Account Executive and the Pharmacist Account Executive attend these meetings.PBM agrees to implement eligibility updates within 24 hours of receipt.PBM agrees to provide biweekly (every 2 weeks) and/or monthly data transmissions (may include feeds to data warehouses) to at least 5 chosen vendors at no charge, and four full, annual electronic claims files, in NCPDP format, at NO charge. PBM will also interact/exchange data with all vendors as needed at no additional charge.The State will have the ability to adjust “refill-too-soon” limits at both retail and mail without any modifications to the guaranteed pricing. Please note: The State currently wishes to maintain the current refill limits of 75% for all medications and 90% for opioids.PBM agrees that all future edits required as a result of plan design changes implemented by the State or its designee, and uploads therefore, shall be completed, after testing, by the PBM within 30 days of request/advisory by the State or its designee.PBM agrees to provide detailed test claim samples/testing reports to insure accurate claims processing when plan changes are implemented.CONTRACT DEFINITIONSYESNOContract DefinitionsHybrid Transparent – PBM agrees to pay participating pharmacies at the PBM’s contracted rate. In the event that the amount paid to the participating pharmacy does not equal the amount invoiced the State, the PBM may retain the difference. The PBM agrees to pass through 100% of ALL rebate revenue earned and will not charge an administrative fee for this arrangement. The PBM also agrees to disclose details of all programs and services generating financial remuneration from outside entities.+Rebates – Compensation or remuneration of any kind received or recovered from a pharmaceutical manufacturer attributable to the purchase or utilization of generic, brand, and specialty covered drugs by eligible persons, including, but not limited to, market share incentives; promotional allowances; commissions; educational grants; market share of utilization; drug pull-through programs; implementation allowances; clinical detailing; rebate submission fees; and administrative or management fees. Rebates also include any fees that the PBM receives from a pharmaceutical manufacturer for administrative costs, formulary placement, and/or access.+AWP (Average Wholesale Price) – AWP will be based on date sensitive (i.e., point of sale), 11-digit NDC as supplied by a nationally recognized pricing source (e.g., MediSpan) for retail, mail order, and specialty adjudicated claims.+Member Copay - Members will pay the lowest of the following: plan copay, plan-negotiated discounted price, usual and customary (U&C), MAC (maximum allowable cost) or retail cash price. Excess copayment retention is not permitted.+Paid Claims - Defined as all transactions made on eligible members that result in a payment to pharmacies or members from the State or State member copays. (Does not include reversals and adjustments.) Each unique prescription that results in payment shall be calculated separately as a paid claim.+Member - All eligible employees, retirees, and their eligible dependents enrolled under the State prescription benefit program.State eligibility and claim data - All eligibility and claims records are the sole property of the State, and must be made available upon request to the State and its representatives. Selling of the State’s data to ANY outside entities must be approved in advance, reported on a monthly basis and all income derived must be disclosed and shared per agreement with the State. Even if PBM has not "sold" the data, they are NOT free to use the data for analyses that they publish or provide at a fee to outside industries.GCN - A five-character numeric figure that represents the clinical formulation; it is specific to active ingredient list, route of administration, dosage form, and drug strength.+Minimum Brand and Minimum Generic Discount Guarantees for both mail and retail shall be defined as follows: (1 - Aggregate Ingredient Cost/Aggregate AWP)+Aggregate Discounted Ingredient Cost prior to application of plan specific copayments will be the basis of the calculation.+Aggregate AWP will be from a single, nationally recognized price source for all claims. (Please indicate source.)+Dispensing Fees are not included in the Aggregate Ingredient Cost.+Zero balance due claims or zero amount claims will be included in the guaranteed measurement for AWP, ingredient cost, achieved discounts or dispensing fee calculations at the discounted cost before copay.+All guarantee measurements shall be calculated prior to the copayment being applied. Entire dollar-for-dollar shortfalls, prior to the application of copayments, will be reimbursed to the State without any adjustments to remove zero balance due or excess copayment claims.+Both the Aggregate Ingredient Cost and Aggregate AWP from the actual date of claim adjudication will be used.+Aggregate AWP will be the date sensitive, 11-digit NDC of the actual product dispensed at both retail and mail and specialty.+Non-MAC, MAC, single-source, and multiple source generic products are to be included in the generic guarantee measurement (regardless of the exclusivity period and/or number of manufacturers) and excluded from brand guarantee measurement.+Compounds, OTC claims, and claims with ancillary charges will be excluded from the guarantee measurements for retail and mail order components.+The guarantee measurement must exclude the savings impact from DUR programs, formulary programs, utilization management programs, and/or other therapeutic interventions.+Measurement will be performed annually via independent audit utilizing date-sensitive AWP derived from a single, nationally recognized price source for all claims.+PBM agrees to provide upon request any proprietary algorithms, hierarchy or other logic employed to define a prescription drug as generic or brand.FINANCIAL – GENERALYESNOPBM will invoice the State twice monthly for claims and once monthly for the administrative services.Confirm that if the State disputes all or a portion of any invoice, the State will pay the undisputed amount timely and notify the PBM in writing, of the specific reason and amount of any dispute before the due date of the invoice. The PBM and the State will work together, in good faith, to resolve any dispute. Upon resolution, the State or the PBM will remit the amount owed to the other party, if any, as the parties agree based on the resolution.There are NO additional fees (beyond those outlined in the financial section) required to administer the services outlined in this Proposal. Any mandatory fees, including clinical and formulary programs fees, must be clearly outlined in the Financial Section.All fees include the cost of claims incurred/filled during the effective dates of this contract regardless of when they are actually processed and paid (run-out).PBM agrees to a review and negotiate the pricing applied to newly introduced generic drugs annually.PBM agrees to adjudicate prescription claims for compound medications with the same dispensing fees and logic associated with traditional claims.All pricing will be effective and guaranteed for the term of the agreement and will not include adjustments for claims volume shifts amongst the various provider channels (e.g., mail utilization rates decline or 90-day retail utilization increases).Confirm all pricing will be effective and guaranteed for the term of the agreement and will not be modified or amended if the State implements or adds a 100% member paid plan design such as a high deductible health plan/consumer-driven health plan option.Confirm all pricing will be effective and guaranteed for the term of the agreement and will not be modified or amended if the State’s membership decreases by 30% or less.All fees will be based on approved paid claims as defined in 12.e. definitions (above in this section).All applicable administrative fees will be on a per paid claim basis as defined in 12.e. definitions. +Each distinct pricing guarantee (including rebates) will be measured and reconciled on a component (e.g. retail brand, retail generic, mail order brand, mail order generic, specialty drugs at participating retail pharmacies, and specialty drugs at the PBM’s Specialty Pharmacy) basis only and guaranteed on a dollar-for-dollar basis with 100% of any shortfalls recouped by the State. Surpluses in one component will not be utilized to offset deficits in another component.PBM will provide a financial reconciliation report within 60 days after the end of each measurement period, and the report will include the contractual and actual discounts and dispensing fees for each component (e.g., retail brands, retail generics, mail brands, mail generics, specialty drugs via Participating Retail Pharmacies, specialty drugs via the PBM’s Specialty Pharmacy).+PBM agrees that any shortfall between the actual result and the minimum guarantee will be paid, dollar-for-dollar, to the State within 90 days of the end of the measurement period.PBM’s financial reconciliation that occurs after the end of the measurement period will use the lower of the AWP pricing at the point of adjudication or the retroactive AWP pricing, if the pricing source the PBM uses issues retroactive AWP pricing for that annual reconciliation time period. +No pricing submitted will be contingent on participation in any proposed clinical management programs, group medical or behavioral health programs proposed by you or any other vendor other than programs that are requested by the State. Further, the pricing guaranteed in the Financial Section of this RFP reflects a) the PBM’s broadest national network and b) the PBM’s broadest formulary (drug exclusions allowed) or preferred drug listing, without mandated utilization management unless otherwise authorized or requested by the State.+No pricing will be contingent on specific utilization patterns. For instance, pricing terms contingent on limited utilization in a specific geographic location (e.g., New Hampshire) is unacceptable. PBM will NOT implement or administer or allow any program that results in the conversion from lower discounted ingredient cost drug products to higher ingredient cost drug products without the prior written consent of the State or its designee.+Mail order pricing and rebates will apply to all claims that adjudicate at mail regardless of days’ supply.PBM agrees that mail order and specialty drug dispensing fees will remain constant throughout the contract term and will not be increased for any increases in postage charges.PBM will guarantee Retail/Mail Order unit cost equalization, meaning that Mail Order unit costs prior to member cost sharing, dispensing fees, and sales taxes charged to the State will be no greater than the unit cost for the same NDC-11 at Retail. PBM agrees to produce a date-sensitive comparison report showing unit costs charged to the State at a GCN-level, and reimburse the State on a dollar-for-dollar basis for all instances where mail order unit costs exceed retail unit’s costs. Report and reconciliation will be provided on an annual basis.The State will be notified of any switch in the AWP source at least 180 days prior to the change. In the event that the AWP source change is not determined by a third party to be price neutral for the State, the State will have the right to terminate the contract with no penalty.PBM will be responsible for collecting any outstanding member cost shares for prescriptions dispensed through the mail order facility. The PBM will not invoice the State for any uncollected member cost shares.FINANCIAL – REBATESYESNO+Guaranteed rebates per brand will be based on all brand prescriptions dispensed, not only on formulary prescriptions dispensed.+Rebates are guarantees on a minimum (i.e., not fixed) basis, and the PBM will pass through 100% of the rebates through to the State.+Over-performance of minimum rebate guarantees will not be used to offset performance guarantee shortfalls in other areas.Rebates will not be withheld for execution of any contract amendments. The State is entering into a three-year agreement and needs no annual renewals/amendments signatures for payment of rebates.PBM will reconcile rebate guarantees to verify that the State is receiving the guaranteed rebates and provide rebate payments and reports listing detailed rebate utilization and calculations to the State quarterly, within sixty (60) days of the quarter’s close, without a request being made by the State.PBM will provide the annual rebate report within 90 days of the end of each contract year. Any shortfall between the actual result and the minimum rebate guarantees will be paid, dollar-for-dollar, to the State within 90 days of the end of the contract year.+All rebate revenue earned by the State will be paid to the State regardless of its termination status as a client. Lag rebates will continue to be paid to the State after termination until 100% of earned rebates are paid.PBM agrees to produce an auditable quarterly report demonstrating pass-through rebates. PBM will attach a sample of the report they intend to use as part of their response.formulary managementYESNOIf requested by the State, the PBM agrees to grandfather the current Express Scripts formulary (preferred) list and respective copayments for up to 90 days following the contract effective date with no impact on the minimum rebate guarantees.With the exception of FDA recalls or other safety issues, the PBM agrees not to remove any drug products, brand or generic, from the State’s formulary or preferred drug listing without notification and prior approval from the State.PBM agrees to notify the State or its designee at least 90 days in advance when a formulary drug is targeted to be moved to or from the preferred/formulary drug list. PBM must provide a detailed disruption and financial impact analysis at the same time. No greater than two percent (2%) of participants will be disrupted by any formulary deletions or all deletions in total, on an annual basis.PBM agrees to remove drugs from coverage or the formulary at most one-time per year and no greater than two percent (2%) of participants will be disrupted by any formulary deletions or all deletions in total, on an annual basis.No alterations to financial guarantees will be made on formulary drug exclusions. pharmacy Network ManagementYESNOPBM will not withhold any financial recoveries from audits performed on the contracted pharmacy network including mail order and specialty pharmacies. Any recoveries will be disclosed and credited to the State.PBM agrees that it will not remove any participating network pharmacies that impact greater than 2% of the State’s prescriptions without communicating to the State at least sixty (60) days in advance of the scheduled change. If the change is not agreeable to the State, the State will have the right to terminate the agreement without penalty.PBM agrees to offer improved pricing terms to the State if greater than 2% of members are impacted by proposed changes to the participating pharmacy network.AUDITING & AUDIT RIGHTSYESNO+PBM agrees that all financial pricing components (discounts, dispensing fees, rebates) are subject to independent, electronic audit utilizing date sensitive AWP information on an NDC level from a nationally recognized pricing source (e.g., MediSpan).The State or its designee will have the right to audit annually, with an auditor of its choice, (for both claims and rebate audits), with full cooperation of the selected PBM, the claims, services and pricing and/or rebates, including the manufacturer rebate contracts held by the PBM, to verify compliance with all program requirements and contractual guarantees with no additional charge from the PBM.The State or its designee will have the right to audit up to 36 months of claims data at no additional charge from the PBM.The State or its designee will have the right to audit, with an auditor of its choice, at any time provided the State gives 90-days advance notice.PBM will provide complete claim files and documentation (i.e., full claim files, financial reconciliation reports, inclusion files, and plan documentation) to the auditor within 30 days of receipt of the audit data request as long as a non-disclosure agreement is in place between the auditor and the PBM.PBM agrees to a 30-day turnaround time to provide the full responses to all of the sample claims and claims audit findings.PBM agrees to financial guarantees for turnaround times for each stage of the audit process.PBM will correct any errors that the State, or its representative, brings to the PBM’s attention whether identified by an audit or otherwise.The State or its designee will have the right to audit up to 12 pharmaceutical manufacturer contracts during an on-site rebate audit.The State’s right to audit shall survive the termination of the agreement between the parties for a period of 3 years.The State will not be held responsible for time or miscellaneous costs incurred by the PBM in association with any audit process including, all costs associated with provision of data, audit finding response reports, or systems access, provided to the State or its designee by the PBM during the life of the contract. Note: This includes any data required to transfer the business to another vendor and money collected from lawsuits and internal audits. legal responsibilitiesYESNOPBM shall indemnify, defend and hold harmless the State, its officers and employees, from and against any