ESBD_544717_1786373766878_Q&A One.docx

Q& A Document #1

1. Utilization Data. To scope our proposal accurately, can the Center provide (or confirm availability of) historical utilization data from the incumbent provider, including at minimum: drug description, NDC, quantity dispensed, days' supply, number of claims, and date of fill? If a sample extract or standard report is available, we would appreciate a copy. Best if we can get 12 – 24 months of utilization where the center was billed for claims.

See attached excel report

2. Pricing Table (Section 4.5 / Exhibit reference). The fee schedule structure provided in the RFP (tiered by Invoice AG Cost, with markup and a flat $1.50 dispensing fee) differs from the pricing structures we typically see in comparable RFPs. Could the Center clarify the calculation methodology it expects — specifically:

(a) is the “markup” figure intended as a multiplier applied to invoice acquisition cost, or as a percentage add-on;

(b) is the dispensing fee flat across all tiers regardless of drug cost; and.

(c) is this the Center's current contracted rate structure, or a reference example proposers should price against?

This is just a reference to our current structure and proposers should bid with their proposed fee structure.

3. Current Distribution Model. Our understanding is that the Center may currently be utilizing a long-term-care-style shipping/distribution model.

a. Does the current pharmacy provider handle all shipping to Center sites?

A: Yes

b. How many ship-to locations does the Center currently have across its service area? Can you provide a list of the centers that receive shipments?

A: We ship to the following locations (15 mental health clinics)

Ward County MHC

Terry County MHC

c. Can the Center share the average number of prescriptions shipped to each location per month?

A: This varies by month and we do not have this information readily available with our current software.

4. Packaging. Are all prescriptions currently dispensed in unit-dose/blister packaging, or is blister packaging limited to a specific patient population, with the remainder dispensed in standard vials with lids?

We use both blister packaging for IDD and 30 day supplies of MH medication. The remainder is dispensed with vials or prefilled injections.

5. Retail Pharmacy Use. Does the Center currently utilize retail pharmacy access for after-hours needs, hospital discharge/crisis situations, or for individuals in rural communities outside delivery range? How does the center handle these types of situations?

A: We do not use after hours medications

6. Receiving and Distribution Process. Does Center staff currently receive bulk/mail-order prescription shipments from the incumbent pharmacy provider on-site and distribute them directly to individuals served, rather than individuals picking up from a pharmacy location?

A: Medication is mailed to the clinic. Only special occasions would a client pick up from the Pharmacy. Each client has a signature sheet for their medications. There is a sticker that is pulled off and put on that sheet and then the client signs by the sticker with the medication information.

7. Inventory Tracking. Does the Center currently have a tracking system or module in place to reconcile what was received from the pharmacy against what was distributed to individuals served?

A: No

8. Return of Unused Medications (Exhibit D, Item 7). The RFP indicates the Center will receive full credit for unused medications returned within 60 days. Under Texas Health and Safety Code §431.021(w) and 22 TAC §291.8, a pharmacy generally may not accept the return of a dispensed/sold prescription drug for resale or re-dispensing, except through the defined health-care-facility return process in §291.8(b), which applies to a facility regulated under Health and Safety Code Chapter 242 and requires sealed/unopened packaging, a specific inventory record, and a credit/reimbursement (not re-dispensing) back to the original dispensing pharmacy. Can the Center confirm whether it is operating, or intends this return provision to operate, under the Chapter 242/§291.8(b) health-care-facility framework, so that we can propose a compliant process?

A: Medications that are not picked up are supposed to be returned to our Medications Clerk and she takes them back to the pharmacy and they are refunded (credit) on the next bill, except for the $6 charge they charge for distributing the PAP meds.

9. How does the center currently manage, track PAP medications? Does the incumbent pharmacy manage the inventory or does the center manage their inventory?

A: Both the pharmacy and PAP Clerk track the PAP Meds.

10. Population and Payor Mix. The RFP states the Center serves over 7,000 individuals across its service area.

Can the Center clarify: what portion of pharmacy utilization is General Revenue (GR) funded versus billed to Medicaid, Medicare, or other third-party payors?

The only Medications that are billed to Medicaid, Medicare or commercial (third party) are injections.

