Department of Insurance Request for Proposal Pharmacy Benefit Manager Oversight and Reform Implementation Services

26-446DOI-FINAD-B-50721

Section A. SCOPE OF WORK

A.1. OVERVIEW AND PURPOSE

The Illinois Department of Insurance (Department) is seeking to procure a contract with a qualified firm to provide Pharmacy Benefit Manager (PBM) oversight and reform implementation services, in alignment with the recently passed Prescription Drug Affordability Act (P.A. 104-0027) and confirming changes made in P.A 104-0439. The selected vendor will support the enforcement of new regulatory requirements, including the elimination of spread pricing, prevention of PBM steering practices, facilitation of 100% rebate pass-throughs, development of annual transparency reports, plan audits, market conduct examinations and provide comprehensive PBM management services and ongoing training to Department staff throughout the term of the contract. The Vendor shall develop and deliver training materials, operational guidance, and knowledge transfer support to ensure Department staff are adequately trained on PBM processes, system updates, workflow changes, and related operational functions. Within thirty (30) days of contract execution, the Vendor shall submit a training plan outlining the proposed training approach and schedule. This contract aims to ensure compliance, protect critical access pharmacies, and improve prescription drug affordability and access across The State of Illinois.

The Department anticipates awarding up to three (3) contracts, a primary, secondary, and tertiary. The Department will rank the Responsive and Responsible Offers by points (Section D). The most Responsive and Responsible Offeror, with the highest number of points, may be awarded the primary contract. The secondary and tertiary contracts will be awarded in rank order. The successful awarded vendor(s) shall be required to execute the Vendor Confidential Information Non-Disclosure Agreement following contract award (Referenced in section G).

Individual requests for services will first be sent to the primary Vendor, who has up to five (5) business days to accept or decline requests for services and must be able to provide the work within the time specified in the contract and scope of work when assigned. If the primary Vendor cannot meet the timelines or declines the work, then it will be offered to the next highest-ranking Vendor, who has five (5) business days to accept or decline the work. If neither the primary nor secondary Vendor elects to conduct the work the Department will continue to the tertiary Vendor.

Should multiple requests for service run simultaneously, or overlap in delivery, the Department may request that the Vendor submit an assessment of their ability to complete each request prior to acceptance. These assessments may include, but not be limited to, potential conflicts of interest, availability of staff, anticipated length of work, and volume of work already being performed at the time of request. Based on the information provided within the assessment, the Department reserves the right to request that the Vendor pass on a request for service should they have reasonable concerns about the Vendor’s ability to complete any or all pending requests for service. The successful vendor shall be required to execute the Vendor Confidential Information Non-Disclosure Agreement following contract award. No Vendor shall perform, nor allow any subcontractor to perform, any Pharmacy Benefit Manager (PBM) oversight, monitoring, auditing, analysis, review, or other related services under the resulting Agreement if a conflict of interest or a perceived conflict of interest exists. A conflict of interest or perceived conflict of interest includes, but is not limited to, any financial, business, ownership, advisory, employment, or contractual relationship between the Vendor (or its subcontractors) and any PBM that is the subject of the oversight or review, or any PBM involved in matters related to the assigned work.

Prior to accepting any request to perform designed services, the Vendor must disclose to the Department any actual or potential conflict of interest or perceived conflict of interest. Any conflicts of interest discovered after acceptance of work request shall be promptly reported to the Department. The Department retains the sole discretion to determine whether a conflict of interest or perceived conflict of interest exists and may require the Vendor to remove involved personnel, replace a subcontractor, take any other action necessary to eliminate the conflict, or whether work request will be retracted and offered to the next highest-ranking Vendor. Failure to disclose or remedy such conflicts may result in termination of work request or other remedies available under this Agreement. Services will be requested on an as needed basis. The Department cannot guarantee a specific quantity of work provided to any Vendor.

A.2. DESIRED OUTCOMES OF THIS PROJECT/ENGAGEMENT

The desired outcome of this project/engagement is that the selected Vendor(s) will provide comprehensive support to the Illinois Department of Insurance in the implementation, oversight, and sustained effectiveness of the Prescription Drug Affordability Act (Public Act 104-0027), as well as compliance with all other applicable Illinois and federal laws governing PBMs.

The Department is seeking a Vendor to provide PBM regulatory oversight to ensure compliance with Illinois and Federal law, and the Prescription Drug Affordability Act. It would be the responsibility of the Vendor to evaluate, make reform recommendations, and provide reform implementation support services regarding the oversight and review provided.

Works requests may include general oversight, Attorney Services, Pricing Specialist Services, Prescription Drug Specialist Services, Fraud Auditing Services, Forensic Accounting Services, Data Specialist Services, and Staff Training Services.

PBM regulatory oversight services will include comprehensive Pharmacy Benefit Manager (PBM) regulatory oversight and reform implementation support service in accordance with applicable Illinois and Federal law, including but not limited to the Prescription Drug Affordability Act and all other applicable State and Federal requirements.

