007-24 Pharmacy Benefits Program.pdf.pdf

DeNerika.Johnson, Acting Director | DeNerika.Johnson@pgcps.org 13300 Old Marlboro Pike | Upper Marlboro, MD 20772 | 301-952 6560

RFP PUR 007-24 PHARMACY BENEFIT MANAGEMENT PLAN COMMERCIAL AND EGWP

RFP PUR-007-24

PHARMACY BENEFIT MANAGEMENT PROGRAM

COMMERCIAL AND EMPLOYER GROUP WAIVER PLAN (EGWP)

ISSUED BY:

The Department of Purchasing and Supply

Services

Attention: Donna Parks, Johnna Smarr, and

Diane Forde

RFP NUMBER:

RFP PUR-007-24

RELEASE DATE:

DECEMBER 20, 2023

PRE-PROPOSAL MEETING:

QUESTIONS DUE DATE:

JANUARY 9, 2024

JANUARY 12, 2024

PROPOSAL DUE DATE:

JANUARY 29, 2024, at 10:00 a.m.

DIRECT ALL INQUIRIES TO PROCUREMENT: DONNA.PARKS@PGCPS.ORG

JOHNNA.SMARR@PGCPS.ORG

DIANE.FORDE@PGCPS.ORG

To All Prospective Offerors:

Prince George’s County Public Schools (PGCPS) is soliciting proposals from qualified vendors for Pharmacy

Benefit Management Program Commercial and Employer Group Waiver Plan (EGWP).

A virtual pre-proposal conference will be held on January 9, 2024 via Zoom. Zoom information will be provided at a later date.

In order to participate in the pre-proposal conference, you must complete Attachment B - Letter of Interest and submit no later than 2:00 p.m., January 5, 2024, to all procurement contacts listed above. While attendance at the pre-proposal meeting is not mandatory, the information presented is informative. All interested Offerors are encouraged to attend.

Solicitation Documents may be obtained by:

● Download the solicitation by accessing the Prince George’s County Public School Board’s website at the following link: https://offices.pgcps.org/purchasing/bids.aspx

● Download the solicitation by accessing eMaryland Marketplace link:

https://emma.maryland.gov/page.aspx/en/usr/login?ReturnUrl=%2fpage.aspx%2fen%2fbuy%2fhomepage

Please respond according to the instructions provided in the RFP. Offerors are cautioned not to make changes to any of the terms and conditions or specifications in this solicitation, doing so may render an Offeror’s Proposal mailto:.stewart@pgcps.org mailto:DONNA.PARKS@PGCPS.ORG mailto:JOHNNA.SMARR@PGCPS.ORG mailto:DIANE.FORDE@PGCPS.ORG https://offices.pgcps.org/purchasing/bids.aspx https://emma.maryland.gov/page.aspx/en/usr/login?ReturnUrl=%2fpage.aspx%2fen%2fbuy%2fhomepage unacceptable and subject to rejection. In addition, offerors should not make any changes to the formatting of the

Excel Technical and Financial Questionnaires.

The Department of Purchasing & Supply Services is not responsible for information obtained from sources outside the Prince George’s County Purchasing Office, including downloads from the County website. Offerors are directly responsible for obtaining updates, changes or addendums either from the updated web page or by contacting the

Purchasing Office for instructions. If the Offeror has questions, they must be in writing and directed to the procurement contacts specified. Failure to adhere to this requirement may subject the Offeror to immediate disqualification.

