Q517--pharmacy benefits services | wichita |

Sources Sought Notice:

This is not a request for formal proposals or quotes, it does not obligate the Government to award a contract. Requests for a solicitation will not receive a response. Responses to this Sources Sought must be in writing.

The purpose of this Sources Sought announcement is for market research to make appropriate acquisition decisions and to gain knowledge of potentially qualified businesses interested in and capable of providing the required services.

Documentation of technical expertise must be presented in sufficient detail for the government to determine that your company possesses the necessary functional area expertise and experience to compete for this acquisition.

Responses to this notice shall include the following:

(a) company name

(b) address

(c) point of contact

(d) phone and email

(e) UEI number

(f) Cage Code

(g) Type of small business, e.g., Services Disabled Veteran Owned Small Business, Veteran-Owned Small Business, 8(a), HUBZone, Women Owned Small Business, Small Disadvantaged Business, Small Business, or Large Business; and

(h) Capability statement that addresses the organization s qualifications and ability to perform as a contractor for the work described below.

This Sources Sought is for Robert J. Dole VA Medical Center, 5500 E. Kellogg Avenue, Wichita, KS who have a requirement for contractor provided third party pharmacy benefit services to support a First Fill Prescription Voucher Program serving eligible Veterans. This program provides first or urgent fill prescriptions when VA pharmacies are unable or impractical to dispense medications, such as after hours emergency room visits, time sensitive medications from Community Based Outpatient Clinics (CBOCs), Home Based Primary Care (HBPC), or telehealth appointments.

The NAICS Code is 527292 (Pharmacy Benefit Management and Other Third-Party Administration of Insurance and Pension Funds) with a Small Business size standard of $45.5 million. SDVOSB/VOSB vendors must be registered in the SBA VetCert database.

Offerors capable of providing this service shall notify the Contract Specialist no later than (NLT) October 12, 2026, 1:00 pm CST via email at maria.owen2@va.gov

All information is to be submitted via email to: maria.owen2@va.gov. Phone calls will not be accepted.

Performance Work Statement

First Fill Prescription Voucher Program Pharmacy Benefit Services

1. Introduction

The Veterans Health Administration (VHA) has a requirement for contractor provided third party pharmacy benefit services to support a First Fill Prescription Voucher Program serving eligible Veterans. This program provides first or urgent fill prescriptions when VA pharmacies are unable or impractical to dispense medications, such as after hours emergency room visits, time sensitive medications from Community Based Outpatient Clinics (CBOCs), Home Based Primary Care (HBPC), or telehealth appointments.

The purpose of this Performance Work Statement (PWS) is to define the scope, objectives, tasks, deliverables, performance standards, and reporting requirements for the contractor s provision of pharmacy benefit services under this program.

2. Scope of Work

The contractor shall provide all personnel, pharmacy network locations, systems, tools, and non personal services necessary to perform first and urgent fill outpatient pharmacy services for eligible VA beneficiaries assigned to the Robert J. Dole VA Medical Center (RJDVAMC) located at 5500 E. Kellogg Dr, Wichita, KS, associated CBOCs, and HBPC programs, as well as additional facilities added during the term of this contract.

The scope of work includes, at a minimum:

Dispensing new prescriptions written by authorized VA providers, with no refills.

Maintaining a geographically accessible pharmacy network with extended and after hours operating times.

Adhering to VA provided emergency medication formulary lists and applicable federal and state laws, regulations, and VA policies.

Providing required reporting, data, and documentation to support billing, quality assurance, performance measurement, and compliance.

3. Technical Requirements

A. Pharmacy Services and Operations

The contractor shall:

Dispense prescriptions only for eligible VA beneficiaries presenting a VA issued ID card, at designated network pharmacies.

Dispense only new prescriptions written by authorized VA providers (RJDVA, CBOC, HBPC), with no refills permitted under this program.

Maintain operating hours that include 24 hour locations and extended evening/weekend access, at a minimum Monday through Sunday coverage, including federal holidays.

Limit the maximum day supply to 10 days for most medications, and up to 14 days for antibiotics/antibacterial agents unless otherwise authorized under emergency conditions.

Dispense generic medications to the extent permitted by law, using AB rated generics that meet all federal and state requirements, and selecting the least expensive product in stock that meets clinical requirements.

Prescriptions must be provided in written form by authorized providers, and dispensing pharmacies must be able to accept and process written prescriptions.

B. Formulary Management

The contractor shall:

Adhere strictly to the VA Emergency Medication Formulary List, dispensing only legend drugs on the approved list unless prior authorization is obtained from the VA Chief of Pharmacy or designee.

Provide real time messaging and hard edits within the pharmacy systems to prevent dispensing of non formulary or prior authorization medications without VA approval.

Maintain and implement a mechanism to receive formulary updates from VA and to update pharmacy systems accordingly in a timely manner.

C. Records, Confidentiality, and Compliance

The contractor and contract pharmacies shall:

Maintain electronic records of all VA prescriptions filled, including patient signatures for each prescription received.

Protect the confidentiality of all VA beneficiary information and comply with the Privacy Act of 1974, HIPAA, and all applicable federal and state privacy and security requirements.