and all claims, actions, demands, costs, and expenses, including reasonable attorney fees and disbursements, as a result of a breach by the PBM of any of its obligations under the Agreement or arising out of the negligent act or omission or willful misconduct of the PBM or its employees or agents.PBM agrees to hold the State harmless for any HIPAA Violations made by the PBM or its Network Pharmacies.PBM will agree to defend claims litigation based on its decisions to deny coverage for clinical reasons.PBM acknowledges that it is compliant with the electronic Data Interchange (“EDI”), Privacy and Security Rules of the Health Insurance Portability and Accountability Act (“HIPAA”), and will execute the appropriate Business Associate Agreement (“BAA”) as provided by the State (copy attached in Appendix G). PBM also agrees that in the event of a privacy violation or data breach, that the PBM will notify the State and the impacted members to a breach and provide any required remedies.PBM agrees that this Agreement or any of the functions to be performed hereunder shall not be assigned by either party to another party, absent advance notice to the other party, and written consent to said assignment, which consent shall not be unreasonably withheld. In the event either party shall not agree to an assignment by the other party, then this agreement shall terminate upon the effective date of said assignment.PBM agrees that in the event of a dispute between the parties, about the payment or entitlement to receive payment, or any administrative fees hereunder, the PBM and the State shall endeavor to meet and negotiate a reasonable outcome of said dispute. In NO event shall PBM undertake unilateral offset against any monies due and owed to the State, whether from manufacturer rebates, credit adjustment or otherwise.PBM will respond to and incorporate future Health Care Reform changes in full compliance with the law and at no additional cost to the State.implementation / TRANSITIONYESNOPBM agrees to load all current Prior Authorizations, open mail order refills, open specialty refills, claim history files, and accumulator files that exist for current members from the existing PBM at NO charge to the State no later than the date of implementation of management by the selected PBM. (NO charge includes no charges being deducted from the implementation allowance for file loading or IT.)PBM agrees to send at least 12 months of claims history data, all current prior authorizations, open mail order refills, specialty transfer files, and accumulator files that exist for the State participants to the next/successor PBM at NO charge if the State terminates the contract with or without cause.PBM agrees to waive any charges to the State or the State’s medical plan claims administrators such as a set-up fee, a programming fee or a monthly fee, for establishing a connection with a Third Party Administrator/Claims processor for real-time, bidirectional data integration, including non-standard data integration formats.PBM agrees to absorb any programming or other administrative costs to meet any existing or future requirements of the Affordable Care Act.PBM will provide draft SPD language for any clinical programs that are to be implemented.PBM agrees to provide online, real time, claim system access to the State or its designee, including access to historical claims data for up to three years following termination of the agreement.PBM agrees to include a clause to the effect that, upon contract termination, the cost of any work required by a new administrator to bring records in unsatisfactory condition up to date shall be the obligation of your firm and your firm shall reimburse such expenses.MEMBER SERVICESYESNOPBM agrees to obtain the State’s approval for all member communication materials before distribution to members.The State reserves the right to review, edit, or customize any communication from the PBM to its membership.PBM mail order service must notify individual participating members and the State or its designee prior to substituting products that will result in a higher member copayment.PBM agrees to duplicate the plan features and level of coverage presently offered to the State’s covered member population.SECTION V: FINANCIALThis RFP requires pricing on a “hybrid transparent” basis with 100% of all rebate revenue being sent to the State. Rebates will be measured based on the minimum rebate guarantees. Bids on a “pass through” discount model are acceptable; however, bids will be measured based on the minimum discount guarantees as requested in the RFP and not on estimated discounts. Pricing shall be based on your Broadest Network.Vendors are required to complete all financial exhibits as instructed. All administrative fees, program fees, and dispensing fees are required on a per-member-per-month or a per-prescription paid basis (as defined in Section IV – 12.e). Note that fees must be based on prescriptions dispensed (not adjustments, errors, or redo's).All services covered under the fee should be listed.ALL FEES ARE BINDING UNTIL THE IMPLEMENTATION DATE (JANUARY 1, 2019) SPECIFIED IN THIS PROPOSAL AND MUST REMAIN GUARANTEED FOR THE FULL 3-YEAR CONTRACT TERM.ADMINISTRATIVE FEESThe State requires the completion of the following Administrative Fee table and questions:Complete the following Administrative Fee TableHYBRID TRANSPARENT PROPOSAL ADMINISTRATIVE SERVICESCY 2019CY 2020CY 2021PBM Core Services$ _____ per Rx$ _____ per Rx$ _____ per RxVaccine Services$ _____ per Rx$ _____ per Rx$ _____ per RxPaper Claims$ _____ per Rx$ _____ per Rx$ _____ per RxE-Prescribing$ _____ per Rx$ _____ per Rx$ _____ per RxElectronic Prior Authorizations$ _____ per Rx$ _____ per Rx$ _____ per RxIndicate which of these services are included for no additional cost:Toll Free Phone LinesY or NY or NY or NMonthly Data Feeds to State/Designee(s)Y or NY or NY or NProspective /Concurrent/Retro DURY or NY or NY or NStandard ReportsY or NY or NY or NAd Hoc ReportsY or NY or NY or NCOB ProgramY or NY or NY or NMandatory Mail Program with Opt-OutY or NY or NY or NDose Optimization ProgramY or NY or NY or NPrior Authorization ProgramY or NY or NY or NStep Therapy ProgramY or NY or NY or NQuantity LimitationsY or NY or NY or NCustom System OverridesY or NY or NY or NAnnual EOB StatementsY or NY or NY or NRetro Termination LettersY or NY or NY or NGroup CodingY or NY or NY or NDrug Notification LettersY or NY or NY or NFormulary Administration/ManagementY or NY or NY or NID CardsY or NY or NY or NAccess to Pharmacy Directories and other member materialsY or NY or NY or NStandard 1st level appeals processingY or NY or NY or NStandard 2nd level appeals processingY or NY or NY or NUrgent appeals processingY or NY or NY or NOverridesY or NY or NY or NAudit Recovery FeesY or NY or NY or NCompound Drug ManagementY or NY or NY or NServices not included in fees above (i.e., services marked “N” above) (show fees separately):Other Services (show fees separately):ADMINISTRATIVE FEE QUESTIONSVENDOR RESPONSEDetail all services and supplies to be provided under your basic fees that are not included in your response to the chart in question 1.Confirm you agree to guarantee your quoted fees until the assumed implementation date.Confirm fees quoted are not contingent upon any of the following:Minimum enrollment or utilization requirements.Participation in any supplemental programs.Direct communication with patient population.Confirm postage is included in ID card generation, duplicate cards, all mail order prescriptions, and any mailings.Confirm quoted fees include postage paid mail order envelopes for member prescription submission.Confirm your organization agrees that all costs for audits, recoveries, collections, and data feeds submitted to the State or their designee will be absorbed by the PBM during the life of the contract. This includes any data required to transfer the business to another vendor and money collected from lawsuits and internal audits.Confirm that multi-language communication phone line support be included in the base administrative fee.Confirm disabled (e.g., hearing-impaired) member calls will be facilitated through your member services area.Will there be any additional charges if the plan of benefits is restructured or new classes of eligible members are added? If so, how are these charges determined and state amount of charges?Detail all data related services included under the base administrative fees including ad hoc reporting, electronic claims files, plan design options, custom mailings, etc. Detail any data related service fees not included in the base administrative fees.Do you have a contractual relationship with third party administrators/ organizations in which you pay service fees? If so, identify the outside organizations that receive these service fees and explain the nature of the relationship.Pricing shall be based on your Broadest NetworkEGWP Administration FeeReview the requested services in “Section VIII.I–Medicare Part D EGWP Program” and provide a per-Part D eligible member-per-month fee for EGWP services.Employer Group Waiver Plan (EGWP) FeePart-D Eligible Member PMPM FeePBM submits all required reporting to CMS$0.00Provide a detailed list of all services included in the above fee.Describe all services not included in the above quoted fee.PRESCRIPTION DRUG PRICINGAWP Reimbursement Basis - Complete the following tables using the drug reimbursement that your organization is willing to guarantee on a dollar-for-dollar basis for each year of the contract. Columns marked "AWP Discount" are to be completed using discount from 100% AWP and dispensing fee logic. All guarantees must be based on the AWP unit cost dispensed at the point of sale.CY 2019Broad Retail NetworkAWP DiscountRetail Supply Up to 31 daysAWP Discount Retail Supply 32-90 days[Use if applicable]AWP DiscountMail Supply1-90 daysCommercial PlansBrand DrugsDiscount from AWP for all brands%%%Dispensing Fee Per Rx$ ____ per Rx$ ____ per Rx$ ____ per RxGeneric DrugsDiscount from AWP for all generics (composite discount of MAC and Non-MAC prices, discounted AWP, or usual and customary retail price)%%%Dispensing Fee Per Rx$ ____ per Rx$ ____ per Rx$ ____ per RxRebatesMinimum Guarantee Per Brand$ ____ per brand$ ____ per brand$ ____ per brandEGWP PlanBrand Drugs2Discount from AWP for all brands%%%Dispensing Fee Per Rx$ ____ per Rx$ ____ per Rx$ ____ per RxGeneric Drugs3Discount from AWP for all generics (composite discount of MAC and Non-MAC prices, discounted AWP, or usual and customary retail price)%%%Dispensing Fee Per Rx$ ____ per Rx$ ____ per Rx$ ____ per RxRebatesMinimum Guarantee Per Brand$ ____ per brand$ ____ per brand$ ____ per brandCY 2020Broad Retail NetworkAWP DiscountRetail Supply Up to 31 daysAWP Discount Retail Supply 32-90 days[Use if applicable]AWP DiscountMail Supply1-90 daysCommercial PlansBrand DrugsDiscount from AWP for all brands%%%Dispensing Fee Per Rx$ ____ per Rx$ ____ per Rx$ ____ per RxGeneric DrugsDiscount from AWP for all generics (composite discount of MAC and Non-MAC prices, discounted AWP, or usual and customary retail price)%%%Dispensing Fee Per Rx$ ____ per Rx$ ____ per Rx$ ____ per RxRebatesMinimum Guarantee Per Brand$ ____ per brand$ ____ per brand$ ____ per brandEGWP PlanBrand Drugs4Discount from AWP for all brands%%%Dispensing Fee Per Rx$ ____ per Rx$ ____ per Rx$ ____ per RxGeneric Drugs5Discount from AWP for all generics (composite discount of MAC and Non-MAC prices, discounted AWP, or usual and customary retail price)%%%Dispensing Fee Per Rx$ ____ per Rx$ ____ per Rx$ ____ per RxRebatesMinimum Guarantee Per Brand$ ____ per brand$ ____ per brand$ ____ per brandCY 2021Broad Retail NetworkAWP DiscountRetail Supply Up to 31 daysAWP Discount Retail Supply 32-90 days[Use if applicable]AWP DiscountMail Supply1-90 daysCommercial PlansBrand DrugsDiscount from AWP for all brands%%%Dispensing Fee Per Rx$ ____ per Rx$ ____ per Rx$ ____ per RxGeneric DrugsDiscount from AWP for all generics (composite discount of MAC and Non-MAC prices, discounted AWP, or usual and customary retail price)%%%Dispensing Fee Per Rx$ ____ per Rx$ ____ per Rx$ ____ per RxRebatesMinimum Guarantee Per Brand$ ____ per brand$ ____ per brand$ ____ per brandEGWP PlanBrand Drugs6Discount from AWP for all brands%%%Dispensing Fee Per Rx$ ____ per Rx$ ____ per Rx$ ____ per RxGeneric Drugs7Discount from AWP for all generics (composite discount of MAC and Non-MAC prices, discounted AWP, or usual and customary retail price)%%%Dispensing Fee Per Rx$ ____ per Rx$ ____ per Rx$ ____ per RxRebatesMinimum Guarantee Per Brand$ ____ per brand$ ____ per brand$ ____ per brandConfirm the pricing listed in the tables 1 to 3 above reflects:PROPOSED PRICINGVENDOR RESPONSEAll guarantees are calculated using the date sensitive AWP based on the 11-digit NDC of the actual product dispensedAll-in generic guarantee inclusive of single-source genericsDrugs with an “Insufficient Supply” are included in the guaranteesSelect, sole source or authorized generics from at least one FDA-approved generic manufacturer with exclusivity or limited availability, supply or competition will be included in the generic pricing guarantees and excluded from the brand pricing guarantees.No single-source generic or generic drug will be included in the brand drug component for the annual discount guarantee reconciliation.Member Cost Share at the point-of-sale (for retail and mail) is based on the lowest of the plan copay/coinsurance, usual and customary charges, negotiated discounted ingredient cost plus dispensing fee or retail cash priceAll guarantees are calculated before the application of member cost shareAll guarantees (including Rebates) are stand-alone with no offsetting (within or across channels)Any guarantee shortfalls are paid on a dollar-for-dollar basisConfirm that the State’s current plan designs qualify for the proposed rebate guarantees. Please give the name of the qualifying rebate guarantee class (if applicable).Provide your proposed source for AWP (average wholesale price) data.How often are AWP prices updated in your adjudication system?Provide your proposed drug type designation or classification (e.g. brand, generic) source (i.e. First DataBank, Medi-Span, Redbook, Other). If other, please specify.Specialty Pharmacy Program PricingThe State currently has an exclusive specialty arrangement and is willing to continue this arrangement into its next PBM contract if it is advantageous for the Plan and its member.Please provide your organization’s definition and qualification criteria of a “specialty drug product.”Provide an AWP-based pricing list of all specialty pharmaceuticals that your company dispenses and distributes to providers and patients. Your pricing must include adequate supplies of ancillaries such as needles, swabs, syringes, and containers. The following items must be included in your list:a.Product Nameb.Therapeutic Group/Therapeutic Categoryc.Guaranteed Minimum AWP discount for all specialty pharmacy program prescriptions for the exclusive specialty arrangement.AWP Reimbursement Basis – Complete the following table using the drug reimbursement that your organization is willing to guarantee on a dollar-for-dollar basis for each year of a contract. Please complete "AWP Discount" using discount from 100% AWP and dispensing fee logic.a. Complete the following table under the proposed exclusive specialty arrangement: Specialty Drugs Dispensed at Participating Retail PharmaciesCY 2019CY 2020CY 2021Overall Effective Discount (OED) Guarantee from AWP%%%Confirm New to Market Specialty Drugs and New to Market Limited Distribution Specialty Drugs will be included in the above OED guaranteeDispensing Fee Per Rx$___ per Rx$___ per Rx$___ per RxAdministrative Fee Per Rx$___ per Rx$___ per Rx$___ per RxRebate - Minimum Guaranteed Per Brand$___ per brand$___ per brand$___ per brandb. Complete the following table: Specialty Drugs Dispensed at the PBM’s Specialty PharmacyCY 2019CY 2020CY 2021Overall Effective Discount (OED) Guarantee from AWP%%%Confirm New to Market Specialty Drugs and New to Market Limited Distribution Specialty Drugs will be included in the above OED guaranteeDispensing Fee Per Rx$___ per Rx$___ per Rx$___ per RxAdministrative Fee Per Rx$___ per Rx$___ per Rx$___ per RxRebate - Minimum Guaranteed Per Brand$___ per brand$___ per brand$___ per brandPlease describe any price inflation guarantee you are putting forth for specialty drugs.Are your proposed guarantees for your retail/mail program contingent upon the State’s purchase of your specialty drug program?Confirm that your specialty program will limit specialty claims to a 30-day supply.ALLOWANCESPlease complete the following table:ALLOWANCEDESCRIPTIONVENDOR RESPONSEImplementation AllowancePlace the dollar ($) per member amount or the flat dollar amount you are offering the State$_____Pre-Implementation Audit Allowance*PBM will agree to reimburse the State for the expense of a Pre-Implementation Audit (up to $35,000) to be conducted at least 60 days prior to the start of or change to claims adjudication.General Pharmacy Program ManagementPlace the dollar ($) per member amount or the flat dollar amount you are offering the State for general expenses related to the management of the pharmacy benefits program such as pharmacy claim and rebate audits, communication expenses, clinical programs, consulting fees or be used as a credit against claim invoices.