mailto:.stewart@pgcps.org

TABLE OF CONTENTS

Contents

1. PART I: INTRODUCTION AND BACKGROUND:

2. PURPOSE

3. SUMMARY OF SERVICES

4. NON-EXCLUSIVE

5. OFFERORS IN LEGAL PROCEEDINGS WITH PGCPS

6. PERIOD OF PERFORMANCE

7. OPTION TO EXTEND SERVICE

8. CONTRACT TYPE

9. CONTINUITY OF SERVICES

10. BONDING

11. POINT OF CONTACTS

PART II: INSTRUCTIONS TO OFFERORS

1. OFFEROR KNOWLEDGE OF TERMS AND CONDITIONS

2. PROPOSAL SCHEDULE

3. PROPOSAL SUBMISSION REQUIREMENTS

4. PROPOSAL MARKINGS

5. PROPOSAL SUBMISSION LAYOUT

6. BIDDER DELIVERY AND ENVELOPE PACKAGING

PART III: SCOPE OF WORK

1. INTRODUCTION

2. BACKGROUND

3. SCOPE OF WORK – ADD SCOPE OF WORK

PART IV: PROPOSAL EVALUATION AND AWARD

1. EVALUATION COMMITTEE

2. EVALUATION PROCESS

3. EVALUATION CRITERIA

4. PROPOSAL AWARD

PART V: GENERAL TERMS AND CONDITIONS

1. PARTNERSHIPS

2. CORPORATIONS

3. SAMPLES

4. PROPOSAL PREPARATION FEES

5. RIGHT TO PROTEST

6. APPEAL OF CONTRACT AWARD DECISION:

7. COMMENCEMENT OF SERVICES

8. ADDENDA

9. STATEMENT OF CONFIDENTIALITY

10. TERM OF AGREEMENT

11. PRE-PROPOSAL MEETING

12. PAYMENT TERMS

13. MINORITY BUSINESS ENTERPRISE PROGRAM

14. LOCAL MBE INITIATIVE

15. MINORITY BUSINESS ENTERPRISE PROHIBITIONS

16. E- COMMERCE

17. CYBER LIABILITY INSURANCE

18. LIQUIDATED DAMAGES

19. FINGERPRINT CRIMINAL HISTORY BACKGROUND CHECKS, CHILD PROTECTIVE

SERVICE CLEARANCES, AND SAFE SCHOOLS TRAINING REQUIREMENTS

20. EDUCATIONAL/MEDICAL/PSYCHOLOGICAL RECORDS

21. PROTECTION OF STUDENT RECORDS

22. LEGAL COMPLIANCE

23. EPA COMPLIANCE

24. STATE OF MARYLAND CERTIFICATE OF GOOD STANDING

25. PERSONAL IDENTIFIABLE INFORMATION (PII)

26. OFFEROR PERFORMANCE EVALUATION

PART VI: SPECIAL TERMS AND CONDITIONS

1. REQUEST FOR PROPOSAL

2. GENERAL REQUIREMENTS

3. PRICES

4. ITEM DELIVERY

5. GUARANTEE AND WARRANTIES

6. ANNULMENTS AND RESERVATIONS

7. TERMINATION OF CONTRACT

8. GOVERNING LAW & VENUE

9. CONTRACT TERMS AND CONDITIONS

10. CHANGES IN TERMS OR DELIVERY

APPENDIX A – PROPOSAL AND ADDENDA ACKNOWLEDGEMENT

APPENDIX B – PAST PERFORMANCE AND REFERENCES

APPENDIX C - NON-COLLUSION CERTIFICATE

APPENDIX D - DEBARMENT AFFIDAVIT

APPENDIX E - ANTI-BRIBERY AFFIDAVIT

APPENDIX F - CERTIFICATE OF INSURANCE COVERAGE

APPENDIX G - FINANCIAL PROPOSAL TERMS

APPENDIX H - MBE FORM

APPENDIX I – STATE OF MARYLAND TAX CERTIFICATION

APPENDIX J – CERTIFICATION OF COMPLIANCE

APPENDIX K – VENDOR CONFLICT OF INTEREST DISCLOSURE FORM

ATTACHMENT A – COST PROPOSAL FORM

ATTACHMENT B – LETTER OF INTEREST FOR PRE-PROPOSAL CONFERENCE

ATTACHMENT C – LETTER OF INTENT TO APPLY

Contents

1. PART I: INTRODUCTION AND BACKGROUND:

2. PURPOSE

3. SUMMARY OF SERVICES

4. NON-EXCLUSIVE

5. OFFERORS IN LEGAL PROCEEDINGS WITH PGCPS

6. PERIOD OF PERFORMANCE

7. OPTION TO EXTEND SERVICE

8. CONTRACT TYPE

9. CONTINUITY OF SERVICES

10. BONDING

11. POINT OF CONTACTS

PART II: INSTRUCTIONS TO OFFERORS

1. OFFEROR KNOWLEDGE OF TERMS AND CONDITIONS

2. PROPOSAL SCHEDULE

3. PROPOSAL SUBMISSION REQUIREMENTS

4. PROPOSAL MARKINGS

5. PROPOSAL SUBMISSION LAYOUT

6. BIDDER DELIVERY AND ENVELOPE PACKAGING

PART III: SCOPE OF WORK

1. INTRODUCTION

2. BACKGROUND

3. SCOPE OF WORK – ADD SCOPE OF WORK

PART IV: PROPOSAL EVALUATION AND AWARD

1. EVALUATION COMMITTEE

2. EVALUATION PROCESS

3. EVALUATION CRITERIA

4. PROPOSAL AWARD

PART V: GENERAL TERMS AND CONDITIONS

1. PARTNERSHIPS

2. CORPORATIONS

3. SAMPLES

4. PROPOSAL PREPARATION FEES

5. RIGHT TO PROTEST

6. APPEAL OF CONTRACT AWARD DECISION:

7. COMMENCEMENT OF SERVICES

8. ADDENDA

9. STATEMENT OF CONFIDENTIALITY

10. TERM OF AGREEMENT

11. PRE-PROPOSAL MEETING

12. PAYMENT TERMS

13. MINORITY BUSINESS ENTERPRISE PROGRAM

14. LOCAL MBE INITIATIVE

15. MINORITY BUSINESS ENTERPRISE PROHIBITIONS

16. E- COMMERCE

17. CYBER LIABILITY INSURANCE

18. LIQUIDATED DAMAGES

19. FINGERPRINT CRIMINAL HISTORY BACKGROUND CHECKS, CHILD PROTECTIVE

SERVICE CLEARANCES, AND SAFE SCHOOLS TRAINING REQUIREMENTS

20. EDUCATIONAL/MEDICAL/PSYCHOLOGICAL RECORDS

21. PROTECTION OF STUDENT RECORDS

22. LEGAL COMPLIANCE

23. EPA COMPLIANCE

24. STATE OF MARYLAND CERTIFICATE OF GOOD STANDING

25. PERSONAL IDENTIFIABLE INFORMATION (PII)

26. OFFEROR PERFORMANCE EVALUATION

PART VI: SPECIAL TERMS AND CONDITIONS

1. REQUEST FOR PROPOSAL

2. GENERAL REQUIREMENTS

3. PRICES

4. ITEM DELIVERY

5. GUARANTEE AND WARRANTIES

6. ANNULMENTS AND RESERVATIONS

7. TERMINATION OF CONTRACT

8. GOVERNING LAW & VENUE

9. CONTRACT TERMS AND CONDITIONS

10. CHANGES IN TERMS OR DELIVERY

APPENDIX A – PROPOSAL AND ADDENDA ACKNOWLEDGEMENT

APPENDIX B – PAST PERFORMANCE AND REFERENCES

APPENDIX C - NON-COLLUSION CERTIFICATE

APPENDIX D - DEBARMENT AFFIDAVIT

APPENDIX E - ANTI-BRIBERY AFFIDAVIT

APPENDIX F - CERTIFICATE OF INSURANCE COVERAGE

APPENDIX G - FINANCIAL PROPOSAL TERMS

APPENDIX H - MBE FORM

APPENDIX I – STATE OF MARYLAND TAX CERTIFICATION

APPENDIX J – CERTIFICATION OF COMPLIANCE

APPENDIX K – VENDOR CONFLICT OF INTEREST DISCLOSURE FORM

ATTACHMENT A – COST PROPOSAL FORM

ATTACHMENT B – LETTER OF INTEREST FOR PRE-PROPOSAL CONFERENCE

ATTACHMENT C – LETTER OF INTENT TO APPLY

EXHIBIT 1 - Technical Questionnaire

EXHIBIT 2 - Commercial Plan Financial Questionnaire

EXHIBIT 3 - EGWP Plan Financial Questionnaire

EXHIBIT 4 - Commercial Plan Re-pricing Sheet

EXHIBIT 5 - EGWP Plan Re-pricing Sheet

EXHIBIT 6 - Commercial Plan Formulary Advanced Control Specialty

EXHIBIT 7 - Commercial Performance Controlled Drug List

EXHIBIT 8 - Commercial Plan Summary

EXHIBIT 9 - SilverScript Annual Notice of Change - 2023

EXHIBIT 10 - SilverScript Formulary 2023

EXHIBIT 11 - SilverScript Evidence of Coverage 2023

EXHIBIT 12 - SilverScript Summary of Benefits 2023

EXHIBIT 13 - SilverScript Annual Notice of Change 2024

EXHIBIT 14 - SilverScript Formulary 2024

EXHIBIT 15 - SilverScript Evidence of Coverage 2024

EXHIBIT 16 - SilverScript Summary of Benefits 2024

EXHIBIT 17 - Monthly Summary of Experience 2020-2023 YTD

EXHIBIT 18 – Census File

