41NHA-S3992-Request-for-Proposals - Final~2.docx

Nevada State Purchasing Division Department of Administration 515 E Musser St Ste 300 Carson City, NV 89701 purchasing.nv.gov nevadaepro.com

Request for Proposals 41NHA-S3992

Release Date 10/22/2026

Solicitation number 41NHA-S3992

Single point of contact name Heather Moon

Single point of contact email hmoon@admin.nv.gov

Single point of contact phone 775-531-3309

Soliciting agency Nevada State Purchasing Division

Contracting agency Nevada Health Authority

Solicitation title Nevada State Pharmacy Benefits Manager

Deadline for submissions 12/29/2026 @ 2:00 P.M.

For deaf and hard of hearing, call 711 and ask the relay agency to dial the single point of contact phone number above.

This request for proposals is available at nevadaepro.com as a bid solicitation.

Table of Contents

Applicable regulations governing procurement

Statute and code. All applicable Nevada Revised Statutes (NRS) and Nevada Administrative Code (NAC) documentation can be found at: www.leg.state.nv.us/law1.cfm.

Single point of contact. Vendors and their representatives shall only contact the single point of contact or use the electronic procurement system regarding this solicitation until after a notice of award (NOA) has been issued. Failure to observe this restriction may result in disqualification of a response per NAC 333.155(3).

Ethics. Prospective vendors are advised to review Nevada’s ethical standards requirements, including but not limited to NRS 281A, NRS 333.800, and NAC 333.155.

Project overview

The Purchasing Division on behalf of the Nevada Health Authority is seeking proposals from qualified vendors to provide pharmacy benefit manager services for Nevada Medicaid and the Public Employees’ Benefits Program as described below and in the scope(s) of work and attachments.

Section 3.1 sets forth the scope of work for pharmacy benefit manager (PBM) services for Nevada Medicaid, specifically the State Pharmacy Benefit Manager (SPBM) as described in NRS 422.051; Section 3.2 sets forth the scope of work for PBM services for the Public Employees’ Benefits Program (PEBP).

The State intends to award one or more contracts in conjunction with this request for proposals (RFP), as determined in the best interests of the State. The State prefers to award both scopes of work described above to one vendor, but may award each scope to a different vendor. Nevada Health Authority shall administer any contract(s) resulting from this solicitation.

The resulting contract(s) shall specify an initial term of 6 years, anticipated to begin June 8th, 2027, subject to Board of Examiners (BOE) approval, with an option to renew for two one (1) year extensions, if agreed upon by vendor(s) and in the best interest of the State.

Contracting agency background

Nevada Health Authority (NVHA) administers Nevada Medicaid and PEBP.

Senate Bill 389 (2025) requires the State to contract with one State Pharmacy Benefit Manager to manage pharmacy benefits for all Nevada Medicaid recipients, including Fee-for-Service (FFS) recipients, and recipients receiving care through Managed Care Organizations (MCOs) contracted with NVHA. PBM services for the State Pharmacy Benefit Manager serving Nevada Medicaid are included in Section 3.1 – SPBM Scope of Work. Approximate estimated covered lives include 141,141 FFS members, and 623,616 MCO members.

PBM services for PEBP recipients are included in this RFP under Section 3.2 – PEBP Scope of Work. Approximate estimated covered lives include 72,000 active and retired employees and their dependents.

Goals and objectives

Any contract resulting from this solicitation will establish requirements for the effective administration and oversight of pharmacy benefits for the applicable program. The State seeks to increase transparency, standardize processes, improve accountability, and achieve administrative and operational efficiencies.

The selected vendor(s) must complete all implementation, transition, testing, and operations-readiness activities necessary to begin providing services by the following service commencement dates:

Section 3.1 – SPBM Scope of Work January 1, 2028 for Medicaid FFS Members January 1, 2029 for Medicaid MCO Members Section 3.2 – PEBP Scope of Work July 1, 2028 Scope of work

See SPBM Scope of Work in ‘Attachments’ tab of NEVADAePro.

See PEBP Scope of Work in ‘Attachments’ tab of NEVADAePro.

Attachments

Attachments incorporated by reference. Applicable to SPBM Scope of Work (3.1) and PEBP Scope of Work (3.2). To be read and not returned.

Terms and conditions for services

Attachments for review. Applicable to SPBM Scope of Work (3.1) and PEBP Scope of Work (3.2). To be read and not returned (unless redlining).

Standard form contract Insurance schedule NVHA Business Associate Addendum (no redlining of document)

Attachments for response. Applicable to SPBM Scope of Work (3.1) and PEBP Scope of Work (3.2). To be completed and returned.

Reference questionnaire

Attachments for response applicable to SPBM Scope of Work (3.1). To be completed and returned.

