This Solicitation opportunity from Texas was posted on August 24, 2024. The submission period has ended. Browse the details below for market research, or find similar active opportunities.

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Pharmacy Benefit Manager

Closed

170-24-ODHR-RFPState & Local

Submission Closed09/23/2024, 12:00:00 AM UTC

Contract Overview

Solicitation details, issuing organization, response deadlines, documents, and interested companies for this government contract opportunity.

Active Opportunities Like This One

NAICS: 524292

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DAS Medical Plan Third-Party Administrator

Solicitation # SRC0000038100

The State of Ohio, through the Department of Administrative Services, is soliciting proposals for one or more contractors to serve as Third-Party Administrators for its self-insured medical plans, known as Ohio Med. The scope includes the administration of three plan options: the Ohio Med PPO, Ohio Med Select, and the Ohio Med HDHP, covering approximately 103,000 lives. The selected contractor will be responsible for administering all claims incurred on or after July 1, 2027, and must ensure a seamless transition of care and eligibility verification. Key requirements include providing case, care, disease, and utilization management, while behavioral health remains a carved-out service. The contractor must also integrate with the state's data warehouse vendor, Merative, and adhere to strict IT security standards, including HIPAA compliance via a Business Associate Agreement and various recognized security certifications such as SOC 2 Type 2 or HITRUST. The contract term runs from the date of signature through June 30, 2030, with options for short-term monthly renewals and potential mutual extensions for up to four additional years. Performance is measured by specific Service Level Agreements, such as mailing ID cards within five days of enrollment and maintaining zero errors in initial eligibility files. Financial terms involve weekly claims billing paid via ACH, with a cost proposal structure based on per employee per month fees for core and disease management services. Award selection is based on a total score combining technical, cost, and presentation evaluations. Proposals must be submitted electronically through the OhioBuys portal, with technical and cost components submitted as separate, non-password-protected electronic envelopes.

Administrative Services

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DEADLINE

Request for Proposal - Third Party Administrative and Actuarial Services

Solicitation # 2025-RFP-127

The City of Cleveland Department of Finance, Division of Risk Management, is soliciting competitive proposals under solicitation 2025-RFP-127 for a single qualified Third-Party Administrator (TPA) to provide comprehensive administrative and actuarial services. The primary objective is to manage Ohio Bureau of Workers' Compensation (BWC) claims and conduct detailed liability reviews to reduce premium costs and minimize organizational exposure. The scope of work includes full claims administration, subrogation identification and negotiation, and the establishment of claims reserves. The selected provider must integrate with the Ohio BWC TPA Portal, the Ohio Industrial Commission systems, and the City's Origami Risk Management Platform and Microsoft Teams, while adhering to strict AES-256 and TLS 1.3 encryption standards and providing annual SOC 1 and SOC 2 Type II reports. Proposals were due by October 29, 2026, for a contract start date of January 1, 2027. The City operates under an individual retro plan and evaluates bidders based on a two-phase process focusing on proposal quality, demonstrated ability, OEO compliance, key personnel credentials, and the proposed schedule, followed by potential interviews. Awardees must comply with the Cleveland Area Business Code and maintain specific insurance coverages, including $1,000,000 limits for Business Automobile Liability and Workers' Compensation employer's liability. The contract requires a 10 percent Cleveland Area Small Business participation goal and adherence to the City's Professional Services Contracts Reimbursables Policy for invoicing and billing.

Finance - Division of Risk Management

POSTED

DEADLINE

State of South Dakota Account Based Plans (HRA, HSA and FSA)

Solicitation # 26RFP19879

The South Dakota Bureau of Human Resources and Administration is seeking a qualified vendor through solicitation 26RFP19879 to provide comprehensive administration services for the state's Account Based Plans. The scope of work includes the management of Health Reimbursement Accounts (HRA), Health Savings Accounts (HSA), and Medical and Dependent Care Flexible Spending Accounts (FSA) for both active employees and COBRA participants. The state aims to secure a partner capable of delivering innovative technology, exceptional service, regulatory compliance, and a positive experience for all participants. Proposals must be submitted electronically via email in MS Word or PDF format to [email hidden] by October 28, 2026, at 5:00 PM CDT, with a total email size limit of 20MB. All submissions must be signed by an authorized representative and reference the solicitation number. The state will not award contracts to entities in arrears on obligations to South Dakota or those deemed irresponsible. Additionally, all IT-related purchases are subject to approval by the Bureau of Information and Technology. An award decision and contract negotiations are anticipated by December 14, 2026.

