MB-3852 - USA (California) - Pharmacy Benefit Management and Claims Administration Program Service - Deadline March 5,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3852

Government Authority located in California; USA based organization looking for expert vendor for pharmacy benefit management and claims administration program service.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide pharmacy benefit management and claims administration program service.
- Benefits Administrator means a self-service contractor with which the county has a contract to
provide full benefits administration such as benefits eligibility and enrollment.
- Compound prescription means a prescription that meets the following criteria: two or more solid, semi-solid, or liquid ingredients, at least one of which is a covered drug, which are weighed or
measured then prepared according to the prescriber's order.
- Concurrent drug utilization review is a series of edits at the point-of-service that are applied to a prescription drug claim comparing member information with the drug dispensed and information in the database related to other medications the member is taking.
- Covered prescription drug services mean those outpatient prescription drugs and pharmacy
products, services and supplies as described in a current County Plan Document.
- Drug classification means the process whereby bidder shall use the indicators of disclosed nationally available recognized reporting service of pharmaceutical drug information to determine the classification of drugs for claim adjudication purposes.
- Enrollee or participant means eligible subscribers and dependents enrolled in the county’s share well choice, share well retiree, well wise choice or well wise retiree plan.
- Explanation of benefit (EOB) is a periodic summary statement of plan and participant paid amounts sent to participants.
- Health plan administrator or third-party administrator (TPA) is the entity with which county has contracted to administer and process claims for the self-insured PPO health plans.
- Identification cards shall mean printed identification cards containing specific information about the prescription drug benefit that will be used by plan Participants. Currently identification cards are
issued by the TPA.
- Limited distribution drugs mean drugs that bidder's specialty pharmacy does not have a direct purchase agreement with the manufacturer or wholesaler distributor of that product. if the manufacturer has designated a specialty product as “limited distribution” or “exclusive distribution”,
but bidder has been able to maintain access and distribution rights to the product, the product will not be considered limited distribution drug for the purposes of the agreement.
- Net paid claim means all paid claims minus reversals for a single prescription fill.
- Participating pharmacy means a retail pharmacy that has entered into an agreement with contractor under which the pharmacy has agreed to provide covered prescription drug services to participants and to comply with applicable regulatory requirements.
- Pharmaceutical manufacturer means a pharmaceutical, biotech or device company which has entered into an agreement with the contractor to offer rebates on pharmaceutical products, supplies or services utilized by participants.
(2) All questions must be submitted no later than February 21, 2020.

[C] Eligibility:

- Onshore (USA Only);

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

[E] Proposal Submission:

Response should be submitted physically (courier or post).

Expiry Date : Thursday, 5 March, 2020

Question Answer Deadline : Friday, 21 February, 2020

Category : Medical Transcription and Others

Country : USA

State : California

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