RFP Third Party Pharmacy Administrator and 340B Program Specialized Services

Transcription

1 RFP Third Party Pharmacy Administrator and 340B Program Specialized Services Department of Public Health San Francisco Health 1380 HOWARD STREET, SUITE 419C SAN FRANCISCO, CA CONTACT: JUNKO CRAFT, CONTRACT ANALYST (415) Date issued: June 6, 2013 E-Question Period June 6, :00 Noon, June 25, 2013 *Letter of Intent (LOI) 12:00 Noon, July 11, 2013 Proposal Due: 12:00 Noon July 18, 2013 *Letter of Intent is mandatory and required in order to submit proposals. P-590 (11-07) 1 of 25 June 6, 2013

2 Table of Contents Page I. Introduction and Schedule... [ 3 ] II. Scope of Services... [ 4 ] III. Minimum Qualification... [ 10 ] IV Submission Requirements... [ 11 ] V. Evaluation and Selection Criteria... [ 14 ] VI. Questions and Contract Award... [ 16 ] VII. Terms and Conditions for Receipt of Proposals... [ 16 ] VIII. City Contract Requirements... [ 21 ] IX. Protest Procedures... [ 22 ] Attachments: RFP Provided separately in a zipped file attachment for this RFP: These forms must be completed in order for a proposer to be considered: A. Appendix A: DPH Forms: RFP Form #1 Solicitation and Offer, #2 Contractual Record Form, and Contract Monitoring Division (CMD) Attachment 2 (see Zip folder) B. Appendix B: Fee(Rates) Schedule C. Appendix C: Standard Forms: Listing and Internet addresses of Forms related to Taxpayer Identification Number and Certification, to Business Tax Declaration, and to Chapters 12B and 12C, and 14B of the S.F. Administrative Code and LBE Certification application D. Appendix D: Acknowledgement of Requirement of Chapter 12B Declaration E. Appendix E: Agreement for Professional Services (form P-500) see Zip folder P-590 (11-07) 2 of 25 June 6, 2013

3 I. INTRODUCTION A. Background The purpose of this RFP is to select a contractor to provide Third Party Pharmacy Claims Adjudication (TPA) and 340B Program Specialized Services for the City and County of San Francisco Department of Public Health s (DPH) integrated service delivery division, SAN FRANCISCO HEALTH. SAN FRANCISCO HEALTH is an integrated healthcare delivery system that operates within the Department of Public Health (DPH) for the City and County of San Francisco. Entities that comprise SAN FRANCISCO HEALTH are: San Francisco General Hospital (SFGH), primary and specialty care clinics on the SFGH campus, and thirteen (13) additional primary care clinics located in various parts of the City and County of San Francisco. City and County of San Francisco residents, regardless of medical insurance status, may seek care from SAN FRANCISCO HEALTH. Patients who are not otherwise insured may be eligible for SAN FRANCISCO HEALTH subsidized healthcare services. SAN FRANCISCO HEALTH subsidized patients receive prescription benefits as part of their comprehensive care. Approximately 275,000 prescriptions are processed annually for patients eligible for the SAN FRANCISCO HEALTH subsidized benefit, and an additional 90,000 prescriptions are generated annually for Medicare, Medicaid managed care and commercial insurance beneficiaries who seek and receive care from SAN FRANCISCO HEALTH providers. SAN FRANCISCO HEALTH is seeking a partner with excellent understanding of the Federal 340B drug purchasing program to provide specialized services to coordinate its participation in the program. Services sought include those required to be compliant with all aspects of federally published 340B program guidance, 340B inventory management, outpatient prescription claims adjudication services for patients who receive care from SAN FRANCISCO HEALTH providers, and 340B contract pharmacy network management. Among other specific services, the successful bidder will possess the ability to accept from SAN FRANCISCO HEALTH and upload into their TPA systems, patient eligibility data every ten (10) minutes; have capacity to identify when drugs dispensed or administered may be replenished with 340B drug purchases; have systems to adjudicate at network pharmacies prescription claims for eligible patients written by eligible providers for drugs on the SAN FRANCISCO HEALTH Drug Formulary; and bring to the partnership a network of retail community pharmacies located within the City and County of San Francisco. This network shall consists of no less than fifteen (15) retail community pharmacies located in various areas, preferably near SAN FRANCISCO HEALTH primary care clinics, of San Francisco County. Additionally, the successful partner will possess systems and processes to identify payer sources (i.e. SAN FRANCISCO HEALTH, Medicare; Medicaid managed care and commercial insurance) for adjudicated prescriptions; track dispensed drug by 11-digit NDC number; provide reports for replenishment to dispensing pharmacy(s) with drugs purchased by SAN FRANCISCO HEALTH under the Federal 340B program; ability to compare and apply different pricing and cost information to individual adjudicated claims based on SAN FRANCISCO HEALTH defined parameters; and extensive capabilities for generating financial, operational and 340B compliance verification reports. Detailed descriptions of the scope of services required of the 340B Manager are outlined below in Section II, subsections A through D. The successful partner and their pharmacy network participants must demonstrate that they provide the customer services and possess the business P-590 (11-07) 3 of 25 June 6, 2013

