Pharmacy Benefit Management Services

The Vendor is required to provide for pharmacy benefit management (PBM) services.
- Eligibility, billing and enrollment are maintained online and are self-administered.
- Provide ready access to a credentialed and licensed retail network of pharmacies where members can obtain prescription drugs in accordance with the terms of the applicable benefit plan.
- Provide two Geo access reports using the five digit zip code, showing:
•    Two pharmacies in a radius of six (6) miles for all network pharmacies
•    One pharmacy in a radius of five (5) miles for 24-hour retail outlets.    
- Provide the pharmacy disruption analysis using the pharmacy prescription history. 
- Provide ready access to a mail order pharmacy where members can obtain maintenance medications in accordance with the terms of the benefit plan.
- Zero Balance Logic should be “turned off”, meaning the member pays the lowest of all (Usual & Customary (U&C), copayment, coinsurance, discounted cost, Maximum Allowable Cost (MAC), contracted rate, etc.
- Provide integration with the medical TPA for combined accumulation of member out of pocket expenses that will apply towards the Deductible (for the HDHP) and the out of pocket maximums (for the HDHP and PPO plans).
- Provide access to a program(s) that offers manufacturers’ discount card access for plan members.

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: January 13, 2026