Inactive

Pharmacy Benefits Management (PBM) Services

Inactive Service-Disabled Veteran-Owned Small Business (SDVOSB) Set-Aside (FAR 19.14)

THIS IS A PRESOLICITATION NOTICE The Department of Veterans Affairs, Network Contracting Office 9, located at 1639 Medical Center Parkway, Suite 400, Murfreesboro, TN, 37129, anticipates issuing a sol... THIS IS A PRESOLICITATION NOTICE The Department of Veterans Affairs, Network Contracting Office 9, located at 1639 Medical Center Parkway, Suite 400, Murfreesboro, TN, 37129, anticipates issuing a solicitation Request for Quotation (RFQ) on or about 08/09/2022 to request quotes for an Indefinite Delivery Indefinite Quantity (IDIQ) contract with a five (5) year base and one (1) option consisting of a five (5) year ordering period, for a total period of performance (POP) of ten (10) years. Performance begins upon anticipated award date of 10/1/2022 through 09/30/2032 to provide Pharmacy Benefit Management (PBM) Services. SET-ASIDE: 100% Service-Disabled Veteran-Owned Small Business (SDVOSB) NAICS Code: 524292 Third Party Administration of Insurance and Pension Funds SBA SIZE STANDARD: $35.0 Million PSC: Q517 DESCRIPTION: This requirement is for the for Veterans Integrated Service Network (VISN) 9 in its entirety. Work will be performed at Contractor s facility or Contracted Pharmacy. Location To Be Determined (TBD). IMPORTANT NOTICE: Interested parties must apply for and receive verification from the Department of Veterans Affairs Center for Veterans Enterprise (CVE) of their SDVOSB status in accordance with 38 CFR part 74 and VAAR 819.70 by submission of documentation of veteran status, ownership and control sufficient to establish appropriate status. Contractor s must be both visible and verified by the Department of Veteran Affairs CVE at the time of submission of quotes. Failure to be both verified by CVE and visible on https://www.vip.vetbiz.gov at the time of quote submission will result in the Contractor s quote being deemed non-responsive. All Contractors are urged to contact the CVE and submit the aforementioned required documents to obtain CVE verification of their SDVOSB status if they have not already done so. VA NOTICE OF TOTAL SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS SET-ASIDE (JUL 2016) (DEVIATION) (a) Definition. For the Department of Veterans Affairs, Service-disabled Veteran-owned small business concern or SDVSOB: (1) Means a small business concern: (i) Not less than 51 percent of which is owned by one or more service-disabled Veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service-disabled Veterans or eligible surviving spouses (see VAAR 802.201 Surviving Spouse definition); (ii) The management and daily business operations of which are controlled by one or more service-disabled Veterans (or eligible surviving spouses) or, in the case of a service-disabled Veteran with permanent and severe disability, the spouse or permanent caregiver of such Veteran; (iii) The business meets Federal small business size standards for the applicable North American Industry Classification System (NAICS) code identified in the solicitation document; (iv) The business has been verified for ownership and control pursuant to 38 CFR 74 and is so listed in the Vendor Information Pages database, (https://www.vip.vetbiz.gov); and (v) The business will comply with subcontracting limitations in 13 CFR 125.6, as applicable. (2) Service-disabled Veteran means a Veteran, as defined in 38 U.S.C. 101(2), with a disability that is service-connected, as defined in 38 U.S.C. 101(16). (b) General. (1) Quotes are solicited only from verified service-disabled Veteran-owned small business concerns. Quotes received from concerns that are not verified service-disabled Veteran-owned small business concerns shall not be considered. (2) Any award resulting from this solicitation shall be made to a verified service-disabled Veteran-owned small business concern. (c) Agreement. A service-disabled Veteran-owned small business concern agrees that in the performance of the contract, the concern will comply with the limitation on subcontracting requirements in 13 CFR § 125.6. (d) A joint venture may be considered a service-disabled Veteran owned small business concern if the joint venture complies with the requirements in 13 CFR 125.15, provided that any reference therein to SDVO SBC is to be construed to apply to a VA verified SDVOSB as appropriate. (e) Any service-disabled Veteran-owned small business concern (non-manufacturer) must meet the requirements in FAR 19.102(f) of the Federal Acquisition Regulation to receive a benefit under this program. (End of Clause) [Deviation per Class Deviation Veterans First Contracting Program (VFCP 2016), dated July 25, 2016, revises provisions and clauses at VAAR 852.215-70, 852.219-10 and 852.219-11, to update the web address for the VIP database and to adjust the limitations on subcontracting to comply with Small Business regulations. This deviation is effective until incorporated into the VAAR or the VAAM or is otherwise rescinded.] Point of Contact: Olonzo