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PROPOSAL FOR

PHARMACY BENEFITS MANAGER

MIDDLESEX COUNTY JOINT HEALTH INSURANCE FUND STATE OF NEW JERSEY

JULY 2011

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SOLICITATION SCHEDULE The projected schedule for this Request for Proposals is as follows:

Issue Date of the RFP ................................................................ July 29, 2011 Questions and requests for clarification or information must be received, in writing, at the Office of the County Purchasing Agent by 2 p.m. (EST) ............................................ August 16, 2011 Pre-proposal meeting, 2:00 p.m. At 75 Bayard Street, New Brunswick ......................................... August 16, 2011 Proposal Submission Due Date Must be received, in writing, at the Office of the County Purchasing Agent by 11:00 a.m. (EST) ...................................... September 15, 2011 Award Date…………………………………………………………..September 30, 2011 The contract will start January 1, 2012.

The pre-proposal meeting is scheduled for 2:00pm on Tuesday, August 16, 2011 in the Office of the County Purchasing Agent, 75 Bayard Street, 3rd Floor, New Brunswick, New Jersey to answer questions and requests for clarification. Information on utilization and census data will be distributed at that time. Proposals submitted without claims repricing will not be entertained. Claims repricing must match National Drug Code and cannot be substituted for less expensive prescriptions within therapeutic class or over-the-counter medications. All attachments must be submitted with proposal. Proposals shall be submitted to Office of the County Purchasing Agent, 75 Bayard Street, 3rd Floor, New Brunswick, New Jersey, 08901. Electronic submission is NOT ALLOWED. These dates are estimates only and the FUND reserves the right to alter this schedule as it deems necessary or appropriate.

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DETAIL SPECIFICATIONS

1.0 INTENT It is the intent of these specifications to identify the requirements for qualified and experienced vendors to provide pharmacy benefit manager services for self insured prescription drug plans to the MIDDLESEX COUNTY JOINT HEALTH INSURANCE FUND hereinafter referred to as the “FUND”, including network management, drug utilization review, outcomes management, and disease management.

The FUND comprises eight separate entities from the Middlesex County. The FUND offers health care benefits to its members. Most of the entities currently provide prescription drug benefits outside the FUND through separate programs. It is the intent of the County to move their current Rx program into the FUND and manage the program through the FUND. The FUND will expand eligibility for Rx benefits to include all the entities that participate in the FUND’s medical plans. Rx coverage will be made available to those entities as their current Pharmacy Benefits Managers’, hereinafter referred to as “PBM”, contracts expire. Those entities include: Middlesex County Board of Social Services, Middlesex County College, Middlesex County Improvement Authority, Middlesex County Utilities Authority, Middlesex County Mosquito Commission, and the Roosevelt Care Center. The FUND will also consider expanding eligibility to Municipalities within Middlesex County as those entities’ PBM contracts expire. The purpose in offering entry into the FUND’s Rx program to Municipalities within Middlesex County is to offer more efficient coverage to those entities. The FUND believes it can offer more competitive Rx plan alternatives to those Municipalities through reduced frictional costs and better discounts associated with a larger self insured plan. The Contractor should provide quotations based upon the prescription volumes included in this RFP. In addition, the Contractor is encouraged to provide alternative quotations based upon prescription volumes increasing at the following levels as member Municipalities join the program: +25%, +50%, +100%, +200%. The FUND plans to take an active role in marketing coverage under the FUND’s Rx program to local Municipalities. 2.0 SCOPE OF SERVICES The Contractor shall perform and complete all the tasks, obligations and responsibilities described to include:

Provide a National Network of Retail Pharmacies of no less than 55,000 providers including major drug store chains such as CVS, Walgreens, Rite-Aid and national retail providers such as Wal-Mart and Target.

Manage the FUND’S prescription drug benefit through retail pharmacy to include:

Process prescriptions through a managed and trained distribution network; and

Interacting with retail pharmacies on a regular basis to assure computerized drug interaction monitoring, correct fill and appropriate drug utilization management as detailed within the contract.

Provide Mail Pharmacy Services to include:

Fulfillment of prescriptions subject to professional ethical and clinical judgment by or under the direction of a licensed pharmacist; and

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Provide appropriate drug utilization management services as detailed within the contract terms (e.g. interaction drug monitoring, physician or member profiling, etc.)

Provide claims processing services to include:

Process prescription drug claims and reimburse covered members as detailed within the contract; and

Provide communications of benefits letters to covered members.

