STATE OF WASHINGTON

HEALTH CARE AUTHORITY

REQUEST FOR INFORMATION (RFI)

RFI NO. 2026HCA6

NOTE: If you download this RFI from the Health Care Authority (HCA) website, you are responsible for sending your name, address, e-mail address, and telephone number to the RFI Coordinator for your organization to receive any RFI amendments or vendor questions/agency answers. HCA is not responsible for any failure of your organization to send the information or for any repercussions that may result to your organization because of any such failure.

SCOPE TITLE: UMP Pharmacy Benefit RFI

RFI RELEASE DATE: September 8, 2026

SUBMISSION DUE DATE: October 9, 2026

RFI RESPONSE: Please limit your entire RFI response to 30 pages or less. At HCA’s discretion, you may also be asked to participate in an ad-hoc conference call with HCA personnel.

Only e-mailed submissions will be accepted.

1. RFI GOALS AND OBJECTIVES

1.1 RFI GOAL

1.2 BACKGROUND

2. CONTENT OF RESPONSES

2.1 RFI RESPONSES

3. ADMINISTRATIVE TERMS AND CONDITIONS

3.1 RFI COORDINATOR

3.2 ESTIMATED RFI SCHEDULE

3.3 VENDOR RFI QUESTION PERIOD

3.4 RESPONSE REQUIREMENTS

3.5 REVISIONS TO THE RFI

3.6 NO OBLIGATION TO BUY OR ISSUE SOLICITATION

3.7 SECURITY AND PRIVACY REQUIREMENTS

4. EXHIBIT A – RFI QUESTIONS

4.1 Implementation Services

4.2 Organizational Overview

4.3 Account Management

4.4 Member and Pharmacy Services

4.5 Eligibility, enrollment, & Data Integration

4.6 Pharmacy Network

4.7 Claims Processing & Benefit Administration

4.8 Data, Reporting, & File Transfers

4.9 Clinical Management and Formulary

4.10 Financial Modeling, Pricing, & Rebates

4.11 Performance Guarantees

4.12 Program Integrity, Audit, & Fraud

4.13 Appeals, Grievances, & Compliance

4.14 Coordination with Medical TPA

4.15 Innovation & Future State

HCA RFI No. 2026HCA6 Page 3 of 18

1. RFI GOALS AND OBJECTIVES

This RFI seeks information from Pharmacy Benefit Administrators (PBAs), Pharmacy Benefit Managers (PBMs), Third-Party Administrators (TPAs), and related vendors that can share valuable experience related to the questions in Exhibit A.

1.1 RFI GOAL

HCA is gathering information that may be used in consideration of a future procurement for a self-insured pharmacy benefit for approximately 435,000 members between the Public Employees Benefits Board (PEBB) and the School Employees Benefits Board (SEBB) Programs.

HCA is seeking information from qualified PBMs, PBAs, TPAs, and related vendors with experience administering large, self-insured public sector pharmacy benefit programs.

Responses from entities other than those identified herein will not be reviewed by HCA.

The purpose of this RFI is to gather information on commercial and Medicare Part D pharmacy benefit administration to include, but not limited to:

A. Pharmacy benefit design;

B. Administrative models (PBM vs. TPA vs. hybrid);

C. Cost containment;

D. Population health strategies;

E. Alignment with medical benefit;

F. Opportunities for enhanced transparency, cost control, and innovation; and G. Alternative financing approaches.

1.2 BACKGROUND

HCA’s current member population includes approximately:

• 300,000 PEBB Program members (employees and dependents),

• 285,000 SEBB Program members (employees and dependents),

• 114,000 PEBB Program Medicare retirees and their dependents,

• 7,300 PEBB Program non-Medicare retirees and their dependents, and

• 2,000 Consolidated Omnibus Budget Reconciliation Act (COBRA)/self-pay members

(subscribers and dependents)

Specific enrollment numbers can be found here.