Haynes, Contract Specialist see contact information on notice. EXCERPT FROM STATEMENT OF WORK PHARMACY BENEFITS MANAGEMENT (PBM) SERVICES VISN-9 PHARMACEUTICAL SERVICES: The Contractor is to provide Pharmacy Benefits Management at contractor s facility or subcontracted facility to include filling, dispensing and counseling on emergency prescriptions and controlled substances in quantities up to a ten-day supply for prescriptions written by the care providers employed at the designated VA Clinics and Community Based Outpatient Clinics (CBOCs) in the region served by the Department of Veterans Affairs Veterans Integrated Service Network (VISN) 9. (Provider lists to be provided to awarded contractor.) Contractor shall provide dispensing fees with discounted rates offered on both brand name and generic prescription as outlined by the American Druggist Blue Book Average Wholesale Price (AWP). At a minimum, the contractor will have a facility located within a thirty minute drive of each VISN 9 CBOC location (see attachment list of CBOC addresses). These facilities shall be handicapped accessible, have handicapped parking spaces available and ample seating for patients waiting on their prescriptions. Under the Department of Veterans CARES initiative, new CBOCs are planned for activation in VISN 9. Additional areas will be added to this contract by mutual agreement as services are needed for new CBOCs in the VISN 9 service area. Offeror shall provide all prescribed therapeutic agents to patients at wholesale pricing per price list minus discount listed in Price Schedule. Any dispensing fees must be included in pricing or listed by the Offeror as a separate line item. The total cost charges to the VA shall be the same or lower than that charged to their best customer and in no case, more than charged to the general public. The contractor must provide a price list to the Contracting Officer showing pricing of the pharmaceuticals. Because prices change constantly, the contractor must submit the revised price list to the Contracting Officer on a quarterly basis. Prescriptions filled under this contract shall be, to the extent permitted by law, the least expensive drug product that the contract pharmacy has in stock. Generic drugs shall be dispensed whenever possible. Generic drugs will be dispensed if, in the professional judgment of the pharmacist, the available substitute product is safe and effective to the greatest extent possible, contains the same chemical ingredients in the same strength and dosage of the brand name. All generic products used shall be in compliance with Federal and State requirements. Brand name products will be dispensed only if there is no therapeutic equivalent product listed as (AB) equivalent. The generic name must be indicated on drug label for all medications. VA Beneficiaries will pick up their own prescriptions at the dispensing pharmacy. No prescriptions are to be mailed. No prescriptions are to be delivered. After start-up of the contract notification of provider information may occur on either the day the VA provider fills in at the CBOC or prior to CBOC duty as time allows. The contractor shall accept a call from the Contracting Officer, OR the Contracting Officer s Representative advising him/her of all new VA provider s state license number and federal and/or state drug license number. The services to be performed by the contractor will be performed in accordance with VA policies and procedures and the regulations of the medical staff by-laws of the VA facility and in accordance with all applicable federal, stated, city and local laws. If a new CBOC is to be opened, the Contracting Officer will notify the Contractor. Additional locations and pharmacies will be added by formal modification to the task order contract. RESOURCES: Prescriptions shall be filled and dispensed for medications on the VISN 9 CBOC Formulary. Contractor shall not provide medications not on this listing without prior approval from the Contracting Officer s Technical Representative. Any revisions to the VA (CBOC) formulary will be provided by Contracting Officer s Technical Representative to the Contracting Officer to be incorporated into the contract by modification processed by the VA Contracting Officer, including any pre-approvals as stated herein. The VISN 9 CBOC formulary will be reviewed periodically by the VA Formulary Committee, and any additions or deletions will be communicated via e-mail to the contractor, who will make these changes in the contractor s systems within five (5) business days. QUANTITIES: The contractor shall fill only new prescriptions for emergent or controlled substance medication up to a ten-day supply with no refills. Exceptions to the ten-day supply limit apply to antibiotics where the entire course of therapy may be dispensed, up to a 14 day supply. The VA will accomplish refills of prescriptions through the pharmacy mail out program. MEDICATION ORDER REVIEW Pharmacist will collect, synthesize interpret patient, prescription and disease data. Check for actual and potential drug-related problems