RFI - Reducing Inappropriate Polypharmacy at the Department of Veterans Affairs.pdf

Request for Information

Reducing Inappropriate Polypharmacy at the Department of Veterans Affairs

VA-25-00104075

August 25, 2025

1. Introduction

This is a Request for Information (RFI) only. Do not submit a quote. This RFI is for planning purposes only and shall not be considered an Invitation for Bid, Request for Task Execution

Plan, Request for Quotation, or a Request for Proposal. Additionally, there is no obligation on the part of the Government to acquire any products or services described in this RFI. Your response to this RFI will be treated only as information for the Government to consider. You will not be entitled to payment for direct or indirect costs that you incur in responding to this RFI.

This request does not constitute a solicitation for quotes or the authority to enter negotiations to award a task order/contract. No funds have been authorized, appropriated, or received for this effort. The information provided may be used by the Department of Veterans Affairs (VA) in developing its acquisition strategy and Performance Work Statement (PWS)/ Product

Description (PD). Any information submitted by respondents to this RFI is strictly voluntary;

however, any information received shall become the property of the Government and will not be returned to the respondent. Interested parties are responsible for adequately marking proprietary, restricted or competition sensitive information contained in their response. The Government does not intend to pay for the information submitted in response to this RFI. Product information, brochures, part numbers, and/or other description information may be included with the submission.

Be advised that set-aside decisions may be made based on the information provided in response to this RFI. Responses should be as complete and informative as possible.

2. Background

VA is seeking information on software that reduces inappropriate polypharmacy regimens to identify accumulative multi-drug interactions, optimizes medication regimes and assists with managing Veteran medication regimens. VA is seeking information on sophisticated technology, supported by clinical evidence, that can demonstrate efficient implementation and real-world return on investment based on actual platform deployments. Polypharmacy, defined as the concurrent use of multiple medications and/or medications that are not necessary, increases the risk of adverse drug events, medication non-adherence, drug-drug interactions, and increases health care costs.

VA remains committed to reducing inappropriate polypharmacy and Potentially Inappropriate

Medication (PIM) in all patient populations across the continuum of care and in all clinical settings, physical and virtual health delivery platforms. VA is particularly interested in polypharmacy amongst Veterans with Post Traumatic Stress Disorder (PTSD) and other health care issues that impact their mental health. This population is commonly prescribed multiple medications, making treatment decisions complex due to the combinations of diagnoses and symptoms.

RFI - Reducing Inappropriate Polypharmacy at VA (VA-25-00104075)

Deprescribing is the targeted discontinuation of medications that are unnecessary or potentially dangerous in the context of the patient’s comorbidities, functional status, treatment goals, and life expectancy. Both polypharmacy and deprescription are associated with risks in Veterans.

The time before and after starting a new psychotropic medication or discontinuing psychotropic medication are high risk periods for negative outcomes, such as overdose and suicide. Prompt and effective efforts to address polypharmacy and PIM use could significantly improve patient safety.

3. Problem Statement:

VA wants an easy-to-use tool to facilitate optimal treatment for each Veteran with their current condition(s), in a shared decision making process with the Veteran.

4. Clinical Requirements

1. For each Veteran, the software shall be automated to present a complete list of active medications prescribed by any VA facility as well as those prescribed in the community

(outside VA). This should include both prescription and non-prescription products that the Veteran is using. A medication history and associated list of inactive and previously trialed medications should also be automatically generated from clinical history available in the patient’s chart.

2. For each Veteran, the software shall automatically assign an evidence-based overall risk score for inappropriate polypharmacy. These scores shall be used to: identify patients who should be prioritized for polypharmacy evaluations and flag prescribers to patients at elevated risk of adverse outcomes during a patient encounter. Veteran risks shall be color coded with icons to facilitate interpretation. Time since the last polypharmacy evaluation review will also be tracked automatically to help facilitate optimal reach and impact.

a. Risk factors for negative outcomes in Veterans with polypharmacy may include, but are not limited to:

i. Hospice / palliative care (Duncan et al., 2020)

ii. Poor appetite / malnutrition (Sciarra et al., 2019)

iii. Cancer diagnosis (Mohamed et al., 2021)

iv. Neurocognitive disorders (Hobson 2015)

v. Psychiatric disorders (Collett 2016)

vi. Age ≥ 65, ≥ 75, ≥ 85 (Marcum et al., 2011)

vii. Katz index of Independence in ADL ≤ 4 (Brorsson & Asberg 1984)

viii. Identified Seniors at Risk ≥ 3 (Dendukuri et al., 2004)

ix. JEN Frailty index ≥ 6 (Kinosian et al., 2018)

x. LACE Score (Aubert et al., 2022)

xi. CAN Score ≥ 90% (Ruiz et al., 2018)

xii. High-Need High-Risk (HNHR) (Dang et al., 2022)

xiii. Delerium Triage Screen (Han et al., 2013)

xiv. Number of ED visits ≥ 2 in the past 6 months

xv. Number of hospitalization / inpatient discharges ≥ 2 in the past 6 months

xvi. Number of events Absent Sick in Hospital ≥ 2

xvii. Number of transitions of care (hospice / palliative / nursing home) > 0

xviii. Documented ICD-10 codes from encounters (or on problem list)

