The Contractor will deliver Pharmacy Benefit Management (PBM) services for the Georgia Ryan White AIDS Drug Assistance Program (ADAP), which is authorized under the Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 11-87, October 30, 2009). ADAPs are state administered programs that provide Human Immunodeficiency Virus Infection (HIV) or Acquired Immunodeficiency Syndrome (AIDS) medications to low-income individuals living with HIV/AIDS disease who have little or no coverage from private or thirdparty insurance. As the Pharmacy Benefit Manager, the Contractor will deliver administrative and pharmaceutical claims adjudication services, coordination of benefits, and point-of-sale processing services to eligible clients, which include at least the following services: • Maintain and expand a statewide comprehensive pharmacy network and claims adjudication system inclusive of coordinating multiple contract pharmacies located throughout the state. • Deliver and manage the ADAP eligibility electronic application and re-certification process • Facilitate coordination of benefits with payers, including Medicare Part D and private insurance as covered by the Health Insurance Continuation Program (HICP) • Facilitate and manage True Out-Of-Pocket (TrOOP) cost tracking according to the Centers of Medicare and Medicaid Services (CMS) Supplement Drug Program Data Sharing Agreement (DSA) • Facilitate the ADAP rebate process and reporting mechanisms. • Deliver and manage a 340B compliant inventory management system • Deliver reporting that meets client level data requirements of Georgia ADAP and the Ryan White HIV/AIDS Treatment Extension Act of 2009 • Ensure that ADAP is the payer of last resort by ensuring there are no other 3rd party payers
