Request for Proposal for Pharmacy Benefit Management Services

97035

RFP Release Date: September 11, 2024 RFP Due Date: October 2, 2024 Effective Date: April 1, 2025

Confidentiality Notice:

This Request for Proposal and the information contained herein is confidential. No part of this Request for Proposal may be reproduced or shared with anyone outside of your organization without prior written consent.

TABLE OF CONTENTS

INVITATION

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

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

Wende Ward – Wende@ARMSRx.com; Cell: (513) 313-7756 Angi Byard – angi@ARMSRx.com; Cell: (513) 502-5372

RFP DELIVERY

Please submit RFPs electronically to the above RFP contacts. PBMs are supplied with an electronic version of this RFP to aid in the preparation of proposal(s). PBM, by accepting these electronic documents, agrees not to modify, alter, or otherwise change the language or format of these documents. Submission of a proposal signifies full agreement with this requirement.

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. Once provided, ARMSRx will release the CIS prescription claims data securely to your organization.

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 Wilsonville, 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 currently administered by Express Scripts.

PLAN DESIGN

· CIS is a NON-ERISA plan with approximately 8,666 employees and approximately 21,589 total members.

· They are carved out for pharmacy from Regence BCBS, utilizing Express Scripts as their PBM.

· CIS is currently on a traditional pricing model and requesting both traditional and pass-through pricing.

· A broad, national network that includes ALL major chain pharmacies, including Kroger pharmacies is required.

· They are utilizing an exclusionary formulary, so vendors can quote their exclusionary formulary option.

· They currently utilize Exclusive Specialty through Free Market Health

· CIS utilizes a specialty copay card/manufacturer assistance program with SaveOn.

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 with CIS policies.

Proposers are expected to have a service model that provides for high-touch, concierge style service which includes a Clinical Pharmacist as part of the account management team.

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.

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. Performance guarantees should be client specific, applicable to with CIS and based on the with CIS individual experience.

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

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

· Network Capabilities

· 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 size clients

· Account Management and Implementation Staffing & Project Management

· Project Management and implementation of historical claims and clinical programs throughout the course of the contract

· Robust 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

CIS reserves 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.

CIS 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 CIS 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 March 1, 2025. 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.

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 and clinical program management

6. 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 Manufacturer Assistance Programs

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 Requirements. If you cannot meet a Requirement, please explain in detail. CIS reserves the right to disqualify vendors upon significant deviation from mandatory and/or contract requirements.

DEVIATE

ADDITIONAL INFORMATION IF DEVIATING

Please confirm you currently have connectivity to Regence BCBS

If not currently connected with Regence BCBS, please indicate your willingness to connect and outline any associated fees for integration/connectivity.

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.

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.

“340B Claim” means a Claim identified by the submission of “20” in any of the Submission Clarification Code fields and/or a Claim submitted by pharmacy owned by a covered entity, as defined in Section 340B(a)(4) of the Public Health Services Act, whose 340B status is coded as “38” or “39” in the NCPDP DataQ database.

Please confirm you are able to accommodate plan design changes at the state level based on legislation that may be enacted within a state in which CIS has employees that reside.

· 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.

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.

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

All earned but unpaid rebates will belong to CIS (i.e., in the event of termination, client shall receive all rebates earned as of the date of termination).

Confirm CIS will receive all manufacturer revenue, and that rebates will include all direct and indirect revenue received from pharmaceutical manufacturers, holding companies, or other contracted entities such as GPOs, as well as other potential fees such as administrative fees, marketing, data, educational, etc. If you disagree indicate what CIS will receive, please outline your specific details. The above will be included in the definition of rebates in the contract.

Confirm that you will provide the greater of 100% of rebates received as defined above or the minimum rebate guarantees.

Confirm Biosimilars will be included in the rebate guarantees and are eligible for rebates.

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 client receives, documentation will be provided at the time payment is received.

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

Confirm CIS and their consultant will have unlimited licenses for system access (i.e., online reporting and eligibility) included at no cost.

Confirm that all member calls and inquiries will be addressed by U.S. based staff and not transferred offshore.

Confirm that upon termination of the relationship, you will provide willingly and expediently so as not to disrupt the members’ transition, all currently provided data files to the medical management vendor(s), consultants and to the new PBM vendor in an electronic format, including the following at no additional cost to CIS.

a. open mail order refill files

b. all current prior authorizations

c. satisfactory claims history to support step therapy programs

d. open specialty medication refills

Confirm that zero balance due claims are included in the discount guarantees prior to the application of member copayment.