RCW 41.05.022 establishes the risk pool for PEBB active employees, SEBB active employees (K-12 school employees), and PEBB retirees, survivors, and their dependents not eligible for Parts A and B of Medicare. PEBB retirees, survivors, and their dependents enrolled in Medicare Part A and Medicare Part B are in a separate risk pool established by RCW 41.05.080. All eligible retiring K-12 school employees move to PEBB Program coverage upon retirement.

https://hca-tableau.watech.wa.gov/t/51/views/EmployeeandRetireeBenefitsEnrollmentDashboard/ERBMemberDashboard?%3AisGuestRedirectFromVizportal=y&%3Aembed=y https://app.leg.wa.gov/rcw/default.aspx?cite=41.05.022 https://app.leg.wa.gov/rcw/default.aspx?cite=41.05.080

HCA RFI No. 2026HCA6 Page 4 of 18

HCA is interested in the PBA community’s knowledge and expertise regarding the benefit structure, implementation, and operation of self-funded, commercial pharmacy benefit plans and Medicare Part D plans.

HCA administers the Uniform Medical Plan (UMP), a self-insured medical and pharmacy benefit program serving PEBB and SEBB populations.

The combined population for UMP exceeds 435,000 members, including:

A. Active employees/dependents B. Non-Medicare Retirees/dependents C. Medicare Retirees/dependents

HCA currently contracts with a single PBA to administer UMP pharmacy benefits for commercial PEBB and SEBB plans, and Part D for Medicare retirees. UMP is required to participate in a prescription drug purchasing consortium under RCW 70.14.060, unless another purchasing arrangement will result in greater discounts and net savings to the state. The consortium contract requires 100% pass-through pricing to participating programs and extensive contractual requirements across implementation, formulary, policy, and prior authorization (PA) customization, operations, reporting, and compliance.

HCA is evaluating future models including:

A. Potentially contracting outside of the consortium or modifications to consortium procurements;

B. Transparent pass-through arrangements;

C. Enhanced clinical and financial accountability;

D. Innovative drug purchasing models;

E. Value-based (or outcomes-based) options; and F. Specialty drug cost management and services.

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HCA RFI No. 2026HCA6 Page 5 of 18

2. CONTENT OF RESPONSES

This section outlines the elements requested in the response to this RFI. The timeline in Section 3.2 includes time for additional questions to address any information not covered in the subsequent sections.

2.1 RFI RESPONSES

HCA is seeking information from PBAs, PBMs, TPA’s, and related vendors who have the capabilities to provide pharmacy benefit plans to the members outlined above. HCA seeks responses that are based on your experience with non-Medicare and Medicare Part D plans.

Qualified entities are requested to respond to the questions outlined in Exhibit A.

Please use the above assumptions and background as a framework in your responses.

This common framework will be utilized to facilitate interpretation of the RFI results.

Responses should:

A. Be clear and concise;

B. Use the provided categories;

C. Reflect real-world implementations; and D. Include examples where possible.

3. ADMINISTRATIVE TERMS AND CONDITIONS

3.1 RFI COORDINATOR

The RFI Coordinator is the sole point of contact in HCA for this RFI. Please submit responses to the RFI Coordinator at the e-mail below.

Name Jerry Nichols

E-Mail Address HCAProcurements@hca.wa.gov

Please be sure to include the RFI Number 2026HCA6 in the subject line of any e-mails.

3.2 ESTIMATED RFI SCHEDULE

Release RFI September 8, 2026

Vendor RFI Questions Due September 22, 2026

HCA Answers Posted* September 25, 2026

Vendor Exhibit A Response due to HCA October 9, 2026

HCA RFI No. 2026HCA6 Page 6 of 18

HCA Ad-Hoc Conference Call Confirmation E-mail Notice sent to Selected Vendor(s)*

October 29, 2026

Ad-Hoc Conference Calls November 3, 2026

November 4, 2026

November 5, 2026

November 6, 2026

8:00 a.m. - 8:30 a.m. PT

8:30 a.m. - 9:00 a.m. PT

8:00 a.m. - 8:30 a.m. PT

8:30 a.m. - 9:00 a.m. PT

8:00 a.m. - 8:30 a.m. PT

8:30 a.m. - 9:00 a.m. PT

8:00 a.m. - 8:30 a.m. PT

8:30 a.m. - 9:00 a.m. PT

* Dates are anticipated and subject to change without an official amendment.

HCA reserves the right to change the RFI schedule at any time.

3.3 VENDOR RFI QUESTION PERIOD

Vendors are provided with an opportunity to ask questions during the vendor question period which starts on the date of the RFI posting and concludes on the Vendor RFI Questions Due date specified in Section 3.2 (ESTIMATED RFI SCHEDULE).

