Pharmacy Database (Electronic Drug File)
PERFORMANCE WORK STATEMENT
For
CPAC Program Management Office, Payer Relations Office
Pharmacy Database Software 2014
TITLE OF PROJECT
1) Purpose
The Department of Veterans Affairs (VA), Veterans Health Administration (VHA), Chief Business Office (CBO),Consolidated Patient Accounts Centers (CPAC), Program Management Office (PMO), Payer Relations Office (PRO) is seeking Pharmacy Database (Electronic Drug File) Software to assist with the continued development of agreements with pharmacy benefit managers (PBMs) and other pharmacy agreements with third party payers (TPPs) and to perform reimbursement rate verifications for selected third-party payer to enforce compliance with federal regulation by comparing reimbursement rates established for commercial retail pharmacies with reimbursement rates established for VA.
2) Background
38 USC 1729 authorizes the Department of Veterans Affairs (VA) to seek reimbursement from third party payers for the cost of non-service-connected medical care furnished to insured Veterans. The money collected from TPPs help to offset the cost of delivering world-class health care services to our nation's Veterans, and is revenue anticipated in the President's budget.
The Veterans Health Administration, Consolidated Patient Accounts Centers has developed a plan to address opportunities for improving revenue cycle business functions, identify new strategies to increase revenue and assist the field facilities in maximizing their revenue stream. Within this effort, CPAC will determine whether and how a PBMs meet federal payment requirements using contractor services to (1) review and document PBMs agreements, (2) provide data analysis and draft recommendations for CPAC to determine if PBMs agreements and rate proposals meet federal payment requirements, and (3) provide additional data analyses related to special projects within Payer Relations Office business objectives.
PRO is assuming management and development of outpatient pharmacy agreements with pharmacy benefit managers and other types of third party payers and requires assistance in determining if agreements and rate proposals from PBMs and other third party payers for outpatient pharmacy services meet federal payment requirements.
3) Performance Objectives
The database software will provide data which will allow VA to determine if the rates pharmacy benefit managers or other third party payers meet federal payment requirements.
4) Scope of Work
Database should provide the industry's most comprehensive drug price data, including:
o Average Wholesale Price (AWP)
o Wholesale Acquisition Price (WAC)
o Direct Price (DP)
o Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL)
o Average Average Wholesale Price (AAWP)
o Generic Equivalent Average Price (GEAP)
o Average WAC (AWAC)
o Generic Equivalent WAC (GEWAC)
o State Medicaid
5) Mandatory Tasks and Deliverables
The database should be updated monthly with the most current electronic drug files and pricing. This will be downloaded and installed by VA staff via secure website. The Contractor shall provide the update within the contract performance period. If for any reason, any update cannot be delivered on time, the contractor shall provide a written explanation three days prior to the due date to the Contracting Officer Representative (COR). This written transmittal shall include a firm commitment of when the file (per agreed upon file type) shall be updated. This transmittal to the COR shall cite reasons for the delay, and the impact on the overall project. The COR will review collaboratively with the program office facts and issue a response in accordance with the contract terms and conditions.
5.1 Schedules for Mandatory Deliverables.
Electronic file updates will be made available on a secure site for upload by VA on a monthly cycle.
5.2 Table of Base Period Mandatory Deliverables Due Dates
REFERENCE Task # DELIVERABLE DUE DATE
Deliverable 1 Task 1.1 Electronic Drug File monthly update Monthly
Service Standards
Customer Account Requests Completed Within 4 Business Hours of Receipt
" Web delivery set-up
" FTP delivery set-up
" Replacement product
" Evaluation data
" User name and password assistance
" W-9 documents
" Product-related questions where the Customer Support Representative
" has immediate access to the information needed
" Subscribe to newsletter
Customer Account Requests Completed Within 16 Business Hours of Receipt
" Invoice reprints
" Account/invoice research (breakdown of fees and other charges)
" Renewal letter copy request
" User fee survey copy request (metrics)
" Vendor registration (online)
" Order entry - general questions/changes
" Order entry - license agreements, amendments, metric updates, account changes
" Subscription modifications
6) Period of Performance.
The period of performance shall be from the date of award of an initial annual software purchase for a base period with 4 optional years. .