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

Confirm you will provide financial guarantee reconciliation within 120 days after year end.

Confirm you will provide rebate guarantee reconciliation within 180 days after year end.

Confirm you will remit to CIS all rebates received from Pharma on a quarterly basis within 90 days after the submitted quarter.

Confirm your offer is based on a broad, national network, including ALL major chain pharmacies including Kroger pharmacies.

PBM will provide a detailed CIS specific contract incorporating all agreed upon provisions within this RFP within fifteen (15) calendar days of contract award.

Please confirm you will allow audit of manufacturer agreements for additional contracts (in addition to standard audit right scope) for any manufacturers with pricing changes (i.e., insulin market changes)

Please confirm you will provide 60-day notification of any network changes that may impact members.

Please confirm you will provide 60-day notification of any pricing changes with financial impact (i.e., insulin market changes, biosimilars, etc.)

· RFP responses and any BAFO negotiation will become part of the contract between CIS and the selected vendor. Bidder agrees 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) are required to be provided within the RFP process including both Open and Exclusive discounts.

Your organization agrees to provide a three-year pricing proposal with improvements for each year of the agreement with annual market checks available each calendar year.

Your organization agrees to support CAA Reporting Requirements at no additional cost.

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.

Your organization will be able to successfully implement this plan given at least a 90-day implementation timeline.

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.

Confirm that if your firm is awarded this contract that your firm’s Legal Department will respond to each request within ten (10) business days with a working document or detailed response to contract language change requests.

Confirm that line-item claim data will be made available in an agreed upon format to CIS and their consultant(s), medical management vendor(s), TPA(s) and any other 3rd party on at least a monthly basis at no additional charge.

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

Please confirm you have completed the pricing tabs in full.

Please confirm you have provided your non-trended rebate estimate for 2025.

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.

LETTER OF INTENT TO BID/ACKNOWLEDGEMENT

Please email to: Wende@armsrx.com; Angi@armsrx.com

Date

Re: RFP for Pharmacy Benefit Management Services

We submit this Letter of Intent to notify CIS of [name of your organization]’s intent to submit a proposal for the Pharmacy Benefit Management Request for Proposal.

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

* Dates are subject to change

ATTACHMENTS TO INCLUDE (please provide in unlocked format)

1. Mandatory and Contract Requirements

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

3. 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.

4. Organizational Chart and Implementation Project Manager, Account Management and Clinical Account Manager bios that will be assigned to CIS.

5. Customized implementation plan (Implementation begins 12-1-2024 for an effective date of 4-1-25)

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

7. Sample Client Reports (Utilization, Clinical Programs, Financial, Rebate)

8. Performance Guarantees, including Implementation Performance Guarantees

9. Copy of the formularies proposed

10. Network disruption including number of impacted pharmacies, utilizers and Rxs

11. Formulary disruption including number of impacted utilizers and Rxs impacted for each proposed formulary. Please provide summary as outlined below as well as drug level disruption detail.

PBM Formulary Name:

Moving to Non- Formulary (Negative Disruption) # of Utilizers Impacted

% of Utilizers Impacted

# of Rxs Impacted

% of Rxs Impacted

% of Utilizers Impacted

# of Rxs Impacted

% of Rxs Impacted

12. Specialty Copay Card/Manufacturer Assistance Program Analysis (Please provide an analysis based on the programs you would propose)

a. Additionally, please complete the following table relative to your proposed specialty program(s).

Annualized Impacted Script Count:

Annualized Unique NDC count:

Program Fees:

Are the program fees factored into est. net savings?

Plan Design Changes/Requirements:

Confirm details around rebate impact relative to this program (i.e., specialty rebates will be impacted):

If a member is not eligible for patient assistance, can they come back on to plan for specialty copay card/manufacturer assistance?

Confidential and Proprietary to ARMSRx

Confidential and Proprietary to ARMSRx

PRICING INSTRUCTIONS

Please provide both traditional and pass-through pricing.