This project will include requests for work in many PBM oversight related fields. For the resulting contract(s), subcontracting is allowed. It is the desire of the Department that the Vendor act as the oversight firm and provide Attorney Services, Pricing Specialist Services, Prescription Drug Specialist Services, Fraud Auditing Services, Forensic Accounting Services, Data Specialist Services, and Staff Training Services either executed by employees on staff, or though established subcontractors. Requirements regarding each listed service are contained within the requirements listed in Section F. Please note that for the utilization of subcontractors, each subcontractor must meet the requirements listed. As such, it is recommended that relationships with subcontractors be established prior to submission of proposals.

A.3. SCHEDULE

Estimated Dates:

· Posting/Published :8/18

· Vendor Questions due: 9/01

· Answers posted: 9/08

· Bid Opening –:9/28

· Award to vendor –10/19Contract executed –11/3

A.4. TERM

A.4.1. TERM OF THIS CONTRACT: The contract resulting from this procurement will have an initial term commencing upon the last dated signature of the Parties or upon execution whichever is later and shall continue for a period of Five (5) years from such commencement date. In no event will the total term of the contract, including the initial term, any renewal terms, and any extensions, exceed ten (10) years. Vendor shall not commence billable work in furtherance of the contract prior to final execution of the contract except when permitted pursuant to 30 ILCS 500/20-80.

A.4.2. RENEWAL: Subject to the maximum total term identified above, the State has the option to renew for a total of four (4) years in any one of the following manners:

· One renewal covering the entire renewal allowance: or

· Individual one-year renewals up to and including the entire renewal allowance

A.4.2.1. Pricing for the renewal term(s), or the formula for determining price, is per the Renewal line-item pricing in BidBuy.

A.4.2.2. Any renewal of the resulting contract is subject to the same terms and conditions that apply to the initial term of the contract unless otherwise provided. The State may renew the contract for any or all of the option periods specified, may exercise any of the renewal options early, and may exercise more than one option at a time based on continuing need and favorable market conditions, when in the best interest of the State. The contract may neither renew automatically nor renew solely at the Vendor’s option.

Section B. CURRENT CONDITIONS

B.1. OVERVIEW & BACKGROUND

The Illinois Department of Insurance will be reliant on an external vendor to provide the audits, financial analysis, investigative support, reporting infrastructure, and other deliverables outlined within this solicitation. The Department does not possess the internal forensic accounting, large-scale data analytics capacity, or specialized PBM regulatory expertise necessary to independently conduct comprehensive financial tracing, rebate validation, spread pricing analysis, or market conduct examination.

B.2. VOLUMES & QUANTITIES

The selected Vendor(s) will assist the Department in establishing oversight, compliance and operational processes related to PBM activities, which provide technical assistance and structured training on the Department’s internal capacity and priorities. The workload cannot be precisely guaranteed as the Vendor(s) may be called upon as needed to support complex reviews, merging companies’ issues, or specialized technical tasks.

B.3. AREAS OF CONCERN

The Illinois Department of Insurance is implementing new oversight responsibilities under the Prescription Drug Affordability Act within a complex and rapidly evolving prescription drug marketplace. Th Department is seeking Vendor(s) to provide services such as expertise in PBM oversight, financial tracing, and data analytics. The Department requires Vendor(s) capable of providing technical leadership and transferring knowledge to Department staff.

Section C. PROPOSAL REQUIREMENTS Only Electronic Submissions through BidBuy Offers will be Accepted

C.1. REQUIRED DOCUMENTS TO COMPLETE AND SUBMIT

The Offeror shall submit the listed documents in BidBuy under the Attachments tab in the appropriate “Required Attachments” spaces.

· Vendor Disclosure or IPG Active Registered Vendor Disclosure

· Technical response

· Offer to the State of Illinois

· Commitment to Diversity

· BEP Utilization Plan Blank documents may be found on the Chief Procurement Officer for General Service’s website at https://cpo-general.illinois.gov/solicitation-and-contract-templates.html and on the BidBuy posting under “File Attachments:”. Business Enterprise Program/Veterans Small Business Program Utilization Plan may be downloaded from the Commission on Equity and Inclusion’s website at https://cei.illinois.gov/purchasing-entity-resources/compliance.html.

Failure to submit Vendor Disclosure or IPG Active Registered Vendor Disclosure, as applicable, and the Utilization Plan(s), as applicable, with the Offer submitted in BidBuy shall render the Offer non-responsive.

Offerors are required to submit their response to the State’s solicitation through BidBuy. Any information sent to the State outside of BidBuy, for example by US Mail, FedEx, UPS, e-mail, or hand delivery, will neither be accepted nor considered. Offeror submissions will only be considered if they are received through BidBuy and on or before the time and date indicated as the “Bid Opening Date” on the BidBuy posting. Any required attachments must be submitted via BidBuy.

