The Vendor is required to provide a secure, cloud-based software as a service (SaaS) formulary management platform that supports covered state and medicare drug coverage formularies, including utilization management (UM) criteria, and enable agency to meet all applicable federal and state regulatory standards.
- Produce compliant digital and print-ready formularies,
- The platform must be a fully cloud-hosted, web-based platform for formulary management, eliminating the need for on-premises infrastructure and enabling anytime, anywhere access for agency administrators.
- The platform must support the creation, management, and updating of multiple drug formularies across the plan year, with industry-recognized drug database integration (e.g., First Data Bank) for timely updates of newly approved or marketed drugs.
- The platform must include tools to support key formulary features, such as drug tiering, clinical utilization management criteria, prior authorization, and step therapy management.
- Automated generation of CMS-compliant files (Formulary Change files, Prior Authorization files, Step Therapy files, Full Formulary files) for submission to the Health Plan Management System (HPMS), conforming to the latest CMS technical specifications.
- Allow for seamless hosting of PDF formularies and related files, with intuitive search functionality and compliance with accessibility standards.
- Assist with loading existing formulary data onto the new platform.
- Deliver live, virtual training sessions, detailed documentation (user manuals, quick-reference guides, etc.), and ongoing training resources ensuring agency users are proficient in platform operations.
- Provide a quality control process to ensure formulary updates are accurately reflected in both PDF files and the searchable formulary interface.
- Contract Period/Term: 3 years
- Questions/Inquires Deadline: January 29, 2026
