SECTIONI. GENERAL

  1. Please provide the full legal name of the organization responding to

this Request for Proposal.

  1. Please describe the corporate structure of your organization, including

the physical locations of those facilities providing relevant services.

Please provide copies of your audited financial statements for our last

two fiscal years.

  1. Please provide a representative list of card-type prescription drug

plans you currently administer in Pennsylvania, and separately for

multi-employer health funds, and for each indicate the annual number

of participants covered.

  1. Describe the terms and conditions under which your company and/or

the contract holder may terminate services.

  1. Please explain your standard subrogation policy provisions and

procedures and any options that are available, along with their

advantages and disadvantages.

  1. Does your organization recognize ERISA fiduciary responsibility?
  1. Is your firm anticipating any significant restructuring in the future?
  1. Is your organization able to provide plan design assistance? For

example, can your organization project savings/additional cost if

the Fund were to modify its plan design?

SECTION II. AMINISTRATION

  1. How do you propose to obtain and update participant eligibility

records?

  1. Do you agree to provide plastic identification cards and replacement

cards on request as needed? Can prescription drug cards be produced

within 24 hours, if necessary? Would there be an extra charge?

  1. Will you need any of the past historical claims records to process

claims on your system? Please describe such information.

  1. Please describe in detail your firm’s level of compliance with, and

readiness to assist the Fund in complying with the provisions of

HIPAA and the DOL regulations on claims appeals.

  1. Will you maintain a toll-free dedicated phone number and/or web-site

for use by Fund participants for drug related questions? During what

hours and days is the toll-free number available? Please describe

services available to the participants:

Determine if their medication is defined as a maintenance drug.

Determine the closest network pharmacy to their house.

Determine the status of their mail order prescription.

  1. The Fund provides prescription drug coverage to active and retired

medicare eligible participants and dependents. Describe the services

you offer in the following areas:

Determination of Creditable Coverage

Notice of Creditable Coverage

Determination of eligibility for subsidy (RDS)

Plan re-design to maximize subsidy (RDS)

SECTION III. REPORTING

  1. Please provide copies of management reports that are available to

the Fund with respect to drug utilization, patient and pharmacist

profiles. Would these reports provide such things as an analysis of the

100 most commonly prescribed drugs (compressing drug strength); a

listing of members who incur $500 or more in claims; separate

utilization information by group/level of benefit? How often will these

reports be provided? How do you typically exchange paid claims

information with your clients? Can this be done electronically?

  1. Can you provide an internet interface between your office and the

Fund? What services would be available to the Fund via the internet?

  1. Describe your utilization Review System as it pertains to identifying

individuals who: stockpile medication, obtain too frequent refills, are

receiving drugs that are harmful when used in combination with other

prescribed drugs, are possible drug abusers. What services do you

provide to interact with prescribing physicians and/or participants in

this regard?

  1. Can you provide samples of management reports that can isolate the

components of cost increases in the prescription drug benefit? For

example; increases in population, cost per prescription, utilization,

new medication, etc.

  1. Describe the means used to coordinate the utilization data of mail

service program with that of the prescription drug card program so

the Fund may receive comprehensive information on its entire

prescription drug plan.

  1. Describe any additional fees associated with any of the reporting

services described above.

SECTION IV. NETWORK

1.Please prepare an analysis of the participant data contained in the supplied zip code census, showing participating network pharmacy access at 2 mile, 5 mile and 10 mile radius

2.Can network pharmacies bill electronically? If so, what audit

procedures does your company have in place to assure billing

accuracy?

3.Describe your protocol for handling problems and complaints about

pharmacies.

  1. Describe in detail the auditing program maintained by your company.

In describing the program, please address the following questions:

How many auditors are involved in pharmacy audits? On what basis

are pharmacies selected for audit? Will you perform an audit at the

request of the client? What percentage of network pharmacies were

audited during calendar year 2004? Will you provide the Fund the

copies of the audits or summaries thereof? Please provide samples of

audit worksheets and reports.

  1. Can the plan sponsor or a plan participant nominate pharmacies to be

considered for inclusion in the network panel? What about deletions

or exclusions? If so, what steps would be required to be made by the

plan sponsor and/or participant?

  1. How often are provider directories updated and dispersed to plan

members? Are they accessible through the internet?

SECTION V. PLAN PROVISIONS

The successful PBM must have the capacity to maintain and administer multi-tiered co-pay drug formularies, acute and maintenance days supply programs, and a mail order component.

  1. Can your organization administer such a program? Can you be pro-active in assisting the Fund to identify new drugs as preferred or non-preferred and to move them back to a “brand name” categorywhen appropriate? What alternatives would you suggest the Fundimplement in terms of plan design to replace the cost saving levelscurrently achieved?

