1-RFP-2025-744-DFA-ID.pdf

RFP-2025-744-DFA-ID, “Workers’ Compensation Cost Containment Service – Pharmacy Benefit Management”

City of Albuquerque Request for Proposals

Solicitation Number: RFP-2025-744-DFA-ID

Workers Compensation Cost Containment Service-Pharmacy Management

January 7, 2026

Deadline for Receipt of Proposals: February 6, 2026 4:00 p.m. (Mountain Time)

The City eProcurement System will not allow Proposals to be submitted after this date and time.

City of Albuquerque

Department of Finance and Administrative Services Purchasing Division

TABLE OF CONTENTS

Page

Introduction 3

Part 1 Instructions to Offerors 5

Part 2 Proposal Format 16

Part 3 Scope of Services 18

Part 4 Evaluation of Proposals 25

Part 5 Draft Agreement 27

Appendix A Cost Proposal

INTRODUCTION

The City of Albuquerque (City) is soliciting proposals from qualified Offerors to provide Pharmacy Benefit Management (PBM) services for its Risk Management Division, part of the Department of Finance and Administrative Services.

Through this RFP, the City seeks to establish an agreement with a PBM provider that delivers exceptional service, optimal value, and cost-effective solutions. For the purposes of this solicitation, PBM encompasses the administration of prescription drug programs specifically related to workers’ compensation claims. This includes processing and payment of prescription drug claims, formulary development and maintenance, pharmacy network contracting, and negotiation of discounts and rebates with drug manufacturers.

BACKGROUND

The primary objectives of this RFP are to ensure compliance with New Mexico Workers’ Compensation Administration rules on medical payments, provide injured employees with timely access to medications, and achieve cost savings. The overall in-network penetration rate is ninety-nine percent (99%). Less than one percent of prescriptions are out of network. Eighty-nine percent (89%) of the prescriptions filled are Generic and eleven percent (11%) are Brand. Less than one percent (.03) of prescriptions are Mail Order. The City sees a limited annual volume of compound prescriptions, with $5715.00 paid in 2024 and $5685.00 in 2023. The average cost per compound is $250.00. For pharmacy charge re-pricing, the City utilizes services from Mitchell Advisor Scripts and does not incur any dispensing fees.

The City is self-insured and self-administers its workers’ compensation liabilities using Origami Risk, a web-based system. The Successful Offeror will be required to develop an electronic interface with the City’s claims system.

The following data is intended to provide background information required to submit an informed response to this RFP.

YEAR Fee Schedule Amount

Savings Allowable Amount

Total Number of Transactions

2023 $275,933 $113,857 $162,076 1231

2024 $253,715 $91,760 $161,955 1091

PART 1

INSTRUCTIONS TO OFFERORS

1.1 RFP Number and Title: RFP-2025-744-DFA-ID, " Workers Compensation Cost Containment Service-Pharmacy Management "

1.2.1 Questions: All questions shall be submitted in written format in the City’s eProcurement system (Bonfire) prior to the close date for questions and answers.

1.3 Purchasing Division: This Request for Proposals (“RFP”) is issued on behalf of the City of Albuquerque by its Purchasing Division, which is the sole point of contact during the entire procurement process.

1.4 Authority: Chapter 5, Article 5 of the Revised Ordinances of the City of Albuquerque, 1994, (“Public Purchases Ordinance”). The City Council, pursuant to Article 1 of the Charter of the City of Albuquerque and Article X, Section 6 of the Constitution of New Mexico, has enacted this Public Purchases Ordinance as authorized by such provisions and for the purpose of providing maximum local self-government. To that end, it is intended that this Public Purchases Ordinance shall govern all purchasing transactions of the City and shall serve to exempt the City from all provisions of the New Mexico Procurement Code, as provided in Section 13-1-98K, NMSA 1978.

1.5 Acceptance of Proposal: Acceptance of Proposal is contingent upon Offeror's certification and agreement by submittal of its Proposal, to comply and act in accordance with all provisions of the following:

1.5.1 City Public Purchases Ordinance

1.5.2 City Purchasing Rules and Regulations: These Rules and Regulations (“Regulations”) are written to clarify and implement the provisions of the Public Purchases Ordinance. These Regulations establish policies, procedures, and guidelines relating to the procurement, management, control, and disposal of goods, services, and construction, as applicable, under the authority of the Ordinance.

1.5.3 Civil Rights Compliance: Acceptance of Proposal is contingent upon the Offeror's certification and agreement by submittal of its Proposal, to comply and act in accordance with all provisions of the Albuquerque Human Rights Ordinance, the New Mexico Human Rights Act, Title VII of the U.S. Civil Rights Act of 1964, as

1.2 Proposal Due Date: February 6, 2026 - NLT 4:00 PM (Local Time) amended, and all federal statutes and executive orders, New Mexico statutes and City of Albuquerque ordinances and resolutions relating to the enforcement of civil rights and affirmative action. Questions regarding civil rights or affirmative action compliance requirements should be directed to the City of Albuquerque Human Rights Office.

1.5.4 Americans with Disabilities Act Compliance: The Offeror certifies and agrees, by submittal of its Proposal, to comply and act in accordance with all applicable provisions of the Americans With Disabilities Act of 1990 and federal regulations promulgated thereunder.

