122436 O5 - PBM Evaluation Criteria.docx

SOLICITATION EVALUATION CRITERIA

SOLICITATION NUMBER: 122436 O5

Administrative Support Services for the State of Nebraska Employee Health Care Prescription Drug Benefit Plans Opening Date: July 18, 2025

Mandatory Requirements The solicitation responses will first be examined to determine if all mandatory requirements listed below have been addressed to warrant further evaluation. Responses not meeting mandatory requirements will be excluded from further evaluation. The mandatory requirement items are as follows:

Contractual Agreement Form signed manually in ink or by DocuSign.

Corporate Overview;

Completed Sections II through IV;

Completed Technical Response, including, but not limited to;

Completed Attachment C – Confirmations & Questionnaire;

Completed Formulary Disruption Analysis as requested in Questionnaire Tab D.3;

Completed Network Disruption Analysis as requested in Questionnaire Tab F.14;

Completed Attachment A - Intent to Propose Form;

Completed Attachment B - Business Associate Agreement;

Completed Attachment D - Performance Guarantee Sheet; and Completed Cost Sheet.

Evaluation Criteria All responses to this solicitation, which fulfill all mandatory requirements, will be evaluated. Each category will have a maximum possible point potential. Areas that will be addressed and scored during the evaluation include:

Part 3 – Cost Cost points should be calculated as follows, accounting for cost realism and reasonableness:

0. Establish lowest realistic cost submitted – lowest cost submitted receives the maximum points.

0. To assign points to all others, the following formula should be followed:

Lowest Cost Submitted Cost Submitted x Maximum Possible Cost Points = Cost Points to Award (see samples below)

Formula

Sample

Sample

Sample

Lowest Cost Submitted

$100,000

$100,000

$100,000

Cost Submitted

$100,000

$200,000

$150,000 x Maximum Possible Cost Points

= Points To Award

20.00

10.00

13.33

122436 O5 Evaluation Criteria