HHS - Medicare Transaction Facilitator - MRAS

Purchase Agency: Centers for Medicare & Medicaid Services (CMS)

Purpose: The task order is for an entity that will assist with activities related to the implementation and operationalization of the Medicare Prescription Drug Provisions of the Inflation Reduction Act (IRA). The entity will provide transaction and customer support services to facilitate the exchange of data between pharmaceutical supply chain entities to verify eligibility for the Medicare Drug Price Negotiation Program.

Work to be Acquired: The entity will serve as a Medicare Transaction Facilitator (MTF) and coordinate requests for and reimbursements of the Maximum Fair Prices (MFP) refund amount between pharmacies and participating manufacturers. They will also provide information and documentation necessary for CMS to administer the program and monitor compliance by manufacturers.

Timeframe: The work referenced in this opportunity is for the Initial Price Applicability Year (IPAY) 2026, as outlined in the Medicare Drug Price Negotiation Program Revised Guidance released in June 2023.

Place of Performance/Delivery: The entity will perform the work in accordance with federal laws and regulations, program instructions and guidance, and public and stakeholder engagement and input.

Notable Information: The entity must have extensive knowledge and experience with Medicare Part D and Part B programs, payment systems, pricing methodologies, claim transactions, HIPAA regulations, secure file transmissions, and IT security standards. They should also have demonstrated experience in program management, contract execution, web application development, help desk support, data handling, financial management, and compliance auditing. Additionally, they must be capable of processing large volumes of claims data on scheduled cadences and coordinating payment transactions between multiple stakeholders.