Pharmacy Point of Sale System

26 April 2024 Pharmacy Point of Sale System The state is seeking a vendor to provide DHHS with a pharmacy benefits solution. 26 April 2024 Open 3/21/2024 1:00 PM MDT Type Request for Proposal No Line Item Close 5/6/2024 4:00 PM MDT Number MK24-70 Currency US Dollar Sealed Until 5/6/2024 4:00 PM MDT 26 April 2024 Contacts Meran Kay mkay@utah.gov 26 April 2024 Commodity Codes Commodity Code Description 85121 Health care provider specialist services including lab, medical imaging radiology, pharmacy, chiropractic, medical diagnostics testing, audiology and speech language pathology, physical therapy, occupational therapy, optometry 43210 Information technology hardware including computer hardware and accessories and printers and input data devices and electronic voting and vote-counting equipment 43221 Information technology telecommunications including call management systems or accessories including background music services 43230

Information technology software including computer software 81112 Data services and internet services and software maintenance and computer hardware maintenance including website design services and internet domains and database management software support and disaster recovery services and support services 85123 Procurement of products, services, and systems relating to Medical cannabis and other pharmaceutical herbs. 26 April 202426 April 202426 April 202426 April 202426 April 202426 April 202426 April 2024 mailto:mkay@utah.gov Issuing Procurement Unit State of Utah Division of Purchasing Conducting Procurement Unit DHHS REQUEST FOR PROPOSALS Pharmacy Point of Sale System SOLICITATION #MK24-70 This Request for Proposals (“RFP”), having been determined to be the appropriate procurement method to provide the best value to the Conducting Procurement Unit, is designed to provide interested Offerors with sufficient basic information to submit proposals. This Request for Proposals ("RFP”) is issued in accordance with the Utah Procurement Code and applicable administrative rules of the Utah Administrative Code. If any provision of this RFP conflicts with the Utah Procurement Code or Utah Administrative Code, then the Utah Procurement Code or Utah Administrative Code will take precedence. It is not intended to limit a proposal's content or exclude any relevant or essential data. Offerors are at liberty and are encouraged to expand upon the specifications to evidence service capability. Purpose of this Solicitation The purpose of this RFP is to enter into a contract to provide DHHS with a Pharmacy Benefits Solution. It is anticipated that this RFP will result in a single contract award to the responsive and responsible offeror with the highest score justified by the procurement code. Closing date and time The closing date and time for this sourcing event is as provided in this posting. If your time is different from that shown, your profile may be set to a different time zone. Please see the attachment titled "Changing Your Time Zone" in the Buyer Attachments section for directions on how to update your profile. It is your responsibility to make sure you submit your response by the date and time indicated above. Length of the Contract The contract resulting from this RFP will be for EIGHT (8) years. Background The Utah Department of Health and Human Services (DHHS) is the single state agency responsible for the administration of the Utah Medicaid program. The DHHS has several offices and divisions including the Division of Integrated Healthcare (DIH) which oversees the Utah Medicaid program. The DHHS provides pharmacy benefits for as many as 360,000 Utah residents. The effective management of delivery of these services requires efficient pharmacy benefit management information technology and support services and the respective support services to design, implement, and operate such systems. The DHHS seeks a highly skilled, highly qualified offeror to provide these systems and support for a pharmacy benefit administrator. The DHHS seeks to contract with an offeror for information technology and support services that can provide all necessary functions to support Utah Fee-for-Service (FFS) Medicaid pharmacy program implementation, execution, and integration of general pharmacy benefit payer services, to include but not be limited to: ● General system and DDI requirements: pharmacy benefit administration information system(s) that are CMS-certified; compliant with all federal and state laws, rules, and regulations; modular and scalable; and include all project start-up planning, project management, implementation, and reporting. ● “Point of sale” claims management and processing: complete integration of all pharmacy benefit management information systems including pharmacy claim adjudication, clinical services support, prior authorization, and drug rebate administration, meeting or exceeding all applicable NCPDP standards. ● Pharmacy Claim Adjudication: real-time “24/7/365” adjudication of pharmacy point-of-sale (POS) claims to include utilization management, preferred drug list implementation support, interaction with other systems, and other functionalities described below, meeting or exceeding all applicable NCPDP standards, including but not limited to batch transaction, benefit integration, billing unit, manufacturer rebates, and Medicaid subrogation. Description ● Clinical Services Support: Medication prior