South Dakota State Government

POSTED

DEADLINE

TPA Workers' Compensation

Solicitation # 127-2026

The Southwest Ohio Regional Transit Authority (SORTA), also known as Cincinnati Metro, is soliciting proposals for a Third-Party Administrator (TPA) to manage its self-insured Workers' Compensation program. The scope of work includes comprehensive claims administration, medical management, cost containment, legal support, and regulatory compliance in accordance with Ohio Bureau of Workers' Compensation and Ohio Industrial Commission requirements. Additionally, the selected vendor will provide safety consulting, OSHA/VSSR review services, and various reporting deliverables, including quarterly claims reports and bi-weekly payment forecasts. The contract is intended to begin in March 2027 and utilizes a firm-fixed price structure for a five-year term. Proposals must be submitted electronically via the OpenGov portal by November 4, 2026, and must be divided into two volumes to keep pricing separate from technical and business qualifications. Evaluation will be based on a points-based system focusing on price, project approach, and firm and staffing qualifications, specifically looking for public-sector or transit-related experience. Award decisions will be made based on the most advantageous proposal to SORTA. The successful contractor must adhere to NET 30 payment terms and comply with various federal and state non-discrimination and equal employment opportunity regulations.

POSTED

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Vehicle Assistance and Claims AdministratorThe Vehicle Assistance and Claims Administrator subcontract, issued by the US Embassy Paris for the Department of State, involves providing roadside assistance and third-party insurance claims management for prime contractors in France. The selected provider will manage assistance for 112 vehicles, settle third-party claims, and recover expenses related to personnel and equipment. Key deliverables include the resolution of claims, the recovery of funds, and detailed documentation of all roadside assistance events. To be eligible, the contractor must possess a Kbis registration and appoint a Project Manager who is fluent in both English and French. The work will be performed in Paris, France, under NAICS code 524292. Responses for this opportunity are due by November 6, 2026.

POSTED

DEADLINE

Announcement of RFP for Retirement Plan Administration and Record Keeping Services

Solicitation # LC26028

Lane County is seeking proposals from qualified firms to provide comprehensive administration, record keeping, education, and investment-related services for its 457 Deferred Compensation Plans and 401(a) Defined Contribution Plan. The primary objectives of this solicitation are to enhance participant retirement outcomes, improve education and communication, and implement robust online transaction capabilities. Additionally, the County aims to reduce expenses, evaluate competitive pricing structures, and streamline administrative functions through automation and integrated reporting. Interested parties must request solicitation documents from the designated consultants by November 12, 2026, at 5:00 PM. The final deadline for proposal submissions is November 20, 2026. The selected firm will be expected to ensure an orderly transition of assets and services while maintaining a strong working relationship with the Deferred Compensation Advisory Committee.

POSTED

DEADLINE

Nevada State Pharmacy Benefit Manager

Solicitation # 41NHA-S3992

The Nevada Health Authority Director's Office is seeking proposals for a Nevada State Pharmacy Benefit Manager under solicitation number 41NHA-S3992. This state-level procurement opportunity is managed by the Nevada Health Authority in Carson City and is open for responses until December 29, 2026. Interested parties should coordinate with the primary purchaser, Heather Moon, or the designated administration contact for further inquiries. All detailed requirements and submission guidelines are contained within the official solicitation attachments provided through the Nevada ePro portal.

