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ATTACHMENT CPICA PROGRAM TECHNICAL QUESTIONNAIRETHE CITY OF NEW YORKOFFICE OF LABOR RELATIONS EMPLOYEE BENEFITS PROGRAMNEGOTIATED ACQUISITION FORPHARMACY BENEFITS MANAGER SERVICES FOR THE PICA PROGRAMFOR CITY OF NEW YORK EMPLOYEES AND NON-MEDICARE RETIREES,AND THEIR DEPENDENTSEPIN: 0220N0006 PICA PROGRAM TECHNICAL QUESTIONNAIREAs part of the Expression of Interest, respondent shall include responses to the questions set forth in the PICA PROGRAM Technical Questionnaire.Instructions for completing the PICA PROGRAM Technical Questionnaire:Every question and subpart thereto must be answered even if the answer is not applicable. In responding to this questionnaire, please first repeat the question with its assigned number and subpart in bold and provide your answer in normal type immediately below the question. For the questions below, please be advised, “PBM” or “Pharmacy Benefit Manager” refers to the respondent entity submitting their responses as part of their Expression of Interest. In order to complete the PICA Program Technical Questionnaire, respondent will need the following documents located on the RFP Page under Additional downloads on the OLR website:1.PICA Covered Prescription Drug List, as of April 15, 2020 (ATTACHMENT I)2.PICA Plan Design & Clinical Programs (ATTACHMENT H)3.Summary of Proposed Contract Terms (ATTACHMENT E)Proposers may submit charts, graphs, and other illustrative exhibits as part of their Expression of Interest. Proposers shall not submit promotional material or brochures without clearly linking such material to a specific part of their response.________________________________________________________________________ Please state the full name of your PBM, its mailing address, and its Federal EIN.Please provide the full name, and contact information (office phone, cell phone, fax, and email address), for all individuals who will represent your PBM in connection with this selection process. Please indicate whether your company operates as a partnership or corporation, and if a corporation, whether it is licensed to conduct business in New York, and whether it is publicly traded. Please list all subcontractors used by your company, including each subcontractor’s name and address, a contact person, and a complete description of the work that is performed by each subcontractor. Subcontractors should include any third-party mail order pharmacy, third party specialty drug pharmacy, repackager, rebate aggregator or pharmacy auditor. If your PBM has executed contracts with multiple subcontractors for the same function (for example, two or more mail order pharmacies), please identify all subcontractors with which your PBM has executed contracts, and specify the subcontractor(s) that you intend to utilize in connection with providing services to the New York City Office of Labor Relations (“OLR”). Please state the number of years your company has been in business as a PBM. Please state the following about your company:Total number of clients with which your company has had contracts at the beginning of calendar years:2017:2018: 2019:Total covered lives under contract, at the beginning of calendar years: 2017:2018: 2019:Total dollar volume of prescription drug claims processed, and total number of prescription drug claims processed, by retail and mail order, for your aggregate book of business, during calendar years:Total Retail $# Rxs Total Mail $ #Rxs2017:2018:2019:Please identify at least four (4) current clients for whom you provide coverage to at least 100,000 lives, and provide for each a contact name, title, telephone number, email address, and for how long each entity has been your client. a. b.c.d.Provide a list of all public sector and union benefit plans for which you provide prescription drug coverage and include a contact name, title, telephone number, email address, and for how long each entity has been your client (add additional sheets if necessary):a.b.c. d. Have you within the past thirty-six-month period had one or more group client contracts terminated? If so, please identify the three clients who have most recently terminated their contracts, and provide for each a contact name, title, telephone number, email address, and the reason for termination: a.b.c. Indicate if your company is contemplating, or, is currently in negotiations with any other company to merge with it or to take over any other company whether or not such company is a prescription benefit management company. If in responding to this question, you indicate your company is contemplating a merger or acquisition, or is in such negotiations, indicate the company or companies involved. Note, you are under an affirmative duty to report such information to OLR's designee immediately if at any time during this selection and negotiation process your response to the question has changed. Has your company been subject in the last ten years to any licensure issues, lawsuits