PART I: INTRODUCTION AND BACKGROUND

1. INTRODUCTION AND BACKGROUND:

The Board of Education of Prince George’s County (The Board) serves the needs of public education in Prince George’s County, covering approximately 1,789 square miles, with a residential population of more than 904,430. Prince George's County Public Schools (PGCPS), one of the nation's 20th largest school districts, has 208 schools and centers, has approximately 131,657 students and nearly 22,000 employees and an annual operating budget of $2.3 billion.

The school system serves a diverse student population from urban, suburban and rural communities located in the Washington, DC suburbs. PGCPS is nationally recognized for college and career-readiness programs that provide students with unique learning opportunities, including dual enrollment and language immersion. The Central administration headquarters is located at 14201 School Lane, Upper Marlboro, Maryland.

2. PURPOSE

The Board of Education of Prince George’s County (The Board) is issuing this Request for Proposal

(RFP) to provide Pharmacy Benefit Management (PBM) Services - Commercial and EGWP as defined in Part III, Scope of Work. The goal of this solicitation is to identify and contract with the PBM that represents the best possible combination of attributes, including fixed fees, program flexibility, risk management, member services, performance guarantees, claims processing integrity, robust reporting capabilities, and sales & marketing support. To the extent possible, PGCPS wishes to duplicate the existing plan design outlined in this RFP, and to minimize formulary disruption.

3. SUMMARY OF SERVICES

This Request for Proposal is soliciting proposals for self-funded pharmacy benefit management and related administrative services (“PBM Services”), including Employer Group Waiver Plan (EGWP) + Wrap Services for Medicare Covered Members. Pharmacy benefit management services that are to be provided include, but are not limited to, the following:

Data Security and Privacy

Managing Claim Payment and Adjudication Systems

Providing Member Services and Support

Network Management / Pharmacy Access

Cost Management / Drug Utilization Review Controls

Medication Therapy Management

Formulary Management / Pharmacy and Therapeutics (P&T) Committee

Rebate Negotiations

4. NON-EXCLUSIVE

The intent of this contract is to provide the Board with an expedited means of procuring supplies and/or services at the lowest cost. This contract is for the convenience of the Board and is considered to be a "Non-Exclusive" use contract. The Board does not guarantee any usage. The Board will not be held to purchase any particular Brand, in any groups, prices or discount ranges, but reserves the right to purchase any item/service listed in the Cost Proposal.

5. OFFERORS IN LEGAL PROCEEDINGS WITH PGCPS

PGCPS recognizes the significant costs and imposition on the time of personnel associated with legal proceedings. Accordingly, PGCPS has adopted a process stating that:

“One factor, among others, that are to be considered when awarding a contract or purchase order is the existence of a pending legal dispute – whether in court or an alternative dispute forum – with any Vendor or Offeror which has submitted a Proposal. Before including consideration of the legal dispute as a factor, the Procurement Officer shall seek the advice of the Office of General Counsel regarding the legal dispute and shall obtain the concurrence of the Superintendent of Schools or his designee.”

6. PERIOD OF PERFORMANCE

The term of this Contract begins on January 1, 2025, with the understanding that certain contract implementation matters will begin the date the Notice of Award is signed by both the Offeror and The

BOARD (the “Effective Date”) and shall continue for a period of five (5) years (“Initial Term”). In its sole discretion, The Board shall have the unilateral right to renew the Contract for two (2) additional one-year option periods successive (each a “Renewal Term”) at the prices established at contract award. “Term” means the Initial Term and any Renewal Term(s).

7. OPTION TO EXTEND SERVICE

The Board may require continued performance of any services within the limits and at the rates specified in the contract. The option to extend provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 12 months.

8. CONTRACT TYPE

The contract resulting from this solicitation shall be Fixed Rate requirements. Vendors are encouraged to partner with local Offerors or firms if they don’t meet all the required expertise or MBE requirements.

Subcontractor and or teaming partner information shall be included in response.

9. CONTINUITY OF SERVICES

The Vendor recognizes that the services under this contract are vital to PGCPS and must be continued without interruption and that, upon contract expiration, a successor, either the PGCPS or another vendor, may continue them. The Vendor agrees to exercise its best efforts and cooperation to effect an orderly and efficient transition to a successor.

10. BONDING (Not Applicable) The Offeror may be required to submit a Bid and or a Performance Bond as indicated below.

A. BID BOND (Not Required If applicable, the bid bond will be in the amount of five percent (5%) as determined by the BOARD and specified in the RFP, to ensure the satisfactory completion of the work for which a contract or purchase order is awarded that may exceed $100K. (COMAR 21.06.07.10). The bond must be made in favor of the BOARD OF EDUCATION OF PRINCE GEORGE’S COUNTY, UPPER

MARLBORO, MARYLAND 20772-9983.

B. PERFORMANCE AND LABOR BOND (Not Required) The awarded vendor(s) will be required to submit a performance and/or labor bond, Cashier’s or Certified Check in the amount of one hundred percent (100%) of the project cost as determined by the BOARD and specified herein to ensure all phases of the project are satisfactory complete for which a contract or purchase order is awarded that exceeds 100K. (COMAR 21.06.07.10).

