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FBO DAILY - FEDBIZOPPS ISSUE OF JULY 14, 2017 FBO #5712
DOCUMENT

G -- Pharmacy Benefit Management (PBM) Program Workers' Compensation Program - Attachment

Notice Date

7/12/2017
 

Notice Type

Attachment
 

NAICS

524292 — Third Party Administration of Insurance and Pension Funds
 

Contracting Office

Strategic Acquisition Center - Frederick;Department of Veterans Affairs;321 Ballenger Center Drive, Suite 125;Frederick MD 21703
 

ZIP Code

21703
 

Solicitation Number

VA119A17R0311
 

Response Due

7/25/2017
 

Archive Date

9/23/2017
 

Point of Contact

Brian Kadel
 

E-Mail Address

15-1653<br
 

Small Business Set-Aside

N/A
 

Description

The U.S. Department of Veteran Affairs (VA) is seeking Small Business sources that are capable of providing support to the VA Human Resources Administration in the task areas described below. The purpose of this notice is to gather capabilities and market information from Small Businesses pertinent for acquisition planning. The responses to this Sources Sought notice will contribute to determining the method of procurement and identify parties having an interest in and the resources to support this requirement. DESCRIPTION OF REQUIREMENT Contractor will be required to provide support specifically to support a National Pharmacy Benefits Management (PBM) Program for workers compensation (WC). The PBM Program will be a national program for VA employees who are injured on the job and require prescription medications, durable medical equipment (DME) (walkers, crutches, canes, splints, muscle stimulators, etc.), physical therapy and diagnostic services (Magnetic Resonance Imaging (MRI), Computerized Tomography Scans (CT), X-Rays, Electromyogram (EMG), Nerve Conduction Velocity (NCV), and other related tests) paid for by the Office of Workers Compensation Program (OWCP) Employee Compensation Fund. This fund is reimbursed annually through a chargeback process by the VA. The PBM will eliminate any out-of-pocket expenses for the injured employee as well as the need to save receipts or file reimbursement forms.   Contractor revenue is generated through negotiated pricing arrangements with providers.   The Contractor pays the provider directly and then bills the Office of Workers Compensation Programs (OWCP) at a rate that incorporates revenue for the Contractor but is less than the Federal Employee Compensation Act (FECA) Fee Schedule. The Contractor selected must negotiate their own contract with pharmacies and providers for diagnostic services that will generate a discount for generic and brand named drugs, DME and diagnostic services at a rate that is below the FECA fee schedule that is acceptable to VA.  The Contractor selected will be responsible for assisting VA staff with achieving the goal of increasing program penetration, defined as the number of services paid through the PBM network compared to out of network. The requirement will provide support for the following two groups of VA employees eligible for coverage under this program: Group 1 - Comprised of those who have an existing claim under the FECA. These employees have fully adjudicated WC claims and have coverage for all prescriptions that meet the OWCP requirements for their accepted injury. Group 2 - Comprised of new FECA claimants. These employees are newly injured on the job and have filed FECA claims pending adjudication by OWCP. VA requires that the PBM Program provide a system for first-fill prescription coverage for employees who sustain a traumatic injury at work. The PBM Program will provide a pharmacy card system to these employees as part of the VA injury packet. Full prescription coverage will be provided to all injured employees upon filing a FECA claim for traumatic injury. Approximately 95 percent of these claims will be approved and all prescription costs covered by OWCP. SUBMISSION INSTRUCTIONS THERE IS NO SOLICITATION AT THIS TIME This Sources Sought notice does not constitute a request for proposals. Submission of any information in response to this Sources Sought notice is purely voluntary. The Government assumes no financial responsibility for any costs incurred. If your organization is a small business and has the potential capacity to perform these services, please provide a capability statement in the format described below. Cover Sheet (1 page) On the cover page please provide the following information: 1. Organization name, address, DUNS number, and web site. 2. Point of contact to include e-mail address and telephone number. 3. Socio-economic status and applicable NAICS codes. 4. If applicable, GSA contract number, schedule, and SIN category. Capabilities Statement and Market Information (12 pages maximum) Rationale: Responses will be reviewed to determine the contractor s capability to successfully conduct a project of a similar size, scope, approach, focus (Program Support Services in a Healthcare supply chain environment), and complexity (i.e. large multi-hospital system). The contractor r shall provide information that demonstrates the value the contractor contributed by similar services to the customer s healthcare organization/enterprise supply chain. Within your capabilities statement, please address your company s ability to meet the following requirements required to operate the PBM Program: 1) Number of years experience in providing PBM services, specializing in Federal worker s compensation, in conjunction with OWCP. 2) Ability to recruit and retain a single program manager assigned full-time to support the VA account with a minimum of 5-years Federal PBM WC program experience. 3) Ability to obtain national access to large pharmacy chains and a majority of other pharmacies with a minimum of 67,000 network pharmacies during the contract term to meet the needs of VA. 4) Ability to electronically transfer all prescription information securely between participating network pharmacy, PBM and OWCP. 5) Ability to establish a claims processing system that will conform to the National Council for Prescription Drug Programs (NCPDP) standards. 