Description
The State of Arizona seeks one or more vendors to provide statewide workers’ compensation cost‑containment services and pharmacy benefit management (PBM) solutions. The contract will be an ID/IQ arrangement with an initial 12‑month term, extendable up to five years, and may be awarded to multiple contractors. Vendors must demonstrate expertise in workers’ compensation claim analysis, cost‑containment strategies, PBM operations (including formulary management, claim adjudication, and rebate handling), and must meet stringent information‑security (GovRAMP) and HIPAA Business Associate requirements. The solicitation demands comprehensive documentation, including insurance certificates, security attestations, and a $1.00 placeholder line‑item in the e‑procurement system.
• Core services: workers’ compensation cost‑containment, PBM administration, 24/7 nurse triage, utilization review, bill review, and pharmacy audit.
• Mandatory compliance: GovRAMP Core (or snapshot within 60 days post‑award), HIPAA BAA, AZDOHS security program, and extensive insurance limits.
• Performance metrics: utilization‑growth targets for nurse triage, bill‑review turnaround (2 business days for questionable bills, 10 days for clean‑claim recommendation), and at least 3 % pharmacy audit coverage annually.
• Financial model: firm‑fixed pricing submitted via an Excel sheet; all rebates must be remitted to the State, with no service fees charged for PBM.