6505--Pharmacy Emergent First Fill SDVOSB Set Aside Sioux Falls VA Health Care System and associated CBOCs

Sources Sought Notice

DESCRIPTION

This is a request for information only and it is not a solicitation announcement.

The purpose of this sources-sought notice is to gain knowledge of qualified potential contractors and their socio-economic size classification in accordance with NAICS code 524292 -

Pharmacy Benefit Management and other third-party administration of Ins. and Pension funds.

Responses will be used by the Government to make appropriate acquisition decisions.

Description of Service

The Sioux Falls VA Health Care System (SFVAHCS) is seeking a Contractor to provide pharmacy benefit management first-fill services. The contractor shall fill first-time prescriptions for patients seen at these facilities and the associated Community-Based Outreach Clinics (CBOCs) and provide medication counseling per Omnibus Budget Reconciliation Act of 1990 requirements (OBRA-90). Prices shall be offered with respect to Average Wholesale Price (AWP).

Locations Covered

Sioux Falls VA Health Care System

2501 West 22nd Street

Sioux Falls, SD 57105

And associated CBOCs

Aberdeen CBOC

3307 SE 10th Ave

Aberdeen, SD 57401

Sioux City CBOC

380 West Anchor Drive

Dakota Dunes, SD 57049

Spirit Lake CBOC

1850 Royal Avenue

Spirit Lake, IA 51360

Wagner CBOC

400 West Highway 46

Wagner, SD 57380

Watertown CBOC

4 19th ST NE

Watertown, SD 57201

Period of Performance

This is a single award for five (5) years, from 07-01-2025 to 06-30-2030; task orders for each ordering period:

Ordering Period

Begins

Ends

1

01-01-2026

12-31-2026

2

01-01-2027

12-31-2027

3

01-01-2028

12-31-2028

4

01-01-2029

12-31-2029

5

01-01-2030

12-31-2030

Task orders will be issued by the Government at its discretion based on the continued need for services, Contractor performance, and availability of fiscal year funds for a given task order.

Task order periods of performance may be for the entire ordering period stated above or a portion of it, depending on the Government's need for services.

Estimated Quantities

The following estimates are estimated amounts based on the VA's historical needs. The estimates are not a guarantee to the Contractor. Actual cost or quantity may be equal, lesser, or greater than the estimate below.

Facility Location

Estimated Number of Generic and Brand Name Prescriptions Filled (Five Year Period of Performance)

Sioux Falls VA Health Care System and associated CBOCs

15,000

Scope of Work

The contractor shall provide an open pharmacy network that will allow Veterans to receive medications at a pharmacy of their choice. The medical facility will provide a list of formulary medications that will be approved for reimbursement. Any medications not on the formulary list would require an override approval. The medical facility will provide and maintain a list of approved prescribers. The provider network will be limited to providers approved by the medical center.

6. Hours of Operations

Pharmacies should have standard operating hours that would allow Veterans the opportunity to fill prescriptions without significant inconvenience.

Federal holidays are:

New Year s Day

Martin Luther King Jr.'s Birthday

President s Day

Memorial Day

Juneteenth

Independence Day

Labor Day

Columbus Day

Veterans Day

Thanksgiving Day

Christmas Day

Any day specifically declared by the President of the United States to be a national holiday.

In addition, the services outlined above will be provided for patients of the VA. These services shall be provided for patients seen in the facility's Emergency Department.

General Requirements

Prescription Fill Process

DESCRIPTION OF WORK/SPECIFICATIONS:

Prescriptions filled shall be in written, verbal, or faxed form provided by authorized providers.

The authorized voucher for that specific location must accompany the patient s prescription. The contractor shall provide voucher forms with appropriate billing and customer service information as well as have the ability to track utilization by VA specific location.

Prescriptions shall be filled and dispensed only for prescription drugs as VA authorized providers.

The Sioux Falls VA will create a formulary also called an Emergent Drug List. Any medications not on the Emergent Drug List (EDL) will require approval by a Sioux Falls pharmacist prior to being filled. The Sioux Falls VA s formulary will be forwarded to the contractor after each UPDATE by the Chief, Pharmacy, or his/her designee.

The Sioux Falls VA will provide a list of approved VA providers that can have prescriptions filled thru this contract. This list will be updated by the facility as needed.

Prescriptions shall be filled and limited to a maximum of ten (10) days supply with the exception of: one vial of insulin on local formulary, one inhaler on local formulary, and a maximum of fourteen (14) days supply of antibiotics on local formulary or limited to restricted quantities as listed in the formulary.

No refills will be authorized. The contractor shall fill out NEW PRESCRIPTIONS ONLY!

Reimbursement shall be determined by the average wholesale price (AWP) discounted by the applicable percentage plus the applicable dispensing fee. The total price charged to the Sioux Falls VA Health Care System shall not exceed that charged to the general public and shall not exceed the price charged by the contractor s lowest third-party reimbursement.

Prescriptions filled under this contract shall be generic drugs ONLY. If medication is available from a manufacturer in generic form, it should be provided to the patient. If the generically manufacturered product is unavailable at the time of Veteran need (i.e. shortage), Contractor staff is to obtain prior authorization approval from a Sioux Falls VA Pharmacist prior to filling that medication for the Veteran.

The Sioux Falls VA Health Care System's beneficiaries will pick up their own prescriptions at the dispensing pharmacy. No prescriptions are to be mailed. No prescriptions are to be delivered. Veterans are not to be charged by the contracted pharmacy under this contract for the prescription dispensed under this contract.

