R408--PHARMACY BENEFIT MANAGEMENT: VISN 22
D.1 Statement of Work Scope: The Department of Veterans Affairs (VA), Veterans Integrated Service Network (VISN) 22, has a requirement to establish a Blanket Purchase Agreement (BPA) with a Contractor to provide pharmacy benefit management (PBM) first-fill prescription services. The Contractors will fill an initial supply of prescriptions for Veterans seen by a VA provider or a VA authorized healthcare provider, henceforth be reference as Providers. Contractor shall also provide medication counseling by a Pharmacist consistent with Omnibus Budget Reconciliation Act 1990 (OBRA-90) and adhere to the VA National Formulary. It is the Government’s intention to award a single award, firm-fixed price BPA for five (5) years. Anticipated contract base period is April 1, 2021 – March 31, 2025. Accelerated Access Initiatives and Community Care Network (CCN) MISSION Act Providers (e.g., VA Video Connect (VVC), Virtual VA Healthcare Hubs and Clinical Call Centers, Non-VA Care/ Non-VA Providers): These initiatives will require the Contractor to facilitate the filling of an initial supply of medication(s). Veterans needing medication will be allowed to take the 1st fill prescriptions to any local community pharmacy for processing. The providers will fax or mail subsequent prescription forms to the respective Outpatient Pharmacy for processing and mail-out to the Veterans. Requirements – Administration: Contractor pharmacies will obtain, verify and maintain all necessary licenses, certification, permits and other legal prerequisites necessary to provide service under this contract and shall be made available upon request by the Contracting Officer (CO). Contractor shall have an established third-party prescription payer/ administrator to process claims (e.g. Optum, Caremark, Express Script, etc…) with a current and active bank identification number (BIN) and Processor Control Number (PCN). Contractor will have an extensive pharmacy network that will satisfy the requirement of the BPA. Personnel assigned by the Contractor to perform the services covered by this contract shall be licensed as a Registered Pharmacist in a State, Territory, or Commonwealth of the United States or the District of Columbia. The Contractor agrees that all information concerning VA beneficiaries shall be kept confidential and shall not be disclosed to any person, except when authorized in writing and according to applicable laws. All adverse drug events reported to a service provider by a Veteran beneficiary under this contract, will be reported to the associated facility’s Contracting Officer Representative (COR) and the CO. Adverse drug events include dispensing errors, drug allergies, and adverse drug reactions. For Recalls, the Contractor is required to follow a standard policy, as well as State and Federal regulations, for notification of affected Veterans. The Contractor shall have a documentation system for product traceability and lot number recordings for product recalls. The Contracting Officer must be notified immediately by telephone and within five (5) days a written notice. The Contractor shall follow a standard policy, as well as State and Federal regulations, for notification of affected patients. The Contractor must communicate with the VA via secure e-mail messaging. Contractor agrees to fulfill all requirements needed to establish and maintain secure email messaging and to comply with all HIPAA requirements concerning Veteran health information. Monthly reports will detail the prescription fill activity by prescribing Healthcare System. Reports will be site specific and detail the number of prescriptions prescribed, total drug cost, brand or generic used, therapeutic breakdown of prescribing, top 25 drugs prescribed, and total dollar claims per site. Reports detailing classification of drugs spend analysis, and performance metrics will also be required monthly. These reports will be sent via encrypted electronic email to the respective Chief of Pharmacy (or designee) for review before monthly payment will occur. Contractor shall have a network of pharmacies to ensure licensed pharmacist are within a 5-mile radius of main Medical Center campus, CBOCs, OPC, or Veterans’ location unless approved in advance by the Contracting Officer. All pharmacy shall provide service during the core hours, Monday tough Friday, 8:00 am to 6:00 pm local time. Telehealth Voucher: Upon the receipt of direction from authorized VA personnel, Contractor may create a separate voucher, referred to as a telehealth voucher, to cover instances where Veterans meet with a health care professional in a virtual environment i.e. by telephone, video conference, or any other method not requiring an in-person visit. Veterans