Pharmacy Claims Switching and Benefit Eligibility Verification Services

The Indian Health Service (IHS) within the Department of Health and Human Services has issued a Sources Sought Notice seeking market research information regarding integrated pharmacy claims switching and real-time benefit eligibility verification services. The procured services will support electronic claims submission, adjudication, and reimbursement from third-party payers across IHS federally operated pharmacy facilities that utilize the Resource and Patient Management System (RPMS). Key requirements include pharmacy claims switching with electronic routing compliant with NCPDP D.0 standards supporting Medicare Part D, Medicaid, and commercial payers; real-time benefit eligibility verification integrated with RPMS pharmacy point-of-sale systems; secure internet-based connectivity with pre- and post-edit functionality; and bundled per-transaction pricing aligned with GSA Schedule rates. Vendors must demonstrate compliance with FISMA, NIST SP 800-53, HIPAA, and Section 508/WCAG 2.0 AA accessibility standards, provide evidence of current RPMS integration capability, and submit responses limited to ten pages including technical details, relevant federal healthcare experience, security approach, and past performance information. The deadline for submitting responses is February 10, 2026 at 5:00 p.m. EST to Darryl.smith@ihs.gov.

This notice does not utilize any small business set-aside designation, though responses from Indian Small Business Economic Enterprises (ISBEE), Indian Economic Enterprises (IEE), and small business concerns are prioritized for consideration. No incumbent contractor or specific award value has been identified in the pre-solicitation materials. The applicable NAICS code is 513210 (Software Publishers) with PSC classification DA10 (IT and Telecom – Business Application/Application Development Software as a Service), and the services will support the IHS Office of Finance and Accounting and Area Offices nationwide across all federally operated facilities. The notice explicitly states that this is for market research purposes only and does not represent an obligation or commitment by the government to issue a formal solicitation or award a contract. Generic capability statements are not acceptable, and vendors must provide commercially available solutions demonstrating substantive experience with similar federal healthcare operations and RPMS platform integration.