SOLICITATION NOTICE
R -- Auditing Services for Pharmacy Benefits Management Program
- Notice Date
- 12/23/2003
- Notice Type
- Solicitation Notice
- Contracting Office
- Office of Personnel Management, Contracting, Facilities and Administrative Services Group, Contracting Division, 1900 E Street, N.W., Room 1342, Washington, DC, 20415-7710
- ZIP Code
- 20415-7710
- Solicitation Number
- OPM-RFP-04-00011HW
- Response Due
- 1/22/2004
- Archive Date
- 2/6/2004
- Point of Contact
- Henry Wong, Contract Specialist, Phone (202) 606-1598, Fax (202) 606-1464,
- E-Mail Address
-
hlwong@opm.gov
- Small Business Set-Aside
- Total Small Business
- Description
- INTRODUCTION The Office of Personnel Management (OPM) Office of Inspector General (OIG) is requesting proposals from contractors to perform data analysis and consulting services to assist OIG in auditing Pharmacy Benefit Managers (PBMs) which administer the mail order and retail drug programs to members of the Federal Employees Health Benefits Program (FEHBP). The contractor will review the compliance and pricing practices for contracts between the BlueCross BlueShield Association, a participating carrier in the FEHBP, and two PBMs, Medco and Advance PCS. The FEHBP was established by Public Law 86-382 and became effective on July 1, 1960. It is the largest employer-sponsored group health insurance program in the world, covering over 9 million Federal employees, retirees, former employees, family members, and former spouses. The Government pays up to 75% of the cost of health benefits coverage, and the enrollee pays the remainder, based on a formula set by law. FEHBP carriers are responsible for adjudicating the claims of and providing health benefits to, enrollees and covered family members in accordance with their contracts with OPM. OPM has the overall responsibility for the administration of the FEHB Program. This includes approving or disapproving carriers/health plans for participation in the FEHB Program; contracting with carriers; negotiating benefit and rate changes with carriers; approving the health plan brochures; and for publishing FEHB regulations, instructions, forms, and documents. OPM is also responsible for receiving and depositing premium withholdings and contributions, remitting premiums to carriers, and accounting for the Federal Employees Health Benefits Fund. The Office of Inspector General (OIG) conducts audits of the various participating health plans participating in the FEHBP. These financial related audits are to determine if the carriers charged costs to the FEHBP and provided services to FEHBP members in accordance with the terms of the contract. Specifically, the OIG reviews claim payments, administrative expenses, and cash management activities of these carriers. BACKGROUND OPM executed the initial contract (CS 1039) with Blue Cross Blue Shield Association (BCBSA) in 1960, following the passage of Public Law 86-382. BCBSA participates in the FEHBP as the Carrier for the Service Benefit Plan and offers benefits to Federal employees on a Government wide basis. An administrative office, the Federal Employee Program Director's Office (FEPDO), was established to provide centralized services to the Federal Government. Today, BCBSA represents over 50 local BCBS plans that provide health benefits to about four million Federal employees, retirees and dependents. The FEPDO continues to provide liaison activities to the Federal Government on behalf of the local BCBS plans. The FEPDO is responsible for ensuring the Federal Government's instructions, requests and policies are implemented by its business partners, in addition to the local Plans, and for ensuring compliance with the Federal contract. In 1990, Tthe BCBSA entered into direct contract arrangements with two significant business partners, Merck/Medco in 1987 and Advance PCS in 1993, to provide a mail order drug program and a retail pharmacy program, respectively. For contract year 2002, these two PBMs were paid approximately $36 billion for benefits to rom the Federal Government for their services through their BlueCross BlueShield subscribers in the FEHBP.contracts. OBJECTIVES AND SCOPE OF WORK The OIG seeks a contractor with specific expertise in the PBM and pharmacy benefits contracting areas to assist OIG in auditing PBMs. The objectives of the contract are to: (1) determine whether Medco and PCS paid pharmacy claims accurately and in accordance with the contract for years 