Price entries on the Items tab will be locked automatically upon submission of the quote. Entering cost, pricing or discount information in the Alternate Description may result in disqualification. If the agency requires pricing to be submitted in an attachment, Offeror shall upload pricing under the “Required Documents” section on the Attachments tab and check the box “Does the attachment contain any pricing, cost or discount information?”. Failure to check this box allows your pricing to be viewed when bids are opened and will result in disqualification of your offer. NOTE: Do not check “Does the attachment contain any pricing, cost or discount information” if the attachment does NOT include pricing, cost, or discount information.

Documents shall be submitted in an electronic format that is accessible and readable using Microsoft Office suite software or Adobe Reader. Corrupted files shall not be considered. It is the Offeror’s responsibility to check that files are accessible and legible after uploading.

The Offeror is solely responsible for ensuring timely submission of their electronic solicitation response. Failure to allow adequate time prior to the Bid Opening Date to complete and submit a response to a solicitation, particularly in the event technical support assistance from the State is required, places the Offeror and their offer or response at risk of not being accepted.

The State encourages the Offeror to ensure that their BidBuy account is up to date. It is recommended that you access your BidBuy account prior to the solicitation due date and time to make sure that your company’s information is up-to-date and your password is current. Files may be uploaded at any time prior to submission.

File size may impact the uploading and downloading speed and may lead to browser time-outs, resulting in failed upload/download attempts. Please consider this dependency when attaching very large documents.

OFFEROR INSTRUCTIONS TO SUBMIT IN BIDBUY

Create Quote:

Note: any pricing entered in the Unit Cost of the Items Tab will be locked until after Technical Evaluations take place. Do not enter cost, pricing, or any discount information in the Alternate Description field. Entering cost, pricing or discount information in the Alternate Description may result in disqualification.

Note: If taking any exceptions to Standard Terms and Conditions an offeror must submit a redline version of the Standard Terms and Conditions with their proposal.

: “Upload” (next to each required attachment) : “Choose File” Note: If a pricing document is required, mark the box next to the question, “Does this attachment contain any pricing, cost, or discount information?”

Failure to mark this box when attaching a pricing document will result in disqualification.

Check this box ONLY if a separate pricing document is required.

Do NOT check this box for any other required quote attachment such as the Technical Proposal, Vendor Disclosure / IPG Active Registered Vendor Disclosure, or Utilization Plan(s), or offer.

Offerors may also view the “Request for Proposal (RFP) Vendor Submission Instructions Video found at https://cpo-general.illinois.gov/vendor-resources.html

C.2. DUE DATE AND TIME FOR SUBMISSION OF OFFERS

Each solicitation contains the Offer due date and time, appearing as the “Bid Opening Date:” on the BidBuy posting. Offeror shall submit Offers in BidBuy, and the State shall open Offers electronically in BidBuy on the “Bid Opening Date”. The Offer must remain firm for 180 days from opening.

C.3. CONFLICT BETWEEN INFORMATION IN ELECTRONIC DOCUMENTS AND ON BIDBUY

If the State provides information in electronic documents (i.e., the RFP and other attachments) that is different or in conflict with the information the State provides on BidBuy, then the information in electronic documents is presumed to represent the State’s intent. If the Offeror provides information in electronic documents that is different or in conflict with the information the Offeror provides in BidBuy through their Seller Account, then the information in electronic documents shall represent the Offeror’s intended submission.

C.4. PUBLISHED PROCUREMENT INFORMATION

The State publishes procurement information, including solicitations, awards, and amendments, on the Chief Procurement Officer for General Services’ Illinois Procurement Bulletin, known as the Bulletin or BidBuy (https://www.bidbuy.illinois.gov/bso/). Procurement information may not be available in any other form or location. Offeror is responsible for monitoring BidBuy. The State will not be held responsible if Offeror fails to receive the optional e-mail notice of future amendments to the solicitation.

C.5. INFORMATION CONTACT

The individual listed in the “Info Contact:” field on the BidBuy posting shall be the single point of contact for this solicitation. Unless otherwise directed, Offeror should only communicate with the Information Contact. The State/Agency shall not be held responsible for information provided by or to any other person.

Suspected errors should be immediately reported to the Information Contact. Do not discuss, directly or indirectly, the solicitation or any Offer with any State officer or employee other than the Information Contact.

C.6. OFFEROR QUESTIONS AND AGENCY RESPONSE

All questions, other than questions raised at the Pre-Submission Conference, pertaining to this solicitation must be submitted in writing to the Information Contact no later than 09/01/2026. Questions received and Agency responses may be posted as a Bid Amendment to the original solicitation on BidBuy; only these posted answers to questions shall be binding on the State. Offeror is responsible for monitoring BidBuy and BidBuy email notifications.

C.7. SMALL BUSINESS SET-ASIDE

In the Bulletin posting, if “Yes” is shown to the question “Is this a Small Business Set-Aside Procurement?”, then Offeror must be registered by the Illinois Small Business Set-Aside Program at the time Offers are due for the Offer to be evaluated. For requirements on qualifying Offeror’s business in the Small Business Set-Aside Program, please go to the Chief Procurement Office for General Service’s website at https://cpo-general.illinois.gov/sell-2-illinois.html .

