Specifications include, but are not limited to: 3.1 Initial and Semi-Annual UMAC Pricing Survey and Analysis. The Contractor shall: (1) design all survey letters: (A) in collaboration with DHHS; and (B) in accordance with Centers for Medicare and Medicaid Services (“CMS”) guidance and all applicable federal or state requirements. (2) conduct a survey of AAC every six months in which 25% of the Population is surveyed; (3) calculate the sample size for the surveys and ensure the sample size provides appropriate statistical validity; (4) ensure all providers within the Population receive the survey at least once every two years unless DHHS approves exceptions; (5) ensure the sample selected from the Population includes pharmacy providers from across the state and stratify the sample by the following pharmacy characteristics to achieve equal sample distribution: (A) urban; (B) rural; (C) independent ownership; and (D) chain ownership; (6) perform data quality assurance checks on survey data submission to identify and remove outlier data, and ensure only reliable invoice cost data is being submitted: (A) If a pharmacy’s cost data are equal to or greater than wholesale acquisition cost (“WAC”), the Contractor must further investigate to ensure the pharmacy submitted actual cost data. (7) contact individual pharmacies regarding survey responses; (8) remove any unreasonable invoice cost data from the UMAC calculations if the pharmacy that submitted the data does not resubmit reasonable invoice cost data as requested by the Contractor; (9) ensure the survey incorporates AAC through drug purchase invoice data as the primary means of calculating UMAC rates for brand and generic drugs, as well as hemophilia clotting factors; (10) for each survey, produce reporting for DHHS which includes at least the following information: (A) the range of costs observed within the invoice data; and (B) the ability of pharmacy providers to purchase drugs at or below the UMAC rate based on costs reported by pharmacy providers.