or government investigations? If so, please identify each matter, describe all allegations, and state either the current status or the resolution of the matter (list on a separate sheet if necessary). Please indicate whether or not your PBM carries errors and omissions insurance and the limits on such coverage; fiduciary and professional liability insurance and the limits on such coverage.Describe what programs, if any, your PBM has in place to detect patterns of abuse by providers.If selected, please provide your proposed implementation schedule for this contract.Retail Pharmacy Network: Please state the number and names of retail pharmacies in your national retail pharmacy network presently under contract with your PBM. Please indicate if you would be willing to offer a more narrow network of retail pharmacies by eliminating one or more large retail chains in order to offer deeper guaranteed discounts. (i)If you were willing to offer a more narrow retail network, based upon your experience with other plans that have narrowed their networks, could you project the anticipated savings the PICA Program could expect in each year of this contract if it eliminated one or more retail networks?Mail Order Pharmacy: Does your company have a Mail Order Pharmacy subsidiary or affiliate, or does it rely on an independent vendor(s) to provide mail order pharmacy services? With regard to each question below concerning each type of mail order pharmacy, indicate in each of your answers: (i) turnaround time in filling mail order prescriptions, with or without manual interventions, once received by the pharmacy;(ii) how many scripts were filled in 2019 (in responding to this, indicate time for automatic fills as well as the time for those scripts that require manual interventions;(iii) hours/days of operationFor All PBMs With a Mail Order Pharmacy Subsidiary or Affiliate: Please identify the formal name of your mail order subsidiary or affiliate, the location of all mail order pharmacies, and the number of years you have had your Mail Order Pharmacy subsidiary or affiliate. Please refer to the Summary of Contract Terms (ATTACHMENT E) which require Pass-Through Pricing for mail order drugs. Accordingly, please describe your PBM’s information system capability for determining the cost of drugs purchased for your Mail Order Pharmacy subsidiary or affiliate. Please refer to the Summary of Contract Terms (ATTACHMENT E). OLR is requesting that Wholesaler Discounts related to a PBM’s purchases for its Mail Order Pharmacy be passed through to OLR. Please also describe whether your Mail Order Pharmacy receives any such discounts after drugs are purchased for your Mail Order Pharmacy, and if it does, whether it receives them on a monthly, quarterly and/or annual basis. Please also describe how your information system accounts for such discounts. Before responding to this question, please note other Wholesaler Discount information found in Question 18 below. For All PBMs Relying On Independent Mail Pharmacy Vendor(s):Please list all mail pharmacy vendor(s) on which you rely, and identify each by name, address, and telephone number, and provide a contact name at each vendor. With respect to each of the vendors listed in response to subparagraph (e) above, please identify the number of years you have used each vendor as your mail order pharmacy, the number of years remaining on your contract with said vendor, and if two or less years remain on your contract, whether you are intending to negotiate a new contract with that vendor, or whether negotiations are under way to contract with a different vendor. Please identify the location of each vendor’s pharmacies, and identify the number of prescription drugs filled by each vendor for your aggregate book of business during calendar year 2019. Please refer to the Summary of Contract Terms (ATTACHMENT E) with regards to Pass-Through Pricing for mail order drugs. Accordingly, please describe your PBM’s information system capability for determining your PBM’s reimbursement costs for each mail pharmacy vendor. Please also describe whether your PBM receives any payments or other financial benefits from your mail pharmacy vendor(s) after drugs are dispensed, and if such payments or financial benefits are received by your PBM, whether and how your information system accounts for such in calculating mail order drug costs.Specialty Drug Pharmacy:a. Does your company have a subsidiary or affiliated Specialty Drug pharmacy, or does it rely on an independent vendor(s) to provide Specialty Drugs? For All PBMs With A Specialty Drug Pharmacy Subsidiary or Affiliate: Please identify the formal name(s) of your Specialty Drug Pharmacy subsidiary or affiliate, the location of each of your Specialty Drug Pharmacies, and the number of years you have owned your own Specialty Drug operation. Please indicate the number of Specialty Drug prescriptions processed by your Specialty Drug Pharmacy during calendar years –2017: 