City of

Long Beach Request for Proposals RFP - HR-24-389

Pharmacy Benefits Management

Pharmacy Benefits Management| RFP - HR-24-389 | Template v04.20.23 | 1

Pharmacy Benefits Management| RFP - HR-24-389 | Template v04.20.23 | 1

Overview

Summary

The City of Long Beach (COLB) is currently soliciting proposals from qualified contractors to deliver Pharmacy

Benefit Management (PBM) services for its self-insured

Preferred Provider Organization (PPO) and Health

Maintenance Organization (HMO) products. The PBM services encompass various categories of services, each of which plays a crucial role in ensuring the effective management and delivery of pharmacy benefits to COLB's members.

Key Dates

Release Date: May 2nd

Pre-Proposal Meeting: May 14th, 2024 at 2:00PM

Questions Due to the City: May 16th, 2024 at 5:00PM

Posting of the Q&A: May 23rd, 2024

Proposals Due: June 4th, 2024 at 11:00AM

The City reserves the right to modify these dates at any time, with appropriate notice to prospective Contractors.

Proposal Information

Instructions for what to include in your proposal and how to submit it are detailed in Section 4.

Proposals must be submitted electronically via

LongBeachBuys.com.

Official Contact

Abraham Torres rfppurchasing@longbeach.gov

All communication with the City related to this RFP must be directed to the contact listed above.

mailto:rfppurchasing@longbeach.gov

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Contents

1 The Opportunity

1.1 Project Summary

1.2 Background

1.3 Goals

1.4 Award Terms

2 Scope of Work

2.1 Description of Services

2.2 Performance Metrics & Contract Management

2.2.1 Performance Metrics

2.2.2 Contract Management

2.2.3 Contract Payment

3 How We Choose

3.1 Minimum Qualifications

3.2 Evaluation Criteria

4 Proposal Instructions & Content

4.1 Timelines & Instructions

4.2 Proposal Content

4.3 Narrative Proposal Template

5 Terms & Conditions

5.1 Acronyms/Definitions

5.2 Solicitation Terms & Conditions

5.3 Contract Terms & Conditions

5.4 Additional Requirements

5.5 Protest Procedures

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1 The Opportunity

1.1 Project Summary

The City of Long Beach (COLB) is currently soliciting proposals from qualified contractors to deliver

Pharmacy Benefit Management (PBM) services for its self-insured Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) products. The PBM services encompass various categories of services, each of which plays a crucial role in ensuring the effective management and delivery of pharmacy benefits to COLB's members.

1.2 Background

The City of Long Beach (City) is the seventh largest city in the state of California and employs approximately 6,500 full and part-time personnel throughout 22 departments. The Benefits Division, housed in the City’s Human Resources Department, administers competitive and comprehensive benefits that provide financial protection for City employees, retirees, and their dependents in a cost-effective manner. In addition to the administration of the benefit plans, staff in the Benefits Division provide the following services:

• Benefits-related trainings to departmental staff

• Disability and Unemployment claims processing

• Citywide Wellness Program

• Oversight/Coordination of Retirement Counseling

Currently, there are approximately 6,500 employees and 13,200 members enrolled in the PPO and HMO plans offered. The City has approximately $19 million in annual Drug Spend across all plans. Total City drug spend has been approximately $36.4 million in annual drug spend over the past two plan years.

To assist Suppliers to better understand the current COLB plan and population, the following information is provided under the Attachments section in Long Beach Buys:

COLB Plan and Population Attachments

• Employee Census with enrollment information

• Rx Claims Files

• Summary Plan Descriptions

• Clinical Management Programs

1.3 Goals

This RFP has the following state goals:

• Secure a contract with a single Pharmacy Benefit Manager (PBM) PBM for pharmacy benefit for comprehensive account management, network and formulary management, utilization management, and custom clinical programs to ensure continuity of service.

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• Reduce annual drug spend by 10% over the next fiscal year while maintaining or improving the quality and coverage of pharmacy for City employees, retirees, and their dependents.

• Achieve a 90% satisfaction rate among City employees, retirees and their dependents with the services and representation provided by the administration of the City’s benefits plans within the next fiscal year.

• Maintain a member and account management satisfaction score of 90% or above, as measured by quarterly surveys, for the City and its members over the term of the contract.

• Continuously offer quality member and account management satisfaction for the City and its members.

1.4 Award Terms

This contract will be for a period of two (2) years with the option to renew for three (3) additional one-year periods. The total contract term will not exceed five (5) years. The City reserves the right to award multiple contractor(s) or a single contractor at the City’s sole discretion. The contractual relationship to be established will be via an Administration Only Services (“ASO”) agreement.

2 Scope of Work

2.1 Description of Services

The City of Long Beach (COLB) is currently soliciting proposals from qualified contractors to deliver

Pharmacy Benefit Management (PBM) services for its self-insured Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) products. The PBM services encompass various categories of services, each of which plays a crucial role in ensuring the effective management and delivery of pharmacy benefits to COLB's members.

Below are the tasks and responsibilities associated with each service category:

General Bidding Requirements

• Ability to comply with Freedom of Information Act (FOIA) throughout the bid processes.