1.5.5 Insurance and Bonding Compliance: Acceptance of Proposal is contingent upon Offeror's ability to comply with the insurance requirements as stated herein.

Please include a certificate or statement of compliance in your Proposal and bonds as required.

1.5.6 Ethics:

1.5.6.1 Fair Dealing. The Offeror warrants that its Proposal is submitted and entered into without collusion on the part of the Offeror with any person or firm, without fraud and in good faith. Offeror also warrants that no gratuities, in the form of entertainment, gifts or otherwise, were, or will be offered or given by the Offeror, or any agent or representative of the Offeror to any officer or employee of the City with a view toward securing a recommendation of award or subsequent contract or for securing more favorable treatment with respect to making a recommendation of award.

1.5.6.2 Conflict of Interest. The Offeror warrants that it presently has no interest and shall not acquire any interest, direct or indirect, which would conflict in any manner or degree with the performance of services required under the contract resulting from this RFP. The Offeror also warrants that, to the best of its knowledge, no officer, agent or employee of the City who shall participate in any decision relating to this RFP and the resulting contract, currently has, or will have in the future, a personal or pecuniary interest in the Offeror’s business.

1.5.7 Participation/Offeror Preparation: The Offeror may not use the consultation or assistance of any person, firm company who has participated in whole or in part in the writing of these specifications or the Scope of Services, for the preparation of its Proposal or in the management of its business if awarded the contract resulting from this RFP.

1.5.8 Debarment or Ineligibility Compliance: By submitting its Proposal in response to this RFP, the Offeror certifies that (i) it has not been debarred or otherwise found ineligible to receive funds by any agency of the federal government, the State of New Mexico, any local public body of the State, or any state of the United States; and (ii) should any notice of debarment, suspension, ineligibility or exclusion be received by the Offeror, the Offeror will notify the City immediately.

Any Proposal received from an Offeror that is, at the time of submitting its Proposal or prior to receipt of award of a contract, debarred by or otherwise ineligible to receive funds from any agency of the federal government, the State of New Mexico, any local public body of the State, or any state of the United States, shall be rejected.

Upon receipt of notice of debarment of an Offeror awarded a contract as a result of this RFP (“Contractor”), or other ineligibility of the Contractor to receive funds from any agency of the federal government, the State of New Mexico, any local public body of the State, or any state of the United States, the City shall have the right to cancel the contract with the Contractor resulting from this RFP for cause in accordance with the terms of said contract.

1.5.9 Goods Produced Under Decent Working Conditions: It is the policy of the City not to purchase, lease, or rent goods for use or for resale at City owned enterprises that were produced under sweatshop conditions. The Offeror certifies, by submittal of its Proposal in response to this solicitation, that the goods offered to the City were produced under decent working conditions. The City defines “under decent working conditions” as production in a factory in which child labor and forced labor are not employed; in which adequate wages and benefits are paid to workers;

in which workers are not required to work more than 48 hours per week (or less if a shorter workweek applies); in which employees are free from physical, sexual or verbal harassment; and in which employees can speak freely about working conditions and can participate in and form unions. [Council Bill No. M-8, Enactment No. 9-1998]

1.5.10 Graffiti Free: When required, the Contractor will be required to furnish equipment, facilities, or other items required to complete these services, that are graffiti-free. Failure of Contractor to comply with this requirement may result in cancellation of the contract resulting from this RFP.

1.6 City Contact: The sole point of contact for this RFP is the City of Albuquerque Purchasing Division. Questions regarding this RFP should be directed to the following Purchasing representative unless otherwise specified in the solicitation. The City Contact will communicate with Offerors through its e-procurement system, Bonfire. Offerors will receive e-mail notifications from Bonfire to the e-mail that Offeror included in its Bonfire registration. Offerors are responsible for monitoring any communications sent through Bonfire and responding to any requests for information or directives within stated deadlines. Offerors who fail to abide by this instruction may be deemed nonresponsive.

• Isaiah Davila, Senior Buyer, Department of Finance and Administrative Services, Purchasing Division

• Phone: (505) 768-3319 or E-Mail: idavila@cabq.gov

• Post Office Box 1293, Albuquerque, New Mexico 87103

1.7 Contract Management: The contract resulting from this RFP will be managed by the Department of Finance and Administrative Services, Risk Division.

1.8 Clarification: Any explanation desired by an Offeror regarding the meaning or interpretation of this RFP must be requested in writing not less than ten (10) working days prior to the deadline for the receipt of Proposals to allow sufficient time for a reply to reach all Offerors before the submission of their Proposals. No extension of time will be granted based on submission of inquiries subsequent to the required date nor will such inquiries be answered. All inquiries must be directed to the Purchasing Division as stated herein and must be submitted through the City’s eProcurement system Bonfire. The City will not respond to questions that are submitted by any other means than electronically through the City’s eProcurement system. Oral explanations or instructions given before the award of the contract or at any time will not be binding. Purchasing shall prepare answers to questions in the form of Addenda to this RFP and shall post all such Addenda to the online eProcurement System.