6) Ability to bill for prescriptions using the 11-digit National Drug Code (NDC) Number. 7) Ability to provide a pharmacy authorization method to eligible employees. This method is required by OWCP and limited to VA employees. 8) Ability to establish a mail order program option for any VA employee to utilize when requesting this service. The contractor will be required to send out information packets to eligible VA employees to inform them of the mail order option and instructions for requesting this service. 9) Ability to contact treating physicians for generic substitution in allowable cases. 10) Ability to establish a Reporting and Review Program to include the following: Detection of inappropriate or unusual prescription usage patterns by providers or employees Screening for drug or drug contra-indications, drug and age contra-indications, drug and pregnancy contra-indications Duplicate prescriptions Therapeutic overlap Early refill Prospective, concurrent, and retrospective DUR program 11) Ability to implement a Report Information System that includes: cost savings, classes of drugs provided, unusual prescription practices by treating providers, proposed fee schedule revisions and actual cost savings. 12) Ability to phase in PBM services to support about 300,000 employees of which about 18,000 employees receive prescriptions, durable medical equipment and diagnostic services as a benefit of the WC program. 13) Ability to provide efficient, accurate, and timely processing of DME requests for compensable medical conditions by implementing well-defined and documented internal quality assurance procedures to ensure the correct and most efficient processing of requests, referrals, and integrity of data. 14) Ability to assure accurate and timely reports inquiries, requests to treating physician, claimant, and Health and Resource Management staff within a timeframe acceptable to VA. 15) Ability to implement reimbursement for duplicate bill payment, monitor providers for billing outside of network, capture billing outside of network, and fraud and/or abuse protection programs. 16) Ability to bill for all DME items using definable and/or acceptable coding. 17) Ability to ensure contracted discount rate is below FECA fee schedule used for DME items. 18) Ability to implement a DME and medical imaging and testing Utilization Review Program that includes at a minimum the following: a. Detection of provider or employee fraud, abuse or inappropriate utilization patterns b. Screening for DME contraindications, DME/age contraindications, c. Duplicate DME d. Therapeutic overlap e. Early refill of DME supplies f. Determination, follow up and tracking of actual need of supplies (e.g., for TENS unit) 19) Ability to provide dedicated and security-cleared customer service representatives for VA job-injured employees to access 24/7 to provide information regarding claim denials, claim, drug information, payments, etc. 20) Ability to institute performance metrics every 30 days, to measure the effectiveness of the contract. 21) Describe any recent (within the past 3 years) and relevant (similar scope) experience as a contractor (specify prime or sub), where you have supported large enterprise wide healthcare supply chain program support services. The list should include the following information: Organization/Agency that awarded the contract/task order Name and contact information for Contracting Officer Description of the award, to include a short synopsis of the scope/statement of work. Period and place of performance Solicitation type (i.e. set aside small, SDVOSB, VOSB, full and open competition/MOBIS RFQ, open market RFQ or RFP, etc.) Type of award (i.e. firm fixed price with a SOW/ PWS, or hourly staffing) Name and contact information for the Contracting Officer s Representative (COR) 22) Ability to provide designated clinical pharmacist support for assistance with program-specific policy development and implementation. Failure to respond to this Sources Sought notice would be viewed as non-interest/non-capable in performing this future requirement. Capability statements are due by 10:00 AM EDT on Tuesday, July 25, 2017. The page limit for capability statements is 12 pages (not including cover page). Capability statements must be submitted to Brian Kadel at brian.kadel@va.gov and Lindi Sylvester at lindi.sylvester@va.gov. 52.215-3 Request for Information or Solicitation for Planning Purposes (Oct 1997) (a) The Government does not intend to award a contract on the basis of this solicitation or to otherwise pay for the information solicited except as an allowable cost under other contracts as provided in subsection  31.205-18, Bid and proposal costs, of the Federal Acquisition Regulation. (b) Although proposal and offeror are used in this Request for Information, your response will be treated as information only. It shall not be used as a proposal. (c) This solicitation is issued for the purpose of: Information. (End of provision)
 

Web Link

FBO.gov Permalink
(https://www.fbo.gov/spg/VA/AFMLOVASS/VASSMD/VA119A17R0311/listing.html)
 

Document(s)

Attachment
 

File Name: VA119A-17-R-0311 VA119A-17-R-0311.docx (https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=3653132&FileName=VA119A-17-R-0311-000.docx)

Link: https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=3653132&FileName=VA119A-17-R-0311-000.docx

 

Note: If links are broken, refer to Point of Contact above or contact the FBO Help Desk at 877-472-3779.
 

Record

SN04576609-W 20170714/170712234938-b072497e784741a1656535ce27f95273 (fbodaily.com)
 

Source

FedBizOpps Link to This Notice
(may not be valid after Archive Date)

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