The network is large and the next contract is slightly larger
CMS’s Medicare Part D transaction facilitator routes about 80 million pharmacy coordination-of-benefits transactions each month, according to a GAO bid-protest decision. The next base-plus-four-options procurement has an expected value of about $131.7 million.
The incumbent’s 2021–2026 task order was valued at $126.752 million. The new estimate is $4.948 million higher, a 3.90% increase, although contract scope, competition and actual award price may differ.
| Measure | Value |
|---|---|
| Monthly transactions | About 80M |
| Prior task-order value | $126.752M |
| Expected new value | $131.7M |
| RFI responses | 12 |
| Phase-one quotations | 2 |
The incumbent’s pricing support failed an audit test
A GSA inspector-general audit found RelayHealth’s sales disclosures current, accurate and complete but not a suitable basis for negotiation. The company had no comparable non-schedule sales and could not support proposed transaction pricing or 33 labor-category rates with actual costs.
GSA followed the audit recommendation not to extend RelayHealth’s schedule contract. That finding concerned the incumbent’s pricing support; GAO said the audit did not conclude that the underlying Medicare services were noncommercial.
CMS used wider market research, but competition narrowed
CMS received 12 responses to its request for information: the incumbent, two other large businesses and nine small businesses. All but RelayHealth said they could perform through federal schedule contracts, and CMS held meetings with four vendors.
Only two vendors submitted phase-one quotations by the deadline. GAO still found CMS’s schedule and commercial-service determination reasonable and denied the protest. The record supports a distinction between broad market interest and the smaller number that actually competed.
Method and limits
What’s the Scoop With Broach compared the old and expected contract values, calculated the 3.90% difference and traced the audit, market-research and quotation counts in the decision. A monthly transaction count is workload, not a per-claim payment.
The redacted protest decision does not disclose vendor prices or the final award. Denial of the protest validates the procurement approach under the record reviewed; it does not guarantee future service quality or cost savings.
Sources and further reading
GAO bid-protest decision B-424672, NDCHealth/RelayHealth ↗
Health Care Financing Administration building photograph and public-domain record ↗