When applicable, the Board reserves the right to request performance and labor bond for amount over or under $100K. The bond, cashier or certified check must be made in favor of the BOARD OF EDUCATION OF PRINCE GEORGE’S COUNTY and mailed to 13300 Marlboro Pike, Upper Marlboro, Maryland 20772-9983 prior to the start of performance.

11. POINT OF CONTACTS

The Offeror’s performance will be under the direction of the Procurement Department ensuring the Offeror's compliance with the requirements of this contract to include managing the daily activities of the contract, providing guidance to the contract, and coordination. The Offeror shall be accountable to the end users on all matters relating to the scope of work.

PROCUREMENT CONTACTS TECHNICAL CONTACT

Donna Parks, Supervisor of Purchasing Services Nick Venturini, Director Benefit Services Johnna Smarr, Procurement Specialist (Do Not Contact) Diane Forde, Records Keeping Clerk

Donna.Parks@pgcps.org Johnna.Smarr@pgcps.org Diane.Forde@pgcps.org

Your questions are important to PGCPS. To ensure that your questions are received and addressed in an expeditious manner, please ensure that you forward all email inquiries to all Procurement contacts listed above.

mailto:.stewart@pgcps.org mailto:Donna.Parks@pgcps.org mailto:Johnna.Smarr@pgcps.org mailto:Diane.Forde@pgcps.org

PART II: INSTRUCTIONS TO OFFERORS

1. OFFEROR KNOWLEDGE OF TERMS AND CONDITIONS

Before submitting Proposals, Offerors are expected to fully inform themselves as to the conditions, requirements, and specifications before submitting a Proposal. Offeror shall acquaint themselves with all State and Federal governing laws, ordinances, etc. and otherwise familiarize themselves with all matters, which may affect the Proposal. The act of submitting a Proposal shall be considered as meaning that the Offeror has so familiarize themselves; therefore, there shall be no misunderstanding or lack of information. Offerors, or their authorized representatives, are expected to fully inform themselves as to the conditions, requirements, and specifications before submitting Proposals. Failure to do so will be at the Offeror's own risk and Offeror cannot secure relief on the plea of error. Neither law nor regulations make allowance for errors of omission or commission on the part of Offerors.

All correspondence concerning the Proposal and contract, including Notice of Award, copy of the Contract, and Purchase Order, will be provided electronically.

2. PROPOSAL SCHEDULE

Due to the constant need of the Solicitation, milestones are listed with target dates. Please adhere to the schedule unless notified by way of an Addendum.

Event

Event Due Date or Occurrence Date

Issuance of RFP December 20, 2023

Letter of Intent to Attend Pre-Proposal

Conference and Letter of Intent to Apply

Due no later than 10:00 a.m. January 5, Encrypted Link Sent to Vendors Commencing December 21, 2023

Pre-Proposal Conference January 9, 2024 @ 11:00 a.m.

Questions Due

Due no later than 2:00 pm. January 12, Posting of Addendum January 18, 2024 (approximate date)

Proposal Due Date January 29, 2024 @ 10:00 am

Proposal Evaluation March 2024

Oral Interviews (if held) March 2024

Award Issuance May-June 2024

Benefits Open Enrollment October 2024

Exhibits 1 - 18 will be available for pickup via electronic portal, Zendto. Zendto is an encrypted secure site. Only those Respondents who submit Attachment C -- Letter of Intent to Apply will receive notice via email from Zendto.

All interested respondents will also be required to utilize the Zendto link to submit their proposals electronically.

NOTE: PGCPS Offices will be closed December 25, 2023 – January 2, 2024. However, emails will be monitored for forwarding Zendto technical files during this period.

3. PROPOSAL SUBMISSION REQUIREMENTS

In order to be eligible, Proposals must be received via electronic portal, Zendto, no later than January 29, 2024 @ 10:00 a.m. Only proposals that are submitted via the encrypted electronic portal, Zendto by the date as specified will be utilized during the evaluation process. Proposals that are not submitted via this portal may be ruled non-responsive. The Proposal shall consist of the required documentation for each volume as identified. Offerors shall retain one (1) original copy of the Proposal for their files. PGCPS may request the original notarized documents that were posted electronically before final award execution.

NOTE: Only those Respondents who submitted their Letter of Intent to Apply will receive a notice via email from Zendto. Approximately ten (10) days prior to the deadline for the submission of all proposals, potential Offerors who completed Attachment C -- Notice of Intent to Apply will receive a notice via email from Zendto to submit their proposal. The notice will contain a link generated by Zendto. Zendto is an encrypted, secure site. All interested Respondents shall utilize the link provided to submit their proposals electronically. All proposal submissions via Zendto are automatically encrypted and are date/time stamped. Therefore, please upload your documents no later than the deadline date and time indicated in the RFP or subsequent addenda.

All Respondents who upload their proposal documents onto the Zendto portal will receive an automated response advising the school system has “picked up” the documents when they are retrieved by the PGCPS Purchasing Office.

It is the Respondent’s responsibility to submit their proposals on time via the electronic portal.

It is also the Respondent’s responsibility to ensure the proposal has been uploaded properly on Zendto. Therefore, it is recommended that Respondents become familiar with this portal, as well as the submission process prior to the due date and time of this solicitation.

PGCPS reserves the right to request Respondents to provide proof of uploaded proposals via Zendto. Respondents that fail to provide adequate proof of submission of their proposal via Zendto may be declared non-responsive and will not be included in the evaluation process.

The electronic Proposal shall show the full business address, telephone number, email and fax number of the Offeror and be signed by the person or persons legally authorized to sign contracts and commit the company.

4. PROPOSAL MARKINGS

All Proposals shall be submitted without redactions. All sections of the Proposal that are considered Confidential or Proprietary shall be clearly marked within the Proposal. The Offerors’ shall provide justification for any and all confidential or proprietary information. Justification must be on a separate word document and submitted with the Technical Proposal.