• Demonstrate an ability to continue the current plan designs and utilization management (UM) programs in the submittal offer.

• Ability to assist with the Consolidated Appropriations Act Pharmacy Benefits and Costs (CAA

RxDC) reporting requirements and compliance. In addition, support the submission of files P2, D3-D8 and applicable parts of CAA RxDC’s narrative response.

• During the contract term, the City will have no data restrictions and may obtain and share any data with any third party.

• Upon termination, the City will have no restrictions on obtaining and sharing its data with any third party.

Administrative Process Requirements

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• Demonstrate the capacity to seamlessly integrate all medical deductible and out-of-pocket maximum amounts with pharmacy benefits across all plans, ensuring readiness for the January 1, 2025, go-live date.

• Ensure stability and continuity in service delivery, including client experience service, by avoiding any major system changes that may impact clients within the initial 18 months.

• Demonstrate proficiency in managing all levels of appeals, including first, second, and coordinating third-party appeals, ensuring comprehensive coverage of the appeals process.

• Ensures full compliance with HIPAA regulations to safeguard the confidentiality and security of protected health information.

• Adhere to all Health Care Reform provisions, including those outlined in the 2021 Consolidated

Appropriations Act, and implement a streamlined process to address any related complaints.

• Ensure full compliance with all Federal and State laws and provisions governing the City’s benefit program.

• Adheres to strict confidentiality and data security protocols to safeguard client and member protected health information (PHI), personal identifiable information (PII), and related materials.

• Demonstrate capacity to send data to City of Long Beach's third-party vendors with at least seven

(7) reoccurring claim files included at no cost.

• Demonstrate willingness to send data and all relevant transition files to City of Long Beach's new vendor to assist in a transition upon the conclusion of the contract term at no additional cost.

• City of Long Beach will retain control over plan design modifications and changes during the contract term.

• Demonstrate willingness to comply with the transition at no cost to the City, termination fees, or withholding of reconciliations or rebates in the event of contract termination.

• Provide seamless continuity of service by loading twenty-four (24) months of retail, mail, and specialty claims history from the previous carrier at no additional cost.

• Load prior authorization history and open refill transfer files during implementation.

• Upon termination, commit to provide to the City or its designee a copy of the formulary, Claims detail, eligibility format, Plan Participant utilized pharmacy National Council for Prescription

Drug Programs (NCPDP) numbers, mail service and specialty open refill files, open prior authorization (PA) info, applicable accumulator amounts, drug coverage/utilization management details, and any information that may assist in a transition and/or RFP process, at no cost.

Eligibility and Claims Administration and Systems

• Accept, both future and retroactive, effective and termination dates for eligibility (up to 90 days).

• Assign a unique identifier for eligibility and has the capability to cross reference against SSN or can use a unique identifier assigned by the Client or the third-party administrator (TPA)/Carrier.

• Process and load eligibility information.

• Notify the City of Long Beach and their designated eligibility vendor of any discrepancies within

24 hours of receipt.

• Conduct thorough and quality assurance checks regarding eligibility updates.

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• Conduct testing and review eligibility files to ensure accuracy including reviewing protocols before initiating auto-updates of eligibility files.

• Provide the City with an online tool for managing eligibility.

• Ability to review claim system and identify and edit duplicate claims.

• Ability to view claim system screens to identify duplicate claims paid across both medical and Rx benefits.

• Maintains at least three (3) years of claims history on the system.

• Capacity to retrieve archived claim information within forty-eight (48) hours of request.

• Adjudicate Medicaid subrogation claims, upon request.

• Ensure that a disaster recovery plan, contingency plans, and recurrent testing are in place to prevent disruptions in the distribution channel.

• Guarantee the implementation of security systems and protocols to safeguard confidential patient records both in storage and in transit.

• Ensure all eligible locations are Verified Internet Pharmacy Practice Sites (VIPPS) certified and licensed in every state.

• Guarantee that the website maintains at least 99.9% availability.

• Ensure the City retains ownership of its claim data and associated management data (e.g. prior authorization data, mail order scripts) in the event PBM service agreement termination and provide an industry accepted standard file will be provided at no charge.

• Provide secondary processing site and off-site storage backup capability to ensure continuity of service and data security in the event of a primary site failure.

• Ensure the claim system utilized is developed, owned, and managed by the awarded contractor.

• Demonstrate the ability to receive both manual and automated eligibility files from two distinct systems.

Customer Service Requirements

• Ensure live customer service support 24/7/365, allowing immediate access for members, pharmacies, or physicians to reach a nurse/pharmacist if needed.

• Ensure member/patient website or online portal encompass features such as order inquiry/product selection, pricing of medications, view plan design and formulary, therapeutic alternatives and view/find retail pharmacy providers, order identification (ID) card replacements, view their explanation of benefits (EOB) statements.

• Deliver digital solution with features tailored for employee/patient use, including but not limited to:

- Order Inquiry/Product Selection

- Real-time pricing of medication, including the pharmacy's Usual & Customary charge, e.g.

$4.00 generics

- Access to plan design, formulary, and clinical rules.

