Illinois BidBuy #27-478HFS-MEDPR-B-54400

Illinois Medicaid Pharmacy Benefit Services Extension and Data-Interface Change Requests

Illinois HFS is extending its Medicaid pharmacy benefit services agreement with Gainwell Technologies LLC and funding data-interface change requests. - Government buyer: Illinois Department of Healthcare and Family Services (HFS), Medical Programs, Office of Procurement Management. - Award status: This is a change-order extension of an existing agreement, not a request for new bids. Gainwell Technologies LLC is named as the service provider. - Services: Continued Medicaid pharmacy benefit management, including pharmacy benefit administration, claims adjudication, prior authorization, rebate administration, clinical management, fraud, waste, and abuse support, reporting and analytics, technical infrastructure, and system integration. - Change requests: Four data-mapping and interface projects cover member and eligibility data (322), provider data (240), claims data (282), and voucher payments (113). The four draft requests have a combined estimated cost of $142,719. - Funding: The extension has a stated not-to-exceed total of $18,226,128, including up to $1,410,000 for change management and $16,816,128 for design, development, implementation, maintenance, and operations. - Notable requirements: Data transformations must map client-provided files into Gainwell target tables for conversion and ongoing interfaces. The work also involves a structured change-approval process, milestone-based payments, system integration, and applicable federal, state, HIPAA, and security requirements. - OEMs: No product manufacturers or OEMs are identified.

Description

This notice is not a solicitation. HFS gives notice of its intent to extend its current Medicaid Enterprise Systems Pharmacy Benefit Management Services agreement for one year, through October 28, 2027, to align with the NASPO Master Agreement. The change also adds funding for necessary Change Requests, including an identified total not-to-exceed extension cost of $18,226,128. The services include pharmacy benefit administration, drug rebate and clinical management, fraud prevention, reporting and analytics, and related technical and integration support.

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