Specifications include, but are not limited to: 1.1.1 Process point of sale pharmacy transactions, independent pharmacy bill transactions, and paper bill transactions to meet the State of Maine’s needs and expectations, as described within this RFP. 1.1.2. Have experience with medication claim reviews and will be able to provide suggestions on pharmacy management as well as Morphine Equivalent score. 1.1.3 Review point of sale request and paper bills with trained pharmacy personnel. 1.1.4. Provide qualified administrative support staff positions required to perform the PBMS processes and reporting requirements. If a pharmacy provider submits a point of sale request or paper bill with non-formulary medication, the awarded Bidder will contact the claims analyst for a final decision. 1.1.5. Attend to the claim details to avoid claimants obtaining medications unrelated to the work injury, re-filling medications too soon and appropriate dosage and days fill. 1.1.6. Calculate savings from amount saved below fee schedule here: https://www.maine.gov/wcb/Departments/omrs/medfeesched.html 1.1.7. Serve as a consultant to appropriate employees when administrative decisions must be made regarding pharmacy management of Workers’ Compensation claims. Provide Pharmacy and DME services. 1.1.9. Maintain SOC I and SOC II compliance. 1.1.10. Periodically evaluate the performance of the program and provide results to the Department upon request. 1.1.11. Ensure resources are dedicated to the achievement and ongoing support and maintenance of corporate-level certifications and corporate credentials related to Pharmacy Benefit Management.