$_____* As indicated in Section III.D, the State intends to hire a firm to conduct a pre-implementation audit to ensure that the State’s plan designs and financial terms are programmed correctly in the Contractor’s claims system and the claims are being correctly adjudicated. The State will not be charged by the Contractor for this audit process.The State requests that Vendor’s provide a pre-implementation audit allowance to reimburse the State for any expenses incurred for conducting such audit. Generic Drugs - Dispensing RatesComplete the table below for contract Years 1, 2, and 3. Note that generic dispensing rate includes only true instances of generic dispensing (i.e., excluded are multi-source brand drugs dispensed under member-pay-difference plan designs).Guaranteed GDRRetail ≤ 31 daysMail OrderCY 2019%%CY 2020%%CY 2021%%What dollar amount are you prepared to put at risk for failure to meet your GDR guarantee?Confirm the PBM’s Generic Dispensing Rate Guarantee will be measured and reconciled on a component basis and a shortfall in one delivery channel will not be used to offset a shortfall in another delivery channel.Right to Remove or Add ServicesIMPORTANT NOTE – The State reserves the right to remove services from the pharmacy administration contract. If your proposed financial terms and fees would be different if any of the following plans are removed from the contract, you must complete additional copies of the financial exhibits reflecting the different terms and fees.Possible plans removed from pharmacy administration contractIndicate which of the two scenarios below appliesProposed financial terms and fees unchangedProposed financial terms and fees change and alternative terms are includedNon-Medicare Retiree PlanMedicare (EGWP) Retiree PlanSECTION VI: PERFORMANCE GUARANTEESThe State requires vendors to agree to place a minimum amount of $400,000 per contract year at risk for performance guarantees. The exhibit below identifies the specific performance guarantees that are the basis of performance responsibilities for any resulting contract. Vendors are encouraged to place at risk a greater amount than the minimum of $400,000 per contract year; a vendor’s willingness to offer meaningful guarantees (greater than the minimum) will be reflected in their score. Performance guarantee metrics may be self-reported, but are subject to independent audit by the State. All guarantees shall be set and measured annually. Provide the total amount per contract year at risk for performance guarantees. At time of contract, the parties shall mutually agree to the allocation of the at risk funds.Performance GuaranteeTotal Amount at RiskImplementationIndicate the Total Implementation Performance Guarantees Amount you are proposing to the State.$_____________Ongoing (annual)Indicate the Total Ongoing Annual Performance Guarantees Amount you are proposing to the State (at least $400,000).$_____________Ongoing (annual)PBM agrees the State may allocate its preferred weighting (e.g., 0% to 30%) for the Performance Guarantees below prior to the start of each Contractual Year.Yes / NoYou are required to respond to each performance guarantee by indicating your organization’s willingness to agree to each performance guarantee and the requested measurement basis (State account specific performance or the vendor’s book-of-business performance). Vendors are strongly encouraged to agree to provide guarantees on the State account specific performance for the majority of the measurements. Using a book-of-business measurement for many of the guarantees diminishes or eliminates their value to the State and this will be reflected in the vendor’s score. StandardRequested Measurement BasisConfirm Your Willingness to Guarantee [Yes/No]Implementation Performance GuaranteesClean ImplementationNo systems errors, ID card delays, and the State online access to all tools prior to effective dateState account specificImplementation TimelineImplementation team will be assigned and introduced to the State within 5 business days of G&C approvalState account specificImplementation TeamImplementation team members will not change and will be responsible for the accurate installation of all administrative, clinical and financial parameters for the State’s programState account specificID Card MailingAll ID cards will be mailed at least 10 days prior to the effective date and will be 100% accurate (provided that a valid eligibility file was received at least 15 days prior to the effective date)State account specificImplementation Satisfaction ScorecardAssigned Account Executive will work with the State prior to the start of implementation to agree on terms of a satisfaction scorecard to be issued to the State after effective date for completionState account specificOngoing (Annual) Performance GuaranteesPayment Accuracy & System PerformanceProtected Health Information (PHI)PBM guarantees no incidents in violation of HIPAA Security Rules which results in a transmission of electronic PHI for the State's covered members.State account specificPlan Design Change Administration AccuracyImplementation of all plan design changes will be 100% accurate.State account specificPricing Change AccuracyImplementation of all pricing changes will be 100% accurate. State account specificFinancial accuracyPercentage of claim payments made without error relative to the total dollars paid will be at least 99%State account specificMail Service Non-Financial AccuracyThe mail service pharmacy shall guarantee dispensing accuracy of at least 99.996% (correct participant name, correct participant address, correct drug, correct dosage form, and correct strength) State account specificSystem DowntimeAt least 99.5% access to its systems by all the retail pharmacies in PBM’s network 24 hours a day, 7 days a week, 365 days a yearState account specificClaims Eligibility DataEligibility loads not to exceed 24-hours after receiptState account specificEligibility Data Error ReportingEligibility file error reporting on all eligibility file updates will be provided to the State within 2 business daysState account specificEligibility Error Rate AuditsError rate identified through quarterly audits shall not exceed, on an average basis, 2%. This is measured and reported on a quarterly basis.State account specificInvoicing ErrorsAll invoicing errors will be credits back to the State by next billing cycle or PBM will pay interestState account specificAccount ManagementContract Drafting CooperationResponse to recommended contract language changes within 10 business days. State account specificState Approval of Member Communications100% of all member communications will be approved by the State – exceptions for drug recalls and urgent patient safety communicationsState account specificMember communication mailing errors100% of all member communications shall be accurate. Should a mailing be sent in error or contain erroneous information regarding any aspect of the plans administration the vendor shall pay a penalty per erroneous document.State account specificDelivery of Standard ReportsWithin 30 days of end of reporting quarterState account specificAccuracy of Standard ReportsAll standard reports provided will be 100% accurate.State account specificPharmacy Audit ResolutionWithin 6 months of identification and notification to PBM by the State or its designeeState account specificPBM Account Teams PerformanceThe State may assess a penalty per Contract Year if, after the first Contract Year and each successive Contract Year, the State’s benefits staff do not rate PBM account team’s performance for such Contract Year an average of 3 or better on a scale of 1 to 5 (5 being the best based on a range of performance criteria agreed to between the State and PBM at the beginning of such Contract Year)State account specificAccount Management TurnoverAccount team members will remain constant for at least the first 18 months of the contact period, unless a change in account management staff is requested by the State. State account specificMember ServicesMail Turnaround – Prescriptions not requiring intervention95% of prescriptions dispensed within average of 2 business days and 100% within average of 3 business daysState account specificMail Turnaround – Prescriptions requiring intervention95% of prescriptions dispensed within average of 4 business days and 100% within average of 5 business daysState account specificPaper Claims Turnaround95% of prescriptions reimbursed within average of 10 business days and 100% within average of 14 business days.State account specificID Cards Mailing98% of all ID cards are sent within 5 business days of receipt of eligibility. 100% mailed within 10 business days.State account specificReplacement ID Card MailingStandard replacement ID cards will be produced within an annual average of five (5) business days of the request.State account specificMailing Member MaterialsAll applicable member materials (for example, mail order forms) will be mailed at least 10 days prior to the effective date and will be 100% accurate (provided that eligibility file was received at least 30 days prior to the effective date). State account specificPhone Average Speed of Answer100% of calls to State-specific toll free line shall be answered within 20 seconds (excluding IVR).State account specificPhone Abandonment Rate100% of calls to the State-specific toll free line shall be answered with an abandonment rate of 3% of lessState account specificWritten Inquiry Answer Time95% of inquiries responded to in 5 business days – 100% in 20 business daysState account specificMember Satisfaction SurveyThe PBM agrees to conduct a Member Satisfaction Survey for each contract year and that the Satisfaction Rate will be 90% or greater. A yearly penalty may be assessed against the PBM for failure to meet this standard. “Member Satisfaction Rate” means (i) the number of Eligible Persons responding to PBM annual standard Patient Satisfaction Survey as being satisfied with the overall performance under the Integrated Program divided by (ii) the number of Eligible Persons responding to such annual Patient Satisfaction Survey; the State must provide timely approvals and responses, and a minimum of 20% of surveys must be returned for the Performance standard to be applicable.State account specificIssue Resolution: Verbal Inquiries PBM will resolve 99% of all telephone issues at the first point of contact (the number of telephone inquiries completely resolved at the time of initial contact divided by the total number of calls)State account specificIssue Resolution: Written InquiriesPBM will resolve 98% of all written inquiries within 10 business days of receipt of inquiryState account specificIssue Resolution: State Staff Involvement / EscalationPBM will resolve member issues within 48 business hours for any case that required the involvement of the State’s staff due to incorrect or incomplete information being provided by the PBM. If not resolved within 48 hours, a penalty will be applied per case, up to an annual maximum.State account specificRetail PharmacyRetail Pharmacy Audit100% of participating retail pharmacies will be subject to automated review audits and 20% of participating pharmacies will be subject to further investigation (e.g., desk audits, on-site audits, etc.) as a result of the automated review audits. Book of businessRetail Pharmacy TurnoverLess than 5% of retail pharmacies will leave the retail network.Book of businessReportsAd-hoc ReportsA minimum of 90% of Ad-hoc reports will be delivered to State within 7 business days of the request. Ad-hoc reports are defined as reports that are not part of the vendor’s standard reporting packageState account specificStandard ReportsA minimum of 95% of standard reports will be delivered to the State within 3 business days of the request. State account specificOnline Reporting Data AvailabilityOnline reporting data will be available within an annual average of fifteen (15) business days after the billing cycle that contains the last day of the month.State account specificClaims Detail FileAll claims detail files sent to external vendors will be provided within 8 days of request or scheduled delivery date. State account specificAuditsProvide Data Extract requestedWithin 30 days of request date or within 10 business days of executed confidentiality agreement (whichever occurs first). State account specificProvide Data Extract requestedWithin 30 days of request date or within 10 business days of executed confidentiality agreement (whichever occurs first). State account specificProvide Complete Response to Data RequestWithin 30 days of request.State account specificResponding to Data Reconciliation RequestsWithin 10 business days of request.State account specificProviding Initial Response to Audit FindingsWithin 30 days of receipt of findings.State account specificSECTION VII: REQUIRED PROTECTION OF CONFIDENTIAL INFORMATION AND DATA SECURITYThis section includes expectations on how the State’s confidential information will be protected by its Business Associate(s) as well as required contract language and required insurance coverage levels. Confidential Information. In performing its obligations under the Agreement, and applicable Business Associate Agreement (“BAA”), the Business Associate, inclusive of any subsidiaries and any related entities (“BA”) shall gain access to information of the State, including personal health information (PHI) personally identifiable information (PII), and other personal, private, and/or sensitive information, hereinafter collectively referred to as “Confidential Information.” The BA shall not use the State’s Confidential Information developed or obtained during the performance of, or acquired, or developed by reason set forth within the Agreement and applicable BAA, except as is directly connected to, and necessary for, the BA’s performance under the Agreement, or unless otherwise permitted under the Agreement and/or applicable BAA.Data Protection. Protection of Confidential Information which may be provided to the BA as part of the Agreement and applicable BAA shall be an integral part of the business activities of the BA. The BA shall ensure that there is no inappropriate or unauthorized use of the State’s information at any time. To this end, the BA shall develop and implement policies and procedures to safeguard the confidentiality, integrity and availability of the State’s information. The BA also will comply with the following terms and conditions:Confidential Information obtained by the BA shall become and remain property of the State and shall at no time become the property of the BA unless otherwise explicitly permitted under the Agreement and applicable BAA;At no time shall any data, information, or processes which either belong to, or are intended for the use of, the State be copied, disclosed, or retained by the BA, or any party related to the BA by business (subcontractor) for subsequent use in any transaction that does not relate to the delivery of Services to the State (See the applicable BAA); The BA shall not provide any information collected in the connection with the provision of Services under the Agreement and applicable BAA for any purpose other than performing its obligations to provide the contracted Services, unless otherwise explicitly permitted under the Agreement;In the event that the BA stores Confidential Information, including but not limited to PHI, and PII, this data shall be encrypted by the BA while both at Rest or in Motion. The BA shall have proper security measures in place for the protection of the State’s data. The BA shall also ensure that any BA subcontractor(s) has proper security measure in place for protection of the State’s data. Such security measures shall comply with the HIPAA Privacy Rule, Standards for Privacy of Individually Identifiable Health Information, HIPAA Security Rule, Security Standards for the Protection of Electronic Protected Health Information, the Health Information Technology for Economic and Clinical Health Act (“HITECH), and all other applicable data protection and privacy laws, including privacy laws of the State of New Hampshire and any other applicable state, which may apply now or in the future. Controls. The BA shall, and shall ensure that any subcontractor(s) used by the BA shall, have, maintain, and use at all times proper controls for secured storage of, limited access to, and rendering unreadable prior to discarding, all records containing the State’s Confidential Information, including but not limited to PHI, and PII. The BA shall not store or transfer Confidential Information collected in connection with the services rendered under this Agreement outside of the North America. This includes backup data and disaster recovery locations. Data Breach Notification. The BA shall, and shall ensure that any subcontractors used by the BA shall, inform the State of any security breach, or potential breach, that jeopardizes, or may jeopardize the State’s data or processes (i.e. any “Security Incident”). For purposes of reporting under this Section, the definition of a Security Incident shall be limited to the successful unauthorized access, use, disclosure, modification, or destruction of information, or the interference with system operations in an information system, and/or the potentially successful unauthorized access, use, disclosure, modification or destruction of information, or the potential interference with systems operations in an information system. Notification of a data breach, or potential data breach, shall be given to the State within 24 hours of its