REQ-DASOBO-00174921_AMD-1_RamsellRx_OHA_Signed.pdf

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REQUEST FOR SPECIAL PROCUREMENT (SP) No. REQ-DASOBO-00174921, Amendment No. 1 (SP AMD-1) to Original SP No. REQ-DASOBO-00018620

PART A. Requesting Agency must complete Items 1 through 13.

1. Requesting Agency Name: The Department of Administrative Services, State Procurement Services (DAS SPS), on behalf of the Oregon Health Authority (OHA)

2. Date of Request: May 24, 2026 3. Agency Number: 10700 OBO 44300

4. Agency Contact Name: Jay Jung 5. Phone: 971-283-0023

6. Type of Request: X Contract-specific Special Procurement

7. Amendment Time Period Requested: From: Upon Approval To: February 28, 2029

8. Total Estimated Cost for Amendment Time Period: $10,090,000

9. Title (Supplies and Services sought): Public Health Pharmacy Benefits Management (PH- PBM) and Medication Therapy Management for People Living with HIV (Services)

10. Amendment Request.

a. Request Summary:

DAS SPS, on behalf of OHA, requests approval for this SP No. REQ-DASOBO-00174921 (SP Amd-1) to REQ-DASOBO-00018620 (2021 SP) to amend Contract No. PO-DASOBO- 00004646 (previously OHA Contract No. OHA-147854) (Contract) with Ramsell Corporation (Contractor) to:

(1) increase the maximum, not-to-exceed compensation (NTE) payable to Contractor;

(2) extend the Contract for two (2) years beyond the current term of February 28, 2027;

(3) update the fee schedule in Exhibit A, Part 2 Payment & Financial Reporting;

(4) update Exhibit A and Exhibit A-1 for Third Party Access to Agency Information Systems; and

(5) add to the Statement of Work (SOW) provisions, allowing for Contractor to negotiate and execute contract pharmacy agreements with retail pharmacies in order to maintain client access to medications.

b. Background:

CAREAssist, administered by the OHA Public Health Division (PHD), is Oregon’s AIDS Drug Assistance Program (ADAP). State ADAPs are funded by federal grant dollars, program income (insurance reimbursements), and pharmaceutical rebates; and exist in every State and US territory to ensure vulnerable, low-income people living with HIV have access to

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FDA-approved medications and are supported in achieving viral suppression to improve health outcomes. People with HIV who are virally suppressed have zero chance of transmitting HIV to sex partners, making HIV treatment one of the most important HIV prevention strategies available. Oregon’s ADAP is ranked #1 in the nation, with a rate of 96% of clients virally suppressed.

The current CAREAssist Contract was procured through SP No. OHA-4065-15 (2015 SP), with no protests. The 2021 SP was issued to extend the Contract another six (6) years, allowing sufficient time for market research and appropriate procurement action in preparation for the Contract’s expiration date of February 28, 2027. Again, there were no protests received.

Table 10.b below represents the Contract and related Amendments history, terms and cumulative costs to date:

Table 10.b: Contract and Amendment History and Cumulative Costs:

Action Term Action Amount Cumulative Contract NTE

Contract OHA 147854

2016-

$3,600,000 $3,600,000

Contract Amd. 1 2017-

$17,000,000 $20,600,000

Contract Amd. 2 2017-

0 $20,600,000

Contract Amd. 3 2021-

$3,570,000 $24,170,000

Contract Amd. 4

Contract number changed to PO-

DASOBO-

00004646

2022-

$27,750,000 $51,920,000

Contract Amd. 5 0 $51,920,000

Contract Amd. 6 0 $51,920,000

Totals through Amd 6: $51,920,000

For additional historical and background information, see Attachment 1, 2015 SP

(OHA-4065-15) and Attachment 2, 2021 SP (REQ-DASOBO-00018620).

