Pharmacy Benefit Management Services

The State of Delaware is seeking a pharmacy benefit management partner to provide commercial and Employer Group Waiver Plan (EGWP) Medicare Pharmacy Benefit Management Services. The selected organization will be responsible for administering the State's pharmacy benefit program, including prescription claim adjudication, participant enrollment maintenance, and comprehensive management of the Medicare Part D EGWP. The organization must have prior experience directly related to the services requested in this RFP and must be able to demonstrate its ability to meet the general evaluation requirements. Some key services include: * Prescription claim adjudication * Participant enrollment maintenance * Comprehensive management of the Medicare Part D EGWP * Secure transmission of enrollment and claims data * Patient and provider education * Network pharmacy management * Formulary management and rebate administration * Systematic prospective, concurrent, and retrospective drug utilization review * Clinical management programs * Fraud, waste, and abuse detection and prevention programs * Mail order and specialty pharmacy services * Dedicated member support services * Meaningful and timely management reporting * Integration with the State's medical and wellness programs