410 - Nevada Health Authority Director's Office

POSTED

DEADLINE

Solicitation # 2611-KP

The Sacramento Housing and Redevelopment Agency (SHRA) is soliciting proposals under RFP 2611-KP for a qualified actuarial services firm to manage its Other Post-Employment Benefits (OPEB) program. The selected contractor will be responsible for measuring liabilities, supporting funding decisions, and providing essential data for financial reporting and long-term planning. Key deliverables include GASB 75 reporting packages for fiscal year ends 2026 through 2030 and full actuarial valuations as of December 31 for 2026, 2027, and 2028. The scope also encompasses advisory services for prefunding strategies, scenario modeling, and the development of Actuarially Determined Contributions (ADCs) to ensure the fiscal sustainability of retiree medical and dental benefits. The contract is structured for an initial one-year term with options to extend for up to four additional periods, not to exceed five years in total. Proposals are due by October 29, 2026, via the OpenGov portal, with an anticipated start date of December 7, 2026. Evaluation follows a two-stage process where technical proposals must score at least 70% to be considered responsive before cost proposals are reviewed. Award criteria emphasize technical expertise in public-sector OPEB valuations, past performance with similar governmental agencies, and the qualifications of the project team. The agreement requires strict adherence to GASB 75 standards, the Federal Privacy Act of 1974, and applicable Actuarial Standards of Practice.

POSTED

DEADLINE

Medicaid Medication Risk Reduction Initiative

Solicitation # RFP-2027-DMS-01-MEDIC

The New Hampshire Department of Health and Human Services, Division of Medicaid Services, is soliciting proposals for a statewide Medicaid Medication Risk Reduction Initiative (MMRRI). This program will be led by New Hampshire licensed clinical pharmacists to reduce medication-related problems, adverse drug events, polypharmacy, over-prescribing, and risks associated with opioids and behavioral health medications. The selected vendor will implement a technology solution to analyze pharmacy claims and encounter data to identify high-risk beneficiaries, conduct comprehensive medication reviews, and generate actionable medication safety reports for patients and providers. The contract has an anticipated total funding value of approximately 33,553,391 dollars, distributed across five budget periods through September 2031, and is supported by federal funds under the Rural Health Transformation Program. Key performance requirements include a guaranteed positive return on investment by the end of the third contract year, measured by a reduction in total cost of care on a per member per month basis. Vendors must possess at least three years of experience in pharmacy data analysis and medication review. Award decisions will be based on a point system evaluating technical and cost responses, with a minimum technical score of 1,600 points required to avoid disqualification. The contractor must adhere to strict data security standards, including maintaining an Information Security Management System and ensuring all data processing occurs within the United States. Compliance with Title VI of the Civil Rights Act, the Americans with Disabilities Act, and 2 CFR Part 200 is mandatory. Proposals are due by October 28, 2026, and must be submitted as separate technical and cost documents.

Dhhs-Department Of Health & Human Services

POSTED

DEADLINE

Pharmacy Drug Benefits

Solicitation # HHS0017240

The Texas Department of State Health Services (DSHS) is soliciting proposals under solicitation number HHS0017240 for a Pharmacy Benefits Manager (PBM) to support the Texas HIV Medications Program (THMP). The selected PBM will act as a secondary payor to manage prescription drug benefits, premium payments, and copayments through three primary programs: the State Pharmacy Assistance Program (SPAP) for Medicare Part D costs, the Texas Insurance Assistance Program (TIAP) for medication copayments and COBRA premiums, and the Texas Insurance Assistance Program-PLUS (TIAP-PLUS) for private and federal marketplace plan assistance. The scope of work involves processing medication claims and monthly invoice premium payments, with historical data indicating the management of over 15,000 claims for approximately 2,764 participants. The contract features an initial one-year term with the possibility of four additional one-year extensions and one final option period at the discretion of DSHS. Award selection is based on best value, evaluated through a weighted scoring system consisting of the Project Workplan (45%), Cost Proposal (35%), and Qualifications and Experience (20%). Proposals must be submitted by November 19, 2026, via either USB drive or an online bid room. Requirements include a narrative proposal limited to 40 pages, a separate Excel-based cost proposal, and a VetHUB Subcontracting Plan. The contract is governed by Texas Government Code Section 2155.144 and incorporates various HHS uniform terms, additional provisions, and a Data Use Agreement.