Attachment 4.5.1. - Cost Schedule Attachment 4.5.2. - Technical Proposal Questions Attachment 4.5.3. - Requirements Matrix Attachment 4.5.4. - Cloud Hosting Questionnaire

Attachments for response applicable to PEBP Scope of Work (3.2). To be completed and returned.

Timeline

Questions. All questions regarding this solicitation shall be submitted using the bid Q&A feature at nevadaepro.com.

Timeline. The following represents the proposed timeline for this project.

All times stated are Pacific Time (PT).

These dates represent a tentative schedule of events.

The State reserves the right to modify these dates at any time.

The deadline for submissions is the nevadaepro.com bid opening date and time. Late quotes will not be accepted.

Evaluation

Evaluation and scoring are conducted in accordance with NRS 333.335 and NAC 333.160-333.165.

Responses shall be kept confidential until a contract is awarded.

In the event the solicitation is withdrawn prior to award, responses remain confidential.

The evaluation committee is an independent committee established to evaluate and score qualitative evaluation factors for the solicitation.

The State, at its option, may limit participation in cost scoring, presentations, or both to vendors above a natural break in relative scores.

Financial stability shall be scored on a pass or fail basis.

Evaluation Criteria for SPBM Scope of Work (3.1). Responses shall be consistently evaluated and scored based upon the following factors and relative weights.

Evaluation Criteria for PEBP Scope of Work (3.2). Responses shall be consistently evaluated and scored based upon the following factors and relative weights.

PEBP Quality Bonus: The PEBP proposal will be evaluated and scored before the Medicaid proposal. A vendor will receive PEBP Quality Bonus points based on its final PEBP technical score as follows: 0 bonus points for a score of 600 or less; 30 bonus points for a score from 601 through 700; 50 bonus points for a score from 701 through 800; 80 bonus points for a score from 801 through 900; and 100 bonus points for a score from 901 through 1,000. The PEBP Quality Bonus will be added to the vendor’s Medicaid technical score.

The total cost score will include items 1,3,4 and 5 from the cost schedule and will exclude any optional administrative fees.

Cost factor. The cost factor score will be based on the following equations, unless the subject solicited requires alternative scoring. The highest proposed cost from any vendor and the lowest proposed cost from any vendor will be added together to generate a combined total. For each vendor, that proposed cost will be subtracted from the previously combined total. This number is then divided by the highest proposed cost. The resulting number is multiplied by the cost factor weight to generate a weighted cost score.

Presentations. The State may require vendors to make a presentation. The State reserves the right to add additional criteria for presentations. The State reserves the right to forego presentations and select vendor(s) based on written responses submitted.

Best and final offers. Pursuant to NAC 333.165, the State reserves the right to permit revised responses or add criteria to obtain the best offers.

Mandatory minimum requirements

Pursuant to NRS 333.311 a contract cannot be awarded to a response that does not comply with the requirements listed in this section. Response shall include confirmation of compliance with all mandatory minimum requirements.

Nevada Law and State indemnity. Pursuant to NRS 333.339, any contract that is entered into may not: (1) require the filing of any action or the arbitration of any dispute that arises from the contract to be instituted or heard in another state or nation; or (2) require the State to indemnify another party against liability for damages.

No Boycott of Israel. Pursuant to NRS 333.338, the State of Nevada cannot enter a contract with a company unless that company agrees for the duration of the contract not to engage in a boycott of Israel. By submitting a response, vendor agrees that if it is awarded a contract, it will not engage in a boycott of Israel as defined in NRS 333.338(3)(a).

nevadaepro.com vendor registration. Pursuant to NRS 333.313, vendor must be registered at nevadaepro.com to respond to the solicitation. Vendor information must match Nevada business license and sam.gov entity registration. Vendor information in nevadaepro.com will be used for contract formation. Email address(es) associated with general mailing address or default bid mailing address (if different from general mailing address) in nevadaepro.com will be used for formal notifications. If a vendor has a different contact name and email for negotiations, that should be indicated on the title page(s) of their response.

Nevada business license. Pursuant to NRS 353.007, prior to contract execution awarded vendor must hold a state business license pursuant to NRS chapter 76 unless exempted by NRS 76.100(7)(b). Business license must match nevadaepro.com vendor registration.

System for Award Management (sam.gov) Prior to contract award vendor must hold an active entity registration in sam.gov. Entity registration must match nevadaepro.com vendor registration.

Contract responsibility. Awarded vendor shall be the sole point of contract responsibility. The State shall look solely to the awarded vendor for the performance of all contractual obligations which may result from an award based on this solicitation, and the awarded vendor shall not be relieved for the non-performance of any or all subcontractors.