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c. Current Need:

OHA needs to amend the Contract for an additional two (2) years, allowing for a formal Request for Information (RFI) process to research current market conditions, while ensuring client Services are continued; add pharmacy contracting services to the scope of work; and ensure database investments are realized.

CAREAssist currently contracts with 37 pharmacy locations across Oregon (including 2 mail order options). As a 340B Drug Pricing Program covered entity, CAREAssist partners with these pharmacies to dispense 340B discounted medications to eligible clients.

Increasingly, health insurance plans are restricting pharmacy access by imposing specialty pharmacy requirements. Additionally, Providence and PacificSource are exiting the individual marketplace in Oregon in 2027 – both being providers that have allowed clients to use CAREAssist contract pharmacies unrestricted. In order to maintain access to medications within the CAREAssist program model, additional specialty pharmacies will need to be added to the CAREAssist contract network. CAREAssist lacks the capacity to address this need and has concluded this scope of work is best added to the PBM Services Contract.

CAREAssist is currently developing a new program client data system under a separate contract #DASPS-1778-20, which resulted as award under Request for Proposals (RFP) #DASPS-2226-18. This multi-year IT development project had an initial release in August 2026, with the project set to conclude in 2027. Data is exchanged between CAREAssist’s and Ramsell’s systems daily, and Ramsell has worked with the contractor for the system development to ensure no disruption of services. That project team identified that not renewing the Ramsell contract would be a high/critical risk to the success of that $23 million investment project. Based on these findings, it is paramount to the project that OHA continue the CAREAssist ADAP services provided by Ramsell.

Continuing the Services provided by Ramsell is essential to ensuring clients do not experience gaps in access to critical medication and support. The contracted services are essential to the CAREAssist pharmacy model and is the primary functional method to deliver required federal services and ensure insurance reimbursement revenue (program income) is received by the program, funds that support 80% of the CAREAssist Program’s operating budget.

With the Contract extended, OHA’s clients would continue to receive the array of customized public health pharmacy benefit management and medication therapy management services Ramsell has been providing, specifically:

• Client services: Ramsell provides a set of direct client services to clients, including a Medication Therapy Management Program (MTM). MTM provides phone-based support to patients through direct adherence counseling with an HIV pharmacist. Medical providers and Ryan White case managers can refer clients directly to the MTM program for low-barrier access to services to improve patient outcomes and contain costs.

Ramsell also auto-generates referrals based on usage data indicating client need. A

REQ-DASOBO-00174921 (18620)_AMD-1_RamsellRx_OHA Page 4 of 7 highly unique feature of the current system is that Ramsell has partnered with Oregon’s ADAP’s contracted pharmacies to provide an even more comprehensive and integrated service for clients.

• Eligibility validation: Real-time, continuous electronic insurance and CAREAssist eligibility checking to ensure clients can access medications when needed.

• Claims adjudication: Like a traditional PBM, CAREAssist’s PH-PBM adjudicates pharmacy claims on the program’s behalf, but also provides additional customized and enhanced services, including: centrally process claims in real time, claim adjudication, record keeping and reports to clients, payment to providers and fiscal intermediaries (e.g., processing of co-payments, deductibles for medications; track data and contractual price agreements required to receive rebates; performing electronic split billing at pharmacy point of service, pay pharmacy invoices, and bill ADAP; invoice and manage rebates and discounts with pharmaceutical companies; serve as electronic data transfer agent to meet all requirements related to Medicare True Out-of-Pocket (TrOOP) payments [serve as TrOOP coordinator and prepare reports]; paying health insurance co-payments and deductibles).

• Rebating: As part of the federal 340B Program, CAREAssist is eligible for pharmaceutical rebates for 340B eligible clients. Rebates is a unique feature of an ADAP, as not all 340B covered entities are able to collect rebates on full cost medications. Similar to the collection of insurance reimbursements, these 340B rebates are also a key source of income for OHA’s CAREAssist program. The PH-PBM processes OHA’s rebates and invoices approximately 10,000 eligible claims per year to the manufacturers. OHA PHD is unaware of any other PBM with the ability to track and provide this essential service when multiple contracted pharmacies are used.