authorization implementation, including integration of adjudication of medications billed through medical systems (“HCPCS”) and capability for automated PA systems; and Drug Utilization Review (DUR) systems support: design and implementation of edits, support for quality programs, clinical documentation capabilities, etc. ● Prior Authorization: functionality to support all aspects of prior authorization administration and adjudication, with functionality for automated PA systems, electronic health record integration, and other functionalities listed below. ● Drug rebate administration: complete management of all drug primary and supplemental rebates and associated reporting required and compliant with federal and state laws and Department policies and direction. ● Seamlessly integrate with the Utah Department of Technology Services’ Provider Reimbursement Information System for Medicaid “PRISM” system. ● Call center: provide call center services as described in the scope of work. The expectation of the offeror is that the transition to new systems and services and implementation of new systems and services results in no or minimal patient, provider, and DHHS disruption. Further, these new systems and services shall deliver additional, quantifiable incremental value to patients, providers, and DHHS. Lastly, these systems shall meet the CMS pharmacy systems outcomes certification requirements. This contract is proposed to start by July 2024, have an implementation period of 6-9 months, and “go live date” (at which time the offeror’s system(s) will accurately perform all contracted capabilities) on or before March 1, 2025. This Request for Proposal (RFP) may result in an eight year contract to a single contractor. Current Environment The Department currently operates in the MMIS system, while production of the PRISM system will be completed prior to “go live” for the proposed new systems. The pharmacy claims processing system will process prescription pharmacy claims in real time and interfaces with the PRISM system, the Data Warehouse, the Accountable Care Organizations (ACOs), and Prepaid Mental Health Plans (PMHPs). PRISM Project work has designed this system interface with the MMIS replacement system (PRISM) as this project progresses. The pharmacy claims processing system is capable of performing numerous claims processing edits to ensure Utah Medicaid operates efficiently and in compliance with all state and federal statutes and regulations. In the current system, nearly all POS functions are configured by the vendor; the offeror’s bid should assume the offeror does all required POS “Start-up” tasks (as per those respective Work Plans) and Department will set policies and CONTRACTOR will do system programing, implementation, and maintenance relative to those policies as per the “Special Requirements” documents. The prior authorization (PA) system allows state staff to receive prior authorization requests and adjudicate these requests. The system tracks all aspects of the request and has reporting capabilities. The system interfaces with the pharmacy claims processing system to allow for real-time adjudication of the requests and simultaneous claims processing. In the current system all PAs are configured by the vendor; the offeror’s system should allow PAs to be configured by either the DEPARTMENT or the offeror. Proposals should accommodate the DEPARTMENT managing PAs during business hours and should also include that the offeror provide after-hours / state holiday / emergency call center support for POS and PA management. The drug rebate management system (DRMS) will interface with the PRISM system, ACOs and Data Warehouse. The DRMS is capable of performing all functions required by the federal Medicaid drug rebate program including, but not limited to, generating invoices, tracking payments, loading drug rebate files, exporting files, and all federal reporting. As per Special Requirements details these tasks are managed by the current vendor and the DEPARTMENT expects the new offeror to continue in this capacity. With the implementation of Utah’s new PRISM system, it is imperative to contract for pharmacy software services delivered by a modernized system that will ensure compatibility with the PRISM system while also supporting robust and comprehensive pharmacy operations through and after the transition. Additional Notes: Utah’s systems use Medi-Span (MDDB). All reports, files, and interfaces must be provided to DHHS in Medi-Span. Utah is currently conducting a pharmacy study that may result in a potential carve out of pharmacy benefits from MCEs. In the event of such a carve out, Utah may make additional changes to the pharmacy benefit model. Utah may at some point in the future include additional State of Utah programs or plan benefits in the provided system. Issuing Procurement Unit, Conducting Procurement Unit, and Solicitation Number The State of Utah Division of Purchasing is the issuing procurement unit and DHHS is the conducting procurement unit for this RFP (referred to as “the State”). The reference number for this RFP is Solicitation #MK24-70. This solicitation number must be referred to on all proposals, correspondence, and documentation submitted to the State relating to this RFP. Any solutions that include cloud services, IaaS, PaaS, SaaS, MaaS, CaaS & XaaS, etc. must be implemented using the existing State of Utah DTS accounts for those hosted