Stat Exam of Scrip World LLC dba Meritain Pharmacy Solution

Summary (Newest Update)

Background The West Virginia Department of Revenue, Offices of the Insurance Commissioner (OIC) is seeking qualified vendors to conduct statutory and market conduct examinations of pharmacy benefit managers in the State of West Virginia. This initiative is in compliance with W. Va. Code §33-2-9, the Pharmacy Benefit Managers Act (W. Va Code §33-51), and the Health Benefit Plan Network Access and Adequacy Act (NAA) (W. Va Code §33-55). The goal is to assist the Health Policy Division in fulfilling its regulatory responsibilities. Work Details The selected vendor will be responsible for drafting a formal report of examination that includes findings, conclusions, and recommendations for corrective or regulatory action regarding Scrip World, LLC dba Meritain Pharmacy Solutions. The examination will cover practices related to pharmacy benefits management, including: - Procurement of prescription drugs - Administration of prescription drug benefits - Operating mail-service pharmacies - Claims processing - Managing retail pharmacy networks - Paying claims for dispensed drugs - Developing clinical formularies - Rebate contracting administration - Managing patient compliance programs. The scope also includes preparing examination planning memorandums per NAIC guidelines, documenting procedures performed during the examination period, drafting formal Reports of Examination and Management Comment Letters within specified timelines, and conducting follow-up procedures as directed by the OIC. Period of Performance The examination period covers January 1, 2023 to December 31, 2025. The expected start date for the examination is June 1, 2026, with an expected completion date of May 31, 2027. Place of Performance The contract work will primarily take place in Sandy, UT where Scrip World LLC dba Meritain Pharmacy Solutions is located; however, it may involve travel within West Virginia as necessary for examinations. Bidder Requirements Vendors must demonstrate qualifications including: - A minimum of five to eight years of experience in pharmacy benefit management (PBM) - At least three years of regulatory PBM exam experience - A Certified Insurance Examiner (CIE) designation among team members - A licensed pharmacist on staff with experience in reviewing PBM claims. Vendors must also provide a detailed work plan identifying major tasks and a cost quotation detailing fees for each level of participant involved in the examination.