C.8. BUSINESS ENTERPRISE FOR MINORITIES, WOMEN, AND PERSONS WITH DISABILITIES ACT PARTICIPATION AND UTILIZATION PLAN

The BidBuy posting indicates whether this solicitation contains a goal to include businesses owned and controlled by minorities, women, and persons with disabilities. If this solicitation contains a goal, then failure to complete and submit a Utilization Plan, including documentation demonstrating good faith efforts when requesting a waiver, shall render the Offer non-responsive. 30 ILCS 575/4(e). All questions regarding the subcontracting goal must be directed to the Information Contact indicated in BidBuy no later than 09/01/2026. See the Utilization Plan for NIGP codes used to establish this goal.

BEP Goal: 5% Go to https://cei.illinois.gov/vendor-resources/get-bep-certified.html for complete requirements for BEP certification. Go to State of Illinois Commission on Equity and Inclusion at https://supplierdiversitymanagementportal.illinois.gov/home.aspx to search for certified BEP vendors.

C.9. VETERAN SMALL BUSINESS PARTICIPATION AND UTILIZATION PLAN

The BidBuy posting indicates whether this solicitation contains a goal to include businesses owned and controlled by military veterans. If this solicitation contains a goal, then failure to submit a Utilization Plan as instructed later in this solicitation may render the Offer non-responsive. All questions regarding the subcontracting goal must be directed to the Information Contact indicated in BidBuy no later than [insert question due date from C.6]. See the Utilization Plan for NIGP codes used to establish this goal.

VBP Goal: 0% Go to https://cei.illinois.gov/programs0/veterans-business-program.html for complete requirements for Veteran Owned Small Business (VOSB) or Service-Disabled Veteran Owned Small Business (SDVOSB) certification. Go to State of Illinois Commission on Equity and Inclusion at https://supplierdiversitymanagementportal.illinois.gov/home.aspx to search for certified VOSB and SDVOSB vendors.

C.10. SECURITY

Bid/Performance Bond: $ N/A. If a bond is required, Offeror must submit the Bid Bond with your offer or Performance Bond to the Information Contact within ten (10) days after contract execution. The bond must be from a surety licensed to do business in Illinois. An irrevocable letter of credit is an acceptable substitute. The form of security must be acceptable to the State.

C.11. TERMS AND CONDITIONS

Standard Terms and Conditions will become a part of any resulting contract. To view the Standard Terms and Conditions, please go to https://cpo-general.illinois.gov/solicitation-and-contract-templates.html.

Section D. EVALUATION PROCEDURES

D.1. EVALUATION PROCESS

The State assesses each Offer for Responsibility (E.10) and Responsiveness. The State considers the information provided and the quality of that information when assessing Offers. If the State finds a failure or deficiency, the State may reject the Offer or reflect the failure or deficiency in the assessment.

There are three scored parts to each proposal – technical, commitment to diversity, and pricing. Each part of the proposal is evaluated and ranked independently of the other parts of the proposal. The results of the evaluation of all three parts shall be used in ranking the proposals.

The State may award to the most responsive and responsible offeror whose offer best meets the specified criteria.

D.2. RESPONSIVENESS

A responsive offeror is one who submits an offer that conforms in all material respects to the Request for Proposal and includes all required forms.

D.2.1. The State will determine whether the Offeror complied with the instructions for submitting offers. Except for late submissions, and other requirements that by law must be part of the submission, the State may require that an Offeror correct deficiency as a condition of further evaluation.

D.2.2. Subcontractor Disclosure: If the Offer includes any subcontractors, then Offeror shall complete the Subcontractor Disclosure section of the Offer to the State of Illinois.

D.2.3. If completing IPG Active Registered Vendor Disclosure, then responsiveness may include and may not be limited to:

· Active Illinois Procurement Gateway registration # with expiration date

· Certifications timely to this solicitation

· Disclosure of lobbyists for Offeror and parent entity(ies)

· Disclosure of pending and current contracts

D.2.4. If completing Vendor Disclosure, required parts may include and may not be limited to:

D.2.5. The State will determine whether the Offer meets the stated technical requirements. Minor differences or deviations that have negligible impact on the price or suitability of the supply or service to meet the State’s needs may be accepted or corrections allowed. If no offeror meets a particular technical requirement, the State may waive that requirement.

D.2.6. When the specification calls for “Brand Name or Equal,” the brand name product is acceptable. Other products will be considered with proof that the other product meets stated specifications and is equivalent to the brand product in terms of quality, performance, and desired characteristics.

D.3. EVALUATION METHODOLOGY

The Technical Requirements are described in Sections F.2. and F.3. The State evaluates the Technical Requirements without consideration of price.

D.3.1. Total Number of Points Available for Technical Requirements is: 1000.

D.3.2. Offeror shall complete and return Sections F.2., F.3.