Pricing and Rebates

Contractor shall agree to charge the lesser of: discounted rate, MAC or usual and customary.

Contractor shall agree to return 100% of all rebates to the FUND.

Provide customer service operations to include a toll-free customer service line which shall be available 24 hours a day, 7 days a week, as well as provide emergency pharmacist services 24 hours a day.

Provide a formulary program to include:

Formulary brochures distributed directly to covered members on an annual basis, listing preferred brand-name products and;

Contact prescribers to obtain approval for substitution of formulary drugs.

Contact members to discuss therapeutic compliance, education and similar programs.

Provide maintenance of records and audits. Such information shall not be made available to others for any purpose other than preparing statistical analysis reports or for other business purposes, in which case subscriber information will not be identifiable.

Contractor shall abide with implementation dates, in accordance with a timetable outlined with the FUND.

Without charge, provide the following to active or retired employees: implementation kits, introductory cover letter, identification cards with a toll free phone number, a standard benefit brochure, mail service order forms, paper claim reimbursement forms and a formulary brochure.

Prepare Member communication pieces consistent with the requirement of the FUND. All communication pieces must be approved by the FUND prior to release or distribution.

Provide client eligibility data in an agreed-upon medium and format.

Provide the FUND with a set billing schedule, including electronic fund transfer or Automated Clearing House within 5 days after the receipt of an invoice.

Provide term and termination provisions, including timeline provisions, obligations and events during contract term.

Comply with all applicable Federal, State and Local laws and regulations.

Provide a copy of a written SAS-70 audit report (must have been prepared independently within the immediate 12 months) prior to the award of any Agreement and thereafter as requested by the FUND.

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Quarterly, provide the FUND with current Rebate information or opportunities and FDA decisions regarding changes and additions to prescription medications in a timely manner.

Provide for payment to be remitted directly to providers electronically in a format that will comply with all applicable HIPAA standards.

Administer the prescription drug benefit plan in effect at the time of plan implementation. Contractor shall assist in design, implementation and administration of the initial benefit plan and any revisions or amendments to the pharmacy benefit plan. At no additional cost, Contractor shall be responsible for correcting incorrect pharmacy benefit plan information immediately, but no later than forty-eight (48) hours of receipt of notice of the incorrect information, with notification to Participating Pharmacies.

Upon presentation of an ID Card, Members may obtain Covered Drugs at Participating Pharmacies through the Retail Pharmacy Network. Contractor will make available to the FUND an electronic updated list of each network upon request updating network Pharmacies on the Contractor’s website at least monthly. Each Participating Pharmacy is required to verify the Member’s eligibility and submit Prescription Drug Claims for processing on-line in National Council for Prescription Drug Programs format, hereinafter referred to as “NCPDP” through Contractor’s on-line claims processing system. Participating Pharmacies will dispense prescriptions to Members in a quantity not to exceed a 30-day supply unless otherwise specified in the Contract. Contractor shall direct Participating Pharmacies to charge and collect the applicable Member Contribution from such Member for each Covered Drug dispensed.

Contractor is to maintain criteria to establish when and how a Participating Pharmacy shall be audited to determine compliance with its Pharmacy Provider Agreement. Contractor shall maintain documentation related to each audit performed and shall disclose such information upon request by the FUND.

Maintain and implement a current Maximum Allowable Cost hereinafter referred to as “MAC” list; updating this list on a semi-annual basis, and research and correct any errors necessary within forty-eight (48) hours of Contractor’s or the FUND’S detection of an error, with notification of the error and correction to the FUND.

Attempt to establish and maintain a local office in the Central Jersey area for account management;

Contractor shall address performance concerns as identified by the FUND within a time frame mutually agreed upon, giving priority to recurrent issues. Any expense required to rectify the problem shall be borne by the Contractor.

Contractor shall cooperate with all the FUND vendors including any medical insurer, third party administrator or government entities as necessary to effectively administer pharmacy benefit management services. The Contractor shall also cooperate to assist in the FUND’S obligations of CMS filing requirements, coordination of prescription utilization for the purpose of healthcare utilization coordination, disability or other risks to the Member or the FUND. This may include sharing of pharmacy expenditures and member eligibility file feeds.

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Respond to the FUND’s staff verbal inquiries within twenty-four (24) hours regarding any matter of program management or other services provided by Contractor under this Agreement and respond to specific and general written inquiries of the FUND’d staff received by mail, facsimile transmission, email or other writing within five (5) business days of receipt of such inquiry. Contractor shall provide follow-up as necessary to resolve outstanding issues in a timely manner. Contractor’s responses shall be in writing unless otherwise requested by the FUND’d staff.

