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State of Vermont Agency of Human Services
Pharmacy Benefits Management (PBM) RFP
Bidder’s Conference
January 7, 2014
Conference Logistics
■ Please place telephone on mute during the call, prior to the Q&A section
■ Send Kate Jones ([email protected]) an email with “Bidders’ Conference
Attendance” in the subject line and with your contact information in the body of the
email in order to record your attendance. Do NOT include any questions in this email.
■ There will be a break during the conference in order for participants to submit questions
to the State that the Vendor would like addressed during the conference. Please submit
those emails to [email protected] with “PBM Bidders’ Conference Question” in the
subject line.
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AGENDA
■ Introductions
■ Background
■ RFP Process
■ Addendum changes
■ RFP Scope and Requirements
■ Q&A
■ Closing remarks
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Introductions
■ Kate Jones
■ Lori Collins
■ Nancy Hogue
■ Michael Hall
■ John Hunt
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Background
■ Vermont seeks to procure a contemporary Pharmacy Benefit Management solution that
is built on MITA 3.0 compliant architecture meeting CMS Seven Standards and
Conditions.
■ The PBM solution is part of the overall MMIS component of the Health Service
Enterprise
■ The State views this as a partnership to support the Governor’s Strategic Plan for
Healthcare Reform. Specific objectives of this plan are to:
– reduce the growth of healthcare cost;
– assure universal access to high quality health coverage;
– improve the health of Vermonters; and
– assure greater fairness in healthcare financing in Vermont.
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RFP Process
■ The RFP process consists of the following key steps –
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RFP released by the State
Vendor question and answer period
Vendor briefing
Vendor proposals (technical and cost responses) received by the State
Evaluation of vendor proposals by the State
Oral presentations are conducted by vendors admitted to the field of competition as determined
by the State
– Best and final offers are received
– Discussions with vendors admitted to the field of competition are conducted as determined by the
State
– Vendor selection and contract
■ Answers to additional questions posed on today’s call will be posted by January 9.
■ Proposals are due on January 31, by 3PM ET
■ The State anticipates making an award announcement by early March and that work
will begin under the resultant contract on May 1
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Amendment to RFP
■ Template B has been updated and a new version has been posted to the web site
■ Amendments to the RFP will be issued:
– To provide response to questions submitted by proposing Vendors
– To clarify language within the RFP and Templates B, E, F, H, I, and L
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Proposal Submissions
■ Proposals in response to this RFP must be divided into two appropriately labeled and
sealed packages marked Technical Proposal and Cost Proposal.
■ All proposal submissions should be clearly labeled with the RFP number.
■ The contents of each package must be as follows:
– Package 1 — Technical Proposal
• Technical Proposal addressing all requirements specified in the RFP using the response forms provided in
Templates A through K.
– Package 2 — Cost Proposal
• Cost Proposal using the form provided in Template L Cost Workbook.
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RFP Scope and Requirements
■ The new PBM solution will replace the current solution with current technology, and higher services
and service levels.
■ It will be flexible and extensible to support the State Duals Demonstration Project when it is initiated
and the State’s move to a Single Payer System in 2017.
■ The Vendor will be responsible for all facets of the day-to-day clinical and operational administration
of Vermont’s pharmacy benefit including
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Adjudication of pharmacy claims,
Call center operations,
Utilization management and drug utilization review programs,
Benefit design and clinical support,
Rebate management, and
Reporting and analysis.
■ Claims Processing and Operational Support
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The Vendor must ensure claims processing policies and procedures are in compliance with all applicable state
and federal laws, regulations, rules, and policies. Claims adjudication is the responsibility of the Vendor; however,
provider payments are made by the State's current MMIS Contractor
■ Financial Management
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Financial support services are an important component of the PBM services being solicited. The Department
seeks Vendor services in the administration of all rebate programs, including the Federal OBRA ’90 rebates,
supplemental rebates and State-only rebates. It will also rely on the Vendor to support the State’s participation in
the Sovereign States Drug Consortium (SSDC) multi-state supplemental rebate pool.
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Interaction with other State Systems and Solutions
■ The PBM Solution will be required to interface and integrate with other relevant major
solutions currently in place or about to be in place including:
– An integrated eligibility solution which will be acquired and deployed in the foreseeable future
– The current MMIS solution, and a new MMIS solution which will be acquired and deployed in the
foreseeable future
■ The State is deploying a Health Services Enterprise Platform which will provide key
shared capabilities for a number of Healthcare and Human Services programs and
solutions.
– It is based on the the Oracle SOA stack and will provide a portal, shared functionality for
Screening, Application and Determination, Enterprise Information Exchange, Master Data
Management, and Analytics and Business Intelligence.
– Notwithstanding that the PBM solution is a freestanding solution operated by the Vendor, the
State has a preference to leverage this platform to the degree possible.
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Break and Question Collection
■ Please submit questions to [email protected] with “PBM Bidders’ Conference
Question” in the subject line.
■ The State will discuss questions today, however, responses are not binding until the
final written answers are posted on the Procurement website.
■ Vermont estimates the answers will post by January 9th.
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Question and Answer
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Closing Remarks
■ Answers to questions will be posted 1/9/14
■ Technical and Cost Proposals due 1/31/14 at 15:00hrs ET
■ Tentative Award Announcement – Early March
■ Anticipated Contract Start Date – 5/1/14
■ Thank you for your time
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