services, where possible. DTS has accounts with most major cloud producers (AWS, GCP, Azure, etc.). It is expected that State of Utah data reside on the DTS managed accounts for these and all providers. If applicable, please ensure that the solicitation response incorporates the use of these DTS accounts and that the pricing quoted does not include vendor hosting costs as costs would be paid directly to the hosting providers through DTS's existing accounts. If it is not possible to utilize the DTS cloud services accounts, please provide the reasoning why to the solicitation’s Q&A board so as to allow the State to amend this solicitation requirement if appropriate. If the State of Utah Division of Technology Services is conducting this solicitation then the Division of Technology Services has the authority to allow any and all State of Utah Executive Branch Agencies to participate in any contract resulting from this solicitation in the event a procurement need arises. Allowing additional Executive Branch Agencies to participate in a contract resulting from this solicitation will require a contract amendment and participation will be limited to the procurement items or scope of work identified in this solicitation. All technology contract amendments will be issued in accordance with State of Utah Technology Governance Act § 63F-1-205, Utah Procurement Code, and Utah Administrative Rule R33-12-502. Additionally, IT procurements may be subject to third party review and additional reference checks as a matter of course. Additional Information Offerors are prohibited from communications regarding this RFP with the conducting procurement unit staff, evaluation committee members, or other associated individuals EXCEPT the State of Utah Division of Purchasing procurement officer overseeing this RFP. Wherever in this RFP an item is defined by using a trade name, brand name, or a manufacturer and/or model number, it is intended that the words, “or equivalent” apply; and invites the submission of equivalent products by the Offerors. Offerors may be required to submit product samples to assist the chief procurement officer or head of a procurement unit with independent procurement authority in evaluating whether a procurement item meets the specifications and other requirements set forth in the request for proposals. Product samples must be furnished free of charge unless otherwise stated in the invitation for proposals, and if not destroyed by testing, will upon written request within any deadline stated in the invitation for proposals, be returned at the Offeror's expense. Samples must be labeled or otherwise identified as specified in the invitation for proposals by the procurement unit. The State reserves the right to conduct discussions with the Offerors who submit proposals determined to be reasonably susceptible of being selected for award, followed by an opportunity to make best and final offers pursuant to UCA § 63G-6a-707.5, but proposals may be accepted without discussions. New Technology Pursuant to Utah Administrative Rule R33-12-502 the awarded contract(s) may be modified to incorporate new technology or technological upgrades associated with the procurement item being solicited, including new or upgraded: (i) systems; (ii) apparatuses; (iii) modules; (iv) components; and (v) other supplementary items. Further, a maintenance or service agreement associated with the procurement item under the resulting contract(s) may be modified to include any new technology or technological upgrades. Any contract modification incorporating new technology or technological upgrades will be specific to the procurement item being solicited and substantially within the scope of the original procurement or contract. Legislative Appropriations Additional funding may be added to the awarded contract(s) if additional funding is provided to the procurement unit for the purpose identified in the scope of work by the legislature. Evaluation Administrative and Mandatory Minimum Requirement Compliance Each proposal received shall be evaluated as outlined in this RFP and the Utah Procurement Code. To be responsive and responsible Offerors must review and respond to the following sections of this RFP: prerequisites, buyer attachments, questions, and items. • The Prerequisites section includes the objective and subjective criteria that will be used to evaluate the proposals, which include the mandatory minimum requirements, technical criteria, and other prerequisites that Offerors must read and agree to in order to respond to this RFP. • The Buyer Attachments section includes the standard contractual terms and conditions of this RFP and other documents required for this RFP. • The Questions section allows the State to ask Offerors questions regarding this RFP. Offerors must review each section carefully. To determine which proposal provides the best value to the conducting procurement unit, the evaluation committee shall evaluate each responsive and responsible proposal that has not been disqualified from consideration under the provisions of Part 7 of Utah Code 63G-6a, using the criteria described in this RFP. After the evaluation and final scoring of proposals is completed, the State shall award the contract as soon as practicable (subject to the requirements of Utah Code Section 63G-6a-707(10)) to the eligible responsive and responsible Offeror, subject to Utah Code Section 63G-6a-707(10), provided the RFP is not canceled in accordance with Utah Code Section 63G-6a-902. Required to View Event Prerequisites Required to Enter Bid 26 April 2024 1. If received, a solicitation award does not constitute a binding contract. 