Pharmacy Benefit Management Services

The vendor required to provide pharmacy benefit management (PBM) to prescription drug benefit administration and clinical management services for the agency, including but not limited to, the following:
•    Network administration: establish, maintain, and manage retail, specialty, and mail-order pharmacy networks; ensure adequate access, credentialing, and performance oversight. 
•    Claims processing and adjudication: real-time claims adjudication; eligibility file management; coordination of benefits; prior claim reversals and adjustments; fraud, waste, and abuse monitoring. 
•    Formulary and utilization management: develop and manage formularies; implement prior authorization, step therapy, quantity limits, and other utilization controls aligned with plan sponsor direction.
•    Clinical programs: provide clinical interventions and cost-management programs. 
•    Specialty and high-cost drug management: specialty pharmacy services and care management; limited distribution drug handling; management of manufacturer programs; outcomes reporting. 
•    Rebates and financial management: negotiate manufacturer rebates and other revenue; administer and remit rebates per contract; provide full transparency and audit support; ensure pass-throughs as required. 
•    Member and provider services: member support pharmacy help desk; communications for formulary changes, pa requirements, and benefit updates. 
•    Reporting and analytics: provide standard and ad hoc reporting, dashboards, and data extracts (including claims detail); support performance guarantees and reconciliation. 
•    Implementation and ongoing account management: project management for implementation, testing, and go-live; ongoing account management, issue resolution, and plan design support. 
•    Compliance and data security: maintain privacy compliance, required certifications, and data security controls; support audits and regulatory reporting as applicable.

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: January 19, 2026