ASES seeks new pharmacy benefit manager for gov’t health plan
By The Star Staff
Puerto Rico Health Insurance Administration (ASES by its Spanish acronym) Executive Director Jorge Galva Rodríguez announced on Wednesday that he has begun a process of requesting proposals (RFP) from companies interested in being the pharmacy benefit manager, manager of the Medicaid Drug Reimbursement Program (MDRP) and other drug reimbursement services, jointly referred to as rebate aggregator, for the Puerto Rico government health plan, known locally as Plan Vital.
“We have taken the initiative to continue strengthening our organization to ensure that our beneficiaries receive optimal services and effective costs. Likewise, to continue executing healthy public administration measures and to continue with the process that I established to improve contracting practices,” Galva said in a written statement. “Together with my work team we have projected that this competition process will generate millions in savings which will be reversed to provide greater access and services to patients, who are our reason for being.”
“I am convinced that with this process we are going to reduce costs, promote competitiveness and prepare Puerto Rico for entry into the Medicaid Drug Rebate Program (MDRP).”
The MDRP is a program that includes the Centers for Medicare & Medicaid Services, state Medicaid agencies, and participating drug manufacturers and helps offset the federal and state costs of most outpatient prescription drugs dispensed to patients with Medicaid. Some 600 drug manufacturers currently participate in the program.
Galva noted that for the competition process ASES has invited more than 20 companies specialized in the aforementioned services established in Puerto Rico and the mainland United States.
“This initiative is consistent with the public policy of the Governor of Puerto Rico, Pedro Pierluisi, to provide more access to the beneficiary,” Galva said. “At the same time, to execute the best practices of sound public administration. That is why the [process] is open and transparent. That is why we issue public notices in Puerto Rico newspapers, among other efforts.”
ASES, created under Act No. 72 of 1993, to date has 1.3 million beneficiaries under Plan Vital.
Galva, who is also a health and hospital administrator, said “the interested parties must have the necessary infrastructure and financial capacity to begin providing all services as of February 1, 2022.”
“The selected entity [and/or entities] must comply with the independence and non-conflict of interest requirements that include, among others, that at the time of signing the Contract, the Proponent (s) and any Subcontractor (s) to be hired (s) to perform functions and responsibilities under the Scope of Work of this RFP, other than: (a) a pharmaceutical company; (b) pharmacy; (c) PSG Health Care Management Organization (MCO) or health service provider, collectively “PSG Participant”; (d) owned or controlled by a pharmaceutical company, pharmacy or PSG Participant; or (e) does not own or control a pharmaceutical company, pharmacy or PSG Participant,” he said in the statement. “ASES reserves the right to waive guarantees of independence and no conflict of interest. At the time of the award of the RFP, the interested parties must be authorized to do business in Puerto Rico, have a current certification from the Single Registry of Professional Service Providers (RUP) of the ASG, be registered in the Award Management System of the Federal Government (SAM), and not be disqualified, suspended, proposed for disqualification or declared ineligible for the award of contracts by any federal and state department or agency.”
As of April 1, 2021, entities interested in obtaining an electronic copy of the RFP specifications and participating in the process must send a signed request by email to firstname.lastname@example.org, at least by the most senior ranking local managerial official, indicating: (a) interest in submitting a Proposal; (b) that it has the necessary legal and financial capacity; and (c) the contact information (name, position, email and telephone number) of the person authorized to communicate during the process with the ASES “Procurement Contact,” according to the statement. Upon receipt of the request, ASES will send the bank information for the corresponding payment of the specifications, which will have a non-refundable cost of $5,000 payable exclusively by electronic bank transfer in the name of ASES.
“The payment must be made by the entity that will present the proposal. After payment, the interested entity will send to ASES by email the evidence of payment provided by the banking institution, which must include: (a) date of payment; (b) amount of the bank transfer made to ASES; and (c) name of the interested entity making the payment,” the publication reads. “Any shortfall in payment, even caused by the collection of a transaction fee or charge made by the financial institution or an inn.