Project Overview
Change Healthcare, acquired by Optum in 2022, through competitive procurement started May 1, 2014 on contract #34056, to implement and operate the current PBM system that was certified by CMS on March 28, 2018. The system components are nearing the end of support and for adherence with bulletin 3.5 the solution must go out to bid for re-procurement which entails RFP, RFP scoring, contracting, implementation, testing, and certification.
The current PBM provides a suite of Prescription Benefit Management services to the State, which includes expertise in pharmacy claims processing, clinical management of DVHA’s drug benefits, pharmacy clinical and cost-management strategies, preferred drug list management, provider call center support, retrospective and prospective drug utilization review, pharmacy reporting and analytics, and drug rebate processing.
These operational and clinical services are supported by a suite of IT applications, including a point-of-sale claims processing platform, prior authorization processing, help desk call management, reporting and analytics tools, and rebate administration platforms. The vendor also operates a 24/7 call center to service providers that is staffed by pharmacists and pharmacy technicians which assists the pharmacies with claims processing issues and with processing all Medicaid members prior authorization requests for drugs.
In early SFY22, DVHA was engaged by the state of Georgia through the National Association of State Procurement Officials (NASPO) to participate in the multi-state RFP to competitively reprocure the PBM system.
Key Contacts
- Sandi Hoffman/Lisa Hurteau – Project Sponsor
- Lisa Hurteau – Business Lead
- TBD – Resource Needed Project Manager
- Grant Steffens-Hodgkins/TBD – Technical Lead
- Bob Maddock – Business Analyst
- Paul Pratt/Serena Kemp – Portfolio Manager
- Sean Judge – Enterprise Architect
- Renee Taylor – Quality Lead
- Shelley Dimick – Certification Lead
- Meaghan Kelley – DVHA Procurement Lead
- Deb Damore – NASPO Procurement Lead