Request for Proposals

ENTITLED: "Pharmacy Benefit Services for The Empire Plan, Student Employee Health Plan, and NYS Insurance Fund Workers' Compensation Prescription Drug Programs"

Release Date: May 1, 2024

Proposal Due Date: July 2, 2024 3:00 p.m. ET

The Pharmacy Benefit Services RFP has been Amended as of June 6, 2024.

All inquiries, questions, filings and submission of Proposals must be directed in writing to:

NYS Department of Civil Service
Attn: Office of Financial Administration
Empire State Plaza, Swan Street Building, Core 1
Albany, New York 12239

E-mail: DCSprocurement@cs.ny.gov

Table of Contents  

Request for Proposals

Pharmacy Benefit Services RFP Amended June 6, 2024

Appendix

APPENDIX A - Standard Clauses for New York State Contracts, dated June 2023

APPENDIX B - Standard Clauses for All Department of Civil Service Contracts, dated March 2024

APPENDIX B-1 (NYSIF) - General Specifications, dated February 2024

APPENDIX B-2 (NYSIF) - Contract Provisions, dated December 2023

APPENDIX B-3 (NYSIF) - NYSIF Vendor Security Survey, dated May 2023

APPENDIX B-4 (NYSIF) - NYSIF Mutual Non-Disclosure Agreement, dated November 2023

APPENDIX C - Information Security Requirements, dated March 2023

APPENDIX D (NYSIF) - NYSIF Participation by Minority and Women-Owned Business Enterprises, dated February 2023


Attachments

ATTACHMENT 1 - Offeror Affirmation of Understanding and Agreement

ATTACHMENT 2 - Procurement Lobbying Policy

ATTACHMENT 3 - Formal Offer Letter

ATTACHMENT 4 - Questions Template

ATTACHMENT 5 - Debriefing Guidelines

ATTACHMENT 6 - Performance Guarantees

ATTACHMENT 7 - New York State Required Certifications

ATTACHMENT 8 - Non-Material Deviations Template

ATTACHMENT 9 - Subcontractors or Affiliates

ATTACHMENT 10 - Confidentiality and Non-Disclosure Agreement

ATTACHMENT 11 - Freedom of Information Law Request for Redaction Chart

ATTACHMENT 12 - New York State Subcontractors

ATTACHMENT 13 - Offeror Attestations Form

ATTACHMENT 14 - Biographical Sketch Form

ATTACHMENT 15 - Glossary of Defined Terms Amended June 6, 2024

ATTACHMENT 16 - NYSIF Vendor Profile

ATTACHMENT 17 - NYSIF Vendor Security Survey

ATTACHMENT 18 - Offeror's Proposed Retail Network Pharmacy File

ATTACHMENT 19 - File Layout Specifications for Offeror's Proposed Retail Pharmacy Network

ATTACHMENT 20 - Offeror's Proposed Retail Pharmacy Network Access Prerequisite Worksheet

ATTACHMENT 21 - Comparison of Current Program Network Pharmacies and Proposed Network - PLACEHOLDER

ATTACHMENT 22 - Enrollment by Zip Code & Geo Access Network Report File - PLACEHOLDER

ATTACHMENT 23 - Plan Enrollment by Month

ATTACHMENT 24 - Enrollment by Plan, by Age

ATTACHMENT 25 - Covered Lives by Plan

ATTACHMENT 26 - Covered Lives by Union Group

ATTACHMENT 27 - DCS NYSIF Prescription Drug Program Copayment Matrix

ATTACHMENT 28 - Benefit Programs

ATTACHMENT 29 - Various Empire Plan Publications

ATTACHMENT 30 - Employee Benefit Cards

ATTACHMENT 31 - NYSIF Claimant Card Letter

ATTACHMENT 32 - HCAP Providers for The Empire Plan - PLACEHOLDER

ATTACHMENT 33 - Schedule of MIS Reports

ATTACHMENT 34 - NYS Detailed Claim File Layout (DCS)

