CIS PBM RFP 11.11.2022 Final for Release.pdf

Confidential and Proprietary to ARMSRx

625 Main Street, Suite 20 | Windermere, FL 34786 www.ARMSRx.com

Request for Proposal for Pharmacy Benefit Management Services

RFP Release Date: 11/11/2022 RFP Due Date: 12/09/2022 Effective Date: 01/01/2024

TABLE OF CONTENTS

INVITATION

RFP CONTACTS

RFP DELIVERY

LETTER OF INTENT TO BID/ACKNOWLEDGEMENT

COMPANY BACKGROUND

CIS PHARMACY CLAIM STATISTICS

CIS PLAN DESIGNS

GENERAL EXPECTATIONS

SCOPE

EVALUATION CRITERIA

GENERAL INSTRUCTIONS

A. ORAL COMMUNICATIONS

B. CHANGES TO RFP

C. EXCEPTIONS / DEVIATIONS

D. AUTHORIZATION TO DO BUSINESS

E. PRE-CONTRACTUAL EXPENSES

F. WITHDRAWAL; PROPOSAL IRREVOCABLE FOR 90 DAYS

G. DISPOSITION OF PROPOSALS

H. IMMATERIAL DEFECTS IN PROPOSAL

I. WRITTEN AGREEMENT

J. TERM OF CONTRACT

K. NEWS RELEASES

CIS CONTRACT CONSIDERATIONS

RFP TIMELINE

MANDATORY REQUIREMENTS

ATTACHMENTS TO INCLUDE

GENERAL INFORMATION

ACCOUNT MANAGEMENT

IMPLEMENTATION

PHARMACY NETWORKS

SPECIALTY PHARMACY

MAIL ORDER

CLAIMS ADJUDICATION

PRICING

MEMBER CALL CENTER

PHARMACY HELP DESK

MEMBER AND PHYSICIAN ON-LINE SYSTEM CAPABILITIES

DATA AND REPORTING

FORMULARY AND REBATES

ELIGIBILITY

AUDITS

CLINICAL PROGRAMS

PERFORMANCE GUARANTEES

REFERENCES

PRICING INSTRUCTIONS

PRICING TEMPLATE

SPECIALTY PHARMACY PRICING

REBATES

GENERIC EXCLUSIVITY

ADDITIONAL SERVICES

CREDITS/ALLOWANCES

INVITATION

ARMSRx Pharmacy Benefit Consultants, on behalf of CIS, is requesting proposals from qualified providers to provide Pharmacy Benefit Management services as a self-funded client on behalf of their members. CIS requires an experienced Pharmacy Benefit Manager to administer a range of PBM services as described in the Company Background and Overview sections of this RFP.

RFP CONTACTS

ARMSRx Pharmacy Benefit Consultants 625 Main Street, Suite 20 | Windermere, FL 34786 | www.ARMSRx.com

Please submit Letter of Intent to Bid, questions, and RFP response to:

Wende Ward - Wende@ARMSRx.com; Office: (513) 313-7756 Gary Homar – Gary@ARMSRx.com; Office: (636) 515-6050

RFP DELIVERY

Please submit RFPs electronically to ARMSRx. Upon receipt of Intent to Bid, ARMSRx will provide each qualifying bidder a secure folder to deliver complete electronic versions of their RFP response.

LETTER OF INTENT TO BID/ACKNOWLEDGEMENT

Please complete the Letter of Intent to Bid/Acknowledgement included herein stating your intention to bid on the CIS Request for Proposal to Wende@ARMSRx.com and Gary@ARMSRx.com by November 23, 2022.

COMPANY BACKGROUND

CIS is a public entity that provides insurance and risk management services to Oregon cities and counties and other public entities created by these cities and counties. Based in Salem, CIS was formed in 1981 by its parent organizations, the League of Oregon Cities and Association of Oregon Counties. The majority of cities and counties in Oregon participate in one or more CIS programs (property, liability, workers’ compensation, and health benefits). These participating entities are considered CIS member-employers.

A component of CIS is its employee benefits program, which is called CIS Benefits. Approximately 270 public Member Employers offer some combination of medical, dental, vision, life, voluntary life or disability coverage. These Member Employers range in size from one employee to over 600 employees and many are subject to collective bargaining. In addition to insurance products, CIS Benefits offers its members an extensive health risk management/wellness program, sponsored flexible spending account/pretax programs, COBRA and retiree administration, and related services. All premium contributions made by employers/employees become part of either the city or county trust and are used exclusively for the provision of benefits.

Currently, CIS offers a Kaiser health plan option and a Regence health plan option. This RFP applies to membership enrolled in the CIS Regence BlueCross BlueShield of Oregon (“Regence”) health plan. CIS currently offers several benefit plan designs, please see copay table below. Pharmacy benefit management services are administered by Express Scripts.

