Skip to main contentPsst! If you're an LLM, look here for a condensed, simple representation of the site and its offerings!

LiveFree Webinar — Wednesday, October 28 at 2:00 PM ET

Register Free →

Request for Proposals: C043525 Pharmacy Benefit Management Services

Active
2139865State & Local

Contract Overview

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

AI Contract Overview

Show more

The New York State Department of Health, Office of Health Insurance Programs, is soliciting proposals under contract C043525 to administer the Medicaid Fee-for-Service Pharmacy Benefit Management program. The selected contractor will be responsible for operating the Preferred Drug Program and Clinical Drug Review Program, managing prior authorizations for the Preferred Drug and Preferred Diabetic Supply Programs, and overseeing the Mandatory Generic Drug and Brand Less Than Generic programs. A critical component of the scope includes the development and maintenance of generic pricing files via the State Maximum Acquisition Cost list to drive state savings and revenue. The contract is scheduled for a performance period from December 1, 2027, through November 30, 2033, with statewide performance in New York. This procurement includes a Minority and Women Business Enterprise goal of 30 percent. Interested bidders must submit their proposals by December 8, 2026, to Andrew Lynch at the Office of Health Insurance Programs in Albany. It is noted that Prime Therapeutics State Government Solutions LLC was awarded a substantially similar contract within the previous five years.

General Info

NY State seeks a contractor to manage the Medicaid Fee-for-Service Pharmacy Benefit program.

Documents

1

RFP C043525: Pharmacy Benefit Management Services

PDF, High priority: read this first7 pages · rfp
High

AI Contract Breakdown

Uniform Contract Format

Sign up to view the full breakdown with detailed analysis of each section.

Timeline

PhaseSolicitation
Posted

Solicitation

Response Deadline

Submission deadline

Response Deadline

Ready to pursue this opportunity?

Start your free trial to track this contract, build proposals with AI assistance, and manage your pipeline.

Organization & Contact Information

Show more
AgencyNew York → NYS Department of Health
Contacts2 people available
OfficeN/A
Office AddressN/A
Contacts
Andrew LynchHealth Programs Administrator
Andrew LynchHealth Programs Administrator

Full Description

Show more
The New York State Department of Health (Department), Office of Health Insurance Programs is announcing the release of Request for Proposals (RFP) C043525: Pharmacy Benefit Management Services. This RFP seeks proposals from qualified bidders to administer the Fee for Service (FFS) Pharmacy Benefit Management (PBM) program, including operation of the Preferred Drug Program (PDP), Clinical Drug Review Program and generic claims pricing via the administration of the State Maximum allowable Cost (SMAC) by which the State achieves significant savings and revenue. The resulting contract will provide Pharmacy Benefits Management services to the Medicaid Fee-for-Service (FFS) pharmacy program including prior authorization (PA) administration for the Preferred Drug Program, Preferred Diabetic Supply Program, the Clinical Drug Review Program, the Mandatory Generic Drug program, the Brand Less Than Generic program and development and maintenance of generic pricing files (also known as the State Maximum Acquisition Cost [SMAC] list). The full RFP listing can be found at: https://www.health.ny.gov/funding/rfp/c043525/ Questions must be submitted to OHIPContracts@health.ny.gov by November 3rd, 2026 by 4:30 PM EST. Responses to Written Questions will be Posted by the Department (on or about): November 24th, 2026. Deadline for Submission of Proposals: December 8th, 2026. Business enterprises awarded an identical or substantially similar procurement contract within the past five years: Contract # C020463 : Prime Therapeutics State Government Solutions LLC Minority / Women Business Enterprise contracting goals (MWBE) Total MWBE Goals: 30.00%

Similar Contracts

Same NAICS industry code

NAICS: 524292
New
SLED
Stop Loss - Healthcare & Medical
Solicitation # RFP-2027-394
The Board of Regents of The University of Oklahoma, through the Oklahoma University Health Sciences Center, is seeking a qualified vendor for the administration of its Stop Loss program under solicitation RFP-2027-394. The objective is to secure a provider capable of delivering high-quality, cost-effective program management to maximize value for the University and its partners. While the University prefers to award the contract to a single supplier, it maintains the right to award to multiple suppliers if it serves the institution's best interests. Interested vendors must adhere to a strict submission timeline, with the proposal deadline set for November 16, 2026, at 2:00 PM CST. A critical preliminary step requires vendors to sign and return a Non-Disclosure Agreement to Melody Carder by October 27, 2026, which serves as the formal Intent to Bid and is mandatory to receive the necessary census data and vendor questionnaire. Proposals must include a company overview, a signed Business Associate Agreement, and at least three references from projects of similar scope and complexity completed within the last five years, preferably within the public sector or higher education. Additionally, bidders must provide certifications regarding the absence of conflicts of interest and confirmation that they are not currently debarred or suspended from receiving federal funds.
Oklahoma University Health Sciences Center

