Medicaid Enterprise Systems - Pharmacy Benefit Services (2025 - 2035)

This contract establishes a cooperative portfolio of Master Agreements under the Medicaid Enterprise Systems for Pharmacy Benefit Services, administered by the State of Georgia with CMS approval, spanning a base term of one year from October 29, 2025, with nine optional one-year renewal periods allowing for a potential ten-year performance period through October 28, 2035. Authorized participants are State Medicaid Agencies, leveraging the agreements to procure services across four defined categories: Pharmacy Fraud, Waste, and Abuse Audit Services; Pharmacy Benefit Administrator Services; Pharmacy Clinical Management Services; and Pharmacy Drug Rebate Services. The solicitation was issued through NASPO under number ADT-186 and managed via the Georgia Procurement Registry, with evaluation criteria heavily weighted toward technical merit at 80% and cost at 20%, emphasizing a best-value trade-off approach rather than lowest-price selection. Multiple vendors including Gainwell Technologies, Prime Therapeutics, Medimpact, Myers and Stauffer, NorthStar Healthcare Consulting, Optum RX, and Conduent State Healthcare have been awarded across these categories. While the lead agency is the Georgia Department of Community Health and the place of performance is Georgia, services are expected to support participating states broadly. The contract structure is inferred as an Indefinite Delivery/Indefinite Quantity (IDIQ) with no explicit contract value disclosed, and no detailed pricing, payment, or invoicing mechanisms provided. Compliance with federal Medicaid regulations, particularly 42 CFR Part 455, is mandatory, and all agreements must receive CMS approval prior to activation. Specific contract clauses, representations, certifications, inspection criteria, packaging requirements, and detailed delivery schedules are not documented in the available materials, with only procedural and structural elements provided.