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19 PERFORMANCE WORK STATEMENT (PWS) [TEMPLATE] Kansas City VAMC Prescription Fill Services Part 1 General Information 1. GENERAL: This is a non-personal services contract to provide Pharmacy Benefits ... 19 PERFORMANCE WORK STATEMENT (PWS) [TEMPLATE] Kansas City VAMC Prescription Fill Services Part 1 General Information 1. GENERAL: This is a non-personal services contract to provide Pharmacy Benefits Management (Emergency Prescription Fill and After Hours) services to eligible Veteran beneficiaries assigned to the Kansas City Veterans Administration Medical Center s (KC VAMC) Community Based Outpatient Clinics (CBOCS) and Home-Based Primary Care (HBPC) program. The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government. Description of Services/Introduction: The Contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform Pharmacy Benefits Management as defined in this Performance Work Statement (PWS), section 5 except for those items specified as government furnished property and services. The Contractor shall perform to the standards in this contract. 1.2 Background: In the event a Veteran is unable to obtain emergent prescriptions from the KC VAMC, due to the geographic location of the CBOC or HBPC location where they are seen by the provider, the VA needs a Pharmacy Benefit Management vendor to coordinate the billing and formulary management. Objectives: SERVICES: Emergency Fill and After-Hour Service Specifications Required: The contractor s pharmacies shall dispense urgent medications from original prescriptions written by VA providers assigned to KCVAMC, the VA CBOCs, and the VA HBPC program within 30 minutes from presentation of the prescription by the patient. Prescriptions filled will be in written form provided by a KCVAMC provider, a CBOC provider, or an HBPC VA provider. Dispensing pharmacies must be able to accept the written or electronic prescription (when available). The Contractor shall fill ONLY NEW PRESCRIPTIONS on form 'KC- CBOC-PRESCRIPTION' pharmacy non-VA medication order template. In the event of unusual circumstances that require a verbal or telephonic prescription fill, the Pharmacy will follow the proper protocol procedures in order to complete the prescription within the 30-minute fill requirement. VA key personnel from KCVAMC Pharmacy Service are only authorized to provide approval for changes to the Contracted Pharmacy Formulary, Chief of Pharmacy and Outpatient Supervisor. Urgent therapeutic equivalent substitutions as a result of back order or approved formulary product unavailability can be approved through the KCVA Pharmacist on call, who can be reached 24/7 at 816-255-2506. In the event this number changes, alternate contact can be provided up on award. This includes but is not limited to urgent therapeutic equivalent substitutions as a result of back order or approved formulary product unavailability. Urgent prescriptions will be filled and dispensed only for medications listed in the Medication Formulary List as authorized by the KCVAMC (See attachment #2 KC VAMC ER Formulary Listing). An updated Emergent Formulary Medication List will be e-mailed to the contractor at time of BPA award and after each update by the Chief of Pharmacy or his/her designee. Listing will consist of drug name, strength, and form(s) for each drug that is added along with the National Drug Codes. There shall be a mechanism in place, provided by the contractor, to provide real-time messaging and hard edits to the pharmacies in order to limit dispensed medications to the specified Emergent Formulary Medication List to prevent non-formulary or prior authorization medications from being dispensed without specific prior approval by the Chief of Pharmacy or his/her designee. In addition, there must be a mechanism in place to update the Emergent Formulary Medication List as needed. The contractor must have a minimum of two licensed pharmacies accepting its plan in each of the CBOC locations and within the designated zip code areas. The intent of the Government is that the contractor has a minimum of two licensed pharmacies in all service areas to provide patients with more choices and additional access to pharmacies. Prescriptions shall be filled and limited to the maximum quantity and day supply defined in the KCVAMC ER Formulary List. The maximum amount of emergency fill prescriptions will not exceed the ten (10) day supply (unless repackaging is not an option). In this case, the contractor will dispense as indicated on the prescription. Antibiotics shall not exceed a fourteen (14) day supply. No prescription refills will be authorized. The contractor shall only fill new prescriptions with no refills. All prescriptions must have proper auxiliary labels attached and appropriate counseling and drug interaction sheets provided. Prescriptions shall be filled with generic drugs to the extent permitted by law, and the least expensive drug product the pharmacy has in stock will be dispensed. Generic drugs shall be dispensed if, in the professional judgement of the pharmacist, the substitute product is available, safe, and effective, and to the greatest extent possible, contains the same chemical ingredients of the same strength, quantity, and dosage of the brand name. All generic products used must be AB rated per the Red Book. All generic products used must be in compliance with Federal and State requirements. Prescriptions must be filled with an appropriate AB rated equivalent product. In the case of a Dispense as Written (DAW) provider signed prescription the contracted pharmacy must contact the KCVAMC Pharmacy for approval. VA beneficiaries or their designees