Contractor shall respond to all Members written inquiries, including complaints and grievances received by mail, facsimile transmission, email or other writing within five (5) business days of receipt of such inquiry. The Contractor shall have the obligation to reverse any error or take appropriate actions to resolve errors as allowed by Agreement.

The Contractor’s responses shall be in writing unless otherwise requested by the FUND’s staff.

Provide clinically-based medication/case management programs and services, including drug use review, Prior Authorization, therapeutic intervention, disease management, physician consultation, development and management services for the Retail Preferred Product List, and emerging therapeutic issue notification specific to the prescription drug program of the FUND. Unless otherwise expressly stated in this Agreement, such programs are provided at no charge.

Perform a standard prospective (concurrent) DUR of drug therapy using predetermined standards for each prescription submitted for processing on-line, or point-of-sale, in order to assist the pharmacist in screening to identify potential drug therapy problems, including therapeutic duplication, drug-disease contraindications, adverse drug-drug interactions, incorrect drug dosage, incorrect duration of drug treatment, drug-allergy interactions (as performed by Participating Pharmacies), clinical abuse or misuse, and certain other circumstance that may be indicative of inappropriate prescription drug usage.

Implement a retrospective DUR program for ongoing periodic examination (no less frequently than quarterly) of claims data and other records in order to identify patterns of fraud, abuse, gross overuse or inappropriate or medically unnecessary care. As mutually agreed upon, Retrospective DUR may include: therapeutic appropriateness; over utilization and underutilization; appropriate use of generic products; therapeutic duplication; drug-disease contraindication; drug-drug interaction; incorrect drug dosages; incorrect duration of drug treatment; and clinical abuse or misuse. Contractor shall notify the FUND accordingly so a course of action can be determined.

Through the use of Pharmacy educational outreach programs, educate physicians and pharmacists on common drug therapy problems to improve prescribing and dispensing practices.

Provide Prior Authorization (“PA”) services for Covered Drugs designated within the Contract. Prior authorized drugs must meet the FUND-approved guidelines before they are deemed to be Covered Drugs. The PA program shall include medical exception reviews and overages, as appropriate, quantity limits, non-preferred product determinations and benefit exclusion as specified and directed by the FUND. Upon the request of the FUND, the Contractor shall handle first and/or second level appeals at no additional cost to the FUND.

Contractor may contact Members, their physicians and Participating Pharmacies to promote generic substitution, therapeutic management or other prescription management programs under the direction and agreement of the FUND.

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Deliver reports to the FUND in accordance with the time frames outlined within the performance guarantees. The Contractor and the FUND shall mutually agree on the content, form, format and method of delivery of such reports to enable the FUND to evaluate the services under this Agreement. As necessary and mutually agreed upon, these reports may be amended. Such reports, which may be written and/or presented, shall include, but are not limited to:

Utilization statistics;

Claims processing volume and statistics;

Cost savings;

Customer service and grievance and appeal responses;

An electronic file of priced or paid claims;

The Contractor shall not make changes, modifications, deletions, or alterations to the Retail Preferred Drug List in any manner or way without the FUND’S prior written permission.

Provide to the FUND staff training, as determined and requested by the FUND of all Contactor systems and products available to the FUND staff as part of this Agreement, prior to implementation and at least annually thereafter upon the request of the FUND.

2.0 IDENTIFICATION CARDS The successful vendor shall supply plastic identification cards, customized by and issued in accordance with County instructions. The fee to mail all cards (including postage), original and/or replacements, shall the borne by the successful proposer. A sample layout will be distributed at the pre-proposal meeting on August 16, 2011. 3.0 INVOICING The vendor shall mail to the Office of the County Comptroller, the hard copy of the invoice summary attached to the CD or Diskettes of the detailed invoice. These invoices shall be generated and mailed to the County on a bi-weekly basis. The FUND will submit payment to the vendor on a bi-weekly basis. 4.0 DISPENSING FEE

The FUND shall pay a dispensing fee of no more than $1.50. A lower fee is allowed. The dispensing fee must be indicated on proposal sheet.

5.0 THE BENEFIT The prescription benefit allows for a 30 day supply with refills permitted as prescribed at the local pharmacy.

