Responses to Questions 75D301-20-R-67926 WTCHP PBM.xlsx
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| Request for Information (RFI) Number 75D301-20-R-67926.pdf |
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Set 1
| RFI #: 75D301-20-R-67926 WTCHP PBM | ||||
| Question | ||||
| Number | RFI Reference | |||
| (if applicable) | Question | WTCHP Response | ||
| 1 | What is the expected date WTCHP will release the responses to the vendor questions? | 4/9/20 | ||
| 2 | Please provide the percentage of brand drugs vs. generics dispensed for 2019 claims. | In 2019, generic dispensing was 69.73% of all transactions. | ||
| 3 | Question 11 | Are the pharmacies operated by the Clinical Centers for Excellence (CCEs) included in the current PBM’s retail network? | There are currently no pharmacies operated by the CCE's. Some of the institutions the CCE's are affiliated with have internal outpatient pharmacies. Health and Hospitals - Gouverneur Pharmacy (NABP = 3356260), NYU Center Hospital https://nyulangone.org/locations/ambulatory-care-pharmacy (NABP = 3367605). Those are contracted with the current retail network. | |
| 4 | Question 2 | Does the WTCHP have a preferred program type (workers’ compensation vs. alternative administrative model)? | While the current model is a quasi-workers' compensation benefit model, WTCHP is open to the model or models that provide the highest quality of service, convenience of benefit access, and effective cost control. You may present more than one solution that your firm is capable of administering with the reasons and rationale for your recommendations. | |
| 5 | Question 2 | Is the WTCHP researching alternatives to the workers’ compensation-type model because the current PBM program does not meet the needs of the WTCHP? If so, could the WTCHP identify areas where they are seeking improvement? | WTCHP is seeking opportunities to improve the quality of the program to our members, lessen the administrative burden of the program on the CCEs and WTCHP staff, gain more administrative oversight capabilities, and to achieve the highest degree of cost efficiency for the Program. | |
| 5 | Where are the CCE’s located? | Primarily in New York. This information is available online. | ||
| 5 | Please confirm this RFI is for purposes of replacing your current PBM, and whether respondents may offer support only in the area of assisting in the PBM evaluation process (versus providing PBM services). | This RFI is for the purpose of generating information and approaches to PBM Management in anticipation of a new award in the future. | ||
| 5 | How does your PBM get paid? | WTCHP declines to share the current practice for the purpose of this RFI in an attempt to gather unique market place solutions, preferably pricing models that increase transparency for drug prices | ||
| 5 | Current PBM | Managed Care Advisors, Inc. | ||
| 5 | Have you considered a Retail 90 network? | The current benefit design is successful at increasing the utilization of the mail order benefit and in doing so, lowering overall cost. WTCHP would be open to a Retail 90 network in the benefit design if the savings to the Program would increase and there was minimal impact to member access to pharmacies | ||
| 5 | Can the WTC Health Program send us a listing of each of their formularies, including the OTC drug list? | The Program cannot provide the formularies at this time. The top 5 drugs by transaction in 2019 were albuterol MDI, fluticasone nasal spray, montelukast, omeprazole DR, and pantoprazole. Top 5 drugs by spend were budesonide-formoterol inhaler, tiotropium bromide inhaler, lenalidomide, omepreazole, and albuterol MDI. The top 5 drug classes were antiasthmatic and bronchodilator sympathomimetic, antineoplastics, PPI's, immunomodulators, and bronchodilators/anticholinergic. Over the counter products that are allowed in the Program include - PPI, nasal steroids, antihistamines, saline nasal solutions, nicotine replacement therapies (See: https://www.cdc.gov/wtc/ppm.html#pharmacy_otcDrugs) | ||
| 5 | Does the WTC Health Program manage its own formulary today, or is this managed by the PBM? | WTCHP manages its own formularies. WTCHP is seeking a vendor that can make formulary recommendations that can improve the Program while creating cost efficiencies through formulary management. | ||
| 5 | Can the WTC Health Program provide us with copies of the file layout for prescribers and member eligibility? | Not at this time but it may be provided for in connection with future procurements. | ||