1. 9 Submission of P r o po s a l s . The Offeror’s Proposal must be submitted electronically through the eProcurement system pursuant to the following requirements:

1.9.1 Electronic Copy. Submit your complete Proposal including all forms, attachments, exhibits, Technical Proposal, Cost Proposal, etc. using the eProcurement System at https://cabq.bonfirehub.com/portal/?tab=openOpportunities. Please allow a minimum of two (2) business days to submit your proposal. If you do not have a username and password, please register as this is the only method to submit electronically on the Bonfire portal. Please make sure to register on the system in order to receive notices and submit a response to a solicitation. For assistance, please contact support@gobonfire.com or 1-800-354-8010. Failure to submit your proposal electronically through the City’s eProcurement system shall result in your proposal being deemed nonresponsive.

1.9.2 Format. Each file uploaded to the eProcurement System shall be in single PDF format unless otherwise indicated. The City’s preferred format is Optical Character Recognition (OCR) searchable PDF format. Do not encrypt files and do not password protect the documents submitted.

1.9.3 ALL PROPOSALS MUST BE RECEIVED BY THE CITY PURCHASING

DIVISION AS SPECIFIED HEREIN. IF YOU FAIL TO COMPLY WITH THE SUBMISSION

REQUIREMENTS IN THIS SECTION 1.9, THE CITY SHALL DEEM YOUR PROPOSAL

NONRESPONSIVE.

mailto:idavila@cabq.gov https://cabq.bonfirehub.com/portal/?tab=openOpportunities http://www.cabq.gov/vendor/email-notification mailto:support@gobonfire.com

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1.9.4 No other methods of Proposal delivery. Neither telephone, facsimile, nor telegraphic Proposals shall be accepted.

1.9.5 Modification. Proposals may be modified or withdrawn only by written notice, provided such notice is received prior to the Proposal Due Date.

1.9.6 Receipt of Proposals. The only acceptable evidence to establish the time of receipt of Proposals by City Purchasing Office is the time-date stamp of the eProcurement System.

1.9.7 Acknowledgment of Addenda to the Request for Proposals. Receipt of Addenda to this RFP by an Offeror must be acknowledged in the City’s eProcurement system. Failure to acknowledge an Addendum may result in your response being deemed non-responsive.

1.10 Modifications to Scope of Services: In the event that sufficient funds do not become available to complete each task in the Scope of Services, the Scope of Services may be amended, based upon the cost breakdown required in the Cost Proposal.

1.11 Required Contract Terms: The Required Contract Terms can be accessed at this link https://www.cabq.gov/dfa/purchasing-division/vendor-services/terms-and-conditions, click on “Request for Proposals Required Contract Terms”. The Offeror certifies that it accepts the Required Contract Terms, or has uploaded its exceptions to the Required Contract Terms in the City’s e-Procurement system, under “Requested Information” “Exceptions to Section 1.11 Required Contract Terms.” Any exceptions shall be identified by the RFP Section, Subsection, and must state the specific exception the Offeror has, as well as any alternative language. The City’s receipt of exceptions in a response is not an acceptance of any requested changes to the Required Contract Terms. The Required Contact Terms may differ from the terms in the final contract awarded under this RFP.

1.12 Draft Agreement: A copy of the Draft Agreement to be entered into is included in the RFP. The Offeror certifies that it accepts the terms and conditions of the Draft Agreement, or has noted exceptions in its response. The City’s receipt of exceptions in a response is not an acceptance of any requested changes to the Draft Agreement. The Draft Agreement may differ from the final Agreement.

1.13 Contract Term: The contract resulting from this solicitation is anticipated to have a term of three (3) years with two (2) possible extensions of one (1) year. Contract term shall not exceed five (5) years.

1.14 Evaluation Period: The City reserves the right to analyze, examine and interpret any Proposal for a period of ninety (90) days after the hour and date specified for the receipt of Proposals. The City reserves the right to extend the evaluation period if it feels, in its sole discretion, such an extension would be in the best interest of the City.

1.15 Evaluation Assistance: The City, in evaluating Proposals, reserves the right to use any assistance deemed advisable, including City contractors and consultants.

https://www.cabq.gov/dfa/purchasing-division/vendor-services/terms-and-conditions

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1.16 Rejection and Waiver: The City reserves the right to reject any or all Proposals and to waive informalities and minor irregularities in Proposals received.

1.17 Award of Contract:

1.17.1 When Award Occurs: Award of contract occurs when a Purchase Order is issued or other evidence of acceptance by the City is provided to the Offeror. A Recommendation of Award does not constitute award of contract.

1.17.2 Award: If a contract is awarded, it shall be awarded to the responsive and responsible Offeror whose Proposal conforming to this RFP will be most advantageous to the City as set forth in the Evaluation Criteria.

1.18 Cancellation: This RFP may be canceled for any reasons and any and all Proposals may be rejected in whole or in part when it is in the best interests of the City.

1.19 Negotiations: Negotiations may be conducted with the Offeror(s) recommended for award of contract.

1.20 City-Furnished Property: No material, labor, or facilities will be furnished by the City unless otherwise provided for in this RFP.

1.21 Public Records:

1.20.1 The Purchasing Division’s procurement file and any documents relating to this RFP, including the Proposals submitted by Offerors, shall be open to public inspection in accordance with applicable law after the recommendation of award of a contract has been approved by the Mayor or the Mayor’s designee.

