AIDS DRUG ASSISTANCE PROGRAM (ADAP) PRESCRIPTION FULFILLMENT BENEFIT & INFORMATION MANAGEMENT
All components listed in this section are mandatory. The bidder must bid on
all services, not just a portion thereof. Tasks are associated with a project
deliverable when appropriate. The Division of Public Health reserves the right
to negotiate the requirements and associated reimbursement with the
selected contractor relative to the tasks listed below.
Proposals are being solicited for the following services:
Provide comprehensive pharmacy benefit & information management;
Client Eligibility Administration, Coordination of Benefits and Payer of Last
Resort Program Management, Statewide Pharmacy Network, Claims
Processing, ADAP Formulary Management, ADAP Program Member
Technical Support, Reporting and Data Management.
Client Eligibility - Client eligibility must be managed electronically with real
time data to ensure that at the time of service eligible clients receive
approved items on the ADAP formulary. All eligible clients will be issued a
program eligibility card, which will assure them service at any of the
private pharmacies within the network.
Coordination of Benefits and Payor of Last Resort - Clients primary and
secondary insurance is billed first to ensure that Ryan White Part B/ADAP is
payor of last resort.
Statewide Pharmacy Networks A statewide pharmacy network must be
available to dispense program formulary items in the various
geographical areas where the eligible clients are located.
Claims Processing Adjudicate electronic claims received from the
network pharmacies. Twice a month provide the Ryan White Part B/ADAP
program a billing statement and a claims adjudication summary.
ADAP Formulary Management All network pharmacies will have an up
to date program formulary. Only items on the formulary will be approved
at the time of service.
ADAP Program Member Technical Support staff a help desk to provide
information regarding pharmacy locations and to provide answers to
most questions regarding eligibility for the Prescription Drug Benefit Plan.
Reporting and Data Management - Electronic reports for Ryan White Part
B/ADAP grant requirements such as ADAP repots, RDR reports, RSR reports,
are compatible with HRSA Careware software system and submitted prior
to reporting requirement due date. Enrollment eligibility data
management, Payment and invoice processing, Formulary management,
Data storage and tracking, Report generation, Ad hoc data reporting,
Prescription claims processing, Prior authorization processing, and Secure
Internet applications.
