Welcome to NYC.gov | City of New York



REQUEST FOR PROPOSALS FORPHARMACY BENEFITS MANAGER SERVICES FOR THE PICA PROGRAMFOR CITY OF NEW YORK EMPLOYEES AND RETIREES,AND THEIR DEPENDENTSe-PIN 00217P0005Attachment CPICA RFP QuestionnaireT.1 Experience:Describe the successful relevant experience of the Proposer and the proposed key staff in providing the work described in the Scope of Services section of this RFP. Specifically provide the following information:T.1.1 Please complete the table below regarding your organization:??CY 2016Total BusinessCY 2016 Public Sector EntitiesCY 2016 Union Welfare FundsTotal Number of Covered LivesTotal Number of Scripts DispensedTotal AWP Dollars ProcessedTotal Number of Client AccountsTotal Number of Client Accounts/Groups with Over 100,000 covered lives (excluding health plans)Total Number of Client Accounts/Groups with Over 500,000 covered lives (excluding health plans)Major Owners of the OrganizationT.1.2 Provide any significant updates to the chart above for 2016.T.1.3 Confirm that the Proposer has at least 5 years’ experience in administering pharmacy benefits manager services.T.1.4 Provide a sample list of clients to whom the Proposer provides pharmacy benefits manager services and note, in particular, public sector employers and union welfare funds.T.1.5 Provide the number and names of clients acquired and lost during the last three (3) calendar years, as well as the clients lost and acquired during the first six (6) months of 2016. Indicate your national member retention percentage in 2015.T.1.6 Include a listing of at least three relevant references, including the name of the reference entity, a brief statement describing the relationship between the Proposer as applicable, and the reference entity, and the name, title, e-mail address and telephone number of a contact person at the reference entity, for the Proposer. T.1.7 Please complete the chart below with regard to your proposed account management and members’ services teams for the Plan:?Name/TitleYears of PBM ExperienceNumber of Assigned AccountsLocationRole DescriptionStrategic Account ExecutiveAccount ManagerImplementation ManagerClinical PharmacistsT.1.7 Please complete the chart below with regard to personnel turnover in the Proposer’s organization.?CY 2016Overall Book-of-BusinessCall Center RepresentativesStrategic Account ExecutivesAccount ManagersClient-Facing Clinical PharmacistsT.1.8 Indicate whether the Proposer anticipates any changes in the next year regarding key personnel in the organization.T.2 Organizational Capability:Demonstrate the Proposer’s organizational (i.e., technical, managerial and financial) capability to provide the work described in the Scope of Services section. Specifically address the following:T.2.1 Describe your organization's unique strengths and any additional relevant organizational information.T.2.2 Describe the Proposer’s primary business objective and plans for future growth for the next five (5) years, and state whether the Proposer has a limitation on the number of new clients it intends to accept.T.2.3 Describe the level of coverage for errors and omissions insurance and any other fiduciary or professional liability insurance and bonding the proposing firm carries. Provide the names of vendors providing such insurance and bonding.T.2.4 State whether or not the proposing organization or any officer or principal of the proposing organization has been involved in any litigation or regulatory action, if so, describe and provide the current status of such litigation or regulatory action.T.2.5 State whether or not there is any litigation or licensing matter, or federal or state investigation pending against the Proposer’s company or any officer, principal or network provider. If so, provide details.T.2.6 State whether or not the Proposer or any of the Proposer’s subsidiaries or affiliated organizations, have ever been indicted or otherwise accused of any criminal or civil misconduct since 2011. If so, explain and indicate the outcome of such proceedings and the actions taken by the Proposer to prevent any repetition of such circumstances. State whether or not the Proposer has ever been accused by the government of a violation of the Medicare or Medicaid statutes or regulations (or other statutes or regulations in any states or territories of the United States) since 2011. If so, explain the claim and its outcome, as well as any remedial action taken to correct such claim.T.2.7 Include an organizational chart of the proposing organization.T.2.8 Include copies of the Proposer’s audit report or certified financial statement for the last three (3) years, or a statement as to why reports or statements are unavailable.T.2.9 Indicate the Proposer’s most recent ratings by the following organizations. If the Proposer is not rated by one or more of these agencies, explain why anizationRating and DateORExplanation Why Not RatedStandard and PoorsFitchA.M. BestMoody’sT.3 Proposed Approach:T.3a PersonnelT.3a.1 Describe your proposed Account Management model, with reference to the team you described above. Describe their experience specific to Specialty Drug Management programs.T.3a.2 Are members of the account team responsible for the production of new business and, if yes, indicate which members and for what percentage of time. T.3a.3 Describe and demonstrate the effectiveness of the Proposer’s policies for controlling workload. State whether or not there is a limit on the number of accounts that a particular employee may handle and if so, indicate that limit.T.3b Claims AdministrationT.3b.1 Describe how the Proposer assists the members in answering claims questions and claims appeal procedures.T.3b.2 Indicate if the following resources will be designated (have other clients) or dedicated (have no other clients other than the Plan).?ResponseStrategic Account ExecutiveDedicated / Designated / PooledAccount ManagerDedicated / Designated / PooledImplementation ManagerDedicated / Designated / PooledClinical PharmacistDedicated / Designated / PooledFinancial AnalystDedicated / Designated / PooledCall Center Service RepresentativesDedicated / Designated / Pooled?T.3b.3 Describe fully and demonstrate the effectiveness of the methods the Proposer uses to control claim costs.T.3b.4 Describe and demonstrate the effectiveness of internal audit review procedures