2025_Sharewell_Choice_PPO_Health_Plan_Document.pdf

This is a health plan document for the 2025 Sharewell Choice PPO plan administered by the County of Orange, California in conjunction with a Pharmacy Benefit Management and Claims Administration Program procurement. The document outlines the prescription drug benefits and coverage details for the Sharewell Choice PPO health plan, which serves county employees, non-Medicare retirees, Medicare retirees, and their dependents. The RFP for the pharmacy benefit management services was posted on January 7, 2025, with proposals due on February 13, 2025, and vendor presentations scheduled for March 27, 2025. The selected PBM contractor will enter into a three-year contract with two optional one-year renewal terms, with an anticipated start date of January 1, 2026. The pharmacy benefit management program must coordinate with Blue Shield of California and Alight Solutions to manage claims processing, eligibility, and administrative functions across multiple health plans including Sharewell Choice, Wellwise Choice, Wellwise Medicare Retiree, Wellwise Non-Medicare Retiree, and Sharewell Retiree.

The current pharmacy program is administered through OptumRx in a carve-out arrangement with Blue Shield of California. The selected vendor must demonstrate substantial experience with public sector clients and maintain a broad pharmacy network throughout California, with capabilities to serve both commercial plans and an Employer Group Waiver Plan (EGWP) for Medicare retirees. The RFP does not specify explicit set-aside designations or restrictions on respondent types, though vendors with demonstrated public sector pharmacy benefit management experience are preferred. No specific budget range was disclosed in the available documentation. The comprehensive scope of services includes customer support, claims processing, clinical programs, pharmacy network management, and full compliance with applicable healthcare regulations and requirements.