4-Price Proposal - Insurance Admin and PBM.docx
DOCX document 17 KB Posted
- Solicitation number
- PCSD12232025WKT
- Issued by
- Utah
About this file
This is a Price Proposal document for Group Medical and Pharmacy Benefit Management (PBM) Services submitted to the Purchasing Department of an unnamed school district (PCSD) in Utah. The RFP seeks proposals for services effective September 1, 2026, with three submission options available: Combined Medical and PBM Proposal for fully integrated services, Medical Administration Only for claims administration excluding PBM, or PBM Only for pharmacy benefit management. The contract term is three years from the commencement date, with options for the District to extend for up to two additional one-year periods under the same terms and conditions, followed by potential year-to-year renewals for up to five additional years if deemed in the best interest of the procurement unit. All renewals require written determination from the District and are contingent upon satisfactory contractor performance, continued service need, and funding availability.
The District currently operates under a self-funded model administered by UnitedHealthGroup, with UMR serving as the medical third-party administrator and Optum Rx as the pharmacy benefit manager. The RFP may result in multiple contract awards to responsive and responsible vendors with the highest procurement scores. Specific pricing terms, set-asides, funding amounts, or other financial requirements are not detailed in this proposal document excerpt. The evaluation and award methodology will be based on vendor qualifications and scoring justification according to procurement code standards.
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Other files
| File | Type | Posted |
|---|---|---|
| 6-Mandatory Minimum Requirements - Medical and PBM Providers.xlsx | XLSX spreadsheet | |
| 2-PCSD Standard Terms and Conditions for Services.pdf | ||
| 3-Claim of Business Confidentiality Updated.pdf | ||
| 7-RFP SOW - Insurance Admin and PBM.docx | DOCX document | |
| 1-PCSD Vendor Prerequisites - RFP.docx | DOCX document | |
| 5-Additional Information on Current Coverage.xlsx | XLSX spreadsheet |
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Text version
Price Proposal Provo City School District believes it is in the best interest of the district to have costs revealed and evaluated as part of the technical criteria. The complexity and uniqueness of these services make creating an equitable cost sheet challenging and onerous. To adequately score cost, all factors of the proposals including the technical criteria and ability to meet the scope of work must be considered in addition to the cost alone. Allowing cost to be evaluated as part of the technical criteria will enable the evaluation team to determine which proposal is the most advantageous to the district. This exception is in accordance with the State of Utah Code 63G-6a-707(7)(b). – Woody Turnbeaugh, Procurement Official Offerors are required to provide a detailed listing of all administrative fees, costs, and related charges associated with fulfilling the requirements of this contract.
Offerors must clearly indicate whether they are submitting a proposal for:
· Medical Administration (ASO) services only;
· Pharmacy Benefit Management (PBM) services only; or
· Combined Medical and PBM Administration.
If submitting a combined proposal, Offerors must specify whether Medical and PBM services can be sold independently, and must describe any impact such separation would have on pricing, guarantees, or contractual terms. There is no guarantee that an Offeror will be awarded both this contract and any stop loss/reinsurance coverage being solicited under a separate RFP process.
Price Proposal Submission Process
1. Provide a detailed Schedule of Administrative Services and Associated Fees.
Include all base ASO fees, network access fees, care management fees, utilization review, COBRA, eligibility, reporting, termination / run-out fees and any other administrative charges.
2. Itemize each component where a cost applies.
Identify any optional or add-on services separately.
3. Provide a brief explanation of the methodology used to determine each fee, including any membership, utilization, or claim volume assumptions.
4. Summarize all proposed costs and identify any potential additional charges, pass-through fees, or variable cost components that may apply under this ASO arrangement.
5. Clearly state all pricing guarantees, assumptions, and limitations, including minimum enrollment requirements, contract term assumptions (early termination penalties), and the duration of administrative fee guarantees.
Additional Submission Requirements
· PBM Offerors:
Must submit complete Ringmaster pricing and contract documentation as part of their proposal. Submissions must include all formulary pricing, network discounts, dispensing fees, rebates, guarantees, and administrative costs in the Ringmaster pricing template format specified by PCSD.
· Medical Administrator Offerors:
Finalists may be required to perform a complete claims repricing analysis using de-identified Provo City School District claims data. Repricing instructions and data will be provided to finalists during the evaluation process.
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