- Ability to locate all retail pharmacy providers within the network.

- Online refill ordering functionality

- Viewing of ID card

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- Options for Lower cost alternatives for both drugs and pharmacies

- Push messaging capabilities to ensure timely communication.

• Provide a dedicated, toll-free customer service number for members to reach the PBM, offering comprehensive services, including but not limited to and it will offer the following services:

- Rx status/ordering refills

- Access to pharmacist support

- Support with first fills at mail order.

- Information on how to navigate the prescription program.

- Support regarding UM programs; step therapy; prior authorization process.

- Escalation of orders.

- Guidance through the appeals process.

• Implement and maintain a call tracking system that logs each member or client inquiry.

• Ensure availability of multi-lingual speaking representatives at all times to accommodate members and dependents at all times.

• Customer service is expected to be organized into designated units, such as clinical specialists, specialty unit, nursing support care, and general assistance servicing several accounts rather than limited to one location.

• Provide a designated group of customer service representatives to service the City of Long Beach account.

• Capability to enable members to email customer service with a guaranteed twenty-four (24) hour response time.

• Demonstrate willingness to participate in cultural training for designated customer service unit.

• Capacity for all incoming and outgoing customer service calls to be recorded and available upon request. .

• Ensure all written member inquiries are documented, recorded and retrievable at any time from the system for the City’s review.

• Implement monthly monitoring of all customer service representatives as part of the comprehensive quality assurance and satisfaction program.

• Deliver mail order member communication materials to member residences.

• Assist in processing run-out claims post termination to facilitate transition for a period of at least

180 days. Offer integration of a hotlink from City HR portal with single sign-on functionality.

Account Management and Implementation

• Include PharmD resources as part of the account team to provide pharmacist support.

• Ensure a dedicated financial analyst as part of the account team.

• Meet a go-live date of January 1, 2025, if final decision is made within 90 days of the effective date.

• Ability to participate in quarterly face-to-face meetings (including PharmD support) to discuss strategic ideas to meet the City of Long Beach's objectives.

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• Ability to process transition of care files in the incumbent vendor’s layout inclusive of specialty and mail-order prescription information from the outgoing incumbent to effectively manage the transition of specialty and mail-order prescriptions.

• Accept and utilize claims data from the incumbent PBM for retrospective reviews or prior approvals of managed drugs (e.g., prior authorizations, step therapy edits).

• Accept and incorporate prior authorizations from incumbent PBM during implementation.

• Provide y the City members and dependents with website access prior to the “go live date” of

January 1, 2025, to review formularies, pricing, and mail-order parameters, etc.

• Provide the City with the flexibility to customize communications materials according to specific needs and preferences.

• Provide the City of Long Beach pharmacy summary plan documents.

• Ensure a comprehensive and current listing of all plan program elections and plan design details for each plan offered by the City throughout the duration of the contract, available upon request for audit or review within a maximum of five (5) business days.

• Monitors and promptly notifies the City of any impact of legislative activity and Food and Drug

Administration (FDA) information within the pharmacy industry.

• Notify the City of new drugs in the pipeline and provide a pipeline analysis (low impact, moderate impact, high impact) via a quarterly report.

• Conduct a financial analysis of upcoming generic drugs including saving projections and presents the results to the City as needed.

• Track and report quarterly member complaints and appeals, providing comprehensive reporting to the City.

• Support the need for claims-level issue escalation and management by providing a designated day-to-day contact who is expert in claims systems queries, can work directly with the rest of the

Account Team on active member claim issues, and is able to contact members directly to address and resolve claim issues.

• Support the ability to replace a portion of or all of the account team upon thirty (30) days advanced written notice in the event of discontent with service level delivered, with the ability to interview replacement with a choice of no less than two (2) options for replacement team members.

Reporting/Integration Requirements

• Provide claims data to the City of Long Beach, the Medical TPA, Advocacy/Wellness Respondent, data warehouse, FSA administrator, etc., on a monthly basis.

• Capacity to provide copies of both Annual and Quarterly management report templates.

• Ability to grant access to standard management reports. Demonstrate the capability to independently create management reports for City users included.

• Demonstrate capacity to undertake the completion of Medicare Part D Creditable Coverage analysis.

• Demonstrate the ability to complete or assist with the analysis of quantitative and non-quantitative limits regarding Mental Health Parity.

• Ability to produce comprehensive written Evidence of Coverage (EOC) and formulary.

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• Offer all members with Explanation of Benefits (EOB) statement annually, identifying savings opportunities, and shall do so without imposing any additional costs.

• Utilize claims history data to compare cost and utilization trends during the first 12 months of contract term.

• Assume the cost for replacement of lost, spoiled, or stolen medications.

• Demonstrate ability to implement a drug recall process, encompassing internal procedures and notification to clients, prescribers, and impacted members.

• Provide quarterly reporting on all call center metrics.

• Provide standard management and utilization reports, as well as non-standard management and utilization reports and ad hoc reports upon request.