5. PROPOSAL SUBMISSION LAYOUT

The completed bid documents(s) should be without interlineations, alterations, or erasures. The bid should present all information in a concise manner, neatly arranged, legible, and in terms understandable for evaluation. All information requested is to be addressed directly and completely. It is more desirable to give additional information than less when the answer could be misinterpreted. The submission layout will include four (4) parts:

GENERAL FORMAT- FOUR-PART SUBMISSION

Volume I - Technical Proposal

Volume II – Minority Business Enterprise (MBE)

Volume III – Cost Proposal

Volume IV – Appendices

Note: Each Volume should include a cover sheet detailing the Volume number and Title, RFP number and Title and the name of the Offeror.

6. BIDDER DELIVERY AND ENVELOPE PACKAGING

The bidder shall upload their Proposal electronically through Zendto and package their bid in two separate Zendto envelopes as noted below.

A. VOLUME I – TECHNICAL PROPOSAL (Envelope One) The Technical Proposal shall be submitted electronically via Zendto secured portal by the deadline date indicated in this RFP in PDF format. Note: The Technical excel Questionnaire (Exhibit 1) shall be submitted in the Excel file provided in this RFP (not in PDF format). Certain other reports shall also be submitted electronically as outlined in the Technical Questionnaire.

Offerors shall not include any pricing in their technical proposal. Offeror shall include a table of contents and all pages in the technical proposal must be numbered, consecutively from beginning to end and separated by tabs as described below:

1) TAB A – TRANSMITTAL LETTER

Offeror shall include a brief transmittal letter prepared on the Offerors’ letterhead, and signed by an individual who is authorized to commit the Offeror to the services and requirements in the RFP and Proposal. This transmittal letter shall include:

a) The name, title, address, telephone number, and electronic mail address of the person authorized to bind the Offeror to the contract and the person who will receive all official notices concerning this RFP.

b) The Offerors’ Federal Tax Identification Number or Social Security Number.

c) The Offerors’ PGCPS iSupplier ID Number must be listed. To obtain an iSupplier ID number, you must register with PGCPS at https://www.pgcps.org/offices/purchasing/isupplier

d) A brief statement of the Offerors’ understanding of the work to be done, the commitment to perform the work, and a statement of why the firm believes it is best qualified to perform the work specified in RFP.

e) A statement that the Proposal is a firm and irrevocable offer for a period of one hundred twenty (120) days following the closing date for receipt of initial Proposals or the closing date for receipt of a best and final offer, if applicable.

2) TAB B – LEGAL CLAIMS

Offeror shall identify any claims during the past three (3) years and provide information on any pending litigation, lawsuits etc. The failure to provide accurate information may be determined to be a material breach of any future agreement or contract with The Board. If applicable, the Offeror must state no claims exist.

3) TAB C – EXPERIENCE AND CAPABILITIES

Offeror shall prepare and present a Technical Proposal in such a way as to provide a straightforward description of response to experience and qualifications, product quality, demonstrated capacity to perform, past performance and references to satisfy the requirements of the RFP.

4) TAB D - TECHNICAL RESPONSE TO RFP SCOPE OF WORK

Technical Questionnaire (Exhibit 1) is included with this solicitation. Note, the Technical Questionnaire has separate tabs allowing vendors to respond to specific questions and information requests. Vendors should respond to the questions and requirements outlined in the Technical Questionnaire (Exhibit 1) in its entirety. Each tab represents a separate form.

All sections must be separated by tabs when submitting the responses to the Questionnaire.

The following form / tabs must be completed in the format provided:

General Company Information

Account Management Claims Information

Clinical - DUR & Prior Authorization

Customer Service

Eligibility

Formulary

Generics

Implementation

Mail Order

Reporting

Retail Networks

Specialty Pharmacy

High Cost Rx Financial Assistance Technology https://www.pgcps.org/offices/purchasing/isupplier

Note: Please do not modify any tab within the Technical Proposal Bid Forms document.

Modifying any tab or layout may eliminate your company from consideration.

Do not:

- Add Cells

- Delete Cells

- Renumber questions or Add Questions

- Delete Questions - If you cannot respond to a question please just note - "No

Response Available" or "N/A".

Responses to questions should be brief and concise. "Yes" or "No" responses are encouraged when appropriate. The maximum number of characters for a response is 700.

The primary requirement is that you accurately answer the questions posed.

Copy and pasting large-preformatted responses from marketing materials that, while answering the question, also provide extensive information not related to the particular question, may be negatively scored.

Specific instructions on how to complete each section is included within the Technical Questionnaire.

Electronic File shall include a cover sheet detailing the RFP number, as well as the name of the Offer and labeled “Volume I, Technical Proposal.

B. VOLUME II - MINORITY BUSINESS ENTERPRISE (MBE) (Envelope One)

Offerors shall submit MBE information electronically in Zendto under the Technical Proposal folder in a separate file, titled as such. A MBE goal of 15% has been established for the contract representing a percentage of the total Contract dollar value, including all renewal option terms.

Minority Businesses included in the Proposal package at time of opening, cannot be changed without prior approval of the Director of Purchasing and Supply Services.

By submitting a response to this RFP, the Offeror acknowledges the overall MBE participation goal and commits to achieving the overall goal by utilizing certified minority business enterprises, or will include a full or partial waiver of the overall goal with the Proposal.

1) Offerors shall describe how they intend to meet the MBE goals or justify why the goal cannot be met.

C. VOLUME III – COST PROPOSAL (Envelope Two) The Offerors cost proposal shall include all labor, delivery, materials, tools, and equipment to perform work.

All pricing shall remain fixed for the full contract term, including renewals thereto unless an escalation or adjustment is included herein. Offerors should not include any portion of their Technical Proposal in its Cost Proposal.

Financial Submission Documentation shall include the following:

1) Offerors shall complete “Appendix G – Financial Proposal Terms and Attachment A

– Cost Proposal Form”.

Offerors shall also provide the Cost Proposal in excel format as requested on the following:

Exhibit 2 - Commercial Plan Financial Questionnaire Exhibit 3 - EGWP Plan Financial Questionnaire.

Please submit under a separate cover as described in Part II. Section 3. The following Tabs are included in the Financial Questionnaires and must be completed as instructed.