CIS PHARMACY CLAIM STATISTICS

CIS Pharmacy Spend Information

For the Period: January 1, 2022 – October 31, 2022

Claim Count Days’ Supply Member Spend Total Plan

Spend

Retail Brand 1-83 Day Supply 13,672 341,140 $182,849 $4,290,461

Retail Brand 84+ Day Supply 1,358 153,571 $21,636 $1,411,339

Retail Generic 1-83 Day Supply 96,799 2,705,124 $494,256 $1,631,864

Retail Generic 84+ Day Supply 18,986 2,032,867 $132,072 $607,226

Mail Order Brand 3,138 207,469 $43,274 $2,429,593

Mail Order Generic 17,751 1,438,194 $157,886 $624,009

Specialty Brand 1,722 55,177 $2,971,234 $9,746,518

Specialty Generic 730 23,035 $75,110 $508,705

Number of Employees 8,256

Number of Members 20,793

CIS PLAN DESIGNS

CIS Flat Dollar Copay Plans Current Benefits

Copay Plan A, B, C and D Generic Preferred Non-Preferred

Retail $5.00 $25.00 $50.00

Retail 90 $10.00 $50.00 $100.00

Mail $10.00 $50.00 $100.00

Specialty 30 $5.00 $25.00 $50.00

Copay Plan E, F, G and H Generic Preferred Non-Preferred

Retail $10.00 $40.00 $100.00

Retail 90 $20.00 $80.00 $200.00

Mail $20.00 $80.00 $200.00

Specialty 30 $50.00 $100.00 $200.00

Copay Plan Ashland* Generic Preferred Non-Preferred

Retail $5.00 $30.00 $55.00

Retail 90 $15.00 $90.00 $165.00

Mail $10.00 $60.00 $100.00

Specialty 30 $5.00 $30.00 $55.00

*Please note: While we are showing this Ashland plan design here as current, this plan design will be removed in

2024.

CIS Coinsurance Plans Current Benefits

Generic Preferred Non-Preferred

Retail 20.00% 20.00% 20.00%

Mail 20.00% 20.00% 20.00%

Specialty 30 20.00% 20.00% 20.00%

GENERAL EXPECTATIONS

A primary area of focus will be on the proposer’s level of support and flexibility to align with CIS objectives for their pharmacy benefit program.

Qualified proposers are vendors that have demonstrated experience in the requested services and can demonstrate their ability to provide the services described in this RFP. It is expected that a proposer will have the necessary professional staff to administer the program(s) effectively in compliance with all applicable laws, regulations, and CIS policies.

The submission of a response to this proposal will be considered a representation that:

1) The vendor has carefully vetted all conditions which affect or may affect, at some future date, the performance of services covered by the proposal;

2) The vendor is fully informed concerning the conditions to be encountered and the quantity and quality of work to be performed; and

3) The proposer is familiar with all federal and state laws which may apply to the services provided and the persons employed to complete the services.

It is expected the rates and rebates improve with the market over time through annual market checks and contractual amendments.

Transparency in pricing and rebates is preferred and will score higher within the evaluation process.

CIS expects a sound service recovery plan for members and Human Resources staff. Timely and effective identification and resolution of issues is important and expected. Vendors should incorporate specific and meaningful Performance Guarantees to support implementation, turnaround times for client inquiries and ongoing services levels.

Furthermore, CIS expects Performance Guarantees which truly highlight and support your offer. The expectation is exceptional service at the Account Management level, for the Membership, and staff. We advise you to address all operational areas with a specific focus on staffing and service recovery. Also, performance guarantees should be client specific, applicable to CIS, and based on the CIS individual experience.

ARMSRx will perform all financial analyses. Pharmacy data will be provided for your review and evaluation of the CIS drug mix and utilization.

SCOPE

CIS desires to partner with an organization to provide Pharmacy Benefit Management Services for their Prescription program. The services shall include, but are not limited to:

1. Electronic and paper claims processing and payment

2. Comprehensive and timely support of data exchange

3. Pharmacy network contracting and management

4. Rebate contracting and administration

5. Clinical support, including ability to support custom formulary and alternative clinical programs

6. Standard and customized Step Therapy, Quantity Level Limits, Prior Authorization programs

7. Standard and Ad Hoc monthly and quarterly reports

8. Web-based reporting and operations tools

9. Benefit design and implementation services

10. Eligibility administration

11. Member ID Cards

12. Dedicated Account and Clinical management team with executive level sponsorship

13. Toll free customer service; toll free pharmacy help desk; robust member portal

14. On-line Coordination of Benefits

15. Pharmacy Audit and FWA (Fraud, Waste and Abuse) programs

16. Specialty patient assistance programs

EVALUATION CRITERIA

All proposals received in accordance with these RFP instructions will be evaluated to determine if they are complete and meet the requirements specified in this RFP. An award will be made to the Proposer whose offer is judged to be the most advantageous to CIS, though CIS expressly reserves the right to reject all proposals and make no award under this RFP.

The following criteria will be considered in evaluating the proposals:

Quality of the proposal, including an expressed understanding of CIS’ requirements Ability to agree to the critical definitions provided in the RFP.

Cost Schedule Qualifications; including delivering lower cost through clinical programs, exceptional account management services, actionable reporting, exceptionable member and pharmacy call center and communications

Experience, particularly with similar projects Account Management and Implementation Staffing & Project Management Project Management and implementation of historical claims and clinical programs throughout the course of the contract Audit rights References Miscellaneous, including exceptions/deviations

GENERAL INSTRUCTIONS

A. ORAL COMMUNICATIONS

Any oral communication by CIS’ contact person(s) or designee concerning this RFP is not binding and shall in no way modify the RFP or the obligations of CIS, a proposer or selected firm(s).

B. CHANGES TO RFP

ARMSRx and CIS reserve the right to modify the requirements of this RFP.

If it is necessary to make material changes to the RFP, CIS will issue a written RFP addendum. This includes responses to written questions received by the specified deadline. All such addenda issued shall become part of the RFP.