Department of State Health Services

POSTED

DEADLINE

DAS Behavioral Health Third-Party Administrator RFP

Solicitation # SRC0000040548

The State of Ohio, through the Department of Administrative Services, is soliciting proposals for a Third-Party Administrator to manage its self-insured Behavioral Health Benefit Plan. Starting July 1, 2027, the selected contractor will provide administrative services for approximately 43,800 employees and 104,600 total lives. Key responsibilities include managing eligibility, claims history, prior authorizations, utilization management, and data integration with the State's data warehouse. The contract runs from the date of signature through June 30, 2030, with the possibility of a one-month discretionary renewal and further mutual renewals for up to four additional years. To be eligible, offerors must be NCQA accredited and comply with the Mental Health Parity and Addiction Equity Act. The evaluation process is based on a total score derived from technical requirements, cost, and presentations, with the highest-ranking responsible offeror recommended for award. Financial terms utilize a not-to-exceed unit cost fee structure, and the contractor must provide a Benefits Fund of at least 150,000 dollars. Strict compliance is required regarding HIPAA through a Business Associate Agreement, State IT policies, and secure data transfer protocols via SFTP. Proposals must be submitted electronically through the OhioBuys portal, consisting of separate technical and cost volumes.

Administrative Services

POSTED

DEADLINE

Employee Benefits- Life/STD/FSA/HSA/COBRA

Solicitation # 27-011CH-32RFP

The Tempe Union High School District is soliciting proposals under solicitation number 27-011CH-32RFP to secure a provider for the administration of employee benefits, including Basic and Voluntary Life and Accidental Death and Dismemberment, Short-Term Disability, Flexible Spending Account, Health Spending Account, and COBRA administration. The intended contract period runs from July 1, 2027, through June 30, 2032. Key requirements include the waiver of pre-existing condition limitations for initially enrolled employees and dependents, the elimination of active-at-work restrictions, and a guarantee that no employee suffers a loss of benefits during a carrier change. The selected vendor must provide a designated account management team, bilingual educational materials, and attendance at four days of annual open enrollment meetings in Tempe, Arizona. The award process utilizes a point formula system across three phases: initial evaluation, vendor interviews, and a best and final offer. Evaluation factors include responsiveness, cost, and past performance, with a minimum of 500 technical points required to proceed to price evaluation. The District intends to award the least number of vendors necessary, with contracts potentially awarded by individual product lines. Proposals must be submitted via the OpenGov portal by November 19, 2026. The contract is subject to Arizona Revised Statutes and School District Procurement Rules, featuring a zero-tolerance gift policy and net 30-day payment terms. Implementation must be completed 60 days prior to open enrollment, with a required 45-day support period following the July 1 effective date.

Business Services

POSTED

8 days ago

DEADLINE

in 22 days

AI Contract Overview

The City of Brownsville is seeking proposals from qualified Pharmacy Benefit Managers to address the escalating costs of specialty medications while ensuring positive outcomes for patients. The selected partner will be responsible for providing transparent and aligned services that reflect the city's interests, with a focus on understanding and optimizing clinical programs. The contract aims to strike a balance between controlling costs and minimizing patient disruption, while also offering innovative, market-leading programs suited to the dynamic pharmaceutical industry. The project has a budget range of approximately $5 million to $20 million, with a deadline for responses set for September 23, 2024. This initiative underscores the city's commitment to improving healthcare affordability and quality through strategic pharmacy benefit management.

General Info

Agency

Texas → City of Brownsville

NAICS

524292 - Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds

Place of Performance

TX, USA

Set-Aside

NONE

Documents

No documents available

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AI Contract Breakdown

Uniform Contract Format

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Timeline

PhaseClosed

PostedAug 24

Solicitation

Response DeadlineSep 23

Deadline has passed

Submission Closed

09/23/2024, 12:00:00 AM UTC

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Organization & Contact Information

AgencyTexas → City of Brownsville

ContactsNo contacts available

OfficeN/A

Organization / Agency

Texas → City of Brownsville

Office AddressN/A

ContactsNo contact information available

Full Description

The City of Brownsville is soliciting proposals for a qualified Pharmacy Benefit Management partner to: 1. Effectively address rising specialty medication costs while positively impacting patients 2. Achieve full transparency and alignment of City’s interests 3. Understand and optimize effective clinical programs 4. Balance cost-control with patient intervention/disruption 5. Provide forward-thinking and market-leading programs in a rapidly changing industry