D.3.3. Relative Weight in Point Format

Proposed Technical Solution (Desirable elements)

D.4. COMMITMENT TO DIVERSITY ELEMENTS

Sections 20-15 and 35-30 of the Illinois Procurement Code (30 ILCS 500/) require offerors to be evaluated on their commitment to diversity. The points available for Commitment to Diversity are described in Section F.4. and are equivalent to 20% of the Technical Requirements points. The State evaluates Commitment to Diversity without consideration of price.

D.4.1. The total number of points for Commitment to Diversity is 200.

D.4.2. Offeror shall complete and return Section F.4 Commitment to Diversity

D.4.3. Commitment to Diversity Categories: The percentages at the end of each section reflect the weighted distribution of points available identified in D.4.1.

Commitment to Diversity Categories

Category 1 – BEP Compliance - Whether the Offeror meets the set goal for contracting or subcontracting with businesses owned by women, minorities, or persons with disabilities or completed a Good Faith Effort Waiver for this procurement. 5%

Category 2 – Subcontracting/Contracting with any WMD businesses (not limited to BEP vendors) - Whether the Offeror has contracted/subcontracted within the prior calendar year with businesses owned by women, minorities, or persons with disabilities. 10%

Category 3 – Diversity, Equity and Inclusion (DEI) Spend – Offeror’s percentage of business, education and/or community spend from prior calendar year gross revenue that involves businesses owned by women, minorities and/or persons with disabilities. The assisted businesses are not required to be certified in the Illinois Business Enterprise Program. 20%

Category 4 – DEI Time - Offeror’s hours spent in the prior calendar year on promoting DEI in the workplace, the community, education institutes, or supporting businesses owned by women, minorities, or persons with disabilities. The assisted business is not required to be certified in the Illinois Business Enterprise Program. The success or failure of each event does not impact the points achieved. The event may be voluntary or paid time. 20%

Category 5 – DEI Policies - The vendor has provided a written copy/screenshot of their current written workforce diversity, equity, and inclusion (“DEI”) policy. The policy provided must be actionable plans, not overarching concepts around DEI. 10%

Category 6 – Diversity in Staffing - % of individuals on governing board and/ or Senior executives who identify as women, minorities or person with disabilities. 10% % of individuals in management /supervisor positions who identify as women, minorities or person with disabilities. 13% % of total staff who identify as women, minorities or person with disabilities. 12%

D.5. MINIMUM REQUIRED POINTS

Requests for Proposal may specify that offerors must receive a minimum number of points in their Technical and Commitment to Diversity proposals combined to be considered for price evaluation and award.

The State determines how well offers meet the Technical and Commitment to Diversity requirements and rank the offers from best to least qualified using a point ranking system (unless otherwise specified) as an aid in conducting the evaluation. Offerors who receive fewer than the minimum required points will not be considered for price evaluation and award.

D.5.1. The total number of available points for Technical and Commitment to Diversity is 1200 D.5.2. A minimum of 840 of the available (Technical and Commitment to Diversity) points is required for price evaluation and award consideration.

D.6. PRICE

The State opens Price proposals after evaluating all Technical and Commitment to Diversity proposals.

If the State does not consider the price to be fair and reasonable and negotiations fail to meet an acceptable price, the State reserves the right to cancel the award and take appropriate action to meet the needs of the State. The State determines whether the price is fair and reasonable by considering the offer, including the offeror's qualifications, the offeror's reputation, all price proposals submitted, other known prices, the project budget, and other relevant factors.

D.6.1. The total number of points for Price is 240.

D.6.2. The State will determine Price points using the following formula:

Maximum Price Points X (Lowest Price/Offeror’s Price) = Total Price Points

For the purpose of price evaluation only, the total of all hourly rates will be considered. The total will be the sum of all hourly rate quotes provided.

D.7. MAXIMUM AVAILABLE POINTS

The maximum number of points is 1000 (Technical) + 200 (Commitment to Diversity) + 240 (Price) = 1440 maximum available points.

Section E. ADMINISTRATIVE REQUIREMENTS

E.1. GOVERNING LAW AND FORUM

Illinois law and rules govern this solicitation and any resulting contract. Offeror must bring any action relating to this solicitation or any resulting contract in the appropriate court in Illinois. This document contains statutory references designated with “ILCS”. To view the full text, go to https://ilga.gov/Legislation/ILCS/Chapters . The Illinois Procurement Code (30 ILCS 500) and the Standard Procurement Rules (44 ILL. ADM. CODE PART 1) are applicable to this solicitation. To view them respectively, go to and Illinois General Assembly - ADMINISTRATIVE CODE.

E.2. PUBLIC RECORDS AND REQUESTS FOR CONFIDENTIAL TREATMENT

Offers become the property of the State. All offers will be open to the public under the Illinois Freedom of Information Act (FOIA) (5 ILCS 140) and other applicable laws and rules, unless Offeror requests in its Offer that the State treat certain information as confidential. A request for confidential treatment will not supersede the State’s legal obligations under FOIA. The State will not honor requests to keep entire Offers confidential. Offerors must show the specific grounds in FOIA or other laws or rules that support confidential treatment. Regardless, the State will disclose the successful Offeror’s name, the substance of the Offer, and the price.