ARMSRx will e-mail written RFP addenda to all recipients of record of the original RFP and post such addenda on CIS’ website (www.cisoregon.org/about/rfs). Recipients of record are those parties to whom ARMSRx directly sent a copy of the RFP.

It is the responsibility of each proposer to ensure they have all addenda ARMSRx has issued. This may be done by going to the website listed above prior to the proposal submittal deadline.

C. EXCEPTIONS / DEVIATIONS

Any exceptions to or deviations from the requirements set forth in this RFP, must be declared in the deviation sections in the questionnaire.

D. AUTHORIZATION TO DO BUSINESS

The Proposer must be authorized to do business in the State of Oregon and in the local jurisdiction in which it is located or where the work will be performed.

E. PRE-CONTRACTUAL EXPENSES

CIS shall not be liable for pre-contractual expenses incurred by a proposer in the preparation of its proposal and proposers shall not include any such expenses in their offers. Pre-contractual expenses are defined as expenses incurred by the Proposer to: (1) prepare and submit its proposal to CIS; (2) negotiate with CIS on any matters related to this RFP; and (3) any other expenses incurred by the Proposer prior to the date of award, if any.

Issuance of this RFP and receipt of proposals does not commit CIS to award a contract. CIS reserves the right to postpone the award for its own convenience, to accept or reject any or all proposals received in response to this RFP, to negotiate with more than one proposer simultaneously, or to cancel all or part of this RFP.

F. WITHDRAWAL; PROPOSAL IRREVOCABLE FOR 90 DAYS

A Proposer may withdraw its proposal at any time prior to the submittal deadline by sending ARMSRx a request in writing from the same person who signed the submitted proposal. As of the deadline for submittal, any proposal received by ARMSRx and not withdrawn becomes an irrevocable offer available for acceptance by CIS immediately and for ninety (90) days thereafter. The Proposer is responsible for the accuracy of the proposal submitted, and no allowance will be made for errors or price increases that the Proposer later alleges are retroactively applicable.

G. DISPOSITION OF PROPOSALS

All materials submitted in response to this RFP become the property of CIS, except for information identified by the Proposer as being proprietary. A blanket statement that all contents of the proposal are proprietary will not be honored by CIS. Please note that as a public entity, CIS is subject to Oregon public records law, which may require the disclosure of information regarding proposals or a subsequent contract.

H. IMMATERIAL DEFECTS IN PROPOSAL

CIS may waive any immaterial deviation or defect in a proposal. CIS’ waiver shall in no way modify the RFP documents or excuse the Proposer from full compliance with the RFP if awarded the contract.

I. WRITTEN AGREEMENT

The Proposer selected for contract award through this RFP shall be required to enter into a written agreement with CIS governing the provision of professional services to CIS members and other eligible entities. The agreement will include pertinent terms and conditions set forth in this RFP and will reflect the Proposer’s offer or the outcome of contract negotiations. The agreement will also include, to the extent applicable, the provisions described in Section L below and any terms or conditions added by addendum.

It is anticipated that the Proposer may enter into separate agreements with subcontractors to fulfill the terms of this contract. CIS will not be a party to those separate agreements, nor in any fashion a guarantor or indemnitor of them.

J. TERM OF CONTRACT

If a contract is awarded through this RFP, it will be effective upon full execution of the agreement, which CIS expects to be on or about January 1, 2024. No agreement with CIS shall be in effect until a contract has been approved by the CIS Board of Trustees or designee and has been signed by both parties.

K. NEWS RELEASES

News releases pertaining to any award resulting from this RFP may not be issued without the prior written approval of CIS.

CIS CONTRACT CONSIDERATIONS

CIS contracts will be subject to the following standards. These are not exclusive and other contract clauses and provisions will obviously be applicable as well. However, these are areas respondents to CIS RFP should be aware of in considering and preparing responses.

MANDATORY PROVISIONS:

1. Indemnity Provision. There shall be no provision requiring CIS to indemnify contractor for contractor’s acts or omissions. Indemnity provisions should be mutual and reciprocal. Our standard indemnity clause is as follows:

Contractor agrees to hold harmless, indemnify, and defend CIS, and its officers and employee from and against all claims, suits, actions, losses, damages, liabilities, costs, and expenses of any nature resulting from, arising out of, or related to the acts or omissions of Contractor or its officers, employees, subcontractors, or agents in performance of services pursuant to this Contract. CIS agrees to hold harmless, indemnify, and defend Contractor and its officers and employees from and against all claims, suits, actions, losses, damages, liabilities, costs and expenses of any nature resulting from, arising out of, or related to the acts or omissions of CIS or its officers, employees, subcontractors, or agents pursuant to this Contract.

2. Independent Contractor Status. The following shall be included in CIS contracts:

Contractor shall perform the required services as an independent contractor and not as an “officer, employee, or agent” of CIS as those terms are used in ORS 30.260 through 30.300.

Although CIS reserves the right to evaluate the quality of the service provided by Contractor, CIS will not control the means or manner of Contractor’s performance.

3. Governing Law and Venue. The governing laws and venue for any disputes arising out of the contractual relationship shall be Oregon. The contract shall include the following clause or the substantial equivalent:

This contract shall be governed by the laws of the State of Oregon without regard to principles of conflicts of law. Any claim, action, suit or proceeding between CIS and Contractor arising from or related to this contract shall be brought and conducted in the Circuit Court of Marion County for the State of Oregon; provided, however, if a claim must be brought in a federal forum, then it shall be brought in the U.S. District Court for the State of Oregon.

