Addendum 1 RFP HR-24-380 QA Final.pdf
PDF 203 KB Posted
- Attached to
- Workers Compensation Pharmacy Benefit Network
- Solicitation number
- HR-24-380
- Issued by
- Los Angeles County, California
About this file
RFP HR-24-380: Workers Compensation Pharmacy Benefit Network Addendum No. 1
This document is Addendum No. 1 (Q&A) issued by the City of Long Beach Department of Financial Management for Request for Proposal (RFP) HR-24-380 regarding a Workers Compensation Pharmacy Benefit Network. The addendum addresses 28 questions submitted by prospective proposers and modifies language in the original RFP. Proposers must acknowledge receipt of this addendum by signing and submitting it with their proposals, or face potential disqualification. The City operates approximately 6,000 employees with approximately 1,900 open workers' compensation claims. The City is soliciting proposals for pharmacy benefit management services and is open to various solutions that meet the required scope of work. All proposals will be evaluated consistently against criteria specified in the RFP. The current pharmacy benefit manager is Optum/Timesys, the claims system is Claims Enterprise (Riskonnect), and the bill review partner is Lien on Me.
The City prefers the pricing model that is most cost-effective and does not require proposers to use a specific pricing form or template; vendors must develop their own templates to capture all aspects of the pharmacy billing process. The City declined to provide a standardized cost proposal template but indicated that 2025 pharmacy transaction summary data is available. The City also deferred responses to multiple detailed questions regarding system integration with utilization review vendors, compliance with California electronic billing regulations, first-fill protocols, network density metrics, real-time eligibility verification timelines, dispute resolution procedures, spread pricing transparency, manufacturer rebate pass-through guarantees, network penetration rates, and financial performance guarantees, stating these items would be clarified after an award is made. The City is open to various approaches regarding California regulatory compliance, dispute resolution procedures, transparent pricing models, rebate guarantees, and performance guarantees, provided solutions meet the required scope of work.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment A~11.pdf | ||
| Pro Forma Agreement Sample~6.pdf | ||
| Attachment C~11.pdf | ||
| RFP HR-24-380.pdf | ||
| Optum - City of Long Beach -Total Pharmacy Summary 2025.xlsx | XLSX spreadsheet | |
| Mandatory Attachment B Equal Benefits Ordinance Form~26.pdf |
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Text version
Department of Financial Management 411 West Ocean Boulevard, 6th Floor
Long Beach, CA 90802
(562) 570-6425
September 23, 2026
NOTICE TO PROPOSERS
ADDENDUM NO. 1: Q & A
No. RFP HR-24-380
Workers Compensation Pharmacy Benefit Network
This addendum changes and supersedes the language in the original RFP.
Please acknowledge receipt of this addendum by signing and submitting with your proposals. Any proposer who fails to submit this addendum may be disqualified.
The City would like to remind Proposers that pursuant to Section 5.2.27 of the RFP, the City will not be responsible for or bound by any oral communication or any other information or contact that occurs outside the official communication process specified herein, unless confirmed in writing by the City Contact.
The questions and answers are as follows:
1. Q: California Regulatory Compliance & Best Practices: Explain how your point-of-sale (POS) system automatically enforces the California Medical
Treatment Utilization Schedule (MTUS) Drug Formulary. How does it dynamically handle 'Exempt' versus 'Non-Exempt' drug status?
A: The City is interested and open to all proposals and solutions.
Proposers are welcome to submit their proposed solutions that meet the required scope of work. All proposals will be evaluated consistently against the criteria specified in the RFP.
2. Q: California Regulatory Compliance & Best Practices: What is your operational timeline for updating your system when the Administrative
Director of the CA Division of Workers' Compensation (DWC) issues new formulary rules, updates, or executive mandates?
RFP HR-24-380
Pg. 2
3. Q: California Regulatory Compliance & Best Practices: Describe your system's integration with the City's Utilization Review (UR) vendors. How do you track and enforce Independent Medical Review (IMR) decisions to prevent unauthorized drug dispensing while ensuring valid care is not delayed?
A: The City is unable to answer this question at this time, we will be able to provide clarity after an award has been made.
4. Q: California Regulatory Compliance & Best Practices: Are your billing systems fully compliant with California’s electronic billing and payment regulations (E-Billing) per Labor Code mandates?