2. Offerors are encouraged to review this RFP prior to the deadline to submit a proposal, even if a proposal has been submitted, in case an addendum has been issued by the issuing procurement unit. 3. All questions must be submitted through SciQuest during the Question and Answer period. 4. Offeror must guarantee its pricing for the period described in this RFP. 5. If it is determined to be in the best interest of the Conducting Procurement Unit, interviews and presentations may be held at the option of the State. 6. Offerors may request that part of its proposal be protected by submitting a Claim of Business Confidentiality Form. See the Buyers Attachment section. 7. The proposed Scope of Work has been attached to this RFP in the Buyer's Attachment. 8. The mandatory minimum requirements are the objective criteria in which the conducting procurement unit will evaluate proposals. Offerors must upload a document which provides a point by point response to the mandatory minimums listed in this prerequisite. 9. To determine which proposal provides the best value to the State, the evaluation committee will evaluate each responsive and responsible proposal that has not been disqualified or rejected using the subjective criteria listed in this prerequisites section. 10. Offeror's cost proposals will be evaluated independently. 11. All proposals in response to this RFP will be evaluated in a manner consistent with the Utah Procurement Code, Administrative Rules, policies and the evaluation criteria in this RFP. Offerors bear sole responsibility for the items included or not included within the proposal submitted by the Offeror. Each area of the evaluation criteria must be addressed in detail in the proposal. 12. Offeror may take exception and/or propose additional language to the Standard Terms and Conditions that have been attached to this RFP. 13. Offeror must agree with the following in the event they are awarded a contract. 14. The issuing procurement unit may not accept a proposal after the time for submission of a proposal has expired. 15. Offeror acknowledges the requirements to submit a proposal through SciQuest. 16. Proposals must be submitted electronically, through SciQuest. 26 April 202426 April 202426 April 202426 April 202426 April 2024 Buyer Attachments 1. Attachment A_General Provisions (3).docx 2. Attachment B_IT Standard Terms and Conditions 11 Jan 2024 (1) (1).docx 3. Attachment C_DHHS BAA Template 8.14.2023.docx 4. Attachment D_DHHS Point of Sale SOW Outline (5).docx 5. Attachment E_Technical Criteria Narrative Questions (1) (1).docx 6. Attachment F_Pharmacy Special Requirements (4) (1).docx 7. Attachment G_Cost Proposal Form_08.09.2022 (1).xlsx 8. Attachment H - Performance Standards.docx 9. Attachment I_PRISM Interface Document (2).docx 1 0. Attachment J - Final Scoresheet (1).xlsx 1 1. Attachment K - Introduction_Purpose_Background (1).docx 1 2. Claim of Business Confidentiality 12.7.20.pdf 1 3. 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Only costs submitted on THIS form in THIS section will be used. Any alterations to this form, or using the incorrect form will result in the vendor being non-responsive. 1.5 Do you acknowledge that you will be asked to sign a Business Associate Agreement form Attachment C if and when you are awarded a contract? 1.6 Do you agree to and understand the Performance Standards listed in Attachment H? If no, please upload redlines in question 1.7. 1.7 If you have redlines to attachment H regarding question 1.6, please upload them here. 1.8 Do you acknowledge that there will be a demonstration section to this RFP for those that pass the Minimum Mandatories and minimum Technical Threshold? 1.9 Please upload your organization’s annual financial statements for the last two (2) fiscal years. If the financial statements have been audited then please provide a copy of the independent certified public accountant’s (CPA) Opinion Statement and report. Group 2: Acceptance of Prerequisites Instructions: 2.1 Offeror acknowledges that it is the offerors responsibility to upload any and all documents in responding to the solicitation. If the vendors fails to upload a document, uploads an incorrect document, uploads a blank document, or uploads any document incorrectly the State of Utah may not allow the vendor to make changes following the closing of the solicitation. 2.2 Is Offeror presently or has Offeror ever been debarred, suspended, proposed for debarment, or declared ineligible by any governmental department or agency, whether international, national, state, or local? 2.3 Offeror acknowledges that they do not have financial ties to individuals or entities on an OFAC sanctions list. 2.4 If Offeror has any information that is not already provided within its proposal that if known to the State would impact the State’s determination on offeror’s responsiveness for a contract award (i.e., legal action, recent turn-over in major personnel, loss of a major contract, any alleged violations of federal, state or local regulations, etc.), please mark “yes” to this question and upload such information in the space provided below. Otherwise, please mark “no”. Please see UCA 63G-6a-120 & 902 for additional details. 