4 attributes described on the service description. By the time of proposal submission, the successful partner will demonstrate contact with the San Francisco Contract Monitoring Division and will have begun or completed all requirements for compliance to regulations. This contract does not include patients receiving care through County Community Behavioral Health Services (CBHS) from CBHS providers or patients receiving primary medical care from non-san FRANCISCO HEALTH affiliated providers. B. Contract Term and funding The contract shall have an original term of five (5) years from July 1, 2014 through June 30, The City will have five (5), one (1) year options to extend the contract for a period. (Total of 10 years) Based on Fiscal Year figures, the annual contract award will not exceed $4.2million which includes pass through amounts to network pharmacies for prescription dispensing fees. The City may exercise the award in its sole, absolute discretion. C. Schedule The anticipated schedule for selecting a provider is: Proposal Phase Timeline Time/Date Date issued: June 6, 2013 E-Question Period June 6, :00 pm, June 25, 2013 Letter of Intent (Mandatory) 12:00 Noon, July 11, 2013 Proposal Due: 12:00 Noon July 18, 2013 Estimated Review and Contracting Timeline Technical Review July 25, 2013 Selection Process August, 2013 Contract Negotiation September, 2013 Contract Development October/ November, 2013 Service Starting Date July 1, 2014 II. SCOPE OF SERVICES 340B PROGRAM SPECIALIZED SERVICES A. 340B Program Participation Coordination The successful partner shall: A1. Possess excellent knowledge and understanding of the Federal 340B drug pricing program, including and not limited to the following: regulations and requirements of the program, contract pharmacy arrangements, virtual inventory management procedures, drug replenishment using 11-digit NDC processes, government and drug manufacturer auditing requirements. A2. Upon review of current SAN FRANCISCO HEALTH 340B participation and systems, P-590 (11-07) 4 of 25 June 6, 2013

5 provide recommendations and implementation strategies for ways to improve efficiency, guide 340B program compliance, and maximize benefits of 340B program participation. A3. Assist with accurate posting of all pertinent and required information for SAN FRANCISCO HEALTH 340B covered entities, contract pharmacy(s), wholesale distributor, other, on the HRSA OPA website. A4. Meet with the contract administrator and other SAN FRANCISCO HEALTH staff as requested, and as needed. A5. Designate a dedicated account manager and service representative to the SAN FRANCISCO HEALTH. A6. Adhere to the implementation timeline established by the SAN FRANCISCO HEALTH, which shall be within ninety (90) days of contract certification. A7. Provide at no additional cost, a dedicated help line for SAN FRANCISCO HEALTH staff and the contract administrator during the contract implementation phase and for a minimum of three (3) months following implementation. A8. Provide training to selected SAN FRANCISCO HEALTH staff of all applicable claims and reporting software and equipment provided by the contractor. A9. Implement systems to identify appropriate wholesale account from which to purchase replenishment supplies of drugs used by patients in mixed use hospital settings and processes to place order(s), track receipt, and monitor for compliance to 340B requirements. A10. To prevent drug diversion and duplicate manufacturer discounts, conduct audits and other quality improvement activities of their services and services of any subcontractors and the network pharmacies, as requested and agreed upon by mutual consent of the contractor and contract administrator. A11. Assist with audits of the SAN FRANCISCO HEALTH prescription benefit program by other interested parties, when requested by the SAN FRANCISCO HEALTH contract administrator. A12. Assist in developing policies and procedures, as necessary to maintain compliance to all HRSA and OPA 340B program participation requirements. A13. Prepare and submit invoices for all services provided directly or through SAN FRANCISCO HEALTH-approved subcontractor, including prescription processing fees by contract pharmacy network, in format and frequency specified by the SAN FRANCISCO HEALTH contract administrator. A14. Assist in identification of opportunities and implementation of systems to enhance cost savings and revenue enhancement. B. THIRD PARTY CLAIMS ADJUDICATION COORDINATION B1. Provide directly or through a SAN FRANCISCO HEALTH-approved subcontractor, P-590 (11-07) 5 of 25 June 6, 2013

6 ability of online, point-of-service electronic claims adjudication for prescriptions, which includes and is not limited to: verifying patient and provider eligibility, formulary status of prescribed medication, patient co-payment status. The successful partner or partner s SAN FRANCISCO HEALTH-approved subcontractor shall: B2. Operate the online claims adjudication twenty-four (24) hours per day, seven (7) days per week. Downtime shall be no more than 1% of total operating time within each month; performance significantly outside the established threshold of 1% shall be reflected in the contractor s annual monitoring report. B3. Possess the ability to identify adjudicated claims eligible to be replenished by 340B drug purchases among claims adjudicated for all patients receiving care from SAN FRANCISCO HEALTH providers, and ability to monitor revenue from claims not replenished but billed to commercial and other non-medi-cal third party payers. B4. Possess systems to compare and apply different pricing and cost information (e.g. Medicare MAC pricing, pharmacy usual and customary price) to individual adjudicated claims based on SAN FRANCISCO HEALTH established parameters and criteria, and bill SAN FRANCISCO HEALTH the lowest of negotiated SAN FRANCISCO HEALTH dispensing fee and other applied pricing parameter (e.g. Medicare MAC pricing, pharmacy usual and customary price.) B5. Possess the ability to track dispensed or administered drug by 11-digit NDC number, identify which drugs may be purchased for replenishment using 340B pricing and which drugs must be purchased at other than 340B, and provide SAN FRANCISCO HEALTH with reports of drugs ordered for replenishment by claim, 11-digit NDC, SAN FRANCISCO HEALTH covered entity for whom purchased and by contract pharmacy, if applicable. B6. The inventory tracking system must also have the ability to carry over quantities of administered or dispensed drug that did not reach package size levels to subsequent replenishment period. Tracking and ordering of inventory for replenishment shall use electronically available information provided by the SAN FRANCISCO HEALTH and not rely upon manual systems or reports maintained or provided by the SAN FRANCISCO HEALTH. B7. Accept monthly updates to the approved SAN FRANCISCO HEALTH drug formulary via electronic or verbal (telephone) communication, and apply the updated information to the formulary database within one (1) business day. B8. Implement a SAN FRANCISCO HEALTH-defined prior authorization request (PAR) process, and track, monitor and report approvals and denials. B9. Provide electronic documentation and tracking of non-formulary and restricted drug approvals. B10. Submit to the SAN FRANCISCO HEALTH contract administrator or designee for approval, bi-weekly invoices for prescription processing fees and non-replenished drug supplies paid through this contract. P-590 (11-07) 6 of 25 June 6, 2013

