3-JM26-59 Part 8 form U3P posting.pdf

Department of Government Operations Division of Purchasing and General Services 4315 S 2700 W, FL 3, Taylorsville, UT 84129-2128 Phone: 801-957-7160 www.purchasing.utah.gov

Issuing Procurement Unit: Division of Purchasing

Conducting Procurement Unit: DHHS/Division of Integrated Healthcare

NOTICE OF INTENT TO AWARD A CONTRACT WITHOUT ENGAGING IN A STANDARD PROCUREMENT PROCESS

The Division of Purchasing is publishing this notice pursuant to the Utah Procurement Code. The Conducting Procurement Unit submitted this form to the Division of Purchasing claiming that it intends to award a contract without competition if it is determined by the Division of Purchasing, in writing, that:

● there is only one source for the procurement item;

● transitional costs are a significant consideration in selecting a procurement item; or

● the award of a contract is under circumstances, described in rules adopted by the applicable rulemaking authority, that make awarding the contract through a standard procurement process impractical and not in the best interest of the procurement unit.

In the subsequent pages the Conducting Procurement Unit has identified its justification for wanting to award a contract without engaging in standard procurement process.

Determination of Other Interested Vendors

If the procurement item identified in this notice is to be awarded as a sole source (only one source for the procurement item), then this notice will help determine if there are any other interested and qualified vendors that meet the specifications of this notice. Any such vendors must submit the following information:

● The name of the contesting person; and

● A detailed explanation of the contest, including documentation showing that there are other competing sources for the procurement item.

In addition, a vendor should include:

● Documentation that your firm can provide a comparable or better procurement item that meets or exceeds the specifications;

● Documentation that your firm can also provide the same proprietary procurement item or an equivalent procurement item; and

● If transitional costs are identified as the justification for this notice, submit a cost comparison of the identified transitional costs with your firm’s anticipated transitional costs.

Regardless of any prior communications with the Division of Purchasing or the State, all vendors interested in responding to this notice must submit a response to this posting containing complete responses to all of the information requested above.

DO NOT CONTACT THE CONDUCTING PROCUREMENT UNIT. Any questions regarding this notice, including obtaining additional information, can be obtained through the Division of Purchasing during the publication period. No action is required if you agree with this notice.

If the purpose of this notice is an intent to award a sole source, after the public notice period has passed, and the Division of Purchasing determines that there are other interested and qualified vendors that meet the specifications of this notice, then the Division of Purchasing will not award a contract pursuant to this notice. An award without competition may still be made even if there are other interested vendors when the basis for the award is due to transitional costs or impracticality as stated above.

If, after the public notice period has passed, no valid contests have been received, then the Division of Purchasing may award a contract to the identified vendor without engaging in a standard procurement process.

Read the entire form very carefully before responding to this notice.

It is anticipated that this procurement will result in a:

RESULT ACTION

x

Agency Contract

The term of this contract (or extension) will be: 6 months and renewal options: 0 .

The agency may not make the procurement until the solicitation process is completed and a contract is written and signed by the agency, the vendor, and the Division of Purchasing.

Purchase Order The agency may not make the procurement until the solicitation process is completed, the purchase order is signed by the Division of Purchasing and delivered to the agency and the vendor.

Description of procurement item to be purchased:

Contract is for drug rebate management services to support the Medicaid pharmacy operations which procures primary and supplemental pharmacy rebates from contracted labelers. The drug rebate management services are a mandatory part of the Medicaid Pharmacy program and are a significant source of revenue/savings for the State Medicaid Program. The rebate services support evaluating pharmacy rebates captured from point-of-sale pharmacy claims;

invoicing manufacturers, ensuring correct rebate invoicing;

receiving and managing rebate payments; managing disputed invoices for both fee-for-service and accountable care organization pharmacy claims, on behalf of Utah Medicaid. This is a 6-month contract extension to support ongoing operations until the new POS system is implemented 10/1/2026, at which point the drug rebate management services will transition to the new agreement.