1.20.2 An Offeror who chooses to submit material they consider a “Trade Secret” must do so in a segregated file clearly designated as containing trade secrets both in the file name and within the contents of the file itself. These segregated files are to be used by the City for reference only. An Offeror’s failure to segregate such materials constitutes a failure to reasonably, under the circumstances, maintain the materials’ secrecy and Offeror indemnifies and holds the City harmless for any and all liability resulting from the disclosure of any materials not segregated as described above.

1.20.3 If an Offeror submits with a proposal material required by law to be kept confidential, the Offeror must segregate such material in a separate file. Such a file should be clearly designated as “Legally Confidential” in both the file name and within the contents of the file. The contents of the file must include a description and citation to the legal basis for why the material must be kept confidential. Failure to segregate the material and describe the legal basis for why it is to be kept confidential may result in the information being disclosed. Designating the entire proposal confidential is not acceptable without providing the legal basis and may result in the information being disclosed. Offeror indemnifies and holds the City

11 RFP-2025-744-DFA-ID, “Workers’ Compensation Cost Containment Service – Pharmacy Benefit Management” harmless for any and all liability resulting from such disclosure resulting from information not segregated as described above.

1.20.4 Pricing, makes and models or catalog numbers of items offered, delivery terms, and terms of payment shall not be designated as trade secrets or required to be kept confidential by law.

1.20.5 The City will endeavor to restrict the release of material segregated and designated as “Trade Secret” or “Legally Confidential to only those individuals involved in the review and analysis of the Proposals, and to any other party as required by law or court order. Under the New Mexico Inspection of Public Records Act (Sections 14-2-1 et seq, NMSA 1978) (“Act”) the City may redact trade secrets and other material required to be kept confidential by law, but may not redact proprietary or confidential information. Any Proprietary or Confidential Data provided as part of a Proposal is subject to public inspection under the Act.

Notwithstanding any provision of this RFP, the City shall not be responsible or liable to the Offeror for any disclosure of records required by the Act or an order of a court or other tribunal with jurisdiction over the City.

1.21 Procurement Preferences: A Pay Equity Preference as provided in Section 5-5-31 R.O.A. 1994 (as amended by C/S O-17-33) and the State Preferences as provided in 13-1- 21 NMSA 1978 are applicable to this solicitation. To request the application of a preference, as applicable, Offeror shall submit with its Proposal a City Pay Equity Preference Form or the New Mexico State Certification for the requested preference.

1.22 Request for Proposals Protest Process:

1.22.1 RFP Documents: If the protest concerns the specifications for the RFP or other matters pertaining to the solicitation documents, the protest must be filed with the Chief Procurement Officer no later than 5:00 p.m., ten (10) business days prior to the deadline for the receipt of Proposals.

1.22.2 Recommendation of Award: If the protest concerns the Recommendation of Award, the protest must be filed with the Chief Procurement Officer no later than 5:00 p.m. of the tenth (10th) business day after the receipt of notice of the Recommendation of Award.

1.22.3 Timely Protests: Protests must be received by the Chief Procurement Officer prior to the appropriate deadline as set out herein, or they will be rejected.

The Chief Procurement Officer may waive the deadline for good cause, including a delay caused by the fault of the City. Late delivery by the U.S. Postal Service or other carrier shall not be considered good cause.

1.22.4 How to File a Protest: Any Offeror who is aggrieved in connection with a competitive solicitation or recommendation of award of a contract may protest to the City Chief Procurement Officer. The protest shall be addressed to the Chief

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Procurement Officer, must be submitted in written form and must be legible.

Protests may be electronically delivered via email or mailed. Facsimile, telephonic, telegraphic or any other type of electronic protests will not be accepted.

1.22.5 Required Information: The protest shall contain at a minimum the following:

1.22.5.1 The name and address of the protesting party;

1.22.5.2 The number of the competitive solicitation;

1.22.5.3 A clear statement of the reason(s) for the protest detailing the provisions believed to have been violated;

1.22.5.4 Details concerning the facts, which support the protest;

1.22.5.5 Attachments of any written evidence available to substantiate the claims of the protest; and

1.22.5.6 A statement specifying the ruling requested.

1.22.6 Delivery of Protests:

1.22.6.1 By Mail: Protests may be mailed in an envelope marked “PROTEST” with the solicitation number. Protests which are mailed should be addressed as follows:

Chief Procurement Officer City of Albuquerque, Purchasing Division P.O. Box 1293 Albuquerque, NM 87103 PROTEST, RFP Number

1.22.6.2 By Electronic Mail: Protests may be emailed to:

Kathleen Oney, Chief Procurement Officer koney@cabq.gov

The message should clearly indicate “PROTEST” and the RFP number in the subject line.

1.22.7 Protest Response by Chief Procurement Officer: The Chief Procurement Officer will, after evaluation of a protest, issue a response. Only the issues outlined in the written protest will be considered by the Chief Procurement Officer.