discovery by the BA or the BA’s subcontractor(s). Full disclosure of the Security Incident shall be made and include all available information. The BA shall cooperate fully with the State, including but not limited to: make efforts to investigate the causes of the breach or potential breach; promptly take measures to prevent any future breach; and minimize any damage or loss resulting from the breach, or potential breach. In addition, the BA shall inform the State of the actions it is taking, or will take, to reduce the risk of further loss to the State. HIPAA Breach Notification Rule, 45 CFR §§ 164.400-414, the Federal Trade Commission’s Health Breach Notification Rule 16 CFR Part 318, and RSA 359-C:20 require public breach notification to individuals whose information has been or may be misused. All legal notifications required as a result of a breach of information, or potential breach, collected pursuant to this Contract shall be coordinated with the State. The BA shall ensure that any subcontractors used by the BA shall similarly notify the State of a data breach, or potential data breach within 24 hours of discovery, shall make a full disclosure, including providing the State with all available information, and shall cooperate fully with the State, as defined above.Data Security Breach Liability. In addition to the BA’s obligations as set forth in the form contract P-37 (attached hereto as Appendix F) and the Business Associate Agreement (attached hereto as Appendix G) if the BA , or any subcontractor(s) used by the BA, is determined by any forensic analysis or report, to be the likely source of any loss, disclosure, theft or compromise of State’s data or information, and regardless of the BA’s belief that the BA, or subcontractor used by the BA, has complied with all data Security and Breach rules, or any other security precautions and is not responsible for the assessments, fines, losses, costs, and penalties and reimbursements resulting from said loss, the State shall recover from the BA all costs of response and recovery resulting from the Breach or potential Breach, including but not limited to: credit monitoring services, mailing costs and costs associated with website and telephone call center services that are necessary due to the Breach or potential Breach.Data Breach Insurance. In addition to the BA’s insurance obligations as set forth in the form contract P-37 (attached hereto as Appendix F), the BA shall carry Data Security & Cyber Insurance coverage for unauthorized access, use, acquisition, disclosure, failure of security, breach of confidential information, of privacy perils, in an amount not less than $10 million per annual aggregate, covering all acts, errors, omissions, at minimum, during the full term of this Agreement and the applicable BAA. Such coverage shall be maintained in force at all times during the term of the Agreement and applicable BAA and for a period of two years thereafter for services completed during the term of the Agreement and consistent with the governing BAA. The State shall be given at least thirty (30) calendar days’ notice of the cancellation or expiration of the aforementioned insurance for any reason, at the address provided in the P-37. Data Recovery. The BA shall be responsible for ensuring backup and redundancy of the State’s data, including but not limited to Confidential Information for recovery in the event of a system failure or disaster event within the BA’s data storage system(s) and/or a BA subcontractor(s)’ data storage system(s). Process upon Conclusion/Termination of Services. At the conclusion of the Agreement, either through completion or termination, the BA shall implement an orderly return of State’s data in a format defined by the State at no additional cost to the State. At the State’s request, the BA shall destroy all data in all forms. Data shall be permanently deleted and not recoverable according to National Institute of Standards and Technology approved methods. The BA shall provide State with certificates of destruction and/or certificates verifying that all information has been returned and none retained. Destruction /Disposal of State’s Data. Upon termination of the Agreement and applicable BAA for any reason, the BA, with respect to any Confidential Information, including but not limited to PHI, or PII, either received from the State, or created, maintained, or received by the BA on the State’s behalf, shall:Where feasible, return or destroy the Confidential Information the BA still maintains in any form, at the sole discretion of the State, except where certain types of information must be retained for the State’s benefit, such as records of actuarial determinations, which will be maintained as agreed upon by the State;Continue to use appropriate safeguards as identified in the Data Protection provisions above with respect to any Confidential Information that is retained as agreed upon by the BA and the State; Not use or disclose Confidential Information retained other than for purposes for which such information has been retained, and subject to the same terms and conditions as set forth in the original Agreement and/or BAA, as amended in writing, by both parties, if applicable.Access to System Logs. The BA shall allow the State access to system security logs, latency statistics, etc., that affect the Agreement and applicable BAA, the State’s data and/or processes. This includes the ability of the State to request a report of the records that a specified user accessed over a specified period of time. Import/Export Data. The State shall have the ability to import or export data in piecemeal manner or in its entirety at its discretion without interference from the BA and with the BA’s assistance, at no additional cost to the State. Notification of Governmental Authorities. With respect to instances in which the BA, or BA subcontractor(s) consider notifying Governmental Authorities concerning civil acts, the BA or BA subcontractors shall notify the State in writing and consult with the State prior to making any such notification; and immediately endeavor in good faith to reach agreement on the need and nature of such notification. If such agreement cannot be reached within seventy-two (72) hours after the BA, or BA subcontractor(s) has provided the State with written notice, the BA or BA subcontractor(s) shall have the right to inform Government Authorities solely to the extent required by applicable law.Damages in the event of a breach or potential breach: A Security Incident, including a potential breach, or potential privacy-related compliance issue, may cause the State irreparable harm for which monetary damages would not be adequate compensation. In the event of such a Security Incident, the State is entitled to seek equitable relief, including a restraining order, injunctive relief, specific performance and any other relief that may be available from any court, in addition to any other remedy to which the state may be entitled at law or in equity. Such remedies shall not be deemed exclusive, but shall be in addition to all other remedies available at law or in equity, subject to any express exclusion or limitations in the Agreement to the contrary.This Section VII Required Protection of Confidential Information and Data Security shall survive termination or conclusion of the Agreement and applicable BAA.SECTION VIII: TECHNICAL QUESTIONNAIREORGANIZATIONAL STABILITY & EXPERIENCERespond to the following questions:ORGANIZATIONAL STABILITY & EXPERIENCEVENDOR RESPONSE1.Provide the latest annual report, financial statement, SSAE 16 or SAS 70 type II, and other financial reports that indicate the financial position of your organization. From these documents, please provide the following:a.Current ratiob.Debt to equity plete the following table:a.Parent Companyb.Year PBM Establishedc.Total Number of Covered Lives (CY 2017)% from top 10 clients (CY 2017)Total Number of Covered Lives (CY 2016)d.Total Number of Scripts Dispensed (CY 2017)e.Total AWP Dollars Processed (CY 2017)f.Total Number of Clients (CY 2017)g.Number of Group Plans Terminated in Past 12 Months3.Provide the total number of years of direct PBM experience for the lead Account Manager, Financial Services, and Clinical staff assigned to this account. Provide a resume for each.4.Indicate the number of any outstanding legal actions pending against your organization.Can you assure the State these actions will not disrupt business operations?5.What general and professional liability coverage do you currently have in place for the entity that is bidding to protect the State from losses or negligence? Describe the type and amount of the fidelity bond insuring your employees that would protect the State in the event of a loss.ADMINISTRATIVE, MEMBER & CLAIM PAYING SERVICESConfirm you agree to the following service specifications:ADMINISTRATIVE, MEMBER & CLAIM PAYING SERVICESVENDOR CONFIRMATIONThe State chooses to be invoiced on a bi-weekly (every two weeks) basis for the prior two weeks of claims to be paid via electronic wire with the State as the originator of the transaction. However, the State will accept invoicing on a semi-monthly (twice a month) basis for the prior two weeks (approximately) of claims. The State would agree to make payment within five business days of receipt of the invoice. Confirm you agree to this arrangement.The State chooses to be invoiced on a monthly basis for administrative costs for the prior month to be paid via electronic wire with the State as the originator of the transaction. The State would agree to make payment within five business days of receipt of the invoice. Confirm you agree to this arrangement.Confirm you agree to send quarterly reports electronically as well as present mid-year and annual meetings in person with the State to discuss plan performance, present financial results, etc.Confirm you provide automated services that are available 24/7.Confirm you agree to attend open enrollment meetings and other meetings as requested by the State.Confirm you will provide dedicated clinical, account management, and customer service staffing to the State. The State requires that the vendor assign individuals to the State Plan for account management and clinical support on a regular and ongoing basis. The State requires that the vendor’s customer service team also be assigned to the State Plan and have the appropriate knowledge of the State’s plans of benefits. It is understood that these individuals may be assigned to other plans.Confirm that you provide a live person to answer the customer service phone lines 24 hours per day, seven days per week. An option to speak to a representative as part of an interactive voice response system is acceptable.Confirm you will offer the State’s staff online access to information and services via the Internet or through CRT interface.Confirm you have the ability to produce temporary ID cards and/or proof of benefits in “real time”.Confirm your organization will send recovery letters to members who continue to use their drug card after their termination.Confirm you provide member support services for selecting and/or locating network pharmacies.Respond to the following questions:ADMINISTRATIVE, MEMBER & CLAIM PAYING SERVICESVENDOR RESPONSEConfirm that no penalties or interest will be charged to the State for late funding/payment.For the customer/member service center proposed for the State provide the following:a.Location of the call centerb.Days of Operationc.Hours of OperationFor the customer/member service center proposed for the State provide the following for CY 2017:a.Percent of calls abandonedb.Percent of calls handled by live representativec.Number of seconds to reach a live customer service representativeHow do you track member complaints?List the top 5 member complaints related to retail, mail order, and the specialty pharmacy program. What processes/ remedies have been put into effect to resolve these complaints?All member service call recordings and notes between the PBM and the State’s members will be the State’s property.PBM agrees to document 100% of the State’s member service calls through call recordings and call notes. PBM will forward call recordings, written transcripts, and call notes at the State’s request within two business days of the request being made.PBM agrees to provide the State with a dummy login to access the PBM’s member website prior to the go-live date.PBM will provide the State with a virtual tour of its CSR system and any custom messaging system.PBM will not automatically enroll the State in any programs that involve any type of communications with members or alterations of members’ medications, without express written consent from the State.The PBM agrees to, at minimum, quarterly calls to review member service issues. The PBM agrees to allow the Fund to review member service quality issues to the resolution endpoint.The PBM agrees to a minimum of one annual meeting with call center executives to discuss services regarding enrollment and member issues.Can you produce replacement ID cards within 24 hours, if necessary?Do you currently perform membership satisfaction surveys? Provide a copy of the latest results of the survey. What percent of members indicated that they were “satisfied or very satisfied” with the overall program?How do you remind members regarding refills and compliance? Indicate methods and frequency of interventions.How often is the Internet directory updated?What services are available to members via the Internet? Provide detail regarding current Internet capabilities.Describe security systems and protocols in place to protect confidential patient records. Is the site VIPPS certified and licensed in every state?Please provide the following information regarding the proposed account team:Name of Team MemberYears of PBM ExperienceNumber of Assigned AccountsLocationStrategic Account ExecutiveAccount ManagerImplementation ManagerClinical PharmacistsPlease provide the PBM’s Book-of-Business Turnover Rate for the following divisions:CY 2017Overall Book-of-BusinessStrategic Account ExecutivesAccount ManagersClient-Facing Clinical PharmacistsREPORTING, IT & DATA INTEGRATIONRespond to the following questions:REPORTING, IT & DATA INTEGRATIONVENDOR RESPONSEIndicate for each report noted below whether you can provide such a report. If you can provide the requested report, indicate the price or if the cost is included in the basic fee.Yes/NoCostFrequencya.Eligibility Report which shows accuracy of updates and changesb.Paid Claims Summary (Ingredient cost, days supply, dispensing fees, taxes, copay totals by month)c.Detail Claim Listing (Utilization and Ingredient cost by individual claimant, listing the Drug name and dosage, submitted charge, allowable charge, paid)d.Cost Sharing Report (Amounts determined to be ineligible, amounts applied to copays and coinsurance, and amounts adjusted for COB)e.Detailed Utilization Report (# of prescriptions submitted by single source brand, multi-source brand and generic drugs, including average AWP, Ingredient cost per Rx, Dispensing fee, and average days supply) Drug Report (detail of cost and utilization by top drug products)g.High Amount Claimant reporth.Therapeutic Interchange Report detailing success rates and cost impacts of PBM initiated interchanges i.Drug Utilization Review activity and Savings Report by type of editj.Member compliance and adherence to therapy k.Formulary Savings and Rebate report l.Paid Claims Summary (see b.) showing total number of claims, eligible charges and claim payments for each categorym.Prior Authorization and other clinical program reportingn.Specialty Rx reportingo.Pharmacy cost and utilization reportingCurrently the State’s Rx data is transferred twice a month from the PBM to the medical administrator. Please confirm you are able to continue this practice.Do you agree to provide at no cost to the State annual member electronic EOB statements?FORMULARY MANAGEMENT & REBATESConfirm you agree to the following formulary management and rebate(s) specifications:FORMULARY MANAGEMENT & REBATESVENDOR CONFIRMATIONConfirm that you will pass through 100% of formulary rebates from manufacturers of generic drugs in addition to brand and specialty drugs.Confirm that you indicated, in the financial section of this RFP, if you require a formulary management fee and the amount or percentage proposed. Other than these fees, confirm that you guarantee that 100% of all rebates collected will be passed through to the State. Confirm that you guarantee that any formulary switches which are not economically advantageous to the State on an ingredient cost basis will be reported and reimbursed to the State on a dollar-for-dollar basis using the least expensive, therapeutically equivalent alternative drug as the basis for reimbursement.Respond to the following questions:FORMULARY MANAGEMENT & REBATESVENDOR RESPONSEProvide the name of the Formulary you are proposing to the State.If applicable, provide the number of drug exclusions as well as a list of the excluded drugs and the therapeutic alternativesDoes the PBM use an external organization for rebate aggregation? If so, which one?Confirm a member is able to obtain an excluded prescription through a Prior Authorization without impact to the guaranteed rebatesAre any P&T committee members employed by or under contract with any drug manufacturers?Are any P&T members directly employed by your organization?Are any generic drugs considered “non-preferred” on your proposed