41NHA-S3992 - sPBM - Attachment 4.5.2. - Technical Proposal Questions.docx
DOCX document 172 KB Posted
- Attached to
- Nevada State Pharmacy Benefit Manager
- Solicitation number
- 41NHA-S3992
- Issued by
- Nevada
About this file
This is a Technical Proposal Questions document issued by the Nevada Health Authority Nevada Medicaid for the Single Pharmacy Benefit Manager (SPBM) contract opportunity (41NHA-S3992). The document outlines the evaluation criteria and narrative questions that contractors must address in their technical proposals to demonstrate their qualifications, approach, capabilities, and relevant experience managing Medicaid pharmacy benefit programs. Contractors must respond to questions across five topic areas: Contractor Experience, Implementation, Clinical and Program Management, and Financial Operations and Administration. The technical proposal carries a total weight of 100 points in the evaluation process, with Implementation questions weighted most heavily at 37 percent, followed by Financial Operations and Administration at 27 percent, Clinical and Program Management at 26 percent, and Contractor Experience at 10 percent. All responses must follow strict formatting requirements, including 12-point Times New Roman font, single spacing, one-inch margins, consecutive page numbering, and searchable PDF format, with page limits ranging from two to twelve pages per question depending on the topic.
Contractors are required to demonstrate Medicaid-specific experience, with strong preference given to examples from state Medicaid programs; those without Medicaid experience may provide comparable low-income insurance program examples. Responses must clearly articulate how proposed approaches will fulfill contractual requirements, align with program goals, represent innovation or best practices, and include relevant data with methodology explanations. Where subcontractors will be used, contractors must identify them and explain how performance will be ensured. Key evaluation areas include the contractor's experience with similar Medicaid PBM programs over the past five years, detailed implementation plans for fee-for-service and managed care transitions, system capabilities and data management, clinical program management including Preferred Drug Lists and Drug Utilization Review, pharmacy network adequacy, value-based purchasing arrangements, claims processing platforms, rebate administration, and fraud, waste, and abuse detection. The document does not specify proposal submission deadlines, contract award dates, or contract term lengths, as this attachment focuses solely on the technical proposal question requirements and evaluation framework.
View the file
Other files
Show all 22
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Attachment 4.5.2. – Technical Proposal Questions This Request for Proposal (RFP) attachment outlines the Technical Proposal Questions that Contractors must answer in their Technical Proposal responding to this Solicitation. Contractors will be evaluated on the quality and completeness of their responses to the questions, and responses should demonstrate the Contractor’s full understanding of all contractual requirements contained in the Scope of Work.
The Contractor must provide a response to each question in this attachment. As prompted by the question, Contractors are expected to discuss their:
1. Approach to addressing the issue in the narrative question, highlighting how their approach will (a) allow the Contractor to fulfill the contractual requirements, (b) align with outlined program goals, and (c) represent innovation and/or best practices;
1. Capabilities to implement their proposed approach, which could include organizational structure, staffing resources, operational infrastructure, intended approach to engaging subcontractors, established operational protocols, and technology infrastructure and resources (e.g., IT systems and system capabilities); and
1. Experience related to the issue in the narrative question that illustrates how the Contractor has successfully addressed this issue in contexts comparable to those required of the Single Pharmacy Benefit Manager (SPBM) in Nevada.
Contractors should not assume that the individuals involved in the evaluation process are familiar with any current or past work activities with the State or in other states.
Responses to each question should be complete and may not reference responses provided to other questions in the Technical Proposal.
When citing relevant experience, the Contractor must clearly state what program(s), state(s), and year(s) the experience comes from and how it will translate to the Single PBM program (e.g., Medicaid enrollment covered, populations served [e.g., fee-for-service, managed care, dual eligible], pharmacy benefit scope [e.g., pharmacy, specialty, physician-administered drugs], claims volume, clinical programs, rebate program administration, PDL development and maintenance]) and to the issues discussed in the question. In responding to a question, if the Contractor will use a subcontractor to fulfill any part of the response, the Contractor must provide the name of the subcontractor and explain how the Contractor will ensure the subcontractor’s performance will be no less effective than if performed by the Contractor. Contractors with experience delivering Medicaid pharmacy benefit management services are strongly encouraged to use Medicaid examples whenever possible. Contractors without relevant Medicaid experience may provide examples from a comparable low-income insurance program.
When providing data in a response, Contractors must include a brief description of each data measure, why it is a relevant measure of impact for the example provided, and a brief explanation of the data methodology (including sample size, where appropriate).
Contractors must adhere to the prescribed formatting requirements and guidelines outlined in Section 9 of the RFP. All materials must be prepared using 12-point Times New Roman font, single spacing, and one-inch margins on all sides. Pages must be numbered consecutively and require headers detailing the solicitation number, Contractor name, and attachment title applied consistently throughout the document. All submissions shall be provided in searchable, text-based PDF format, and scanned or image-only documents are prohibited. Contractors must label each section of their response in accordance with the exact question numbers or titles provided in the solicitation, and the use of unusual fonts, colored text, decorative elements, or embedded multimedia content is not permitted. Contractors are strongly encouraged to adhere to the recommended question-specific response lengths included in this attachment. The evaluation committee will not consider or score any pages submitted beyond the stated page limit for any given question. The question page limits, scoring weighting, and maximum number of points available are outlined in the table below.
