Audit Services

The vendor is required to provide audit services for 340b compliance.
- Annual 340b compliance audit:
• Verify office of pharmacy affairs information system (OPAIS) registration is accurate and complete. 
• Verify compliance of client eligibility per program policy via a sampling of client certification documentation and program database records.
• Verify compliance with 340b requirements regarding the process used to ensure diversion of discounted drugs does not occur. 
• Verify compliance with 340b requirements ensuring the pharmacies are not receiving duplicate discounts, specifically Medicaid or other manufacturer discount programs.
- Program compliance audit: 
• Verify that other payment sources were utilized prior to billing medication or fees to the program to include verifying that insurance requirements (i.e., prior authorization, step therapy requirements) were met prior to billing program as primary. 
• Verify that all zero-dollar claims are adjudicated through the program pharmacy benefit manager (PBM) or other identified process. 
• Verify pharmacies are adhering to the replenishment model and have adequate stock to dispense medications at all times. 
• Verify needed reversal claims are processed per each pharmacy contract and timeline. 
• Verify accuracy of PBM invoicing and remittance. 
• Verify timely payment of insurance reimbursements owed to the program.
• Verify accounts receivable documentation.
- Contractor shall submit deliverables as follows:
• Comprehensive final audit plan to include testing scope, methodology, procedures, project schedule, and tools and approved by agency due to authority within 30 days post of award of this contract. 
• Schedule and lead quarterly virtual meetings with agency to provide verbal progress reports. 
• Final audit report due by 10/31 of each calendar year. 
• The audit report will be reviewed and approved by agency prior to finalizing. 
• At a minimum, the final audit report shall include:
o Executive summary, which provides a high-level summary of the report contents; 
o Detailed description of the audit scope and methodology, which includes the time period covered, and areas reviewed; 
o A list of data requests made and reviewed; 
o Policy and procedure review, which include any recommendations for improvement; 
o Internal controls review, which includes evaluating contract oversight of the 340b components of the program; and 
o Findings and conclusions, which includes outlining areas of success, recommendations for improvement, and any compliance violations
- As-needed consultation services upon request of the agency (0-60 labor hours):
• Review the program policies, procedures and pharmacy contract language and provide recommendations for improvement. 
• Develop draft processes and procedures. 
• Provide fee for service consultation services to ensure program understanding of state and federal policy and regulation changes and impacts. 
• Other within-scope 340b consultative services and submission of authority -requested related within deliverables.
- Contract Period/Term: 2 years
- Questions/Inquires Deadline: July 16, 2025