2000 through 2002, (2) identify unusually high utilization of a particular drug by a pharmacy, physician, or member, (3) identify the 50 highest utilized drugs dispensed to FEHBP subscribers, (4) identify potential fraudulent claims, (5) identify ways to improve the contracts, and (6) assist OIG personnel in using the software analysis to audit the PBMs. The OIG plans on performing audits of these two PBMs using the data analysis provided by the contractor/consultant. The contractor is required to review 100 percent of the claims provided. The contractor is also required to provide a separate analysis for each of the PBMs. In order to achieve the objectives, the OIG believes that the contractor's data analysis should allow the OIG audit staff to: A. Verify various contract provisions related to pricing and administration, including, but not limited to: * Verify that correct Average Wholesale Price (AWP) was used and that the correct discount and administrative fees were applied. * Verify that correct dispensing fees were applied. * Verify the amount due from rebate programs. * Verify the amount of savings from generic drug substitution. * Identify any input errors. B. Identify any unusual trends or patterns when comparing the three years of data. C. Identify prescription splitting. D. Match drug therapy to medical diagnosis. E. Analyze the controls in place to manage these drug programs. F. IdentifyIdentify phantom and/or kited claims. G. Identify unauthorized product substitution. H. Identify the dispensing of substandard products. The contractor may demonstrate that its data analysis can meet the objectives by supplementing the above eight requirements. TECHNICAL QUALIFICATIONS Contractor must have capacity to store and analyze three years of claim records comprising approximately 175 million claim lines. Also, the OIG requires remote access to contractor's data base. These records are confidential and must be securely stored and transmitted. OTHER REQUIREMENTS The vendor, including all employees and subcontractors, must sign a confidentiality statement. Also, the vendor must provide security assurances, including storage, transmission, and destruction of, the claims data provided by the OIG. PROJECT LEADER The contractor shall provide a project leader who will be responsible for the performance of the work. The contractor will also designate an alternate when the project leader is absent. The project leader must have the authority to act for the contractor. The contractor must identify the key personnel that are essential to the success of the contractor's effort as described in its proposal. Substitutions for the critical personnel listed by the contractor must be approved, in advance, by the Contracting Officer Representative. CONTRACTING OFFICER All questions concerning this request for proposal should be made to Henry Wong, Contracting Officer, at 202 606-1598 (Voice Mail) or via email at hlwong@opm.gov. CONTRACTING OFFICER REPRESENTATIVE At the time of issuance of the request for proposal, the Contracting Officer will designate a Contracting Officer's Representative (COR), to provide technical direction and control during contract performance. The COR will not be authorized to change any contract terms and conditions. That authority is reserved exclusively to the Contracting Officer. RESUMES The Contractor shall include in their response for proposal the resumes of the individuals to be assigned to the project team. The Government must be given the opportunity to interview these individuals for project suitability. TERM OF CONTRACT The term of this contract will be from the date of issuance of the contract award through the date of completion. PLACE OF PERFORMANCE Services will primarily be performed off-site (contractor's facility). However, contractor will be allowed to perform services as needed at the Office of Personnel Management, Office of Inspector General, 1900 E Street, NW Washington DC 20415. TRAVEL The contractor's costs for travel, lodging, meals, and all other expenses incurred by the contractor's personnel in performance of work under this contract are included in the firm fixed-price for this procurement and are not separately reimbursable. INITIATION OF WORK Work under this contract will commence within thirty (30) days after award of the contract. COMPLETION OF WORK The deliverable products must be completed and provided to OIG within 90 days after the contract is awarded. DELIVERABLE