ATTM 023.xlsx

This file is a reporting specification document for the South Carolina Department of Health and Human Services (SCDHHS) Pharmacy Benefit Services (PBS) contract, detailing the required reports and metrics for pharmacy benefit management oversight. The document outlines a comprehensive suite of reporting requirements organized by frequency—yearly, quarterly, monthly, and weekly—to monitor financial performance, drug rebates, claim activities, and service delivery metrics across the pharmacy benefit program. Key reports include Executive Summary Reports (yearly financial summaries), CMS 64.9R reports (quarterly drug rebate tracking), Cash Flow Reports (monthly deposit tracking), and SCM Claims Extracts (weekly claim activity monitoring). Additional reports track family planning drug rebates, invoice totals by manufacturer, balance sheet positions, performance guarantees, call center activities, determination turnaround times, and pharmacy utilization and expenditure metrics. These reports serve to ensure comprehensive visibility into both financial transactions and operational performance across the pharmacy benefit program.

The reporting structure demonstrates a multi-layered accountability framework requiring detailed tracking of rebates, claims processing, and service quality metrics. The reports encompass financial reconciliation through quarterly adjustment reports and monthly balance sheets, compliance monitoring through performance guarantee reports (both detailed and summary levels), and operational performance assessment through call center activity reports and determination turnaround time analysis. The inclusion of weekly extract summaries identifying the top 20 most expensive medications categorized as "Other" indicates focus on cost containment and utilization management. The diverse reporting requirements across multiple time intervals—from weekly claims data to yearly executive summaries—establish a robust monitoring system for the contractor to maintain financial accuracy, ensure regulatory compliance with CMS requirements, and demonstrate service delivery performance across pharmacy benefit services operations.