Indiana Department of Administration #005030000088864

Indiana Medicaid Pharmacy Benefits Administrator services

Indiana is seeking a Pharmacy Benefits Administrator to operate its fee-for-service Medicaid pharmacy benefit. - Government buyer: State of Indiana; Indiana Department of Administration (IDOA) is the issuing agency, with the Family and Social Services Administration (FSSA) as the customer and the Office of Medicaid Policy and Planning (OMPP) referenced as a program stakeholder. - Requested services: Implement and operate a Pharmacy Benefits Administration system, including claims adjudication, pricing and payment; prior authorization; pharmacy support; rebates; drug utilization review; audits; rate setting; preferred drug list management; reporting and analytics; data conversion; communications and training; and transition support. - Potential additional scope: Pricing is requested for physician-administered drug claims and a Medication Therapy Management program. The solicitation also requests pricing adjustments for a carve-out scenario and contemplates a Single PBA alternative; details and volumes are not provided. - Named technology providers/products: MuleSoft API Gateway and GoAnywhere Managed File Transfer are identified for interoperability. No commercial PBA vendor or manufacturer is named as the offeror or incumbent. - Notable requirements: The State emphasizes auditable processing, extensive data conversion, security, business continuity, and measurable service performance. The cost proposal evaluates four base years, with optional maintenance and operations years five and six; a 20% monthly M&O performance incentive pool is tied to key performance measures. The solicitation also establishes subcontracting goals of 3% for Indiana Veteran Owned Small Businesses and 10% for Indiana Small Business Program participants. - Quantities and part numbers: No product quantities or product part numbers are specified. The RFP identifier is 27-88864.

Description

The solicitation seeks a respondent to provide Pharmacy Benefit Administrator (PBA) services for the State’s fee-for-service Medicaid pharmacy benefit. The PBA will administer the benefit in accordance with State-defined policies, program requirements, and reimbursement methodologies. The solicitation identifies FSSA Medicaid Policy & Plan as the customer and establishes a 3% subcontracting goal for Indiana Veteran Owned Small Businesses.

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