shall not be required to present the telehealth voucher. The telehealth voucher may be faxed by the appropriate VA personnel to the appropriate pharmacy. Requirement – Pharmacist: Pharmacist shall adhere to all state and federal regulations. Veterans will receive the filled prescription within two hours of authorization by a Pharmacist. The Veteran will receive counseling from a Pharmacist for each prescription filled. The Contractor shall provide a Registered Pharmacist who will be expected to: Collect, synthesize and interpret the prescription and disease data Check for actual and potential drug related problems, including: Therapeutic duplication Drug-disease contradictions Drug-drug interactions (including interactions with over-the-counter drugs) Incorrect drug dosage Drug-allergy interactions Identify, clarify and resolve drug-related problems with prescriber and the Veteran. Offer the Veteran counseling by a Pharmacist consistent with Omnibus Budget Reconciliation Act (OBRA) 1990 requirement to ensure appropriate use and optimal outcomes from drug therapy. The counseling shall include but not be limited to: Name, description and use of medication; 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 dosage is missed; Proper storage; What the Veteran can expect from the medication; The balance of the prescribed medication that will be mailed from the associated healthcare system’s pharmacy; If applicable, conduct an inquiry with the prescribing facility about the Veteran’s balance of prescriptions. Be available to answer any drug related questions that a Veteran may have after the prescription is filled. All Veterans shall be treated with dignity, courtesy and respect. The pharmacy will maintain documentation for all prescriptions filled. Veterans will sign for each prescription received. All prescriptions must have proper auxiliary labels attached and counseling consistent with Medicaid Regulation. Dispensing Locations: The pharmacy locations for filling and dispensing prescriptions must be within a five-mile radius of the respective CBOC, OPC, or Veterans’ location. The Contractor must have a minimum of one licensed pharmacy in each of the areas identified for coverage. The location of each pharmacy filling and dispensing prescriptions under this contract shall be provided to the Contracting Officer. Instructions: D.4.1. Prior Authorization Procedures: The Contractor will support a prior authorization procedure which must be: Real time Electronic Secure Allow for multiple contacts Available during the following core hours, Monday tough Friday, 8:00 am to 6:00 pm local time Contractor’s pharmacies shall fill and dispense medication from original prescriptions written by the Provider. All prescriptions from VA providers must be written on VA form 10-2577F. Any approved non-VA providers shall use a prescription blank meeting Federal and State legal requirements. Providers may send the prescriptions electronically, via fax, or in any other legally required or acceptable manner. Oral medication dispensed shall not exceed fourteen (14) days. For prescriptions that extends beyond 14 days the prescribing provider shall be contacted and made aware of the restrictions. Specialty compounded medications may not exceed the amount ordered by the Provides or Federal or State law allowances. There shall be no refills of oral prescriptions. The Contractor shall fill ONLY NEW PRESCRIPTIONS. Under special conditions, i.e. after hurricane or other natural disasters, the CO may authorize refills tu written approval. Prescriptions will be filled and dispensed only for drugs that are on the VA national formulary, a list can be found at the VA Pharmacy Benefits Management Services website: https://www.pbm.va.gov/nationalformulary.asp. The facility’s Contracting Officer Representative (COR) may limit prescriptions filled and dispensed to medications of urgent need as determined by VA clinical staff and will follow safe and effective formulary management principles practiced within the VA. This may include adjudication of medications on a case-by-case basis as defined by local medical center procedure. If this is the case, the VA will maintain an emergent drug list of medication the Contractor may fill without prior authorization. The ordering facility COR or designee will email this “emergent drug list” to the Contractor at the time of the task order is issued and provide updates to the list as necessary. 