2018:2019:Please refer to the Summary of Contract Terms (ATTACHMENT E) with regards to Wholesaler Discounts related to a PBM’s drug purchases for its Specialty Drug Pharmacy which are to be passed through to OLR. Please describe whether your Specialty Drug Pharmacy receives any such discounts after drugs are purchased for your Specialty Drug Pharmacy, and if it does, whether it receives them on a monthly, quarterly and/or annual basis. Please also describe how your information system accounts for such discounts. Before responding to this question, please note other Wholesaler Discount information found in Question 18 below. Please refer to the Summary of Contract Terms (ATTACHMENT E) with regards to the requirement for Pass-Through Pricing for Specialty Drugs. Accordingly, please describe your PBM’s information system capability for determining the cost of drugs purchased for your Specialty Drug Pharmacy. Please indicate whether any other entity has an ownership or financial interest in your Specialty Drug Pharmacy. For All PBMs Relying On An Independent Specialty Drug Pharmacy Vendor(s):Please identify current vendor(s), by name, address and telephone number, and provide a contact name at your vendor(s). With respect to each of the vendors listed in response to subparagraph (g) above, please identify the number of years you have used each vendor as your specialty drug pharmacy, the number of years remaining on your contract with said vendor, and if two or less years remain on your contract, whether you are intending to negotiate a new contract with that vendor, or whether you are considering (or have already commenced) negotiations with a different vendor. i.Please identify the number of Specialty Drug prescriptions filled by each vendor for your aggregate book of business during calendar year 2019. j.Please refer to the Summary of Contract Terms (ATTACHMENT E) with regards to the requirement for Pass-Through Pricing for Specialty Drugs. Accordingly, please describe your PBM’s information system capability for determining your PBM’s reimbursement costs for each Specialty Pharmacy vendor. k. Please also describe whether your PBM receives any payments or other financial benefits from your specialty pharmacy vendor(s) after drugs are dispensed, and if such payments or financial benefits are received by your PBM, whether and how your information system accounts for such in calculating mail order drug costs.Wholesaler Discounts:Please refer to the Summary of Contract Terms (ATTACHMENT E) With regards to the defined term - “Wholesaler Discounts” which includes discounts that a PBM receives for both mail and specialty drugs. Please indicate whether your PBM – or your subsidiary or affiliated pharmacy – receive such discounts, and if you do, whether you receive them on a monthly, quarterly or annual basis (or some or all of the above). b.Please refer to the Summary of Contract Terms (ATTACHMENT E). Although Wholesaler Discounts will contractually be required to be passed through to OLR, given that the discounts may occur with both mail and specialty drugs, and the difficulty of auditing such Discounts, the amounts passed through will not be factored into Average Annual Guarantees or Financial Benefit (Rebate) Guarantees. However, OLR believes that it should weigh the value of such Wholesaler Discounts in selecting its next PBM. Accordingly, OLR requests that each PBM indicate its willingness to provide an estimate of likely annual Wholesaler Discounts, once claims data is provided.Claim Processor Feesa.Please refer to the Summary of Contract Terms (ATTACHMENT E). OLR has also defined a term “Claim Processor Fees” and is asking each PBM to pass through to OLR all Claim Processor Fees earned on OLR scripts. Please indicate whether your PBM-retail pharmacy contracts contain provisions requiring the payment of such fees. b.Please refer to the Summary of Contract Terms (ATTACHMENT E). Although Claim Processor Fees will contractually be required to be passed through to OLR, the amounts passed through will not be factored into Average Annual Guarantees or Financial Benefit (Rebate) Guarantees. However, OLR believes that it should weigh the value of such Claim Processor Fees in selecting its next PBM. Accordingly, OLR requests that each PBM indicates its willingness provide an estimate of likely Claim Processor Fees, once claims data is provided.Retail Pharmacy Audits: Please describe the following concerning your PBM’s retail pharmacy audits: How are retail pharmacies selected for an audit? How many retail pharmacies are audited annually? What percentage of retail pharmacies receive “on-site audits”? What is audited in your standard “on-site audit”? What percentage of retail pharmacies receive “desk audits”? What is audited in your standard “desk audit”? Contracts with Pharmaceutical Manufacturers, Wholesalers and Distributors, Repackagers and Other Third Parties: Please refer to the Summary of Contract Terms (ATTACHMENT