A. Questions regarding the RFI will only be accepted in writing, sent by e-mail to the RFI Coordinator. The Vendor must use the following e-mail subject line when submitting questions:

i. “RFI 2026HCA6 Question(s) – [Vendor Name]”

B. HCA anticipates it will post answers to the questions in Washington’s Electronic Business Solution (WEBS) as an RFI amendment on the HCA Answers Posted date specified in Section 3.2 (ESTIMATED RFI SCHEDULE).

C. HCA is under no obligation to respond to any questions received after the Vendor RFI Questions Due date but may do so at its discretion.

3.4 RESPONSE REQUIREMENTS

A. Written Response – Required

i. Please limit your response to 30 pages or less. Responses must be provided in an electronic format, such as Adobe Acrobat or Microsoft Word.

You only need to provide a single copy of your response. Responses may be provided in more than one file and submitted in more than one e-mail. HCA requires that all responses be submitted via e-mail to the RFI Coordinator in Section 3.1.

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ii. Please note that HCA will not accept zipped or compressed files in connection with this RFI. HCA will not open any such file. If individual files to a response are too large, please send multiple e-mails instead of compressing files.

B. Response Font, Margins, and Paper Size

The response must be clear and conform to the following requirements:

i. Use the font identified below:

a. Arial (not Arial Narrow) at a font size of 11 points.

b. A font size of less than 10 points may be used for mathematical formulas or equations, figures, tables, or diagram captions and when using a Symbol font to insert Greek letters or special characters.

ii. Margins, in all directions, must be at least one (1) inch. No vendor-supplied information may appear in the margins.

iii. Paper size must be no larger than standard letter paper size (8 ½” by 11”).

These requirements apply to all sections of response, including supplementary documentation.

C. Page Formatting

Since many reviewers will be reviewing proposals electronically, vendors are strongly encouraged to use only a standard, single-column format for the text. Avoid using a two-column format since it can cause difficulties when reviewing the document electronically.

While line spacing (single-spaced, double-spaced, etc.) is at the discretion of the vendor, established page limits must be followed.

D. Ad-Hoc Conference Calls (at HCA’s discretion)

HCA may choose to request a conference call with one or more vendors to ask clarifying questions or seek additional information. HCA will work with the vendor(s) to schedule the call(s). If selected for a conference call, you will be e-mailed by the RFI Coordinator with the available conference call dates and times.

Please note: This will not be a discussion of any prospective HCA solicitation, and any conference calls will be focused on HCA learning more about the industry via the questions in Exhibit A.

HCA RFI No. 2026HCA6 Page 8 of 18

E. Cost of Response

Respondents will not be reimbursed for any costs associated with preparing or presenting any response to this RFI.

F. Response Property of HCA

All materials submitted in response to this RFI become the property of HCA. HCA has the right to use any of the ideas presented in any response to the RFI.

G. Public Records and Proprietary Information

Any information contained in the response that is proprietary or confidential must be clearly designated as such. The page and the particular exception(s) from disclosure must be identified. Each page claimed to be exempt from disclosure must be clearly identified by the word “confidential” printed on the lower right-hand corner of the page. Marking the entire response as confidential will be neither accepted nor honored and may result in disclosure of the entire response.

To the extent consistent with Chapter 42.56 RCW, the Public Records Act, HCA will maintain confidentiality of your information marked confidential or proprietary. If a request is made to view your proprietary information, HCA will notify you of the request and of the date that the records will be released to the requester unless you obtain a court order enjoining that disclosure. If you fail to obtain the court order enjoining disclosure, HCA will release the requested information on the date specified in its notice to you.

HCA’s sole responsibility will be limited to maintaining the above data in a secure area and to notify you of any request(s) for disclosure for so long as HCA retains your information in HCA records. Failure to label such materials, or failure to timely respond after notice of request for public records has been given, will be deemed a waiver by you of any claim that such materials are exempt from disclosure.

3.5 REVISIONS TO THE RFI

HCA reserves the right to amend this RFI at any time. In the event it becomes necessary to revise any part of this RFI, addenda will be provided via e-mail to all individuals who have made the RFI Coordinator aware of their interest. Addenda will also be published on WEBS. The website can be located at fortress.wa.gov/ga/webs. For this purpose, the published questions, answers, and any other pertinent information will be provided as an addendum to the RFI and will be placed on the website.