Ensure no patient information is stored on mobile devices and that access to VA information systems is restricted to personnel with appropriate background investigations and training, in accordance with VA directives.

All protected health information and sensitive personal information shall be handled in accordance with VA directives, 45 CFR Part 164, and applicable VA handbooks and policies.

D. Quality of Service and Counseling

The contractor shall:

Provide high quality service for patients and providers, with an account management team that communicates directly with the VA Contracting Officer s Representative (COR)/Facility POC to address and promptly resolve issues.

Offer pharmacist counseling to ensure optimal outcomes from drug therapy, including medication name and use, dose and route, precautions, common side effects and actions, self monitoring techniques, missed dose instructions, and proper storage.

4. Delivery & Location Information

Services shall be provided to VA beneficiaries associated with:

Robert J. Dole VA Medical Center and designated Community Based Outpatient Clinics (CBOCs) and HBPC programs within the primary service area and additional areas added during the contract term.

The contractor shall provide and maintain a list of participating pharmacies that are:

Geographically accessible to RJDVA and each CBOC.

Handicapped accessible.

Equipped with accessible weekday, weekend, and evening hours, including drive through windows where available.

The list shall include, at a minimum: facility name and address, pharmacy name and address, phone/fax, pharmacists names and license numbers with expiration dates, accessibility status, distance from VA facilities, availability of drive up windows, hours and days of operation, and normal waiting times.

5. Security Requirements

Contractor and subcontractor personnel requiring access to VA information and information systems must comply with VA, federal, and state security and privacy requirements, including VA Directive and Handbook 0710 (Personnel Suitability and Security Program), applicable cyber security and privacy training, and VA Rules of Behavior.

The contractor shall:

Request logical or physical access to VA information systems only to the extent necessary to perform contract services.

Notify the ordering Contracting Officer immediately when personnel with access to VA information or systems are reassigned or separated, including unfriendly terminations.

Report all known or suspected security or privacy incidents, including data breaches involving sensitive personal information, to the ordering Contracting Officer, ISO, and Privacy Officer in accordance with VA policy and any applicable Business Associate Agreement.

Where required, the contractor shall be liable for liquidated damages in the event of data breaches involving sensitive personal information, as specified by 38 U.S.C. §5725 and VA contract provisions.

6. Period of Performance

Base Year: 01/04/2027 01/03/2028

Option Year 1: 01/04/2028 01/03/2029

Option Year 2: 01/04/2029 01/03/2030

Exercise of option years shall be at the Government s discretion, based on continued need, contractor performance, and availability of funds.

7. Work Hours

Pharmacy services under this program must be available:

Through a network that includes 24 hour pharmacies providing coverage Monday through Sunday, including weekends and federal holidays.

Through additional pharmacies open at least Monday through Saturday from 8:00 a.m. to 9:00 p.m. local time, or as specified by the VA for accessibility.

8. VA Points of Contact

The contractor shall designate a program manager (Primary and Alternate) and provide contact information to the CO and Facility POC within five (5) days of contract award.

9. Installation and Cleanup

Not applicable; services under this PWS relate to pharmacy benefit administration and dispensing rather than physical installation of equipment. Any on site activities at VA or pharmacy locations shall be conducted in a manner that does not disrupt normal operations and comply with VA safety and housekeeping requirements.

10. Training

All contractor and subcontractor employees requiring access to VA information or information systems shall:

Complete VA Cyber Security Awareness and Rules of Behavior training and annual refresher training.

Complete appropriate VA privacy training and any role based information security training required, with documentation of completion provided to the ordering CO or representative within one week of contract initiation and annually thereafter.

Failure to maintain current training and signed Rules of Behavior may result in suspension or termination of physical or electronic access and removal from contract work.

11. Warranty and Maintenance Service

Not applicable for physical products; however, the contractor shall maintain all pharmacy benefit management systems, data interfaces, and reporting tools used to support this program in good working order and ensure continuous, reliable operation. System maintenance must not compromise data integrity, privacy, or availability of service to VA beneficiaries.

12. Performance Metrics and Quality Control

The contractor shall develop and maintain a quality control program to ensure services are performed in accordance with commonly accepted commercial practices, The Joint Commission standards, VA handbooks and directives, and all applicable laws and regulations.

Key performance areas include:

Accuracy and timeliness of dispensing and documentation.

Compliance with formulary and prior authorization requirements.

Responsiveness to VA inquiries and corrective actions.

Patient counseling and service quality.

The Facility POC may monitor performance through observation, inspection of services, record review, and assessment of complaints. When unacceptable performance occurs, the POC may issue a Contract Discrepancy Report (CDR), and the contractor shall provide and implement a corrective action plan within the timeframe specified in the CDR.

A. Quality Assurance Surveillance Plan (QASP)

The Government will use the following performance objectives, standards, acceptable quality levels, and surveillance methods to evaluate contractor performance. These standards are derived from the service, compliance, reporting, counseling, and responsiveness requirements in the SOW.

