As ADAPs increasingly contract with third parties for pharmacy and related services, this toolkit provides critical guidance on planning, selecting, and implementing a benefits management contract tailored to your program's specific needs.
This toolkit is a practical resource, complete with checklists, templates, and examples from other states to help ADAP programs make informed decisions.
Toolkit Content
The toolkit offers comprehensive support for navigating the complexities of third-party administration, covering key areas such as:
- Understanding Benefits Managers: The toolkit defines the roles of various third-party administrators (TPAs), including:
- Pharmacy Benefits Managers (PBMs): For establishing pharmacy networks, processing claims, managing rebates, and ensuring access to medications.
- Insurance Benefits Managers/Administrators (IBMs/IBAs): For assistance with client enrollment in health plans, managing premium payments, and coordinating cost-sharing payments.
- Medical Benefits Managers (MBMs): For facilitating payments for medical benefits, such as provider-administered drugs like long-acting injectables.
- Navigating the Procurement Process: The resource provides detailed guidance on the competitive process for securing a TPA. It outlines how to engage stakeholders and develop a comprehensive scope of work (SoW) to attract the best vendor. It also explains different types of requests, such as Requests for Proposals (RFPs) and Requests for Quotes and Qualifications (RFQQ).
- Selecting and Utilizing a Contractor: The toolkit provides key considerations and strategies for the entire contracting lifecycle, including:
- Selection: Guidance on forming an evaluation team and using weighted scoring to assess proposals based on criteria like technical expertise, past performance, and cost-effectiveness.
- Collaboration: Best practices for building a strong partnership with your contractor, defining roles and responsibilities, and maintaining open communication.
- Monitoring: Strategies for effective contract monitoring to ensure compliance with all terms and HRSA HAB expectations.
Also available on the NASTAD website.
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