2.5 Please upload information impacting Offeror’s responsiveness here. 2.6 Offeror acknowledges that it must acquire and maintain all applicable federal, state, and local licenses before the contract is entered into. Licenses must be maintained throughout the entire contract period. Persons doing business as an Individual, Association, Partnership, Corporation, or otherwise shall be registered with the Utah State Division of Corporations and Commercial Code. NOTE: Forms and information on registration may be obtained by calling (801) 530-4849 or toll free at 877-526-3994, or by accessing: www.commerce.utah.gov. 2.7 In the event that an Offeror offers pricing discounts for educational entities that (1) are applicable to this solicitation and (2) result in lower pricing than what is generally offered to other governmental entities, please attach a separate cost proposal labeled “Educational Pricing” to your proposal. This cost proposal for Educational Pricing is to be submitted in addition to the original Cost Proposal Form and will only be available to authorized end users. The Educational Pricing will not be used to evaluate costs. Offeror acknowledges that it has read and understands this question. 2.8 Does Offeror have an outstanding tax lien in the State of Utah? If yes, Offeror must provide a statement regarding its debarment or suspension. Group 3: Vendor Information Instructions: 3.1 Please provide your firm's legal company name. 3.2 Please provide your federal tax identification number. (If the vendor is sole proprietor please do not provide your social security number.) 3.3 Please provide your firm's contact information for this contract, including the name, phone number, and email address of your firm's authorized representative. 26 April 202426 April 202426 April 2024 3.4 Please provide your ordering address and the remit to address. Please clearly identify each address. 3.5 Please provide your firm's State of Utah Sales Tax ID Number. If you do not have a State of Utah Sales Tax ID Number, please write "N/A". 3.6 Identify your firm's type of business. 3.7 Is Offeror (owners, principles, partners) a retiree currently receiving benefits through the Utah Retirement Systems (URS)? 3.8 Is Offeror an employee of the State of Utah? If yes, then Offeror must submit an external employment form signed by Offeror's manager at the State of Utah. Group 4: Vendor's Submission Instructions: 4.1 Offeror/Bidder understands and acknowledges that if Offeror/Bidder accessed the "View as PDF" document available on the Utah Public Procurement Place Business Opportunities website and did not login to Offeror/Bidder's account in the Utah Public Procurement Place system, that Offeror/Bidder may not be viewing the entire the sourcing event and therefore may not be viewing the complete sourcing event requirements. Offeror/Bidder acknowledges that Offeror/Bidder has logged into Utah Public Procurement Place account and viewed the full sourcing event requirements including hyperlinks before submitting a response to a sourcing event. 4.2 Potential Conflicts of Interest. Vendor must identify any conflict, or potential conflict of interest, that might arise during the contract. If no conflicts are identified or expected, write “None” in this section. 4.3 If your firm is requesting parts of its proposal be protected please upload your Claim of Business Confidentiality Form here as well as your redacted proposal. 4.4 Any exceptions to the Terms and Conditions must be uploaded here in the format outlined in Prerequisites: Standard Terms and Conditions (Exceptions and Negotiations). Further, any vendor terms and end user agreements (EULAs) required by your firm must also be uploaded here in the format outlined in Prerequisites: Standard Terms and Conditions (Exceptions and Negotiations). If you are submitting exceptions you must also provide contact information of your firm's legal personnel (name, email, and phone #) for T&Cs negotiations. Exceptions and/or additions submitted after the date and time for receipt of proposals will not be considered. If you have no exceptions or additions, upload a document stating "None" . 4.5 Offeror affirms that yes that pursuant to the Code of Federal Regulations 2 CFR 200.216 - Prohibition on certain telecommunication and video surveillance services or equipment, that none of the goods (including component parts) or services offered within its proposal are from the entity Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate of such entities). 4.6 Vendor understands and acknowledges that its response, including all uploaded documents, will not be considered received by the State of Utah unless the Vendor clicks submit. Even if Vendor uploads all required documents and responds to all required questions its response will not be considered if it does not click submit. Offeror acknowledges that after completing the solicitation it must click on the link in the left hand menu bar labeled “Review & Submit”, then check the box under the “Certification” heading to certify their bid. Then click the blue box labeled “Submit Response” in order to submit their bid. Once the response has been submitted, Vendor will receive a confirmation that the response was successfully submitted. Vendors who fail to submit their response will not have their response reviewed and will be ineligible for further consideration under this solicitation. 26 April 202426 April 202426 April 2024