including: Therapeutic duplication Drug-disease contraindications Drug-drug interactions (including interactions with over-the-counter drugs) Incorrect drug dosage Inappropriate duration of treatment Drug-allergy interactions Clinical abuse/misuse PATIENT-FOCUSED CARE All patients will be offered counseling by a pharmacist consistent with Omnibus Budget Reconciliation Act (OBRA) 1990 requirement to ensure appropriate use and optimal outcomes form drug therapy. Counseling includes the following information at minimum: Name, description and use of the medications. Dose, dosage form and route Special directions and precautions Common side effects and action required if they occur Techniques for self-monitoring drug therapy Action to be taken if a dose is missed Proper storage What the patient can expect from the medication A pharmacist will be available to answer any drug-related questions that a patient may have after the prescription is filled. This may be in the form of written and/or verbal information. FORMULARY MANAGEMENT Strict adherence to the CBOC Formulary is expected to ensure cost-effective and safe medications are dispensed. Prescription services will conform to the attached CBOC Formulary (Reference Attachment). Medical supplies, injectables. and prosthetic items are not included in this contract except for insulin vials and syringes. Medical supplies, injectables, and prosthetic items will be provided (directly to the patient) by the appropriate VA Pharmacy Service. Any other exceptions to the prescription formulary requirements of the contract must be pre-authorized by the respective COR at the responsible VA facility. Decisions of the VA STATION COR are final. VA CORs may retroactively approve exceptions, but the decision to retroactively consider, review or approve retroactive request for exceptions is solely at the discretion of the VA. QUALITY CONTROL/IMPROVEMENT All medication errors and medication related incidents will be recorded and reported to the COR at the applicable VA Medical Center every month. Adverse drug event reporting: All medication errors, adverse drug reactions or allergy reactions related to medications dispensed under this contract shall be reported to the COR of the responsible VA Medical Center. Customer complaints/suggestion/compliments will be recorded and forwarded to the COR or his/her designee at the applicable VA Medical Center every month (or more frequently if a significant problem occurs). OPERATIONAL REQUIREMENTS Prescribers will be responsible for providing all necessary dispensing information. This includes name, address, date of birth, social security number and telephone number of the patient and the name, address, DEA and telephone numbers of the physician. Prescribers will also be requested to list the indication for medication prescribed in the instructions for use on each prescription. The Contractor shall designate a program manager (contractor representative) under this contract delivery order and shall provide his/her name, title, address, phone number, fax number, and e-mail address to the Contracting Officer and each COR. The program manager shall work closely with the COR in regard to all services covered by the contract delivery order and/or any issues arising under the contract delivery order. QUALIFICATIONS Pharmaceutical care provided to beneficiaries under this contract shall meet all standards applicable to Medicaid recipients in the State where the services are provided. Personnel assigned by the contractor to perform the services covered by this contract shall be licensed in good standing in a State, Territory or Commonwealth of the United States or the District of Columbia. The qualifications of such personnel shall also be subject to review by the VA Chief of Staff and approval by the VA Facility Director. Offerors are required to obtain all Federal, State, and/or local licenses and certifications(s) applicable to the provision of Pharmaceuticals and Pharmacy Services. License shall be current and in good standing and a copy forwarded to the Department of Veterans Affairs Contracting Officer at the time of award. Contractor shall fill prescription within one-hour period from presentation of the prescription by the patient. The contractor agrees that all information concerning VA beneficiaries shall be kept confidential and shall not be disclosed to any person, except as authorized in writing and according to all applicable laws. Staff Competency: The contractor shall have an employee competency assessment and evaluation system in place for pharmacists filling prescriptions for Veterans. The contractor shall continuously meet or exceed Joint Commission Medication use standards related to procurement, preparation, dispensation, control and security, recall, and patient education. Additional information related to these standards can be accessed through the Joint Commission website at www.jointcommission.org. PACKAGING AND MARKINGS: All prescriptions MUST have appropriate auxiliary labels attached to the containers. Consideration must be given to a patient s ability