1.22.8 Protest Hearing: If a hearing is requested, the request must be included in the protest and received within the time limit. Only the issues outlined in the protest will be considered by the Chief Procurement Officer, or may be raised at a protest hearing. The granting of a hearing shall be at the discretion of the Chief Procurement Officer following review of the request.

mailto:koney@cabq.gov

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1.23 Insurance:

1.23.1 General Conditions: The City will require the successful Offeror, referred to as the Contractor, to procure and maintain at its expense during the term of the contract resulting from the RFP, insurance in the kinds and amounts hereinafter provided with insurance companies authorized to do business in the State of New Mexico, covering all operations of the Contractor under the contract. Upon execution of the contract and on the renewal of all coverages, the Contractor shall furnish to the City a certificate or certificates in form satisfactory to the City as well as the rider or endorsement showing that it has complied with these insurance requirements. All certificates of insurance shall provide that thirty (30) days written notice be given to the Risk Manager, Department of Finance and Administrative Services, City of Albuquerque, P.O. Box 470, Albuquerque, New Mexico, 87103, before a policy is canceled, materially changed, or not renewed. Various types of required insurance may be written in one or more policies. With respect to all coverages required other than professional liability or workers’ compensation, the City shall be named an additional insured. All coverages afforded shall be primary with respect to operations provided.

1.23.2 Approval of Insurance: Even though the Contractor may have been given notice to proceed, it shall not begin any work under the contract resulting from this RFP until the required insurance has been obtained and the proper certificates (or policies) are filed with the City. Neither approval nor failure to disapprove certificates, policies, or the insurance by the City shall relieve the Contractor of full responsibility to maintain the required insurance in full force and effect. If part of the contract is sublet, the Contractor shall include any or all subcontractors in its insurance policies, or require the subcontractor to secure insurance to protect itself against all hazards enumerated herein, which are not covered by the Contractor's insurance policies.

1.23.3 Coverage Required: The kinds and amounts of insurance required are as follows:

1.23.3.1 Cyber Liability Errors & Omissions/Professional Liability:

Separate or combined coverage for (1) Cyber liability insurance, including but not limited to liability arising out of or associated with Internet activities and the use or operation of computers and computer networks, and (2) errors and omissions/professional liability insurance. The combined limits of liability for the policy or policies shall be not less than $1,000,000.

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1.23.3.2 Commercial General Liability Insurance. A commercial general liability insurance policy with combined limits of liability for bodily injury or property damage as follows:

$2,000,000 Per Occurrence

$2,000,000 Policy Aggregate

$1,000,000 Products Liability/Completed Operations $1,000,000 $5,000

Personal and Advertising Injury Medical Payments

Said policy of insurance must include coverage for all operations performed for the City by the Contractor and contractual liability coverage shall specifically insure the hold harmless provisions of the contract resulting from this RFP.

1.23.3.3 Workers' Compensation Insurance. Workers' compensation insurance policy for the Contractor's employees, in accordance with the provisions of the Workers' Compensation Act of the State of New Mexico, (the "Act"). If the Contractor employs fewer than three employees and has determined that it is not subject to the Act, it will certify, in a signed statement, that it is not subject to the Act. The Contractor will notify the City and comply with the Act should it employ three or more persons during the term of the contract resulting from this RFP.

1.23.3.4 Increased Limits: During the life of the contract the City may require the Contractor to increase the maximum limits of any insurance required herein. In the event that the Contractor is so required to increase the limits of such insurance, an appropriate adjustment in the contract amount will be made.

1.23.3.5 Additional Insurance: The City may, as a condition of award of a contract, require a successful Offeror to carry additional types of insurance.

The type and limit of additional insurance is dependent upon the type of services provided via the contract by the successful Offeror.

1.24 Pay Equity Documentation. All Proposals shall include a Pay Equity Reporting Form that can be accessed at https://www.cabq.gov/gender-pay-equity-initiative. Offerors who believe they are exempt because they are an out-of-state contractor (meaning that you have no facilities and no employees working in New Mexico) are not required to report data, but must still submit a Pay Equity Reporting Form with the box verifying the exempt status checked. Any Proposal that does not include a Pay Equity Reporting Form https://www.cabq.gov/gender-pay-equity-initiative

15 RFP-2025-744-DFA-ID, “Workers’ Compensation Cost Containment Service – Pharmacy Benefit Management” shall be deemed nonresponsive, as stated in the Public Purchases Ordinance, 5-5-

31. A Pay Equity Reporting Form will be automatically issued within two (2) business days of completing your information at the link above. To ensure you have your form before the deadline for solicitation close, please access the link at least three (3) business days prior to the solicitation deadline. Please contact the “City Contact” identified above in Section

1.6 with any questions about the Pay Equity Reporting Form.

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PART 2

PROPOSAL FORMAT

A “Proposal” consists of two distinct sections—a “Technical Proposal” and a “Cost Proposal”—that are submitted separately in Bonfire. Failure to submit the Technical Proposal and Cost proposal separate, shall result in the City deeming your submission non-responsive.

2.1 Technical Proposal Format, Section One

2.1.1 Offeror Identification: State name and address of your organization or office and nature of organization (individual, partnership or corporation, private or public, profit or non-profit). Subcontractors, if any, must be identified in a similar manner. Include name, email address and telephone number of person(s) in your organization authorized to execute the Draft Agreement. Submit a statement of compliance with all laws stated herein. Submit a statement of compliance with all laws stated herein. Submit a statement of agreement of the Terms and Conditions of the Draft Agreement; state exceptions.

