Pharmacy Benefit Management Services

The Vendor is required to provide for pharmacy benefit management services (PBM).
- The PBM will provide services including but not limited to consistent formulary, access to online detailed reporting for district, and other designated parties, maximized rebates, consistent administrative process and functions, utilize consistent cost management process, provide access to prior authorization approval district, and other designated parties, allow regular electronic exchanges of eligibility information between district, third party administrator and community health partners, conduct educational programs for local physicians concerning pharmacy cost issues and special programs.
- Approximately 1,000 district employees/dependents are currently enrolled with our pharmacy benefit management services provider.
- Electronic platform utilized and if the firm uses a remitter service to receive and send funds using electronic media.
- Please include any information of the platform it utilizes and the preferred method of sending and receiving funds and data.
- The chosen administrator will be expected to bear the cost of installation of appropriate administrative systems, contract preparation, billing, network enhancements, related administrative manuals, enrollment forms, and communication with employees and providers in a timely manner.
- Administrative cost & rebates
• Quoted rebate guarantee should be based on all drugs not just those for which rebates are obtained.
• Full pass-through of rebates with a guaranteed minimum rebate as well as full pass-through pricing as an option.
• Bend or eliminate trends in the future by striving for the lowest ultimate cost by delivering a transparent, innovative program that optimizes both the cost savings and the clinical outcomes to the district as well as its covered, employees and dependents.
• Address the cost spiral in specialty medications from a use and unit cost perspective.
• Deliver a stable formulary which carefully balances rebates and the lowest net cost and is updated as appropriate with sufficient notice of changes to employees, and employed affiliated providers.
• Demonstrate the ability to provide at least the current level of cost management process (i.e., ability to administer a therapeutic mac for proton pump inhibitors (PPIS) step therapy, generic substitution, concurrent drug utilization management, over-the-counter (OTC) programs, etc. - Ability to provide monthly claims extracts as required by district benefits consultant if needed and ensure a fully integrated data reporting system that is compatible with the systems and process utilized by the district, and benefits consultant, to enhance understanding of claims utilization and disease management.
- Details on structured program(s) to assist district in addressing potential abuse or diversion of narcotic medications such as oxycodone, etc.
- Additional reporting
• Effectiveness of cost management programs.
• Overall cost performance.
• Willing to adjust and make changes to reports to address the needs of district on an ongoing basis.
• Provide a robust quarterly reporting process that assesses the cost performance of the plan, offers insights concerning principal cost drivers, suggestions to address and mitigate those cost drivers as well as compare the performance of the plans to your book of business and other public entity employers.

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: July 14, 2025