Audit Rights Requirements

• Allow the City or its third-party representative (not subject to approval by the vendor) access and the right to audit all claims, utilization, rebates, performance guarantee provisions, contracts

(pharmaceutical manufacturers and pharmacy networks), discounts negotiated directly with the manufacturers, administrative fees, and other information relevant to account services.

• Ensure that all aspects of claims transacted for City of Long Beach by the PBM are subject to audit, even if the PBM deems the information to be confidential in nature, subject to a signed confidentiality agreement.

• Grant the City the right to audit records in any one given contract year for the entire term of the contract and up to one year post termination.

• Provide support and access to claims information to the City and its auditors at no charge. Any associated charges to conduct an audit by the Auditor will be covered by the City.

• Conduct periodic audits as part of the course of business. Provide copies of any internal audits and quality assurance reports.

• Ability to explain audit procedures in place, if utilizing a third-party for any aspects of claims fulfillment (e.g., Mail Order, Specialty).

• Pass-through any and all audit recoveries to the City as a result of auditing the pharmacy network.

Clinical Operations

• Demonstrate the ability to review and replicate the clinical programs currently in place within the

City.

• Provide standard utilization management programs (e.g., Prior Authorization, Step therapy, etc.) to control utilization and improve outcomes.

• Deliver outcomes reporting on all implemented clinical programs.

• Offer comprehensive reporting around program fees, savings, and member impact to support decision-making processes for the City.

• Provide member communications for any City-covered membership that may be affected by a vendor-implemented program at no additional cost.

• Implement programs associated with monitoring Fraud, Waste, and Abuse, as well as controlling potential narcotic over utilization.

• Monitor and provide oversight for all compounded medications.

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• Implement programs aimed at improving medication adherence.

Formulary Management

• Demonstrate the ability to manage the access of covered medications with input from the City to align with standard formulary offerings and best practices for full clinical coverage.

• Provide the covered list of medications for City membership, including but not limited to designation of preferred medications, medications that may be excluded from coverage with suggested alternatives, and medications which may have associated utilization management applied for coverage.

• Ensure that for medications initially excluded from the formulary, there is an option for medical necessity prior authorization to bring medications back into coverage.

• Establish an independent Pharmaceutical and Therapeutics (P&T) Committee to advise and review all aspects of the formulary.

• Offer access to programs aimed at driving savings for both the City and its membership by promoting generic utilization where available.

• Provide access to information regarding rebate management, whether internal or through a third-party, as it pertains to formulary management and future changes.

• Capacity to provide the City with timely reporting and member impact resulting from periodic formulary changes and updates.

• Supply the City with financial implications should the City wish to decline future formulary management changes.

• Conduct member outreach communications to identify potential formulary changes and disruption on current medications taken.

• Offer services for prior authorization and appeals determinations as they relate to managing the implemented formulary.

Retail Network Access

• Demonstrate the ability to provide the City with access to a broad national retail pharmacy network that includes all major chains and relevant independent pharmacies.

• Commit to recruiting out-of-network pharmacies into the network if deemed meaningful to City membership.

• Notify the City and membership with at least 30 days’ notice should a contract pharmacy leave the network and impact more than 2% of Membership.

• Offer a limited network arrangement for future decision-making, should the City wish to review opportunities for additional savings.

• Provide member service tools for pharmacy location searching as well as pharmacy pricing tools.

Mail Order Access

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• Provide the City and members access to fill maintenance medications for up to 90 days’ supply through a mail order pharmacy.

• Implement system redundancies in the mail order distribution system to support members experiencing disruptions or drug shortages in the normal dispensing process (e.g., national emergency, weather closures, strike, etc.).

• Ensure timely filling, dispensing, and mailing out of prescriptions (<2 days for claims requiring no intervention, 5 days for claims requiring intervention).

• Offer the option for Auto-refill capabilities without automatically enabling it.

• Commit to not charging for increases in shipping/postage during the life of the contract.

• Ensure that the mail order pharmacy is licensed to ship medications to all 50 states and all US territories, including access to temperature-controlled medications.

Specialty Pharmacy Services

• Provide the City and its membership access to specialty medications through either an internal or third-party pharmacy.

• Ensure that the specialty pharmacy is fully staffed and equipped to handle medications that require special handling and shipping to avoid medication waste.

• Offer members access to member services trained to navigate complex disease states.

• Ensure that member services are trained in patient counseling regarding medication side effects.

• Ability to grant member services access to a complete history of all medications utilized by a member, not just specialty, for medication consultations.

• Provide access to clinical programs for all specialty medications to confirm medical necessity and prevent off-label use.

• Offer access to programs to manage and track adherence for specialty drug therapies.

• Track, measure, and report member satisfaction related to specialty pharmacy services.

• Provide same-day delivery for members in emergency situations.

• Offer access to programs addressing rising plans and member costs associated with specialty medications.

• Provide access to manufacturer assistance programs to lower plan and member costs.

• Contract with manufacturers and pharmacies for Limited Distribution Drugs, with or without direct access.

• Periodically provide the City with drug pipeline updates and associated cost and member impact for future planning.

• Work with the City and associated outside vendors to review Specialty Infusions or medications filled under the medical benefit for cost-saving opportunities.

