Pharmacy Benefit Manager Services

The Vendor is required to provide pharmacy benefit manager (PBM) to pharmacy benefit administrator, they should also have the same cyber coverage limits required of the pharmacy benefit administrator.
- Pharmacy benefit administrator will provide employer with at least ninety (90) days written notice for cancellation or non-renewal that are not replaced and material changes in policy.
- Requirement:
1. Cost (60%)
• Fixed costs: include insurance costs and administrative costs
• Variable costs: costs stated as a percentage of paid claims, cost management (i.e., shifting of more and less workload to city staff)
• Ability to reduce claims expenses
• Cost of PBM integration with current third-party administrator
• Rebate transparency
2. Financial stability (pass/fail)
• Financial stability (am best or equivalent agency rating)
3. Claims processing (20%)
• Turnaround time excluding medical review of claims
• Pended claims procedures
• Statistical accuracy
• General service procedures
• Dedicated service team
• Willingness to contractually establish performance criteria
• Turnaround time of prescription resolution issues
• Claims transparency capabilities
• Claims adjudication process
4. Past performance (10%)
• Active and terminated references
• Past relationship with client
• Recognitions and reputation of proposer
• Claims processing accuracy
5. Network and service area (10%)
• Current pharmacy network and disruption analysis.