Request for Proposals
Pharmacy Benefit Services
Request for Proposals
ENTITLED: "Pharmacy Benefit Services for The Empire Plan, Excelsior Plan, Student Employee Health Plan, and NYS Insurance Fund Workers' Compensation Prescription Drug Programs"
Release Date: August 14, 2023
Proposal Due Date: November 13, 2023 3:00 p.m. ET
The Pharmacy Benefit Services RFP has been Amended as of October 30, 2023
All inquiries, questions, filings and submission of Proposals must be directed in writing to:
NYS Department of Civil ServiceAttn: Office of Financial Administration, Floor 17
Agency Building 1, Empire State Plaza
Albany, New York 12239
E-mail: DCSprocurement@cs.ny.gov
Table of Contents
Request for Proposals
Pharmacy Benefit Services RFP Amended October 30, 2023
Appendix
APPENDIX A - Standard Clauses for New York State Contracts
APPENDIX B - Standard Clauses for All Department Contracts
APPENDIX D (NYSIF) Amended
Attachments
ATTACHMENT 1 - Offeror Affirmation of Understanding and Agreement
ATTACHMENT 2 - DCS 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
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 - Enrollment by Plan, by Month
ATTACHMENT 24 - Enrollment by Plan, by Age
ATTACHMENT 25 - Covered Lives by Plan Amended
ATTACHMENT 26 - Covered Lives by Union Group Amended
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 Amended
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 - January 2023
ATTACHMENT 51 - Preferred Drug Lists - January 2023 (Excel)
ATTACHMENT 52 - Excluded Drug Lists - January 2023
ATTACHMENT 52 - Excluded Drug Lists - January 2023 (Excel)
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 Amended
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 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 - 2022 Incurred Claims
ATTACHMENT 72 - Selected Financial Data
ATTACHMENT 73 - 2020-2022 Incurred Claims by Month - Combined
ATTACHMENT 74 - 2020-2022 Incurred Claims by Month - EGWP
ATTACHMENT 75 - 2020-2022 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 Amended
ATTACHMENT 84 - Layout Specifications for DCS Program Informational Claims Data File Amended
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 Amended
ATTACHMENT 89 - Specialty Pharmacy Program Dispensing Fees
ATTACHMENT 90 - Pharma Revenue Guarantee Quote Amended October 30, 2023
ATTACHMENT 91 - Documentation to Support Pharma Revenue Guarantee Quote
ATTACHMENT 92 - Claims Administration Fee(s) Quotes
ATTACHMENT 93 - Vaccination Administration Fees Amended
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 Amended
ATTACHMENT 98 - Paper Claims New
ATTACHMENT 99 - Prescribing Fee-Eligible Medications New
ATTACHMENT 100 - August 2023 Formulares by NDC New
ATTACHMENT 101 - September 2023 EGWP Formulary New