Joe Lombardo Governor
NEVADA HEALTH AUTHORITY
NEVADA MEDICAID
4070 Silver Sage Drive Carson City, Nevada 89701
NVHA.NV.GOV
Stacie Weeks, Director
Ann Jensen, Administrator
Technical Proposal Question Scoring:
| Topic Area |
| Question Number |
| Page Limit |
| Scoring (Weight) |
Contractor Experience
| 1. Contractor experience with similar Medicaid PBM programs |
| 5 pages for narrative; no page limits for summary table |
| 10% |
| Total Percentage of Score |
| 10% |
Implementation
| 1. Implementation of FFS PBM |
| 10 |
| 12% |
| 2. System and Data Implementation |
| 8 |
| 10% |
| 3. Implementation for PBM Expansion to Managed Care Enrollees |
| 8 |
| 10% |
| 4. Operational Changes to Support PBM Expansion to Managed Care Enrollees |
| 6 |
| 5% |
| Total Percentage of Score |
| 37% |
Clinical and Program Management
| 1. Preferred Drug List (PDL) |
| 6 |
| 7% |
| 2. Physician-Administered Drug (PAD) Program |
| 5 |
| 5% |
| 3. Drug Utilization Review (DUR) |
| 6 |
| 7% |
| 4. Pharmacy Networks |
| 2 |
| 3% |
| 5. Value Based Purchasing (VBP) |
| 6 |
| 4% |
| Total Percentage of Score |
| 26% |
Financial Operations and Administration
| 1. Claims Processing |
| 8 |
| 12% |
| 2. Rebates |
| 7 |
| 8% |
| 3. Fraud, Waste, and Abuse (FWA) |
| 6 |
| 7% |
Total Percentage of Score
27%
| TOTAL |
| 100% |
Technical Proposal Questions
1. Contractor Experience
| 1. Contractor experience with similar Medicaid PBM programs |
| Describe the Contractor’s Medicaid pharmacy benefit management experience for a state Medicaid program (FFS or managed care) in the past five years. Responses must include a summary table with the information listed below for each state where the Contractor served in such capacity, including examples of how the Contractor improved, optimized, or enhanced program operations, performance, transparency, or outcomes where applicable: |
· Name of state/state program;
· Start and end date of the contract;
· Geographic service area
· Populations served (e.g., FFS, managed care)
· Pharmacy benefit scope (e.g., prescription drugs, specialty, physician-administered drugs)
· Medicaid enrollment and annual paid pharmacy claims for each contract year reported
· Clinical programs (e.g., medication therapy, pharmacy lock-in)
· Rebate program administration
· PDL development and maintenance
· Instances of sanctions due to non-compliance including contract suspensions, termination, penalties, or corrective action plans (imposed by the State or other regulator)
Implementation
| 1. Implementation of FFS PBM |
| Provide a detailed implementation plan that demonstrates the Contractor's approach to achieving a seamless transition and implementation of Nevada's statewide Medicaid pharmacy benefit management (PBM) for its fee-for-service (FFS) program by the implementation date. Include the Contractor's approach to implementation governance and oversight; project management methodology; implementation staffing, including key personnel and how the Contractor will ensure continuity of appropriate expertise throughout implementation; hiring and training; and risk mitigation/contingency planning. |
| 2. System and Data Implementation |
| Describe the Contractor’s approach, capabilities, and timeline for system build, testing, and data transfer in support of implementation. Explain how the Contractor will complete initial system testing and validation prior to the implementation date, including how accuracy, timeliness, issue remediation, and service quality will be assessed and confirmed. |
Include the Contractor’s system reliability controls and operational support processes, including system monitoring, alerting, backup procedures, disaster recovery, business continuity planning, recovery time objectives, and communication protocols. Explain how the Contractor will identify, prioritize, and respond to system failures or service disruptions, restore operations, and prevent recurrence.
Also describe the Contractor’s approach and timing for receiving and transferring the data necessary to perform the required services, including claims history, provider data, enrollee data, and prior authorization information.
| 3. Implementation for PBM Expansion to Managed Care Enrollees |
| Describe the Contractor’s approach for implementing pharmacy benefit management for Medicaid managed care enrollees following the implementation for fee-for-service enrollees. Include the Contractor’s implementation strategy, coordination with other contractors and stakeholders, implementation schedule, key milestones and activities, risk mitigation measures, and the approach and timing associated with receiving and transferring the data necessary to support the required services, including claims history, provider data, enrollee data, and prior authorization information. |
| 4. Operational Changes to Support PBM Expansion to Managed Care Enrollees |
| Describe the Contractor’s approach, experience, and capabilities for managing operational changes, system updates, policy changes, and regulatory changes associated with expanding pharmacy benefit administration from Medicaid fee-for-service (FFS) enrollees only to both FFS and Medicaid managed care enrollees without disrupting services to those enrollees. Include how the Contractor will test, approve, communicate, and monitor changes, and how the Contractor will identify and respond to implementation issues, including the use and oversight of manual workarounds, corrective actions, or contingency procedures when necessary. |
Also describe the Contractor’s experience implementing a similar transition in another state or program, including key challenges encountered, how they were addressed, and lessons learned that will be applied to this implementation.