Each tab represents a separate form.

Commercial Plan Financial Questionnaire RFP Business & Contract Requirements

Claim Repricing Instructions Financial Questions For Incumbent Only Pricing & Rebate Offer MAC Summary Specialty Assistance Programs Rebates Single Source Generics Discount Guarantee Claims Termination File Costs Rebate Eligible Brand Claims Revenue Included In Rebates Minimum Required Claim Fields Recommended Cost Containment Programs

EGWP Plan Financial Questionnaire

RFP Business & Contract Requirements Claim Repricing Instructions Financial Questions For Incumbent Only Pricing & Rebate Offer MAC Summary Rebates Single Source Generics Discount Guarantee Claims Termination File Costs Rebate Eligible Brand Claims Revenue Included In Rebates Minimum Required Claim Fields Recommended Cost Containment Programs

2) Do not amend, alter, or leave blank any items on the Proposal Form or include additional clarifying or contingent language on or attached to the Proposal Form. Items or costs required to provide the services and deliverables as proposed, but not identified will be the sole responsibility of the Offeror.

3) The Offeror shall demonstrate its financial stability. The Offeror shall include a fiscal integrity / financial statement for the last two calendar years. If the Offeror has not had its financial statements audited by an independent accounting firm, the Offeror must submit such un-audited financial statements.

D. VOLUME IV - Appendices and Exhibits (Envelope Two) Offerors shall submit the Appendices electronically in eMMA under the Technical Proposal folder in a separate file, titled as such. The Offeror shall sign, date, and notarize where applicable all appendices identified. Appendices shall be packaged together as one file and delivered under Volume IV.

o Appendix A – Proposal and Addendum Acknowledgement o Appendix B – Past Performance and References o Appendix C – Non-Collusion Certificate o Appendix D – Debarment Affidavit o Appendix E – Anti-Bribery Affidavit o Appendix F – Certificate of Insurance Coverage o Appendix G – Financial Proposal Form o Appendix H – MBE Form o Appendix I – Certificate State of Maryland Tax Certification o Appendix J – Certification of Compliance o Appendix K – Vendor Conflict of Interest Disclosure Form

Failure to provide any of the requested information or documents in this solicitation may render the Proposal non-responsive.

PART III: SCOPE OF WORK

1. INTRODUCTION

The BOARD is requesting proposals for self-funded pharmacy benefit management and related administrative services (“PBM Services”), including Employer Group Waiver Program (EGWP) + Wrap

Services for Medicare Covered Members.

Under the current self-funded PBM arrangement, there are approximately 20,000 subscribers and 36,500 members (both subscribers and dependents) in total. The annual plan spend is approximately $244 million, excluding prescription drug rebates, other price concessions, and EGWP related subsidies.

- 13,500 subscribers and 27,600 members (non-Medicare Commercial plan)

- 6,500 subscribers and 8,900 members (Medicare EGWP plan)

Excluded from this RFP are drug related items administered under the medical benefits and prescription drug coverage offered by the fully insured Staff Model Health Maintenance Organization (HMO). A separate medical solicitation (PUR-008-24 Self Insured and Fully Insured Medical Plan) addresses the insured Staff Model HMO prescription drug component.

Overview

Currently, PCGPS provides self-funded prescription drug plans for its employees, retired employees, and eligible dependents through (1) a Commercial Plan for Covered Members, administered by CVS

Caremark, and (2) an Employer Group Waiver Program (“EGWP”) + Wrap Services for Medicare

Covered Members, administered by SilverScript.

The EGWP is a customized employer group prescription drug plan (“PDP”), administered in accordance with Title I of the Medicare Prescription Drug Improvement and Modernization Act of 2003 and its implementing regulations at 42 C.F.R. Part 423 ("Part D"), issued and enforced by the Centers for

Medicare and Medicaid Services ("CMS"), as well as other applicable CMS instructions, requirements, guidance and policies (collectively, "CMS Requirements") and includes any additional coverage that qualifies as "other health or prescription drug coverage" (as defined in 42 C.F.R. 423.2305).

Specifically, PGCPS is an employer that offers an “employer-sponsored group prescription drug plan” within the meaning of 42 C.F.R. § 423.454 and desires to continue such coverage for its Part D eligible beneficiaries (“Medicare Covered Members”) on a self-insured basis and to collect premiums from and provide premium assistance to eligible Medicare Covered Members through an EGWP Prescription benefit management, disease management, and specialty pharmacy services are offered by the current

PBM.

The BOARD desires to continue to self-fund the coverage provided to Covered Members and Medicare

Covered Members under the plans offered.

Drug Plan Design – To Be Paired With Self-Funded Medical Plan Offering (2021 and later)

Any standalone self-funded medical or drug elections that were made prior to 2021 will continue to be standalone. Beginning 1/1/2021, PGCPS requires new elections for medical and drug coverages to be paired together.

For short term medicines, the member pays $10 for generics, $40 for preferred brand-name, and $70 for non-preferred brand-name drugs for up to a 34-day supply. For longer term medicines, the member pays $20 for generics, $80 for preferred brand-name, and $140 for non-preferred brand-name drugs for up to a 90-day supply, using CVS Caremark Mail Service or CVS Pharmacy locations. The maximum out-of-pocket cost is $1,500 per individual / $3,000 per family. For a complete description, please see

RFP supplemental documents that describe the plan.

Special rules may apply to EGWP enrollees, per CMS guidelines and regulations. When retirees or their dependents become eligible for Medicare, PGCPS requires those individuals to enroll in Medicare Parts

A & B and provide their Medicare Beneficiary Identifier (MBI) to the PGCPS Benefits Office. PGCPS will then transition those Medicare-eligible members from the Commercial plan to the EGWP plan. There are separate formularies and administrative procedures for Commercial and EGWP plans. See attached

Exhibits 6, 7, 8, 10, 11, 12, 14, 15, and 16.

2. BACKGROUND

The Board of Education of Prince George’s County (The Board) serves the needs of public education in Prince George’s County, covering approximately 1,789 square miles, with a residential population of more than 904,430. Prince George's County Public Schools (PGCPS), is one of the nation's 20th largest school districts, has 208 schools and centers, has more than 136,500 students and nearly 22,000 employees and an annual operating budget of $2.3 billion.

