MACPAC_Request_for_Quote_Rx_Claims_JM_Final_5142018.pdf

MACPAC Request for Quote

Dataset – Pharmaceutical Claims Introduction The Medicaid and CHIP Payment and Access Commission (MACPAC) is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP).

MACPAC serves as an independent source of information on Medicaid and CHIP, publishing issue briefs and data reports throughout the year to support policy analysis and program accountability.

Data specifications MACPAC seeks a pharmaceutical claims dataset to support a policy analysis project evaluating Medicaid prescription drug utilization. All specifications are requirements unless they are noted as preferred factors.

1) Payer type: Medicaid, Medicare Part D, and commercial payers at the plan level. Medicaid information should include both fee-for-service and managed care. The ability to link to Managed Markets Insight & Technology (MMIT) formulary data available is required (see “linkage capabilities” below for additional information).

2) Outpatient prescriptions: Significant majority of prescriptions dispensed in the United States for each payer, with the following claims-level details available about each prescription

a) Unique patient identifier (to support deduplication and longitudinal analysis)

b) Unique prescriber identifier, preferably unencrypted national provider identifier (NPI)

c) Prescriber specialty

d) Location of patient/pharmacy, at least at the three digit ZIP code level. A more granular level of detail would be preferred, subject to relevant privacy protection procedures.

e) Non-proprietary product information such as national drug code (NDC) or RxNorm Concept Unique identifier (RXCUI) that can be linked to publically available drug dictionaries

f) Dispensing information such as date filled, quantity and day supply

g) Payer and plan identification

h) Patient demographics including age group and gender. Additional patient demographics including birth month/year and race/ethnicity are preferred.

i) Paid amount

j) Units dispensed

3) Time period: Data no more than 12 months old (e.g., between 2017 and 2018). Please specify options for how the time period may be defined–e.g., one month, 12 months aggregated, or 12 one-month data sets–and how those options affect pricing.

4) Geography: Sufficient detail to support state-level analyses. There should be a significant majority of claims in a state and have representative samples for the majority of plans available in the state.

5) Medical claims would be preferred from both physicians and hospitals for a recent but large percent of the US market representing diverse payer types, geography (nearly all states), etc. Also prefer claims from mid-level providers and other facilities such as FQHCs, CMHCs.

6) Medicaid: Pharmaceutical claims are required and medical claims. Preference for data from 42 CFR Part-2 covered entities.

7) Linkage capabilities: the data resource must be able to support:

a) Patient-level linkage between the pharmacy and medical claims information described above

b) Linkage at the plan level to formulary information available from MMIT including Medicaid preferred drug lists and formularies for Medicare Part D sponsors, and commercial payers. The capability for linkage to additional data sources that contain formulary information is preferred.

c) Linkage to additional variables, such as laboratory data for a substantial portion of the population, would be preferred to support potential future analyses

8) Customer service: well-established procedures for executing relevant agreements with a government client and any subcontractors in a timely manner; providing data in a timely manner; and providing technical support for client questions around data quality and interpretation.

Instructions to Vendors

The quote should also include the following:

A confirmation or explanation of the vendor’s capacity to meet the requirements and preferences numbered above, or lack thereof.

Any specific licensing requirements including:

o any limitations or changes in price associated with using the data for a single project or multiple projects, o how long MACPAC would have rights to the data, o limitations in providing the data to a MACPAC subcontractor to conduct the analysis on our behalf.

Vendor’s price options, including any applicable differences in price based on the ability to meet the requirements and preferences numbered above.

How the vendor will provide the data (online portal, one time data transfer, etc.)

References

Bidders must provide the names and phone numbers of three current clients to serve as references.

Criteria for Evaluation

Bidders will be selected based on a combination of the following criteria:

The capacity to meet the data specifications balancing the requirements over preferences stated above.

References Price: Based on the best value to the government

Questions regarding the request for proposal must be submitted via email to jessica.morris@macpac.gov no later than 5:00 PM Eastern Standard Time (EST) on Friday May 25, 2018 (Note: Date corrected on 5/15/18.) All answers will be released in writing to all bidders no later than 5:00 p.m. EST on Thursday May 31, 2018.

The quotes are due no later than Friday June 8, 2017 at 12:00 noon EST. Late responses will not be accepted. Notification of “no-bid” would be appreciated.

Prospective contractors must be registered in the System for Award Management (SAM) (www.sam.gov) database prior to award of a contract or agreement.