Clinical and Program Management
| 1. Preferred Drug List (PDL) |
| Describe the Contractor’s experience and approach to developing, maintaining, and implementing a Preferred Drug List (PDL), including coordination with the State’s Pharmacy Committees and implementation of clinical policy changes. |
| 2. Physician-Administered Drug (PAD) Program |
| Describe the Contractor’s strategies and capabilities for collaborating and supporting the State’s oversight of its Physician-Administered Drug (PAD) Program, including the development and maintenance of PAD clinical criteria, support for Drug Utilization Review (DUR) Board review and reporting, management of PAD fee schedules, compliance with applicable billing and regulatory requirements, and coordination with the State, MCOs, providers, and other stakeholders to support consistent program implementation and quality assurance and how the Contractor will improve, optimize, and maintain program performance over time. |
| 3. Drug Utilization Review (DUR) |
| Describe the Contractor’s method and capabilities for meeting the Drug Utilization Review (DUR) program requirements, including prospective DUR (pro-DUR), retrospective DUR (retro-DUR), and annual CMS DUR reporting requirements and the Contractor's IT systems, data, and information used to support these activities. Include how the Contractor maintains audit trails, traceability, and documentation across DUR activities and related program operations, identifies and resolves exceptions, tracks recurring issues, and supports State review and oversight. Provide examples of the Contractor’s experience using DUR activities to significantly improve outcomes in other state Medicaid programs. |
| 4. Pharmacy Networks |
| Describe the Contractor’s strategy and approach for identifying pharmacy network gaps in Nevada, barriers, and addressing the gaps to support network development and ongoing access to care for Medicaid members, including how the Contractor will monitor network performance, resolve access issues, and improve network adequacy over time. |
| 5. Value Based Purchasing (VBP) |
| Describe the Contractor’s experience, methods, and capabilities in soliciting, negotiating, implementing, and managing value-based purchasing (VBP) arrangements for pharmacy benefits, including how the Contractor evaluates opportunities to improve and expand VBP arrangements throughout the term of the Contract. Address the following in the Contractor’s response: |
a. The types of VBP arrangements the Contractor has developed or supported, including the therapeutic areas involved, the types of providers or other parties participating, and whether the arrangements were planned or implemented.
b. The Contractor’s approach to identifying opportunities for VBP arrangements, assessing readiness to contract, and managing the agreement development and implementation process.
c. The Contractor’s approach to data sharing, reporting, and support for participating providers or other contracted parties, including how the Contractor uses data to monitor performance, support success under the arrangement, and reduce administrative burden.
d. The Contractor’s method for evaluating the effectiveness of VBP arrangements, including the performance measures used, the process for tracking outcomes and savings, and how findings are used to inform future arrangements.
e. The Contractor’s staffing, organizational resources, and controls for managing VBP arrangements, including confidentiality and separation of State information from other client accounts, as applicable.
Financial Operations and Administration
| 1. Claims Processing |
| Describe the Contractor’s pharmacy claims processing platform, including platform ownership, scalability, disaster recovery, system availability, and planned enhancements over the next 5 years. Describe the system’s capability to meet all claims processing requirements, including coordination of benefits and support for different payment methodologies and rate files based on provider type, enrollee type, claim type, and other applicable attributes. Include the Contractor’s process for monitoring claims processing performance, validating file accuracy, and reporting operational results to the State. Include how the Contractor identifies errors or exceptions, corrects defects, and ensures the State receives accurate, timely, and transparent reporting regarding claims operations. |
| 2. Rebates |
| Describe the Contractor’s experience, capabilities, and approach to managing Medicaid drug rebate programs, including maximizing supplemental rebate opportunities, administering accurate and timely invoicing, collecting and reconciling rebates, maintaining compliance with applicable federal and state drug rebate requirements, and providing transparent reporting to the State. Describe the rebate process, including claim data collection, accuracy checks, and maintenance of audit trails; how quarterly CMS drug file updates are handled, including new NDCs, terminations, and rebate amount updates; and how rebate disputes with manufacturers are resolved and tracked. Include how the Contractor supports auditability and identifies and resolves invoice or collection discrepancies. Provide examples of how the Contractor has successfully managed Medicaid pharmacy rebates in other state Medicaid programs. |
| 3. Fraud, Waste, and Abuse (FWA) |
| Describe how the Contractor will meet Fraud, Waste, and Abuse (FWA) program requirements in a Medicaid PBM environment, including how the Contractor will detect, escalate, refer, investigate, and resolve issues, and how the Contractor will report FWA review findings and corrective actions to the State. Provide examples of the Contractor’s experience performing similar FWA activities in other state Medicaid programs, including relevant quantitative results or performance measures, where available. |
image1.png image2.png image3.svg
File details come from the government source that posted it. Updated .