Request for Proposal
Pharmacy Benefit Services for The Empire Plan, Excelsior Plan,
Student Employee Health Plan and New York State Insurance
Fund Workers' Compensation Prescription Drug Programs
Table of Contents
Request for Proposals (RFP) | |
Section I: | Introduction |
Section II: | Procurement Protocol and Process |
Section III: | Administrative Proposal Requirements / Word Version |
Section IV: | Technical Proposal Requirements / Word Version |
Section V: | Cost Proposal Requirements / Word Version |
Section VI: | Evaluation and Selection Criteria |
Section VII.A: | Draft Contract (DCS Version) | Section VII.B: | Draft Contract (NYSIF Version) |
Section VIII: | Glossary of Terms |
Appendix | |
Appendix.A: | Standard Clauses for New York State Contracts |
Appendix.B: | Standard Clauses for All DCS Contracts |
Appendix.B: | Standard Clauses for All NYSIF Contracts |
Appendix.C: | Third Party Connection and Data Exchange Agreement (DCS) / Word Version |
Appendix.C: | Third Party Connection and Data Exchange Agreement (NYSIF) / Word Version |
Appendix.C-1: | Information Security Standards |
Appendix.D: | Participation by Minority and Women-Owned Business Enterprises: Requirements and Procedures |
Appendix.D-1: | Minority and Women-Owned Business Enterprises - Equal Employment Opportunity Policy Statement (DCS) / Word Version |
Appendix.D-1: | Minority and Women-Owned Business Enterprises - Equal Employment Opportunity Policy Statement (NYSIF) / Word Version |
Appendix.D-2: | MWBE Utilization and Reporting Responsibilities Under Article 15-A |
Exhibit III | |
Exhibit III.A: | 2015 - 2017 Incurred Claims |
Exhibit III.B: | Intentionally Left Blank |
Exhibit III.C: | Selected Financial Data |
Exhibit III.D: | 2017 Incurred Claims by Month - Combined |
Exhibit III.D.1: | 2016 Incurred Claims by Month - Combined |
Exhibit III.D.2: | 2015 Incurred Claims by Month - Combined |
Exhibit III.D.3: | 2017 Incurred Claims by Month - EGWP |
Exhibit III.D.4: | 2016 Incurred Claims by Month - EGWP |
Exhibit III.D.5: | 2015 Incurred Claims by Month - EGWP |
Exhibit III.D.6: | 2017 Incurred Claims by Month - Commercial |
Exhibit III.D.7: | 2016 Incurred Claims by Month - Commercial |
Exhibit III.D.8: | 2015 Incurred Claims by Month - Commercial |
Exhibit III.E: | Current Brand-Generic Classification |
Exhibit III.F: | Paid Claims Per Cycle |
Exhibit III.G: | NYSIF Prescription Plan Payments |
Exhibit III.H: | NYSIF Quarterly Breakdown Payments |
Exhibit III.I: | Medical Exception Program Claims Experience |
Exhibit III.J: | External Appeal Review Fees |
Exhibit III.K: | NYSHIP Compound Claims Summary / Excel Version |
Exhibit IV | |
Exhibit IV.A: | Program Services Matrix |
Exhibit IV.B: | Diversity Practices Questionnaire / Word |
Exhibit IV.C: | NYS Diversity Practices Scoring Matrix |
Exhibit V | |
Exhibit V.A: | Proposed Claim Reimbursement Quote / Excel Version |
Exhibit V.B: | Layout Specifications for DCS Program Informational Claims Data File / Word Version |
Exhibit V.B.1: | Layout Specifications for NYSIF Program Informational Claims Data File / Word Version |
Exhibit V.B.2: | Designated Specialty Pharmacy Identifiers |
Exhibit V.C: | Retail and Mail Service Pharmacy Generic Drugs - MAC List Costs per GPI / Excel Version |
Exhibit V.D: | Specialty Pharmacy Program Dispensing Fees / Excel Version |
Exhibit V.E: | Pharma Revenue Guarantee Quote / Excel Version |
Exhibit V.E.1: | Documentation to Support Pharma Revenue Guarantee Quote |
Exhibit V.F: | Claims Administration Fee(s) Quotes / Excel Version |
Exhibit V.G: | Vaccination Administration Fees / Excel Version |
Exhibit V.H: | DCS Classified Generic Drugs |