| 5 | Can you please provide a list of CCEs, and include detail on those that manage their own retail pharmacies. Please provide us with the NABP of each pharmacy. | The current CCE's are Mount Sinai, FDNY, Health and Hospitals (H&H), NYU, Rutgers, SUNY Stoneybrook, Northwell, and the William Street Clinic (WSC). We also have a National Provider Network (NPN). The WSC and NPN are operated by Logistics Health Incorporated (LHI). Our clinics are housed within the institutions as a separate program with separate funding. None of our clinics have internal outpatient pharmacies, however some of their institutions do have outpatient pharmacies. Health and Hospitals - Gouverneur Pharmacy (NABP = 3356260), NYU Center Hospital https://nyulangone.org/locations/ambulatory-care-pharmacy (NABP = 3367605). | ||
| 5 | Is the WTC Health Program fund currently receiving rebates from its incumbent PBM? | WTCHP is requesting vendors to propose their recommendations for the most appropriate model for the Program with the reasons and rationale for the complete offering that would include the pricing and cost structure. This may or may not include receiving rebates. | ||
| 5 | Is WTC Health Program open to alternative benefit models as it pertains to managing the pharmacy benefits? | Yes. WTCHP is requesting vendors to propose their recommendations for the most appropriate model for the Program with the reasons and rationale. Vendors can propose more than one model. | ||
| 5 | Are there or will there be any work comp state reporting requirements on WTC health plan pharmacy prescriptions processed by chosen PBM? | No | ||
| 5 | Is the World Trade Center Health Program (WTCHP) solicited as a part of the CDC within HHS or MHS in the DOD? If neither, can you please specify the Federal agency with procurement responsibility for WTCHP? | Through the CDC within HHS. | ||
| 5 | Is WTCHP considered a quasi-Federal agency that receives funding from the Federal Government OMB or another Federal agency but is not part of the Federal government? If a quasi-Federal agency, which organization provides funding to WTCHP? | WTCHP Is part of a Federal Agency. Mandatory funded Program within CDC (similar to CMS). | ||
| 5 | Will the WTCHP RFP solicitation be governed by FAR Part 12 acquisition guidelines? If not, what acquisition guidelines will govern this solicitation? | FAR Part 12 has been traditionally used, but CDC has not made a determination for future awards. | ||
| 5 | What company or organization is the incumbent for the upcoming solicitation? What is the contract number? b. How many option years remain and when is the end of the current contract if all option years are exercised? | MCA, 200-2016-90833, OY4, Contract End Date: 1/31/2021 | ||
| 5 | Once new members are evaluated for their approved condition(s) with the associated formulary(s), and are assigned eligibility, what are the benefits of a Workers Compensation model over a traditional PBM benefit plan? | WTCHP is currently seeking recommendations for benefit models for this Program your firm is capable of administering along with the reasons and rationale for your recommendations. | ||
| 5 | How long on average does it take to evaluate a new potential new member from the application process to eligibility? | It takes 3 weeks for an application to be processed that does not require follow up. However, many do require follow up so it can vary depending on how quickly issues are resolved. | ||
| 5 | How many new potential members applied for WTCHP benefits in 2019? How many were approved? Of those approved, what was the average number of approved conditions were authorized? | The Program enrolled 9,081 in 2019, and denied 87 applications. Once a member is enrolled, they are eligible to get certified if they have symptoms. Certification and enrollment are separate processes. Not all enrolled members have certifications to get treatment. In 2019, 55,783 (55% of the total enrollment) had certifications. Twenty eight percent had 1 certification. For more stats please look here https://www.cdc.gov/wtc/ataglance.html#memberZadroga under "Members by Number of Certifications". | ||
| 5 | What are your projections for potential new approved members from 2020 to 2025? | As of December 2019, there were 102,249 enrolled members of which 55% had a certified condition. Of those enrolled, 27,345 (27%) received prescriptions in 2019. The Program enrolled 9,081 in 2019, 9,028 in 2018, and 7,016 in 2017. The program anticipates the last two year's trend to continue. For more information on enrollment statistics please see https://www.cdc.gov/wtc/ataglance.html#memberZadroga. | ||