2.1.2 Executive Summary: Provide a summary highlighting the major features of the proposal. The City should be able to determine the essence of the proposal by reading the executive summary.

2.1.3 Experience: Please provide detailed responses to the following items regarding your organization’s experience in Pharmacy Benefit Management (PBM):

2.1.3.1 PBM Experience Overview: Describe your organization experience in providing PBM services. Specifically, indicate how long your organization has delivered PBM services to Workers’ Compensation carriers and/or self-insureds entities.

2.1.3.2 Network Composition: State the total number of pharmacies included in your network. Identify whether any major pharmacy chains in the Albuquerque, NM area are excluded from your network.

2.1.3.3 Competitive Differentiation: Explain what distinguishes your organization from your competitors focusing on technical capabilities, service delivery and any unique features or innovation that provide added value.

2.1.3.4 Current References: Provide at least five (5) current references;

include entity name, contact person and contact information (phone and/or email).

2.1.3.5 Past Experience: Describe a minimum of three (3) projects of similar scope and size, For each project include: Name of the client or entity, 17 RFP-2025-744-DFA-ID, “Workers’ Compensation Cost Containment Service – Pharmacy Benefit Management” year completed and contact person and contact information. References must be for work performed in the past three to five (3 to 5) years.

2.1.3.6 Municipal/Government Experience: Detail your organization’s relevant experience with municipalities or other government entities.

2.1.4 Management Structure: Provide an overview of your organizational structure and management team. Describe the key staff members that will be assigned to the City account including educations, training, experience and where they are located (include resumes to demonstrate their ability and experience).

2.1.5 Response: A point-by-point response, in the order listed, to each requirement under Part 3 Scope of Services. Demonstrate how the Offeror intends to provide excellent customer service to the City. The response shall include a detailed transition plan, including a timeline for transition.

2.1.6 Summary: A complete narrative of the scope of services to be performed including the ability, approach and resources needed to fulfill the City’s performance expectations.

2.2 Cost Proposal Format, Section Two

2.2.1 Total Cost: Submit the required Cost Proposal (Appendix A) separately from your Technical Proposal (upload Appendix A in the City’s eProcurement system).

Failure to submit your cost separately from your Technical Proposal shall result in your proposal being deemed non-responsive.

2.2.2 All Costs: All costs to be incurred and billed to the City should be descried by the Offeror for each item, to allow for a clear evaluation and comparison, relative to other Proposals received. All costs should include any applicable gross receipts taxes. The Offeror should understand that the City will not pay for any amounts not included in the cost Proposal –for example, insurance or taxes – and that liability for items not included remains with the Offeror.

2.2.3 Response Format: The Offeror shall submit Appendix A in the exact format provided. The Offeror shall complete all charts using Medi-Span, a nationally recognized Average Wholesale Price (AWP) publications for prescriptions. Pricing data shall reflect AWP values as of October 1, 2025. The Offeror shall clearly indicate its proposed discount off AWP for each listed item. The Offeror’s response to this section will be used in performing a cost/price analysis. The Offeror may also submit its discounted price for a second AWP publication. If Offeror uses a different publication that results in better cost savings Offeror shall provide the name of the publication were indicated on Appendix A.

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PART 3

SCOPE OF SERVICES

3.1 Pharmacy Benefit Management (PBM) Services:

The City is soliciting Proposals from qualified Offerors to provide Pharmacy Benefit Management (PBM) Services specifically for Workers’ Compensation claims. The successful Offeror shall deliver a comprehensive PBM solution that includes:

• A robust national pharmacy network ensuring injured employees have access to prescription services 24/7.

• Efficient processing and adjudication of pharmacy charges.

• Implementation of a drug utilization review program.

• Reduction of annual pharmacy costs beyond the New Mexico Workers’

Compensation Fee Schedule.

• Streamlined administrative processes to reduce time and effort for City staff.

3.1.1 Pharmacy Bill Reduction: The successful Offeror shall receive, review, reduce, and pay pharmacy bills in accordance with the New Mexico Fee Schedule and Rules, or contracted pharmacy rates—whichever provides the greatest cost savings to the City.

Offerors must respond to the following:

A. Generic vs. Brand Name Drug Dispensing Policy:

1. Describe your company’s policy regarding the dispensing of generic versus brand name medications.

2. Do you utilize a step therapy protocol to encourage the use of generics before brand name drugs? If so, please explain your approach.

3. Do you offer an e-prescribing platform that enables medical providers to access the injured employee’s formulary and medication history at the point of care?

4. Do you provide a pharmacy mail service option for injured employees?

B. Pricing Compliance: Detail the measures your organization takes to ensure prescription pricing remains within or below the New Mexico Fee Schedule.

C. Paper Bill Processing: Explain your process for handling paper bills submitted by pharmacies or third-party billers.

D. Out-of-Network Capture: Describe your methodology for identifying and managing prescriptions filled outside of your pharmacy network.

E. Compound Medications: Outline your approach to reviewing, approving, and pricing compound medications.

3.1.2 Specialty Drugs: The City of Albuquerque seeks the most competitive pricing available for specialty pharmaceuticals related to cancer treatment, HIV prophylaxis, and Hepatitis C. This requirement stems from statutory obligations to provide coverage for

19 RFP-2025-744-DFA-ID, “Workers’ Compensation Cost Containment Service – Pharmacy Benefit Management” cancer and blood-borne pathogen claims for its firefighters and police officers.