xix. Risk of falls

xx. Chronic disease index score (Putnam et al., 2002)

xxi. Charlson Comorbidity index (Charlson 2022)

xxii. Veteran overwhelmed in managing current medications

xxiii. Medication Possession Ratio (Sperber et al., 2017)

xxiv. Renal or hepatic impairment

xxv. Number of medications

1. Beers list ≥ 2 Beers Medications

2. ACB score ≥ 4

3. High daily scheduled frequency medication ≥ 1

4. Number of prescribers ≥ 3

5. Prescriptions present from both VA and community

6. Prescriptions not filled or delayed fill

7. Prescriptions reported as not being used by patients

b. Veteran risk factors and decision support display shall be modifiable by VA in a timely and low burden manner as best practices evolve.

3. For each Veteran, the software shall automatically generate a suggested evidence-based risk score for each medication on their medication list in the context of the complete clinical picture. These scores will be reviewed and updated by a provider during a polypharmacy review, or by any provider at any time. These scores shall be the basis for flagging potentially unnecessary or inappropriate medications at the time of prescription.

Medication risks shall be color coded with icons.

a. Medication risk factors may include, but are not limited to:

i. Side effects

ii. Drug-drug interactions

iii. Fall Risk

iv. Cognitive Function

v. Drowsiness

vi. Multiple Drugs with the same mechanism of action (ex. serotonin, acetylcholine, etc.)

vii. Drugs with competing effects (ex. stimulants and depressants)

viii. Patient allergies

ix. Patient demographics

x. Efficacy of drug, formulation, and dose (based on National Drug Code

(NDC))

xi. Frequency taken

xii. Dose

xiii. Instructions for use

xiv. Change in Veteran disease or symptom state

xv. Duplication of therapy

xvi. Days supplied

xvii. Medication formulation

xviii. Time To Benefit (TTB) exceeds life expectancy

xix. Medications that should be time limited

b. Medication risk factors shall be easily modified by VA as best practices evolve.

4. The software shall facilitate informed shared clinical decision making between the prescriber and the Veteran by providing at least the following information for all known drugs. This information shall be kept current by the vendor and include sources.

a. Drug identification

b. Drug indications (both FDA approved and off-label use)

c. Drug-drug interactions

d. Pharmacogenomics gene profile

e. Criteria for Use

f. Side effects

g. Provider and patient educational materials

h. Other risks

i. Drug disease considerations / warnings

j. Effectiveness of the drug for specific conditions

5. The software shall facilitate recording of adverse events secondary to polypharmacy or deprescribing by automatically linking to VADERS under MedSafe and JSPR

6. The software shall automatically interface with VA Veteran communication tools to facilitate medication reconciliation, medication reminders, and distribution of educational materials, for example:

a. Behavioral Health Lab Touch

b. Mental Health Assistant Mobile

c. My HealtheVet

d. Oracle patient portal

e. VA Annie text communication

7. The software shall facilitate collaboration and shared treatment planning across clinical teams (i.e. primary care, specialty care, pharmacy, nursing, etc.).

a. May support other clinical activities like patient population management of drug therapy and related software like Pharm D tool and other clinical programs intended to streamline a clinician’s evaluation of effective drug therapy management and med reconciliation.

8. The software shall minimize the time for users to come to an informed clinical decision regarding treatment changes, including new prescribing, changes in prescriptions and deprescribing, as well as consideration of evidence-based non-pharmacological treatment options.

9. The software shall provide recommendations to health care providers and

a. Shall not provide a specific output or directive

b. Shall provide options to enhance a health care decision

c. Shall not support time-critical decision making

d. Shall not replace or direct the provider’s judgement

e. The provider has final say

5. Other Critical Requirements

1. The software shall meet all VA IT requirements and obtain the necessary approvals.

a. Federal Risk and Authorization Management Program (FedRAMP)

b. Authority to Operate (ATO)

2. All VA prescribers and staff reconciling medications shall have access to the software.

3. Patient Health Information and Personally Identifiable Information shall be secure, and access shall be granted only to those with a need to know. Metrics and deidentified data shall be available throughout VA in real time.

4. A user’s ability to edit data shall be controlled by the user’s Electronic Health Record account details.

5. Software shall be interoperable with VA systems and seamlessly integrated. Data exchange across systems shall be automatically updated at least once per day.

a. Bidirectional data exchange with both Computerized Patient Record System

(CPRS) and Cerner / Oracle Health EHR

b. Provide a secure, standards-based Application Programming Interface (API) (e.g., FHIR R4 or higher) to support client applications and an ability to integrate with existing VA APIs

c. Include smooth integration into clinical medical record workflows, e.g. using

Clinical Decision Support (CDS) hooks or other triggers to make decision support available at the time of decision-making

d. Meets CPDP standards

e. Health Information Exchange (HIE) compliant

f. Integrated with and complementary to existing VA medication deprescribing web-based tools

