The World Trade Center (WTC) Health Program was created by the Zadroga Act to offer healthcare services to responders and survivors of the 9/11 attacks. The program provides medical monitoring and treatment for conditions linked to the attacks, with enrollment numbers showing a recent increase in both responders and survivors. The program presents unique challenges in managing pharmacy benefits due to its limited coverage scope, which only includes specified conditions. A prescription benefit manager (PBM) is needed to deliver comprehensive pharmacy services while ensuring compliance with federal regulations, including a need for customized technology to manage formularies and prior authorizations effectively. Key tasks for the PBM include developing a functioning pharmacy network across the US, implementing electronic systems for efficient claims processing, conducting regular audits, and establishing a quality assurance plan. The PBM must also provide transparent pricing, manage change controls, and implement an effective communications strategy to keep stakeholders informed. This contract encompasses all aspects of pharmacy benefit operations for the WTC Health Program, aimed at ensuring optimal care for enrollees while maintaining regulatory compliance and cost-effectiveness.

The Centers for Disease Control and Prevention (CDC) is seeking interested parties to provide Pharmacy Benefits Manager (PBM) services for the World Trade Center (WTC) Health Program, aimed at administering pharmacy benefits for responders and survivors affected by the 9/11 attacks. This contract spans three years with specific implementation and operational timelines, including a transition period, a peak operational phase, and a transition-out phase. The WTC Health Program, established under the Zadroga Act, requires customized drug formularies and prior authorization processes to ensure that only medically necessary treatments are provided in line with the program's regulations. Respondents are expected to demonstrate capabilities in system customization, customer care, clinical services, reporting, and cost control. Challenges in implementation and continuity of care during transitions are acknowledged, with emphasis on the need for innovative solutions and collaboration. Interested vendors must submit their qualifications by February 14, 2025, to support the unique needs of this limited-benefit health program while ensuring compliance and operational efficiency throughout the contract duration.