formulary (i.e., subject to the “non-preferred” copay)? If yes, please describe in detail and provide examples. (If no, then your response to question #9 below should be 100% for generics at both retail and mail. Please confirm.) Do you have a Formulary Grievance Process in place to address member concerns regarding formulary alternatives?If yes, explain this process in detail.For the State’s top 100 retail brand prescriptions by cost during November 1, 2016 through October 31, 2017 for both the commercial and EGWP populations, please complete the Excel spreadsheets provided in Appendix C indicating whether each brand drug will be considered “preferred” or “non-preferred.”For the State’s top 100 mail brand prescriptions by cost during November 1, 2016 through October 31, 2017 for both the commercial and EGWP populations, please complete the Excel spreadsheets provided in Appendix C indicating whether each brand drug will be considered “preferred” or “non-preferred.”8 The two (2) electronic copies of your RFP response shall include responses to questions #7 and #8 in the MS Excel format provided. DO NOT PDF your response.Based on the State’s detailed claim-by-claim prescription drug data during November 1, 2016 through October 31, 2017 for both the commercial and EGWP populations (Appendix B), please indicate what percent of retail and mail generic and brand prescriptions are currently considered “preferred” on your proposed formulary:CommercialRetailMailPreferred Generics as a Percent of all Generics:%%Preferred Brands as a Percent of all Brands:%%EGWPRetailMailPreferred Generics as a Percent of all Generics:%%Preferred Brands as a Percent of all Brands:%%DRUG UTILIZATION REVIEWConfirm you agree to the following drug utilization review specification:DRUG UTILIZATION REVIEWVENDOR CONFIRMATIONConfirm that reported savings from drug utilization review will be based on a State-specific claim-by-claim analysis.Respond to the following questions:DRUG UTILIZATION REVIEWVENDOR RESPONSEIt is expected that all pharmacies will have real-time online edits. If this is not the case, indicate the variation. Complete the following table separately for pharmacy network and mail order:Real Time Edit Criterion(yes/no)% of Pharmacies that Satisfy Criterion% of Pharmacies with real time, Online editsPercent of Total Rxs Denied (In CY 2017)Eligible Employee/DependentEligible DrugContract Price of DrugDrug InteractionsDuplicate PrescriptionRefill too SoonProper DosageProper Days SupplyGeneric AvailabilityPatient CopaymentsOther (List)Provide most recent quarterly book of business savings for the following programs:Concurrent DUR _______% of Total Ingredient CostsRetrospective DUR _______% of Total Ingredient CostsPrior Authorization _______% of Total Ingredient CostsDo you have edits or programs in place designed to detect and address potential drug fraud, waste, and/or abuse?If yes, explain and include a listing of the specific drugs targeted by these programs.What criteria and methodologies are used to identify and monitor high cost claimants?How do you guard against the filling of separate prescriptions for the same or similar drugs at different pharmacies on the same day?Within five days after the initial fill?Will you reimburse the State for any amounts paid for any day supply dispensed for each claimant beyond the indicated amount? [During instances of lost or stolen Rxs, the State and patient will be responsible for their respective cost shares.]Identify which of the following edits are performed at the point-of-sale:Performed at the Point of Sale (Yes or No)Ineligible participantPre-existing conditionCoordination of Benefits (COB)Benefit maximums for certain drug typesDrug is inappropriate for the patient due to ageDrug is inappropriate for the patient due to genderQuantity versus TimeAllergyIncorrect AWP or formula priceUsual Customary Reasonable (UCR) inputDuplicate RxRefill too soonIncorrect dosageRx splittingDrug interactionsOver utilizationUnder utilizationAggregate Benefit MaximumsPossible Narcotic AbuseOther Point of Sale (POS) Edits (provide list)NETWORK MANAGEMENT & QUALITY ASSESSMENTConfirm you agree to the following network management and quality assessment specifications:NETWORK MANAGEMENT & QUALITY ASSESSMENTVENDOR CONFIRMATIONConfirm that safeguards exist for preventing one group's experience from being charged to another.Confirm that you guarantee that the State will be charged the generic price and the member charged the generic copay if a generic is out of stock.Confirm that your organization will comply with all HIPAA regulations and that you provide, upon request, supporting documentation outlining your organizations HIPAA policies and procedures as they relate to management of the prescription benefit plan for the State.Confirm that the State has the ability to pend payments to pharmacies currently identified by the State and reported to PBM as engaging in suspicious dispensing practices.Confirm that you will set a maximum reimbursement dollar limit on all compounded claims and notify the State when the limit is exceeded.Confirm that the State will receive a 90day notice, when possible, of any event or negotiation that may cause a disruption in the retail pharmacy network access.MAIL ORDERConfirm you agree to the following mail order specifications:MAIL ORDERVENDOR CONFIRMATIONConfirm that you will set the threshold for the uncollected member cost share at mail at $100.Confirm that you will be responsible for collection of member cost share and will be at risk for uncollected monies.Respond to the following questions:MAIL ORDERVENDOR RESPONSEComplete the following for your proposed mail order facility for the State:a.Mail-order facility locationb.Days of Operationc.Hours of OperationComplete the following for your proposed mail order facility for the State for CY 2017a.Total Scripts Filledb.Utilization as Percent of Capacityc.Average Turnaround with No Intervention Requiredd.Average Turnaround Intervention RequiredComplete the following for your proposed mail order facility for the State:a.Number of full-time Clinicians/ Pharmacists on staff at facilityb.Number of part-time Clinicians/ Pharmacists on staff at facilityc.Number of Registered Pharmacistsd.Number of Pharmacy Technicianse.Number of Other clinical staff (specify)f.Which organizations are used for delivery services?Does your mail order facility have auto refill?If so, please confirm members will have the ability to turn auto refill ON and OFF via the website and via phone.SPECIALTY PHARMACY PROGRAMConfirm you agree to the following specialty pharmacy program specification:SPECIALTY PHARMACY PROGRAMVENDOR CONFIRMATIONConfirm that members will not incur any additional costs for the delivery of specialty drugs.Confirm the PBM agrees to notify the State and its members at least 60 days prior to the addition of a drug to specialty drug list and at least 90 days prior to a deletion of a drug from the specialty drug list.Confirm the State reserves the right to approve any addition to the specialty drug list.Respond to the following questions:SPECIALTY PHARMACY PROGRAMVENDOR RESPONSECan your organization implement a separate plan design for specialty drugs?Are your proposed guarantees for your retail/mail program contingent upon the State's purchase of your specialty drug program?Based on the State’s prescription drug claims experience for November 1, 2016 through October 31, 2017 (Appendix B), indicate (in the table below) the percent retail and mail prescriptions/AWP that will be considered Specialty Drugs under your proposal and covered under your proposed specialty financial terms in Section mercialEGWPSpecialty Rx’s at Retail as a Percent of all Retail Rx’s%%Specialty AWP at Retail as a Percent of all Retail AWP%%Specialty Rx’s at Mail as a Percent of all Mail Rx’s%%Specialty AWP at Mail as a Percent of all Mail AWP%%Based on the State’s prescription drug claims experience for November 1, 2016 through October 31, 2017 (Appendix B) for prescriptions that were dispensed at retail, and are considered Specialty Drugs under your proposal and your specialty drug program pricing list provided in response to question 2 included under “Specialty Pharmacy Program Pricing” in Section V, what is the weighted average AWP discount for these Specialty Drugs at retail? Provide the weighted average separately for the commercial and EGWP populations.Based on the State’s prescription drug claims experience for November 1, 2016 through October 31, 2017 (Appendix B) for prescriptions that were dispensed at mail, and are considered Specialty Drugs under your proposal and your specialty drug program pricing list provided in response to question 2 included under “Specialty Pharmacy Program Pricing” in Section V, what is the weighted average AWP discount for these Specialty Drugs at mail? Provide the weighted average separately for the commercial and EGWP populations.MEDICARE PART D EGWP PROGRAMConfirm you agree to the following Medicare Part D EGWP program specifications:MEDICARE PART D EGWP PROGRAMVENDOR CONFIRMATIONConfirm that you provided your per-Part D eligible member-per-month administrative fee for EGWP in your response to the Financial Section of this RFP.Confirm that your administrative fee includes all CMS required member communications.Confirm that you and your EGWP product meet all CMS requirements.Confirm that, for each Medicare-eligible Retiree who is age 65 and older, plus any known Medicare-eligible dependents of theirs, who received benefits for Medicare Part D “Covered Drugs”, during the requested data period, you provide aggregate prescription drug data for each individual that contains the following elements (only for claims that are Medicare Part D covered drugs), in an Excel format, to include:a.Unique de-identifiable claimant ID numberb.A unique de-identifiable member ID numberc.Claimant coverage status (disabled active, retired, dependent of retiree)d.Claimant date of birthe.Total claims paid by the Statef.Total drug costs (including dispensing fees and sales tax, but not including admin fees.)g.Total claims paid by the claimanth.Total rebates – If rebates cannot be provided by each individual claimant, rebate information in aggregate for Medicare retirees or total rebates for the State if not separated by eligibility is expected.Respond to the following questions:MEDICARE PART D EGWPVENDOR RESPONSEDescribe how you ensure adequate reporting to the State of the manufacturer rebates retained by the PBM in lieu of administrative fees.How do you propose to submit claims information for drugs that may be payable under either Medicare Part B or D?Do you use the CMS simplified methodology, which allows a plan sponsor to reduce costs by 0.3 percent rather than identifying drugs that could be payable under Part B or D?If not, what other method is used?*If an individual has prescription drug coverage under the State’s Rx plan and also enrolls in another Medicare Part D prescription drug plan, how do you identify such a situation at the point of sale?Do you perform the coordination of benefits at the point of sale or do paper claims have to be submitted?*a.At the point of saleb.Paper claims have to be submittedA PBM (or other administrator) must contractually acknowledge that the information it will provide to the State will be used by the State for the purpose of obtaining federal funds. Provide a copy of your certification language.a.Attachedb.Not attachedPlease indicate whether your firm is currently a CMS approved Medicare Part D prescription drug plan that can contract with plan sponsors to establish and manage EGWPs.Please indicate whether any EGWP functions are sub-contracted to other organizations. If so, please describe.Provide a description of your MTM program including the processes for enrollment, targeting, intervention, and outcomes reporting.Provide your book-of-business prescription drug event (PDE) error rate for 2016 and 2017.Describe the transition process you will utilize for members who are currently using non-formulary prescription drugs, drugs requiring prior authorization, step therapy, and quantity level limits.Describe the enrollment/disenrollment process and include detail regarding the timing of when enrollment/disenrollment changes go into effect. SECTION IX: NETWORK DISRUPTIONRespond to the following questions:Confirm that your proposal is based on your broadest network.What is the current number of retail pharmacies in your network?List any pharmacy chain with over 50 stores that are excluded from your quoted network.Based on all the State’s retail prescriptions during November 1, 2016 through October 31, 2017 (Appendix B), please prepare a “disruption” analysis and complete the following tables for both the commercial and EGWP populations. As indicated, provide the requested information for all pharmacies located within the State of New Hampshire and all pharmacies located outside of New mercial*Retail PharmaciesLocated in theState of NHNOT in theState of NHAll Retail PharmaciesTotal retail pharmacies in claims data:Total count of these retail pharmacies in your network:Total retail prescriptions in claims data:Total retail prescriptions in your network:EGWP*Retail PharmaciesLocated in theState of NHNOT in theState of NHAll Retail PharmaciesTotal retail pharmacies in claims data:Total count of these retail pharmacies in your network:Total retail prescriptions in claims data:Total retail prescriptions in your network:* Your disruption analysis should only include positive retail prescriptions. These claims are indicated:(1) with an “R” in the “MailRetailInd” field; and(2) by a positive “1” in the “ClaimCounter” field.SECTION X: CLIENT REFERENCESProvide the name of your five (5) largest public sector (states, municipalities, etc.) clients for which you provide comparable services as requested in this RFP.For these five clients, provide:Key contact’s name, including phone number and email addressAddressNumber of active members (i.e., employees and dependents)Number of non-Medicare retiree membersNumber of Medicare retiree membersA summary of the services provided by the Vendor to the client The State reserves the right to contact any or all of these clients for references and consider the references’ experiences with the vendor in the Client References score.Additionally, the State also reserves the right to use itself as a reference and consider its own experiences with the vendor in the Client References score. APPENDICES: GROUP INFORMATIONAppendix AREQUESTED PLAN DESIGNSAppendix BDETAILED CLAIMS EXPERIENCEAppendix CMONTHLY ENROLLMENT AND TOP 100 BRAND DRUGSAppendix DPLAN DEVIATIONS FORMAppendix E STATE OF NH TRANSMITTAL LETTERAppendix F P-37 FORM CONTRACTAppendix G BUSINESS ASSOCIATE AGREEMENT Appendix H DATA REQUEST FORMAPPENDIX AREQUESTED PLAN DESIGNS, SERVICES & PROGRAMSPlease see plan design information in the following files attached to this RFP:Active Plan Summary of Benefits are provided for the current plan designs effective since November 1, 2011. Currently, all the active groups have the same plan design.SONH Rx - Active Summary.pdfSONH Rx - Active Booklet.pdfNon-Medicare Retiree Plan Summary of Benefits are provided for the current plan designs effective since January 1, 2016. SONH Rx - Non-Medicare Retiree Summary.pdfSONH Rx - Non-Medicare Retiree Booklet.pdfActive and Non-Medicare Retiree Plans – Additional InformationMail Order Opt Out Program.pdf Express_Scripts_National_Preferred_Formulary_List.pdfExpress_Scripts_Preferred_Drug_List_Exclusions.pdfMedicare Retiree Plan Summary of Benefits are provided for the current plan designs effective since January 1, 2016. SONH Rx - EGWP Benefit Overview.pdfSONH Rx - EGWP Evidence of Coverage Booklet.pdfHISTORIC PLAN CHANGESActive Plan – No plan design changes in the past 5 years. Medicare Retiree Plan – Effective January 1, 2015, transitioned to an EGWP.Retiree Plans (Non-Medicare and Medicare) – Effective January 1, 2016, the below copayment and maximum out-of-pocket changes were implemented for all retirees.Prior toJanuary 1, 2016EffectiveJanuary 1, 2016Retail Pharmacy (31-day supply)Generic Copayment$10$10Preferred Brand Copayment$20$25Non-Preferred Brand Copayment$35$40Mail Order Pharmacy (90-day supply)Generic Copayment$1$10Preferred Brand Copayment$40$50Non-Preferred Brand Copayment$70$80Annual Maximum Out-of-Pocket(retail and mail order combined)$500 individual / $1,000 family$750 individual / $1,500 familyAPPENDIX BInformation below needs to be requestedPlease see Appendix H: Data Request form and contact Danielle Bishop at Danielle.Bishop@ to request this information. Access to this data on the State’s FTP site shall be provided to prospective Vendors who manifest a reasonable likelihood of meeting the minimum qualifications of this RFP. Such likelihood shall be evidenced by the apparent provider network of the prospective Vendor. DETAILED CLAIMS EXPERIENCE FOR REPRICINGText files for both the Commercial and EGWP populations containing the State’s detailed prescription drug claims experience for each prescription dispensed is available upon request. These files contain the following information for all prescriptions dispensed from November 1, 2016 through October 31, 2017.Plan Option*National Drug Code (NDC)Prescription Fill DatePrescription Fill. NumberDays Supply DispensedMetric Units DispensedFormulary IndicatorRetail / Mail IndicatorDAW CodeClaim StatusPharmacy NABP NumberPatient Relationship* The “PlanGroupHierarchy_2” field identifies the Plan Option. The Retiree Plan prescriptions in the Commercial population file have the field values listed in the chart below. (All other field values indicate Active Plan prescriptions.) Retiree PlanRETU65POSRETU65PPORETO65MEDLEGO65RETAPPENDIX CInformation below needs to be requestedPlease see Appendix H: Data Request form. Contact Danielle Bishop at Danielle.Bishop@ to request this information. Access to this data on the State’s FTP site shall be provided to prospective Vendors who manifest a reasonable likelihood of meeting the minimum qualifications of this RFP. Such likelihood shall be evidenced by the apparent provider network of the prospective Vendor. MONTHLY ENROLLMENT AND TOP 100 BRAND DRUGSMonthly enrollment counts from October 2016 to October 2017(tab #1)State’s Commercial top 100 retail brand prescriptions by cost 11/1/2016 – 10/31/2017 (tab #2)State’s Commercial top 100 mail brand prescriptions by cost 11/1/2016 – 10/31/2017 (tab #3)State’s EGWP top 100 retail brand prescriptions by cost 11/1/2016 – 10/31/2017 (tab #4)State’s EGWP top 100 mail brand prescriptions by cost 11/1/2016 – 10/31/2017 (tab #5)APPENDIX DPLAN DEVIATIONS FORMThis form needs to be completed and returned with your proposal in order to be considered in the carrier selection process.Active Plan Design[ ]This is to certify that the submitted proposal includes no deviations to the Active Plan design as outlined in the benefit summaries.Non-Medicare Retiree Plan Design[ ]This is to certify that the submitted proposal includes no deviations to the Non-Medicare Retiree Plan design as outlined in the benefit summaries.Medicare (EGWP) Retiree Plan Design[ ]This is to certify that the submitted proposal includes no deviations to the Medicare Retiree Plan design as outlined in the benefit summaries.All Other Requirements outlined in the RFPImportant: Note that any deviations determined to be material may result in the rejection of the bid.