E). OLR would like its PBM to execute a contract that obligates the PBM to pass through all “Financial Benefits” from all “Pharmaceutical Manufacturers” to PICA Program. Please refer to the Summary of Contract Terms (ATTACHMENT E) which defines “Financial Benefits” as all payments or discounts from all third parties to the PBM, regardless of the “label” used for the payment, including but not limited to all: rebates, discounts, administrative or other fees, chargebacks, grants, etc. Please refer to the Summary of Contract Terms (ATTACHMENT E) which defines “Pharmaceutical Manufacturers” as inclusive of drug manufacturers, wholesalers, distributors, and repackagers. Please respond to the questions below based on the Definitions for “Financial Benefits” and “Pharmaceutical Manufacturers” in the Summary of Contract Terms (ATTACHMENT E). Does your company perform its own Financial Benefit contracting, or does it rely on an independent company to contract for Financial Benefits? Does your company sell claims or other data to any Pharmaceutical Manufacturers or to IMS or any other third party? If so, to which entities are claims or other data sold by your PBM? Does your PBM currently have clients whose claims or other data you do not sell? For PBMs That Perform Their Own Financial Benefit Contracting:Please identify the formal name of any subsidiary responsible for Financial Benefit Contracting. Please indicate the number of Pharmaceutical Manufacturers with which you currently have active contracts:Please indicate how many contracts with Pharmaceutical Manufacturers were negotiated, or renegotiated, by you, during calendar years: 2017:2018:2019:For PBMs That Rely On An Outside Vendor To Contract For Financial Benefits:Please identify all third-party vendors on whom you rely to contract for Financial Benefits, and provide the name, address and telephone number for each. With respect to each of the vendors listed in response to subparagraph (g) above, please identify the number of years you have used each vendor to contract for Financial Benefits, the number of years remaining on your contract with each such vendor, and if two or less years remain on your contract, whether you are intending to negotiate a new contract with that vendor, or whether you are considering (or have already commenced) negotiations with a different vendor. Please identify the number of contracts each third-party vendor currently has with Pharmaceutical Manufacturers. Please identify whether you have audited the vendors you have used, how often said audits have been conducted by you, when the last audit was completed by you for each vendor, and precisely what you have audited (in particular, how many Pharmaceutical Manufacturer contracts were audited). Improving Controls Over Specialty Drug Usage: OLR is considering steps to undertake to increase its control over Specialty Drug usage. Accordingly, OLR wishes to evaluate each PBM’s ability to provide such assistance. a.Please describe any efforts you have undertaken for clients to assist them in ensuring that Specialty Drugs are dispensed and covered through your PBM, rather than through the clients’ health insurance contracts or benefits. Please provide any suggestions you may have for the control of Specialty Drug usage and costs, and identify the cost, if any, for each such program, should OLR choose to implement it. Patient Assistance Programs & Coupons:Please identify any programs you run to assist plan administrators in evaluating whether to exclude coverage of certain drugs, while simultaneously steering Plan Beneficiaries to use Patient Assistance Programs. If you have worked with other Plans to implement such a strategy, please state how many Plans, identify the potential number of excluded drugs, provide a list of potential drugs, and describe the typical savings. Please identify any programs you run to enable plan administrators (as opposed to plan members) to obtain the benefit of available coupons for mail or specialty drugs (e.g., by artificially inflating an existing copay by the value of the coupon, and then using the coupon to return the copay to its pre-existing value). If you run such programs, please describe the scope of the available programs by identifying the number of drugs and/or therapeutic categories on which you run such programs. Also, please confirm that you are also able to ensure that accumulator files can reflect the actual amount incurred by the plan beneficiary. In connection with mail order dispensed drugs, please provide the same type of information as described above in subparagraph (b). Please identify whether you are willing and able to block the use of coupons at your mail order pharmacy and/or specialty drug pharmacy, if requested to do so. Please identify any other methods you use to control coupon use (particularly at retail pharmacies) or to take advantage of coupons for mail and specialty drugs by reducing plans’ costs. Explanation of Benefit Capabilities: