Group Medical and Pharmacy Benefit Management Services

The Vendor is required to provide group medical and/or pharmacy benefit management (PBM) services, effective September 1, 2026.
- Provide to present proposals that demonstrate proven experience serving large public-sector clients, excellence in claims administration, data analytics, network management, clinical programs, and commitment to transparency and accountability.
- The district also provides additional programs, including preschool, adult high school completion, concurrent enrollment, advanced placement, special education, music, career technology, elementary dual language, multicultural programs, and gifted and talented programs.
- Medical Administration Services
•    Process all medical claims accurately and in compliance with applicable laws and regulations.
•    Maintain a robust provider network offering comprehensive access for District employees.
•    Provide dedicated account management, implementation support, and responsive customer service.
•    Integrate eligibility, enrollment, and claims data exchange with the PBM vendor as applicable.
•    Deliver reporting and analytics on plan performance, cost containment, and utilization.
•    Participate in the District’s claims repricing process for finalist consideration.
- Pharmacy Benefit Management Services
•    Provide agency-accredited PBM services, including retail, mail-order, and specialty pharmacy management.
•    Administer a transparent pricing model with rebate disclosure and clear definitions of all revenue sources.
•    Deliver comprehensive formulary management, clinical programs, and member engagement tools.
•    Coordinate with the medical administrator for eligibility, accumulator, and data exchange.
- Combined Proposals
•    Integrate Medical and PBM functions to ensure seamless coordination of care and consolidated reporting.
•    Provide unified eligibility and data interfaces.
•    Deliver a single, combined ID card and consolidated member communications.
•    Clearly identify cost impacts if Medical or PBM services are unbundled.

- Contract Period/Term: 3 years
- Questions/Inquires Deadline: December 19, 2025