Data encryption and stateside data. State IT requires that data be encrypted in transit and in rest. State IT requires that State data assets must be maintained in the United States and data will not be held offshore.

Confidentiality and certification of indemnification

Submitted responses, which are marked confidential in their entirety, or those in which a significant portion of the submitted response is marked confidential shall not be accepted. Pursuant to NRS 333.333, only proprietary information may be labeled a trade secret as defined in NRS 600A.030(5). All proposals are confidential until the contract is awarded; at which time, both successful and unsuccessful vendor proposals become public information.

Vendors shall submit proprietary information and confidential business information in separate files, flagged as confidential in nevadaepro.com. The State shall not be responsible for any information contained within a response; responses shall be released as submitted.

By submitting a response vendor acknowledges its responsibility to act in protection of labeled information and agrees to defend and indemnify the State of Nevada for honoring such designation. Failure to so act shall constitute a complete waiver, and all submitted information shall become public information; additionally, failure to label any information that is released by the State shall constitute a complete waiver of any and all claims for damages caused by the release of the information.

Vendor certifications

Vendor understands and acknowledges that the representations within their response are material and important and shall be relied on by the State in evaluation of the response. Any vendor misrepresentations shall be treated as fraudulent concealment from the State of the true facts relating to the response.

Any and all prices that may be charged under the terms of the contract do not and shall not violate any existing federal, State, or municipal laws or regulations concerning discrimination or price fixing. Vendor agrees to indemnify, defend, and hold the State harmless from liability for any such violation.

All response terms, including prices, shall remain in effect for a minimum of 180 days after the response due date. In the case of the awarded vendor, all response terms, including prices, shall remain in effect throughout the contract term.

The price(s) and amount of this response have been arrived at independently and without consultation, communication, agreement or disclosure with or to any other contractor, vendor, or potential vendor. No attempt has been made at any time to induce any firm or person to refrain from proposing or to submit a response higher than this response, or to submit any intentionally high or noncompetitive response. All responses shall be made in good faith and without collusion.

The information included in this response has been arrived at independently and without non-public information obtained from State officials, staff, or their agents.

All employees and contractors assigned to the project are authorized to work in this country.

Vendor has a written equal opportunity policy that does not discriminate in employment practices with regard to race, color, national origin, physical condition, creed, religion, age, sex, marital status, sexual orientation, developmental disability or disability of another nature.

Vendor has a written policy regarding compliance for maintaining a drug-free workplace.

Critical items

In addition to the scope of work and attachments, the items listed in this section are critical to the success of the project. These items will be used in evaluating and scoring responses. Vendor response should address items in this section in enough detail to provide evaluators an accurate understanding of vendor capabilities. Responses that fail to sufficiently respond to these items may be considered non-responsive.

Standard form contract. The State strongly prefers vendors agree to the terms of the attached standard form contract as is. Ability to agree to contract terms is a high priority to the State. Vendors who cannot agree to the contract as is must include a redlined Word version of the attached standard form contract with their response, with comments justifying the benefit to the State for each requested change. To the extent a vendor has prior contractual dealings with the State, no assumption should be made that terms outside those provided herein have any influence on this project.

Indemnification. Required contract terms on Indemnification: "To the fullest extent permitted by law, Contractor shall indemnify, hold harmless and defend, not excluding the State’s right to participate, the State from and against all liability, claims, actions, damages, losses, and expenses, including, without limitation, reasonable attorneys’ fees and costs, arising out of any breach of the obligations of Contractor under this contract, or any alleged negligent or willful acts or omissions of Contractor, its officers, employees and agents. Contractor’s obligation to indemnify the State shall apply in all cases except for claims arising solely from the State’s own negligence or willful misconduct. Contractor waives any rights of subrogation against the State. Contractor’s duty to defend begins when the State requests defense of any claim arising from this Contract."

Limited liability. Required contract terms on Limited Liability: "The State will not waive and intends to assert available NRS Chapter 41 liability limitations in all cases. Contract liability of both parties shall not be subject to punitive damages. Damages for any State breach shall never exceed the amount of funds appropriated for payment under this Contract, but not yet paid to Contractor, for the Fiscal Year budget in existence at the time of the breach. Contractor’s tort liability shall not be limited."

Insurance schedule. The State strongly prefers vendors agree to the terms of the attached insurance schedule as is. Vendors who cannot agree must explain which areas are causing non-compliance and attach a redline if necessary. Awarded vendor shall maintain, for the duration of the contract, insurance coverages as set forth in the fully executed contract. Work on the contract shall not begin until after the awarded vendor has submitted acceptable evidence of required insurance. Failure to maintain any required insurance coverage or acceptable alternative method of insurance shall be deemed a breach of contract.

