DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

Indian Health Service Rockville, MD 20857

Sources Sought Notice

Title: Pharmacy Claims Switching and Benefit Eligibility Verification Services Agency: Indian Health Service Issue Date: Wednesday, February 4, 2026 Due Date: Tuesday, February 10, 2026, no later than 5:00pm EST POCs: Responses must be submitted via email to Darryl.smith@ihs.gov. Include “Pharmacy Claims –

Your Company Name” in the Subject of the email.

This Sources Sought Notice (SSN) is for market research and planning purposes only and shall not be construed as a solicitation or an obligation or commitment to issue a solicitation by the Indian Health Service (IHS). This SSN is seeking information from the specific types of entities listed below to assess their capabilities in fulfilling the requirements set forth in this SSN. The information from this SSN will be used to determine the appropriate set-aside, if any, in accordance with the applicable regulations listed. The Government encourages the identified to respond to this Notice and will be assessed of their capabilities in the following priority:

1. Indian Small Business Economic Enterprise (ISBEE),

2. Indian Economic Enterprise’s (IEE) in accordance with HHSAR 326.603-1.

3. Small business concerns in accordance with FAR 19.502-2 (b)(1) & (2).

Responses to the information requested will assist the Government in determining the appropriate acquisition method, including whether any ISBEE/IEE or small business set-aside is possible based on the Contracting Officer’s reasonable expectation of obtaining offers from two or more relevant concerns that will be competitive in terms of market price, product quality, and delivery capability. An organization that is not considered an ISBEE/IEE firm or small business under the applicable NAICS code should NOT submit a response to this notice. The applicable primary NAICS code for this requirement is 513210 – Software Publishers. Generic capability statements are not sufficient and may not be considered when assessing entity capabilities.

Background

The Indian Health Service (IHS) is the principal federal health care provider and health advocate for Indian people, and its goal is to raise their health status to the highest possible level. IHS provides a comprehensive health service delivery system for approximately 2.3 million American Indians and Alaska Natives (AI/AN) who belong to 573 federally recognized Tribes in 37 states. IHS has 12 Area Offices and 10 Accounting Offices across the United States.

These offices support the extensive health care delivery network and provide managerial, financial and administrative support to the hospitals, clinics and health centers. All work under this contract shall be performed in direct support of the IHS Office of Finance, and Accounting (OFA) and Area Offices (including their respective facilities) within the IHS.

The Indian Health Service operates pharmacy services across federally operated facilities that rely on the Resource and Patient Management System (RPMS) for pharmacy point-of-sale (POS) operations. IHS requires integrated pharmacy switching and real-time benefit eligibility verification services to support electronic claims submission, adjudication, and reimbursement from third-party payers.

Due to the legacy nature of RPMS, switching and eligibility services must interface seamlessly with existing RPMS pharmacy modules without requiring system redevelopment or additional Government-funded interfaces.

Scope of Required Capabilities

Respondents must demonstrate the ability to provide commercially available pharmacy switching and eligibility verification services that meet all of the following minimum requirements:

http://www.bia.gov/WhoWeAre/BIA/OIS/TribalGovernmentServices/TribalDirectory/index.htm http://www.bia.gov/WhoWeAre/BIA/OIS/TribalGovernmentServices/TribalDirectory/index.htm

Pharmacy Claims Switching and Benefit Eligibility Verification Services

A. Pharmacy Claims Switching

• Electronic routing of pharmacy claims in compliance with NCPDP D.0 standards (and future adopted versions)

• Support for Medicare Part D, Medicaid, commercial insurance, and other third-party payers

• Secure, internet-based connectivity (dial-up optional)

• Pre- and post-edit functionality to improve claim acceptance rates

• Ability to provide bundled, per-transaction pricing consistent with GSA Schedule pricing

• Advance notification and coordination of system updates, testing, and implementation

B. Benefit Eligibility Verification

• Real-time eligibility verification integrated with RPMS pharmacy POS

• Support for PBM onboarding and eligibility database maintenance

• Audit logging, dispute resolution support, and eligibility accuracy controls

• No additional cost to IHS for portal access or eligibility interfaces

C. Technical & Compliance Requirements

• Existing, operational interface with RPMS

• Compliance with:

o FISMA o NIST SP 800-53 security controls o HIPAA Privacy and Security Rules o Section 508 / WCAG 2.0 AA accessibility standards

• Ability to support nationwide IHS deployment across all federally operated facilities

Submission Information

Interested vendors shall submit capabilities (no more than 10 pages) addressing the following:

1. Technical Capability o Description of existing pharmacy switching solution o Confirmation of current RPMS integration (required) o Description of eligibility verification capabilities o Compliance with NCPDP D.0 standards

2. Relevant Experience o Federal healthcare clients (IHS, VA, DoD, CMS preferred) o Length of time solution has been operational o Experience supporting enterprise-wide pharmacy operations

3. Security & Compliance o FISMA/NIST compliance approach o HIPAA safeguards o Section 508 conformance (VPAT availability)

4. Commercial Availability o Confirmation that services are commercially available o Pricing structure (high-level, non-binding)

Pharmacy Claims Switching and Benefit Eligibility Verification Services

Cover Page Please provide a cover page to include:

1. Company Name

2. Company Designation (ISBEE/IEE/SB)

3. Type of Business – as applicable (e.g. 8(a), Woman Owned Small Business, HUBZone, etc.)

4. UEI Number

5. Point of contact

6. Primary NAICS Code(s)

7. Existing federal contracting vehicle(s) numbers, as applicable (e.g. GSA MAS number, NITAAC/CIO SP3, etc.)

8. System for Award Management (SAM) registration status. Note, all respondents must be registered on the

SAM located at http://www.sam.gov/ prior to any potential award.

Past Performance

• Please provide any past performance information to support demonstration of your capabilities in the relevant technical areas and magnitude of work.

Other Information (Optional) You may include any other information that may be helpful in developing or finalizing the requirements of the potential acquisition.

Submission Format To assist the Government in an expeditious review of your capabilities, the capability statement should be organized as follows:

• Cover page

• Executive Summary

• Technical Areas in the order listed

• Past Performance

• Other Information, as applicable

The tailored capability statement should not exceed 10 pages excluding Past Performance information. Font must not be less than 10 point (for readability) and may be submitted in either in either Microsoft Word or Adobe Portable Document Format (PDF) but must be a standard 8-1/2 by 11 inch in paper size. All proprietary information should be marked as such.

Generic capability statements are not sufficient and will not be considered compliant with the requirements of this notice.

Disclaimer and Important Notes This notice does not obligate the Government to award contract. Any information provided by industry to the Government as a result of this SSN is strictly voluntary. Responses will not be returned. No entitlements to payment of direct or indirect costs or charges to the Government will arise as a result of contractor submission of responses, or the Government's use of such information or otherwise pay for the information provided in response. The Government reserves the right to use information provided by respondents for any purpose deemed necessary and legally appropriate. Any organization responding to this notice should ensure that its response is complete and sufficiently detailed to allow the Government to determine the organization’s capabilities to perform the work. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted. After a review of the responses received, a pre-solicitation synopsis and solicitation may be published on a government GPE. However, responses to this Notice will not be considered adequate responses to any resultant solicitation.

Confidentiality. No classified, confidential, or sensitive information should be included in your response. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s).

Thank you for your interest in IHS programs.

http://www.sam.gov/