will pick up prescriptions at the dispensing pharmacy. No prescriptions will be mailed or delivered to patients. All patients will adhere to the serving pharmacies pick up process and procedures. Contract pharmacies shall maintain an electronic record of VA prescriptions filled and require the patient to sign next to each prescription number for each prescription received. The Contractor shall provide a Program Manager (contractor representative) under this BPA and shall provide his/her name, title, address, phone number, fax number, and e-mail address. The program manager (contractor representative) shall work closely with the COR in regard to all services covered by the BPA and/or any issues arising under the BPA. Program Manager will have oversight on all contractual obligations that are stated within the PWS and responsible for the meeting the reporting requirements and evaluation factors. All patients shall be offered counseling by a pharmacist to ensure appropriate and optimal outcomes from drug therapy. Counseling should include the following: Name, description, and use of 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 shall be available to answer any drug-related questions a patient may have after the prescription is filled. This may be in the form of written and/or verbal information. The contractor shall have sufficient qualified employees to support all services in the event an employee scheduled to work becomes ill, resigns, is terminated by the contractor, or is otherwise unavailable to work. Contract requirements are not altered or mitigated by inclement weather. The contractor shall accept a call from the COR advising him/her of all existing and/or new VA provider's state license numbers and his/her federal and/or state drug license numbers. The contractor shall immediately notify its contract pharmacies of the provider information so as to avoid delay in patient services. 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. PRICING: As services are needed for new CBOCs in the KCVAMC primary service area, additional pharmacies will be added to the BPA. If a new CBOC is to be opened, the Contracting Officer (CO) will notify the contractor in advance of the opening. At that time, the contractor shall submit a listing of proposed pharmacies for that area to the CO and supporting licenses/state certifications documents. The KCVAMC Chief of Pharmacy shall approve additional pharmacies for that area to the CO. Additional pharmacies shall be added to the BPA only through the Contracting Officer by a bilateral modification and the issue of Notice to Proceed. The contractor shall be required to fill all prescription orders written during the BPA period of performance. The fact that the estimated dollar value is not obtained shall not constitute a price adjustment under the BPA task order. Reimbursements shall be determined by the Average Wholesale Price (AWP) discounted by the applicable percentage plus the applicable dispensing fee. The total price charged to the VA shall not exceed that charged to the general public and shall not exceed the price charged by the Contractor s lowest third-party reimbursement plan. Average Wholesale Price (AWP) will be based on the current Pharmacy Fundamental Reference Redbook and Redbook Updates published by Medical Economics Data, Inc. Contractor shall be required to provide KCVAMC COR with a current copy of the REDBOOK at the time of BPA award and provide any updates throughout the BPA terms. If a contractor offers to use any other means of providing pricing, they shall provide appropriate documentation similar to that of the REDBOOK and its updates. Award of a BPA will not be made to any offeror who does not provide sufficient evidence to substantiate the 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 BPA shall be licensed in good standing without restrictions in a State, Territory, or Commonwealth of the United States or District of Columbia. Offerors are required to verify all Federal, State, and/or local licenses and certification(s) applicable to the provision of Pharmacy Services. All Pharmacies state licenses and Proof of Liability Insurance must be in an active state, not be expired. The qualifications of contractor personnel shall be subject to a review by the KCVAMC Chief of Pharmacy and the KCVAMC Chief of Staff. Contractor shall provide evidence of all employed Pharmacists, confirming that each Pharmacist has a current valid state license for that servicing pharmacy location. The Contractor, its employees, agents, and subcontractors shall not be VA employees for any purpose. Contractor employees shall read, understand, speak, and write English fluently. The contractor shall verify that all Licensed Pharmacists are: Licensed in the States applicable to employment Able to collect, synthesize and interpret patient prescriptions, and disease data Able to verify for factual and potential drug related problems, including (but not limited to): Therapeutic duplication Drug disease interactions Incorrect drug dosage Drug-allergy Able to identify, clarify, and resolve drug related problems with the prescriber and patient Able to answer any drug related questions that a patient may have after prescription is filled Treats all patients with dignity, courtesy, and respect. 1.4 Scope: Pharmacy Benefits Management Services. The Contractor shall provide the following: Emergency Fill and After-Hour Service Specifications Required: The contractor s pharmacies shall dispense urgent medications from original prescriptions written by VA providers assigned to KCVAMC, the VA CBOCs, and the VA HBPC program within 30 minutes from presentation of the prescription by the patient.