7 B11. Submit invoices that include, and are not limited to: patient and provider specific information by pharmacy, total fee charges by pharmacy, collected co-payment deducted from payment by pharmacy, total monthly amount due. B12. Communicate changes in SAN FRANCISCO HEALTH policies relevant to this contract to all pharmacies in the SAN FRANCISCO HEALTH pharmacy network within twentyfour (24) hours of receipt of notification to contractor of change. B13. Remove and/or add pharmacy(s) to the SAN FRANCISCO HEALTH pharmacy network at the discretion of the SAN FRANCISCO HEALTH contract administrator or designee. Changes to the SAN FRANCISCO HEALTH pharmacy network shall occur within five (5) working days of receipt of written notice to the contractor by the SAN FRANCISCO HEALTH. B14. Have fraud monitoring processes in place. B15. To prevent duplicate manufacturer discounts, provide documentation specified by the SAN FRANCISCO HEALTH contract administrator that SAN FRANCISCO HEALTH claims and prescription claim data are excluded from manufacturer rebate programs engaged in by the contractor. B16. Possess a process to electronically transmit prescription data from SAN FRANCISCO HEALTH network pharmacies for individual patients to the patient s SAN FRANCISCO HEALTH electronic medical record. B17. Maintain toll-free telephone and facsimile help lines that shall be staffed to assist with questions by SAN FRANCISCO HEALTH staff and prescribers, and network pharmacies. B18. Maintain, during off-hours, a toll-free voice mail recording system with all messages answered within the next business day. B19. Provide, upon request of the SAN FRANCISCO HEALTH contract administrator, a report detailing the number and types of calls received according to date and time, as well as response call dates and times, and calls abandoned. C. CONTRACT PHARMACY COORDINATION C1. Provide directly or through a SAN FRANCISCO HEALTH-approved subcontractor, a network of no less than fifteen (15) community retail pharmacies located within the City and County of San Francisco that are able and willing to participate in a drug replenishment model of prescription distribution to SAN FRANCISCO HEALTH patients. Locations of community retail pharmacies shall preferably be near SAN FRANCISCO HEALTH clinics. At least one (1) pharmacy in the network will provide 24-hour, 7-days per week prescription services. Inclusion of a community retail pharmacy in this network shall be approved by the SAN FRANCISCO HEALTH contract administrator, and the approved pharmacies will collectively be known as the SAN FRANCISCO HEALTH pharmacy network. Each pharmacy in the SAN FRANCISCO HEALTH pharmacy network shall: P-590 (11-07) 7 of 25 June 6, 2013

8 C2. Possess a current and valid pharmacy permit issued by the California Board of Pharmacy, and is recognized as a pharmacy provider by the National Association of Boards of Pharmacy (NABP.) C3. Agree to be posted on the OPA website as a contract pharmacy for SAN FRANCISCO HEALTH 340B covered entity(s.) C4. Be an authorized California State Medi-Cal provider. C5. Be an authorized AIDS Drug Assistance Program (ADAP) provider. C6. Be currently contracted, in good standing, with Medicare Part D plans including all plans serving dual eligible Medicare recipients. C7. Posses an operating computerized patient drug profile system that provides concurrent information to the dispensing pharmacist on patient-specific drug-drug interactions, drugnutrient interactions, and potential adverse effects. The computerized system must also be able to generate written drug information and dosing instructions intended for the lay public that may be provided to the patient. C8. Agree to accept telephone, facsimile or electronically transmitted prescriptions for eligible patients from authorized SAN FRANCISCO HEALTH prescribers. C9. Have the ability to process and adjudicate prescription claims online, using an 11-digit NDC identification code. C10. Agree to dispense drugs to eligible SAN FRANCISCO HEALTH patients from selfpurchased current inventory and receive replenishment supplies of inventory, along with a prescription dispensing fee, in lieu of receiving payment for cost of drugs dispensed. C11. Agree to establish with the drug wholesale distributor designated by the SAN FRANCISCO HEALTH a ship to account for replenishment of drug inventory dispensed to SAN FRANCISCO HEALTH clients. C12. Agree to accept replenishment drug inventory on a weekly or bi-weekly delivery schedule from the SAN FRANCISCO HEALTH designated wholesale distributor. C13. Agree to allow quantities of drugs that have not reached the SAN FRANCISCO HEALTH established replenishment level to be carried forward until the established replenishment level (full package size) is reached, or until 180-days post replenishment is reached. C14. Agree to accept payment for drugs dispensed that do not reach established replenishment levels (full package sizes) within 180-days of last dispensing, and all Schedule II controlled substances, if applicable. Payment will be based on a billing algorithm or MAC pricing set by the SAN FRANCISCO HEALTH. C15. Agree to return-to-stock and adjust electronic prescription dispensing history and drug inventory levels within seven (7) working days of prescription filling if the patient has not picked-up the prescription within that time. P-590 (11-07) 8 of 25 June 6, 2013