The school system serves a diverse student population from urban, suburban and rural communities located in the Washington, DC suburbs. PGCPS is nationally recognized for college and career-readiness programs that provide students with unique learning opportunities, including dual enrollment and language immersion. The Central administration headquarters is located at 14201 School Lane, Upper Marlboro, Maryland.

PGCPS has engaged the services of Bolton Partners and Girling Benefits Consulting to assist the school district with this solicitation.

Note: All questions should be referred to PGCPS Contacts as listed in Part I, item 11 Point of Contact.

3. SCOPE OF WORK

Pharmacy benefit management services that are to be provided include, but are not limited to, the following:

- Data Security and Privacy – Bidder will comply with current healthcare industry standards, including HIPAA, to secure all PGCPS protected health information (PHI) and personally identifiable information (PII). Bidder will have policies and procedures to address the securing and handling PGCPS data, including action plans involving a breach of sensitive information.

- Managing Claim Payment and Adjudication Systems – Processing prescription claims according to PGCPS plan designs, plan accumulator exchanges (if applicable), clinical program requirements, contractual terms, and regulations for PGCPS covered pharmacy-related benefit items, which include certain prescription drugs and non-drug products.

- Providing Member Services and Support – Call center, ID cards, paper claim forms, member online tools (website and/or app), and personalized communications involving benefits, required member actions, and drug updates.

- Network Management / Pharmacy Access – Offer adequate number of access points to a broad national network of pharmacies, including retail, mail, and specialty options.

- Cost Management / Drug Utilization Review Controls – Ensure safe, effective, and cost-efficient use of prescription drugs.

- Medication Therapy Management – Review prescriptions for possible excessive use, recognized and recommended dosage regimens, drug interactions, and other safety measures. Includes review of prescriber-submitted member history and documentation (prior authorizations), processes involving step therapy, quantity limits, and more.

- Formulary Management / Pharmacy and Therapeutics (P&T) Committee – Managing a list of preferred drugs, specialty drug, and preventive drugs that corresponds to PGCPS’ copay tier structures and overall cost management strategy.

- Rebate Negotiations – PBM engaging with pharmaceutical manufacturers to negotiate price concessions on certain drugs. Rebates and related items are then shared with PGCPS to reduce plan costs.

- Reporting and Analytics – Support PGCPS with experience reporting needs, create and present comprehensive utilization reviews, share clinical insights, provide access to PBM clinicians, offer robust self-service online reporting tools to PGCPS and consultant, and upon termination- support PGCPS and new PBM with any transition files (claim history, open refill, prior authorizations, mail order, etc.)

- Regulatory Compliance – Complying and supporting PGCPS plans with federal and state regulations and reporting requirements, including CMS RxDC reporting.

- CMS EGWP Administration – Satisfying all CMS filing and reporting requirements involving Part

D related plans, eligibility management, claim reporting requirements, low income subsidies, late enrollment penalties, coverage gap discount program (manufacturer discount program), prospective catastrophic reinsurance, reconciliation reporting, and all of the Part D plan design changes as a result of the Inflation Reduction Act of 2022 (sections 11201 and 11401), including any administrative impact to PGCPS involving the Medicare Drug Price Negotiation Program.

Although we do not anticipate PGCPS needing CMS Retiree Drug Subsidy (RDS) services, please continue to quote a separate line item to identify the associated administrative costs.

4. TECHNICAL SPECIFICATIONS

PGCPS has a secure website for qualified Plan Vendors to upload and download documents.

Vendors must submit Attachment C – Letter of Intent to Apply prepared on the Contractor’s letterhead to the specified buyers to obtain access to the RFP Technical Forms (Exhibits 1 through 12). Access to the RFP Technical Forms will be provided only to those qualified vendors who submit the Letter of Intent to gain access.

The secure website will only be available during the solicitation process and closed at the end of the deadline date for submission of proposals or closed upon request by the PGCPS Purchasing Department.

NOTICE: The Technical Proposal response must not include any pricing or cost information. If any pricing or cost information amounts of any type (including pricing relating to other projects) is included in any part of the technical response, PGCPS may deem the proposal to be non-responsive and reject it.

5. MINIMUM QUALIFICATIONS

Qualified Respondents must have at least ten (10) years of experience in providing self-funded and/or fully insured pharmacy plan benefits, including claims administration and provider network services. In addition, responding vendors must have experience providing such services to at least four (4) Public School or Public Sector clients similar in size to PGCPS.

Note: Respondents are not required to provide both the self-funded and fully-funded programs.

The Board will not consider proposal responses from agents, brokers and consultants.

PART IV: PROPOSAL EVALUATION AND AWARD

1. EVALUATION COMMITTEE

Only proposals that are submitted via eMMA will be utilized during the evaluation process. Proposals that are not submitted via this portal will be ruled non-responsive.

Evaluation of the proposals will be performed by a committee established for that purpose and will be based on the criteria set forth below. The contract resulting from this RFP will be awarded to the

Offeror(s) whose proposal(s) is/are the most advantageous to The Board, considering price and technical factors set forth herein. The Board will consider the Offeror's record and performance of any prior contracts with The Board, federal departments or agencies, or with other public bodies.

Offeror, including any of their representatives, subcontractors, affiliates and interested parties shall not contact any member of the Committee or any person involved in the evaluation of the proposals. All inquiries related to this procurement must be handled by the RFP officials identified on the cover page.

Failure to comply with this directive may, at the sole discretion of the Board result in the disqualification of an offeror from the procurement process. The Evaluation Committee will make the final determination about acceptability of proposals.

2. EVALUATION PROCESS

The committee will evaluate each technical proposal using the evaluation criteria set forth below. As part of this evaluation, the Committee, at its sole discretion, may hold discussions with all qualified Offerors.

Discussions may be conducted via teleconference or may take the form of questions to be answered by the Offerors and conducted by mail, E-mail, or facsimile transmission at the discretion of The Board.