OLR believes providing annual written and/or electronic EOBs to Plan Beneficiaries is a valuable educational tool. Please state whether your PBM is able to provide (written and/or electronic) EOB statements. i. With regard to written EOBs, will your PBM provide such on an annual basis at no charge? If not, please indicate what you would charge for mailing annual EOBs. Please state whether your PBM is able to provide (written and/or electronic) EOB statements solely to those Plan Beneficiaries who obtained drugs during the year. i. In the event that your PBM is able to limit EOB mailings only to those Plan Beneficiaries who obtained drugs during the year, please confirm that your PBM can also track the number of letters transmitted and if you charge for providing annual written EOBs, whether you would invoice OLR only for such letters. Please indicate any methods you employ to enable Plan Beneficiaries to opt out of receiving written EOBs, and to only receive electronic EOBs. Do your contracts with retail pharmacies require them to provide a Plan Beneficiary with printed information on how much of the drug's cost was covered by the PICA Program when a Beneficiary picks up his/her prescriptions? If not, would you be willing to require this information be provided in future contracts?Service Issues: a. Ability to Service the PICA Program: (i) How many account representatives will you assign to the PICA Program? How many other clients will each individual be servicing? Please attach a background and resume for each individual assigned as an account representative to PICA Program. (ii) Will you ensure that the National Accounts service unit be the team to provide service to the PICA Program? (iii) How many customer service call centers do you operate, with what hours of operation for each, where are they located, and with how many personnel in each? If any of your call centers that would be servicing OLR Plan Beneficiaries are located outside the United States of America, would you agree to only use US-based call centers to service OLR Plan Beneficiaries?(iv) Would you be willing to create a separate dedicated call center and call-in line to process and to respond to calls from OLR Plan Beneficiaries and, if so, would it be staffed 24 hours a day, 365 days a year, except for required maintenance?(v) At what percentage of your total capacity are you (or your current vendor) operating for processing and shipping mail order prescriptions? For processing and shipping specialty prescriptions? For “handling” retail prescriptions that require any ‘touching’ before the prescriptions are dispensed? For your customer call centers? (vi) What is your projected capacity for doing each of the above, as of today’s date? Are you in the process of hiring – or do you have any plans to hire – additional staff to expand your capacity for any of the above, before 1/1/2021? (vii) Please identify the steps you would be willing to take to increase your capacity, were OLR to become a new client, and the lead time that would be required for each step.(viii) Please describe in detail how your customer service representatives assist Beneficiaries with (1) questions; (2) claims; and (3) appeals. In responding to (3) appeals, please detail each step of your current appeal process, including procedures you have in place for handling expedited appeals.(ix) Indicate how many of your customer service representatives who would be servicing PICA members are bi- or multi-lingual, what language(s) they speak and their hours of availability.(x) Is any portion of your workforce unionized? If so, list what unions represent what portion of your workforce.b.Priority Cue: (i) Do you have the ability after inputting all scripts that are received to create a ‘priority cue’ that will enable you to ensure that all OLR scripts after being input into the system are “moved to the head of the line” and processed and serviced before other clients’ scripts are processed and serviced?(ii) If so, would you be willing to generate a priority cue for OLR to ensure OLR scripts are handled before other client scripts are handled, and to insert contract language ensuring priority cue treatment? c.Availability of Pharmacists:(i) Are pharmacists on duty to assist with all telephone inquiries? (ii) If so, on what days of the week, and during what hours each day? (iii) How many pharmacists are available for your aggregate book of business? (iv) Would you be willing to create a segregated group of pharmacists to work with the OLR book of business? d. Availability of Physicians: (i) Do you have physicians on staff and if so how many and what are their specialties and hours of work? (ii) Do you use physician consultants? If so, in what capacity? e. Physician Prescribing Patterns: (i) Do you monitor individual physician prescribing patterns? If so, how? (ii) What metrics are used to measure physician compliance and non-compliance? (iii) What reports do you generate that you would be willing to share with OLR concerning physician compliance and non-compliance? f. Dispensing Accuracy: (i) What reports do you generate to track the accuracy of your PBM’s mail and specialty drug dispensing (with accuracy measured as the correct drug dispensed at the correct dosage level with the correct number of pills per bottle)? (If you use a third-party vendor for either mail or specialty drugs, please answer the same question by describing the reports you obtain from said vendor(s)). (ii) What information is contained in each report? Please provide a detailed description. (iii) How often do you generate each of the reports you have identified above (or receive them from your third-party vendor)?