The Washington State Health Care Authority (HCA) is initiating this Request for Proposals (RFP) to solicit Responses from qualified Bidders for the Design, Development and Implementation (DDI) and maintenance of a modular Pharmacy Point of Sale (POS) solution. The POS solution encompasses the automated functions necessary to receive and adjudicate all pharmacy Fee-for-Service (FFS) claims, Managed Care Organization encounters, and process drug rebate invoicing. The overall services and components to be acquired through this RFP encompass the following:

• Fully functioning Pharmacy POS solution that will seamlessly integrate with HCA’s Medicaid Management Information System (MMIS) named ProviderOne;
• Flexible and configurable rules for easy program updates by state staff;
• Prior Authorization (PA) database that allow staff to perform prior authorization request processing and determination;
• Drug Rebate database that allows staff to manage the invoicing and dispute resolution processes;
• Self-service portal features for providers to submit prior authorizations online, inquire on status and to retrieve PA correspondence;
• Robust PA workflow processes and procedures including dashboard and reporting capabilities to effectively manage workloads;
• Self-service portal features for manufacturers to retrieve drug rebate invoices and claim level detail;
• Operational reports that provide for the effective management of pharmacy and drug rebate programs;
• DDI project management and staffing services, staff and provider training and certification support; and
• Ongoing system operations and maintenance.

HCA intends to award one contract to provide the services described in this RFP, which includes the DDI effort. On-going operations and maintenance services will begin at the conclusion of DDI after the Vendor meets the State’s system acceptance criteria.

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