9 C16. Agree to stock and dispense only certain generic or brand agents, identified by 11-digit NDC code, when specified by SAN FRANCISCO HEALTH. C17. Agree to accept the lesser of agreed upon dispensing fee and Medicare MAC or pharmacy usual and customary price for each prescription dispensed. C18. Comply with SAN FRANCISCO HEALTH policies regarding maximum days supply, lost prescriptions, acceptable refill intervals, non-formulary drug requests, and other relevant prescription dispensing activities. C19. Collect prescription co-payments established by SAN FRANCISCO HEALTH from affected patients. The co-payment amount will be deducted from the dispensing fee or usual and customary price paid by the SAN FRANCISCO HEALTH. C20. Agree to quarterly and as-needed prescription file audits by the SAN FRANCISCO HEALTH. C21. Agree to maintain auditable records of purchasing, inventory management, and prescription transactions and provide records to SAN FRANCISCO HEALTH upon request. C22. Agree to not receive drugs through the SAN FRANCISCO HEALTH replenishment process that are sold or transferred to non-san FRANCISCO HEALTH patients or entities who are not eligible to receive them. C23. Provide culturally sensitive and linguistically appropriate prescription services to all SAN FRANCISCO HEALTH patients. C24. Agree to assist SAN FRANCISCO HEALTH communicate major program changes to patients through the distribution of SAN FRANCISCO HEALTH provided flyers, brochures and/or signs. D. REQUIRED REPORTS The successful partner shall directly or through a SAN FRANCISCO HEALTH-approved claims administration subcontractor, and at no additional cost to SAN FRANCISCO HEALTH: D1. Provide monthly management reports that include and are not limited to: patient prescription benefit utilization; individual and aggregate provider prescribing patterns by drug and cost; prescription costs per therapeutic class. D2. Monthly drug use reports that include and are not limited to: prescription claim per therapeutic class; non-formulary and prior authorization drugs approved or denied during the month. D3. Monthly financial reports that include and are not limited to: co-payment amounts collected by individual network pharmacies; prescription claims by number and costs per participating pharmacy; total of individual claim charges to SAN FRANCISCO HEALTH showing use of prescription dispensing fee or Medicare MAC/pharmacy usual and customary price and deduction from charge of prescription copayment amount; P-590 (11-07) 9 of 25 June 6, 2013

10 revenue realized by claim from commercial and other non-medical prescription payer sources. D4. Provide inventory reports at periods specified by the SAN FRANCISCO HEALTH contract administrator that shall include and are not limited to: 11-digit NDC number, name and description of drugs dispensed for report period listed by participating pharmacy; replenishment order quantities per participating pharmacy and pharmacy account name and number; quantities of drugs not replenished and carried over to next replenishment period, by 11-digit NDC number and participating pharmacy. D5. Provide monthly reports, by pharmacy and 11-digit NDC number, of drugs not reaching replenishment levels (full package size) 180-days after last dispensed, and amount owed to the pharmacy for non-replenished drug based on a billing algorithm or MAC price established by the SAN FRANCISCO HEALTH. D6. Provide monthly reports of drugs replenished to contract pharmacies identifying individual clinics from which claims used for replenishment report were generated. Report of replenished and non-replenished drugs for this report shall be listed by 11- digint NDC number, drug name, quantities dispensed, and quantities replenished. D7. Provide quarterly reports on total operating down times with each month, calls to the customer service help line, and responses to these calls. D8. Provide online and real-time claims information that may be used by the contract administrator for ad hoc report writing purposes. D9. Provide all reports in formats that can be printed and/or exported into spreadsheets (e.g. Excel) and data base management (e.g. Access) programs. D10. Provide reports at frequency necessary to monitor performance via mutually agreed upon performance guaranteesd11. Provide reports that demonstrate use of appropriate wholesale distributor accounts for replenishment of drugs used by patients in mixed use hospital settings. D11. Provide reports that demonstrate use of appropriate wholesale distributor accounts for replenishment of drugs used by patients in mixed use hospital settings. III. MINIMUM QUALIFICATIONS 1. Have been in business as a provider of 340B program services to 340B eligible entities for at least the past five (5) years. 2. Currently providing varied and in-depth 340B program services to at least three (3) 340B eligible and participating entities. 3. Directly or indirectly (e.g. subcontractor) able to provide third party prescription claims adjudication services, including pharmacy network management and formulary, patient, and provider eligibility verification at point of service. P-590 (11-07) 10 of 25 June 6, 2013