[ ]This is to certify that the submitted proposal adheres to all the requirements outlined in the RFP with the following exceptions:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________[ ]This is to certify that the submitted proposal adheres to all the requirements outlined in the RFP with no deviations.____________________________________ Signature____________________________________ Print Name____________________________________ TitleAPPENDIX ESTATE OF NEW HAMPSHIRE REQUEST FOR PROPOSAL TRANSMITTAL LETTERDate: ___________________ Company Name: ________________________________________Address: __________________________________________________________________________________________________________________To: Point of Contact: Danielle Bishop Telephone: 603-271-3290 RE: Proposal Invitation Name: Pharmacy Benefit Management ServicesRFP Number: 2018-203RFP Posted Date (on or by): December 8, 2017RFP Opening Date and Time: January 19, 2018 at 2:00 PM (ET) [Insert name of signor]_____________________________, on behalf of _____________________________ [insert name of entity submitting RFP(collectively referred to as “Vendor”) hereby submits an offer as contained in the written RFPRFP submitted herewith (“RFP”) to the State of New Hampshire in response to RFP # 2017-192 for Administration of Medical Benefit services at the price(s) quoted herein in complete accordance with the RFP. Vendor attests to the fact that: 1. The Vendor has reviewed and agreed to be bound by all RFP terms and conditions. 2. The Vendor has not altered any of the language or other provisions contained in the RFP document. 3. The RFP is effective for a minimum period of 6 months from the RFP Opening date as indicated above. 4. The prices Vendor has quoted in the proposal were established without collusion with other vendors. 5. The Vendor has read and fully understands this RFP. 6. Further, in accordance with RSA 21-I:11-c, the undersigned Vendor certifies that neither the Vendor nor any of its subsidiaries, affiliates or principal officers (principal officers refers to individuals with management responsibility for the entity or association): Has, within the past 2 years, been convicted of, or pleaded guilty to, a violation of RSA 356:2, RSA 356:4, or any state or federal law or county or municipal ordinance prohibiting specified bidding practices, or involving antitrust violations, which has not been annulled; Has been prohibited, either permanently or temporarily, from participating in any public works project pursuant to RSA 638:20; Has previously provided false, deceptive, or fraudulent information on a vendor code number application form, or any other document submitted to the state of New Hampshire, which information was not corrected as of the time of the filing a bid, proposal, or quotation; Is currently debarred from performing work on any project of the federal government or the government of any state; Has, within the past 2 years, failed to cure a default on any contract with the federal government or the government of any state; Is presently subject to any order of the department of labor, the department of employment security, or any other state department, agency, board, or commission, finding that the applicant is not in compliance with the requirements of the laws or rules that the department, agency, board, or commission is charged with implementing; Is presently subject to any sanction or penalty finally issued by the department of labor, the department of employment security, or any other state department, agency, board, or commission, which sanction or penalty has not been fully discharged or fulfilled; Is currently serving a sentence or is subject to a continuing or unfulfilled penalty for any crime or violation noted in this section; Has failed or neglected to advise the division of any conviction, plea of guilty, or finding relative to any crime or violation noted in this section, or of any debarment, within 30 days of such conviction, plea, finding, or debarment; or Has been placed on the debarred parties list described in RSA 21-I:11-c within the past year. Authorized Signor’s Signature _______________________________ Authorized Signor’s Title ________________________NOTARY PUBLIC/JUSTICE OF THE PEACE COUNTY: ___________________________ STATE: ______________ZIP: _________________ On the _____ day of _______________, 2017, personally appeared before me, the above named ________________________, in his/her capacity as authorized representative of ________________, known to me or satisfactorily proven, and took oath that the foregoing is true and accurate to the best of his/her knowledge and belief. In witness thereof, I hereunto set my hand and official seal. _________________________________________________________ (Notary Public/Justice of the Peace) My commission expires: _________________________________________________________ (Date) Form P37-AAPPENDIX F82867526225500Subject:SAMPLE FORM - TO BE COMPLETED BY SELECTED VENDORFORM NUMBER P-37 (version 5/8/15)752475-51435Notice:This agreement and all of its attachments shall become public upon submission to Governor and Executive Council for approval. Any information that is private, confidential or proprietary must be clearly identified to the agency and agreed to in writing prior to signing the contract.00Notice:This agreement and all of its attachments shall become public upon submission to Governor and Executive Council for approval. Any information that is private, confidential or proprietary must be clearly identified to the agency and agreed to in writing prior to signing the contract.AGREEMENTThe State of New Hampshire and the Contractor hereby mutually agree as follows:GENERAL PROVISIONS1.IDENTIFICATION.State Agency Name1.2 State Agency Address1.3 Contractor NameContractor Address1.5 Contractor Phone Number1.6 Account NumberCompletion Date1.8 Price Limitation1.9 Contracting Officer for State AgencyState Agency Telephone Number1.11 Contractor Signature1.12 Name and Title of Contractor Signatory1.13 Acknowledgement: State of , County of On , before the undersigned officer, personally appeared the person identified in block 1.12, or satisfactorily proven to be the person whose name is signed in block 1.11, and acknowledged that s/he executed this document in the capacity indicated in block 1.12.1.13.1 Signature of Notary Public or Justice of the Peace [Seal] 1.13.2 Name and Title of Notary or Justice of the Peace1.14 State Agency Signature Date:1.15 Name and Title of State Agency Signatory Approval by the N.H. Department of Administration, Division of Personnel (if applicable) By: Director, On: Approval by the Attorney General (Form, Substance and Execution) (if applicable) By: On: Approval by the Governor and Executive Council By: On: 2. EMPLOYMENT OF CONTRACTOR/SERVICES TO BE PERFORMED. The State of New Hampshire, acting through the agency identified in block 1.1 (“State”), engages contractor identified in block 1.3 (“Contractor”) to perform, and the Contractor shall perform, the work or sale of goods, or both, identified and more particularly described in the attached EXHIBIT A which is incorporated herein by reference (“Services”).3. EFFECTIVE DATE/COMPLETION OF SERVICES. 3.1 Notwithstanding any provision of this Agreement to the contrary, and subject to the approval of the Governor and Executive Council of the State of New Hampshire, if applicable, this Agreement, and all obligations of the parties hereunder, shall become effective on the date the Governor and Executive Council approve this Agreement as indicated in block 1.18, unless no such approval is required, in which case the Agreement shall become effective on the date the Agreement is signed by the State Agency as shown in block 1.14 (“Effective Date”).3.2 If the Contractor commences the Services prior to the Effective Date, all Services performed by the Contractor prior to the Effective Date shall be performed at the sole risk of the Contractor, and in the event that this Agreement does not become effective, the State shall have no liability to the Contractor, including without limitation, any obligation to pay the Contractor for any costs incurred or Services performed. Contractor must complete all Services by the Completion Date specified in block 1.7.4. CONDITIONAL NATURE OF AGREEMENT. Notwithstanding any provision of this Agreement to the contrary, all obligations of the State hereunder, including, without limitation, the continuance of payments hereunder, are contingent upon the availability and continued appropriation of funds, and in no event shall the State be liable for any payments hereunder in excess of such available appropriated funds. In the event of a reduction or termination of appropriated funds, the State shall have the right to withhold payment until such funds become available, if ever, and shall have the right to terminate this Agreement immediately upon giving the Contractor notice of such termination. The State shall not be required to transfer funds from any other account to the Account identified in block 1.6 in the event funds in that Account are reduced or unavailable.5. CONTRACT PRICE/PRICE LIMITATION/ PAYMENT.5.1 The contract price, method of payment, and terms of payment are identified and more particularly described in EXHIBIT B which is incorporated herein by reference.5.2 The payment by the State of the contract price shall be the only and the complete reimbursement to the Contractor for all expenses, of whatever nature incurred by the Contractor in the performance hereof, and shall be the only and the complete compensation to the Contractor for the Services. The State shall have no liability to the Contractor other than the contract price.5.3 The State reserves the right to offset from any amounts otherwise payable to the Contractor under this Agreement those liquidated amounts required or permitted by N.H. RSA 80:7 through RSA 80:7c or any other provision of law.5.4 Notwithstanding any provision in this Agreement to the contrary, and notwithstanding unexpected circumstances, in no event shall the total of all payments authorized, or actually made hereunder, exceed the Price Limitation set forth in block 1.8.6. COMPLIANCE BY CONTRACTOR WITH LAWS AND REGULATIONS/ EQUAL EMPLOYMENT OPPORTUNITY.6.1 In connection with the performance of the Services, the Contractor shall comply with all statutes, laws, regulations, and orders of federal, state, county or municipal authorities which impose any obligation or duty upon the Contractor, including, but not limited to, civil rights and equal opportunity laws. This may include the requirement to utilize auxiliary aids and services to ensure that persons with communication disabilities, including vision, hearing and speech, can communicate with, receive information from, and convey information to the Contractor. In addition, the Contractor shall comply with all applicable copyright laws.6.2 During the term of this Agreement, the Contractor shall not discriminate against employees or applicants for employment because of race, color, religion, creed, age, sex, handicap, sexual orientation, or national origin and will take affirmative action to prevent such discrimination.6.3 If this Agreement is funded in any part by monies of the United States, the Contractor shall comply with all the provisions of Executive Order No. 11246 (“Equal Employment Opportunity”), as supplemented by the regulations of the United States Department of Labor (41 C.F.R. Part 60), and with any rules, regulations and guidelines as the State of New Hampshire or the United States issue to implement these regulations. The Contractor further agrees to permit the State or United States access to any of the Contractor’s books, records and accounts for the purpose of ascertaining compliance with all rules, regulations and orders, and the covenants, terms and conditions of this Agreement.7. PERSONNEL.7.1 The Contractor shall at its own expense provide all personnel necessary to perform the Services. The Contractor warrants that all personnel engaged in the Services shall be qualified to perform the Services, and shall be properly licensed and otherwise authorized to do so under all applicable laws.7.2 Unless otherwise authorized in writing, during the term of this Agreement, and for a period of six (6) months after the Completion Date in block 1.7, the Contractor shall not hire, and shall not permit any subcontractor or other person, firm or corporation with whom it is engaged in a combined effort to perform the Services to hire, any person who is a State employee or official, who is materially involved in the procurement, administration or performance of this Agreement. This provision shall survive termination of this Agreement.7.3 The Contracting Officer specified in block 1.9, or his or her successor, shall be the State’s representative. In the event of any dispute concerning the interpretation of this Agreement, the Contracting Officer’s decision shall be final for the State.8. EVENT OF DEFAULT/REMEDIES.8.1 Any one or more of the following acts or omissions of the Contractor shall constitute an event of default hereunder (“Event of Default”):8.1.1 failure to perform the Services satisfactorily or on schedule; 8.1.2 failure to submit any report required hereunder; and/or8.1.3 failure to perform any other covenant, term or condition of this Agreement.8.2 Upon the occurrence of any Event of Default, the State may take any one, or more, or all, of the following actions:8.2.1 give the Contractor a written notice specifying the Event of Default and requiring it to be remedied within, in the absence of a greater or lesser specification of time, thirty (30) days from the date of the notice; and if the Event of Default is not timely remedied, terminate this Agreement, effective two (2) days after giving the Contractor notice of termination; 8.2.2 give the Contractor a written notice specifying the Event of Default and suspending all payments to be made under this Agreement and ordering that the portion of the contract price which would otherwise accrue to the Contractor during the period from the date of such notice until such time as the State determines that the Contractor has cured the Event of Default shall never be paid to the Contractor; 8.2.3 set off against any other obligations the State may owe to the Contractor any damages the State suffers by reason of any Event of Default; and/or8.2.4 treat the Agreement as breached and pursue any of its remedies at law or in equity, or both.9. DATA/ACCESS/CONFIDENTIALITY/ PRESERVATION.9.1 As used in this Agreement, the word “data” shall mean all information and things developed or obtained during the performance of, or acquired or developed by reason of, this Agreement, including, but not limited to, all studies, reports, files, formulae, surveys, maps, charts, sound recordings, video recordings, pictorial reproductions, drawings, analyses, graphic representations, computer programs, computer printouts, notes, letters, memoranda, papers, and documents, all whether finished or unfinished.9.2 All data and any property which has been received from the State or purchased with funds provided for that purpose under this Agreement, shall be the property of the State, and shall be returned to the State upon demand or upon termination of this Agreement for any reason.9.3 Confidentiality of data shall be governed by N.H. RSA chapter 91A or other existing law. Disclosure of data requires prior written approval of the State.10. TERMINATION. In the event of an early termination of this Agreement for any reason other than the completion of the Services, the