Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED130066. Pharmacy Point-of-Sale (POS)YESwithoutReq #Description of RequirementcustomizationPOS.41 CMS and/or their agents XPOS.42 Commercial drug file vendor XPOS.43 Other as identified by BMS during DDI and accepted viaXformal change control (the Vendor is expected to exhibit awillingness to support BMS defined interfaces)POS.44 Ability to support the following online processing of pharmacy Xclaims through networks provided by contracted switch vendors:POS.45 Transmission and online real-time processing of pharmacy XclaimsPOS.46 Real-time access to Member and Provider eligibilityXinformationPOS.47 Prior Authorization processing XPOS.48 Third Party Liability (TPL) processing and response XPOS.49 Respond to Drug Utilization Review (DUR) alerts XPOS.50 Notification of co-payment requirements XPOS.51 Other as identified by BMS during DDI and accepted viaXformal change controlPOS.52 Pharmacy POS should support an eligibility transaction through Xnetwork Providers to provide or support Provider queries oneligibility. (The POS should support NCPDP eligibility requesttransactions).POS.53 4. Drug FilePOS.54 The Pharmacy POS drug file is expected to have the capability to Xindicate preferred drug status.POS.55 The Pharmacy POS drug file is expected to have the capability to Xindicate prior authorization requirements.POS.56 Ability to develop, implement and maintain the BMS’s customized Xdrug database.POS.57 Ability to, at a minimum, support all data elements provided by a Xcommercial drug file vendor for each drug. (BMS prefers thevendor use First DataBank (FDB) and the AWP pricing file fromMedispan. Currently, all clinical and therapeutic policies are basedon FDB nomenclature, while AWP pricing is supported by usingMedispan file.POS.58 Ability to maintain a master drug data file, which contains an Xentire list of products available including legend and Over thePOS.59POS.60POS.61Counter (OTC) drugs, as well as others as specified by the BMS.Ability to maintain, at a minimum, all standard drug-specific dataelements used by pharmacy claims processors and the BMSspecificdata elements.Ability to provide for electronic update of the drug database froma commercial drug file vendor on at least a weekly basis or asdirected by the BMS. (BMS does not expect to bepurchasing/leasing the commercial drug file. The Vendor isexpected to be responsible for this contract. First DataBank is thecurrent vendor and Medispan’s AWP pricing file was added inSeptember 2011).Ability to overwrite data transferred from commercial drug filevendor.XXXYESwithcustomizationNOunabletoprovide14.2-75