Vendor background

Provide a background, history, and why vendor is qualified to provide the services described in this solicitation. Background should include, at a minimum, the location(s) of the office(s) that would perform the work and the number of employees locally and in total. History should include, at a minimum, the number of years in business and company headquarters location. Provide a brief description of the length of time vendor has been providing services described in this solicitation to the public or private sector. If your company has worked with the State previously, include information about those engagements.

Key personnel. Provide a resume free of photos or overly stylized formatting for proposed key personnel, whether employed directly or through a subcontractor.

Current or former employees. If you employ (a) any person who is a current employee of an agency of the State of Nevada, or (b) any person who has been an employee of an agency of the State of Nevada within the past two (2) years, and if such person shall be performing or producing the services which you shall be contracted to provide under this contract, you shall disclose the identity of each such person in your response, and specify the services that each person shall be expected to perform.

Exclusions. All conditions and provisions of this solicitation are deemed to be accepted by the vendor and incorporated by reference in the response, except such conditions and provisions that the vendor expressly excludes in the response. Any exclusion shall be in writing and included in the response at the time of submission.

Subcontractors

Subcontractors are defined as a third party, not directly employed by the contractor, who shall provide services identified in this solicitation. This does not include third parties who provide support or incidental services to the contractor.

Vendor shall disclose all proposed subcontractors. Response should include a vendor information response form for each proposed subcontractor.

Vendor shall not allow any subcontractor to commence work until all insurance required of the subcontractor is provided to the vendor.

Vendor shall certify that subcontractors comply with mandatory minimum requirements except contract responsibility.

Vendor response shall identify specific requirements of the project for which each subcontractor shall perform services.

How the work of any subcontractor(s) shall be supervised How channels of communication shall be maintained How compliance with contracts terms and conditions will be assured Previous experience with subcontractor(s)

Confidential business information

The information requested in this section is designated as confidential business information by the Administrator pursuant to NRS 333.020(5)(b) and is not public information pursuant to NRS 333.333.

This information should be submitted as a separate attachment, flagged as confidential in nevadaepro.com.

Dun and Bradstreet number. Vendor shall provide their Dun and Bradstreet Number.

Financial information. Vendor shall provide the last two full years and current year interim (a) profit and loss statements and (b) balance statements.

Disclosure. Vendor shall provide complete disclosure of any alleged significant prior or ongoing contract failures, contract breaches, any civil or criminal litigation or investigations pending which involves the vendor or in which the vendor has been judged guilty or liable.

Conflict of interest. Vendor shall disclose any existing or potential conflict of interest relative to the performance of the contractual services resulting from this solicitation. Any such relationship that might be perceived or represented as a conflict shall be disclosed. By submitting a response in response to this solicitation, vendors affirm that they have not given, nor intend to give at any time hereafter, any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant or any employee or representative of same, in connection with this procurement. Any attempt to intentionally or unintentionally conceal or obfuscate a conflict of interest shall result in disqualification of a vendor response. An award shall not be made where a conflict of interest exists. The State shall determine whether a conflict of interest exists and whether it may reflect negatively on State vendor selection. The State reserves the right to disqualify any vendor on the grounds of actual or apparent conflict of interest.

Client references

Vendor shall provide reference questionnaire attachment to client references from similar projects performed for private or public sector clients within the last five years.

The single point of contact must receive at least three complete reference questionnaire documents directly from the client references via email.

The purpose of these references is to document relevant experience and aid in the evaluation process.

Reference questionnaire will not be accepted directly from proposing vendors.

Client references shall not be requested from the contracting agency.

The State will not disclose client references, but may confirm if a reference questionnaire has been received.

The State reserves the right to contact client references during evaluation or negotiations.

Submission checklist

This section identifies documents that vendors shall submit to be considered responsive. Vendors are encouraged to review all requirements to ensure all requested information is included in their response.

Responses must be submitted as a quote through nevadaepro.com.

Vendors are encouraged to submit a single file attachment per section where possible.

Technical proposal information and cost proposal information shall not be included in the same attachment.

Cost proposal attachment shall not be flagged as confidential in nevadaepro.com.

Additional attachments may be included, but are discouraged and should be kept to a minimum.

Technical proposal

Title page Table of contents Signed certification regarding lobbying Response to mandatory minimum requirements Response to critical items Response to scope of work Other informational material

Proprietary information. If necessary. Attachment should be flagged confidential in nevadaepro.com.

Title page Table of contents Trade secret information, cross referenced to the technical proposal (alternatively, a redacted technical proposal and a full confidential technical proposal can be submitted)

Cost proposal

Confidential business information. Attachment should be flagged confidential in nevadaepro.com.

Other attachments. If necessary, not recommended.

Client references. Not submitted directly by vendor. To be submitted to sole point of contact.

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