11 4. Directly or indirectly (e.g. subcontractor) provide a retail community pharmacy network consisting of at least fifteen (15) pharmacies located within the City and County of San Francisco. 5. Directly or indirectly (e.g. subcontractor) able to maintain virtual inventory records and logs for the purposes of purchasing replenishment of dispensed inventory from appropriate wholesale accounts. 6. Able to complete required forms and documentation of the RFP and to comply with all contracting policies, laws, rules and regulations of the City and County of San Francisco. IV. SUBMISSION REQUIREMENTS A. Letter of Intent (Mandatory) Prospective proposers are requested to submit a mandatory Letter of Intent (LOI) on their agency s letterhead to the DPH Office of Contracts Management and Compliance by 12:00 Noon, on July 11, 2013 to indicate their interest in submitting a proposal under this RFP. Such a letter of intent is mandatory and will prevent acceptance of an agency s proposal if it is not submitted in time. B. Time and Place for Submission of Proposals Proposals must be received by 12:00 Noon, on Thursday, July 18, Postmarks will not be considered in judging the timeliness of submissions. Proposals may be delivered in person to the DPH Office of Contracts Management & Compliance ( Contracts Office ), or mailed to: Junko Craft, Contract Analyst San Francisco Department of Public Health Office of Contracts Management and Compliance 1380 Howard St., 4 th Floor, #419c San Francisco, CA Proposers shall submit one (1) original and seven (7) copies of the proposal and one (1) copy, separately bound, of required CMD Forms in a sealed envelope clearly marked RFP Third Party Pharmacy Administrator and 340B program Specialized Services to the above location. The original copy of the proposal must be clearly marked as ORIGINAL. Proposals that are submitted by facsimile, telephone or electronic mail will not be accepted. The offeror shall include the following statement in their cover letter: The offeror certifies that no officer, employee or agent of the City and County of San Francisco, exercising any function or responsibility in connection with the proposed services contract or with planning or carrying out of any agreement relative to this offer has any personal financial interest, direct or indirect, in the operation of the offeror. Offeror understands that false certification to this effect will disqualify the offeror. This certification shall constitute a warranty, the falsity of which shall entitle the City to pursue any remedy authorized by law and shall include the right, at the option of the City of terminating any contract for default as a result thereof. P-590 (11-07) 11 of 25 June 6, 2013

12 C. Format All submission must be typewritten; double spaced and on recycled paper and printed on doublesided pages to the maximum extent possible. Please bind the proposal with a binder clip, rubber band or single staple. Please do not bind your proposal with a spiral binding, No binders. You may use tabs or other separators within the document. If your response is lengthy, please include a Table of Contents. D. Proposal Content Failure to provide any of this information or forms may result in a proposal being disqualified. Firms interested in responding to this RFP must complete the required forms and describe how it meets the Minimum Qualifications and provide required information using the proposal content below: 1. Required Forms: Required Forms are provided on paper/ hard copy or electronically (See Zip File). Appendix A: RFP Form#1-Solicitation and Offer, #2 Contractual Record Form 2. CMD Forms to be Submitted with Proposal (Appendix A) a. All proposals submitted must include the following Contract Monitoring Division (CMD) Forms contained in the CMD Attachment 2 (Appendix A): i) Form 2A, CMD Contract Participation Form, ii) Form 3, CMD Non Discrimination Affidavit, iii) Form 4, CMD Joint Venture Form (if applicable), and iv) Form 5, CMD Employment Form. If these forms are not returned with the proposal, the proposal may be determined to be non-responsive and may be rejected. b. Please submit only one (1) copy of the above forms with your proposal. The forms should be placed in a separate, sealed envelope labeled CMD Forms. If you have any questions concerning the CMD Forms, you may call Kelly Dwyer, Contract Monitoring Division Contract Compliance Officer at (650) or via at Kelly.Dwyer@flysfo.com 3. Minimum Qualifications Statement: Please describe how you meet the Minimum Qualifications below in no more than 5 pages: a. Have been in business as a provider of 340B program services to 340B eligible entities for at least the past five (5) years. b. Currently providing varied and in-depth 340B program services to at least three (3) 340B eligible and participating entities. c. Directly or indirectly (e.g. subcontractor) able to provide third party prescription claims adjudication services, including pharmacy network management and formulary, patient, and provider eligibility verification at point of service. P-590 (11-07) 12 of 25 June 6, 2013

13 d. Directly or indirectly (e.g. subcontractor) provide a retail community pharmacy network consisting of at least fifteen (15) pharmacies located within the City and County of San Francisco. e. Directly or indirectly (e.g. subcontractor) able to maintain virtual inventory records and logs for the purposes of purchasing replenishment of dispensed inventory from appropriate wholesale accounts. f. Able to complete required forms and documentation of the RFP and to comply with all contracting policies, laws, rules and regulations of the City and County of San Francisco. 5. Firm Qualifications and Experience (no more than 5 pages) a. Provide a statement of qualifications for your organization, including an organization chart, a statement of the size of firm, a description of services provided by your organization, and a statement of the extent of experience/history providing the services requested by this RFP. b. How many full time employees (FTEs) do you plan to assign to this project if you are selected? c. List the professional qualifications for each individual that would be assigned to provide services requested by this RFP, including applicable degrees, additional applicable training, and any professional certifications/licensing. 6. Proposed Approach (no more than 5 pages) a. Describe how you will fulfill each of the needs outlined under the description of services (Section II. Scope of Services) for this RFP. Include details such as project plans and specifics such as schematics and equipment, as necessary. b. List your needs for physical space, existing San Francisco Healthology and/or equipment during this engagement, if any. c. List any items in the Scope of Services that you cannot provide. d. Describe the measurements/metrics/deliverables/assessments you will provide on at least an annual basis to allow assessment of the services you will provide. e. Provide information on any other pertinent services, if any, you can offer that will enhance the SAN FRANCISCO HEALTH s participation in the 340B program. 7. Customer Service (no more than 2 pages) a. In the event of a problem encountered by SAN FRANCISCO HEALTH, its clients/patients, and/or other applicable constituent, describe how you will address such problems and the timeframe for addressing them. 8. Claims and Violations against Your Organization (no more than 5 pages) a. List any current violations or claims against your organization and those having occurred in the past five years. 10. References (no more than 3 pages) P-590 (11-07) 13 of 25 June 6, 2013