If Offeror requests confidential treatment, Offeror must submit additional copy/copies (see Instructions for Submission of Offers in Section C.) of the Offer with proposed confidential information redacted. This redacted copy must tell the general nature of the material removed and shall retain as much of the Offer as possible. In a separate attachment, Offeror shall supply a listing of the provisions identified by section number for which it seeks confidential treatment and identifies the statutory basis or bases under Illinois law, including a detailed justification for exempting the information from public disclosure.

Offeror will hold harmless and indemnify the State for all costs or damages associated with the State defending Offeror’s request for confidential treatment. Offeror agrees that the State may copy the Offer to facilitate evaluation, or to respond to requests for public records. Offeror warrants that such copying will not violate the rights of any third party.

E.3. MINORITY CONTRACTOR INITIATIVE

The State requires a fee of $15 to cover expenses related to the administration of the Minority Contractor Opportunity Initiative. Any offeror awarded a contract of $1,000 or more under Section 20-10, 20-15, 20-25 or 20-30 of the Illinois Procurement Code (30 ILCS 500) is required to pay a fee of $15. The Comptroller shall deduct the fee from the first check issued to the Vendor under the contract and deposit the fee in the Comptroller’s Administrative Fund. 15 ILCS 405/23.9.

E.4. FEDERAL FUNDS

The resulting contract may be partially or totally funded with Federal funds. Upon notice of intent to award, the percentage of supplies and/or services involved that are Federally funded and the dollar amount of such Federal funds will be disclosed.

E.5. EMPLOYMENT TAX CREDIT

Offerors who hire qualified veterans and certain ex-offenders may be eligible for tax credits. 30 ILCS 500/45-67 and 45-70. Please contact the Illinois Department of Revenue (217-524-4772) for information about tax credits [35 ILCS 5/216, 5/217].

E.6. RESERVATIONS

Offeror must read and understand the solicitation and tailor the Offer and all activities to ensure compliance. The State reserves the right to amend the solicitation, reject any or all offers, award by item/services, group of items/services, or grand total, and waive minor defects. The State may request clarification, inspect Offeror’s premises, interview staff, request a presentation, or otherwise verify the contents of the Offer, including information about subcontractors and suppliers. The State may request Best & Final Offers when appropriate. The State will make all decisions on compliance, evaluation, and terms and conditions, and shall make decisions in the best interests of the State and in accordance with the Illinois Procurement Code, rules and other applicable State and Federal statutes and regulations. This competitive process may require that Offeror provides additional information and otherwise co-operates with the State. If an offeror does not comply with requests for information and cooperate, the State may reject the offer as non-responsive to the solicitation. Submitting an offer does not entitle Offeror to an award or a contract. Posting a vendor’s name in a Bulletin notice does not entitle the vendor to a contract. The State is not responsible for and will not pay any costs associated with the preparation and submission of any offer.

Awarded Offeror(s) shall not commence and will not be paid for any billable work undertaken prior to the date all parties execute the contract, unless approved in writing in advance by the State Purchasing Officer or the Chief Procurement Officer (or designee).

E.7. AWARD

The State is not obligated to award a contract pursuant to this solicitation. If the State issues an award, the award will be made to the responsive and responsible offeror whose offer best meets the specified criteria unless otherwise permitted by the Illinois Procurement Code and Illinois Administrative Code. However, if the State does not consider the price to be fair and reasonable and negotiations fail to meet an acceptable price, then the State reserves the right to cancel the award and take appropriate action to meet the needs of the State. The State will determine whether the price is fair and reasonable by considering the offer, including the offeror's qualifications, the offeror's reputation, all prices submitted, other known prices, the project budget and other relevant factors. The State will post a notice to the Bulletin identifying the apparent most responsive and responsible offeror.

E.8. INVOICING ADDRESS

The awarded Vendor shall invoice at the completion of the contract unless invoicing is tied in the contract to milestones, deliverables, or other invoicing requirements agreed to in the contract. The Bulletin posting contains the “Bill-to Address:” where invoices should be sent.

Vendor shall not bill for any taxes unless accompanied by proof that the State is subject to the tax. If necessary, Vendor may request the applicable Agency’s Illinois tax exemption number and Federal tax exemption information.

E.9. PROTEST REVIEW OFFICE

Offeror may submit a written protest to the Protest Review Office following the requirements of the Standard Procurement Rules. 44 ILL. ADM. CODE 1.5550. For protests related to specifications, the Protest Review Office must physically receive the protest no later than fourteen (14) days after the solicitation or related addendum was posted to the Bulletin. For protests related to rejection of individual proposals or awards, the protest must be received by close of business no later than fourteen (14) days after the protesting party knows or should have known of the facts giving rise to the protest. The Protest Review Office’s information is as follows:

Chief Procurement Office Attn: Protest Review Office Email: cpogs.pro@illinois.gov

