122436 O5 - PBM Evaluation Criteria.docx

DOCX document 24 KB Posted

Attached to
Administrative Support Services for the State of Nebraska Employee Health Care Prescription Drug Benefit Plans
Solicitation number
122436 O5
Issued by
Blaine County, Nebraska

About this file

The document is an evaluation criteria file for Solicitation Number 122436 O5, issued by the State of Nebraska for Administrative Support Services for Employee Health Care Prescription Drug Benefit Plans. The solicitation seeks a Pharmacy Benefit Manager (PBM) to provide comprehensive administrative services for the state's employee health plans, covering approximately 13,600 enrolled members including active employees, pre-65 retirees, COBRA participants, and dependents. The proposal responses are due by July 18, 2025, at 2:00 p.m. Central Time, with an anticipated contract award in October 2025. The initial contract term will run through June 30, 2029, with options to renew for two additional one-year periods, and the benefit plan year commencing on July 1, 2026.

The evaluation criteria include a comprehensive scoring system with 100 base points (25 for Corporate Overview, 55 for Technical Response, and 20 for Cost), with potential additional 20 points for vendor demonstrations. The cost evaluation will be based on a formula comparing submitted costs, with the lowest realistic cost receiving maximum points. The solicitation requires vendors to have at least five years of self-funded group experience, be licensed in all 50 states, and currently serve a public sector group health plan with a minimum of 15,000 lives. Key requirements include a Business Associate Agreement for HIPAA compliance, performance guarantees with potential financial penalties, and a detailed proposal covering claims adjudication, member enrollment, formulary management, clinical management, pharmacy network management, and member services. The state expects transparent pricing, minimum AWP discounts, and comprehensive rebate guarantees, with administrative service fees to be paid only after the benefit plan year begins.

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Other files

File Type Posted
Intent to Award.pdf PDF
122436 O5 - Optum Response.pdf PDF
122436 O5 - Attachment A - Intent to Propose.docx DOCX document
122436 O5 - Addendum One- Questions & Answers and Updated Attachment C.docx DOCX document
122436 O5 - BCBS Response_.pdf PDF
122436 O5 - BCBS Response.pdf PDF
PBM 122436 O5- Addendum Two- Questions and Answers- Round Two V2.pdf PDF
122436 O5 Prescription Drug Benefits Plan RFP.pdf PDF
122436 O5 - PBM Evaluation Criteria.docx DOCX document
122436 O5 - Rightway Response.pdf PDF
122436 O5 - Attachment C1 - Confirmations & Questionnaire.xlsx XLSX spreadsheet
122436 O5 Prescription Drug Benefits Plan RFP.docx DOCX document
122436 O5 - Cost Sheet.xlsx XLSX spreadsheet
FinalEvaluationDocument.pdf PDF
122436 O5 UnitedHealthcare Response.pdf PDF
122436 O5 - Attachment D - Performance Guarantees.xlsx XLSX spreadsheet
122436 O5 - Attachment B - Business Associate Agreement.doc DOC document
122436 O5 Solicitation List of Respondents.pdf PDF
122436 O5 - MedImpact Response.pdf PDF
122436 O5 Prescription Drug Benefits Plan RFP.docx DOCX document
122436 O5 - Attachment D - Performance Guarantees.xlsx XLSX spreadsheet
122436 O5 - Attachment C1 - Confirmations & Questionnaire.xlsx XLSX spreadsheet
122436 O5 - Attachment B - Business Associate Agreement.doc DOC document
122436 O5 - Attachment A - Intent to Propose.docx DOCX document
122436 O5 - Cost Sheet.xlsx XLSX spreadsheet
122436 O5 - Addendum One- Questions & Answers and Updated Attachment C.docx DOCX document
122436 O5 Solicitation List of Respondents.pdf PDF
122436 O5 Prescription Drug Benefits Plan RFP.pdf PDF
PBM 122436 O5- Addendum Two- Questions and Answers- Round Two V2.pdf PDF
122436 O5 - PBM Evaluation Criteria.docx DOCX document
122436 O5 - Cost Sheet.xlsx XLSX spreadsheet
122436 O5 - Attachment A - Intent to Propose.docx DOCX document
122436 O5 - Addendum One- Questions & Answers and Updated Attachment C.docx DOCX document
122436 O5 - Attachment B - Business Associate Agreement.doc DOC document
122436 O5 - Attachment D - Performance Guarantees.xlsx XLSX spreadsheet
122436 O5 Prescription Drug Benefits Plan RFP.pdf PDF
122436 O5 - Attachment C1 - Confirmations & Questionnaire.xlsx XLSX spreadsheet
122436 O5 Prescription Drug Benefits Plan RFP.docx DOCX document
PBM 122436 O5- Addendum Two- Questions and Answers- Round Two V2.pdf PDF
122436 O5 - Attachment B - Business Associate Agreement.doc DOC document
122436 O5 - Addendum One- Questions & Answers and Updated Attachment C.docx DOCX document
122436 O5 - Attachment C1 - Confirmations & Questionnaire.xlsx XLSX spreadsheet
122436 O5 - PBM Evaluation Criteria.docx DOCX document
122436 O5 Prescription Drug Benefits Plan RFP.docx DOCX document
122436 O5 - Cost Sheet.xlsx XLSX spreadsheet
122436 O5 - Attachment D - Performance Guarantees.xlsx XLSX spreadsheet
122436 O5 Prescription Drug Benefits Plan RFP.pdf PDF
122436 O5 - Attachment A - Intent to Propose.docx DOCX document
122436 O5 - Attachment A - Intent to Propose.docx DOCX document
122436 O5 Prescription Drug Benefits Plan RFP.pdf PDF
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Text version

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:

Evaluation Criteria
Possible Points
Part 1 Corporate Overview
25
Part 2 Technical Response
55
Part 3 Cost
20
Total Points without Vendor Demonstrations
100
Vendor Demonstrations, (if required)
20
Total Points with Vendor Demonstrations
120

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

File details come from the government source that posted it. Updated .