The plan will cover: Injectables, Federal legend drugs, Diet drugs, State restricted drugs, Imitrex (vials), Male Sexual Dysfunction Drugs, Cox Inhibitors, Accutane under age 25, proper diagnosis required for ages 25 and over, Federal legend vitamins (adult), Federal legend vitamins (children), allergy serums, anabolic steroids, bee sting kits, cholesterol lowering drugs, compounded prescriptions, cough and cold preparations, anti-ulcer medications, diabetic drugs (oral), diabetic lancets, diabetic test strips, diabetic machines, insulin on prescription, mental

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health drugs, non-sterodial anti-inflammatory drugs, prenatal vitamins, retin-a under age 25, proper diagnosis for ages 25 and over, syringes and needles, Imatrex auto injector, Yohimbine, nicotine cessation products, immune altering drugs, fertility drugs (oral and injectable), Dexedrine, contraceptives, oral and other, whether medication or device, regardless of intended use, growth hormone, immunization agents, biological sera, blood or blood plasma, Levonorgestrel (Norplant) Minoxidil (Rogaine)

6.0 CONTRACT The Contract shall consist of the specifications prescribed in this RFP, the signed proposal from the vendor, and the resolution of the FUND accepting the proposal unless an alternate Contract is specifically set forth in the bidding documents. The vendors shall supply, with their proposal submission, a sample of all company-specific contracts, service agreements, etc. that the FUND may be required to sign, if applicable. Failure to provide this documentation may result in rejection of proposal. 7.0 MEDICARE PART D PARTIAL ASSIGNMENT Under the Medicare Prescription Drug Benefit Program set forth in Part D of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (the “Act”), the County of Middlesex has established a Qualified Prescription Drug Plan (QR-PDP) in order to apply for Subsidy Payments (as defined below) in order to continue to provide prescription drug benefits for its Medicare-eligible members. The vendor shall be responsible for providing certain services related to Medicare Plans, including QR-PDPs under the Act. 7.1 QR-PDP PHARMACY BENEFIT MANAGEMENT SERVICES.

Vendor shall provide the FUND and Medicare Members with all the benefits of provided to non-Medicare Members serviced under the County’s Self-Insured Prescription Drug Program. No commissions, marketing fees or other remuneration will be paid by the vendor to brokers, TPA’s or consultants relating to Prescription Drug Claims attributable to QR-PDP utilization.

The vendor shall create Subsidy Reports in a format and with content consistent with the requirements of the Medicare Drug Rules and file, on behalf of the FUND, for Subsidy Payments and meet its QR-PDP reporting obligations under the Medicare Drug Rules. The FUND shall provide to the vendor, in a timely manner, any elements and data required under the Medicare Drug Rules (eg., Member social security numbers, the CMS issued Plan and Sponsor ID and Application ID) in a format reasonable required by the vendor.

The vendor shall acknowledges, in accordance with 42 CFR 423.884 ©(3)(ii) that information provided to CMS in connection with the RDS Plan Sponsor Application is for purposes of obtaining Federal Funds.

The vendor shall certify that the information it provided the FUND is accurate and complete. The vendor shall provide reasonable access and support to the County in the event of a CMS audit of the QR-PDP.

The vendor shall have full responsibility of submitting reports to CMS. The vendor shall update eligibility and request for payments on a monthly basis. An end of year reconciliation shall be provided to the client by the vendor. This

reconciliation shall follow the specifications outlined by CMS. The vendor is required to make available ongoing client webcasts or memos to

provide additional information from CMS regarding updates and changes in regulations.