E.10. RESPONSIBILITY

A responsible Offeror is one who has the capability in all respects to perform fully the contract requirements and who has the integrity and reliability that will assure good faith performance. The State determines whether the Offeror is a “responsible” offeror; an offeror with whom the State can or should do business. For example, the State may consider the following:

E.10.1. A “prohibited bidder” includes any person assisting an employee of the State of Illinois by reviewing, drafting, directing, or preparing any invitation for bids, a request for proposal, or request of information, or providing similar assistance unless such assistance was part of a publicly issued opportunity to review drafts of all or part of these documents. For purposes of this section, an employee of the State of Illinois means one who, by the nature of his or her duties, has the authority to participate personally and substantially in the decision to award a State contract. No person or business shall submit specifications to a State agency unless requested to do so by an employee of the State. No person or business that contracts with a State agency to write specifications for a particular procurement need shall submit a bid or proposal or receive a contract for that procurement need.

Nothing herein is intended to prohibit a vendor from bidding or offering to supply developing technology, supplies or services after providing the State with a demonstration of the developing technology, supplies, or services; provided the subject of the demonstration to the State represents industry trends and innovation and is not specifically designed to meet the State's needs. Nothing herein is intended to prohibit a person or business from submitting a bid or offer or entering into a contract if the person or business: (i) initiates a communication with an employee to provide general information about products, services, or industry best practices and, if applicable, that communication is documented in accordance with Section 50-39 of the Illinois Procurement Code or (ii) responds to a communication initiated by an employee of the State for the purposes of providing information to evaluate new products, trends, services, or technologies.

E.10.2. Other factors that the State may use to evaluate to determine responsibility include, but are not limited to: political contributions, certifications, conflict of interest, financial disclosures, taxpayer identification number, past performance in business or industry, references (including those found outside the Offer), compliance with applicable laws, financial responsibility, insurability, effective equal opportunity compliance, payment of prevailing wages if required by law, capacity to produce or sources of supply, and the ability to provide required maintenance service or other matters relating to the offeror’s ability to deliver in the quality and quantity within the time and price as specified in this solicitation.

E.10.3. Awarded offerors must always have financial resources sufficient, in the opinion of the State, to ensure performance of the contract and must provide proof upon request. The State may require a performance bond if, in the opinion of the State, it ensures performance of the contract. The State may terminate the contract, consistent with the termination for cause provision of the contract, if the vendor lacks the financial resources to perform under the contract.

E.10.4. The State may require that an offeror correct any deficiencies as a condition of further evaluation.

E.11. BidBuy Terminology and Guidance: BidBuy is an online e-procurement system. There may be some difference between the procurement terminology used in this solicitation and the terms used in BidBuy. Please learn more about BidBuy by accessing the online resources found here:

https://pathway2procurement.illinois.gov/bidbuy.html

Section F. PROPOSAL FORMS Offeror must complete and return:

· The following three (3) tables include: Contract Requirements (Section F.1), Technical Requirements: Mandatory Requirements with Evidence (Section F.2), and Proposed Technical Solution (Section F.3)

· Commitment to Diversity per (Section F.4)

· Offer to the State of Illinois

Please read and follow each instruction carefully.

F.1. CONTRACT REQUIREMENTS

Please read each contract requirement carefully in F.1. These contract requirements shall be included in any contract resulting from this solicitation.

Items included in the following table are to become part of the resulting contract(s) as possible work request responsibilities, however, the Department does not guarantee any or all of the following items will become part of a resulting work request. The Department does not guarantee a minimum workload or number of work requests. Requests will be made on an as needed basis.

CONTRACT REQUIREMENTS

PBM Regulatory Oversight

F.1.1. Vendor(s) shall maintain current and thorough knowledge about all applicable federal and state laws, including but not limited to the prescription Drug Affordability Act (H.B. 1697).

F.1.2. Vendor(s) will manage and run market conduct examinations and financial reviews of PBMs F.1.3. Vendor(s) will review PBM contracts with health plans, pharmacies, Pharmacy Services Administrative Organizations (PSAOs), and affiliated entities to identify statutory violations, prohibited steering practices, spread pricing, and rebate retention inconsistencies and provide corrective recommendations as needed.

F.1.4. Vendor(s) will review transparency reporting, annual filings, and documentation submitted by PBMs to ensure completeness and statutory compliance.

F.1.5. Vendor(s) will assess PBM reimbursement methodologies including, but not limited to, lower-of logic, usual and customary pricing, Actual Wholesale Price (AWP), National Average Drug Acquisition Cost (NADAC), and other industry pricing benchmarks and provide corrective recommendations as needed.

F.1.6. Vendor(s) will examine drug manufacturer rebate arrangements and evaluate the flow of rebates through affiliated and non-affiliated entities and provide corrective recommendations as needed.

F.1.7. Vendor(s) will provide written findings identifying statutory violations, regulatory concerns, and recommend corrective actions.

F.1.8. Vendor(s) will provide weekly status updates during active examinations and present final reports within timelines established by the Department.

Attorney Services

F.1.9. Vendor(s) must provide, either through direct employment or through sub-contracting, attorney services with expertise in complex health care and PBM-related agreements.

