CMS Sources Sought: Third Party Administrator (TPA) for the Medicare Part D Coverage Gap Discount Program (CGDP)

Notice ID: HHSCMS-SBSS-2021-000001S-TPA


  1. The contractor shall have the necessary infrastructure support to effectively interface with all stakeholders. This includes CMS, pharmaceutical manufacturers, Part D sponsors, and contracted CMS personnel involved with the operation and administration of the Medicare Coverage Gap Discount Program.
  2. The work that will be addressed under the future contract will require the contractor to have advanced knowledge of the Medicare Part D program, Coverage Gap Discount Program, Prescription Drug Event (PDE) file data, and be able to develop and maintain a transparent electronic, web based, financial automated clearing house (ACH) payment process system that is fully operational to meet the CMS Part D Coverage Gap Discount Program scheduled operations deadlines.
  3. The contractor shall have the capabilities and infrastructure sufficient to meet all CMS IT Systems Security compliance requirements including, but not limited to, experience with ARS Controls, ACT, FISMA, A-123, CFO, OIG, and GAO audits and to comply with National Automated Clearing House Association (Nacha) guidelines.
  4. The contractor shall have the ability to communicate timely, accurately and reliably, both internally and externally, to ensure open and effective dissemination and coordination of information to all affected parties involved in the Discount Program operations. These parties include, but are not limited to: CMS staff, pharmaceutical manufacturers and their third party vendors, Part D sponsors, CGDP program auditors, the Drug Data Processing System (DDPS) contractor, and other CMS data analysis contractors, as applicable.
  5. The TPA shall serve as the single point of contact for all pharmaceutical manufacturer and Part D sponsor plan questions concerning TPA functions, invoices, disputes, audits and data associated with the CGDP. The contractor shall facilitate payment between parties to ensure invoiced amounts are paid. The contractor shall respond to pharmaceutical manufacturer and Part D sponsor telephone, written, and e-mail inquiries regarding third party administrator transactions or transaction processing requirements and provide answers, recommended remedies and/or appropriate system intervention.
  6. The TPA contractor shall provide the physical facilities, technology, customer contact and data analysis staff and the IT and management personnel to operate and manage a customer service and support operation center that receives inquiries from pharmaceutical manufacturers and Part D sponsors. The contractor shall provide expert Medicare Customer Service Representatives (CSRs) during all hours of operation, sufficient to handle projected volumes of telephone, e-mail, and written correspondence…

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