Pharmacy Benefit Services

The Vendor is required to provide for a pharmacy benefit services (PBS) solution to modernize and support the Medicaid Pharmacy business and technical environment.
- Trading Partners interact with the system integrator by consuming web services and file exchanges exposed by the Integration Hub. This allows MES Modernization solutions to securely exchange data to and from Trading Partners.
- State Directed Pharmacy Benefit Preferred Drug List: Agency has transitioned to a single Preferred Drug List (PDL). The Contractor will provide technical solutions to improve the overall functionality of the PDL and how this information is communicated to stakeholders by making some information outward-facing and more transparent.
- Clinical Consultation and Staffing: While the current PBS vendor does provide staffing to support Agency, staffing levels in the current contract and the skills of assigned staff are not sufficient to fully meet Agency needs. Agency seeks a solution that improves both the staffing level assigned to the Contract and the overall knowledge and skills of this staff as it relates to the state pharmacy solution.
- Increased Automation for Prior Authorization: The current PBS solution heavily utilizes fax and phone for prior authorization activities as required by the current contract. Agency seeks a solution that will include more automated processes to more efficiently support prior authorization functionality.