HCA reserves the right to cancel or reissue this RFI at any time, without obligation or liability.

https://apps.leg.wa.gov/rcw/default.aspx?cite=42.56 https://fortress.wa.gov/ga/webs/

HCA RFI No. 2026HCA6 Page 9 of 18

3.6 NO OBLIGATION TO BUY OR ISSUE SOLICITATION

HCA will not contract with any vendor as a result of this RFI. While HCA may use responses to this RFI to draft a competitive solicitation for the subject of these services, issuing this RFI does not compel HCA to do so.

Responding to this RFI will not be a requirement of future solicitations. Responses and information provided in response to this RFI will not be considered when evaluating bidders responding to any future solicitation.

If HCA does a solicitation, HCA will post it on WEBS.

3.7 SECURITY AND PRIVACY REQUIREMENTS

Any solution HCA procures and implements will need to comply with applicable state, federal, and industry regulations, such as the following:

A. HIPAA Privacy, Security and Breach Notifications;

B. WA State OCIO Security Standard, OCIO 141.10;

C. 42 CFR Part 2;

D. RCW 70.02;

E. HCA Privacy and Security Policies, such as HCA 1-02 and HCA 6-16;

F. NIST 800-53 Rev 4; and G. Industry certifications.

Further information about any of the above can be provided at vendor request.

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HCA RFI No. 2026HCA6 Page 10 of 18

4. EXHIBIT A – RFI QUESTIONS

4.1 Implementation Services

A. Describe your implementation approach, including:

i. Implementation Project Plan (IPP);

ii. Timeline and milestones; and

iii. Risk identification and mitigation.

B. How do you support:

i. Eligibility file loading and testing;

ii. Benefit Plan Design (BPD) configuration;

iii. Custom Preferred Drug List (PDL) implementation and member disruption; and

iv. Claims history and PA migration from a group’s previous TPA or carrier.

C. Do any implementation services require additional fees? If yes, what does the cost structure look like? What implementation services are included in the base administrative fee vs. additional cost?

4.2 Organizational Overview

A. Provide an overview of your organization, including:

i. Years in operation offering:

a. Commercial plans; and

b. Medicare Part D plans.

ii. Ownership structure:

iii. Experience with public and private sector accounts with the following membership:

a. Self-funded commercial plans:

1. 50,000-99,999 members:

2. 100,000+ members:

b. Self-funded Medicare Part D plans:

1. 50,000-99,999 members:

2. 100,000+ members:

iv. Total covered lives for current contracts:

a. Commercial:

b. Medicare:

B. Identify and describe which services are performed internally vs. subcontracted.

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4.3 Account Management

Please indicate if there is a difference between commercial plan and Medicare Part D plan administration for these questions.

A. Describe your account team structure.

i. How many staff do you typically assign to an account this size? What roles are dedicated versus designated and what tasks are the dedicated positions responsible for?

ii. How does your team support state and federal legislative activity and legislative reviews? Do you have dedicated staff for legislative activity/reviews? Are you able to determine not-to-exceed costs for applicable proposed legislation when a fiscal analysis is requested as part of the legislative review process?

4.4 Member and Pharmacy Services

A. Describe your customer service center.

i. Do you have the administrative capability to assign specific representatives to with:

a. 50,000-99,999 members?

b. 100,000+ members?

ii. Hours (including 24/7 support) and whether the hours are customizable.

iii. Call center capabilities.

iv. Pharmacist availability.

v. Other clinical support staff.

vi. Describe your interpretive services available to enrollees when calling the customer service call center.

vii. Geographically, where are your customer service activities performed?

viii. Do you use artificial intelligence (AI) in any part of your customer service operations? For example, the call center or chat?

ix. Is any customer service or clinical review performed outside of the United

States?

x. Online pharmacy search tools, including client personalization abilities

B. What client-service level expectations do you guarantee? Examples may include:

i. Account inquiry response times.

ii. Issue/member resolution.

iii. Data requests and report development/delivery.

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iv. PA turnaround times.

v. Other.

C. What customer service metrics do you track?

D. Describe:

i. Digital tools (apps, portals);

ii. Accessibility (language, disability support);

iii. Member satisfaction measurement; and

iv. Compliance with WCAG requirements.

4.5 Eligibility, enrollment, & Data Integration

A. Describe your eligibility system capabilities:

i. HIPAA eligibility file processing;

ii. Real-time updates; and

iii. Retroactive adjustments.

B. How do you:

i. Integrate with medical TPAs on exchanging eligibility files;

ii. Integrate with other data files such as medical claims files;

iii. Conduct eligibility audits; and

iv. Reconcile data discrepancies.