• Auditing: Another requirement of the federal 340B Program is participation in periodic audits. OHA’s PH-PBM can provide data for the purposes of both internal and external audits, and will assist in representing OHA in external audits, including those that are federally required. Ramsell also provides free auditing tools that allows CAREAssist to independently audit its pharmacy contractors.

• Drug Utilization Review: Periodic drug utilization reviews are required by federal funders for purposes of quality improvement and cost containment. OHA’s PH-PBM employs pharmacists with specialized knowledge and experience in HIV pharmacology to conduct prospective clinical claim review via the online Drug Utilization Review process for treatment standards on Oregon’s behalf.

• Business continuity: The PH-PBM Services ensures business continuity for OHA in case of an earthquake or other type of local or statewide emergency. This means OHA could still process the Services for Oregonians receiving CAREAssist if the system went down.

This back-up system is part of OHA’s emergency services and disaster preparation plan, a federal expectation.

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• Assistance with benefit design and business rules: Includes Dispensing Guidelines, covered drugs, exclusions, limits cost-sharing provisions [differential co-payments for generic or preferred drugs], and mail-order dispensing.

• Information management: This includes risk assessment and profiling.

• Pharmacoeconomic studies: This assists with quality assurance and cost effectiveness.

Costs to cover the extension are estimated as shown in Table 10.c:

Table 10.c: Estimated Cost Breakdown for Term requested under SP AMD-1 (Upon Approval through February 28, 2029)

YEAR Contract Period Cost

3/1/26-2/28/27 Increase by $15,000

Year 1 3/1/27-2/29/28 $5,000,000

Year 2 3/1/28-2/28/29 $5,075,000

Total Cost for SP AMD-1 Term (2027–2029): $10,090,000

Note: With SP AMD-1 approval from DAS and execution of the anticipated contract amendment, the cumulative Total Estimated Cost of the Contract will be $62,010,000.

d. Proposed Contracting Procedure:

1. As required by Oregon Administrative Rules (OAR) 125-247-0287, DAS SPS will issue a public notice of the approved SP AMD-1 on OregonBuys® for a period of seven (7) calendar days.

2. The public notice will include provision that any Affected Person(s) may protest the approval of SP AMD-1.

3. DAS SPS, in collaboration with OHA, will respond to and resolve all protest(s), if any.

4. If no protests are received and sustained, DAS SPS, on behalf of OHA, will proceed with amending the Contract as set out in Section 10.a above.

5. DAS SPS and OHA will work with DAS Enterprise Information Services (EIS) and obtain its endorsement prior to executing the Contract amendment, as required.

6. Pursuant to ORS 291.047 and OAR 137-045-0015, DAS SPS will work with the Oregon Department of Justice (DOJ) and obtain its legal sufficiency approval prior to executing the Contract Amendment, as required.

11. Justification for use of Special Procurement:

With the approval of the 2021 SP (Attachment 2), the Contract and all subsequent amendments became authorized and subject to the terms of the SP. Consequently, any further amendments to the Contract outside of the approved 2021 SP – whether for additional time, REQ-DASOBO-00174921 (18620)_AMD-1_RamsellRx_OHA Page 6 of 7 services, or related costs – must first be requested and approved through a Special Procurement Amendment Request to the State Chief Procurement Officer.

The same justification statements detailed in 2021 SP (REQ-DASOBO-00018620) Attachment 2 are still applicable.

12. Findings to Satisfy the Required Standards. This proposed special procurement:

X (a) will be unlikely to encourage favoritism in the awarding of public contracts or to substantially diminish competition for public contracts because:

OHA is preparing a Request for Information (RFI) for PH-PBM and MTM services. In addition to current services, the RFI will include the expanded scope of pharmacy contracting. This RFI is expected to post in Q4 2026. Results of that RFI will inform future procurement actions.