Estimated value of the contract/purchase order/increase: $137,683.72

Freight Cost (F.O.B. Destination, Freight Prepaid): $0.00

Vendor Name: Change Healthcare Pharmacy Solutions / OptumRx

Explain in detail the service or product to be procured (additional information included in attached Scope of Work):

The Medicaid Drug Rebate program was mandated by the Omnibus Budget Reconciliation Act (OBRA) of 1990. At the program's inception, the Division of Medicaid and Health Financing (DMHF) had an in-house Information Technology (IT) system for Point of Sale (POS) transactions. Due to IT system obsolescence, a Request For Proposal (RFP) resulted in a 2011 contract with Goold Health Systems (now known as Change Healthcare) for a POS system and Drug Rebate Management (DRM). The DRM includes an electronic Drug Rebate Management System (DRMS), a highly-specialized information technology software which increases the effectiveness of the rebate program by tracking payments and other relevant information by National Drug Code (NDC). An NDC reflects drug type, drug manufacturer, drug strength, drug form, unit of measure, etc. DRMS also identifies, accumulates, sorts, stratifies, and processes information on approximately 40,000 NDCs for drugs paid through fee for service (FFS) and drugs paid by Accountable Care Organizations (ACOs) contracting with Medicaid. DRMS is vital when billing drug manufacturers for primary and supplemental drug rebates.

It is also critical for the drug rebate dispute and resolution process. Information flows from Medicaid paid claims into DRMS, back to Medicaid for invoicing.

In addition to the critical, specialized functions performed by POS and DRMS, Change Healthcare (CH) staff completes several technical business operations and management functions to bill for, and account for rebates. The management and accounting functions performed by CH are the subject of this procurement. These include the following:

• Reconciliation of State Invoices (ROSI) that include prior quarter adjustments;

• Accounting for overdue payments and invoices;

• Following up on late payments;

• Calculating interest due on late payments;

• Reviewing exclusion reports for accuracy;

• Generating and delivering quarterly invoices; and

• Compiling and completing the quarterly Centers for Medicare and Medicaid Services (CMS) 64.9R form.

CH staff also engages in the Dispute Resolution process with drug manufacturers. This process includes:

• Generating dispute records by NDCs where the manufacturer's payment based on quantity does not equal the invoiced quantity;

• Researching each rebate dispute;

• Adjusting rebate claims as appropriate;

• Contacting providers to request resubmission of incorrectly billed claims;

• Negotiating settlements;

• Generating Quarterly Rebate Offset Amount (QROA) reports;

• Maintaining edits and conversion factors;

• Incorporating the CMS Utilization Report - Export which validates processes for completing the Invoices;

• Incorporating the Quarterly Health Common Procedure Coding System (HCPCS) into the NDC Crosswalk;

• Management for Rebate Utilization Accuracy and reporting; and

• Maintaining contacts and signatories for both dispute management and contract modifications.

CHECK THE BOX THAT IDENTIFIES WHY A CONTRACT SHOULD BE AWARDED WITHOUT ENGAGING IN A STANDARD

PROCUREMENT PROCESS:

☐ Sole Source - There is only one source for the procurement item. Complete Section A

Transitional Costs - Transitional costs are a significant consideration in selecting a procurement item and the results of a cost-benefit analysis demonstrate that transitional costs are unreasonable or cost-prohibitive, and that the award of a contract without engaging in a standard procurement process is in the best interest of the procurement unit.

Complete Section B

Impracticality - The award of a contract is under circumstances, described in rules adopted by the applicable rulemaking authority, that make awarding the contract through a standard procurement process impractical and not in the best interest of the procurement unit.

Complete Section C

Trial use contract for a new or innovative procurement item, or for a procurement item with a novel or unproven use or application. Complete Section D x Extension of a contract without engaging in a standard procurement process. If extension will result in a request to increase the contract total, then also complete Section F below. Complete Section E x Request to increase total contract amount. Complete Section F

SECTION A: ONLY ONE SOURCE

1. What is unique about this procurement item to justify an award of contract without engaging in a standard procurement process? (Explain in detail why the service, product, etc. is only available from a single supplier.)

2. Could the procurement item be reasonably modified to allow for competition?

3. Explain the market research performed.

4. What research have you conducted to ensure the requested procurement item is not available on an existing state cooperative contract?

5. If there is only one source for the procurement item, list the names of other similar vendors contacted, contact person, and a summary of their response.

SECTION B: TRANSITIONAL COSTS

1. Describe the existing procurement item; include the original purchase price and date of purchase for the existing procurement item.

2. Supply the following:

a . Procurement method used to purchase the existing procurement item: (e.g. IFB, RFP, Sole Source):

b . Solicitation number or RQS/RQM number for the existing procurement item:

c. Contract number for the existing procurement item:

3. Attach the cost-benefit analysis, as required by Utah Code Section 63G-6a-802, that demonstrates that transitional costs are unreasonable or cost-prohibitive.

SECTION C: STANDARD PROCUREMENT PROCESS IMPRACTICAL

1.