C. Describe your ability to:

i. Add custom data fields;

ii. Share data with other vendors; and

iii. Provide complete claims data to clients.

D. What capabilities do you have to disaggregate data to identify and address health disparities between populations? For example, can you disaggregate data based upon race, ethnicity, rural status, and primary language?

i. If you do collect data on any of these metrics, how do you utilize it and what have you learned? How have you changed any benefits as a result?

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4.6 Pharmacy Network

If there is a difference between commercial plan and Medicare Part D plan administration for these questions, please outline responses for both populations.

Describe your:

i. Retail network options.

ii. Mail-order network options.

iii. Specialty network options, including limited distribution drugs.

iv. Service area(s).

v. Nationwide access.

vi. Pharmacy contracting strategy.

vii. Do you contract directly with providers/facilities for your pharmacy network, or do you utilize a third party for network contracting? If the latter, please identify the third party and network.

viii. If you offer more than one pharmacy network option, discuss each network offered and the key features/differences of each.

ix. Rural access strategies.

x. What standards do you (or the third party that manages the network) use to determine and monitor the adequacy of your pharmacy network(s)? Please include details such as time/distance/availability standards and whether the standards differ for urban and rural. If urban and rural standards differ, please confirm how you define “urban” and “rural” standards.

xi. How is your pharmacy directory maintained? How often is it updated?

xii. What strategies do you follow if a client indicates concerns for network adequacy issues outside of adequacy standards? If a specific area is noted by members as having limited access, can plans request additional outreach to be completed to improve adequacy in that specific area?

xiii. Are there areas of Washington that are more challenging to cover in your experience? Please describe the nature of those challenges.

xiv. Do you have any pharmacies that are excluded from your network(s), meaning members are not eligible for any coverage or reimbursement of claims from that pharmacy?

xv. For the last 3 years, provide information on your network, highlighting any changes in the number of pharmacies being excluded, closing, or entering the network.

xvi. Network auditing processes to ensure appropriate claims processing and competitive pricing.

4.7 Claims Processing & Benefit Administration

If there is a difference between commercial plan and Medicare Part D plan administration for these questions, please outline responses for both populations.

A. Describe your claims processing system:

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i. Describe or show a diagram of the process from claim intake through payment.

a. Commercial:

b. Medicare:

ii. How long does it take to process a clean claim from intake to payment?

iii. Can a member who paid for a prescription out-of-pocket submit a claim for direct reimbursement?

iv. Do you perform claims audits? Can clients request an audit be performed?

v. Do you use AI in claims adjudication? If so, please describe the process and to what extent it is used? How can you ensure accuracy for a decision made by AI? Example: prior authorization denials or approvals.

vi. Is any aspect of your claims processing or adjudication performed outside of the United States?

vii. Where is your enrollment and claims data stored/located?

viii. Describe how you transmit claims/encounter data electronically to clients or a client’s third-party vendors, including actuaries.

ix. Integration with eligibility reporting

B. Describe your reimbursement methodology and dispensing fees.

4.8 Data, Reporting, & File Transfers

A. Describe how you use reporting to provide oversight to assist with program management, benefit enhancement, reducing costs, , and financial performance.

B. Describe your reporting capabilities:

i. Standard reports;

ii. Custom reports;

iii. Dashboards and whether they are interactive;

iv. Cost modeling;

v. Rebate transparency and reporting;

vi. Real-time claims data portal; and

vii. PA transparency and reporting.

C. Describe your:

i. Data transfer methods (FTP, API, etc.); and

ii. Data security and storage.

4.9 Clinical Management and Formulary

HCA RFI No. 2026HCA6 Page 15 of 18

A. Describe your:

i. Pharmacy and therapeutic (P&T) structure and process.

ii. PDL management strategy and custom PDL capabilities (HCA intends to retain full authority over PDL decisions).

iii. Specialty drug list customization availability to clients.

iv. Coverage policy customization.

v. Cost analysis and rebate management, such as methods and reports for determining the lowest net cost drugs between therapeutic alternatives or in a given drug class.

vi. Can members view which drugs are covered and what their cost share would be?

vii. Are links to formularies available to include in program communications so potential new members and active members can verify coverage of their drugs?

viii. Are price check tools, pharmacy locator, and member portals customizable to the needs of the program.