(iv) Would you be willing to bind yourself contractually to provide said reports to OLR?(v) Please answer the same four questions above, in connection with the issue of tracking, reporting on, and sharing reports concerning your accuracy in shipping prescriptions to the correct individual at the correct address. (vi) Have any complaints been filed in federal or state court, or as an arbitration, during the past three years, as a result of your alleged failure to dispense prescriptions accurately (as defined in subsection (i) above)? If so, please describe the status of each matter, and if resolved, how each was resolved. Timely Dispensing: (i) What reports do you generate to track how long it takes for prescriptions to be dispensed from your mail and specialty drug pharmacies? (If you use a third-party vendor for either mail or specialty drugs, please answer the same question by describing the reports you obtain from said vendor(s)). (ii) What information is contained in each report? Please provide a detailed description. (iii) How often do you generate each of the reports you have identified above (or receive them from your third-party vendor)?(iv) Would you be willing to bind yourself contractually to provide said reports to OLR? (v) Do you generate a WISMO (“where is my order”) report (or similarly titled report)? If so, how often? Would you be willing to bind yourself contractually to provide a WISMO report to OLR on a regular basis? (vi) Do you have any policy in place for automatically overnighting any prescription at no additional cost that has been resident in your system for too many days? If so, how many days must a script be resident before overnighting it to a member? (vi) Would you be willing to bind yourself contractually to place an “automatic overnight” obligation on your PBM, and to have the PBM be liable for the costs of such overnighting? If so, how many days would a script have to be resident in your system to trigger said obligation? Plan Beneficiaries’ Failure To Pay Mail or Specialty Copays: (i) Please refer to the Summary of Contract Terms (ATTACHMENT E). OLR will not be responsible for a Plan Beneficiaries' failure to Pay Mail or Specialty Copays. With that understanding, do you have a computerized system in place to track Plan Beneficiaries’ failure to pay copays for mail and specialty drugs? If so, please provide a detailed description of the system. (ii) If you have such a system in place, can you tailor the system for each client to enable the client to select the total dollar amount that must be reached before a member is refused a prescription? (iii) If you do not have such a system in place, could you create such a system? With what lead time, and at what cost, if any, to a new client? Programs. OLR currently has in place extensive Prior Authorization, Step Therapy and Quantity Limits, Fill Limitations and Refill Too Soon Programs, as well as a Mandatory Generic Program. Please indicate whether you are willing to implement customized programs in connection with each of the above. On-Site Screen Access. OLR would like its plan administrators to monitor drug dispensing on a daily basis, through on-site access to certain screens of PBM information. Please describe your PBM’s ability to provide such access, and identify the maximum information your PBM will be able to provide to OLR. Please also indicate whether the information can be provided in “real time” or with a time lag (which time lag you should identify). Claims Data. Please refer to the Summary of Contract Terms (ATTACHMENT E). OLR would like the PBM to provide a claims data file with each invoice on a bi-weekly basis, as well as concurrent access to claims data for OLR. Please confirm you will be willing to provide each of the above. Coordination of Benefits. OLR would like to, over time, implement a Coordination of Benefits program. Do you have the capability to implement such a program? Eligibility.a.Please refer to the Summary of Contract Terms (ATTACHMENT E). OLR would like to transmit and have input by its PBM electronic eligibility files weekly. Are you capable of receiving weekly transmissions from OLR, and making such transmission “live” for pharmacy utilization within 24 hours, and/or willing to create such capability and