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8.0 INFORMATION / PROJECT All reports, surveys, tables, charts, diagrams, design work, product recordings and other data (including electronic, audio and video) or documentation prepared or compiled by Proposer in connection with the performance of its obligations under the contract, shall be the sole and exclusive property of the FUND. Proposer shall retain in its files sufficiently detailed working papers relevant to its engagement with the FUND. Proposer further agrees that its working papers will be held in the strictest confidence and will not be disclosed or otherwise make available to outside sources, except as required by law, without the written consent of the FUND. 9.0 CONFIDENTIALITY Proposers must agree to keep confidential any and all information concerning the plans, operations or activities of the FUND which may be divulged by the FUND or ascertained by Proposer in the course of performing services under any contract with the FUND. In the event Proposer is required to disclose confidential information pursuant to a subpoena, order of a court, or other legal process, Proposer shall, upon notice of such required disclosure and prior to disclosure, immediately notify the FUND and allow the FUND the opportunity to inspect the information subject to disclosure, and in the event such disclosure is objectionable under any standard or rule of the court, Proposer shall exhaust all legal means to prevent disclosure. 10.0 QUALIFICATIONS AND EXPERIENCE The names and resumes of representative sample personnel who would be providing pharmacy benefit manager services shall be provided. Indicate whether the individual is a full time employee of Proposer’s organization (and if so for how long) or a subcontractor. If the individual is a subcontractor, list the engagements (and the particular responsibilities on each engagements) that the subcontractor has previously worked for Proposer. Proposer shall include list of three (3) persons or businesses, which have knowledge of the Proposer’s ability to successfully perform the services for which this Proposal is submitted. Name of company, contact name, phone number and e-mail shall be provided. The Proposers shall indicate if, during the past five (5) years, any contract and/or agreement has been cancelled or terminated due, in whole or in part, to the fault of Proposer, or a default or breach of contract on the part of the Proposer. Details shall be submitted with the proposal. 11.0 FINANCIAL STABILITY The proposer must provide financial statements for the most recent two year period. For the purposes of organization and potential claims of non-disclosure, proposers should include their financial statements as an appendix to their proposal. The proposer shall describe in detail any current or past bankruptcy proceedings involving the proposer, its predecessors, its affiliates or its principals.

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12.0 LITIGATION HISTORY The bidders shall provide a list of all current and closed litigation that it has been involved within the past five (5) years. The causes of action shall be specified in each case. Where settlements are subject to a non-disclosure agreement, the case may simply be identified by cause of action. If no litigation or notice of claim has commenced against the bidder, it must be so specified. If the bidder has been subjected to liquidated damages or penalties for contract non-compliance in other correctional health care contracts, the details of that action, including cause, cost and corrective measures shall be included with the bid. If no such action has occurred against the bidder, it must be so specified. 13.0 CONSIDERATIONS The major considerations that will enter into the FUND’S decision-making process include the following:

Manage prescription drug costs and utilization while recognizing the impact on total healthcare costs;

Improve patient health outcomes via appropriate and safe drug therapies;

Evaluate pharmacy cost and utilization drivers;

Provide incentives and education for physicians to dispense high-quality and cost-

effective drugs; Improve patient adherence with treatment regimens, including Member education

programs; and

Develop strategies for managing the use of pharmaceutical products characterized as improving quality of life.

Net Cost Considerations Competitive ASO fees Ability to maximize negotiated pharmacy discounts

Manage therapeutic classes through utilization management programs

Network Superiority Availability of your network to cover the FUND employees and retirees Effectiveness of utilization management and large case management

Benefit Provisions Ability to duplicate current benefits.

Administrative Services Superior customer service Proven claims administration system Willingness to dedicate experienced staff to the FUND Indication of an organized approach to program implementation

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Willingness to customize procedures and communications to meet the FUND’S needs

Capability of electronic enrollment and eligibility information management Retiree Medicare Part D Drug Subsidy Eligibility Reporting Cost Reporting

14.0 PRICING Each proposal shall include the rates to be charged for the services listed below. Please use the administrative pricing, rebates and discounts format found in pricing tables in the proposal sheets.. In addition, if any required data transfer fees are to be charged by the current PBM, please indicate your willingness to pay these fee’s on behalf of the FUND.

Retail Dispensing Fee Mail Order Dispensing Fee Retail Administration Mail Order Administration Retail Rebate Mail Order Rebate Utilization Management Services Employee Communications

15.0 SUBMISSION OF PROPOSAL

One (1) original, three (3) hard copies and two (2) cds (in pdf format) of the proposal shall be submitted. Proposals must be signed in ink by the vendor; all fees shall be made with typewriter or pen and ink. Any proposal sheet showing any erasure alteration must be initialed by bidder in ink. Proposals submitted shall be valid for a minimum of 60 days for the date of opening. The County assumes no responsibility for delays in any form of carrier, mail or delivery service causing the proposal to be received after the above mentioned due date and time. Submission by fax, telephone or email is not permitted. Any questions regarding the submission of the proposals shall be directed to Ann V. Hartwick, QPA, Acting Purchasing Agent, 732-745-3277.

Failure to answer all questions completely and furnish all information required in these Proposal Documents may result in disqualification of the Proposer.

