Request for Proposals: Pharmacy Benefit Management Services
ID: 3120003010 • State: Mississippi
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Description
Background
The Mississippi Department of Finance & Administration Office of Insurance is seeking a qualified vendor to provide pharmacy benefit management services for the State and School Employees’ Life and Health Insurance Plan.
This self-insured health plan currently covers approximately 190,000 participants, including active, retired, and COBRA employees from various state agencies and educational institutions.
The current contract with CVS Caremark Pharmacy, Inc. is set to expire on December 31, 2025, necessitating this Request for Proposals (RFP) to ensure continuity of services starting January 1, 2026.
Work Details
The selected vendor will be responsible for a range of services including:
1. Account Management: Hiring sufficient staff, maintaining customer service availability 24/7, providing consultative services regarding pharmacy benefit design, and conducting customer satisfaction surveys.
2. Pharmacy Benefit Manager Services: Delivering quality prescription drug services through discount arrangements with pharmacies, maintaining a pharmacy network that includes independent pharmacies, providing online access to pharmacy directories, and ensuring compliance with performance guarantees.
3. Claims Processing: Verifying eligibility, processing claims accurately according to the lowest cost logic, maintaining detailed claims information, and accommodating multiple plan designs.
4. Federal Reporting: Preparing and filing required reports as mandated by federal law.
5. Coordination of Benefits: Managing secondary payment processes for participants with other insurance coverage.
6. Quality Control: Regularly evaluating claims processing performance and accuracy.
7. Prior Authorization Program: Implementing evidence-based guidelines for prior authorization of certain medications to manage costs effectively.
Period of Performance
The contract will commence on January 1, 2026, following the expiration of the current contract on December 31, 2025.
Place of Performance
The services will be performed primarily in Mississippi but may also include provisions for participants residing in other states.
The Mississippi Department of Finance & Administration Office of Insurance is seeking a qualified vendor to provide pharmacy benefit management services for the State and School Employees’ Life and Health Insurance Plan.
This self-insured health plan currently covers approximately 190,000 participants, including active, retired, and COBRA employees from various state agencies and educational institutions.
The current contract with CVS Caremark Pharmacy, Inc. is set to expire on December 31, 2025, necessitating this Request for Proposals (RFP) to ensure continuity of services starting January 1, 2026.
Work Details
The selected vendor will be responsible for a range of services including:
1. Account Management: Hiring sufficient staff, maintaining customer service availability 24/7, providing consultative services regarding pharmacy benefit design, and conducting customer satisfaction surveys.
2. Pharmacy Benefit Manager Services: Delivering quality prescription drug services through discount arrangements with pharmacies, maintaining a pharmacy network that includes independent pharmacies, providing online access to pharmacy directories, and ensuring compliance with performance guarantees.
3. Claims Processing: Verifying eligibility, processing claims accurately according to the lowest cost logic, maintaining detailed claims information, and accommodating multiple plan designs.
4. Federal Reporting: Preparing and filing required reports as mandated by federal law.
5. Coordination of Benefits: Managing secondary payment processes for participants with other insurance coverage.
6. Quality Control: Regularly evaluating claims processing performance and accuracy.
7. Prior Authorization Program: Implementing evidence-based guidelines for prior authorization of certain medications to manage costs effectively.
Period of Performance
The contract will commence on January 1, 2026, following the expiration of the current contract on December 31, 2025.
Place of Performance
The services will be performed primarily in Mississippi but may also include provisions for participants residing in other states.
Overview
Opportunity Type
Request for Proposal
Opportunity ID
3120003010
Version
1
Response Deadline
Jan. 3, 2025
Past Due
Date Posted
Oct. 16, 2024
Est. Value Range
Experimental
$50,000,000 - $150,000,000
(AI estimate)
Agency Distribution
High
Source
On 10/16/24 MS DEPT FINANCE AND ADMINISTRATION in Mississippi issued Request for Proposal Pharmacy Benefit Management Services with ID 3120003010 due 1/3/25.
Contacts
Documents
Posted documents for Request for Proposals: Pharmacy Benefit Management Services
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Classifications
Opportunity Classification
PERSONNEL SERVICES NON-IT
NAICS
Additional Details
Sub Procurement Category
PERSONNEL SERVICE - NON-TECHNOLOGY
Smart Number
1130-25-R-RFPR-00001-V01