Rates MUST be based on these definitions:

For purposes of this proposal, all Generic guarantees should exclude claims priced at U&C, paper or member submitted claims, compounds, COB or secondary payor, and vaccines. The guarantee should include all other products with a Medispan Multisource Indicator of "Y" at the time of adjudication. Please explicitly define the methodology used for determining the guaranteed rates proposed.

For purposes of this proposal, all brand guarantees should exclude claims priced at U&C, paper or member submitted claims, compounds, COB or secondary payor, and vaccines. The guarantee should include all other products with a Medispan Multisource indicator of "M", "N", or "O" at the time of adjudication. Please explicitly define the methodology used for determining the guaranteed rates proposed.

The PBM may propose alternative methodology for calculating the guarantees. If an alternative is provided, then PBM must provide a detailed explanation on the proposed methodology along with the proposed guaranteed rates. Any explanation as to proposed methodology must include, at a minimum, the following:

· Identify the claims which will be included and excluded.

· Identify the period for which guarantees will be calculated.

· Identify the timeframe for calculations.

· Identify the timeframe for documentation and payment.

· Identify how multi-source brand products will be handled within the guarantee calculation.

If a proposed methodology will exclude a group of generic products due to certain "generic exclusivity" parameters, the PBM must provide a detailed list of such products at the NDC-11 level and must include the period of proposed exclusivity.

Specialty Pricing Section Provide a detailed list of all products, including Limited and Exclusive Distribution, and Biosimilar Drugs, at the NDC-11 level in Excel, currently treated as Specialty.

Identify differences in pricing for Exclusive versus Open plans, and details on when each pricing scheme will apply.

PRICING DEFINITIONS

For purposes of this proposal, all generic guarantees should be reconciled in accordance with the terms in the chart below on an annual basis. The guarantee should include all other products with a Medispan Multisource Indicator of "Y" at the time of adjudication. Please explicitly define the methodology used for determining the guaranteed rates proposed.

Exclude Paper or member submitted claims

Exclude claims for compounded products

Exclude claims for COB or secondary payor

Exclude Vaccine and vaccine administration claims

Include generic claims with limited availability, subject to patent litigation and new to market drugs. If PBM does not agree, provide a detailed list on the Generic Exclusivity section.

Include all other claims with a Medispan Multisource indicator of "Y".

Certify that each guarantee component is measured on a stand-alone basis and an overachievement on one guarantee component will not be netted against an underachievement in another guarantee. Guarantee components are Retail 1-83 days supply, Retail 84 and greater days supply, mail order, and specialty brand and specialty generic. Rebates and performance guarantees stand alone and may not be used to offset any other guarantee.

If other inclusions and exclusions apply - PBM must provide detailed explanation.

Provide detailed methodology how the generic discount guarantees are measured, including frequency of review and reconciliation and payment time frame.

For purposes of this proposal, all brand guarantees should be reconciled in accordance with the term noted in the chart below on an annual basis. The guarantee should include all other products with a Medispan Multisource indicator of "M", "N", or "O" at the time of adjudication. Please explicitly define the methodology used for determining the guaranteed rates proposed.

Exclude Paper or Member Submitted Claims

Exclude Claims for compounded products

Exclude Claims for COB or secondary payor

Include all other claims with a Medispan Multisource indicator of "M," "N," "O"

Exclude Vaccine and vaccine administration claims

Certify that each guarantee component is measured on a stand-alone basis and an overachievement on one guarantee component will not be netted against an underachievement in another guarantee. Guarantee components are Retail 1-83 days supply, Retail 84 and greater days supply, mail order, limited distribution drugs, and specialty brand and specialty generic. Rebates and performance guarantees stand alone and may not be used to offset any other guarantee.

If other Inclusions and Exclusions - PBM must provide detailed explanation.

Provide detailed methodology how the brand discount guarantees are measured, including frequency of review and reconciliation and payment time frame.