14 a. List at least three business references for which you have recently provided similar services. Include contact names and phone numbers for all references provided. b. Indicate the pharmacy and hospital (if applicable) software used by each of the listed references. c. List all drug wholesalers you have worked with to implement split billing and contract pharmacy arrangements. 11. Fees Competitive fees to be submitted for following: a. 340B program coordination services b. TPA services c. Pharmacy network dispensing fees Non-replenished drug payment algorithm 12. Financial Management Capacity Requirements Non-profit proposers must demonstrate a consistent high standard of financial management as evidenced by unqualified audit opinions, a reasonable level of cash reserves, management letters accompanied by audited financial statements that are relatively free of internal control comments, and stable and effective financial staffing. In response to this RFP, proposers must provide ONE copy of: 1) financial statements and accompanying management letters for fiscal year and fiscal year ; 2) a listing of financial management staff and accounting staff including name, job title, length of service, and brief bio-sketch; and 3) a current cash flow statement and projection for the period of July 1, 2012 through June 30, 2013, including available unencumbered operating revenue held in reserve. For profit proposers must demonstrate a high standard of financial management and viability. Accordingly, in response to this RFP, proposers must provide ONE copy of: 1) tax returns for the 2010 and 2011 tax years; 2) a listing of financial management staff and accounting staff including name, job title, length of service and brief bio-sketch; and 3) a current cash flow statement and projection for the period of July 1, 2012 through June 30, 2013, including unencumbered operating revenue held in reserve. V. EVALUATION AND SELECTION CRITERIA Any proposal that does not demonstrate that the agency meets these minimum requirements by the deadline for submittal of proposals will be considered non-responsive and will not be eligible for review and award of the contract. Agencies that do not meet the minimum qualifications will be disqualified from consideration. Agencies that meet the minimum qualifications will be scored on the criteria outlined in Section III. in this RFP. In general, selection will be based on the agency s history of excellence in service provision, experience with 340B program coordination, claims processing, and pharmacy network administration, and the agency s capacity to partner well with other project collaborators. The City intends to evaluate the proposals generally in accordance with the criteria itemized below. P-590 (11-07) 14 of 25 June 6, 2013

15 1. 340B Program Participation Coordination 2. Third Party Claims Administration (TPA) Coordination 3. Contract Pharmacy Network Coordination Experience with program coordination services Experience with 340B audits Breadth and depth of services provided Quality of split billing processes provided Customer service Reports quality Experience with TPA services, coordination Ability to apply MAC pricing to invoicing Ability to apply usual and customary charges against fees Ability to track, accurately order and monitor replenishment supplies based on 11-digit NDC numbers Ability to upload patient eligibility files at 10- minute intervals, 24 hours per day Ability to maintain up-to-date provider files Ability to upload Formulary and other files as specified Quality of PA processes and PA tracking systems Minimum number of pharmacies as specified by RFP in network (15) Ability of pharmacy(s) to handle anticipated volume Pharmacy(s) in various locations within SF County, and preferably close to SAN FRANCISCO HEALTH clinics 4. Proposed Fees Competitive fees submitted for following: 340B program coordination services TPA services Pharmacy network dispensing fees Non-replenished drug payment algorithm 30 points 25 points 20 points 25 points TOTAL POINTS POSSIBLE FROM PROPOSAL: 100 Points TOTAL POINTS POSSIBLE UNDER LBE ORDINANCE: 10 Points This may include: 10% to a certified Micro or Small LBE; or a joint venture between or among certified Micro or Small LBEs; 5% to a joint venture with certified Micro and/or Small LBE participation, whose participation is equal to or exceeds 35%, but is under 40% or 7.5% to a joint venture with certified Micro and/or Small LBE participation, whose participation equals or exceeds 40%; or 10% to a certified non-profit entity. The Contract Analyst will calculate any LBE discount points TOTAL POINTS POSSIBLE: 110 Points P-590 (11-07) 15 of 25 June 6, 2013