4. Insurance. Except under special circumstances, and with the approval and consent of CIS’ Executive

Director, the following minimum insurance provisions shall be specified in the contract:

During the term of this contract, Contractor shall maintain in force insurance coverage compliant with the requirements listed below:

a. Workers’ Compensation insurance in compliance with ORS Chapter 656, if Contractor employs “subject workers”.

b. Comprehensive General Liability insurance applicable to the services provided to CIS, with a combined single limit, or the equivalent, of not less than $1,000,000 each occurrence for Bodily Injury, Personal Injury, and Property Damage, including contractual liability coverage applicable to the indemnity provided under this contract.

c. Automobile Liability insurance applicable to the operation of Contractor’s trucks or automobiles with a combined single limit of not less than $1,000,000 each accident for Bodily Injury and Property Damage, including coverage for owned, non-owned, and hired vehicles, as applicable.

d. Notice of Cancellation or Change. There shall be no cancellation, material change, reduction of limits without 30 days prior written notice from the Contractor or its insurer(s) to CIS.

e. Certificates of Insurance. As evidence of the insurance coverages required by this contract, the Contractor shall provide acceptable insurance certificates to CIS as soon as practicable upon written request by CIS. If requested, complete copies of insurance policies, shall be provided to CIS.

OTHER CONTRACT CONSIDERATIONS:

1. Limitations on Liability and Warranties. Responses to RFPs should include a description of any limitations on liability to either CIS or purported third party liability limitations the Proposer would seek to include in a contract with CIS. These provisions are disfavored and will be a consideration in our review and comparison of RFP responses.

2. Termination. While termination provisions are negotiable, any provision that would not permit CIS to terminate the contract with a reasonable notice period, without further obligation, would be strongly disfavored and allowed only with the consent of the Executive Director. Our preferred termination provision is as follows:

a. This contract may be terminated at any time by mutual written consent of the Parties.

b. CIS may, at its sole discretion, terminate this contract, in whole or in part, upon 30 days’ written notice to contractor. In the event of such a termination, CIS agrees to pay Contractor the fees and expenses reasonably incurred prior to such termination.

c. CIS may terminate this contract immediately upon notice to Contractor, or at such later date as CIS may establish in such notice, if Contractor commits any material breach or default of any covenant, warranty, obligation or agreement under this contract, or fails to perform in a timely manner the services under this contract, and such breach, default, or failure is not cured within 30 calendar days after delivery of CIS’ notice, or such longer period as CIS may specify in such notice.

d. Contractor may terminate this contract upon 10 days’ written notice to CIS if CIS fails to pay Contractor pursuant to the terms of this contract and CIS fails to cure within 30 days after receipt of Contractor’s written notice, or such longer period as Contractor may specify in such notice.

3. Dispute Resolution. CIS disfavors mandatory arbitration provisions. Our position is that alternative dispute resolution is acceptable, but arbitration should be undertaken only when both parties agree to it at the time of the dispute. If arbitration is undertaken, we will not consent to the rules and procedures of the American Arbitration Association. Other standard rules are available, or the parties can simply agree to rules and procedures as they deem appropriate. Provisions requiring mediation as a precedent to other legal action are acceptable.

LETTER OF INTENT TO BID/ACKNOWLEDGEMENT

Date

Wende Ward SVP Strategy/Development ARMSRx 625 Main Street, Suite 20 Windermere, FL 34786 Wende@ARMSRx.com

Re: RFP for Pharmacy Benefit Management Services for CIS

Dear Ms. Ward, We submit this Letter of Intent to notify ARMSRx of [name of your organization]’s intent to submit a proposal for the Pharmacy Benefit Management Request for Proposal on behalf of CIS.

We have reviewed the Mandatory Requirements, questionnaire, and other contents of the RFP and are:

☐ able to meet the requirements of this Request for Proposal, or

☐ unable to meet the requirements of this Request for Proposal.

Our primary point of contact for this RFP is:

Company Name:

Contact Name/Title:

Mailing Address:

Phone Number:

Email:

Sincerely, Your Name Your Title

Signature of Representative: Date:

* If declining to bid, please state reason(s) why:

RFP TIMELINE

Activity Target Dates*

RFP and Intent to Bid distributed to vendors via email November 11, 2022

Intent to Bid due ARMSRx November 23, 2022

ARMSRx provides data via secure FTP login upon receipt of Intent to Bid As received

Q&A Period (e-mail questions, responses provided to all bidders); all questions submitted to ARMSRx.

November 11 - 28, 2022

RFP Pricing and General Questionnaire responses due to ARMSRx December 12, 2022 (By 5:00 pm ET)

ARMSRx to present Report of Findings and Analytics to CIS By January 13, 2023

Notification of Finalist(s) By January 20, 2023

Finalist Presentations and Demonstrations Week of February 6, 2023

Preferred PBM Notification By March 1, 2023

Detailed Agreement for Negotiation By March 1, 2023

PBM Contract Negotiation Complete by May 31, 2023

Implementation Period

Note: Finalized Open Enrollment Materials needed by September 1, 2023 for Open Enrollment in October

March – December 2023

PBM Effective Date January 1, 2024

* Dates are subject to change.

MANDATORY REQUIREMENTS

These requirements are outlined to establish and maintain a successful business relationship. These are a key aspect of the overall criteria and evaluation. Please confirm that your firm can comply with these Mandatory Requirements by indicating “Yes” or “No” in the right column. If you cannot meet a Mandatory Requirement, please explain in detail.