A. Price Negotiation Commitment: Will the Offeror negotiate directly with manufacturers or wholesalers to secure pricing for cancer-related medications at or below the Manufacturer’s List Price or Wholesale Acquisition Cost (WAC), inclusive of all applicable discounts, rebates, or other cost-reduction mechanisms?

B. Billing Methodology: Will the Offeror utilize Actual Acquisition Cost (AAC) billing when it results in a lower cost to the City than the New Mexico Workers’ Compensation Fee Schedule?

C. Cost-Saving Innovations: Offeror shall propose innovative cost-containment strategies that benefit the City, including but not limited to:

• Rebate optimization programs

• Outcomes-based pricing models

• Patient assistance programs

• Specialty drug carve-outs or alternative funding solutions

3.1.3 Custom Formulary: A custom pharmacy formulary shall be developed in collaboration with the City’s Employee Health Center Medical Director and the City’s Workers’ Compensation Coordinator to address the specific clinical and therapeutic needs of the City’s injured employees.

A. Formulary Development Process: Describe in detail the process your organization uses to develop a custom formulary tailored to a client’s unique needs. Include:

• The roles and responsibilities of clinical staff, pharmacists, and client representatives.

• How input from the City’s Medical Director and Workers’ Compensation Coordinator will be incorporated.

• The timeline and methodology for initial formulary creation.

• Any tools or systems used to support formulary design and customization.

B. Formulary Review and Adjustment Intervals: Indicate whether your organization follows set intervals for reviewing and updating the formulary. If so, specify:

• The frequency of reviews (e.g., quarterly, biannually).

• The criteria used to determine necessary changes.

• How stakeholders are notified and involved in the review process.

C. Individualized Formulary Adjustments: Confirm whether the formulary can be modified to accommodate the specific medical needs of individual injured employees. If so, describe:

• The process for requesting and approving such adjustments.

• The role of the prescribing physician and the City’s clinical team.

• Any limitations or exclusions that may apply.

D. Electronic Adjustment Capabilities: Explain whether the City’s Workers’ Compensation team will have the ability to make formulary adjustments electronically.

Include:

• The platform or system used to manage formulary changes.

• User access levels and security protocols.

• Reporting and audit capabilities related to electronic adjustments.

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3.1.4 Authorization & First Fill: The successful Offeror shall provide the City with access to a secure, web-based system designed to support City staff in managing pharmacy claims efficiently. The system must include real-time claim tracking, authorization workflows, reporting capabilities, and user-friendly interfaces for both staff and injured employees.

A. Adjuster Authorization Timeframe:

• Please specify the standard timeframe (in hours or business days) required to obtain adjuster authorization for prescription fills.

• Include any expedited processes available for urgent cases.

B. Communication with Injured Employee:

• Described how and when initial contact is made with injured employee following claim initiation.

• Detail the communication channels used (e.g., phone, email, SMS, mail).

• Written Information: Confirm whether written materials outlining PBM services are provided to injured employees. Include sample documents or describe the format and delivery method.

C. Card Issuance Program:

• Outline your process for issuing pharmacy benefit cards to injured employees.

• Include details on:

o Timing of card issuance (e.g., upon claim initiation, post-authorization).

o Card format (physical, digital, or both).

o Activation procedures and instructions provided to employees.

D. Risk Assumption for Unauthorized Prescriptions:

• Clarify whether the Offeror assumes any financial or operation risk for prescriptions filled without prior authorization.

• If applicable, describe safeguards in place to minimize unauthorized fills and how disputes or reversals are handled.

3.1.5 Drug Utilization Review (DUR) Program: The successful Offeror shall maintain a comprehensive Drug Utilization Review (DUR) program designed to promote safe, effective, and cost-efficient medication use. The Offeror must describe their DUR program in detail, including the following components:

A. Clinical Support Services: Please describe the clinical support services available through your DUR program, including but not limited to:

• Access to licensed pharmacists and clinical staff for consultation

• Real-time clinical decision support tools

• Integration with prescriber and provider networks

• Therapeutic interchange programs

• Medication therapy management (MTM) services

B. DUR Program Capabilities: Explain how your DUR program addresses the following:

1. Medication Appropriateness

• Describe how your system evaluates the appropriateness of prescribed medications based on injury type, dosage, and duration of therapy.

21 RFP-2025-744-DFA-ID, “Workers’ Compensation Cost Containment Service – Pharmacy Benefit Management”

• Include protocols for identifying off-label use, excessive dosing, or extended therapy durations beyond clinical guidelines.

2. Medication Comparison and Contraindication Review

• Outline your process for comparing medications dispensed to an individual to prevent therapeutic duplication, adverse drug interactions, and contraindications.

• Detail the use of automated alerts, pharmacist review, and prescriber outreach.

3. Generic Substitution Evaluation

• Explain your process for evaluating and recommending generic alternatives to brand-name drugs.

• Include cost-benefit analysis, therapeutic equivalency checks, and prescriber notification protocols.

4. Misuse, Abuse, and Fraud Detection

• Detail the mechanisms in place to detect patterns of misuse, abuse, or fraudulent activity.