16 A. Questions VI. QUESTIONS AND CONTRACT AWARD Please note that there will be no Pre-Proposal Conference for this RFP. All questions and requests for information must be received by electronic mail, fax and/ or US Mail and will be answered at the end of the E-Question period, by electronic mail, fax and or US Mail to all parties who have requested and received a copy of the RFP. The questions will be answered by the program staff. This is the only opportunity firms can ask direct programmatic questions of the Department staff. All questions are to be directed to the following address: junko.craft@sfdph.org, OR by electronic mail, fax and or US Mail to: Junko Craft, Contract Analyst San Francisco Department of Public Health Office of Contracts Management & Compliance 1380 Howard St., 4 th floor, #419 San Francisco, CA Phone (415) / Fax (415) E-questions may only be submitted from 12:00 Noon on June 6, 2013 until 12:00 Noon June 25, No questions or requests for interpretation will be accepted after 12:00 Noon on June 25, If you have further questions regarding the RFP, please contact Junko Craft at (415) or Junko.Craft@sfdph.org B. Contract Award The Department of Public Health Community Health Network (SAN FRANCISCO HEALTH) will issue Notices of Intent to Award to the selected Proposer with whom SAN FRANCISCO HEALTH staff shall commence contract negotiations. The selection of any proposal shall not imply acceptance by the City of all terms of the Proposal, which may be subject to further negotiation and approvals before the City may be legally bound thereby. If a satisfactory contract cannot be negotiated in a reasonable time the SAN FRANCISCO HEALTH in its sole discretion may terminate negotiations with the recommended Proposer and begin contract negotiations with the next recommended Proposer. VII. TERMS AND CONDITIONS FOR RECEIPT OF PROPOSALS A. Errors and Omissions in RFP Proposers are responsible for reviewing all portions of this RFP. Proposers are to promptly notify the Department, in writing, if the proposer discovers any ambiguity, discrepancy, omission, or other error in the RFP. Any such notification should be directed to the Department promptly after discovery, but in no event later than five (5) working days prior to the date for receipt of proposals. Modifications and clarifications will be made by addenda as provided below. B. Inquiries Regarding RFP Inquiries regarding the RFP and all oral notifications of intent to request written modification or P-590 (11-07) 16 of 25 June 6, 2013

17 clarification of the RFP, must be directed to: Junko Craft, Contract Analyst San Francisco Department of Public Health Office of Contracts Management & Compliance 1380 Howard St., 4 th floor, #419c San Francisco, CA Phone (415) / Fax (415) junko.craft@sfdph.org C. Objection to RFP Terms Should a proposer object on any ground to any provision or legal requirement set forth in this RFP, the proposer must, not more than ten calendar days after the RFP is issued, provide written notice to the Department setting forth with specificity the grounds for the objection. The failure of a proposer to object in the manner set forth in this paragraph shall constitute a complete and irrevocable waiver of any such objection. D. Change Notices (Addenda) The Department may modify the RFP, prior to the proposal due date, by issuing Change Notices, which will be posted on the website. The proposer shall be responsible for ensuring that its proposal reflects any and all Change Notices issued by the Department prior to the proposal due date regardless of when the proposal is submitted. Therefore, the City recommends that the proposer consult the website frequently, including shortly before the proposal due date, to determine if the proposer has downloaded all Change Notices. E. Term of Proposal Submission of a proposal signifies that the proposed services and prices are valid for 120 calendar days from the proposal due date and that the quoted prices are genuine and not the result of collusion or any other anti-competitive activity. F. Revision of Proposal A proposer may revise a proposal on the proposer s own initiative at any time before the deadline for submission of proposals. The proposer must submit the revised proposal in the same manner as the original. A revised proposal must be received on or before the proposal due date. In no case will a statement of intent to submit a revised proposal, or commencement of a revision process, extend the proposal due date for any proposer. At any time during the proposal evaluation process, the Department may require a proposer to provide oral or written clarification of its proposal. The Department reserves the right to make an award without further clarifications of proposals received. G. Errors and Omissions in Proposal Failure by the Department to object to an error, omission, or deviation in the proposal will in no way modify the RFP or excuse the vendor from full compliance with the specifications of the RFP or any contract awarded pursuant to the RFP. P-590 (11-07) 17 of 25 June 6, 2013

18 H. Financial Responsibility The City accepts no financial responsibility for any costs incurred by a firm in responding to this RFP. Submissions of the RFP will become the property of the City and may be used by the City in any way deemed appropriate. I. Proposer s Obligations Under the Campaign Reform Ordinance Proposers must comply with Section of the S.F. Campaign and Governmental Code, which states: No person who contracts with the City and County of San Francisco, for the rendition of personal services, for the furnishing of any material, supplies or equipment to the City, or for selling any land or building to the City, whenever such transaction would require approval by a City elective officer, or the board on which that City elective officer serves, shall make any contribution to such an officer, or candidates for such an office, or committee controlled by such officer or candidate at any time between commencement of negotiations and the later of either (1) the termination of negotiations for such contract, or (2) three months have elapsed from the date the contract is approved by the City elective officer or the board on which that City elective officer serves. If a proposer is negotiating for a contract that must be approved by an elected local officer or the board on which that officer serves, during the negotiation period the proposer is prohibited from making contributions to: The officer s re-election campaign A candidate for that officer s office A committee controlled by the officer or candidate. The negotiation period begins with the first point of contact, either by telephone, in person, or in writing, when a contractor approaches any city officer or employee about a particular contract, or a city officer or employee initiates communication with a potential contractor about a contract. The negotiation period ends when a contract is awarded or not awarded to the contractor. Examples of initial contacts include: (i) a vendor contacts a city officer or employee to promote himself or herself as a candidate for a contract; and (ii) a city officer or employee contacts a contractor to propose that the contractor apply for a contract. Inquiries for information about a particular contract, requests for documents relating to a Request for Proposal, and requests to be placed on a mailing list do not constitute negotiations. Violation of Section may result in the following criminal, civil, or administrative penalties: a) Criminal. Any person who knowingly or willfully violates section is subject to a fine of up to $5,000 and a jail term of not more than six months, or both. b) Civil. Any person who intentionally or negligently violates section may be held liable in a civil action brought by the civil prosecutor for an amount up to $5,000. c) Administrative. Any person who intentionally or negligently violates section may be held liable in an administrative proceeding before the Ethics Commission held pursuant to the Charter for an amount up to $5,000 for each violation. For further information, proposers should contact the San Francisco Ethics Commission at (415) J. Sunshine Ordinance P-590 (11-07) 18 of 25 June 6, 2013