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 drug list” and to prevent medications that require prior authorization from being dispensed. Formulary list may be reduced by each site; however, it may not expand beyond the national formulary list. Prescriptions filled under this contract shall be generic drugs, to the extent permitted by law, the least expensive drug product the pharmacy has in stock will be dispensed. All generic products used must follow Federal and State requirements. A product is not considered a generic equivalent unless the strength, quantity and dosage are the same as the brand name. All generic drugs must be Federal Drug Administration (FDA) AB rated generics. The generic name must be displayed on all labels for all medication. The only exception to this will be for the drugs on the VA Drug Standardization List, https://www.pbm.va.gov/nationalformulary.asp which will be filled by the name brand only. No prescription shall be mailed. The price the Contractor invoices the VA shall not exceed the price the Contractor charges the general public or the Contractor’s lowest third-party reimbursement plan. There will be not Co-Pay to the Veteran. Other information: Clinical or other medical records of VA beneficiaries treated by the Contractor will remain the property of the VA. The parties agree that such personnel shall not be considered a VA employee for any purpose and shall be considered employees of the Contractor. The parties agree that such personnel shall not be considered a VA employee for any purpose and shall be considered employees of the Contractor. In order to facilitate increased pharmacy participation for Veterans enrolled in VA Accelerated Access or CCN programs, the Contractor may create an “Open Pharmacy, Open Provider Purchase Care” voucher upon direction of the COR or CO. This voucher will not require the pharmacy or provider to be specifically enrolled with the Contractor to provide emergency first fill prescription services. The purpose of the open-ended voucher is to make it easier for Veterans to receive emergency first fills especially in more remote areas where pharmacy participation/registration with the Contractor may be difficult to recruit. Prescription purchases made with the open-ended voucher will be included on the monthly Contractor as specified by the servicing VA COR. Other medications that may be dispensed tough the 1st fill program are Vaccinations administered at community pharmacies and Specialty Compounded medications dispensed tough licensed compounding pharmacies. Specialty Compounded medications are defined as those that need to be manufactured for specific patients or dispensed directly to Veterans by a licensed compounding pharmacy. They may include sterile and non-sterile compounded preparations. Vaccinations shall cover both seasonal and non-seasonal vaccines including those administered for travel abroad. Vaccinations shall include all administrative fees and ingredient costs, with no dispense fees charged to the VA. Below are the potential vaccinations that may be required: Flu (Influenza) - Seasonal Td (Tetanus, Diphtheria) Tdap (Whooping Cough) Meningitis (Meningococcal) Pneumonia (Pneumococcal) Chickenpox (Varicella) HPV (Human Papillomavirus) Hepatitis A (Hep A) Hepatitis A/Hepatitis B combination Hepatitis B (Hep B) MMR (Measles, Mumps and Rubella) Polio Shingles (Herpes Zoster) Yellow Fever Japanese Encephalitis Typhoid Rabies Payment: The VA agrees to reimburse the Contractor on a unit basis for resources furnished at the prices listed in the Schedule of Supplies\Services portion of this contract. Payment of sums due will be paid monthly upon submission, by the Contractor, of a properly prepared invoice receipt and the appropriate VA office. The VA will review the records for agreement with the VA records and verify that the coverage provided for the month is in accordance with the contract. Payment will be authorized by the VA upon verification by the VA of the services bill. Billings rendered by the Contractor to the VA for services furnished a VA beneficiary under the terms of this contract shall be billings in full. Neither the beneficiary, nor his/her insurer nor any other third party shall be billed. In the event the coverage is not provided in accordance with this contract, the payment to the Contractor shall be reduced in direct ratio to the reduction in coverage. Any additional costs incurred by the VA as a result of obtaining coverage from a source other than the Contractor, due to the Contractor’s failure to provide adequate coverage, will be assessed against the Contractor. Contract Security Contractor cannot store Veterans information on a mobile device. Contractor is prohibited from transferring Personnel Health Information (PHI) by fax or non-secure email to and from a VA Medical Center. The C&A requirements do not apply, a Security Accreditation Package is not required. See section D.3 IT CONTRACT SECURITY for other security requirements. 36C26221R0017 Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 22
2/8/21, 4:04 PM