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PROPOSAL SHEET

PHARMACY BENEFITS MANAGER

FUND Pricing Tables Please complete the following tables for your proposal. Guarantee

Name of Network ___________________ Number of Pharmacies ________________ Brand Discount % off AWP Brand Dispensing Fee per Rx MAC Pricing (Yes or No) MAC Generic Discount % off AWP % Generic Rx’s with MAC price Non-MAC Generic Discount % off AWP Generic Dispensing Fee per Rx Lower of UCR Pricing Effective Discount Rate Guarantee

Name of Network ___________________ Number of Pharmacies ________________ Brand Discount % off AWP Brand Dispensing Fee per Rx MAC Pricing (Yes or No) MAC Generic Discount % off AWP % Generic Rx’s with MAC price Non-MAC Generic Discount % off AWP Generic Dispensing Fee per Rx Lower of UCR Pricing Effective Discount Rate

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Page –2- PROPOSAL SHEET (CONT’D)

Mail Order

Guarantee

Brand Dispensing Fee per Rx MAC Pricing (Yes or No) MAC Generic Discount % off AWP % Generic Rx’s with MAC price Non-MAC Generic Discount % off AWP Generic Dispensing Fee per Rx Postage-Paid Return Envelopes

Administration Fees

Guarantee

Network Claims Processing (please specify basis: paid or paid & denied)

Out of Network and Paper Processing Charge (please specify basis: paid or paid & denied)

DUR Program • Concurrent • Retrospective • Prospective

Retail Maintenance Drug Processing Mail Order Claims Processing Other Mandatory/Required Fees

Other

Guarantee

Minimum Rebate Guarantee – Retail Minimum Rebate Guarantee – Mail Order Formulary Rebate Pass-through % DUR Savings Guarantees Generic Dispensing Rate – Retail Generic Dispensing Rate – Mail Order

Generic Substitution Rate – Retail Generic Substitution Rate – Mail Order

Other Proposed Guarantees

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ATTACHMENT A

QUALIFICATIONS AND EXPERIENCE

Attach the names and resumes of representative sample personnel who would be providing pharmacy benefit manager services to the FUND. Indicate whether the individual is a full time employee of Proposer’s organization (and if so for how long) or a subcontractor. If the individual is a subcontractor, list the engagements (and the particular responsibilities on each engagements) that the subcontractor has previously worked for Proposer. Attached: _______yes _________no List three (3) persons or businesses, which have knowledge of the Proposer’s ability to successfully perform the services for which this Proposal is submitted. Name of company, contact name, phone number and e-mail shall be provided. 1 ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 2 ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

3 ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

During the past five (5) years, has any contract and/or agreement been cancelled or terminated due, in whole or in part, to the fault of Proposer, or a default or breach of contract on the part of the Proposer? (Please ‘X’ the appropriate answer and initial after the ‘X’)

__________________ No __________________ Yes If yes, attach details

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ATTACHMENT B

FINANCIAL STATEMENT & LITIGATION HISTORY

D 11.0 FINANCIAL STABILITY Attach financial statements for the most recent two year period. For the purposes of organization and potential claims of non-disclosure, proposers should include their financial statements as an appendix to their proposal.

Attached: _______yes _________no Have there been any current or past bankruptcy proceedings involving the proposer, its predecessors, its affiliates or its principals? (Please ‘X’ the appropriate answer and initial after the ‘X’) __________________ No

__________________ Yes If yes, attach details

D 12.0 LITIGATION HISTORY Attach a list of all current and closed litigation in which the Proposer has been involved within the past five (5) years. The causes of action shall be specified in each case. Where settlements are subject to a non-disclosure agreement, the case may simply be identified by cause of action. If no litigation or notice of claim has commenced against the bidder, it must be so specified.

Attached: _______yes _________no If the proposer has been subjected to liquidated damages or penalties for contract non-compliance in other correctional health care contracts, the details of that action, including cause, cost and corrective measures shall be included with the bid. If no such action has occurred against the bidder, it must be so specified.

Attached: _______yes _________no

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ATTACHMENT C

PHARMACY BENEFITS QUESTIONNAIRE

1. Administrative Information A. Where will this plan be serviced:

i. For Claims ii. For Administration iii. For Customer Service

B. Discuss the account management function, describing the type of personnel that will be the contact person(s) for the FUND on a routine basis. Include a brief biography of the individual(s) that would service this account.

C. Please include a detailed schedule and time frames to implement this program for January 1, 2012.

D. How will you assure that benefits will be duplicated exactly?

E. Please provide specimen contracts and financial agreements.

F. Provide a sample copy of all “standard” management reports that are presently available. What are the associated costs? (If costs are not specific, we will assume that the reports are available at no additional cost). Specify for each report whether the report would be generated quarterly, semi-annually or annually. How long after the experience period will the reports be delivered?