SECTION VI. MAIL ORDER DRUG PROGRAM

  1. Do you maintain your own pharmacy or rent/lease from another

provider? If you rent or lease, how long is your current relationship

under contract?

  1. Identify the location of your mail order facilities.
  1. Provide an example of the order form/envelope participants would use

to submit a mail order prescription.

  1. Can prescriptions be refilled via the internet? If so, please provide the

site address and describe the process.

  1. Do you maintain an “emergency” refill plan to allow participants who

order but do not receive their refill timely or who fail to reorder

timely, the ability to receive an emergency supply of medicine from a

network retail pharmacy? If so, please describe the emergency plan.

  1. What is the maximum supply per prescription that you recommend be

provided via mail order?

  1. What is your in-house turnaround time for filling prescriptions?
  1. Describe the means used to collect the Plan’s co-payment.
  1. What means are used to send prescription medication to participants?

Is there a separate mailing charge? If so, what is the amount?

  1. Is your mail service pharmacy properly licensed and in full compliance with all applicable state and federal laws and regulations?
  1. Would your facilities be available for a yearly on-site visit by an auditor of the Fund’s choosing?
  1. Describe in detail how you would handle a participant’s complaint

regarding:

Medication never received by the participant

Wrong medication received; either never ordered or someone else’s prescription received

Participant insists on brand name, but received generic equivalent.

  1. Who would pay for a second mailing if resolution of one of the above

complaints warranted it?

  1. Describe in detail your quality control system to insure the properdispensing of the medication, dosage, amount, direction, etc. Includea description of all steps in the process from the time the prescriptionis received until the time the medications are mailed and follow-up,if necessary. Would this be open to auditing by a pharmacist of theFund’s choosing?
  1. What type of early refill limitations do you have in place?
  1. What anti-tampering precautions are taken in your packaging/mailing process?
  1. Can you custom design brochures and announcement letters? Who

assumes the cost of such mailings?

SECTION VII. FEES AND ESTIMATED PROGRAM COSTS

  1. Provide an all inclusive administration fee on a per claim or per member per month basis to cover all claims processing, reporting, customer and network services, clinical support at an analysis and recommendation level and eligibility maintenance.

For what period of time will the administrative fees referred to above be guaranteed?

  1. Do you offer performance guarantees of any type? If so, please provide details. If not, why not?

Performance guarantee – Claims Processing/Timeliness

Performance guarantee-Claims Processing/Accuracy

Performance guarantee- Inquiry Responsiveness

Performance guarantee-Claims Processing/Downtime

Performance guarantee-Claims Processing/Response Time

Performance guarantee-File Loads

Performance guarantee-Data Integrity

Performance guarantee-Mail Service

  1. Have your administrative fees been discounted to take into effect any

rebates or any other forms of remuneration directly or indirectly from drug manufacturers? If so, and if you are not administering either the Fund’s rebate program or the utilization review program, then what is the basis for applying the discount?

  1. Describe the discount from current AWP and dispensing fee for each of the following configurations. For generic drugs, indicate the MAC yield for MAC drugs and the AWP discount provided for non MAC’d generic drugs:

Up to 31 days supply filled in a retail network pharmacy

Up to 90 days supply filled in a retail network pharmacy

Up to 90 days supply filled in a mail facility

  1. Have your discounts been enhanced to take into effect any rebates or any other forms of remuneration directly or indirectly from drug manufacturers? If so, and if you are not administering either the Fund’s rebate program or the utilization review program, then what is the basis for applying those enhancements when reporting your discounts?
  1. What is your source for AWP (average wholesale price)? How often are prices updated?
  1. Will you agree to permit an annual audit of your claims files at your expense by client representative to verify the pricing discounts?
  1. Will you agree to permit an annual audit of your contracts with drug

manufacturers or any other party from which you receive rebates or any other form of remuneration?

  1. Will you agree to permit the Fund to meet with drug manufacturers or other parties with whom you have contracts to discuss any direct or indirect form of remuneration you receive from them?
  1. Please describe in detail how you obtain drug rebates for the Fund based on the current plan design. If you have a suggested change in plan design that would enhance the Fund’s ability to obtain rebates,

please describe those changes and project any increase in drug costs that would arise as a result of the design, and separately the additional rebates the Fund would be entitled to. Describe the portion of rebates your company would retain.

12.Where are your rebates and/or discounts or other forms of remuneration obtained from? Include Drug Manufacturers and other third party providers?

  1. What cost-effective services can you provide with respect to providing Fund participants with specialty drugs?

14.What cost saving ideas would you suggest the Trustees consider? Describe their advantages and estimated savings.

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