The vendor is required to provide pharmacy benefit manager (PBM) services for medical plan administrative services and stop loss insurance.
- The firm selected shall meet the minimum qualifications and provide the following services, including, but not limited to:
a. Claims administration
• Provide efficient operations to ensure claims are paid accurately and timely
b. Pharmacy network
• Offer well-established pharmacy network
c. Employer and employee services
• Provide enhanced customer service through communication plans, a user-friendly website including provider quality and pricing information
d. Online enrollment capabilities
• Provide a streamlined process for enrollment for members and for county administrators, etc.
e. General support and consultative services
• PBM shall provide to client general support and consultative services regarding pharmacy benefit design and formulary design, general drug use and cost data, pharmacy network design, member communications drug utilization review, and clinical programs identified in the exhibits of this agreement.  
• Non-traditional, supplemental programs and consulting may be desired by client.  
• Such activities will be defined and any related costs communicated to client prior to initiating any work.  
f. Program reporting
• PBM shall make available to client PBM standard management information reporting including claim level reporting allowing client to tie PBM payments to participating pharmacies with amounts charged to client for covered drugs dispensed to members.  
• These reports include an executive report package, key statistics, and a pre-formatted report library.  
g. Utilization review
• Comprehensive prospective and retrospective electronic drug utilization review (DUR) and drug utilization evaluation (DUE) services are available in the PBM system for no additional charge
h. Account management
• This is a set of services that PBM provides to ensure that every client has an opportunity to thoroughly understand the capabilities of our systems and services and has a chance to relate to PBM their specific needs and priorities for future product direction and/or potential client specific customizations
i. Communication and cooperation with client vendors
• PBM shall communicate with and coordinate its program management activities with client vendors in order to facilitate member access to other programs and services of client.
• Requests for multiple custom file formats to client vendors may incur a charge to program at PBM discretion based on the number and extent of customizations required.
- Contract Period/Term: 1 year
- Questions/Inquires Deadline: May 12, 2025