Description
The State of South Carolina seeks a vendor to design, implement, and operate a comprehensive Pharmacy Benefit Services (PBS) program for Medicaid beneficiaries. The award will be a fixed‑price, multi‑year contract that includes a one‑year implementation phase, two‑year operations & maintenance, and up to four optional one‑year renewals. The contractor must provide claims processing, prior‑authorization, drug utilization review, rebate management, help‑desk support, training, data conversion, and full compliance with HIPAA, CMS, and state security standards. Key deliverables include a functional PBS platform, integration with the State’s MMIS, ongoing support, and documentation for CMS certification.
• Claims adjudication of ~140 k pharmacy claims per month and prior‑authorization for POS and PAD drugs.
• Rebate processing, value‑based rebate capability, and comprehensive reporting to CMS and the State.
• Full lifecycle services: system design, development, testing, deployment, training, help‑desk, and two‑year operations with optional renewals.
• Mandatory insurance, security, and staffing requirements, including a South Carolina‑licensed Pharmacy Director and extensive key‑personnel roster.