| 5 | For Prior Authorizations (PA), does your current PBM use defined PA criteria to make decisions on behalf of WTCHP administrative staff or CCE staff so external intervention is not required today? Is this the structure you desire in the future? What role do you desire to have in PA appeals for the next contract? | Currently WTCHP staff and CCE staff administer the PA process. The WTCHP has been, over the last 3 years, developing established and defined PA criteria and hope to have this mostly complete before the contract is awarded. WTCHP desires that this process and appeals be consolidated by and overseen by the PBM as much as possible. | ||
| 5 | To what degree has WTCHP defined criteria to allow a PBM to determine eligibility and clinical requirements to drugs by condition(s)? Does WTCHP contemplate further defining existing criteria before releasing the RFP to a degree a PBM can perform this role independently on their behalf? | The Program will be done reviewing all classes of drugs in the formulary by September 2020, which means there should be complete PA criteria at that point. The medication PA criteria can be as simple as verifying a member has a specific certification to qualify for the drug. There are also step therapy criteria, and generic first, preferred/non-preferred drug designations. There are also more complicated approvals where forms have been developed with decision logic for drugs such as airway biologics. The Program is open to further defining criteria, when necessary, based on the needs and recommendations of the PBM. | ||
| 5 | Does your current PBM vendor maintain all pharmacy data in NCPDP transaction formats? Are all medications tracked by NDC11 numbers? Is your current PBM required to transition all eligibility, historical claims, authorized providers, formularies, PA criteria, and all other operational data to the next contractor? | Yes | ||
| 5 | Will current COB information on existing members be transferred to the potential new contractor? If so, what percentage of your members that filled a prescription in 2018 or 2019 have COB information on file? | This data should be available by the award of the new contract. In 2019, the COB rate for pharmacy was 9%. Improving COB, particularly for pharmacy, is a major priority for the Program. | ||
| 5 | Are authorized prescribers required to use an Electronic Health Record system that directly interfaces to your PBM to allow for EPrescribing, electronic formulary inquiry, and electronic PA (ePA) to increase speed, accuracy, and reliability of prescribing? | An EHR system is not in use at this time. WTCHP would like to explore the benefits of EPrescribing to create time, access, administrative, and cost efficiencies within the Program. | ||
| 5 | For the RFP, providing 1 – 2 years of historical claims data is the most beneficial way to help PBMs save you money. De-identifying the data with de-identified member ID numbers but maintaining the same member ID number for each person so associated claims can be evaluated is critical. Using de-identified historical data will allow PBMs to help you clearly understand clear savings you can expect moving forward. Will 1-2 years of historical data claims be provided with the RFP? | Yes - 1 to 2 years of claims data will be available | ||
| 5 | Does WTCHP have any desire to drive more retail claims to mail if it proves to be a less expensive channel? Does WTCHP have the ability to restrict future fills at retail to encourage channel movement to mail if it is more cost effective? | Yes - We do have the ability to restrict future fills at retail to encourage movement to mail if it is more cost effective. The Program does have some challenges with this design parameter due to the COB requirement of the Program, since some primary insurers have restrictions on mail order steerage. | ||
| 5 | Of the 416,288 total claims, what percentage were 30 day vs 90 day fills? How many were specialty claims? | In 2019, the Program had 40.31% mail order penetration. On October 1st, 2019, the Program required all retail transactions be limited to a 30 days supply. | ||
| 5 | Has the implementation of the New York State Workers’ Compensation Drug Formulary in December 2019 had any effect on the five formularies utilized by the WTCHP? | No |
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