There are ten (10) Federal holidays set by law (U.S.C. Title 5 Section 6103):
Under current definitions, four are set by date:
New Year's Day January 1
Independence Day July 4
Veteran's Day November 11
Christmas Day December 25
If any of the above falls on a Saturday, then Friday shall be observed as a holiday. Similarly, if one falls on a Sunday, then Monday shall be observed as a holiday.
The other six are set by a day of the week and month:
Martin Luther King Day Third Monday in January
Washington's Birthday Third Monday in February
Memorial Day Last Monday in May
Labor Day First Monday in September
Columbus Day Second Monday in October
Thanksgiving Fourth Thursday in November
7) Place of Performance.
The Contractor shall support this effort at approved Contractor facilities or as directed by the COR and mutually agreed to by Contractor.
8) Type of Contract.
A Firm- Fixed Price Task Order/Contract will be issued for this effort. This will be a multiyear agreement, first year purchase with 4 annual renewals.
9) Changes to the PWS.
Any changes to this PWS shall be authorized and approved only through written correspondence from the Contracting Officer. A copy of each change will be kept in a project folder along with all other products of the project. Costs incurred by the contractor through the actions of parties other than the Contracting Officer shall be borne by the contractor.
10) Government and Contractor Responsibilities.
a. The CPAC shall provide the contractor with copies of documents that the VA is required to provide.
b. The contractor shall request other VA documentation deemed pertinent to the work accomplishment directly from the COR. The contractor is expected to use common knowledge and resourcefulness in securing all other reference materials, standard industry publications, and related materials that are pertinent to the work.
c. The contractor shall maintain frequent communications with the PRO and the COR to conduct work in progress reviews.
11) Formal Acceptance or Rejection of Deliverables.
The VA shall have 15 business days to review each document and provide feedback and comments. The contractor shall have five business days to incorporate comments. A final review shall be conducted with the COR. Delivery of the post-final review document with incorporated comments from the final review meeting shall constitute acceptance by the VA with COR's written approval.
12) Quality Standards for Deliverables - Performance Measures: Service Standards:
12.1 Customer Account Requests Completed Within 4 Business Hours of Receipt
" Web delivery set-up
" FTP delivery set-up
" Replacement product
" Evaluation data
" User name and password assistance
" W-9 documents
" Product-related questions where the Customer Support Representative
" has immediate access to the information needed
" Subscribe to newsletter
12.2 Customer Account Requests Completed Within 16 Business Hours of Receipt
" Invoice reprints
" Account/invoice research (breakdown of fees and other charges)
" Renewal letter copy request
" User fee survey copy request (metrics)
" Vendor registration (online)
" Order entry - general questions/changes
" Order entry - license agreements, amendments, metric updates, account changes
" Subscription modifications
13) PRIVACY REQUIREMENTS
13.1 GENERAL
Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal law s, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security.
13.2 ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS
a. A contractor/subcontractor shall request logical (technical) or physical access to VA information and VA information systems for their employees, subcontractors, and affiliates only to the extent necessary to perform the services specified in the contract, agreement, or task order.
b. All contractors, subcontractors, and third-party servicers and associates working with VA information are subject to the same investigative requirements as those of VA appointees or employees who have access to the same types of information. The level and process of background security investigations for contractors must be in accordance with VA Directive and Handbook 0710, Personnel Suitability and Security Program. The Office for Operations, Security, and Preparedness is responsible for these policies and procedures.
c. Contract personnel who require access to national security programs must have a valid security clearance. National Industrial Security Program (NISP) was established by Executive Order 12829 to ensure that cleared U.S. defense industry contract personnel safeguard the classified information in their possession while performing work on contracts, programs, bids, or research and development efforts. The Department of Veterans Affairs does not have a Memorandum of Agreement with Defense Security Service (DSS). Verification of a Security Clearance must be processed through the Special Security Officer located in the Planning and National Security Service within the Office of Operations, Security, and Preparedness.
d. Custom software development and outsourced operations must be located in the U.S. to the maximum extent possible. If such services are proposed to be performed abroad and are not disallowed by other VA policy or mandate, the contractor/subcontractor must state where all non-U.S services are provided and detail a security plan, deemed to be acceptable by V.A., specifically to address mitigation of the resulting problems of communication, control, data protection, and so forth. Location within the U.S may be an evaluation factor.
Shamike Bethea
910-482-2120 Ext 5199
[email protected]
