Texas Health and Human Services Commission HHSC

1. Texas Health and Human Services Commission (HHSC) Texas State Pharmacy Assistance Program (SPAP) Request for Proposals # 53700-08-34885 Vendor Conference 08-30-07

2. Welcome Introductions Steve Bailey, Manager, Enterprise Contract and Procurement Services (ECPS) Shawn Constancio, HUB Coordinator, Department of State Health Services (DSHS) Dwayne Haught, Manager, Texas HIV Medication Program Housekeeping Items

3. HHSC Procurement Roles ECPS- Responsible for procurement activity HUB- Responsible for HUB activity Program- Responsible for project scope, requirements, performance, results, contract management/monitoring Legal- Questions/answers and legal activity

4. Texas HIV SPAPVendor Conference Overview Procurement Activities HUB Items RFP Overview Questions Submittal Break Preliminary Responses to Questions Closing Comments

5. Procurement Activities Questions & Answers Sole Contact, Elizabeth Ward, ECPS Procurement Schedule Solicitation Access Submission Requirements Solicitation Changes Screening & Evaluation Award Information

6. HUB Subcontracting Plan(HSP) Requirements

30. Department of State Health Services HUB Program Office Shawn Constancio, CTPM DSHS HUB Coordinator (512) 458-7394 or (800) 243-7487 shawn.constancio@dshs.state.tx.us

31. RFP Overview Texas HIV State Pharmacy Assistance Program (SPAP)

32. Project Background The Medicare Modernization Act included a prescription drug benefit for Medicare beneficiaries The prescription drug benefit/Medicare Part D was implemented on January 1, 2006 Medicare beneficiaries with incomes <135% of FPL and who have limited assets receive financial assistance through Social Security with Part D premiums and out of pocket costs related to their medication regimens Referred to as �extra help� or Low Income Subsidy

33. Project Background Medicare Part D is a tiered benefit with three phases of reimbursement Phase I is a mix of client paid OOP expenses and Medicare paid drug costs Phase II is the self pay phase commonly called the �doughnut hole� Phase III is the catastrophic pay phase where clients OOP expenses are only 5% of the total cost of their medication regimen

34. Project Background The obvious goal is to advance the client into the catastrophic payment phase of Medicare Part D

35. Project Background In 2006, when Part D started ~ 25% of Texas ADAP Clients were eligible for Medicare Most were eligible for LIS and were transitioned from Texas ADAP to Medicare Part D Plans Approximately 850 individuals with Medicare remain on the Texas ADAP Denied LIS or have partial LIS High out of pocket costs for HIV medications through Medicare Texas ADAP does not have the infrastructure to pay Part D Costs ADAP contributions toward Part D do not count as TrOOP

36. State Pharmacy Assistance Program Uniquely designed programs that assist elderly and disabled clients with accessing prescription medications Funded totally with State General Revenue (GR) State GR counts as Medicare Part D TrOOP Clients advance to the money-saving catastrophic payment phase of Medicare Part D Existing GR from Texas ADAP will fund SPAP Medicare Part D clients currently served by ADAP will move to the SPAP

37. Project Mission Provide Medicare Part D wrap around coverage for Texas ADAP Clients who are eligible for Medicare Interface electronically with pharmacies, prescription drug plans and Medicare Manage drug expenditures Obtain Manufacture Rebates

38. Scope of Work Oversee the payment of Medicare Part D deductibles, coinsurance, co-payments and costs of medications during any gaps in coverage for clients enrolled in the SPAP Coordinate with all Part D Plans in Texas Ensure that applicable expenditures are credited toward client�s annual TrOOP expenditure requirements

39. Scope of Work Establish and monitor cost containment measures Example: annual cap on client expenditures Ensure SPAP does not pay for Medicare excluded medications under Part D Ensure that SPAP does not pay for medications not approved by the SPAP or the Part D plan formulary for which the client is enrolled

40. Scope of Work Pursue and coordinate pharmaceutical manufacturer rebates available to DSHS for medications dispensed to Texas HIV SPAP clients.� This coordination would include adjudication of claims and dispute resolution with pharmaceutical companies

41. Performance Measures Submits required program data within negotiated DSHS timeframe Resolves payment errors made to Medicare part D plans within negotiated timeframe Reports SPAP enrollee out-of-pocket payments to the CMS Troop facilitator monthly following CMS guidelines Convenes, at minimum, quarterly SPAP/PBM contractor conference calls

42. Texas Health and Human Services Commission (HHSC) Questions Submittal Followed by Break

43. Texas HIV SPAPTentative Responses to Vendor Questions Formal, written responses to vendor questions will be posted on the procurement website as the questions are answered. All responses will be posted on the website by September 10, 2007.