implement it? If not, please specify the minimum time frame you would be willing to accept for receiving and processing electronic eligibility files. Secure PBM to Client Communications. OLR must ensure that its PBM has a secure means to transmit information. Please identify which of the below are currently available, as of your response date, (For each item that is not available, please identify the lead time for making such available, or any alternative methods you could make available, to ensure controls are in place to ensure secure transmissions.): A Secured VPN or Secure-FTP protocol that includes PGP encryption of all exchanged information files to be placed and received from the Vendors secured Server location. A HIPAA-compliant Benefit Enrollment and Maintenance Transaction (834 Transaction) file which OLR will provide on a timely basis to be placed on a vendors’ secured server directory folder. Any and all additional information files necessary for exchange between OLR and the selected vendor will be located on the vendors’ secured server directory folder (this information can be current DAW files received from our prescription company and other reports). c.An “Order Refill Transfer” file should be available between the current OLR prescription benefit company and a selected vendor to ensure historical information is passed successfully. d.OLR should have remote access to a vendor’s online eligibility application for inquiry and update permissions.e.Technical cooperation between OLR’s Information Technology department and the acceptable vendor should be available to provide for a successful transition of accurate information files and reporting. f. Prior to contract award, would respondent be willing to compare the tape layout of OLR’s current PBM with your tape layout and identify any issues that would likely impede or otherwise hinder a seamless transition?Mobile Apps: OLR is interested in providing its Plan members with any tools that might be available to assist them in obtaining low-cost drugs and tracking their drug use. Please describe any and all mobile apps that you provide, and the functions that all such apps provide. Also, please identify any added costs, if any, for providing such apps, either for OLR or for Plan Beneficiaries. Reporting and Meetings: a. ?Provide a list of the standard reports you will provide to OLR and indicate how often such reports will be provided and in what form.b. Is your system capable of providing OLR with the ability to run standard reports for itself? If so:(i) list the standard reports OLR to which would have access c.? Is your system capable of allowing OLR to define and generate ad hoc reports for itself? If so:(i) would you agree to permit OLR to define and generate ad hoc reports for itself without restriction?d. OLR also will require complex, customized reports to be provided at least quarterly at no additional charge. These reports will include but may not be limited to those listed below in (i-iv). Please indicate your wiliness to provide each of these reports.(i) a list of all Limited Distribution Drug ("LDD") that shall include the same data fields as required for standard reports, when the LDD was added to the formulary and in what tier, and the discount applied to each such drug in the previous quarter(ii) a list of all drugs requiring Prior Authorization ("PA") that shall include a detailed description of the PA, when the PA was added or removed for a drug, and, with regard to each such drug that carries a PA, how often the PA was granted as well as denied in the previous quarter(iii) a list of what drugs by name that had Fill Limitations ("FL") that were provided and in what quantities in the previous quarter(iv) Rebate reports: indicating by each drug name and NDC all rebates received by PBM and passed through to OLR for each such drug in the previous quartere.Will your service team be willing to meet in person with OLR and the PICA Committee in NYC on a monthly or on as needed basis?Please identify to which health plans you provide pharmacy benefit management services?Please discuss (and include materials to document) how your PBM’s services distinguish you from competitors in the marketplace. Include in your discussion the types of clinical programs your PBM would recommend implementing to better manage the types of drugs covered by the PICA Program in terms of improving patient outcomes and containing plan costs. Indicate whether or not there would be any additional charges for such clinical programs.The person whose signature appears below has the authority to bind the respondent submitting the Expression of Interest to the statements above.ON BEHALF OF Respondent: ___________________________________(name of entity)BY: ___________________________________ (signature) Date: _________________Print Name: _______________________________Title: _____________________________________ ................
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