New York State Contract Reporter #C042530

NY State Seeks Contractor for EPIC and American Indian Health Pharmacy Program Administration

This opportunity from the New York State Department of Health seeks a contractor to administer the Elderly Pharmaceutical Insurance Coverage (EPIC) Program and the American Indian Health Program (AIHP) pharmacy component. - Government Buyer: - New York State Department of Health, Office of Health Insurance Programs, Division of Finance and Rate Setting - Programs Covered: - EPIC (serving 300,000+ seniors) - AIHP (serving ~9,500 members from six recognized Tribal Nations) - Services Requested: - Pharmacy program administration and support - Member enrollment and eligibility determination - Online pharmacy claims processing - Provider enrollment and reimbursement - Premium payment reconciliation - Therapeutic drug monitoring and drug utilization review - Community outreach and call center operations - Mailroom, printing, quality assurance, audit, banking, system development, reporting, and transition support - Quantities: - No specific quantities or part numbers; services are for the entire EPIC and AIHP populations - Unique/Notable Requirements: - Strict security, reporting, and staffing requirements - 30% Minority and Women-Owned Business Enterprises (MWBE) participation goal - No Service-Disabled Veteran-Owned Business (SDVOB) goal - Contractor not paid for operational expenses until all implementation activities are completed - Pricing for years 4-7 subject to annual CPI adjustments - OEMs and Vendors: - No specific OEMs or vendors named in the solicitation - Past contracts awarded to Magellan Medicaid Administration, Inc. - Place of Performance and Delivery: - Primary locations in Albany, NY, including One Commerce Plaza and Corning Tower at Empire State Plaza

Description

The New York State Department of Health is seeking proposals to procure a contractor to support the operation of the Elderly Pharmaceutical Insurance Coverage (EPIC) Program and the American Indian Health Program (AIHP). The scope includes pharmacy program functions, public Medicaid programs, online pharmacy claims processing, participant eligibility and application processing, provider enrollment and reimbursement, therapeutic drug monitoring, and community outreach. The contract term is from June 1, 2027, to May 31, 2034, and the solicitation encourages participation from Minority and Women-Owned Business Enterprises with a 30% goal.

View original listing