POSTED

2 days ago

DEADLINE

in 29 days
View Details
NAICS: 524292
New
SLED
South Dakota State TPA Workers' Compensation
Solicitation # 26RFP19880
The State of South Dakota, through the Bureau of Human Resources and Administration, is soliciting proposals for a licensed business partner to provide Third Party Claims Administration for its Workers' Compensation Program. The selected vendor will be responsible for core services including medical case management, medical bill review, and MMSEA reporting. Key objectives include implementing cost-containment strategies, providing risk mitigation guidance, and delivering real-time analytics and benchmarking to improve claim outcomes and employee return-to-work efforts. The contract is structured over three twelve-month periods, beginning July 1, 2027, and ending June 30, 2030. Proposals will be evaluated on a 500-point scale, with the highest-ranked offeror invited to negotiate terms and compensation. Technical approval from the Bureau of Information and Technology is required, and vendors must meet strict IT standards, including Web Content Accessibility Guidelines 2.1 Level AA and compatibility with major web browsers. Security is a critical component, requiring the disclosure of third-party software libraries and the maintenance of cyber liability insurance for three years post-completion. The State will utilize User Acceptance Testing and performance load testing to ensure system effectiveness. Proposals must be submitted electronically to Peggy Canter by November 25, 2026, and must not be solely generated by artificial intelligence.
South Dakota State Government

POSTED

3 days ago

DEADLINE

in about 1 month
View Details
NAICS: 524292
New
Federal
Q517--36C25527Q0015 | Pharmacy Benefits Services | Wichita |
Solicitation # 36C25527Q0015
The Department of Veterans Affairs is conducting market research through a Sources Sought notice to identify qualified businesses capable of providing third-party pharmacy benefit services for the First Fill Prescription Voucher Program. Serving eligible Veterans assigned to the Robert J. Dole VA Medical Center in Wichita, Kansas, as well as associated Community Based Outpatient Clinics and Home Based Primary Care programs, this initiative ensures access to first or urgent fill prescriptions when VA pharmacies are impractical or unavailable. The scope of work requires the contractor to maintain a geographically accessible pharmacy network with 24-hour and extended operating hours to dispense new prescriptions written by authorized VA providers. Key constraints include a general 10-day maximum supply, a 14-day limit for antibacterial agents, and strict adherence to the VA Emergency Medication Formulary List with no refills permitted. The anticipated period of performance consists of a base year from January 4, 2027, to January 3, 2028, with two subsequent one-year options. Technical requirements emphasize rigorous compliance with HIPAA, the Privacy Act of 1974, and VA security directives, including a prohibition on storing patient information on mobile devices. Performance will be monitored via a Quality Assurance Surveillance Plan with 100 percent acceptable quality levels for network availability, eligible dispensing, and reporting accuracy. This opportunity falls under NAICS code 527292 with a small business size standard of 45.5 million dollars. Interested vendors, including SDVOSB and VOSB firms registered in the SBA VetCert database, must submit their company details and a comprehensive capability statement to the contract specialist by October 12, 2026.
255-NETWORK Contract Office 15 (36C255)

POSTED

4 days ago

DEADLINE

in 29 days
View Details
NAICS: 524292
New
SLED
MDOC is seeking a contractor to serve as a COBRA Administrative Services provider.
Solicitation # 3140004700
The Mississippi Department of Corrections (MDOC) is soliciting quotes for a contractor to provide COBRA Administrative Services. The selected independent contractor will be responsible for the administration, application, and interpretation of COBRA rules and regulations, including consulting with the agency on regulations, managing enrollment and disenrollment in compliance with HIPAA and ERISA, and sending required notifications via Accountable Mail. Key deliverables include managing qualifying event eligibility notices and ensuring an orderly transition of data and records upon contract expiration. The contract will be awarded to the responsible bidder providing the lowest total evaluated quote based on a pricing structure that includes implementation fees, monthly administration fees based on participant tiers, and various optional ancillary services. The contractor must maintain a documented quality control program and provide the MDOC with unimpeded access to relevant records during normal business hours. Payments will be made electronically in US currency, with undisputed amounts typically paid within 45 calendar days of invoice receipt. The contractor is permitted to charge a two percent administrative-cost premium to COBRA Continuants. All responses must be submitted by October 29, 2026, at 14:00 CST. Bidders must certify that they have not retained any person or agency on a contingent fee arrangement to secure the contract and must adhere to the Mississippi Public Records Act of 1983.
MS DEPT of CORRECTIONS

