SSN 180387 Part D Formulary and Benefits Assessments Part D Formulary and Benefits Assessments THIS IS NOT A FORMAL REQUEST FOR PROPOSAL (RFP) AND DOES NOT COMMIT THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) TO AWARD A CONTRACT NOW OR IN THE FUTURE This is a SOURCES SOUGHT NOTICE (SSN) to determine the availability of small businesses on the GSA 00Corp Professional Services Schedule (PSS) that have the capability to support the Centers for Medicare & Medicaid Services (CMS) in conducting Medicare Part D Formulary and Benefits Assessments. CMS desires to obtain a contractor that will assist the agency in reviewing Part D sponsor formularies and benefits related to the prescription drug program. A. General Background In January 2005, the Centers for Medicare & Medicaid Services (CMS) issued the final rule on the Medicare prescription drug benefit. This new voluntary prescription drug benefit program was enacted into law in December 2003, in Section 101 of the Medicare Prescription Drug, Improvement and Modernization act of 2003 (MMA). The addition of a prescription drug benefit to Medicare represents a landmark change to the Medicare program that will significantly improve the health care coverage available to millions of Medicare beneficiaries. The prescription drug benefit program or Part D, became available to beneficiaries beginning on January 1, 2006. As of late 2017, over 42 million beneficiaries are enrolled in Medicare Part D. The drug benefit is offered to Medicare beneficiaries through over 5000 Medicare Advantage drug plans (MA-PDs) and stand-alone prescription drug plans (PDPs). The effective monitoring and oversight of the Medicare Part D benefit requires CMS to conduct data analyses using various sources of input data, which may include, but are not limited to: • Analyzing and summarizing contract/plan benefit and formulary offerings, enrollment data and prescription drug event (claims) data. • Analyzing the relationship between drug utilization and health status or other characteristics of the beneficiary or plan. The Contractor shall conduct planned and ad hoc data analyses for the Medicare Part D program. This initiative will assist CMS in determining whether the Part D formulary and benefit offerings are being administered as approved or dictated by Title I of the MMA. Results of these analyses may influence future Part D formulary and/or benefit requirements. INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law. B. Skills required of the contractor shall include: • Knowledge and understanding of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003 and the Medicare Prescription Drug Benefit Manual. • Knowledge and experience with pharmacy benefit management practices including the review/operations of formularies, tier structures, cost-sharing and drug utilization management (DUM) tools including prior authorization, step therapy and quantity limits. • Ability to provide data and/or reports to CMS or Part D sponsors as directed by CMS via a secure method and in a format designated by CMS, such as a SAS® dataset, Microsoft Excel® table, Microsoft Access™ database, delimited text file, or other specified format. • Prior experience that demonstrates the ability to perform data production requirements using the most cost efficient methods available. • Prior experience using multiple data sources from different organizations to produce multiple data files. • Having a history of keeping to a schedule managing multiple tasks. • Experience in effective project management. • Ability to produce ad hoc reports in response to CMS inquiries with short turn around times. • Prior experience performing multiple analyses under tight timeframes. • Prior experience using and analyzing large data sets and merging data from multiple sources. C. Description of Major Tasks: The major tasks for Medicare Part D Formulary and Benefits Review include: • Facilitating the monitoring and oversight of the Medicare Part D benefit between and within contract years, the Contractor shall provide analyses related to prescription drug event, enrollment and risk adjustment data. Data files constructed under this task are expected to be very large (e.g. the task will include the building of person level records and plan level records). Depending on the specific scenario and type of data being analyzed, the Contractor shall utilize any of the following types of analyses:  Univariate statistics,  Frequency distributions,  Weighted statistics,  Statistical outlier identification,  Regression modeling,  Or other types of analyses specified by CMS. The Contractor shall access data sources including, but not limited to:  Prescription drug event data from the Drug Data Processing System (DDPS) INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.      