5. Q: Early Care & Employee Benefit Optimization (‘Earliest Indicated
Time’): Describe your 'First-Fill' protocol. How do you guarantee that an injured City employee receives their initial, essential medications at the pharmacy before a claim is formally accepted or denied by the City's adjuster?
6. Q: Early Care & Employee Benefit Optimization (‘Earliest Indicated
Time’): Provide data demonstrating your retail network density within Long
Beach and surrounding areas. What is your guaranteed geographic radius metric ensuring employees have immediate local access to a 24-hour pharmacy?
7. Q: Early Care & Employee Benefit Optimization (‘Earliest Indicated
Time’): Detail your process for real-time eligibility verification. How quickly after an injury is reported can a digital or physical pharmacy benefit card be activated for the injured worker?
Pg. 3
8. Q: Early Care & Employee Benefit Optimization (‘Earliest Indicated
Time’): Detail your formal dispute resolution and grievance procedure for handling pharmacy access blocks, ensuring injured workers have an expedited appeal path if a critical medication is flagged at the counter.
9. Q: Cost Containment Goals & Financial Integrity: Do you offer a 100% transparent pass-through pricing model? Provide contractually binding definitions proving the complete elimination of spread pricing across your entire retail and mail-order network.
10. Q: Cost Containment Goals & Financial Integrity: Guarantee the percentage of drug manufacturer rebates that will be returned 100% directly to the City of Long Beach's Workers' Compensation Insurance Fund.
11. Q: Cost Containment Goals & Financial Integrity: What is your guaranteed
In-Network Network Penetration Rate? What automated mechanisms or outreach programs do you deploy to mitigate costly out-of-network pharmacy billings?
Pg. 4
12. Q: Cost Containment Goals & Financial Integrity: Detail your clinical blocks against high-cost compound medications and your mitigation strategies to control and reduce physician-dispensing (repackaged) drug costs.
13. Q: Cost Containment Goals & Financial Integrity: What specific financial performance guarantees (with exact liquidated damages or fee-at-risk percentages) will you commit to regarding implementation deadlines, billing accuracy, and customer helpdesk response times?
14. Q: Regarding registering with the California Department of Managed Health
Care (DMHC), please confirm registration is required for this Workers'
Compensation Pharmacy Benefit Network solicitation (RFP - HR - 24-380)?
15. Q: Who is the current PBM?
A: Optum/ Timesys
16. Q: What claims system do you use?
A: Claims Enterprise (Riskonnect)
Pg. 5
17. Q: Who is your bill review partner?
A: Lien on Me
18. Q: How many employees does the City of Long Beach have?
A: About 6,000
19. Q: How many open workers' compensation claims does the City have?
A: About 1,900
20. Q: How many annual prescriptions are filled?
A: Please see the attached summary for our 2025 pharmacy transactions
21. Q: What is the annual pharmacy spend for the City?
22. Q: What type of pricing is the City interested in?
A: The city would prefer the pricing model that is the most cost effective for the City.
23. Q: Is there a pricing form that needs to be included in the RFP?
A: No
24. Q: To assist proposers in developing the requested annual Cost Proposal, will the City provide available historical pharmacy utilization and cost information for the most recent 12-month period, including total pharmacy spend, prescription volume, and number of claimants utilizing pharmacy benefits? If available, please also provide prescription-level utilization data and information related to out-of-network.
Pg. 6
25. Q: In order for vendors to properly underwrite their pricing offers and accurately present all costs on an annual basis (as requested in Section 4.2 of the RFP), please provide the City’s annual script volume for workers’ compensation claims.
26. Q: In order for vendors to submit a Cost Proposal in a clear, itemized Excel format that allows for a competitive evaluation and comparison of all proposed costs (as requested in Section 4.2 of the RFP), please provide an
Excel template for all proposing vendors to complete and include with their
RFP responses.
A: The vendors need to develop their own template to make sure all aspects of the pharmacy billing process is captured.
27. Q: Will the City provide a 6 or 12-month pharmacy claims dataset for vendors to analyze and provide the City with insights for potential cost containment?
28. Q: Does the City have a preferred pricing model (pass-through or traditional
AWP discount)?
A: The city would prefer the pricing model that is the most cost effective for the City.
PREPARED BY:
William Reyes William Reyes, Procurement Analyst I
Pg. 7
ACKNOWLEDGED BY:
Company Name
Print Name Title
Signature Date
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