• Include analytics, behavioral flags, and coordination with regulatory or law enforcement agencies when necessary.

5. Opioid Monitoring and Alerts

• Describe specialized alerts or flags that notify adjusters and physicians of opioid prescriptions.

• Include criteria for triggering alerts (e.g., high dosage, long duration, multiple prescribers) and any support offered for opioid risk mitigation strategies.

C. Physician Intervention Letters: The Offeror shall:

• Generate and distribute physician intervention letters addressing:

o Excessive duration of medication use beyond clinical guidelines.

o Concurrent prescribing of narcotics and sedatives.

o Use of multiple sedative medications.

• Include clinical rationale and evidence-based recommendations in each letter.

• Track and report physician response rates and subsequent prescribing changes.

D. Drug Usage Data: The Offeror shall:

• Provide detailed drug utilization data at both the individual member level and across defined sub-groups (e.g., age, condition, geographic region).

• Support custom segmentation and trend analysis upon request.

• Ensure data is accessible in formats compatible with internal analytics platforms.

E. Electronic Reporting: The Offeror shall:

• Offer secure, web-based access to all standard and custom reports.

• Ensure real-time or near-real-time data availability.

• Include dashboards for monitoring key performance indicators (KPIs), utilization trends, and cost metrics.

F. Utilization Monitoring and Management: The Offeror shall:

• Describe its process for identifying and managing over- and under-utilization of medications.

• Include criteria used for flagging utilization concerns (e.g., dosage thresholds, refill patterns, therapeutic duplication).

• Detail intervention strategies, including member outreach, prescriber engagement, 22 RFP-2025-744-DFA-ID, “Workers’ Compensation Cost Containment Service – Pharmacy Benefit Management” and clinical case review.

• Provide examples of successful utilization management programs and outcomes.

G. Drug Utilization Review (DUR) Reporting: The Offeror shall:

• Indicate the frequency of DUR reporting (e.g., monthly, quarterly).

• Detail the scope of standard DUR reports, including:

o High-risk medication combinations.

o Non-adherence patterns.

o Prescribing trends by therapeutic class.

3.1.6 Data System Requirements: The Successful Offeror shall maintain a robust and secure data system capable of receiving, processing, and managing claim data to support injured employee eligibility verification, pharmacy billing, utilization reporting, and invoicing.

The system must meet the following minimum requirements:

A. System Integration: Offeror shall demonstrate the ability to interface seamlessly with the City’s workers’ compensation claims management system, Origami Risk, at no additional cost to the City. Integration must support real-time data exchange and ensure system compatibility.

B. Daily Claims Loading: Offeror shall implement a method to load claims into its system on a daily basis to ensure timely prescription fulfillment for injured employees. The process must support automated updates and minimize delays in pharmacy access.

C. Electronic Data Transfer: Offeror shall ensure that pharmacy invoice and claim data— including but not limited to claim details, payment information, and pharmacy invoice images—are electronically transferred to and from the City’s claims management system.

Data exchange must be secure, auditable, and compliant with applicable privacy regulations.

D. Pharmacy Billing Management: Offeror shall receive electronic billing from participating pharmacies and maintain the capability to identify and track duplicate billing, service dates, original bill amounts, and recommended reductions. The system must support automated flagging and reconciliation of discrepancies.

E. Payment Transfer File: Offeror shall provide the City with a comprehensive payment transfer file that includes the following data elements for each pharmacy bill:

• Claim number

• Claimant name

• Date prescription was filled

• Prescribing provider’s name

• Medication name, dosage, and quantity

• Invoice charges

• Reductions applied

• Final allowance amount

The City shall generate payment based on the individual claim file as presented in the payment transfer file.

F. Invoicing and Reimbursement Process: Offeror shall describe its invoicing methodology and cycle, including timelines for invoice generation, submission, and reconciliation. Additionally, Offeror shall outline the process for reimbursing pharmacies, including payment timelines, dispute resolution procedures, and audit capabilities.

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3.1.7 Data System and Reporting Requirements: The successful Offeror shall:

• Maintain a robust data system capable of implementing and monitoring cost containment strategies and utilization review protocols to ensure optimal management of pharmacy benefits.

• Provide the City with on-demand access to ad hoc reporting tools that allow for customizable data queries and real-time analytics.

• Deliver comprehensive reports on a monthly, quarterly, and annual basis.

These reports must include:

o Detailed activity by claim o Medication dispense history o Medical fee schedule adherence o Pharmacy Benefit Management network savings

3.1.8 Security and Compliance Requirements: The proposal must include:

• A description of security measures and data backup systems, including how these systems meet or exceed all applicable Federal regulations.

• Confirmation that all services and systems proposed are fully compliant with the Health Insurance Portability and Accountability Act (HIPAA), ensuring the confidentiality, integrity, and availability of protected health information (PHI).

3.1.9 Customer Service Line Requirements: The successful Offeror must maintain and operate a customer service line. Please provide detailed responses addressing the following:

A. Service Operation and Accessibility: Explain the functionality of the customer service line, including who can access it, the hours of operation, and the types of information or assistance available.

B. Handling of Rejected or Denied Transactions: Describe the process for managing transactions that are rejected or denied, including…