to open childproof containers. Generic name must be indicated on drug label for all medications. Beyond use dating and lot numbers should be present on all dispensed containers. MEDICAL RECORDS: Representatives of the VA are authorized to visit the premises of service contractors during business hours for purposes of evaluation and auditing, which may include inspection of prescription records. SPECIAL CONTRACT REQUIREMENTS WORK HOURS: The services covered by this contract shall be furnished by the contractor as defined herein. The contractor will not be required, except in case of emergency, to furnish such services during off-duty hours as described below. The following terms have the following meanings: Work hours: At minimum, the contractor's hours of operation will be Monday through Friday, 8:00 a.m. - 4:30 P.M (local time), excluding all National Holidays or any other day specifically declared by the President of the United States to be a national holiday. However, contractors are strongly encouraged to have facilities capable of having the most accessible day and evening hours. National Holidays: The ten (10) holidays observed by the Federal Government are: New Year s Day Birthday of Martin Luther King, Jr. Washington' Birthday Memorial Day Juneteenth Independence Day Labor Day Columbus Day Veterans Day Thanksgiving Day Christmas Day HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) The services to be provided under this task order contract are subject to protection under regulations issued by the Department of Health and Human Services, as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR Parts 160 and 164, Subparts A and E, the Standards for Privacy of Individually Identifiable Health Information ( Privacy Rule ), and 45 CFR Parts 160 and 164, Subparts A and C, The Security Standard ( Security Rule ). A Business Associate Agreement (BAA) must complete and signed in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The completed and signed BAA must be returned to the Contracting Officer within two (2) days after receipt of award. HHS/OIG To ensure that the individuals providing services under the contract have not engaged in fraud or abuse regarding Sections 1128 and 1128A of the Social Security Act regarding federal health care programs, the Contractor is required to check the Health and Human Services Office of Inspector General (HHS/OIG), List of Excluded Individuals/Entities on the OIG Website (www.hhs.gov/oig) for each person providing services under this contract. Further the Contractor is required to certify in its proposal that all persons listed in the Contractor s proposal have been compared against the OIG list and are NOT listed. During the performance of this contract the Contractor is prohibited from using any individual or business listed on the List of Excluded Individuals/Entities. PRIVACY ACT/VA CONFIDENTIALITY STATUTES Any VA Contractor s employees who are given access to VA records that are protected by the Privacy Act of 1974 (Title 5 U.S.C. Section 552a) or any other VA Confidentiality Statute, including Title 38 U.S.C. Sections 5701 (which protects the confidentiality of the names and addresses of VA beneficiaries and their dependents), 5705 (which protects the confidentiality of medical quality assurance records, and 7332 (which protects the confidentiality of drug, alcohol, sickle cell anemia and HIV records) shall be considered to be employees of the agency (VA) for all intents and purposes pertaining to the confidentiality requirements of these laws. Appropriate procedures must be instituted to safeguard all such information received in performance of this contract. No information will be disclosed to any Contractor/subcontractor employee except as necessary and appropriate on a need to know basis to carry out the provisions of this contract. Any Contractor/ subcontractor employee who makes an unauthorized disclosure or re-disclosure of protected information will be guilty of a misdemeanor and subject to a fine of up to $5,000 for a first offense. A second offense of any VA Confidentiality Statute will result in a fine of up to $20,000. CONTRACTING OFFICER S REPRESENTATIVES (CORs) The VISN-wide Contracting Officer s Representative (COR) shall be responsible for the overall technical administration of this contract as outlined in the COR Delegation of Authority. Pharmacy Staff shall be responsible for reviewing and certifying invoices to ensure they reflect accurately the work completed in accordance with the requirements of the task orders. Through invoices entered in IPPS, the Pharmacy Staff shall also verify that services billed were indeed rendered. COR shall furnish the Contracting Officer notice of any unsatisfactory areas. COR shall be responsible for the technical administration of the task orders as outlined in the COR Delegation of Authority. INVOICES/BILLING SUMMARY INVOICES: The contractor shall bill the individual VA facilities monthly for services rendered in their respective CBOCs. The VA will pay for services based on the rates established in the Schedule of