Integrated Data Repository (IDR) Beneficiary data from the Medicare Beneficiary Database (MBD) Long Term Care Minimum Data Set (MDS) Risk adjustment data, Out of Pocket Cost (OOPC) data Other CMS databases Analyses to be performed may include, but are not limited to: • The contractor shall provide a yearly Formulary Administration Analysis (FAA) • The Contractor shall provide a yearly Transition Monitoring Program Analysis (TMPA) • The Contractor shall provide a yearly Marketed versus Approved (MvA) analysis • The contractor shall provide a Specialty Tier analysis to ensure that Part D sponsors are compliant with Centers for Medicare & Medicaid Services (CMS) policy, where drugs with negotiated prices exceeding an amount specified in the Call Letter per month may be placed on specialty tiers. • Other reports, data, and analyses specified by CMS, such as:  Evaluating prescription drug event, enrollment data, and/or risk adjustment data for drug utilization and/or costs such as: • Contract/plan drug claims and cost shares for formulary, nonformulary, and excluded drugs • Contract/plan drug claims and cost shares assessed for Low Income Subsidy (LIS) beneficiaries • Contract/plan drug claims and cost shares from Long Term Care (LTC) facilities • Contract/plan drug claims and cost shares for preferred and nonpreferred pharmacies  Comparing contract/plan prescription drug event and enrollment data with benefit and formulary offerings such as: • Negative formulary change request data • Tier designations and cost share data • Gap coverage data • Drug utilization restrictions • Excluded drug coverage data • Home infusion bundling • Zero cost share tiers • Free first fill files INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law. • Developing criteria for an efficient formulary model and a process for constructing an efficient formulary, and evaluate existing Part D formularies against this model. • Constructing predictive models for beneficiary plan characteristic choices. • Recommending additional or alternative analyses for purposes of Part D monitoring and oversight. • The Contractor shall provide all data or reports to CMS or Part D sponsors as directed by CMS via a secure method and in a format designated by CMS, such as:  SAS® dataset  Microsoft Excel® table  Microsoft Access™ database  Delimited text file  Other specified format. D. Required Demonstrated Knowledge and Experience Potential offerors must demonstrate the following knowledge and experience: • Demonstrate knowledge and understanding of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). • Demonstrate knowledge and understanding of Chapters 1, 5, 6, and 7 of the Medicare Prescription Drug Benefit Manual. • Ability to interface with data systems in a secure environment. • Ability to store, retrieve and analyze formulary and benefit files and data. • Ability to conduct meetings and participate in conference calls with Part D sponsors to communicate formulary and/or benefits related concerns. • Ability to develop a work management plan that includes resource planning by activity, key staff types devoted to each activity, milestones pertinent to successfully completing the activity and quality insurance processes to ensure accurate and consistent outcomes. • Ability to conduct ad-hoc analyses and produce ad-hoc reports in response to CMS inquiries. • Ability to produce formulary and/or benefits review results in a comprehensive format stipulated by CMS by the required deadlines. • Ability to produce monthly and annual reports of all activities. Along with the above, the following specific information is requested: (a) company descriptive literature; (b) specific related corporate experience; (c) experience with the type of performance expectations mentioned above; and (d) references (to include a point of contact and phone number) with firsthand knowledge of the experience cited in (b), and (c) above; (e) Business information outlined below. INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law. Business information: a. DUNS b. Company Name c. Company Address d. Company Point of Contact, phone number and email address e. Type of company under NAICS: 541611 – Administrative Management and General Management Consulting Services (Size Standard: $15 million), as validated via the Central Contractor Registration (CCR). All offerors must register on the CCR located at https://www.sam.gov. Additional information on NAICS codes can be found at www.sba.gov. f. Current GSA Schedules appropriate to this Sources Sought Notice g. Point of Contact, phone number and email address of individuals who can verify the demonstrated capabilities identified in the responses. Responses are limited to no more than ten (10) pages for the capability statement. Capability statements shall designate any/all teaming arrangements and the work proposed to be performed by each team member. All transmitted information marked proprietary shall be treated as such. Therefore, businesses should identify any proprietary information in their responses. Proprietary materials will neither be distributed, nor discussed with, any other organization. Information submitted in response to this will be used at the discretion of the Government. Further, the information submitted will remain confidential insofar as permitted by law, including the Freedom of Information and Privacy Acts. Respondents should be aware that this SSN is for marketing purposes only and any responses thereto, or lack thereof, will not constitute a commitment by CMS to treat any potential offeror more or less favorably in the anticipated forthcoming solicitation and/or ultimate award. Please be advised that CMS will not respond directly to organizations submitting information in response to this SSN. Documentation should be sent electronically via e-mail to: Centers for Medicare & Medicaid Services (CMS) Attn: Rachel Johnson, Contract Specialist Office of Acquisitions and Grants Management (OAGM) Mailstop: B3-30-03 7500 Security Boulevard Baltimore, MD 21244 Email: rachel.johnson@cms.hhs.gov INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.