MANDATORY REQUIREMENTS AGREE/DEVIATE

ADDITIONAL

INFORMATION IF

DEVIATING

Bidders agree that if this proposal results in your company being awarded a contract and if, in the preparation of that contract, there are inconsistencies between what was proposed and accepted versus the contract language that has been generated and executed, that any controversy arising over such discrepancy will be resolved in favor of the language contained in the proposal or correspondence relating to your proposal.

Specialty, Limited and Exclusive Distribution Drug, and Biosimilar Pricing Lists (NDC-11 level discount schedule in Excel) is provided within the RFP process including both Open and Exclusive discounts.

PBM will provide a detailed CIS-specific contract incorporating all agreed upon provisions within this RFP within ten (10) calendar days of contract award.

Confirm that if your firm is awarded this contract that your firm’s Legal Department will respond to each request within five business days with a working document or detailed response to contract language change requests.

Your organization will load all current Prior Authorizations, open mail order refills, open specialty refills, one-year claim history and accumulator files that exist for current members from the incumbent PBM at no additional charge.

Your organization will be able to successfully implement this plan given at least a 150-day implementation timeline.

All determinations of drug coverage or exclusions are the sole discretion of CIS and failure to comply with annual coverage changes/ exclusions recommended by your organization shall not result in financial penalties nor provide the right to amend pricing.

Your organization agrees to provide a Traditional pricing option and a transparent, Pass-Through pricing option; CIS will choose their preferred pricing arrangement.

Your organization agrees to provide an all-in generics offer related to the financial guarantees. See the Pricing and Guarantees sections for more information.

MANDATORY REQUIREMENTS AGREE/DEVIATE

ADDITIONAL

INFORMATION IF

DEVIATING

Your organization agrees to provide a three-year pricing proposal with improvements for the years 2025 and 2026 with annual market checks available each calendar year.

Your organization will allow the client or their designated consultant to conduct annual market assessments during the contract term to determine the continued competitiveness of pricing and associated financial guarantees. In the event the client determines that current pricing is less favorable than available in the competitive market, your organization agrees to enter into good faith negotiations to reach agreement on market-competitive revisions to the program pricing terms. If, after ninety (90) days, the parties have been unable to reach agreement on an equitable modification term, then the client may terminate the contract with thirty (30) day notification.

Any costs incurred by bidders in preparing and submitting responses to this RFP are the sole responsibility of the bidder.

Confirm documentation and NDC-11 level rebate reporting will be provided at the time rebate payments are received. Additionally, confirm that any other payments that CIS receives, documentation will be provided at the time payment is received.

Confirm CIS will have the ability to terminate the contract at any time without cause, with a 30-day notice.

Bidders must agree that should the financial arrangements be required to change as a result of government action that the resulting financial impact be cost neutral to both parties.

All responses must be provided in a working format (i.e. MS Word, MS Excel) and NOT a locked format document (i.e. PDF).

RFP responses and any BAFO negotiation will become part of the contract between CIS and the selected vendor.

Bidders agree not to contact CIS directly during this RFP process as this will result in immediate disqualification.

CONTRACT REQUIREMENTS AGREE/DEVIATE

ADDITIONAL

INFORMATION, IF

DEVIATING

1. Contract Requirement

Indemnity Provision. There shall be no provision requiring CIS to indemnify contractor for contractor’s acts or omissions. Indemnity provisions should be mutual and reciprocal. Our standard indemnity clause is as follows:

Contractor agrees to hold harmless, indemnify, and defend CIS, and its officers and employee from and against all claims, suits, actions, losses, damages, liabilities, costs, and expenses of any nature resulting from, arising out of, or related to the acts or omissions of Contractor or its officers, employees, subcontractors, or agents in performance of services pursuant to this Contract. CIS agrees to hold harmless, indemnify, and defend Contractor and its officers and employees from and against all claims, suits, actions, losses, damages, liabilities, costs and expenses of any nature resulting from, arising out of, or related to the acts or omissions of CIS or its officers, employees, subcontractors, or agents pursuant to this Contract.

2. Contract Requirement

Independent Contractor Status. The following shall be included in CIS contracts:

Contractor shall perform the required services as an independent contractor and not as an “officer, employee, or agent” of CIS as those terms are used in ORS 30.260 through 30.300. Although CIS reserves the right to evaluate the quality of the service provided by Contractor, CIS will not control the means or manner of Contractor’s performance.

3. Contract Requirement

Governing Law and Venue. CIS contracts shall subject to the laws of Oregon and venue for any disputes arising out of the contractual relationship. The contract shall include the following clause or the substantial equivalent:

This contract shall be governed by the laws of the State of Oregon without regard to principles of conflicts of law. Any claim, action, suit or proceeding between CIS and Contractor arising from or related to this contract shall be brought and conducted in the Circuit Court of Marion County for the State of Oregon; provided, however, if a claim must be brought in a federal forum, then it shall be brought in the U.S.

District Court for the State of Oregon.

4. Contract Requirement

Insurance. Except under special circumstances, and with the approval and consent of CIS Executive Director, the following minimum insurance provisions shall be specified in the contract:

During the term of this contract, Contractor shall maintain in force insurance coverage compliant with the requirements listed below:

Workers’ Compensation insurance in compliance with ORS Chapter 656, if Contractor employs “subject workers”.