F.1.10. Vendor(s) must review and interpret complex PBM agreements, delegated service agreements, rebate contracts, administrative services agreements, and related intercompany arrangements.

F.1.11. Vendor(s) will be responsible for the identification of interrelated functional delegations among PBMs, health plans, GPOs, pharmacies, and affiliated entities.

F.1.12. Vendor(s) will provide legal analysis regarding compliance with State and Federal laws and regulatory requirements.

F.1.13. Vendor(s) will assist the Department in drafting regulatory guidance, enforcement recommendations, corrective action plans, and policy memoranda.

F.1.14. Vendor(s) will support enforcement actions, administrative proceedings, or regulatory initiatives as directed.

F.1.15. Vendor(s) and sub-contractor(s) will be held to a professional standard of conduct applicable to legal professionals.

Pricing Specialist Services

F.1.16. Vendor(s) will analyze PBM reimbursement methodologies and pricing models, including lower-of-logic, MAC lists, AWP-based pricing, NADAC, and usual and customary methodologies and provide corrective recommendations as needed.

F.1.17. Vendor(s) will evaluate manufacturer rebate structures, administrative fee arrangements, and price concession mechanisms and provide corrective recommendations as needed.

F.1.18. Vendor(s) will assess differences between provider reimbursement and health plan sponsor payments.

F.1.19. Vendor(s) will evaluate the prescription drug supply chain, including manufacturers, wholesalers, PBMs, pharmacies, and plan sponsors. Evaluation will be for reporting year 2026 forward.

F.1.20. Vendor(s) will identify pricing trends, outliers, and risk indicators and provide corrective recommendations as needed.

F.1.21. Vendor(s) will provide recommendations for corrective actions related to pricing transparency and compliance.

Prescription Drug Specialist Services

F.1.22. Vendor(s) will review PBM audit methodologies and pharmacy audit practices. Evaluations will be for reporting year 2026 forward.

F.1.23. Vendor(s) will identify PBM steering mechanisms within contracts, claims data, or reimbursement structures and provide corrective recommendations as needed.

F.1.24. Vendor(s) will evaluate specialty pharmacy and mail-order pharmacy operations and reimbursement practices and provide corrective recommendations as needed.

F.1.25. Vendor(s) will review compliance related to 340B pharmacy arrangements and provide corrective recommendations as needed.

F.1.26. Vendor(s) will assess PSAO relationships and pharmacy contracting arrangements and provide corrective recommendations as needed.

F.1.27. Vendor(s) will provide recommendations regarding pharmacy reimbursement fairness, transparency, and regulatory compliance.

Fraud Auditing and Forensic Accounting Services

F.1.28. Vendor(s) will follow financial transaction trails across affiliated and non-affiliated PBM entities.

F.1.29. Vendor(s) will analyze intercompany transfers, administrative fees, rebate flows, and revenue allocations.

F.1.30. Vendor(s) will investigate financial discrepancies, potential financial crimes, or regulatory violations.

F.1.31. Vendor(s) will perform forensic analysis of corporate reorganizations and related transactions.

F.1.32. Vendor(s) will identify improper financial practices or concealment of spread pricing or rebate retention.

F.1.33. Vendor(s) will provide detailed written reports documenting findings and evidentiary support.

Data Specialist Services

F.1.34. Vendor(s) shall collect, clean, validate, and analyze large-scale claims, pricing, rebate, and enrollment datasets.

F.1.35. Vendor(s) shall utilize data dictionaries and public use files, including CMS Exchange Public Use Files (PUFs), CMS Prescription Drug Profiles, and Prescription Drug Data Collection (RxDC) submissions.

F.1.36. Vendor(s) shall conduct forensic data analysis to detect anomalies, trends, and potential statutory violations.

F.1.37. Vendor(s) will develop trending reports, dashboards, and analytic summaries.

F.1.38. Vendor(s) will verify completeness and accuracy of statutory filings and required regulatory submissions.

F.1.39. Vendor(s) will provide technical documentation describing methodologies, assumptions, and validation procedures.

Training Services: To be provided by the Primary Vendor only

F.1.40. The Primary Vendor shall be responsible not only for the management and administration of the PBM services, but also for providing ongoing staff training and operational knowledge transfer to Department staff.

F.1.41. Primary Vendor shall submit a comprehensive training implementation plan outlining the proposed training approach, schedule, methods, materials, and staff support strategy within thirty (30) calendar days of contract execution. The initial submission is intended to establish the framework and timeline for training activities and does not require completion of all training modules within the first thirty (30) days.

F.1.42. The Primary Vendor shall provide ongoing training as operational needs evolve, including but not limited to:

· New processes, procedures, or system enhancements.

· Changes in PBM operations or program requirements.

· Updated regulatory or compliance requirements.

· Newly introduced information, workflows, or functionality.

· Situational or issue-specific operational guidance as needed.

F.1.43. The primary Vendor shall determine and recommend appropriate training methods and delivery approaches based on Department operational needs and best practices.