[Notice issued May 30,2023; Notice revised June 16, 2023]
The Alabama Department of Insurance (DOI) hereby gives notice of the issuance of a Request for Proposals (RFP) for qualified respondents to provide the DOI with professional Pharmacy Benefits Manager (PBM) examination services.
Contracts are contemplated to be awarded for a term of two years, from October 1, 2023, through September 30, 2025. Responses to the RFP must be received not later than June 30, 2023, at 3:00 PM CDT. Each response must include one original unredacted response in printed form plus one identical electronic copy in PDF format on one USB drive.
The RFP is listed in the State of Alabama Accounting and Resource System (STAARS). You may learn about STAARS at http://vendors.alabama.gov/, and can register as a Vendor at https://procurement.staars.alabama.gov/webapp/PRDVSS1X1/AltSelfService.
REVISIONS TO THIS NEWS RELEASE AND RESPONSES TOQUESTIONS WILL BE POSTED BELOW.
Questions regarding Section 1.2.1.2, which states the contractor will, “Evaluate the compliance of PBMs with Alabama PBM Law, Ala. Code §§ 27-45A-1, et seq., and other applicable statutes by reviewing the PBM’s claims handling, payment practices and PBM licensing compliance.”
Question 1: Please provide clarity on which claims contractors would be asked to review? For example, would we be reviewing claims brought under public sector health plans, such as state employee health benefit plans, etc.; or would this be a review of claims filed under private sector health plans?
Answer 1: All PBMs are subject to licensing and review; the manner in which a PBM handles all claim types, including public and private plans, major medical plans, both group and individual plans, HMO and other managed care plans, and workers compensation, will require review for compliance under Ala. Code §§ 27-45A-1, et seq.
Question 2: Does Alabama state law prescribe payment practices with which PBMs must comply aside from the law referenced within this section?
Answer 2: PBMs are subject to the PBM law referenced above as well as the Pharmacy Audit Integrity Act, Ala. Code §§34-23-180, et seq.
Question 3: Will the State please provide a copy of the PBM license application for review?
Answer3: The PBM license application is an online process. Attached is a link to a PDF document with a series of screen-shots showing all the questions on the application:
https://www.aldoi.gov/PDF/News/PBMApplication.pdf
Questions regarding Section 1.2.1.3, which states the contractor will, “Conduct limited scope examinations of PBMs to review their market conduct in relation to the statutory requirements applicable to PBMs operating in the state of Alabama.”
Question 4: Will contractors be able to access claim data files from the actual pharmacies?
Answer 4: Yes.
Question 5: Will contractors be able to access contract and plan design documents between PBMs in question and their clients?
Answer 5: Yes, when necessary.