Costs. Invoices shall include the contract number, the applicable station task order number, and the contractor s tax identification number. Invoices WITH NO PATIENT-SPECIFIC DATA shall be submitted to Tungsten. Patient-specific data will be provided via encrypted e-mail directly to the VA facilities. DETAILED INVOICES: Contract pharmacies shall maintain a secure electronic log of VA Prescriptions filled and have the patient sign next to each prescription number for each prescription received. This log shall be securely maintained at the contract pharmacy and be readily accessible for random VA audit. The VA will randomly audit all billings. The contractor must make prescription records available to the auditor in a timely manner at the location where dispensed if requested. Invoices shall contain at a minimum the following information: Invoice number and date of invoice Patient s Name Patient s Social Security Number and date of birth Name of Provider and Provider ID Prescription Number and NABP number Date Rx written and date Rx dispensed Generic/Brand code Name, strength, quantity, days supply, and NDC number of medication dispensed Contractor s charge (includes ingredient cost of medication, dispensing fee, administrative fee, and total amount due) The detailed invoice with patient/prescription-specific information shall be sent electronically, with VA-approved encryption to the respective station COR for review and certification: THIS INFORMATION WILL BE PROVIDED ON THE RFQ PAYMENT IN FULL: Payments by the VA shall constitute full payment. Neither the patient nor his/her insurance carrier(s) shall be billed by the Contractor for services and supplies provided under this contract. The contractor/subcontractor must store, transport, or transmit VA sensitive information in an encrypted form, using VA-approved encryption tools that are, at a minimum, FIPS 140-2 validated. ALL mailings containing patient information SHALL be sent with the ability to be tracked; this can be by certified mail, priority mail with tracking, FedEx, DHL, or any other option that provides the Contractor with tracking capabilities. Contract award will be made to the offer that best meets the requirements as stated in the solicitation and whose offer provides the most favorable discount from the AWP (average wholesale price) listed in the most current (latest) edition of the Pharmacy Fundamental Reference REDBOOK and REDBOOK updates or Medi-Span, and the most favorable dispensing fee. Contract award will also be to the offeror that has pharmacies within its network that are geographically accessible to the CBOC, both patient and handicapped accessible, and which have the most accessible day and evening hours. ATTACHMENT C ESTIMATED QUANTITIES The CBOCs in each location average the following volumes for outpatient pharmacy-filled medications. The Offeror is to mark the CBOCs that will be included in their offer (see Attachment for CBOC locations). CLINIC ESTIMATED NUMBER OF PRESCRIPTIONS (X) IF INCLUDING IN OFFER TENNESSEE SERVICED BY TENNESSEE VALLEY HEALTHCARE SYSTEM VA Tullahoma CBOC 50 VA Clarksville CBOC 2000 VA Chattanooga OPC 2000 VA Nashville (Charlotte Ave) Clinic 50 VA Nashville (Meharry) Clinic 50 VA Nashville Evening Clinic 50 VA Athens CBOC 50 VA Bowling Green CBOC 50 VA Cookeville CBOC 50 VA Dalton Drive CBOC 50 VA Dover CBOC 50 VA Gallatin CBOC 50 VA Glenis Drive CBOC 50 VA Glenis Drive 2 CBOC 50 VA Hopkinsville CBOC 50 VA International Plaza CBOC 50 VA Maury County CBOC 50 VA McMinnville CBOC 50 VA Pointe Center CBOC 50 VA Roane County CBOC 50 VA Jackson CBOC 750 SERVICED BY JAMES H. QUILLEN (MOUNTAIN HOME) VAMC VA Knoxville CBOC 3500 VA Rogersville CBOC 50 VA Campbell County CBOC 400 VA Morristown CBOC 500 VA Morristown East CBOC 50 VA Sevierville CBOC 900 VA Downtown West VA Clinic 500 VA Mountain City CBOC 100 KENTUCKY SERVICED BY LEXINGTON VAMC VA Somerset CBOC 1230 VA Morehead CBOC 750 VA Hazard CBOC 170 VA Berea CBOC 230 SERVICED BY LOUISVILLE VAMC VA Grayson County (Clarkson) CBOC 2000 VA Carroll County (Carrollton) CBOC 150 Greenwood VA Clinic 150 Stonybrook VA Clinic 150 Newburg VA Clinic 150 Fort Knox VA Clinic 1000 Robley Rex VA Medical Center 50 SERVICED BY TENNESSEE VALLEY HEALTHCARE SYSTEM VA Bowling Green CBOC 50 VA Hopkinsville CBOC 50 INDIANA SERVICED BY LOUISVILLE VAMC VA Scott County (Scottsburg) CBOC 150 New Albany VA Clinic 150 VIRGINA SERVICED BY MOUNTAIN HOME VAMC VA Norton CBOC 50 VA Marion ROC 10 VA Bristol CBOC 200 VA Jonesville ROC 100 VA Vansant ROC 20 ARKANSAS SERVICED BY MEMPHIS VAMC VA Jonesboro CBOC 700 VA Helena CBOC 1100 MISSISSIPPI SERVICED BY MEMPHIS VAMC VA Tupelo CBOC 700 ESTIMATED QUANTITIES: It is impossible to determine the exact quantities that will be required during the contract term. Each offeror whose offer is accepted in whole or in part shall be required to provide all items that may be ordered during the contract term. The fact that all estimated quantities are not ordered shall not constitute a price adjustment under any resulting contract. END OF STATEMENT OF WORK END OF PRESOLICITATION NOTICE