2.2 Performance Metrics & Contract Management

2.2.1 Performance Metrics

The table below highlights the targets that will be tracked and reviewed collaboratively with the Awarded

Contractor during the contract. This list is an indication of the performance metrics of interest to the City and is not exhaustive or final. As a part of a response to this RFP, Proposers may propose additional or

Pharmacy Benefits Management| RFP - HR-24-389 | Template v04.20.23 | 12 alternative performance metrics to be tracked on a regular basis. The final set of performance metrics and frequency of collection will be negotiated by the successful Proposer and the City prior to the finalization of an agreement between parties and may be adjusted over time as needed.

METRIC DESCRIPTION TARGET DATA SOURCE

1. Account

Management

Satisfaction

Overall satisfaction with Account team, responsiveness, reporting, and issue resolution

To be determined by

City of Long Beach on an ongoing basis (met

vs. not met)

N/A

2. File Integration, accuracy, and timeliness

Overall success of file integration and accuracy

Target above 99% accuracy

File specification

3. Prescription

Accuracy

Overall success of mail order turnaround time, and participating retail pharmacy access

Target above 99% accuracy

Member/issue resolution and feedback

4. Customer Service Call center for member and issue resolution

Phone average of answer less than 30 seconds, phone abandonment rate under 2%, overall satisfaction

Call center data specifications

5. ID Card production Success with ID Card production and timeliness

Target above 99% accuracy

Vendor Feedback specifics

2.2.2 Contract Management

The awarded contractor will receive consistent support and communication from a designated City liaison throughout the duration of the contract. This liaison will serve as the primary point of contact for the contractor and will send out reminders regarding upcoming deadlines for reports, invoices, and narrative metrics. These efforts aim to provide clarity about deadlines and address any questions or concerns to ensure that any issues can be openly shared and resolved in a timely manner.

Kickoff Meeting:

The awarded contractor is required to participate in a project kickoff meeting, which will include the introduction of key project staff, a review of the project scope and timelines, an overview of contractor invoicing and reporting requirements, and the establishment of a regular schedule for project meetings and reporting.

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Milestone and Deliverables:

The awarded contractor shall submit the following deliverable to City staff by the designated deadline and receive approval before implementation. Final deadlines shall be negotiated and agreed upon during contract negotiations.

• Comprehensive report outlining the integration process, including timeliness, milestones, and resource requirements to ensure readiness for the January 1st, 2025, go-live date.

• Detailed plan outlining strategies and procedures to ensure prescription accuracy for mail order and retail pharmacy services.

Communications and Reporting

The awarded contractor and City staff shall meet regularly during the start of the engagement to review project status, address project issues, assess opportunities to improve effectiveness and efficiency. After the Go-Live Date, the contractor and City staff shall meet regularly to review project status and performance, address issues, assess opportunities to improve effectiveness and efficiency, and review service data and monitor performance.

The contractor shall provide requested reports on an as needed basis in the time frames requested to assist in the collective bargaining process or to allow the City to meet its obligations under collective bargaining agreements. The contractor will consult collaboratively with staff to identify cost savings, efficiencies, and performance improvements during the life of the contract.

2.2.3 Contract Payment

The City of Long Beach issues payment based upon services rendered. After a contract is finalized and work is performed, the Contractor should invoice the City. The City will remit payment within 30 calendar days of being billed.

3 How We Choose

3.1 Minimum Qualifications

Proposers must meet the following requirements to be eligible:

• Qualifications to conduct business in the City.

• Not have been debarred by Federal, State, or local government.

• Verifiable experience serving as a Pharmacy Benefit Manager for other large-scale government entities, municipality, or public sector clients.

• Ability to administer a benefit with 340b utilization program.

• Ability to keep records in accordance with any Federal, state, or local mandates and document retention standards.

• Supplier is willing to offer pricing guarantees that are considered “floor” or minimum guarantees and are to be calculated/reconciled with the excess value, including on maximum allowable cost

(“MAC”) performance, to be passed along to the City of Long Beach.

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3.2 Evaluation Criteria

Proposals shall be consistently evaluated based upon the following criteria:

CRITERIA Weight

1. Organizational Capacity & Experience

• Demonstrated track record of successfully implementing similar projects in comparable organizations or municipalities.

• Availability of skilled personnel with relevant expertise in pharmacy benefit management and healthcare administration.

• Evidence of strong organizational infrastructure and resources to support the scale and complexity of the project.

30%

2. Method of Approach

• Detailed description of the proposed methodology for integrating pharmacy benefit management services with existing systems and processes.

• Demonstrate the capacity to ensure continuity in service for the January 1, 2025, Go-Live date.

• Demonstrate capacity to deliver comprehensive services outlined in Exhibit A Scope of Work.

• Plan for addressing potential challenges or obstacles and proactive measures for risk mitigation.

40%

3. Communications & Reporting

• Ability to participate in mandatory meetings.

• Ability and experience in data collection and reporting.

• Comprehensive communication plan outlining regular updates, channels of communication, and escalation procedures.

• Commitment to responsiveness and transparency in addressing City inquiries, feedback, and concerns throughout the contract term.