During the evaluation process, the committee may request technical assistance from any source.

a. Following the completion of the technical evaluation of all Offerors’ technical proposals, including any discussions, the committee will rank each qualified Offerors’ technical proposal.

b. The cost proposal of each qualified proposal will be distributed to the Evaluation Committee following the completion of the technical evaluation. The cost proposals will not be distributed to the committee until the technical evaluation is completed. The Committee will determine total costs of the proposals with the support of PGCPS’s Health and Welfare consultants, in order to establish a financial ranking of the proposals from lowest to highest.

c. The Evaluation Committee may reject in whole or in part any and all proposals, waive minor irregularities, and conduct discussions with all responsible Offerors in any manner deemed necessary to serve the best interests of the Board.

d. Based on the results of the evaluation, the highest rated offeror(s) may be invited by the Director of Procurement to make oral presentations to the Committee (if required). The Committee will then conduct its final evaluation of the proposals.

e. If it is determined to be in the best interest of The Board, the Board may invite Offerors to make final revisions to their technical and/or financial proposals through submission of a Best and Final Offer.

f. Should the Committee determine in writing and at its sole discretion that only one offeror is fully qualified, or that one offeror is clearly more highly qualified than the others under consideration, a contract may be negotiated and awarded to that offeror. The Committee will make appropriate recommendations to the Board, if appropriate, prior to actual award of contract. The Committee will recommend the Offeror whose overall proposal provides the most advantageous offer to the Board considering both price and technical factors set forth in this RFP.

3. EVALUATION CRITERIA

The evaluation criteria include proposal responsiveness, demonstration of capability to perform, price factors, and responsibility. The Board reserves the right to: (1) reject in whole or in part any and all proposals and waive minor irregularities; (2) Reject any or all proposals, or portions thereof; (3) Cancel a RFP and re-solicit.

The Evaluation committee will evaluate proposals using the criteria listed below. The committee shall determine which proposals have the basic requirements of the RFP and shall have the authority to determine whether any deviation from the requirements of the RFP is substantial in nature.

The points awarded for your offers will be based on the following:

A numeric evaluation system based on 100 evaluation points will be used to score the proposals. The maximum points awarded for each category are listed below:

PBM SCORING GRID Max Score

Instructions:

Each category receives a score.

The score is then multiplied by the weighting factor.

(a) (b) (a) x (b)

Category Elements Score Weight Total

Drug Discounts & Guarantees 25

50% 20 Rebates 10

Administrative & Ancillary Fees 3

Discount Guarantees Reconciliation 2

Member Negative Formulary Disruption 10

5% 1.5 Clinical Support 10

Account Management 10

Compliance with RFP Contractual Requirements 10

10% 2 Termination Costs & Provisions 10

Compliance with Business & Contract Requirements 10

Copay Assistance, PAP & Discount Cards 10

5 Drug Utilization Management 10 5% 0.5

Member Service Support 10

10% 3 Prior Authorization Protocals and Criteria 10

Performance Guarantees 10

Specialty Pharmacy Program Management 10

Non-Specialty Cost Control Programs 10

8 MBE Participation 5 5% 2

TOTAL POINTS AND WEIGHTED SCORE 175 33.0

See Part III, Scope of Work for additional information.

4. PROPOSAL AWARD

The Award of this contract will not be final and complete until: (1) Offeror has an active iSupplier, (2) the

Offeror submits complete and satisfactory documentation required under the Contract and/or documentation required by the Procurement Officer; and (2) the Contract is signed by the Department following any required approvals of the Contract, including approval by the Board, if such approval is required.

PART V: GENERAL TERMS AND CONDITIONS

1. PARTNERSHIPS

Proposals by partnerships shall be signed with the partnership name by one of the members of the partnership or by an authorized representative, followed by the signature and designation of the person signing, who shall also state the names of the individuals composing the partnership.

2. CORPORATIONS

Proposals by corporations shall be signed with the name of the corporation, followed by the signature and designation of the officer having authority to sign. When requested, satisfactory evidence of authority of the officer signing on behalf of the corporation shall be furnished. Anyone signing the proposal as agent shall file satisfactory evidence of authorization to do so.

3. SAMPLES

Offerors may be required to submit samples of each product awarded with an affidavit stating that the chemical composition of the sample submitted is identical with the composition tested prior to the proposal and all remain unchanged during the period of the contract. This requirement shall be part of the specifications of the product or products requested if applicable.

If Samples are required, a properly tagged sample and descriptive data shall be submitted to the address specified no later than the date specified. The tag on the sample shall indicate the item number, the name of the company submitting the sample, and the IFB number. The Board will not be responsible for any samples not picked up within 30 days of the notification of Vendors to do so. Samples may be retained by The Board until Vendors are notified to remove them. Vendors agree that The Board will incur no liability for samples that are damaged, destroyed, lost, or consumed in testing processes.

Failure to submit the above information when requested is sufficient grounds for rejection of the proposal.

4. PROPOSAL PREPARATION FEES

The Board will not be responsible for any costs incurred by a Offeror in preparing and submitting a proposal in response to a proposal.

5. RIGHT TO PROTEST

The Director of Purchasing and Supply Services shall attempt to resolve informally all protests of proposal award recommendations. Vendors are encouraged to present their concerns promptly to the

Buyer and/or Purchasing Supervisor for consideration and resolution. The Director of Purchasing shall inform the Chief Financial Officer (CFO) upon receipt of the protest. Open dialogue is helpful for all parties and disputes are often only a misunderstanding of the evaluation and recommendation process.

A vendor who does not file a timely protest before the contract is executed by the Board is deemed to have waived any objection.

a. An interested party (bidding of standing or offeror) must file a protest with the Purchasing Office within five (5) calendar days of the recommendation of award or notification to the offeror or bidder that their proposal or bid will be rejected.

b. Purchasing and Supply Services a proposed award of a contract for supplies, equipment, services, or maintenance. An offeror of standing is a offeror who would be directly next in line for an award should the protest be supported.

c. The protest shall be in writing addressed to the Purchasing Supervisor with a copy to the Director and shall include the following:

i. The…