Contractor shall deliver to the Contracting Officer, not later than fifteen (15) days after the date of termination, a report (“Termination Report”) describing in detail all Services performed, and the contract price earned, to and including the date of termination. The form, subject matter, content, and number of copies of the Termination Report shall be identical to those of any Final Report described in the attached EXHIBIT A.11. CONTRACTOR’S RELATION TO THE STATE. In the performance of this Agreement the Contractor is in all respects an independent contractor, and is neither an agent nor an employee of the State. Neither the Contractor nor any of its officers, employees, agents or members shall have authority to bind the State or receive any benefits, workers’ compensation or other emoluments provided by the State to its employees.12. ASSIGNMENT/DELEGATION/SUBCONTRACTS. The Contractor shall not assign, or otherwise transfer any interest in this Agreement without the prior written notice and consent of the State. None of the Services shall be subcontracted by the Contractor without the prior written notice and consent of the State.13. INDEMNIFICATION. The Contractor shall defend, indemnify and hold harmless the State, its officers and employees, from and against any and all losses suffered by the State, its officers and employees, and any and all claims, liabilities or penalties asserted against the State, its officers and employees, by or on behalf of any person, on account of, based or resulting from, arising out of (or which may be claimed to arise out of) the acts or omissions of the Contractor. Notwithstanding the foregoing, nothing herein contained shall be deemed to constitute a waiver of the sovereign immunity of the State, which immunity is hereby reserved to the State. This covenant in paragraph 13 shall survive the termination of this Agreement.14. INSURANCE.14.1 The Contractor shall, at its sole expense, obtain and maintain in force, and shall require any subcontractor or assignee to obtain and maintain in force, the following insurance:14.1.1 comprehensive general liability insurance against all claims of bodily injury, death or property damage, in amounts of not less than $1,000,000per occurrence and $2,000,000 aggregate ; and14.1.2 special cause of loss coverage form covering all property subject to subparagraph 9.2 herein, in an amount not less than 80% of the whole replacement value of the property.14.2 The policies described in subparagraph 14.1 herein shall be on policy forms and endorsements approved for use in the State of New Hampshire by the N.H. Department of Insurance, and issued by insurers licensed in the State of New Hampshire. 14.3 The Contractor shall furnish to the Contracting Officer identified in block 1.9, or his or her successor, a certificate(s) of insurance for all insurance required under this Agreement. Contractor shall also furnish to the Contracting Officer identified in block 1.9, or his or her successor, certificate(s) of insurance for all renewal(s) of insurance required under this Agreement no later than thirty (30) days prior to the expiration date of each of the insurance policies. The certificate(s) of insurance and any renewals thereof shall be attached and are incorporated herein by reference. Each certificate(s) of insurance shall contain a clause requiring the insurer to provide the Contracting Officer identified in block 1.9, or his or her successor, no less than thirty (30) days prior written notice of cancellation or modification of the policy.15. WORKERS’ COMPENSATION.15.1 By signing this agreement, the Contractor agrees, certifies and warrants that the Contractor is in compliance with or exempt from, the requirements of N.H. RSA chapter 281-A (“Workers’ Compensation”). 15.2 To the extent the Contractor is subject to the requirements of N.H. RSA chapter 281-A, Contractor shall maintain, and require any subcontractor or assignee to secure and maintain, payment of Workers’ Compensation in connection with activities which the person proposes to undertake pursuant to this Agreement. Contractor shall furnish the Contracting Officer identified in block 1.9, or his or her successor, proof of Workers’ Compensation in the manner described in N.H. RSA chapter 281-A and any applicable renewal(s) thereof, which shall be attached and are incorporated herein by reference. The State shall not be responsible for payment of any Workers’ Compensation premiums or for any other claim or benefit for Contractor, or any subcontractor or employee of Contractor, which might arise under applicable State of New Hampshire Workers’ Compensation laws in connection with the performance of the Services under this Agreement. 16. WAIVER OF BREACH. No failure by the State to enforce any provisions hereof after any Event of Default shall be deemed a waiver of its rights with regard to that Event of Default, or any subsequent Event of Default. No express failure to enforce any Event of Default shall be deemed a waiver of the right of the State to enforce each and all of the provisions hereof upon any further or other Event of Default on the part of the Contractor.17. NOTICE. Any notice by a party hereto to the other party shall be deemed to have been duly delivered or given at the time of mailing by certified mail, postage prepaid, in a United States Post Office addressed to the parties at the addresses given in blocks 1.2 and 1.4, herein.18. AMENDMENT. This Agreement may be amended, waived or discharged only by an instrument in writing signed by the parties hereto and only after approval of such amendment, waiver or discharge by the Governor and Executive Council of the State of New Hampshire unless no such approval is required under the circumstances pursuant to State law, rule or policy.19. CONSTRUCTION OF AGREEMENT AND TERMS. This Agreement shall be construed in accordance with the laws of the State of New Hampshire, and is binding upon and inures to the benefit of the parties and their respective successors and assigns. The wording used in this Agreement is the wording chosen by the parties to express their mutual intent, and no rule of construction shall be applied against or in favor of any party. 20. THIRD PARTIES. The parties hereto do not intend to benefit any third parties and this Agreement shall not be construed to confer any such benefit.21. HEADINGS. The headings throughout the Agreement are for reference purposes only, and the words contained therein shall in no way be held to explain, modify, amplify or aid in the interpretation, construction or meaning of the provisions of this Agreement.22. SPECIAL PROVISIONS. Additional provisions set forth in the attached EXHIBIT C are incorporated herein by reference.23. SEVERABILITY. In the event any of the provisions of this Agreement are held by a court of competent jurisdiction to be contrary to any state or federal law, the remaining provisions of this Agreement will remain in full force and effect.24. ENTIRE AGREEMENT. This Agreement, which may be executed in a number of counterparts, each of which shall be deemed an original, constitutes the entire Agreement and understanding between the parties, and supersedes all prior Agreements and understandings relating hereto.APPENDIX GNote: Below is the State’s current Business Associate Agreement (BAA). The Selected Vendor will be required to sign the State’s BAA when executing the contract.The Contractor identified in Section 1.3 of the General Provisions of the Agreement agrees to comply with the Health Insurance Portability and Accountability Act, Public Law 104-191 and with the Standards for Privacy and Security of Individually Identifiable Health Information, 45 CFR Parts 160 and 164 and those parts of the HITECH Act applicable to business associates. As defined herein, “Business Associate” shall generally have the same meaning as the term “business associate” at 45 CFR 160.103, and in reference to the party to this Agreement, shall mean Contractor. “Covered Entity” shall generally have the same meaning as the term “covered entity” at 45 CFR 160.103, and in reference to the party to this Agreement shall mean the State of New Hampshire Department of Administrative Services Employee and Retiree Health Benefit Program. “HIPAA Rules” shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164.BUSINESS ASSOCIATE AGREEMENTDefinitionsThe following terms used in this Agreement shall have the same meaning as those terms in the HIPAA Rules: Breach, Data Aggregation, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, Protected Health Information, Required By Law, Secretary, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use.All terms not otherwise defined herein shall have the same meaning as those set forth in the HIPAA Rules.Privacy and Security of Protected Health Information (PHI)Permitted Uses and DisclosuresBusiness Associate shall not use, disclose, maintain or transmit PHI except as reasonably necessary to provide the services set forth in this Agreement or any agreement between the parties, or as required by law. Business Associate is authorized to use PHI to de-identify the information in accordance with 45 CFR 164.514(a)-(c). Business Associate shall de-identify the PHI in a manner consistent with HIPAA Rules. Uses and disclosures of the de-identified information shall be limited to those consistent with the provisions of this Agreement.Business Associate may use PHI as necessary to perform data aggregation services, and to create Summary Health Information and/or Limited Data Sets. Contractor shall use appropriate safeguards to prevent use or disclosure of the information other than as provided for herein, shall ensure that any agents or subcontractors to whom it provides such information agree to the same restrictions and conditions that apply to Contractor, and not identify the Summary Health Information and/or Limited Data Sets or contact the individuals other than for the management, operation and administration of the Plan.Business Associate may use and disclose PHI (a) for the management, operation and administration of the Plan, (b) for the services set forth in the Agreement, which include (but are not limited to) Treatment, Payment activities, and/or Pharmacy Benefit Management as these terms are defined in this Agreement and 45 C.F.R. § 164.501, and (c) as otherwise required to perform its obligations under this Agreement, or any other agreement between the parties provided that such use or disclosure would not violate the HIPAA Regulations.Business Associate may disclose, in conformance with the HIPAA Rules, PHI to make disclosures of De-identified Health Information, Limited Data Sets, and Summary Health Information. Contractor shall use appropriate safeguards to prevent use or disclosure of the information other than as provided for herein, ensure that any agents or subcontractors to whom it provides such information agree to the same restrictions and conditions that apply to Contractor, and not identify the De-identified Health Information., Summary Health Information and/or Limited Data Sets or contact the individuals. Business Associate may also disclose, in conformance with the HIPAA Regulations, PHI to Health Care Providers for permitted purposes including health care operations.Business Associate may use PHI for the proper management and administration of the Business Associate or to carry out the legal responsibilities of Business Associate. To the extent Business Associate discloses PHI to a third party, Business Associate must obtain, prior to making any such disclosure, (a) reasonable assurances from the third party that such PHI will be held confidentially and used or further disclosed only as required by law or for the purpose for which it was disclosed to the third party; and (b) an agreement from such third party to notify Business Associate of any breaches of the confidentiality of the PHI, to the extent it has obtained knowledge of such breach.To the extent practicable, Business Associate shall not, unless such disclosure is reasonably necessary to provide services outlined in the Agreement, disclose any PHI in response to a request for disclosure on the basis it is required by law without first notifying Covered Entity. In the event Covered Entity objects to the disclosure it shall seek the appropriate relief and the Business Associate shall refrain from disclosing the PHI until Covered Entity has exhausted all remedies.Minimum Necessary. Business Associate will, in its performance of the functions, activities, services, and operations specified above, make reasonable efforts to use, to disclose, and to request only the minimum amount of PHI reasonably necessary to accomplish the intended purpose of the use, disclosure, or request, except that Business Associate will not be obligated to comply with this minimum-necessary limitation if neither Business Associate or Covered Entity is required to limit its use, disclosure, or request to the minimum necessary under the HIPAA Rules. Business Associate and Covered Entity acknowledge that the phrase “minimum necessary” shall be interpreted in accordance with the HITECH Act and the HIPAA Rules.Prohibition on Unauthorized Use or Disclosure. Business Associate may not use or disclose PHI except (1) as permitted or required by this Agreement, or any other agreement between the parties, (2) as permitted in writing by Covered Entity, or (3) as authorized by the individual or (4) as Required by Law. This agreement does not authorize Business Associate to use or disclose Covered Entity’s PHI in a manner that would violate the HIPAA Rules if done by Covered Entity, except as permitted for Business Associate’s proper management and administration as described rmation SafeguardsPrivacy of Protected Health Information. Business Associate will develop, implement, maintain, and use appropriate administrative, technical, and physical safeguards to protect the privacy of PHI. The safeguards must reasonably protect PHI from any intentional or unintentional use or disclosure in violation of the Privacy Rule and limit incidental uses or disclosures made pursuant to a use or disclosure otherwise permitted by this Agreement. To the extent the parties agree that the Business Associate will carry out directly one or more of Covered Entity’s obligations under the Privacy Rule, the Business Associate will comply with the requirements of the Privacy Rule that apply to the Covered Entity in the performance of such obligations.Security of Covered Entity’s Electronic Protected Health Information. Business Associate will comply with the Security Rule and will use appropriate administrative, technical and physical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of Electronic PHI that Business Associate creates, receives, maintains or transmits on Covered Entity’s behalf.No Transfer of PHI Outside United States. Business Associate will not transfer PHI outside the United States without the prior written consent of the Covered Entity. In this context a “transfer” outside the United States occurs if Business Associate’s workforce members, agents, or Subcontractors physically located outside the United States are able to, store, copy or disclose PHI.Subcontractors. Business Associate will require each of its Subcontractors to agree, in a written agreement with Business Associate, to comply with the provisions of the Security Rule; to appropriately safeguard PHI created, received, maintained, or transmitted on behalf of the Business Associate; and to apply the same restrictions and conditions that apply to the Business Associate with respect to such PHI.Prohibition on Sale of Protected Health Information. Business Associate shall not engage in any sale (as defined in the HIPAA rules) of PHI.Prohibition on Use or Disclosure of Genetic Information. Business Associate shall not use or disclose Genetic Information for underwriting purposes in violation of the HIPAA rules.Penalties for Noncompliance. Business Associate acknowledges that it is subject to civil and criminal enforcement for failure to comply with the HIPAA Rules, to the extent provided with the HITECH Act and the HIPAA pliance With Electronic Transactions RuleIf Business Associate conducts in whole or part electronic Transactions on behalf of Covered Entity for which HHS has established standards, Business Associate will comply, and will require any Subcontractor it involves with the conduct of such Transactions to comply, with each applicable requirement of the Electronic Transactions Rule and of any operating rules adopted by HHS with respect to Transactions.Individual Rights and PHI AccessBusiness Associate shall respond to an individual’s request for access to his or her PHI as part of Business Associate’s normal customer service function, if the request is communicated to Business Associate directly by the individual or the individual’s personal representative. Business Associate shall respond to the request with regard to PHI that Business Associate and/or its Subcontractors maintain in a manner and time frame consistent with requirements specified in the HIPAA Privacy Regulation.In addition, Business Associate shall assist Covered Entity in responding to requests made to Covered Entity by individuals to invoke a right of access under the HIPAA Privacy Regulation. Upon receipt of written notice (including fax and email) from Covered Entity, Business Associate shall make available to Covered Entity, or at Covered Entity’s direction to the individual (or the individual’s