The Washington State Health Care Authority, hereafter called “HCA,” is initiating this Request for Proposals (RFP) to solicit Proposals from firms interested in participating on a project to implement and complete a Cost of Dispensing Survey (CODS) to estimate costs to all retail, long-term care, Section 340B, specialty and mail order pharmacies that dispense outpatient prescription drugs to Apple Health Fee-for-Service Medicaid clients.

The Washington Health Care Authority (HCA) is responsible for the administration of Washington Apple Health (Medicaid) program, a medical assistance program established by Title XIX of the Social Security Act of 1965 and Chapter 74.09 of the Revised Code of Washington. Under federal law, the Centers for Medicare and Medicaid Services (CMS) requires HCA to follow certain standards in setting payment rates to pharmacies who participate in the fee-for-service portion of the Medicaid program. Among other things, HCA must determine a “professional dispensing fee.” HCA and various pharmacy groups entered into a Settlement Agreement on September 13, 2023, in the case of National Association of Chain Drug Stores, et al., v, Washington State Health Care Authority, et al. (Washington State Court of Appeals Case No. 51489-3-II). As part of the Settlement Agreement, HCA agreed to perform or procure a cost-of-dispensing survey.

This is a description of the Scope of Work for the award Contract. To view the Scope of Work in full review Exhibit B, Draft Contract, Attachment 3, Statement of Work.
HCA is seeking a Contractor to design and administer a survey of the costs that retail pharmacies incur to dispense prescription drugs to certain Apple Health clients.
The Contractor will design a survey instrument to collect data elements to estimate the pharmacy costs related to dispensing prescriptions and other services for the Apple Health Fee-for-Service Medicaid program. The Contractor will also administer and analyze the survey data, including performing appropriate statistical comparisons of un-weighted and weighted means to identify significant differences between identified categories of pharmacy characteristics.
The Contractor will produce explanatory reports and validate the survey through a sound, documented statistical validation process, which includes comparing a random sample of participants’ supporting documentation (tax records, blueprints, etc.) to the submitted surveys.
The Contractor will provide a final report containing aggregated, de-identified data from survey respondents to HCA.