Pharmacy Benefit Manager Services

The vendor is required to provide pharmacy benefit manager (PBM) to include:
•    Providing high-quality, exceptional customer service that will “take the member out of the middle”.
•    Providing fiscally sustainable, valuable benefits. 
•    Achieving competitive financial terms.
•    Providing transparency in pricing and fee structures.
•    Ensuring the use of evidence-based guidelines in clinical determinations.
•    Strong support and demonstrated flexibility to support plan changes or initiatives. 
•    Providing high accuracy in claims processing. 
•    Demonstrated ability to manage drug mix with an emphasis on specialty drug management, formulary management and generic drug utilization (ability to identify, dispense and track utilization of authorized generics). 
•    Supporting the state in identifying, analyzing, and implementing innovative quality-oriented claims administration processes and procedures to achieve state objectives, reduce costs, and improve quality of service. 
•    Providing effective tools and resources to support members in managing their health. 
•    Providing seamless implementation for the state and its members. 
•    The successful offeror must be able and fully committed to support the state of with all aspects of the implementation process. 
•    include a detailed implementation timetable with a key task checklist. 
•    Provide a separate implementation plan for each plan group - active employees, non-EGWP retirees and enhanced employer group waiver plan (EGWP) retirees.
•    Coordinating clinical management with the medical administrator, wellness and disease management vendor, and any other vendor or administrator contracted by the state. 
•    Enhanced EGWP expertise and capabilities to deal with complex member issues.
- Privacy of personal information
•    Safeguarding confidential information;
•    Public communication and notification following loss of personally identifiable information; and
•    Personally identifiable information retention.
- Protection against malicious software
•    Protection against malicious code (pre and post introduction to the network environment); and
•    Remediation of systems.
- System planning and acceptance
•    System planning and acceptance;
•    System criteria and testing;
•    Implementation training;
•    Information system documentation; and
•    Security planning.
- Security in system development
•    System planning;
•    Software development and implementation;
•    System awareness;
•    System testing;
•    System acceptance; and
•    Secure system builds.
- Vulnerability management
•    Vulnerability management; and
•    Patch management.
- Cloud and offsite hosting
•    Cloud or offsite hosting services.
- Budget: $65,000,000.00 and $85,000,000.00

- Contract Period/Term: 3 years
- Pre-Proposal Teleconference Date: October 28, 2025
- Questions/Inquires Deadline: November 10, 2025