ATTACHMENT 35 - Claim Cycle Report

ATTACHMENT 36 - Program Reporting

ATTACHMENT 37 - Empire Plan Monthly MAC List

ATTACHMENT 38 - MAC Alert Notice

ATTACHMENT 39 - Monthly MAC Savings Report

ATTACHMENT 40 - Drug Performance Report

ATTACHMENT 41 - Quarterly Performance Guarantee Report

ATTACHMENT 42 - Quarterly Rebate and Other Pharma Revenue Report

ATTACHMENT 43 - NYBEAS Enrollment Record Layout - Control Header

ATTACHMENT 44 - NYBEAS Enrollment Record Layout - Transaction Set Header

ATTACHMENT 45 - NYBEAS EGWP Enrollment Record Layout - Detail File

ATTACHMENT 46 - NYBEAS EGWP Enrollment Record Layout - Header

ATTACHMENT 47 - NYBEAS EGWP Enrollment Record Layout - Trailer

ATTACHMENT 48 - Feedback File Layout

ATTACHMENT 49 - Prior Authorization Drug Lists

ATTACHMENT 50 - Prior Authorization Selected Statistics

ATTACHMENT 51 - Preferred Drug Lists - April 2024

ATTACHMENT 52 Excluded Drug Lists - April 2024

ATTACHMENT 53 - Generic Appeal Selected Statistics

ATTACHMENT 54 - Mail Service and Specialty Pharmacy Claims

ATTACHMENT 55 - Empire Plan Website Statistics

ATTACHMENT 56 - Empire Plan Monthly Call Center Volume

ATTACHMENT 57 - Call Statistics

ATTACHMENT 58 - Vendor Attendance

ATTACHMENT 59 - NYSIF Eligibility Process

ATTACHMENT 60 - NYSIF Billing Process

ATTACHMENT 61 - NYSIF Rebate File Processes (Quarterly-Yearly)

ATTACHMENT 62 - NYSIF Zip Codes

ATTACHMENT 63 - NYSIF Invoice

ATTACHMENT 64 - NYSIF Aging Short Fill File Layout

ATTACHMENT 65 - NYSIF Short Fill Process

ATTACHMENT 66 - NYSIF Error Process

ATTACHMENT 67 - NYSIF Paper Bills

ATTACHMENT 68 - NYSIF Prior Authorization Process

ATTACHMENT 69 - NYSIF Report Fields

ATTACHMENT 70 - NYSIF Additional Reports

ATTACHMENT 71 - 2020 - 2023 Incurred Claims

ATTACHMENT 72 - Selected Financial Data

ATTACHMENT 73 - 2021-2023 Incurred Claims by Month - Combined

ATTACHMENT 74 - 2021-2023 Incurred Claims by Month - EGWP

ATTACHMENT 75 - 2021-2023 Incurred Claims by Month - Commercial

ATTACHMENT 76 - Current Brand-Generic Classification

ATTACHMENT 77 - Paid Claims Per Cycle

ATTACHMENT 78 - NYSIF Prescription Plan Payments

ATTACHMENT 79 - NYSIF Quarterly Breakdown Payments

ATTACHMENT 80 - Medical Exception Program Claims Experience

ATTACHMENT 81 - External Appeal Review Fees

ATTACHMENT 82 - NYSHIP Compound Claims Summary

ATTACHMENT 83 - Proposed Claim Reimbursement Quote

ATTACHMENT 84 - Layout Specifications for DCS Program Informational Claims Data File

ATTACHMENT 85 - Layout Specifications for NYSIF Program Informational Claims Data File

ATTACHMENT 86 - Informational Claims Files - PLACEHOLDER

ATTACHMENT 87 - Designated Specialty Pharmacy Identifiers

ATTACHMENT 88 - Retail and Mail Service Pharmacy Generic Drugs MAC List Costs per GPI

ATTACHMENT 89 - Specialty Pharmacy Program Dispensing Fees

ATTACHMENT 90 - Pharma Revenue Guarantee Quote

ATTACHMENT 91 - Documentation to Support Pharma Revenue Guarantee Quote

ATTACHMENT 92 - Claims Administration Fee(s) Quotes

ATTACHMENT 93 - Vaccination Administration Fees

ATTACHMENT 94 - DCS Brands Classified as Generic Drugs

ATTACHMENT 95 - Retrospective Coordination of Benefits (COB)

ATTACHMENT 96 - Generic Dispensing Rate (GDR) by Union

ATTACHMENT 97 - Program Services Matrix

ATTACHMENT 98 - Paper Claims

ATTACHMENT 99 - Prescribing Fee-Eligible Medications

ATTACHMENT 100 - April 2024 Formularies by NDC

ATTACHMENT 101 - April 2024 EGWP Formulary

Questions/Answers

Response to Questions