Required Services

Performance Standards

Acceptable Quality Level

Methods of Surveillance

Incentive / Remedy

Pharmacy network availability

Contractor maintains a geographically accessible pharmacy network with required weekday, weekend, evening, and holiday coverage, including 24-hour locations where required.

100%

Periodic inspection of network list; random validation of pharmacy hours and access.

Contractor required to correct deficiencies immediately; repeated failure may support issuance of CDR and consideration of payment deduction.

Eligible prescription dispensing

Prescriptions are dispensed only to eligible VA beneficiaries and only for new prescriptions written by authorized VA providers; no refills are permitted.

100%

Random record review; complaint review; periodic audit of filled prescriptions.

Documented noncompliance may result in corrective action and possible payment adjustment for improper fills.

Day-supply compliance

Prescriptions do not exceed 10 days for most medications and do not exceed 14 days for antibiotics/antibacterials unless otherwise authorized.

100%

Random review of prescription records and invoices.

Any noncompliant fills require corrective action and possible reconciliation of improper charges.

Formulary compliance

Contractor dispenses only approved formulary drugs unless prior authorization is obtained from the VA Chief of Pharmacy or designee, and contractor systems prevent unauthorized non-formulary dispensing.

100%

Random monitoring; system/edit review; complaint review; record audit.

Unauthorized non-formulary dispensing may result in CDR, corrective action, and disallowance of related charges.

Generic substitution compliance

Contractor dispenses AB-rated generic medications when permitted by law and uses the least expensive clinically appropriate product in stock.

95%

Random invoice and fill review.

Trends below threshold require corrective action and may affect payment review.

Patient counseling

Pharmacist counseling is available and provided consistent with contract requirements, including medication use, dose, precautions, side effects, missed doses, and storage.

95%

Customer feedback; complaint log; random record review if documented.

Repeated substantiated failures require corrective action plan.

Reporting timeliness

Monthly, quarterly, and annual reports are submitted electronically to the Facility POC within required timeframes and contain required elements by location.

100%

100% inspection of all deliverables.

Late or incomplete reports may support payment withholding until corrected or other negotiated deduction language.

Monthly detailed statement accuracy

Monthly statements include patient name, patient SSN, provider name, drug name, strength, quantity, dispense date, dispensing pharmacy, AWP, and dispensing fee.

100%

100% inspection; record review.

Inaccurate statements require correction; unsupported charges may be adjusted.

Consult documentation response

Contractor provides consult documentation within 10 calendar days of request

100%

100% inspection of requests and response dates.

Failure may result in adjustment of questioned statement amounts, as stated in the SOW.

Complaint resolution / responsiveness

Contractor account management team responds promptly to VA inquiries and works directly with the COR/Facility POC to resolve issues.

95%

Complaint log; email/issue tracking review; periodic inspection.

Failure to respond or resolve timely may result in corrective action requirements.

Records management

Contractor maintains electronic records of prescriptions filled, including patient signatures for each prescription received.

100%

Random record review; periodic inspection.

Missing documentation may result in corrective action and questioned costs.

Privacy and HIPAA compliance

Contractor protects beneficiary information and complies with the Privacy Act, HIPAA, VA privacy requirements, and restrictions on storing patient information on mobile devices.

100%

Random monitoring; incident review; training and compliance record review.

Any breach or material privacy failure shall be referred to the CO immediately and handled under contract, VA policy, and applicable law.

Security/training compliance

Contractor personnel complete required VA cyber security, privacy, and Rules of Behavior training and maintain required access controls.

100%

Periodic inspection of training documentation and access records.

Personnel may be removed from work or access; contractor must correct deficiencies immediately.

13. Reporting and Documentation

The contractor shall provide:

Monthly, quarterly, and annual electronic reports to the Facility POC showing total prescriptions filled and total dollar amounts, by location.

Monthly detailed statements including, at a minimum: patient name, patient SSN, provider name, drug name, strength, quantity, date dispensed, dispensing pharmacy, AWP, and dispensing fee.

Reports containing sensitive information shall be encrypted and/or password protected when transmitted via email.

Pharmacy Service at the RJDVAMC shall review monthly statements, and the contractor shall provide consult documentation within 10 calendar days upon request; failure to do so may require adjustment of statements by the amount in question.

14. Government Responsibilities

The Government shall:

Assign a Facility POC to monitor day to day contractor performance and verify compliance.

Establish and maintain internal record keeping systems to ensure correct reimbursement for prescriptions and services.

Conduct random audits of prescription fills and have access to contractor records during regular business hours with reasonable notice.

15. Budget, Payment, and Pricing

Reimbursements shall be determined by Average Wholesale Price (AWP), discounted by the applicable percentage plus the applicable dispensing fee and shall not exceed prices charged to the general public or to the contractor s lowest third party plan.

AWP shall be based on the current Red Book or equivalent reference, with updates provided to VA throughout the contract term.

16. Terms, Conditions, and Change Management

This PWS is subject to all applicable VA contractual terms and conditions, including confidentiality, intellectual property, data rights, termination, and dispute resolution provisions.

Any changes to the scope, deliverables, or performance requirements must be requested in writing and approved by the Contracting Officer through a contract modification, following VA change management procedures.