Comprehensive General Liability insurance applicable to the services provided to CIS, with a combined single limit, or the equivalent, of not less than $1,000,000 each occurrence for Bodily Injury, Personal Injury, and Property Damage, including contractual liability coverage applicable to the indemnity provided under this contract.

Automobile Liability insurance applicable to the operation of Contractor’s trucks or automobiles with a combined single limit of not less than $1,000,000 each accident for Bodily Injury and Property Damage, including coverage for owned, non-owned, and hired vehicles, as applicable.

Notice of Cancellation or Change. There shall be no cancellation, material change, reduction of limits without 30 days prior written notice from the Contractor or its insurer(s) to CIS.

Certificates of Insurance. As evidence of the insurance coverages required by this contract, the Contractor shall provide acceptable insurance certificates to CIS as soon as practicable upon written request by CIS. If requested, complete copies of insurance policies, shall be provided to CIS.

5. OTHER CONTRACT CONSIDERATIONS:

Limitations on Liability and Warranties. Responses to RFPs should include a description of any limitations on liability to either CIS or purported third party liability limitations the Proposer would seek to include in a contract with CIS. These provisions are disfavored and will be a consideration in our review and comparison of RFP responses.

6. OTHER CONTRACT CONSIDERATIONS:

Termination. While termination provisions are negotiable, any provision that would not permit CIS to terminate the contract with a reasonable notice period, without further obligation, would be strongly disfavored and allowed only with the consent of the Executive Director.

Our preferred termination provision is as follows:

A. This contract may be terminated at any time by mutual written consent of the Parties.

B. CIS may, at its sole discretion, terminate this contract, in whole or in part, upon 30 days’ written notice to contractor. In the event of such a termination, CIS agrees to pay Contractor the fees and expenses reasonably incurred prior to such termination.

C. CIS may terminate this contract immediately upon notice to Contractor, or at such later date as CIS may establish in such notice, if Contractor commits any material breach or default of any covenant, warranty, obligation or agreement under this contract, or fails to perform in a timely manner the services under this contract, and such breach, default, or failure is not cured within 30 calendar days after delivery of CIS’ notice, or such longer period as CIS may specify in such notice.

D. Contractor may terminate this contract upon 10 days’ written notice to CIS if CIS fails to pay Contractor pursuant to the terms of this contract and CIS fails to cure within 30 days after receipt of Contractor’s written notice, or such longer period as Contractor may specify in such notice.

7. OTHER CONTRACT CONSIDERATIONS:

Dispute Resolution. CIS disfavors mandatory arbitration provisions. Our position is that alternative dispute resolution is acceptable, but arbitration should be undertaken only when both parties agree to it at the time of the dispute. If arbitration is undertaken, we will not consent to the rules and procedures of the American Arbitration Association.

Other standard rules are available, or the parties can simply agree to rules and procedures as they deem appropriate. Provisions requiring mediation as a precedent to other legal action are acceptable.

ATTACHMENTS TO INCLUDE

1. Include a cover letter to the RFP Primary contact. At a minimum, the cover letter must contain the following:

Identification of the Proposer, including business name, address and telephone number.

Name, title, address, telephone number, fax number, and e-mail address of a contact person during the period of proposal evaluation.

Acknowledgment of RFP addenda received, if any.

A statement that the proposal shall remain valid for a period of not fewer than ninety (90) days from the due date for proposals.

Any exceptions to any specified criteria in this RFP.

Identification of any information contained in the proposal which the Proposer deems to be confidential or proprietary and wishes to be withheld from disclosure. A blanket statement that all contents of the proposal are confidential or proprietary will not be honored by CIS.

2. Signature of a person authorized to bind the offering firm to the terms of the proposal.

3. Mandatory Requirements

4. Specialty, Limited and Exclusive Distribution Drug, and Biosimilar pricing lists with discounts at the specific NDC-11 level in Excel, please include both Open and Exclusive discounts

5. Assigned Account team bios, including Implementation Project Manager, Account Manager and

Clinical Account Manager.

6. Customized implementation plan

7. Member Portal Overview (if necessary, as attachment, prefer logon to demonstration web site)

8. Client Portal Overview (if necessary, as attachment, prefer logon to demonstration web site)

9. Sample Reports

- Claims Utilization Reports available on-line

- Clinical program reporting and savings

- Financial reports that will be sent to CIS including invoices

- Rebate Reports that will be sent to CIS

- Specialty Patient Assistance Program Reports

10. Implementation Performance Guarantees

11. Copy of the formularies proposed

12. Information on your Copay Optimization/Variable Copay Type Programs

13. Network disruption including number of pharmacies, members and Rxs impacted

14. Formulary disruption including number of members and Rxs impacted

GENERAL INFORMATION

1. Provide an Executive Summary that describes how your organization can best support

CIS.

2. State your company's name and primary contact information for this proposal.

3. Describe your company’s structure including ownership and corporation type.

4. Describe your annual sales and number of covered lives. Provide your breakdown of covered lives by industry segment (Commercial, Medicare Part D, Medicaid)

5. For any services that your organization currently subcontracts, or intends to subcontract for future business delivery, provide the following.

a. Name of Subcontractor

b. Location(s)

c. Contract Period

d. Description of Services Provided

e. Description of Certification/Compliance required for services provided (if applicable) including URAC, NCQA and VIPPS.

6. Describe your disaster contingency plan; if services are subcontracted out include their disaster plan.

7. Confirm all systems are fully HIPAA compliant.

ACCOUNT MANAGEMENT

1. Provide the location and biographies for the Account and Clinical Management team for CIS; include all direct and indirect teams that will be supporting CIS. Include an organization chart.