20%

4. Reasonableness of Cost 10%

4 Proposal Instructions & Content

4.1 Timelines & Instructions

MILESTONE

TIME

(PACIFIC)

& DATE

LOCATION / ADDITIONAL INFORMATION

Release date May 2nd

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Optional Info Session, Pre-

Proposal Meeting

May 14th, 2024 at 2:00

PM

• Virtaul Meeting

• RSVP not required

• Join the meeting here

• Meeting ID: 210 642 287 36

• Passcode: LRNqT4

Questions due to the City May 16th, 2024 at

5:00PM

• Submit all inquiries via email to rfppurchasing@longbeach.gov

Posting of the Q&A May 23rd,

• Responses to the questions will be posted on

LongBeachBuys.com.

Proposals due June 4th, 2024 at

11:00AM

• Proposals should be submitted electronically via

LongBeachBuys.com.

• Late proposals, or proposals submitted through other channels will not be accepted.

• Proposers are responsible for submitting their proposals completely and on time.

o Proposers will receive an e-bid confirmation number with a time stamp from LongBeachBuys.com indicating that the proposal was submitted successfully. The City will only receive proposals that were transmitted successfully.

o For technical support, email or call the City during normal business hours at LBPurchasing@longbeach.gov or (562) 570- 6200.

Evaluation of Narrative &

Cost Proposals

Summer

• An Evaluation Committee will review Narrative & Cost

Proposals to select the proposal that best meets the needs of the City.

• Evaluations will be conducted using a methodology derived from the evaluation criteria listed in Section

3.2.

Interviews/ Demos/ Site

Visits

Summer

• The City may interview or request demos from none, one, some or all Proposers.

Negotiation & Contractor

Selection

Summer

• Selected Contractor(s) will be notified in writing.

• Any award is contingent upon the successful negotiation of final contract terms. If contract negotiations cannot be concluded successfully, the City reserves the right to negotiate a contract with another Contractor or withdraw the RFP.

https://teams.microsoft.com/l/meetup-join/19%3ameeting_NTQzMWQ2MWYtNGU1ZS00MGU0LTk0OGQtMTk3YzQ2ZWJmZGM0%40thread.v2/0?context=%7b%22Tid%22%3a%22313f11c3-4268-4f6a-8d3b-c7e650183e78%22%2c%22Oid%22%3a%22175a46a5-0b9b-48a7-ba2b-ff3d74752727%22%7d mailto:rfppurchasing@longbeach.gov file:///C:/Users/meid/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/X47PW9A6/LongBeachBuys.com file:///C:/Users/meid/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/X47PW9A6/LongBeachBuys.com file:///C:/Users/meid/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/X47PW9A6/LongBeachBuys.com mailto:LBPurchasing@longbeach.gov

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• Negotiations shall be confidential and not subject to disclosure to competing Contractors unless and until an agreement is reached.

Estimated Contract

Execution

Fall 2024

Proposer Debrief After

Contractor is Selected

• Successful and unsuccessful Proposers are encouraged to request phone call or in person meeting with the City to discuss the strengths and weaknesses of their proposal. The intent of the debrief is to provide the

Proposer with constructive feedback to equip them with information to effectively meet the City’s needs and be successful in future proposals.

4.2 Proposal Content

Complete proposals will include the following. Proposers are encouraged to use this table as a checklist to ensure all components are included in their proposal.

PROPOSAL

☐ Narrative Proposal The Narrative Proposal should provide a straightforward, concise delineation of capabilities to satisfy the RFP.

Guidance on preparing a Narrative Proposal is detailed in Section 4.3.

☐ Cost Proposal The Cost Proposal should be prepared utilizing the excel pricing template provided, Attachment ‘COLB Supplier Proposal Template’. Supplier shall complete the following:

• Financial Questionnaire

• Exhibit 1 Pricing Outline

• Exhibit 2 PGs

• Exhibit 3 Plan Designs

• Exhibit 4 Clinical Programs

• Exhibit 5 Formulary Disruption

• Exhibits 6 Prior Authorization

• Exhibits 7 Network Disruption

• Exhibit 8 GeoAccess Summary

PROPOSAL APPENDICES

☐ Financial Stability Proposers should include one or more of the following financial statements to provide the City with enough information to determine the financial stability of the Proposer and subcontractor.

• Two (2) ears of Audited Financial Statement or Corporate Annual

Report

• Business tax return

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• Statement of income and balance sheet

☐ Annual/Quarterly

Client Reports

Provide the Annual/Quarterly Client Reports as an attachment titled:

Attachment 1: Annual/Quarterly Client Reports HR-24-389.

☐ Account Management Org Chart

Provide the Account Management Organization Chart as an attachment titled: Attachment 2: Account Management Org Chart HR-24-389.

☐ Clinical Program

Listing

Provide the Clinical Program Listing as an attachment titled: Attachment

3: Clinical Program Listing HR-24-389.

☐ Fraud Waster &

Abuse Programs and

Examples

Provide examples and information on Fraud Waster & Abuse Programs as an attachment titled: Attachment 4: Fraud Waster & Abuse Programs

HR-24-389.