6. All software inputs and outputs shall automatically be available for analysis using VA tools, including, but not limited to:

a. Transmission of information on use of the decision support system, information provided in the display, suggestions made, and any collected information from clinicians into the VA Corporate Data Warehouse / National Data Systems

7. The software shall facilitate review of individual patient and population clinical outcomes including but not limited to the following listed below. Outcomes shall be easily modified by VA as needs evolve.

a. Quality of Life (for example: SF-36)

b. Mortality

c. Hospitalizations

d. Falls

e. Delirium

f. Functional Status (physical / cognitive)

g. # meds discontinued

h. # meds with dosage decreased

i. # inappropriate meds discontinued

j. # of patients reviewed for polypharmacy

k. Medication adherence

l. Cost

m. Medication burden

8. The software and all underlying code, documentation, data definitions and value sets shall be provided by the original manufacturer for review and validation by VA informatics experts. All additional code, documentation and value sets for updates to the system shall also be provided.

9. Algorithms and data sources shall be updated and validated by the vendor within 2 months of changes in VA requirements as best practices evolve.

10. The software shall support algorithms with multiple possible outcomes to enable studies on the effects of different recommendations (i.e. A/B testing).

11. The software vendor shall maintain the software to all applicable standards.

12. The software vendor shall have a plan to handle scheduled outages, patches, upgrades, etc., including obtaining VA approval at least 2 months before a scheduled event and communicating progress before, during, and after events.

13. The software vendor shall have a plan to handle unscheduled outages, including notifying

VA at time of outage, status updates, and after functionality is restored. The plan should include processes to restore functionality within 24 hours of unscheduled outages.

14. The software shall provide a pathway for users to easily provide feedback.

a. Feedback shall receive a response within 2 business days, be retained and categorized, and transmitted to VA via the Corporate Data Warehouse

6. Responding to this RFI

Respondents shall clearly indicate how their solution does or does not meet each of the clinical and critical requirements in this document. For requirements not currently met by the respondent’s solution, please include information regarding plan, estimated cost, and timeline to implement the requirement.

Additionally, the respondent shall:

1. Provide data that shows their software has:

a. Reduced polypharmacy without adverse events attributable to deprescribing.

b. Validated and transparent clinical algorithms.

c. Met all VA IT requirements and obtained the necessary approvals, or the vendor has a plan and capacity to meet these requirements along with a timeline.

d. An ability to make suggested medication alternatives based on VA’s pharmaceutical formulary.

e. Provide evidence of clinical research or studies noting clinical effectiveness and return on investment of software.

f. Identify the specific scientific sophistication in the software, noting how/if it uses technology like pharmacogenomics, pharmacokinetics, pharmacodynamics, artificial intelligence, FDA Alerts, and/or burden/interactions like sedation, cognitive impair, etc, to identify potential for multi-drug interactions and make suggested alternatives.

g. Identify the number of active software deployments with number of patients scanned/monitored in each deployment over the past 12 months.

h. Identify the processing speed, volume capacity, and software tools to enable the rapid provision of risk scores, flags, etc to provide information to support real-time or near-real time improvement of Veterans health outcomes.

i. Explain how the software increases clinical efficiency and avoids adding steps to clinical workflows and alarm fatigue.

2. Explain the structure and implementation of their software.

3. Explain how the software will be implemented throughout the VA healthcare system, including the deployment schedule, support needed from VA, all costs (development, fees, licenses, volume discounts, pricing structure, etc.), and related factors.

4. Indicate whether their solution can be operational at a VA pilot site by November 15, 2025.

5. Suggest additional software capabilities to reduce inappropriate polypharmacy that are not addressed in this RFI.

6. Provide licensing/cost/pricing models and a rough order of magnitude for the solution and implementation.

7. Submittal Information:

There is a page limitation for this RFI of 15 pages. The Government will not review any other information or attachments included, that are in excess of the 15-page limit. NO MARKETING

MATERIALS ARE ALLOWED AS PART OF THIS RFI. Generic capability statements will not be reviewed. Please provide the following additional information:

a. Vendor Information:

Name of Company:

Address:

Point of Contact:

Phone Number:

Email Address:

Company Business Size & Status:

For VOSB and SDVOSBs, proof of certification with SBA:

Your company’s ability to meet the set aside requirement in accordance with

VAAR 852.219-73 (JAN 2023)

(DEVIATION) VA Notice of Total Set-

Aside for Certified Service-Disabled

Veteran-Owned Small Businesses and

13 CFR §125.6, which states the contractor will not pay more than 50 percent of the amount paid by the

Government to it to firms that are not

SDVOSBs.

Unique Entity Identifier (UEI):

Existing Contractual Vehicles (GWAC, GSA MAS, etc.):

Responses are due no later than 3:00PM (EST) on September 15, 2025 via email to Juan

Quinones at juan.quinones@va.gov. Please note “Reducing Inappropriate Polypharmacy RFI” in the subject line of your response. Mark your response as “Proprietary Information” if the information is considered sensitive. The email file size shall not exceed 5 MB.

OFFERORS ARE ADVISED THAT THIS REQUIREMENT MAY BE DELAYED,

CANCELED, OR REVISED AT ANY TIME.

mailto:juan.quinones@va.gov

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