Specifications include, but are not limited to: 1. Vendor shall comply with all federal laws and all state requirements as applicable to the Kentucky Code. The respondent will comply with all mandatory requirements including but not limited to the list below for the Kentucky Employees' Health Plan (KEHP) which may be implemented at the discretion of the Know Your Rx (KYRx) Coalition plans at any point in the future. 2. Vendor shall provide an URAC Pharmacy Benefit Management accreditation certificate or other proof that URAC Pharmacy Benefit Management accreditation will occur on or before the pharmacy contract effective date. Vendor shall provide a copy of such certificate with the RFP response and label as “Attachment X.” 3. Vendor shall confirm that the Pharmacy Benefit Manager (PBM) has been operating as a PBM for a minimum of five (5) years. 4. Vendor shall confirm that the respondent has collectively 450,000 or more covered lives currently receiving PBM services; and has at least one (1) client with 100,000 or more lives; and has (1) client with at least 30,000 Employer Group Waiver Plan (EGWP) covered lives under Medicare Part D. 5. Vendor shall allow KEHP and any plan under the KYRx Coalition to remove drugs from the respondent’s standard formulary. 6. Vendor shall allow KEHP and any plan under the KYRx Coalition to create custom Prior Authorization criteria, quantity limits, step therapy criteria as well as CEM overrides directed to KYRx for internal review. 7. Vendor shall grant KEHP staff and KYRx Coalition staff access as well as in real time edit rights within respondent’s client website i.e., the ability to enter edits directly into the respondent’s claim and eligibility systems. 8. Vendor shall provide KEHP and the KYRx Coalition each a dedicated account team to address service-related issues and client specific pharmacy benefit needs. 9. Vendor shall allow KEHP and any plan under the KYRx Coalition unlimited data file feeds to third party vendors at no additional charge. 10. Vendor shall allow KEHP and any plan under the KYRx Coalition to change data fields/layout/files to meet state and federal requirements, new vendor program implementations and data warehouse needs at no additional charge.