☐ Specialty Formulary

Listing

Provide the Specialty Formulary Listing as an attachment titled:

Attachment 5: Specialty Formulary Listing HR-24-389.

☐ Standard Reporting

Package

Provide the Standard Reporting Package as an attachment titled:

Attachment 6: Standard Reporting Package HR-24-389.

☐ Limited Distribution

Drug List

Provide the Limited Distribution Drug List as an attachment titled:

Attachment 7: Limited Distribution Drug List HR-24-389.

☐ Signature Ready

Contracts

Provide the Signature Ready Contracts as an attachment tilted:

Attachment 8: Signature Ready Contracts HR-24-389.

☐ Inefficient or Non-essential Drug List

Provide the Inefficient or Non-essential Drug List as an attachment titled:

Attachment 9: Inefficient or Non-essential Drug List HR-24-389.

☐ Implementation

Timelines

Provide the Implementation Timelines as an attachment titled:

Attachment 10: Implementation Timelines HR-24-389.

☐ Center for Medicare and Medicaid

Services (CM)M

Reporting Deadline dates

Provide the CMM Reporting Deadline dates as an attachment titled:

Attachment 11: CMM Reporting Deadlines Dates HR-24-389.

☐ Other Addenda (if applicable)

Colored displays, promotional material, and other collateral are not necessary or desired. However, if a complete response cannot be provided without referencing supporting documentation, it may be provided as an addendum clearly cited in the Narrative or Cost Proposal.

MANDATORY ATTACHMENTS | The following are included as Attachments in Long Beach

Buys. They must be signed by the individual legally authorized to bind the Proposer.

☐ A. Authorization & Certification

☐ B. Equal Benefits Ordinance (EBO) Form

Attachments Which May be Submitted Upon Award | Upon award, Awarded Contractors will be required to submit the following. We encourage you to take note of these requirements, and where possible, include available information as part of your proposal to expedite processing.

☐ C. W-9

☐ D. Business License

☐ E. Proof of Registration with the California Secretary of State

☐ F. Certificate of Insurance

☐ Contact Information | Ensure your organization’s profile is up to date in Long Beach Buys, including an email address, phone number, and for any classifications you may qualify for.

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4.3 Narrative Proposal Template

Proposers should develop a narrative proposal that includes all of the following information.

An editable version of the template below has been posted to Long Beach Buys. Proposers should complete the editable template and submit it as their narrative proposal.

Organizational Capacity & Experience

PROPOSER CONTACT INFORMATION

Organization

Company Name

Company Address

Federal Tax ID Number

Website

Authorized

Representative

Name

Title

Email Address

Phone Number

Other Point of

Contact (if required)

Name

Title

Email Address

Phone Number

PROPOSER CAPACITY & EXPERIENCE

What type of enterprise is the organization?

☐ Non-Profit

☐ Sole Proprietorship

☐ General Partnership

☐ Corporation

State and Date of incorporation:

☐ Limited Liability Company

☐ Other

Please describe why the organization is qualified to provide the services described in this RFP (1-2 paragraphs).

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Please describe your success with similar entities in your industry and where you see your value stand out from the rest of the available vendors.

How many employees does the organization have in total and residing in Long Beach?

Where is the representative(s) that would service the

City’s account located?

Please provide a plan overview for how the project will be staffed, including the percentage of time each employee will be allocated to this project, and the name and the titles of the principles.

REFERENCES

Note: Two former and two current references that are government entities, municipalities, or public sector clients that are similar in size to COLB; at least one of the references should have a Medicare population.

Reference 1

Company

Project Manager

Phone Number

Project Description

Project Start and

End Dates

Reference 2

Project Manager

Phone Number

Project Description

Reference 3

Project Manager

Phone Number

Project Description

Reference 4

Project Manager

Phone Number

Project Description

SUB-CONTRACTOR CONTACT INFORMATION

Does the proposal include subcontractors?

☐ Yes

☐ No

If applicable, provide the following for all subcontractors included in this proposal.

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Organization Company Name

Company Address

Authorized

Representative

Name

Title

Email Address

Phone Number

Other Point of

Contact (if required)

Name

Title

Email Address

Phone Number

SUBCONTRACTOR CAPACITY & EXPERIENCE

What type of enterprise is the organization?

☐ Non-Profit

☐ Sole Proprietorship

☐ General Partnership

☐ Corporation

State and Date of incorporation:

☐ Limited Liability Company

☐ Other

Which specific requirements of this RFP will the subcontractor perform?

Is the subcontractor registered with the California

Department of Industrial Relations? If yes, provide registration number.

Please describe why the organization is qualified to provide the services described in this RFP (1-2 paragraphs).

Please describe the length of time the organization has been providing the services described in this

RFP (1-3 sentences).

How many employees does the organization have nationally, locally, and residing in Long Beach?

City’s account located?

City’s account be located?

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General Information

1. Provide total covered lives under management: Number of Lives (not including drug discount card members).

2. Provide employer sponsored plans (Active only): Number of Lives.

3. Provide employer sponsored plans (Active only): Percent of Total Book of Business.

4. Provide Municipality or Gov. Agencies (Active only): Number of Lives.

5. Provide municipality or Gov. Agencies (Active only): Percent of Total Book of Business.

6. Indicate the number and description of any outstanding legal actions pending against

Respondent's organization. Explain how the organization will assure City of Long Beach that these actions will not disrupt business operations?