The same findings of facts statements detailed in 2021 SP (REQ-DASOBO-00018620) Attachment 2 are still applicable.

and

(b)(i) will result in substantial cost savings to the contracting agency or to the public because:

or

_X__ (b)(ii) will otherwise substantially promote the public interest in a manner that could not practicably be realized by complying with the requirements of ORS 279B.055, 279B.060, 279B.065, or 279B.070, or any rules adopted thereunder because:

In addition to the facts of how the public benefits from the continued Services presented in Section 10.c – Current Need, by adding the scope of pharmacy contracting, OHA will be able to have timely agreements in place with insurance required specialty pharmacies, to meet registration requirements for the federal Office of Pharmacy Affairs Information System (OPAIS), and ensure the program continues to receive 340B cost savings and secure client access to medications.

Additionally, the same findings of facts statements detailed in 2021 SP (REQ-DASOBO- 00018620) Attachment 2 are still applicable.

13. Signature: The actual signature of the Agency Head or designee (e.g., Designated Procurement Officer) is not required on the Request submitted through OregonBuys®. Agency may elect to attach a signed Request as a pdf file through OregonBuys® or submit a signed hard copy Request.

Signature: e.g. Electronically in OregonBuys® _________________

Name/Title: Date:

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PART B.

STATUTORY AND RULE AUTHORITY:

ORS 279B.085(2) states the Director of the Department of Administrative Services may approve a special procurement if the Director finds that a written request submitted under ORS 279B.085(4) demonstrates that the use of a special procurement as described in the request, or an alternative procedure prescribed by the Director will:

(a) Be unlikely to encourage favoritism in the awarding of public contracts or to substantially diminish competition for public contracts; and (b)(A) Result in substantial cost savings to the contracting agency or to the public; or

(B) Otherwise substantially promote the public interest in a manner that could not practicably be realized by complying with requirements that are applicable under ORS 279B.055, 279B.060, 279B.065 or 279B.070 or under any rules adopted thereunder.

OAR 125-246-0170 delegates the authority of the Director of the Department of Administrative Services to approve special procurements to the State Chief Procurement Officer. OAR 125-247-0285 through 125-247-0288 implement

ORS 279B.085.

OAR 125-247-0700(2) Protests and Judicial Review of Special Procurements designates the State Chief Procurement Officer as the Contract Review Authority.

FINDINGS: The findings are accepted, adopted, and incorporated by reference herein.

CONDITIONS OF APPROVAL:

1. Notice Period. The Authorized Agency shall post the Public Notice on OregonBuys®. The Special Procurement may not be used until after the completion of the seven (7) day notice period required pursuant to OAR 125-247- 0287(4), and either:

a. No Written protests are received by the Contract Review Authority, State Chief Procurement Officer, from an Affected Person(s) in response to the notice, or

b. If any protest is received during the notice period, then not until:

i. the State Chief Procurement Officer or delegate issues a written disposition of the protest in accordance with ORS 279B.400 and OAR 125-247-0700 and OAR 137-047-0700, and

ii. confirms in writing the first possible date of use of the Special Procurement.

2. ORS 279A.165 Requirements. Authorized Agency shall comply with the requirements of ORS 279A.165 and OAR 125-247-0287(12) regarding a report about this Special Procurement. Agency shall use a form and follow the instructions provided by the State Chief Procurement Officer or delegate.

3. Authorized Agency shall comply with all Enterprise Information Services (EIS) conditions and requirements prior to PO amendment execution, if any.

4. During the term of this SP, OHA shall conduct market research via a Formal Request for Information (RFI) process for any new technologies and present the results of the RFI to DAS SPS prior to requesting a SP Amendment.

APPROVED:

Kathryn Jones, State Chief Procurement Officer Date:

Department of Administrative Services, State Procurement Services

9/2/26

REQUEST FOR SPECIAL PROCUREMENT (SP) No. REQ-DASOBO-00174921,