11. The RFP references more than 7,000 individuals served across approximately 35 sites, but it does not break down the care settings involved. Could you share the approximate mix of residential or 24-hour staffed settings, such as HCS or ICF group homes, versus outpatient, day program, or independent living settings? That information would help us size delivery volume, packaging needs, and staffing appropriately in our proposal.

We currently operate 15 mental health clinics, 7 vocational day sites and 8 HCS group homes.

12. The RFP references Attachment E in two different ways if I'm reading this all correctly. Section 2.7 refers to a Cost of Ownership Form (Attachment E), while Section 2.9 and the attachment list in Section 4.1.1 refer to Attachment E as the Data Use Agreement. Could you clarify which document Attachment E is intended to be and send it along? If these are meant to be two separate attachments, we would appreciate receiving both.

Attachment E is the Data Use Agreement and will be provided upon contract negotiations.

13. Section 1.0 of the RFP includes a paragraph stating that “The Center is looking for the professional services of a contractor with expertise in public section healthcare audit services to provide expertise in performance, compliance, operational, and information technology audit and advisory services.” That language does not appear elsewhere in the Bid Requirements, Bid Form, or Evaluation Criteria sections. Could you confirm whether this applies to pharmacy service proposals or whether it was included in error?

Sorry, that is old language left in from the template. Please disregard.

14. Can you provide the current average daily census (ADC) of individuals receiving pharmacy services across the organization? Approximately how many active prescriptions are dispensed each month (or annually), including new orders and refills? Approximately what percentage of prescriptions are behavioral health medications versus medications for chronic medical conditions? Can you provide an estimated monthly volume of injectable medications (including long-acting injectable antipsychotics) administered through the program?

See attached Utilization Report Service Locations

5. The RFP references approximately 35 service locations. Are these primarily outpatient clinic locations, administrative offices, residential program hubs, or a combination of these? A combination of all.

6. Approximately how many residential homes, host homes, or other medication delivery destinations are currently supported throughout the service area? Eight

7. What is the typical number of individuals served within each residential home or medication delivery location? Four individuals per host home.

8. Is pharmacy delivery currently made directly to each residential location, or are medications delivered to centralized clinic or regional hub locations for subsequent distribution? A centralized clinic or regional hub.

Pharmacy Operations

9. Is a single pharmacy provider currently servicing the entire organization, or are multiple pharmacy providers utilized across the service area? We currently use a single pharmacy provider for MH services and each IDD area uses a local provider of the client’s choosing.

10. What are the primary factors that prompted the issuance of this solicitation (e.g., contract expiration, organizational growth, service enhancement, operational efficiencies, or other strategic initiatives)? Contract expiration.

11. Are there any anticipated changes in census, expansion of services, or additional residential locations expected during the initial contract term? No.

Financial & Payer Mix

12. Can you provide an estimated payer mix (e.g., Medicaid, Medicare, commercial insurance, uninsured, grant-funded, or self-pay)? Unknown at this time, we are unable to pull this level of reporting from our current system. Overall the Center has a 37% Medicaid rate.

13. Approximately what percentage of prescriptions are currently billed directly to the Center after third-party coordination as the payor of last resort? The center only pays for indigent individuals, and we do not pay any additional fees after third party payment.

Technology & Integration

14. What electronic health record (EHR), prescribing platform, and medication administration systems are currently utilized by the Center? Streamline EHR (Smartcare)

15. Are there any pharmacy system integration requirements, electronic interfaces, or data exchange capabilities that will be expected of the successful vendor? Yes.

Transition & Implementation

16. If a new pharmacy provider is selected, what implementation timeline is anticipated following contract award? No timeline has been set and we will work with the selected vendor on an appropriate timeline.

17. Are there any incumbent pharmacy transition requirements, inventory transfers, medication synchronization activities, or continuity-of-care expectations that the successful vendor should plan for? Unknown at this time.

Performance Expectations

18. Beyond the turnaround times outlined in the RFP, are there any additional Key performance indicators (KPIs), service-level expectations, or reporting requirements that the Center considers critical to a successful partnership? No.

19. Exhibit D, Section 6.b. states that billing cycles will be limited to $700. Could you please clarify this requirement? In our experience, billing cycles are typically defined by a timeframe rather than a dollar amount, and we want to ensure we understand and can meet your expectations. We currently pay a flat $700 per billing cycle (two billing cycles per month) for shipping of medications. This is just our current payment structure and is not a requirement for a new vendor.