G. Are you willing to offer a performance guarantee? If yes, please describe your offer. It should include claim accuracy, eligibility posting, Medicare Part D subsidy services, ID-Card production, telephone response time and responsive information accuracy.

2. Information Systems

A. Please overview the following regarding your Information Systems hardware and

software capabilities:

• Software Features • Maintenance & Data Collection • Plan Design • Reporting • Electronic Reporting • General Hardware Specifications • Optional Client Remote Access • Automated Enrollment Applications

B. What is your system access security process?

C. Briefly describe your disaster backup and recovery process. D. Describe your ability to interface with CMS for Medicare Part D eligibility and

subsidy filing. E. Describe your ability to provide retiree claims data for the ERRP.

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3. Member Satisfaction

A. Please enclose a copy of the results of the latest member survey performed by

your organization.

B. How are member grievances and complaints handled? How is this procedure communicated to employees?

C. How are problems of employees and dependents resolved? Is there an appeals process that employees and dependents can use to resolve disputes? If so, how does it function? What is the typical timeframe to resolve disputes?

4. Client Services

A. Describe your options for eligibility maintenance, including media use/preferred (hard copy, electronic tape, on line), turnaround time for each media, initial vs. ongoing eligibility additions and deletions, etc. Provide sample ID cards. What is the cost and turnaround time for ID cards? Are cards provided for each member of the family? Is dependent information included on the ID cards? Provide detailed information about your “customer service” programs for both the purchasers and the enrollees. Describe your point of sale claims payment system. How is the privacy of the enrollees protected?

B. Do you conduct periodic, objective “customer service” surveys? What have been the results? What are your service goals and expectations?

C. Will you permit full access to prescriptions, paid claims, tracking of rebates, and other data? The access would be for the purpose of auditing on performance guarantees, pharmacy reimbursement, dispensing and the accuracy of data and reporting. Are there any associated charges?

D. Do you currently provide automated interactive telephone communication service? If yes, describe the menu available to callers and indicate if a touch-tone phone is required or if a voice-response feature is available. Will you provide a dedicated toll-free number for the the FUND? Identify any additional cost for a dedicated line.

5. Claims Administration

A. Describe your claims administration service in detail.

B. Describe how you integrate with the medical administrator, and if eligibility, billing, reporting, and any other functions are shared.

C. Where is the claims administration office located? Is it a part of the vendor company, or an outsourced contract?

D. Do you charge administrative fees for denied or rejected claims?

E. Describe the extent to which your claims administration systems are automated, the extent of manual intervention required, a description of internal auditing procedures, system override procedures and controls, turn-around times for claim payments, verification procedures, security of systems and vouchers, and quality control procedures.

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6. Utilization of Prescription Drugs, Including Quality Assurance A. What do you do to educate and inform purchasers, enrollees, physicians, and

pharmacists regarding the appropriate use of drugs? Please provide copies of routine communications.

B. How do you track current drug utilization for the purchaser?

C. How is drug incompatibility identified? What action steps are taken when drug incompatibility is identified?

D. What percent of current prescriptions is for brand-name drugs in your book-of-business?

E. What percent is for generic drugs? What is the cost saving derived from the use of generic drugs in your book-of-business?

F. Please describe each available pharmacy network that you offer, including differences in network size, discount arrangements, and any other managed care or contractual requirements. Please describe your retail network and explain how it is established and maintained. What percentage of your network pharmacies are on-line?

G. Do you own your own retail network, or is it subcontracted to an independent PBM?

H. Do you own your own mail order facility, or is it subcontracted to an independent PBM?

I. What is your overall generic substitution rate for retail and mail order prescriptions?

J. What is the average turnaround time for mail order prescriptions? What quality safeguards are present at the mail order facility to ensure that prescriptions are filled accurately? What safeguards are utilized to prevent tampering?

K. Does the mail order pharmacy have a toll free number to respond to members’ inquiries? What are the hours of operation?

L. How often do you inspect your network pharmacies? Statistical or on-site? What percentages of network pharmacies are audited each year? How are these pharmacies identified for audit?

M. How do you communicate and educate participating pharmacies? Do you proactively inform network pharmacies and members about recalls of prescription drugs (following notification by the drug manufacturer)?

N. Do your network pharmacies agree to advise patients about their prescription drugs, potential side effects, and compliance with prescription drug therapy?