B. Describe your clinical programs to include how you measure outcomes, plan customization, and program integrity standards and health equity:

i. Utilization Management (UM), PA, step therapy;

ii. Opioid programs;

iii. Specialty drug definition and management;

iv. Adherence programs;

v. Pharmaceutical pipeline monitoring and management; and

vi. Other innovative programs.

C. Describe case management services you offer, including direct member or provider outreach.

D. Describe the staffing matrix and credentials of the clinical authorization review staff.

E. Describe what types of clinical review standards are used during the case review process.

F. Describe if and how AI is used in this process.

G. Please describe your organization’s experience and knowledge with receiving, processing and finalizing PA requests.

H. Describe your abilities to process PA requests on a timely basis, start to finish, to include turnaround time expectations/metrics.

I. Can clients make determinations on which drugs require PA?

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J. Describe how an all-electronic submissions PA program works, including submission of backup documentation. If your system does not allow attachments, explain how back up documentation is managed.

K. Can your organization conduct the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys and separate the results specifically by plan level, not only contract level, after completion? Is there an additional cost for this ability? Or what other customer surveys does your organization use?

4.10 Financial Modeling, Pricing, & Rebates

A. Describe your administrative fee structure (Per Member Per Month (PMPM), utilization based, other).

i. Can you provide a PMPM fee structure that includes all services under a specific contract?

B. Do you offer rebate free (upfront drug discounts) strategies?

C. How does your organization prioritize lowest net cost?

D. Confirm that you can guarantee cost-based pass-through pricing on all pharmacy claims.

E. How do you structure guarantees on rebates and network pricing discounts?

F. Would you provide clients with complete information on contractual pricing arrangements with pharmacies, manufacturers, and subcontractors?

G. How do you establish and demonstrate competitive pricing for covered drugs and rebate arrangements?

i. How do you demonstrate lowest net cost?

ii. Provide examples of net cost savings you have accomplished for other clients.

iii. Which drug file database do you use? (e.g., Medi-Span, First Databank, etc.).

H. Are you willing to set administrative fees, rebate, and pricing guarantees for the duration of a multi-year contract term? If no for any of the components above, please explain.

I. Can your organization provide full cost transparency and information related to the clinical criteria, market basket, and formulary placement as terms and conditions in any applicable rebate strategy spanning the entire spectrum of purchasing (manufacturer, rebate aggregator, PBA/PBM, pharmacy, and payer arrangements)?

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J. Can you support pharmacy trend development, either independently or in collaboration with HCA’s contracted actuary?

K. How are specialty drugs and specialty pharmacies managed such to control costs and maintain access?

4.11 Performance Guarantees

A. Describe your standard performance guarantees that you have in place with your contractors/subcontractors.

B. Describe your standard performance guarantees that you offer to clients.

C. How are performance guarantees:

i. Measured;

ii. Enforced; and

iii. Financially reconciled.

4.12 Program Integrity, Audit, & Fraud

A. What audit rights do clients retain? Do clients have the right to look at subcontract contractors and audit subcontractors?

B. What rebate audit rights are available?

4.13 Appeals, Grievances, & Compliance

If there is a difference between non-Medicare plan and Medicare Part D plan

A. Describe your appeals and grievance process.

i. How do you handle claims, appeals and grievances?

ii. What are the qualifications and training of your appeals and grievance staff?

iii. Is any aspect of handling appeals performed outside the United States?

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B. What are your timelines and escalation pathways?

C. How do you ensure compliance with:

i. Affordable Care Act (ACA);

ii. Centers for Medicare & Medicaid Services (CMS);

iii. Other federal regulations; and

iv. Washington State regulations.

D. How do you ensure you are up to date on new or emerging laws or mandates? When new federal or State regulations are passed, how do you ensure compliance with these regulations or mandates? Do you charge clients a fee to implement required laws or mandates?

4.14 Coordination with Medical TPA

A. Describe how you integrate with medical TPAs.

B. How do you support:

i. Care coordination;

ii. Data sharing;

iii. Total cost of care strategies, including channel management;

iv. Member care/service coordination;

v. Prior authorization and UM coordination; and

vi. Medical drug management.

4.15 Innovation & Future State

A. What innovations should HCA consider:

i. Alternative pricing models;

ii. Value-based contracting;

iii. Pharmaceutical pipeline monitoring and planning;

iv. Rebate-free drug pricing;

v. Strategies to manage specialty drug spend ;

vi. Direct-to-employer purchasing; and

vii. Others.