PHARMACY BENEFIT ADMINISTRATION SERVICES

Opportunity Summary
The State of Oregon, acting by and through its Oregon Health Authority, hereinafter referred to as "Agency" is issuing this Request for Proposals (RFP) to execute a Contract with an experienced entity to provide a package of pharmacy administrative Services for the NW Pharmacy Purchasing Consortium (NW Consortium or "Consortium"). The NW Consortium was formed by an Interstate Agreement between the State of Oregon through its Oregon Prescription Drug Program (OPDP) within the Oregon Health Authority (OHA) and the State of Washington through its Prescription Drug Program (WPDP) within the Washington Health Care Authority (HCA). OPDP and WPDP are collectively referred to in this RFP as the "Benefiting Agencies." This RFP is a joint cooperative procurement under Oregon Revised Statutes ORS 279A.200 and ORS 279A.210.

Agency recognizes that in order to provide the comprehensive Services described in this RFP, Proposers may subcontract with other entities

to provide these Services. Throughout this RFP "Proposer" means the legal entity that submits the Proposal, that will be the party to the Contract if awarded, and that is responsible for all of its proposed affiliates and Subcontractors.

This RFP is for administration of the Services described in this RFP. The Benefiting Agencies and the Participating Groups retain full authority for benefit design and member eligibility. Plan designs will include but not be limited to fully insured benefit plans, partially or fully self-insured plans, administrative Services only programs and discount card programs. While there may be a role for an off-the-shelf commercial prescription drug benefit designed by the Proposer, the focus of the RFP is adapting to the needs and requirements of the Benefiting Agencies and the Participating Groups. The Proposer must demonstrate the ability to provide all staffing, systems, and procedures required to perform the Services described in this RFP. The Proposer must be able to accommodate the distinctive eligibility standards and member identification number structures of each Participating Group.

The Proposer must demonstrate the ability to administer multiple benefit designs and provide the full package of Services, including Group Purchasing Organization (GPO) Administration, beginning January 1, 2022 through December 31, 2026 with the option of the Benefiting Agencies to extend the Contract through December 31, 2031. The resulting Contract may be amended to delete Services or to add any Services that are within the scope of Services stated in this RFP. In addition, Proposers agree to negotiate in good faith with Agency to amend any resulting Contract to comply with the Oregon or Washington legislature's benefit mandates or revisions; OHA's or HCA's statutes; federal health reforms; or other statutes and rules that impact the Contract.

The package of Services will include: Administrative Services such as prescription claims adjudication, prescription utilization management, Preferred Drug List (PDL) management, member Services, account management, on-line Services, in-state and national pharmacy network management, mail order pharmacy management, and specialty pharmacy management, GPO and 340B prescription drug pricing for eligible Participating Groups, and potentially GPO pricing for pharmacy, medical supplies and some durable medical equipment.

This RFP is intended to invite innovative cost reduction Proposals relying on strong pharmacy benefit management principles and deep expertise. The high cost of drugs is especially critical for participants who do not have prescription drug insurance.

The Benefiting Agencies believe the best purchasing model is one in which the Participating Groups purchasing prescription drugs receive 100 percent of all payments received from manufacturers related to those purchases, and in which Proposer derives all its income relating to the Contract with the Benefiting Agencies from administrative fees for Services that it provides. Examples of non-transparent models, which the Benefiting Agencies discourage, include Proposers that keep a "margin" or "spread" of the pharmacy reimbursements for claims, hidden rebates such as access rebates or fees paid to Proposer by a manufacturer for inclusion of a medication on a PDL, market share rebates paid to Proposer that achieves greater utilization of a manufacturer's drug, Proposer's rebate service fees and Proposer's sales of employer data to manufacturers and research firms. The Benefiting Agencies are, however, interested in innovative transparent models in which the financial benefits flow to Participating Groups.

The Benefiting Agencies strongly believe that all providers of Services should embrace principles of transparent purchasing. Proposers will be required to propose a transparent purchasing model and agree to the transparent purchasing initiatives of the NW Consortium.

Changes in state or federal law or involvement of additional agencies may create opportunities for Proposer to furnish Services for non-drug products available for purchase to eligible participating entities, such as medical supplies and equipment. In such an event, the NW Consortium Contract may be amended to include benefit management Services for defined non-pharmacy products.

For additional details, click on the "Attachments Exist" button on this ORPIN Opportunity to find out more.

The Sole Point of Contact for this RFP is Coral Ford with the Oregon Health Authority, Office of Contracts and Procurement.