Cloud-Based Pharmacy Formulary Management Solution

A government authority in California is seeking a vendor to provide a cloud-based pharmacy formulary management solution. The required platform must operate as a Software as a Service (SaaS) and support the administration of Medicare drug coverage formularies, including the management of utilization criteria and regulatory submissions. The solution should be fully hosted in the cloud, eliminating the need for on-premises infrastructure and enabling web-based, anytime access for users.

Key capabilities must include the ability to produce compliant digital and print-ready formularies, automated and validated regulatory file submissions, and adherence to industry drug coding standards such as RxNorm, NDC, and FDB, as well as meeting CMS and DMHC technical specifications. The platform should support the creation, management, and updating of multiple drug formularies throughout the plan year, with integration of industry-recognized drug databases to ensure timely inclusion of new drugs. Additional features should include tools for drug tiering, clinical utilization management criteria, prior authorization, and step therapy management.

Automated generation of CMS-compliant files—including Formulary Change Files, Prior Authorization Files, Step Therapy Files, and Full Formulary Files—must be available for submission to the Health Plan Management System (HPMS) in compliance with the latest CMS requirements. The anticipated contract period will be three years.