Review R33-108-101c and provide supporting justification why awarding the contract through a standard procurement process is impractical and not in the best interest of the procurement unit under the circumstances; including any supporting documentation.

2. Supply the following, if applicable:

a. Procurement method used to purchase existing procurement item (e.g. IFB, RFP, Sole Source):

b. Solicitation number or RQS/RQM number for the existing procurement item:

c. Contract number for existing procurement item:

SECTION D: TRIAL USE CONTRACT

1. Describe how this trial use contract for the new or novel procurement item will benefit your agency.

2. Describe how the procurement item is new or innovative, or how the procurement item has a proposed use/application that is novel or unproven.

3. Describe why a trial use contract exception is necessary for this procurement item at this time as opposed to conducting a standard procurement process to procure the procurement item.

4. What research have you conducted to ensure the requested procurement item is not available on an existing state cooperative contract?

5.

How long does the agency need to test the procurement item and what quantities of the procurement item (if applicable) will be necessary to test this procurement item? Note trial use contracts generally cannot exceed a period of 24 months.

SECTION E: EXTENSION OF CONTRACT WITHOUT ENGAGING IN A STANDARD PROCUREMENT PROCESS The procurement official may extend a contract up to 120 days. For extensions beyond 120 days from the original contract end date, the procurement official may extend the contract after consulting with legal counsel.

Original End Date: 12/31/2020 Current End Date: 4/1/2026

Proposed End Date: 9/30/2026. Contract Number: 166149

1.

Is this request for a contract extension the result of a protest, appeal or court action? If yes, agency does not need to complete items 2-5 below. Provide the solicitation number that resulted in a protest and date of the protest, appeal or court action.

N/A

2.

Describe why extending this contract without engaging in a standard procurement process is necessary to avoid a lapse in a critical government service, OR to mitigate a circumstance that is likely to have a negative impact on public health, safety, welfare, or property.

Continuation of existing rebate services for 6 additional months supports necessary processes while the new contract with OptumRx is implemented. This 6-month extension allows continued alignment of current comprehensive pharmacy services until a new POS is implemented on 10/1/2026.

3.

Confirm the procurement unit is currently engaged in a standard procurement process for the procurement item that is subject to the contract extension request and that the standard procurement process is delayed due to an unintentional error.

An RFP has been completed and a new POS vendor has been selected. Due to unanticipated delays the go live for the new POS vendor has been extended 6 months. This contract extension for rebate management will ensure rebate processes remain consistent until POS transition.

4.

Justification for Extension: check all that apply:

☐ The standard procurement process is delayed due to an unintentional error.

☐ A change in an industry standard requires one or more significant changes to specifications for the procurement item.

x To prevent the loss of federal funds.

☐ To mitigate the effects of a delay of a state or federal appropriation.

X To enable the procurement unit to continue to receive a procurement item during a delay in the implementation of a contract awarded pursuant to a procurement that has already been conducted.

☐ To enable the procurement unit to continue to receive a procurement item during a period of time during which negotiations with a vendor under a new contract for the procurement item are being conducted.

5. For the selection(s) above, provide any additional details regarding the circumstances justifying a contract extension.

This contract extension for rebate management will ensure rebate processes remain functional until POS transition, when these services will transition to the new agreement with OptumRx.

SECTION F: REQUEST TO INCREASE TOTAL CONTRACT AMOUNT

If the original solicitation type was an ACWESPP (e.g. sole source) and the proposed contract total will exceed $50,000, then public notice is required to increase the contract total. Public notice is not necessary if the procurement official waives the public notice requirement in accordance with R33-108-101e.

Contractor Name: Change Healthcare Pharmacy Solutions, Inc. Contract Number: 166149

Original Contract Total: $1,005,000.00 Current Contract Total: $2,309,045.72

Proposed Contract Total: $2,446,729.44 % Increase from Original: 143%

Solicitation Number: 16215 Solicitation Type: Sole Source

Product or Service Description:

Contract is for drug rebate management services to support the Medicaid pharmacy operations which procures primary and supplemental pharmacy rebates from contracted labelers.

Why is the contract total being increased? Check all that apply.

X The term of the contract is being extended (also complete Section E above if extending).

☐ The quantity of products or services needed has increased.

☐ The price, rate, or fee for a product or service has increased.

☐ A new or upgraded product or service is needed.

Provide details for the answer that was selected in the previous question. Provide any reasons for the increase.

This six month contract extension for rebate management will ensure rebate processes remain functional until POS transition when these services will move to the new agreement with OptumRx.