2. Please describe the account and clinical team’s experience working with municipalities.

3. Confirm that CIS will have direct, dedicated staff for continuity of knowledge and history to expedite and support the needs of CIS.

4. How many times will the account team meet annually with CIS?

5. What performance guarantees are you offering regarding account management support?

6. How is the Account Management team involved in the implementation process?

7. What is the turnover rate of your Account Managers? How much lead time will you provide if the account team is changed?

8. Please describe your issue resolution process. Please include identification/documentation of an issue, channels and process for investigation, improvement or problem elimination process, and corrective and preventative action with resolution and closure back to the client. Please translate your response into your Performance Guarantee offer.

9. Can CIS and their consulting team have system access to a test environment populated with CIS claim data to QA and test plan design changes prior to changes becoming effective in the system?

10. Please describe how you support your clients relative to federal and state level legislative changes

IMPLEMENTATION

1. Please describe the amount and basis for the implementation credit being offered to CIS (e.g. $##.## per member) and describe in detail what qualifies for reimbursement . Please describe the process for CIS to submit for reimbursement and receive the implementation credit.

2. Confirm that a specific, dedicated team will be assigned to CIS for the duration of their implementation.

3. Describe the implementation process, including required tasks for the CIS team.

4. What performance guarantees are you willing to offer? Include PGs regarding eligibility, benefit plan design accuracy, claims accuracy, formulary accuracy, ID cards, web portal availability, account management and call center training.

5. Describe the testing methodology used to ensure accuracy prior to go-live.

6. Describe the processes in place to support January 1, 2024, go live; for example, staffing available for 1/1 effective clients, resources on site at midnight December 31, describe your command center staffing and availability, how are power status updates delivered and how often, implementation Team Check-in/touch base.

7. Confirm you will load current prior authorizations, open mail order refills, open specialty fills (if necessary) and one-year claim history provided by the incumbent vendor into your system during the implementation process at no additional charge.

Please describe the intake, data import, and testing process along with the expected target date to receive files from incumbent vendor to load for January 1, 2024 go-live date.

8. Describe your billing process including terms, payment method, and late payment penalties.

PHARMACY NETWORKS

1. Detail how many pharmacies participate in each proposed network.

2. Please provide a brief description of the networks available.

3. Confirm your offer is based on a broad, national network.

4. How often are network contracts renegotiated?

5. Do you offer a retail 90 network? How many pharmacies participate in the network?

Are any chains excluded? Indicate extent of retail 90 availability for each of the proposed networks.

6. Describe the process to credential pharmacies.

7. Describe the process to audit network pharmacies.

8. What fraud monitoring programs are in place for contracted network pharmacy dispensing and billing?

9. Regarding the retail and mail order MAC lists:

a. How often are the retail and mail order MAC lists updated?

b. Will a separate MAC list be used for Mail Order claims? If no, please provide a description of the list, how and when it is updated, etc.

c. How many unique GCNs or GPIs are on the MAC list?

d. What percentage of generic products available is covered by your MAC list?

10. Do you allow the adjudication of repackaged NDCs?

11. Does your system fully employ NCPDP D.0 adjudication standards? If no, please describe your deviation.

12. Describe your methodology for pricing compound claims, including any applicable administrative or dispensing fees.

SPECIALTY PHARMACY

1. What is your definition of a specialty drug? Do not include a dollar threshold in the definition.

2. Describe the criteria used in developing your specialty drug list, and how often the list is updated.

3. Provide, as an attachment, a list of all specialty medications (including LDD, Exclusive Distribution, and Biosimilars) at the NDC-11 level in Excel with associated discounts and dispensing fees. If days’ supply has impact or differentiates discounts, please outline clearly. This is a mandatory requirement necessary to assess the specialty offering.

4. What is your default pricing for any new drugs being added to the specialty drug list?

Include the AWP discount and any fees that will apply. If days supply has impact or differentiates discounts, please outline clearly.

5. Provide an overview of the key specialty drug benefit management programs that differentiate your programs from your competitors.

6. Describe the Specialty Pharmacy facility which will service CIS, including the location(s), hours of operation, volume, and capacity, number of employees.

7. Please describe your specialty patient management programs, your firm’s ability and results with medication adherence, patient education, patient outreach, etc.

8. Do you provide members with patient education, counseling and monitoring? If so, describe these components of your program. Does your program have 24-hour access to a clinician for plan members?

9. Describe the ancillary services and supplies offered, including care management programs, special packaging and supplies provided and associated charges.

10. Describe your member benefit support services, including providing access to financial assistance programs for members.

11. Do you have a standard minimum days’ supply for specialty? Can the client determine days’ supply of specialty drugs? Will you share your rationale with the client? Please outline drugs that standardly exceed a thirty days supply.

12. Outline cost control mechanisms/strategies for specialty drugs that exist today and in the near future including inflation protection, or formularies that do not employ rebates. Please outline pricing and provide sample reporting and ROI.

13. Describe your communication plan with the prescriber, patient and medical plan including your ability to work with others to improve member outcomes.

14. Describe the standard reports available to CIS including patient education, counseling, compliance, interventions, and patient outcomes. Provide examples.

15. Describe your oncology drug and patient management program and approach.

16. Describe your quality control process for handling, packaging, temperature control, shipping and delivery of specialty drugs, as well as policy, procedures and protocols that ensure specialty drugs are received by the member in good condition.

