2026.09.08 PBM Vendor Questions and Agency Answers.pdf
PDF 71 KB Posted
- Solicitation number
- 26-446DOI-FINAD-B-50721
- Issued by
- Illinois
About this file
This document is a Vendor Questions and Answers file published by the Illinois Department of Insurance regarding RFP 26-446DOI-FINAD-B-50721 for Pharmacy Benefit Manager (PBM) Oversight and Reform Implementation Services. The initiative, mandated by the recently passed Prescription Drug Affordability Act (H.B. 1697), represents a new program for the state with no incumbent vendor or historical data currently available. The Department of Insurance plans to engage multiple vendors for the scope of work and will publicly disclose which vendors were awarded and their tier designation (primary, secondary, or tertiary) upon award. Subsequent work requests will not be publicly disclosed but may be obtained through Freedom of Information Act requests. The solicitation requires offerors to demonstrate at least five years of direct experience assessing PBM compliance with federal and state laws and directives, including expertise in eliminating spread pricing, rebate pass-through, maximum allowable cost pricing, and appeals processes. This required experience must be held by the prime offeror itself; subcontractor experience cannot fulfill this mandatory requirement unless the RFP explicitly states "by vendor or subcontractor."
The Department of Insurance has declined to provide historical data regarding anticipated claims file volumes, covered individual counts, or total drug spend amounts, citing the new nature of the initiative. All reports, findings, and recommendations generated under this contract will be for internal use only and will not be published publicly, though they may be obtained via FOIA request. The solicitation does not involve oversight of specific plan member populations or current pharmacy benefit data, as this is an oversight and reform initiative rather than direct PBM service provision. Documentation demonstrating compliance with experience requirements may be submitted in flexible formats including resumes, biographies, and executive summaries with no mandatory submission format specified.
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Other files
| File | Type | Posted |
|---|---|---|
| Blank IPG Active Registered Vendor Disclosure Formerly Forms B-v-26-1-8-26-2025-1.docx | DOCX document | |
| Vendor Disclosure Formerly Forms A.docx | DOCX document | |
| 2026.06.29 BEP Utilization plan~1.pdf | ||
| C2D Vendor Guidance .pdf | ||
| 2026.08.06 RFP~2.docx | DOCX document | |
| Offer to the State of Illinois.pdf | ||
| DOI NonDisclosure-Agreement~1.docx | DOCX document | |
| C2D Vendor Answer Sheet.pdf |
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Text version
Illinois Department of Insurance
Pharmacy Benefit Manager Oversight and Reform Implementation Services
26-446DOI-FINAD-B-50721
Vendor Questions and Answers
1. Please clarify Mandatory Requirement F.2:
Must the prime Offeror itself possess the required five years of experience assessing PBM compliance, or may the Offeror satisfy this requirement through a proposed subcontractor that possesses the required experience and will lead and perform the PBM compliance-assessment services?
If a subcontractor’s experience may be used, please identify the documentation the Offeror must submit to demonstrate compliance with F.2.
Answer: Section F.2.1 which states “Offerors must have at least five (5) years of experience directly related to assessment of PBM compliance with federal and state laws and directives, the elimination of spread pricing, rebate pass- through, maximum allowable cost pricing and appeals process” must be met by the Offeror. Subcontractor’s experience is not to be considered for this requirement.
Only requirements that specifically state “by vendor or subcontractor” may be fulfilled by subcontractor experience. For those requirements, please submit a complete description of the related experience. This may be submitted as resumes, bios, executive summaries, etc. There is no mandatory format for submission of this information.
2. Given that the Department of Insurance plans to engage multiple vendors for the scope of work, will the Department be disclosing which vendor is primary vs secondary vs tertiary? On a related note, once the work has begun, with the Department be publicly disclosing which vendor completed which projects?
Answer: Upon award, a notice will be published that will indicate which vendors were awarded and whether they were awarded as primary, secondary, or tertiary. Subsequent work requests are not published but can be obtained via FOIA request if desired.
3. With respect to the data specialist services detailed in the RFP, can you provide any details around the size and scope of the anticipated claims files . . . such as total number of claims included, number of covered individuals represented by the claims, total dollar amount of the drug spend represented in the anticipated files, etc.?
Answer: This is a new initiative and there is no historical data available.
4. With respect to the various reports, findings and recommendations described in F.1, will those reports/deliverables be made public?
Answer: These reports will be for internal use and not published publicly. Reports can be obtained via FOIA request if desired.
5. Who is current PBM vendor? How long has vendor been in place?
Answer: This solicitation is for a firm to provide PBM Oversight and Reform
Implementation Services. This is a new initiative; the Department of Insurance does not have a current vendor providing these services.
6. When does your current PBM contract terminate?
7. When was the last time State of IL ran a PBM RFP?
8. Who is current medical carrier? How long has medical carrier been in place?
Answer: This is not relevant to the solicitation as the solicitation is to establish a contract for PBM Oversight and Reform Implementation Services and not the services of a PBM. Please refer to the scope of the solicitation for full list of requirements and expectations.
9. Do you have a pharmacy consultant in place today or a full-service benefits consultant?
Answer: The solicitation is for a firm to provide PMB Oversight and Reform
10. Please confirm the total number of plan members currently represented on State of Illinois pharmacy benefit.
11. Please confirm the number of pharmacies claims annually.
Answer: This is a new initiative and there is no historical data available.
12. Do you have multiple populations (commercial, EGWP, etc)?
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