Pharmacy Benefit Management

The State of New Hampshire is seeking a qualified vendor to provide pharmacy benefit management services for the Medicaid Fee-for-Service (FFS) Program and the Division of Public Health Services. The selected vendor will be responsible for adjudicating pharmacy claims, managing the delivery of pharmacy benefits, and providing technical and clinical call center services. The vendor must demonstrate at least five years of successful experience in pharmacy benefit management and administration, and have experience with financial risk management and public sector projects. The contract is expected to be effective for a period of five years, with the option to extend for up to five additional years. Key aspects of the job include: • Adjudicating pharmacy claims using the National Council on Prescription Drug Programs (NCPDP) D.0 format or a later release • Providing technical and clinical call center services for providers and individuals receiving benefits • Managing the federal drug and supplemental rebate programs for the NH Medicaid Program • Designing, developing, and implementing the State's Pharmacy Benefits Management (PBM) system • Ensuring compliance with HIPAA and the Privacy and Security Rule