2025_Sharewell_Retiree_PPO_Health_Plan_Document.pdf

This file is a health plan document for the Sharewell Retiree PPO plan administered by the County of Orange, California, in conjunction with a pharmacy benefit management procurement initiative. The document outlines the prescription drug benefits and coverage details for retirees enrolled in the Sharewell Retiree PPO plan, which is one of the health plans included in the County's RFP for pharmacy benefit management and claims administration services. The plan structure includes comprehensive pharmacy network services, mail-order options, and formulary management coordinated with the medical plan. The RFP was released with proposals due February 13, 2025, and vendor presentations scheduled for March 27, 2025, with an anticipated contract start date of January 1, 2026. The selected PBM will provide services under a three-year initial term with two optional one-year renewal periods.

The Sharewell Retiree PPO plan document specifies prescription drug coverage details including copayments, coinsurance, and deductible structures applicable to plan members. The current pharmacy program is administered by OptumRx in a carve-out arrangement with Blue Shield of California, establishing OptumRx as the incumbent vendor. The selected PBM must coordinate with Blue Shield of California and Alight Solutions for eligibility and claims processing integration. Key requirements include demonstrated experience with public sector clients, a broad California pharmacy network, and capability to manage both commercial plans and an Employer Group Waiver Plan (EGWP) for Medicare retirees. No specific contract budget was disclosed in the available documents, though the comprehensive nature of the engagement covering multiple health plans for county employees and retirees suggests significant potential contract value.