Specifications include, but are not limited to: 3.1 Pharmacy benefit management program must include:
• The ability to receive electronic requests for pharmacy benefits through the
Municipality’s computerized claim system, Claim Pilot.
• Describe the process by which you will provide each claimant with a retail drug
card. The card must list an effective date. Retail drug cards must be provided for
new claimants and replacement cards must be provided to existing claimants on
an ongoing basis. Please describe any capabilities you might have to supply such
information in a digital format, e.g., to a claimant’s cell phone via an app.
• The pharmacy ID cards will provide eligible claimants with access to prescription
medications at a large national network of preferred providers.
• Claimants enrolled in the pharmacy benefit program will be entitled to receive
eligible medications via home delivery order.
• Generic medications should be substituted in compliance with Alaska statutes.
• Contractor shall employ medication plans and formularies specific to body part
and nature of injury.
• The contractor shall review prescriptions to identify those not related to the
claimant’s medical treatment.
• Medications that are temporarily blocked at point of sale should be immediately
routed to the Municipality’s claims adjusters for review.
• Contractor is required to follow Municipality’s escalation of approvals process –
24 hours after initial fill request is received by Contractor, if initial authorized
approver has not responded, Contractor will contact next senior Municipality
adjuster for approval, and so forth.
• The contractor shall review prescriptions to identify duplications, early refills, and
possible abuse. MOA must be alerted to any such findings.
• The contractor shall track opioid prescription usage for potential abuse and notify
the prescribing physician of potential problems in writing.
• The contractor shall maintain a clinical staff capable of performing medication
utilization review accompanied by recommendations for therapy, considering
available medical records and prescription history.
• The contractor shall have a staff of clinical pharmacists available to provide
customized support for medication-related decisions.
• The contractor shall provide invoices for services on a daily basis as the services
are incurred via electronic means compatible with the claim system employed by
MOA, Claim Pilot.