Pharmacy Benefits Management Services

The Vendor is required to provide pharmacy benefit management services for their prescription program.
- The services shall include, but are not limited to:
•    Electronic and paper claims processing and payment
•    Comprehensive and timely support of data exchange
•    Pharmacy network contracting and management
•    Rebate contracting, administration, and act compliant reporting
•    Clinical support, including ability to support open or exclusion formularies and alternative clinical programs
•    Standard and customized step therapy, quantity level limits, prior authorization programs
•    Glp-1 strategy for open or limited exclusion formulary
•    Standard and ad hoc monthly and quarterly reports
•    Web-based reporting and operations tools
•    Benefit design and implementation services
•    Eligibility administration
•    Member id cards
•    Dedicated account and clinical management team with executive level sponsorship
•    Toll free customer service; toll free pharmacy help desk; robust member portal
•    On-line coordination of benefits
•    Pharmacy audit and FWA (fraud, waste and abuse) programs
•    Specialty patient assistance programs (pap)

- Letter of Intent to Bid due: March 05, 2026