PRICING TEMPLATE

Guaranteed minimum overall brand discount off of AWP 1-83 days

Guaranteed minimum overall generic discount off of AWP 1-83 days

Guaranteed minimum overall brand discount off of AWP 84-90 days

Guaranteed minimum overall generic discount off of AWP 84-90 days

Guaranteed maximum brand dispensing fee per claim 1-83 days

Guaranteed maximum generic dispensing fee per claim 1-83 days

Guaranteed maximum brand dispensing fee per claim 84-90 days

Guaranteed maximum generic dispensing fee per claim 84-90 days

Guaranteed maximum administrative fee per retail brand claim

Guaranteed maximum administrative fee per retail generic claim

Guaranteed minimum overall brand discount off of AWP 1-83 days

Guaranteed minimum overall generic discount off of AWP 1-83 days

Guaranteed minimum overall brand discount off of AWP 84-90 days

Guaranteed minimum overall generic discount off of AWP 84-90 days

Guaranteed maximum brand dispensing fee per claim 1-83 days

Guaranteed maximum generic dispensing fee per claim 1-83 days

Guaranteed maximum brand dispensing fee per claim 84-90 days

Guaranteed maximum generic dispensing fee per claim 84-90 days

Guaranteed maximum administrative fee per retail brand claim

Guaranteed maximum administrative fee per retail generic claim

MAIL ORDER PHARMACY NAME

ENTER MAIL PHARMACY NAME HERE

Guaranteed minimum overall brand discount off of AWP 1-34 days

Guaranteed minimum overall generic discount off of AWP 1-34 days

Guaranteed minimum overall brand discount off of AWP 35-90 days

Guaranteed minimum overall generic discount off of AWP 35-90 days

Guaranteed maximum brand dispensing fee per claim

Guaranteed maximum generic dispensing fee per claim

Guaranteed maximum administrative fee per mail order brand claim

Guaranteed maximum administrative fee per mail order generic claim

Guaranteed minimum overall brand discount off of AWP 1-34 days

Guaranteed minimum overall generic discount off of AWP 1-34 days

Guaranteed minimum overall brand discount off of AWP 35-90 days

Guaranteed minimum overall generic discount off of AWP 35-90 days

Guaranteed maximum brand dispensing fee per claim

Guaranteed maximum generic dispensing fee per claim

Guaranteed maximum administrative fee per specialty brand claim

Guaranteed maximum administrative fee per specialty generic claim

EXCLUSIVE SPECIALTY

EXCLUSIVE SPECIALTY

Guaranteed minimum overall brand discount off of AWP 1-34 days

Guaranteed minimum overall generic discount off of AWP 1-34 days

Guaranteed minimum overall brand discount off of AWP 35-90 days

Guaranteed minimum overall generic discount off of AWP 35-90 days

Guaranteed maximum brand dispensing fee per claim

Guaranteed maximum generic dispensing fee per claim

Guaranteed maximum administrative fee per specialty brand claim

Guaranteed maximum administrative fee per specialty generic claim

Discount Exclusions:

Please list any claims categories that are excluded from discount guarantees provided for Specialty.

SPECIALTY PHARMACY PRICING

Provide a detailed list of all products currently treated as Specialty, Limited and Exclusive Distribution, and Biosimilar Drugs by NDC 11 with the applicable discounts. Identify differences in pricing for Exclusive versus Open plans. Please provide as Attachment in Excel format.

Status

REBATES

Rebates guarantees should be based on a minimum per brand claim. Deviations that require an average 30 or 90 days supply must be documented below.

1. Please duplicate the tables below to include the following offers: standard formulary with exclusions, standard formulary with exclusions and with step therapy.

2. List any exclusion(s) to your rebate guarantees and provide rebate estimate for 2025 based on the formulary with exclusions.

Rebate Exclusions: Please list any claim categories that are excluded from rebate guarantees provided.

Rebate Estimate: Please provide your non-trended rebate estimate for 4/1/2025-3/31/2026.

GENERIC EXCLUSIVITY

If a proposed methodology will exclude a group of generic products because of certain "generic exclusivity" parameters, the PBM must provide a detailed list of such products at the NDC-11 level and must include the period of proposed exclusivity.

Proposed Generic Exclusivity List under Alternative Guarantee Methodology

CREDITS/ALLOWANCES

Please outline any credits/allowances you are providing to CIS as part of your overall offer.

Implementation Credit

Audit Allowance

Pharmacy Management Allowance

Other

ADDITIONAL SERVICES

Included SERVICES (AT NO ADDITIONAL COST)

Identify the base level of services offered at no additional cost. List your services in one of the program groupings below. Proposers may provide this information in their own format.

Administrative Prior Authorizations

Clinical Prior Authorizations

Member Portal

Client Portal

Step Therapy Programs

DUR Programs

Utilization Management Programs

Clinical Programs

ADDITIONAL SERVICES (OFFERED FOR A FEE)

Identify…