The Vendor is required to provide a comprehensive review of market options is necessary to maintain competitive pharmacy benefits due to the evolving and changing pharmacy industry and increased pharmaceutical costs.
- Customer Service
• Provide the port with a dedicated toll-free telephone line with live caller support available twenty-four (24) hours a day, seven (7) days a week, three hundred sixty-five (365) days a year with no off shoring of call center support.
• At least 80% of incoming calls for the port must be answered by a designated pod of trained customer service representatives who collectively service no more than 5 clients.
• Provide telephonic access to emergency pharmacist services twenty-four (24) hours a day, seven (7) days a week, three hundred sixty-five (365) days a year.
• Provide the port with the right to review the on-line scripting for call center representatives prior to the implementation/effective date.
• The member service teams will be knowledgeable of the specific pharmacy benefit programs of the port to respond to member questions.
• Perform a port-specific (versus book of business) member satisfaction survey at least once annually.
• Member/provider service representatives will have access to a pharmacist in the event the call requires the attention of a clinician.
• Make available a geo-access and customized pharmacy provider locator service via customer service. • Hold call calibration meetings, where the port may listen to selected member calls and provide feedback.
• Provide a telephone tracking system for the port’s specific member/provider telephone inquiries and will provide monthly reports of call volume, first call resolution rates, average waiting times and abandonment rates for retail, mail and specialty.
• Record 100% of all member calls.
• The telephone and online systems will open as early as one (1) month prior to open enrollment and in following contract years will add additional staff during the port’s open enrollment to answer calls from prospective members.
- Account management
• Support annual employee meetings and benefit fairs as required by the port; this may include sending PBM staff and/or materials to meetings and benefit fairs, as determined by the port.
• Attendance, as requested, at a minimum of one (1) healthcare strategy committee meeting.
• Provide detailed account structure reporting of claims, invoiced amounts and manufacturer payments for accounting purposes.
• Provide support for class action settlements and notify the port of litigation against consultant’s organization.
• Provide any necessary standard file feeds or program costs related to current and future rules and regulations at no cost.
- Plan management
• Accept electronic reporting of enrollment from at least six (6) sources for the port.
• Accept various file formats, media and schedules, including daily or even real-time updates at no additional cost.
• Support manual updates and off-cycle files, which may arise from new acquisitions or strike situations.
• Provide immediate online real-time manual eligibility updates for urgent requests by the port.
• Capture both the 9-digit social security number (SSN) and the alphanumeric port id in the eligibility system.
• Add coverage for members who have joined the plan within forty-eight (48) hours of receipt of eligibility data proposer receives.
• Update member information (e.g., address changes) within forty-eight (48) hours of receipt of eligibility data.
• Notify the appropriate party of eligibility issues within twenty-four (24) hours of receipt of eligibility data.
- Contract Period/Term: 3 years
- Pre-Proposal Conference Date: April 28, 2025
- Questions/Inquires Deadline: April 29, 2025