PRODUCTS Contractor will provide electronic spreadsheets of the results of the software analysis, as well as, other written reports to meet Objectives 1 through 5 described in the Objective and Scope of Work section.The contractor will also provide support, when necessary, to document and resolve audit findings. TIME OF PERFORMANCE The milestone dates, in calendar days, for this purchase order are summarized below: Begin work Within 30 calendar days of award of the contract Oral briefing Upon commencement of work Written Status Advisory Weekly PROPOSAL SUBMISSION INSTRUCTIONS. - Detailed written description of how you will accomplish the objectives listed in "Objectives and Scope of Work" section. - Listing of the most recent 5 contracts completed during the past 2 years with a description of the work performed for each of the contracts. Also provide the names and a description of the work performed for any government agencies (federal, state, and local), BlueCross BlueShield plans, and PBMs in the past 3 years. - Submit the names and prior work experience of any subcontractors you may use to complete the contract. - Provide the name and description of any awards or noted accomplishments your company has received that would demonstrate you are capable of performing the services required. - Present the proposal orally (if requested). - Provide a firm fixed price for the six objectives described in the "Objective and Scope of Work" section. The solicitation document and incorporated provisions and clauses are those in effect through FAC 2001-18. The following clauses and provisions are applicable and will be incorporated into the solicitation by reference, and will be available in full text upon request. This acquisition incorporates the following FAR clauses: 52.212-1 INSTRUCTIONS TO OFFERORS-COMMERCIAL ITEMS; 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS-COMMERCIAL ITEMS must be completed and submitted along with the quote (please contact Henry Wong at (202) 606-1598 if a copy is needed; in accordance with FAR 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS-COMMERCIAL ITEMS, the following clauses are incorporated by reference in paragraph (b): 52.222-26 EQUAL OPPORTUNITY ( E.O. 11246); 52.222-35 AFFIRMATIVE ACTION FOR SPECIAL DISABLED AND VIETNAM ERA VETERAN (38 U.S.C. 4212); 52.222-37 EMPLOYMENT REPORTS ON SPECIAL DISABLED VETERANS AND VETERANS OF THE VIETNAM ERA(38 U.S.C. 4212); 52.222-36 AFFIRMATIVE ACTION FOR HANDICAPPED WORKERS(29 U.S.C. 793); 52.212-4 CONTRACT TERMS AND CONDITIONS COMMERCIAL ITEMS. FAR 52.219-19, NOTICE OF TOTAL SMALL BUSINESS SET ASIDE. The North American Industrial Classification System (NAICS) Code for this procurement is 524298, All Other Insurance Related Activities, with a small business size standard of $6 million. FAR 52.232-33, MANDATORY INFORMATION FOR ELECTRONIC FUNDS TRANSFER PAYMENT. FAR 52.212-2, EVALUATION OF COMMERCIAL ITEMS. Award will be based on a trade-off evaluation based on technical proficiency/past performance and price. The technical factors for evaluation of offerors are, in descending order of importance: 1. Software/Hardware to adequately analyze approximately 175 million claim records. 2. Understanding of the scope of the work and technical approach. 3. Contractor capability. 4. Capability to provide OIG remote access to claim data/analysis. 5. Past performance and technical experience. All eligible responsible sources may submit a proposal for consideration. Proposals are due by 3 PM, EST, January 22, 2004, to the Contracting Office address at U.S. Office of Personnel Management 1900 E Street, NW, Room 1342, Washington, DC. Please note that special safe mail handling procedures implemented by the U. S. Postal Service make physical delivery of mail to Federal facilities may cause delay in the delivery of mail. For this reason, faxed proposals will be accepted (followed by hard copy with original signature) to 202-606-1464. Potential offerors are solely responsible for ensuring their offers are received at the designated place, and by the designated time, for receipt of offers.
- Place of Performance
- Address: U.S. Office of Personnel Management, 1900 E Street, NW, Washington, DC
- Zip Code: 20415
- Country: USA
- Zip Code: 20415
- Record
- SN00495284-W 20031225/031223212711 (fbodaily.com)
- Source
-
FedBizOpps.gov Link to This Notice
(may not be valid after Archive Date)
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