FY24 Ivc Pharmacy Benefit Manager   3

Background
The Department of Veterans Affairs (VA) is seeking a Pharmacy Benefit Manager (PBM) Contractor to provide Pharmacy Benefit Management Services for Veteran Family Member Programs. The contract has a period of performance from 4/1/2024 to 3/31/2025, with four additional one-year options to continue services through 3/31/2029. The VA processes pharmacy transactions for various health benefit programs, including CHAMPVA, Caregiver Program, Spina Bifida, Children of Women Vietnam Veterans (CWVV), and Camp Lejeune Family Member Program (CLFMP). The PBM Contractor is expected to provide retail pharmacy services in the most cost-efficient manner, maximize patient safety, and achieve the highest level of beneficiary satisfaction. The Contractor must be accredited through Utilization Review Accreditation Commission (URAC) and comply with NCPDP standards.

Work Details
The Contractor's responsibilities include providing retail pharmacy services, receiving pharmacy claims data in HIPAA designated electronic format, providing a comprehensive retail pharmacy network, achieving the highest level of beneficiary satisfaction, and providing detailed reports of pharmacy claims history. The Contractor must also perform Drug Utilization Review (DUR) of all pharmacy claims processed in their system and have the necessary personnel to authorize overrides to rejected claims from network pharmacies. Additionally, the Contractor is required to ensure that all claims submitted do not include any excluded prescription drugs, medical supplies, or devices.

Period of Performance
The period of performance for the contract is from 4/1/2024 to 3/31/2025, with four additional one-year options to continue services through 3/31/2029.

Place of Performance
The geographic locations where the contract will be performed include the fifty United States, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, the Northern Mariana Islands, the American Samoa, and the Minor Outlying Islands.