The Sioux Falls VA Health Care System will randomly audit prescription fills. The Sioux Falls VA Health Care System will have free access during regular business hours, and upon reasonable notice, to such books, records, invoices, and prescription files as deemed necessary to verify claim information, prescription volume, and the usual and customary charges to the general public for covered prescriptions. The contractor shall make all prescription records and invoices available at the time of the audit.

Contract pharmacies shall maintain a log of Sioux Falls VA Health Care System prescriptions filled and have the patient sign next to each prescription number for each prescription received. A copy of the log shall be maintained at the contract pharmacy and be readily accessible for random VA audit.

All prescriptions must have proper auxiliary labels attached and appropriate counseling and drug interaction sheets provided.

AWP (average wholesale price) shall be based on the current Pharmacy Fundamental Reference REDBOOK and REDBOOK Updates published by Medical Economics Data, Inc., the AWP Medispan or First DataBank pricing schedule and whichever is most advantageous to the government.

The contractor and his/her contract pharmacies shall keep all information concerning the Sioux Falls VA Health Care System's beneficiaries confidential and shall not release or disclose information to any person, except as authorized in writing and according to all applicable laws. The Privacy Act of 1974, Public Law 93-579, February 31, 1974 (S U.S.C. 552a) applies to this procurement.

Pharmacies authorized to fill prescriptions under the contractor's plan shall agree to the following conditions:

All information concerning the Sioux Falls VA Health Care System's beneficiaries shall be kept confidential and shall not be disclosed to any person, except as authorized in writing and according to all applicable laws.

Representatives of the Sioux Falls VA Health Care System are authorized to visit the contractor's site and the premises of any pharmacy filling Sioux Falls VA Health Care System prescriptions during regular business hours for the purposes of auditing and evaluation, which may include the inspection of clinical records.

The contractor shall report all adverse drug events reported by the Sioux Falls VA Health Care System's beneficiaries to the Pharmacy Department at the Sioux Falls VA Health Care System, and to the prescribing provider.

The Government reserves the right to fill any prescription covered under this contract through the use of its own resources and/or staff.

Services provided under this contract will be monitored by the Contracting Officer's Technical Representative (COTR) as designated.

If the contract pharmacy is having difficulty with any claim or any other situation, they will contact the contractor. The contract pharmacy will not contact employees of the facility.

The contractor shall not make authorizations to the contracted pharmacies for prescriptions that fall outside of the normal constraints as stated within. If this occurs, the contractor will be responsible for reimbursing the local pharmacy for the prescription.

Audits

Pharmacy Services at the facility shall review the monthly statements provided by the contractor regarding fills at the local emergent fill pharmacies. Should SF find discrepancies in the billing, a request will be made by the facility to the contractor to provide a copy of the consultation in question.

If the prescription in question is not able to be produced within 10 calendar days, the contractor will adjust the statement by the amount in question. This review process will only be available for 90 days after the date of the prescription fill in question. Thus, the contract pharmacies will only be required to keep the hard copies available for 90 days.

Privacy Requirements

The contractor shall comply with the requirements of the Federal Privacy Act of 1974 (Public Law 93-579), HIPAA (Public Law 104-191), and the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1972 (Public Law 83-255), as well as other statues regarding confidentiality of patient information during and after the execution of this BPA.

The contractor and the contracted pharmacies shall keep all information concerning VA beneficiaries confidential and shall not release or disclose information to any person, except as authorized in writing and according to all applicable laws.

The contractor shall not store patient information on a mobile device. A verbal contact is sufficient to obtain prior authorization when needed. The Contractor is prohibited from transferring Personal Health Information (PHI) by fax or email to and/or from a VA facility.

The contracted pharmacies including subcontracted pharmacies that are authorized to fill prescriptions under the BPA and subsequent task orders must agree to the following conditions:

All information concerning VA beneficiaries shall be kept confidential and shall not be disclosed to any person, except as authorized in writing from VA, and according to all applicable laws.

Representatives of the VA are authorized to visit the contractor s sites and the premises of any pharmacy filling VA prescriptions during regular business hours for the purposes of auditing and evaluation, which may include the inspection of clinical records.

The contractor shall report all adverse drug events reported by VA beneficiaries to both facilities Chief of Pharmacy, COR, to the prescribing CBOC provider, and Emergency Room provider if applicable.

Pharmaceutical services provided to VA beneficiaries meet all standards applicable to Medicaid recipients in the State where services are provided, and standards set forth in the current version of The Joint Commission accreditation manual for Ambulatory Care/Pharmaceutical Services.

Licensing and Qualification Requirements

Pharmacies utilized by the contractor shall be in good standing with their respective State Board of Pharmacy in Iowa, South Dakota, Minnesota, and Nebraska

Pharmacies utilized by the contractor shall have a current Drug Enforcement Administration (DEA) license, controlled substance license, and license from the respective State Board of Pharmacy.

Pharmacists Requirements:

Graduate of an Accreditation Council for Pharmacy Education (ACPE) College of Pharmacy

Licensed in the States of Iowa, South Dakota, Minnesota, and Nebraska (as applicable) and in good standing with the State Board of Pharmacy.

Pharmacy Requirements:

Licensed pharmacy in the State of Iowa, South Dakota, Minnesota, and Nebraska

Current DEA, controlled substance license