The vendor required to provide pharmacy benefit management (PBM) services in accordance with all applicable federal and state laws, regulations, policies and the city’s requirements.
- These tasks include:
• Implementation services;
• General support services;
• Pharmacy benefit manager services; and,
• Clinical management services.
1. Implementation services
• Assign a dedicated implementation team to manage the implementation process and to make changes as needed to account structure, claims file layout, or reporting;
• Provide prescription drug coverage plan documents for the city to review and edit at least one hundred twenty (120) days before the effective date of the plan;
• Work with the city and incumbent as applicable, to transfer competencies and operational expertise essential to administering the city’s pharmacy benefits program with minimal interruption to plan participants;
• Establish and implement data utilization edits that identify and deny duplicate claims, claims fielded too soon, claims requiring authorization when such authorization is not in place, as well as messages to the pharmacist to review and approval or denial of the claim(s) due to safety issues;
• Mail identification cards (id cards) through the use of the country mail or other common or contract carrier services to the homes of newly enrolled employer group waiver plan (EGWP) plan participants within ten (10) calendar days following receipt of notification of approval from the centers for medicare and Medicaid services (CMS).
2. General support services
• Provide an account management team which is the vendor’s staff for PBM services assigned to the city which shall include the following positions:
o Account executive;
o Implementation manager;
o Retiree manager;
o Operational account manager;
o Clinical program manager;
o Clinical pharmacy analyst;
o Data and analytics lead;
o Privacy officer; and
o Customer service manager.
• The dedicated account executive and operational account manager will provide day-to-day management of project tasks and activities, coordination of proposer’s employees, and possess the technical and functional knowledge to direct all aspects of the project.
• The account executive and operational account manager must have at least one (1) back-up staff member designated to handle the overall responsibility of the city.
• The dedicated clinical pharmacy manager to advise on drug-related issues and trends, clinical programs and utilization rules, among other issues, must be specific to the city’s plan.
• The clinical pharmacy manager assigned should have a minimum of one (1) year tenure with the proposer.
3. Pharmacy benefit manager services
• Provide prescription benefit management services including, but not limited to, general support and advisory services regarding pharmacy benefit design and implementation, formulary management, network and rebatement management, administrative and claims processing services, clinical management programs, reporting, marketing, customer service, quality management, and utilization management functions.
4. Clinical management services
• Develop and implement clinical intervention and programs that provide enhance quality and cost-savings to the city.
• All such initiatives are subject to the city’s approval prior to implementation and discontinuance.
• Provide clinical resources (e.g., dedicated pharmacist, etc.) to the city to assist in interpreting pharmacy data and proactively developing cost management strategies.
- Contract Period/Term: 3 years
- Non-Mandatory Pre-Proposal Conference Date: December 29, 2025
- Questions/Inquires Deadline: January 12, 2026