17. Do you offer specialty pharmacy reinsurance?

18. Describe your capabilities in managing specialty dispensing and members under the medical benefit.

19. Do you provide or aggregate rebates for specialty drugs under the medical benefit?

Please describe this program. Please outline requirements for data elements, formats, timeframes, etc. for medical claims data to claim the rebate? Are there fees associated with this service?

20. How does your specialty program integrate manufacturer patient assistance programs for specialty products into the pharmacy benefit to help manage costs for patients and the plan?

21. How does your specialty program manage sites of care to optimize cost effectiveness of therapy?

MAIL ORDER

1. Describe your mail order services; include process and timeframe information from the receipt of the prescription, review process, fulfillment, and shipping for clean prescriptions and prescriptions requiring intervention.

2. Please confirm CIS will not get billed for patient non-payment?

3. How will your PBM assist with transferring open refills during implementation?

4. Please describe your mail order pharmacy. Provide the address(es) and hours of operation.

5. Are pharmacists available to provide patient counseling? Please outline the hours available to members.

6. What are the customer service hours of operation? Describe customer services available.

7. What is the mail order facility’s total operating capacity? What level of capacity do you expect to be operating at in January 2024?

8. Describe the pricing methodology upon which the mail order rates are based.

Example: AWP discount, MAC, or acquisition cost?

9. Describe the policy for split orders.

10. Describe the policy and communications to the physician and member for rejected claims.

11. Are there maximum dollar amounts allowed outstanding on patient accounts? How is this managed between the mail facility, the member and the client? Will CIS be billed at any time for outstanding Member balances?

12. Can members spread their cost share over a 3-month period for mail order drugs at your facility, if the client desires to allow this? Will CIS be billed at any time for outstanding Member balances?

13. How can your company assist members with getting their refills on the same schedule rather than filling drugs individually throughout the month?

14. What options are available for expediting shipping? Include costs.

15. How are lost, stolen, and destroyed shipments handled?

16. How does your mail facility control for temperature in shipments to members?

17. Describe the processes in place for orders that include controlled substances.

18. Confirm shipping fees and/or postage costs will not be increased if any third-party carrier increases its charges.

CLAIMS ADJUDICATION

1. Confirm all claims will be adjudicated using the lesser of logic in the system and that the system will survey, at a minimum, the AWP discount vs. U & C vs. MAC (if applicable) at retail, and the lesser of AWP discount or MAC at mail and specialty.

2. Confirm members will pay the lower of U&C, MAC, copay, or discounted ingredient cost for retail, mail order, and specialty claims.

3. Confirm you will not charge a fee for reversed or rejected claims.

4. Confirm CIS will pay costs and fees only for net paid claims.

5. State any applicable dispensing or administrative fees charged for LTC, Home Infusion, Compound, VA, and ITU claims.

6. What is the source of AWP pricing?

7. Describe the frequency of AWP price updates. If daily, indicate whether prices are updated the same day or in arrears and indicate how much in arrears.

8. Explain how copayments are applied to claims and adjudicated in the system for non-formulary specialty products.

9. Can your system support integration assistance to combine and track member out-of-pocket costs/maximums and is this included in your proposed administrative fee?

10. Can your system administer coupons, copay cards, PAP programs and other manufacturer assistance? Is the system able to differentiate and allocate the funds toward Plan Spend and not attribute to Member out-of-pocket costs?

11. Please describe how long modifications to a client’s benefit plan design will take to implement after client approval. We realize there are different levels of complexity, please provide examples. Please discuss changes that would require programming.

12. What are your standards and guarantees for claim adjudication accuracy?

13. Confirm your system has 99.99% uptime, not including scheduled downtime.

14. List the number of user licenses included at no cost to CIS and their designated consultant for access to the following systems: Claims adjudication (online access to claims, eligibility, authorizations, overrides, etc.) and Reporting systems.

PRICING

1. CIS is requiring an all-in generics offer regarding the pricing guarantees. Confirm your Brand Guarantee Definition is the calculation of the achieved discount for guarantee purposes and shall include Single Source and Multi-Source Brand Products only. Single Source Generic drugs will not be included in the brand guarantees.

2. CIS is requiring an all-in generics offer regarding the pricing guarantees. Confirm your Generic Guarantee Definition is the calculation of the achieved discount for guarantee purposes and shall include Single Source and Multi-Source Generic Products. In addition, the generic guarantees will include any new to market generic drugs limited supply, and any generic products subject to patent litigation. Sourcing and availability will not impact whether a generic drug will be included in the generic guarantees.

3. Confirm you will offer CIS separate discount guarantees for specialty brand and generic products. Disclose the discounts in your proposal for both an open and exclusive arrangement.

4. Confirm that all guarantees will be calculated on a stand-alone category basis.

Overages in one category will not be used to offset shortages in another category.

Categories are Retail 1-83 days’ supply, Retail 84 and greater days’ supply, mail order, specialty brand, specialty generic, and rebates. In addition, rebates, pricing (AWP discounts) and dispensing fees, and performance guarantees cannot be used to offset one another.

5. Outline cost control mechanisms/strategies that exist today and in the near future including inflation protection, or formularies that do not employ rebates. Please outline pricing and provide sample reporting and ROI.

6. Confirm CIS can elect out of any DAW 5 or 9 “House Generic” programs without any financial penalty.

MEMBER CALL CENTER

1. Provide the address and hours of operation of the Member Call Center(s) that will…