This bid is for pharmacy benefit management services for a behavioral health program serving patients throughout Alameda County, California.
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What the job is
Term and volume: Three years starting May 1, 2027, with an optional two-year extension; approximately 1,600 prescriptions annually for 650 uninsured patients, currently filled through 45 retail pharmacies.
Administration: 24/7 electronic claims adjudication, daily eligibility updates, formulary and prior authorization management, Medi-Cal and Medicare Part D coordination of benefits, patient assistance programs, and 340B administration.
Pharmacy access: Coverage in every city and populated unincorporated area, with extended hours, weekends, delivery, blister packing, and Cambodian, Chinese, Farsi, Japanese, Spanish, and Vietnamese language services.
Technology and support: HIPAA-compliant EHR integration included at no additional cost, web-based reporting with Excel exports, monthly claims reconciliation, and dedicated account and pharmacy support. Minimum 99.9% system availability and 99.5% claims and financial accuracy.
Pricing: Itemize annual medication discounts, dispensing fees, and administrative fees. Paid-claim adjudication fees must not exceed $17 per claim, with no fees for rejected or reversed claims. Transparent pass-through pricing and at least 90% of manufacturer rebates returned to the client are required.
XL Eagle