O. Do your network pharmacies review concurrent DUR messages and take action as appropriate and also actively encourage generic substitution?

P. As part of your DUR program, do you identify potential life threatening prescription drugs and proactively contact the physicians and/or pharmacist to prevent danger to the patient?

Q. Are your network pharmacies required by contract to submit their lowest usual and customary price for each claim?

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R. Which mail service pharmacy do you recommend for MIDDLESEX? Describe the reasons for this decision, other larger employers using this facility and the facility’s current usage and capacity. Will customer service representatives assigned to the FUND be located in the same offices as the mail order facility? If not, where are the CSR’s located and how do they access mail order information?

S. Will your contracted pharmacies meet all state and federal licensing requirements? Does your mail service facility meet all state and federal pharmacy licensing requirements?

T. How do you promote the use of mail order service for maintenance drugs?

U. Are your mail order claims (mail service and retail) processed through integrated claims processing systems prior to being dispensed?

V. What disease management programs are presently available? Please describe these programs.

W. What are the cost/credits to the purchaser associated with utilizing these programs? Provide any cost-benefit or cost-savings data to support your disease management programs.

X. Do you apply case management practices and procedures for individual problems with an enrollee? If so, please give further information. Describe any situations where you coordinate with the medical plan utilization review vendor for catastrophic care.

Y. Describe your pre-authorization procedures, and are these services provided within the scope of the base administrative fees?

7. Retiree Drug Subsidy and ERRP

A. Please describe in complete detail how you will assist the FUND in coordinating with CMS for subsidy filing; including but not limited to: applications, actuarial attestations, eligibility filing, Medicare D duplicate eligibility matches and employee communications, cost reporting and reconciliation.

B. Please describe your ability to provide claims information for ERRP reporting.

C. Please describe your ability to implement an Employer Group Waiver with a Wrap Plan (EGWWP).

8. Pricing

A. PBMs use different pricing methodologies, most often based on a discount from the Average Wholesale Price (AWP), plus dispensing fees and other charges. Describe your pricing methodology in substantial detail. Discuss the transparency of your pricing.

B. Please complete the Pricing Tables attached.

C. What is your primary source for establishing AWP rates? How often are these rates updated?

D. Describe your definition of Maximum Allowable Cost? How is it determined?

E. Is there any network differential between what you pay to a retail pharmacist and what you charge the purchaser? If so, what is the amount/value of this differential?

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F. Do you receive any rebates, grants, or other financial incentives from drug manufacturers, wholesalers, distributors, or others? If so, what is the disposition of these? Are these shared in any way with the purchaser? Describe how they are shared.

G. Do you participate in any preferred dispensing fees with any pharmacies?

H. Will you reimburse the eligible individual for any cost of inaccurately dispensed prescription drugs and the cost for the correct replacement prescription drug?

I. Please describe any stop loss reinsurance you can provide and the cost. Stop Loss is available upon request. We competitively bid direct to our carriers in order to obtain the most competitive pricing.

9. Repricing of Claims A claim file of approximately 3 months of claims for repricing (approximately 30,000 claims) will be provided at the meeting on August 16. Your analysis should include all of the following repricing data in separate columns for each record: Gross ingredient cost, i.e. U&C, AWP starting point Discount amount Pricing determination (U&C, MAC, or discounted AWP) Formulary or Non Formulary Mail Order or Retail RX distribution category (single source, multi-source, generic or specialty) Please indicate if the Retail Pharmacy is In-Network or Out-of-Network

Claims repricing information must match the NDC number, and NDC Dispensing Package Size (Day Supply) for each individual record and should not be substituted for less expensive prescriptions within therapeutic class or over the counter medications.

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ATTACHMENT D

PLAN SUMMARIES AND CENSUS DATA

Summaries of the prescription programs and census data will be distributed at the pre-proposal

meeting on August 16, 2011.

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ATTACHMENT E

CLAIMS DATA Actives and Retirees Prescription Volume PYE 8/31/09 PYE 8/31/10

Total Prescriptions 122,163 122,840

Mail 31,075 29,658

Retail 92,088 91,352

Cost Components

Total Gross Costs

Mail

Retail

Total Net Costs 15,693,145 14,319,881

Mail 7,077,987 6,086,480

Retail 8,615,157 8,233,402

Total Member Costs 551,924 549,510

Mail 215,142 204,824

Retail 336,782 344,685

Member Cost Share % 3.5% 3.8%

Mail 3.0% 3.4%

Retail 3.9% 4.2%