19 In accordance with S.F. Administrative Code Section 67.24(e), contractors bids, responses to RFP s and all other records of communications between the City and persons or firms seeking contracts shall be open to inspection immediately after a contract has been awarded. Nothing in this provision requires the disclosure of a private person s or organization s net worth or other proprietary financial data submitted for qualification for a contract or other benefits until and unless that person or organization is awarded the contract or benefit. Information provided which is covered by this paragraph will be made available to the public upon request. K. Public Access to Meetings and Records If a Proposer is a non-profit entity that receives a cumulative total per year of at least $250,000 in City-funds or City-administered funds and is a non-profit organization as defined in Chapter 12L of the San Francisco Administrative Code, the Proposer must comply with the reporting requirements of that Chapter. The Proposer must include in its Proposal (1) a statement describing its efforts to comply with the Chapter 12L provisions regarding public access to Proposer s meetings and records, and (2) a summary of all complaints concerning the Proposer s compliance with Chapter 12L that were filed with the City in the last two years and deemed by the City to be substantiated. The summary shall also describe the disposition of each complaint. If no such complaints were filed, the Proposer shall include a statement to that effect. Failure to comply with the reporting requirements of Chapter 12L or material misrepresentation in Proposer s Chapter 12L submissions shall be grounds for rejection of the Proposal and/or termination of any subsequent Agreement reached on the basis of the Proposal. L. Reservations of Rights by the City The issuance of this RFP does not constitute an agreement by the City that any contract will actually be entered into by the City. The City expressly reserves the right at any time to: 1. Waive or correct any defect or informality in any response, proposal, or proposal procedure; 2. Reject any or all proposals; 3. Reissue a Request for Proposals; 4. Prior to submission deadline for proposals, modify all or any portion of the selection procedures, including deadlines for accepting responses, the specifications or requirements for any materials, equipment or services to be provided under this RFP, or the requirements for contents or format of the proposals; 5. Procure any materials, equipment or services specified in this RFP by any other means; or 6. Determine that no project will be pursued. M. No Waiver No waiver by the City of any provision of this RFP shall be implied from any failure by the City to recognize or take action on account of any failure by a Proposer to observe any provision of this RFP. N. Local Business Enterprise Goals and Outreach The requirements of the Local Business Enterprise and Non-Discrimination in Contracting Ordinance set forth in Chapter 14B of the San Francisco Administrative Code as it now exists or as it may be amended in the future (collectively the LBE Ordinance ) shall apply to this RFP. 1. LBE Subconsultant Participation Goals P-590 (11-07) 19 of 25 June 6, 2013

20 The LBE subcontracting goal has been waived for this RFP. Skip to # Certified LBE Bid Discount /Rating Bonus a) Micro LBE and Small LBE Rating Bonus The City strongly encourages proposals from qualified, certified Micro and Small LBEs. Pursuant to Chapter 14B, a rating bonus will be in effect for the award of this project for any proposers who are certified by CMD as a Micro or Small LBE, or joint ventures where the joint venture partners are in the same discipline and have the specific levels of participation as identified below. For joints ventures, the certified Micro and /or Small LBE must be an active partner in the joint venture and perform work, manage the job and take financial risks in proportion to the required level of participation stated in the proposal, and must be responsible for a clearly defined portion of the work to be performed and share in the ownership, control, management responsibilities, risks, and profits of the joint venture. The portion of the certified Micro and/or Small LBE joint venture s work shall be set forth in detail separately from the work to be performed by the non-lbe joint venture partner. The certified Micro and/or Small LBE joint venture s portion of the contract must be assigned a commercially useful function. Certification applications may be obtained by calling CMD at (415) The rating bonus applies at each phase of the selection process. The application of the rating bonus is as follows: i) 10% to a certified Micro or Small LBE; or a joint venture between or among certified Micro or Small LBEs; ii) 5% to a joint venture with certified Micro and/or Small LBE participation, whose participation is equal to or exceeds 35%, but is under 40% or iii) 7.5% to a joint venture with certified Micro and/or Small LBE participation, whose participation equals or exceeds 40%; or iv) 10% to a certified non-profit entity. The rating bonus will be applied by adding 5%, 7.5%, or 10% (as applicable) to the score of each firm eligible for a bonus for the purposes of determining the highest ranked firm. b) Small Business Administration (SBA) LBE Rating Bonus Pursuant to Chapter 14B.7(E), a 2% rating bonus will be in effect for proposers who are certified by CMD as a SBA LBE; however, the 2% rating bonus shall not be applied at any stage if it would adversely affect a Micro or Small LBE proposer or a J/V with LBE participation. 3. CMD Forms to be submitted with Proposal a) All proposals submitted must include the following CMD Forms contained in the CMD Attachment 2: i) Form 2A, CMD Contract Participation Form, ii) Form 3, CMD Non- Discrimination Affidavit, iii) Form 4, CMD Joint Venture Form (if applicable), and iv) Form 5, CMD Employment Form. If these forms are not returned with the proposal, the proposal may be determined to be non-responsive and may be rejected. b) Please submit only one (1) copy of the above forms with your proposal. The forms should be placed in a separate, sealed envelope labeled CMD Forms. P-590 (11-07) 20 of 25 June 6, 2013