7. Has your organization experienced recent merger or acquisition activity, or has any such pending activity been publicly disclosed? If so, describe, specifically addressing any reorganization or operational changes that would affect your product or services.

8. Are there any recent or anticipated changes in your organizational structure (e.g. key personnel, consolidation of operations, new service centers) that would impact COLB. Include a project plan and timeline if applicable.

9. Has your company ever filed for bankruptcy? If so, when and what is the current status of your filing?

Method of Approach

1. Provide an executive summary, it should demonstrate a clear understanding of the scope of work and contain how your organization will fulfill the requirements and the Scope of Services as outlined in the RFP, including a discussion of the important features and attributes, highlighting any aspects, which separate it from its competitors.

2. If your organization is a current or previous COLB Provider, the Executive Summary should give the agreement term dates, agreement number, and contracting department.

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3. Provide your data security procedures and detail your notification procedures in the event of a breach of confidentiality or sensitive data. Additionally, specify any available legal remedies and other relief measures.

4. Indicate which medical Third-Party Administrator (TPA) you coordinate with for integrated Rx and medical data administration (eligibility, deductible, maximum out of pocket, clinical programs connected to medical benefit). List the vendor and frequency.

5. Confirm you will be able to answer member transition questions during open enrollment and prior to go live date (i.e., formulary, mail-order transfers, new prescriptions, prior authorizations, etc.). How far in advance will that ability be available to members? Discuss your process and tools available to assist members with the transition

Communications & Reporting

1. Describe how your organization will proactively share standard and non-standard management and utilization reports.

2. Describe how your organization will ensure compliance with all laws.

3. Describe how your organization will provide advice to the City of Long Beach regarding benefit design and communication to members.

4. Describe how your organization will work collaboratively with other service providers to improve the quality and cost of services provided to members under their health benefit plans.

5. The City requires that the Awarded Contractor provide proof of payment of any subcontractors used for this project. If the proposal includes subcontractors, please describe the plan for how the City will be notified of such payments.

Customer Service Requirements

1. Are member services locations domestic United State or offshore?

2. Please list member services: Location(s)

3. Member Services: Hours of Operation (Pacific) for live interaction. Please also provide automated availability.

4. Provide Account Management Team: Location(s) and Hours of Operation (Pacific)

5. Confirm ability to comply with respondent's average speed of answer (ASA) rate of 100% under

30 seconds for the assigned service center without IVR.

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6. Confirm ability to comply with respondent's average speed of answer (ASA) rate of 100% under

30 seconds for the assigned service center with IVR.

7. Confirm ability to comply with respondent's abandonment rate of <3% for the assigned service center.

8. Confirm ability to comply with respondent's initial call resolution rate of >95% for the assigned service center.

9. Describe the innovative developments to your mobile apps that have been released recently.

10. Describe the innovative developments to your client web portal that have been released recently.

11. Confirm capacity to maintain an average annual (Voluntary/Non-Voluntary) turnover rate for

Customer Service of <10% for the assigned service center.

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5 Terms & Conditions

5.1 Acronyms/Definitions

1. Awarded Contractor: The organization/individual that is awarded a contract with the City of Long

Beach, California for the services identified in this RFP.

2. City: The City of Long Beach and any department or agency identified herein.

3. Contractor / Proposer: Organization/individual submitting a proposal in response to this RFP.

4. Department / Division: City of Long Beach, Human Resource Employee Benefits Division

5. Evaluation Committee: An independent committee comprised solely of representatives of the City established to review proposals submitted in response to the RFP, evaluate the proposals, and select a Contractor.

6. May: Indicates something that is not mandatory but permissible.

7. Rebates: Any element of compensation or credits received from any pharmaceutical manufacturer derived from plan utilization.

8. RFP: Request for Proposals.

9. Shall / Must: Indicates a mandatory requirement. Failure to meet a mandatory requirement may result in the rejection of a proposal as non-responsive.

10. Should: Indicates something that is recommended but not mandatory. If the Proposer fails to provide recommended information, the City may, at its sole option, ask the Proposer to provide the information or evaluate the proposal without the information.

11. Subcontractor: Third party not directly employed by the Proposer who will provide services identified in this RFP.

12. Transparency Contract Bids: A financial arrangement which represents a 100% direct and complete pass through of all elements of the PBM’s financial arrangements including, but not limited to, discounts, dispensing fees, rebates, administrative service incentive fees, etc., for retail, mail order, and specialty pharmacies by the PBM for a fixed and guaranteed administrative fee.

5.2 Solicitation Terms & Conditions

1. The City reserves the right to alter, amend, or modify any provisions of this RFP, or to withdraw this RFP, at any time prior to the award of a contract pursuant hereto, if it is in the best interest of the City to do so.

2. The City reserves the right to request clarification of any proposal term from Proposers.

3. The City may contact the references provided; contact…