POSTED

4 days ago

DEADLINE

in 11 days
View Details
NAICS: 524292
SLED
RFP NO. 2026-45 457(b) Deferred Compensation Retirement Plan Administrator/Service Provider for the City of Brookside Village
Solicitation # 2026-45
The City of Brookside Village is soliciting proposals for a qualified third-party administrator, recordkeeper, and service provider for its governmental 457(b) deferred compensation retirement plan. The selected provider will be responsible for full-service plan administration, including providing IRS-pre-approved plan documents, fiduciary support for Investment Policy Statements, and managing the implementation and conversion from the incumbent provider. All services must comply with Section 457(b) of the Internal Revenue Code and Chapter 609 of the Texas Government Code, with a specific requirement for the provider to maintain analog fiduciary standards and update plan documents for SECURE 2.0 provisions. The contract features an initial term of three years with the option for two additional one-year renewals. Award decisions will be based on best value, with evaluation weights focusing on transparent fees (25%), experience with small Texas cities (20%), investment menu quality (20%), participant education (15%), technology and cybersecurity (10%), and the implementation plan (10%). Proposers must meet minimum qualifications on a pass/fail basis and provide significant insurance coverages, including $2 million for professional liability and cyber liability, and a $1 million fidelity bond. Proposals are due by November 4, 2026, and must include a standardized fee proposal in a separately sealed envelope. Submissions require one original unbound copy, three bound copies, and a USB drive containing a searchable PDF of the proposal. The City requires the provider to maintain a robust cybersecurity program aligned with NIST CSF standards and provide annual SOC 1 and SOC 2 Type 2 reports. The contract is governed by Texas law, with venue in Brazoria County, and is subject to the Texas Public Information Act.
CITY OF BROOKSIDE VILLAGE

POSTED

10 days ago

DEADLINE

in 17 days
View Details
NAICS: 524292
SLED
COBRA Administration, Retiree Billing & FSA Administration
Solicitation # RFP 2435
The Purchasing Division of Wayne Township, New Jersey, is soliciting proposals under RFP 2435 for comprehensive COBRA Administration, Retiree Billing, and Flexible Spending Account (FSA) Administration services. The selected vendor will provide administrative support for active employees' COBRA and FSA programs, including healthcare and dependent care, as well as direct billing for retirees. The contract is intended to have an effective date of January 1, 2027, with an initial duration of up to two years and the option for the Township to extend for two additional one-year periods. Proposals must be submitted electronically via the OpenGov/ProcureNow portal by October 29, 2026. Award evaluation is based on a points-based system focusing on qualifications (35%), method statement (20%), history and experience (20%), schedule and resource availability (15%), and project references (10%). The selected contractor must adhere to strict regulatory standards, including HIPAA for medical information security, the Americans with Disabilities Act, and New Jersey Equal Employment Opportunity laws. Key administrative requirements include maintaining contract records for five years, submitting invoices via AIA documents, and providing a notarized Non-Collusion Affidavit. Payment terms include a 2% retainage on partial payments, with final payment contingent upon the availability of appropriated funds.
Purchasing Division

POSTED

11 days ago

DEADLINE

in 10 days
View Details
NAICS: 524292
SLED
902795-Pharmacy Benefit Management Services
Solicitation # 902795
The Alameda County Behavioral Health Care Department is seeking a Pharmacy Benefit Management provider to administer prescription coverage for approximately 50,000 annual patients. The contractor will manage coverage for uninsured and HealthPAC patients, as well as specific Medi-Cal and Medicare Part D scenarios, including denied prior authorizations and co-pays. Key responsibilities include providing 24/7 electronic point-of-service claims adjudication, managing the Federal 340B drug purchasing program and Patient Assistance Programs, and maintaining a diverse pharmacy network across Alameda County. The contract requires a fully transparent pass-through pricing model and the implementation of an interface with the department's Electronic Health Record system. The County intends to award a three-year contract with a two-year renewal option to the most responsive and responsible bidder. Eligible bidders must have at least five years of experience providing PBM services to similar government agencies and must be HIPAA compliant. Evaluation criteria include a vendor interview and demonstration, with additional scoring preferences provided for certified small, emerging, and local businesses. The tentative contract start date is May 1, 2027. The selected contractor must provide a dedicated account manager and adhere to strict monthly and quarterly reporting schedules regarding claims, rebates, and performance guarantees.
General Services Agency-Procurement

POSTED

12 days ago

DEADLINE

in 17 days
View Details

More opportunities from New York → NYS Department of Health

Same awarding agency

Ready to Pursue This Opportunity?

Get AI-powered intelligence on this solicitation and the ones like it

Every page of the solicitation package shredded into a compliance breakdown

AI-powered matching based on your capabilities and past performance

Competitor and incumbent history on the requirement

Automated alerts on amendments, Q&A deadlines, and award

Miguel
Hillary
Keith Deutsch
Christine

Join 750+ contractors already using CLEATUS