and benefit thresholds, and indicate who performs audits and how claims are selected.T.3b.5 Describe the basis on and frequency at which the Proposer would allow the Plan to conduct performance or financial audits.T.3b.6 Please provide the following information regarding the proposed call center:LocationDays of OperationHours of OperationPercent of Calls Abandoned (on Average)* 2015* YTD 2016Average Number of Seconds to Reach Representative* 2015* YTD 2016?T.3b.7 Please provide the following information regarding the proposed mail order facility:General Mail OrderSpecialtyLocationDays of OperationHours of OperationTotal Scripts Filled* 2015* YTD 2016Utilization as Percent of Capacity* 2015* YTD 2016Average Turnaround (No Intervention)* 2015* YTD 2016Average Turnaround (Intervention Required)* 2015* YTD 2016T.3b.8 Indicate the minimum amount of lead-time required for the Proposer to be able to implement the plan by January 1, 2018. A prepared detailed implementation timeline/plan for January 1, 2018 should include: timing of significant tasks, names and titles of key implementation staff, responsibilities of the Plan and data requirements (type and format of data). T.3c Reports/Systems/Data CommunicationT.3c.1 Confirm that the Proposer would: (a) meet with the PICA Committee on at least a semi-annual basis for utilization review and strategic planning; and (b) compare the PICA Program’s utilization vis-à-vis industry benchmarks. The Proposer should also confirm they would provide these reports within 60 to 90 days of the close of the reporting period. T.3c.2 Describe the security features that are built into the system. Provide a copy of the Proposer’s systems disaster recovery procedures. State whether or not the Proposer maintains alternates (back-up) site(s) for computer access and data storage, and if so, please describe.T.3c.3 Describe the proposer’s HIPAA privacy procedures, as they would relate to the administration of the PICA Program. T.3d Member Services/Communications:T.3d.1 PBM agrees to service the PICA Program from its national accounts service unit.T.3d.2 How 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?T.3d.3 Please confirm the following with regard to member communications:The PBM agrees to obtain the PICA Program's approval for all member communication materials before distribution to members. The PBM will not automatically enroll the Plan in any programs that involve any type of communications with members or alterations of members' medications, without express written consent from the Plan.The PICA Committee reserves the right to review, edit, or customize any communication from the PBM to its membership.The Plan reserves the right to access all call recordings or call notes from member service calls with its members. PBM agrees to allow the Plan the right to request call recordings and/or notes at any time. PBM agrees to allow the Plan to listen to any recorded calls within 24 hours of the Fund's request.The PBM agrees to allow the Plan with access to its member website with a dummy login prior to the go-live date.T.3d.4 Describe the ways in which your firm can help PICA members and the PICA Committee to maximize the available value of patient assistance and couponing programs.T.3e Pharmacy Network T.3e.1 Do you utilize and proprietary pharmacy network that you directly contract/manage, or do you lease a network? If leased, from whom?T.3e.2 Please describe the depth and breadth of the pharmacy network you are proposing for the PICA plan.T.3e.3 Does the network you are proposing exclude any major chains? If so, please list the chains excluded. T.3f.4 Describe and demonstrate the effectiveness of the Proposer’s credentialing and re-credentialing processes.T.3f.5 Describe and demonstrate the effectiveness of how the Proposer monitors the providers in the Proposer’s network. Explain the professional standards and guidelines that the Proposer uses in its evaluation of providers. State whether or not the Proposer performs provider audits and whether or not the Proposer analyzes claims data to detect patterns of abuse by providers. If yes, to either, describe in detail; if no, to either explain why not. T.3f Formulary ManagementT.3f.1 Provide the name of the Formulary you are proposing to the Plan. If applicable, provide the number of drug exclusions as well as a list of the excluded drugs and the therapeutic alternatives.T.3f.2 Do you use an external organization for rebate aggregation? If so, which one?T.3f.3 Confirm a member is able to obtain an excluded prescription through a Prior Authorization appeal.T.3f.4 Proposers must complete and submit a formulary disruption based on the Attachment E - PICA Claims Experience, located on the RFP Page under Additional downloads on the OLR website and your proposed formulary (including any proposed drug exclusions). Results to be included are the number of members that will require a change as well as the number of prescriptions associated with the formulary change. Include an Excel file that lists the specific drugs that will be negatively impacted (excluded or higher-cost tier) along with the total number of scripts and members impacted for each of these drugs should also be provided. Please provide a summary of your formulary disruption analysis using the table below:Type of ChangeMember Impact% of Total MembersNumber of Scripts Impacted% of Total Scripts (including all brands and generics)No ChangeNegative (lower tier to higher-cost tier)Positive (higher-cost tier to lower tier)Moving from covered to not covered/ExcludedTotal?100.0%?100.0%T.3g Specialty Drug ManagementT.3g.1 Describe your specialty management capabilities. What makes your approach unique and/or better?T.3g.2 Do you own your specialty or specialty management fulfillment center, or is this function outsourced?T.3g.3 Describe your approach to clinical management of patients on specialty medications. Do you have clinical resources specifically designated to specialty? How are they trained? How do they enhance member experiences and increase compliance? T3.g.4, Provide a list of those for which your firm is the exclusive distributor using the PICA Covered Prescription Drug List, as of January 17, 2017 - Attachment F, located on the RFP Page under Additional downloads on the OLR website. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download