personal representative), any PHI about the individual created or received for or from Covered Entity in the control of Business Associate’s and/or its Subcontractors for inspection and obtaining copies so that Covered Entity may meet its access obligations under 45 CFR 164.524, and, where applicable, the HITECH Act. Business Associate shall make such information available in an electronic format where required by the HITECH Act.AmendmentBusiness Associate shall respond to an individual’s request to amend his or her PHI as part of Business Associate’s normal customer service functions, if the request is communicated to Business Associate directly by the individual or the individual’s personal representative. Business Associate shall respond to the request with respect to the PHI Business Associate and its Subcontractors maintain in a manner and time frame consistent with requirements specified in the HIPAA Privacy Regulation.In addition, Business Associate shall assist Covered Entity in responding to requests made to Covered Entity to invoke a right to amend under the HIPAA Privacy Regulation. Upon receipt of written notice (including fax and email) from Covered Entity, Business Associate shall amend any portion of the PHI created or received for or from Covered Entity in the custody or control of Business Associate and/or its Subcontractors so that Covered Entity may meet its amendment obligations under 45 CFR 164.526.Disclosure AccountingBusiness Associate shall respond to an individual’s request for an accounting of disclosures of his or her PHI as part of Business Associate’s normal customer service function, if the request is communicated to the Business Associate directly by the individual or the individual’s personal representative. Business Associate shall respond to a request with respect to the PHI Business Associate and its Subcontractors maintain in a manner and time frame consistent with requirements specified in the HIPAA Privacy Regulation.In addition, Business Associate shall assist Covered Entity in responding to requests made to Covered Entity by individuals or their personal representatives to invoke a right to an accounting of disclosures under the HIPAA Privacy Regulation by performing the following functions so that Covered Entity may meet its disclosure accounting obligation under 45 CFR 164.528:Disclosure Tracking. Business Associate shall record each disclosure that Business Associate makes of individuals’ PHI, which is not excepted from disclosure accounting under 45 CFR 164.528(a)(1).Disclosure Information. The information about each disclosure that Business Associate must record (“Disclosure Information”) is (a) the disclosure date, (b) the name and (if known) address of the person or entity to whom Business Associate made the disclosure, (c) a brief description of the PHI disclosed, and (d) a brief statement of the purpose of the disclosure or a copy of any written request for disclosure under 45 Code of Federal Regulations §164.502(a)(2)(ii) or §164.512. Disclosure Information also includes any information required to be provided by the HITECH Act.Repetitive Disclosures. For repetitive disclosures of individuals’ PHI that Business Associate makes for a single purpose to the same person or entity (including to Covered Entity or Employer), Business Associate may record (a) the Disclosure Information for the first of these repetitive disclosures, (b) the frequency, periodicity or number of these repetitive disclosures, and (c) the date of the last of these repetitive disclosures.Exceptions from Disclosure Tracking. Business Associate will not be obligated to record Disclosure Information or otherwise account for disclosures of PHI if Covered Entity need not account for such disclosures under the HIPAA Rules.Disclosure Tracking Time Periods. Unless otherwise provided by the HITECH Act and/or any accompanying regulations, Business Associate shall have available for Covered Entity the Disclosure Information required by Section 3.j.iii.2 above for the six (6) years immediately preceding the date of Covered Entity’s request for the Disclosure Information.Confidential CommunicationsBusiness Associate shall respond to an individual’s request for a confidential communication as part of Business Associate’s normal customer service function, if the request is communicated to Business Associate directly by the individual or the individual’s personal representative. Business Associate shall respond to the request with respect to the PHI Business Associate and its Subcontractors maintain in a manner and time frame consistent with requirements specified in the HIPAA Privacy Regulation. If an individual’s request, made to Business Associate, extends beyond information held by Business Associate or Business Associate’s Subcontractors, Business Associate shall refer individual to Covered Entity. Business Associate assumes no obligation to coordinate any request for a confidential communication of PHI maintained by other business associates of Covered Entity.In addition, Business Associate shall assist Covered Entity in responding to requests to it by individuals (or their personal representatives) to invoke a right of confidential communication under the HIPAA Privacy Regulation. Upon receipt of written notice (including fax and email) from Covered Entity, Business Associate will begin to send all communications of PHI directed to the individual to the identified alternate address so that Covered Entity may meet its access obligations under 45 CFR?164.524.RestrictionsBusiness Associate shall respond to an individual’s request for a restriction as part of Business Associate’s normal customer service function, if the request is communicated to Business Associate directly by the individual (or the individual’s personal representative). Business Associate shall respond to the request with respect to the PHI Business Associate and its Subcontractors maintain in a manner and time frame consistent with requirements specified in the HIPAA Privacy Regulation.In addition, Business Associate shall promptly, upon receipt of notice from Covered Entity, restrict the use or disclosure of individuals’ PHI, provided the Business Associate has agreed to such a restriction. Covered Entity agrees that it will not commit Business Associate to any restriction on the use or disclosure of individuals’ PHI for treatment, payment or health care operations without Business Associate’s prior written approval.BreachBusiness Associate shall report to Covered Entity, in writing, any use or disclosure of PHI in violation of the Agreement promptly upon discovery of such incident, including any Security Incident involving PHI, ePHI, or Unsecured PHI as required by 45 CFR 164.410. Such report shall not include instances where Business Associate inadvertently misroutes PHI to a provider, as long as the disclosure is not a Breach as defined under 45 CFR §164.402. The parties acknowledge and agree that attempted but Unsuccessful Security Incidents (as defined below) that occur on a daily basis will not be reported. “Unsuccessful Security Incidents” shall include, but not be limited to, pings and other broadcast attacks on Business Associate’s firewall, port scans, unsuccessful log-on attempts, denials of service and any combination of the above, so long as no such incident results in unauthorized access, use or disclosure of PHI.Business Associate shall report a Breach or a potential Breach to Covered Entity upon discovery of any such incident. Business Associate will treat a Breach or potential Breach as being discovered as of the first day on which such incident is known to Business Associate, or by exercising reasonable diligence, would have been known to Business Associate. Business Associate shall be deemed to have knowledge of a Breach or potential Breach if such incident is known, or by exercising reasonable diligence would have been known, to any person, other than the person committing the Breach, who is an employee, officer or other agent of Business Associate. If a delay is requested by a law-enforcement official in accordance with 45 CFR § 164.412, Business Associate may delay notifying Covered Entity for the applicable time period. Business Associate’s report will include at least the following, provided that absence of any information will not be cause for Business Associate to delay the report:Identify the nature of the Breach, which will include a brief description of what happened, including the date of any Breach and the date of the discovery of any Breach; Identify the scope of the Breach, including the number of Covered Entity members involved as well as the number of other individuals involved;Identify the types of PHI that were involved in the Breach (such as whether full name, Social Security number, date of birth, home address, account number, diagnosis, or other information were involved);Identify who made the non-permitted use or disclosure and who received the non-permitted disclosure;Identify what corrective or investigational action Business Associate took or will take to prevent further non-permitted uses or disclosures, to mitigate harmful effects, and to protect against any further Breaches;Identify what steps the individuals who were subject to a Breach should take to protect themselves;Provide such other information as Covered Entity may reasonably request.Security Incident. Business Associate will promptly upon discovery of such incident report to Covered Entity any Security Incident of which Business Associate becomes aware. Business Associate will treat a Security Incident as being discovered as of the first day on which such incident is known to Business Associate, or by exercising reasonable diligence, would have been known to Business Associate. Business Associate shall be deemed to have knowledge of a Security Incident if such incident is known, or by exercising reasonable diligence would have been known, to any person, other than the person committing the Security Incident, who is an employee, officer or other agent of Business Associate. If any such Security Incident resulted in a disclosure not permitted by this Agreement or Breach of Unsecured PHI, Business Associate will make the report in accordance with the provisions set forth above.Mitigation. Business Associate shall mitigate, to the extent practicable, any harmful effect known to the Business Associate resulting from a use or disclosure in violation of this Agreement.Breach Notification to Third Parties. Business Associate will handle breach notifications to individuals, the United States Department of Health and Human Services Office for Civil Rights, and, where applicable, the media. Should such notification be necessary, Business Associate will ensure that Covered Entity will receive notice of the breach prior to such incident being reported.Term and TerminationThe term of this Agreement shall be effective as of ___________, or Governor and Executive Council approval, and shall terminate on ____________ or on the date covered entity terminates for cause as authorized in paragraph (b) of this Section, whichever is sooner.In addition to general provision #10 of this Agreement the Covered Entity may, as soon as administratively feasible, terminate the Agreement upon Covered Entity’s knowledge of a material breach by Business Associate of the Business Associate Agreement set forth herein as Appendix ___. Prior to terminating the Agreement, the Covered Entity may provide an opportunity for Business Associate to cure the alleged breach within a reasonable timeframe specified by Covered Entity. If Covered Entity determines that neither termination nor cure is feasible, Covered Entity may report the violation to the Secretary.Upon termination of this Agreement for any reason, Business Associate, with respect to PHI received from Covered Entity, or created, maintained or received by Business Associate on behalf of Covered Entity, shall:Retain only that PHI which is necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities;Destroy, in accordance with applicable law and Business Associate’s record retention policy that it applies to similar records, the remaining PHI that Business Associate still maintains in any form;Continue to use appropriate safeguards and comply with Subpart C of 45 CFR Part 164 with respect to electronic PHI to prevent use or disclosure of the PHI, other than as provided for in this Section, for as long as Business Associate retains the PHI;Not use or disclose the PHI retained by Business Associate other than for the purposes for which such PHI was retained and subject to the same conditions set out in this Agreement which applied prior to termination; andDestroy in accordance with applicable law and Business Associate’s record retention policy that it applies to similar records, the PHI retained by Business Associate when it is no longer needed by Business Associate for its proper management and administration or to carry out its legal responsibilities.The above provisions shall apply to PHI that is in the possession of any Subcontractors of Business Associate. Further Business Associate shall require any such Subcontractor to certify to Business Associate that it has returned or destroyed all such information which could be returned or destroyed. Business Associate’s obligations under this Section 7.c. shall survive the termination or other conclusion of this Agreement.Covered Entity’s ResponsibilitiesCovered Entity shall be responsible for the preparation of its Notice of Privacy Practices (“NPP”). To facilitate this preparation, upon Covered Entity’s request, Business Associate will provide Covered Entity with its NPP that Covered Entity may use as the basis for its own NPP. Covered Entity will be solely responsible for the review and approval of the content of its NPP, including whether its content accurately reflects Covered Entity’s privacy policies and practices, as well as its compliance with the requirements of 45 C.F.R. § 164.520. Unless advance written approval is obtained from Business Associate, Covered Entity shall not create any NPP that imposes obligations on Business Associate that are in addition to or that are inconsistent with the HIPAA Rules.Covered Entity shall bear full responsibility for distributing its own NPP.Covered Entity shall notify Business Associate of any change(s) in, or revocation of, permission by an Individual to use or disclose PHI, to the extent that such change(s) may affect Business Associate’s use or disclosure of such PHI.MiscellaneousDefinitions and Regulatory References. All terms used, but not otherwise defined herein, shall have the same meaning as those terms in the HIPAA Rules as in effect or as amended. Amendment. Covered Entity and Business Associate agree to take action to amend the Agreement as is necessary for compliance with the requirements of the HIPAA Rules and any other applicable law. Business Associate shall make available all of its internal practices, policies and procedures, books, records and agreements relating to its use and disclosure of Protected Health Information to the United States Department of Health and Human Services as necessary, to determine compliance with the HIPAA Rules and with this Appendix ___.Interpretation. The parties agree that any ambiguity in the Agreement shall be interpreted to permit compliance with the HIPAA Rules.Severability. If any term or condition of this Appendix ___ or the application thereof to any person(s) or circumstance is held invalid, such invalidity shall not affect other terms or conditions which can be given effect without the invalid term or condition; to this end the terms and conditions of this Appendix ___ are declared severable. Survival. Provisions in this Appendix ___ regarding the use and disclosure of PHI, return or destruction of PHI, confidential communications and restrictions shall survive the termination of the Agreement.IN WITNESS WHEREOF, the parties hereto have duly executed this Appendix ___.The State of New Hampshire Employee and Retiree Health Benefit ProgramContractor Signature of Authorized RepresentativeSignature of Authorized RepresentativeName of Authorized RepresentativeName of Authorized RepresentativeTitle of Authorized RepresentativeTitle of Authorized RepresentativeDateDateAPPENDIX HData Request formDataDetailed Claims Experience for RepricingMonthly Enrollment CountsTop 100 Retail Brand PrescriptionsTop 100 Mail Brand PrescriptionsTo obtain the RFP data, please complete this Data Request Form and send to Danielle Bishop at Danielle.Bishop@.Data Request FormWe confirm that we are requesting this information for the sole purpose of responding to the State of New Hampshire’s Administration of Pharmacy Benefits RFP. As a recipient of this information, we will not use or disclose this information for any other purpose than to respond to the State's RFP. We will destroy this information upon the completion of the RFP process. We confirm that our bid will meet the Minimum Qualifications identified in Section II.C of this RFP document.We confirm: We are requesting this information for the sole purpose of responding to the State’s RFP; Our bid will meet the Minimum Qualifications and are prepared to provide documentation supporting this claim, if requested by the State, in order to receive the RFP data file; andOur bid will include complete response to all sections of this RFP.Signed:Print Name:Title:Phone Number: ................
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