Rev. 1/20/26; Law No. 26-CS-003 SC Office of Central Procurement RFP No. 2026-03 Issue Date: January 22, 2026 Commodity Code 958-56 / 949-77 RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

Request for Proposals (RFP) No. 2026-XX

Suffolk County Office of Central Procurement on behalf of the Office of the County Executive, Division of Human Resources (“Department”), and the Office of Labor Relations, Suffolk County Employee Medical Health Plan (“EMHP”) by its Suffolk County’s Labor Management Committee is Seeking Proposals for Pharmacy Benefit Management (“PBM”) Services to the Self-Insured EMHP For the

Employer Group Waiver Prescription Drug Plan (“EGWP Plan”) with Wrap.

ONLY PRINCIPAL PBMS MAY SUBMIT

NO SOLICITATIONS FOR SERVICES OUTSIDE OF THE FOCUS OF THIS RFP

NO BROKERS

Timeline

Advertised/Issue Date: January 22, 2026

Intent to Propose Form Due: February 2, 2026 by 3:30PM (EST)

Technical Questions Due: February 9, 2026 by 3:30PM (EST)

Proposal Due Date: March 12, 2026 by 3:30PM (EDT)

Contract Effective Date: January 1, 2027

Contact/Help Information

Need Help? Please contact Bonfire directly at Support@GoBonfire.com for technical questions or issues related to your submission. You can also visit their help forum at https://bonfirehub.zendesk.com/hc.

All potential Proposers must register with the Office’s Procurement Portal at https://suffolkcountyny.bonfirehub.com/portal/ (the “Portal”) for purposes of downloading and submitting/uploading documents in connection with this RFP.

Uploading your submission

• Upload your submission at the Portal above.

• Logging in and/or uploading your file(s) does not mean your response is submitted. Proposers must successfully upload all the file(s) and MUST click the SUBMIT button before the closing time.

• You will receive an email confirmation receipt with a unique confirmation number once you finalize your submission. This will confirm that you have successfully submitted your proposal.

• Each submitted item of requested information will only be visible to Suffolk County after the closing time.

• If the file you are submitting is required by this RFP, you will not be able to complete your submission until the requirement is met.

• Uploading large documents may take significant time, depending on the size of the file(s) and your Internet connection speed.

• Please note the type and number of files allowed. The maximum upload file size is 1000 MB. Please do not embed any documents within your uploaded files, as they will not be accessible or evaluated.

• Minimum system requirements: Internet Explorer 11, Microsoft Edge, Google Chrome, or Mozilla Firefox. Java Script must be enabled.

Late Proposals Will Be REJECTED mailto:Support@GoBonfire.com

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

Table of Contents

Section I Administrative Information

1. Purpose of RFP

2. Coordinating Departments

3. Background Information

4. Evaluation Committee and Award of Contract

5. Questions and Comments

6. Due Date for Proposals

7. Submission of Proposals

8. RFP Policies and Procedures

9. RFP Posted on Bonfire Portal

10. Reservation of Rights

11. Pre-Proposal Required Form

12. Proposal Format

13. Award Criteria

14. Contract Terms and Conditions

15. Use of County Resources to Interfere with Collective Bargaining Activities Local Law No. 26-2003

16. Non-Responsible Bidder

17. Effective Period of Proposals

18. NYS Freedom of Information Law (FOIL)

Section II Proposer Profile

1. General Information/Proposer’s History

2. Qualifications and Experience of Personnel

3. Financial Viability

4. Client History

5. References

6. Conflicts of Interest and/or Potential Conflicts of Interest

7. Subcontractors

Section III Background Information

Section IV Technical Requirements

1. Overview

2. Minimum Requirements

3. Additional Required Contract Provisions

Section V Technical Services Specifications (Detailed Scope of Services)

Section VI Cost Proposal/Fee Schedule

1. Separate File

2. Cost Proposal/Fee Schedule is One of Several Evaluation Criteria

3. Additional Information

4. Alternative Proposals

5. Format for Cost Proposal/Fee Schedule

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

6. Contract Years

7. Financial Requirements

8. Administrative Fees

Section VII Model Contract

Appendix A Pre-Proposal Required Form

Intent to Propose Form For the Self-Funded Employee Medical Health Plan (EMHP) of Suffolk County. All interested Proposers must complete this page and return via Bonfire at: https://suffolkcountyny.bonfirehub.com/portal by February 2, 2026.

Appendix A-I Excel Data File

Provided upon completion and submission of Intent to Propose Form

Appendix B Certification Letter

Suffolk County Required Compliance Forms In Accordance with County Laws

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

Section I Administrative Information

1. Purpose of RFP

a. The County of Suffolk (“County”), on behalf of the Suffolk County Departments set forth on page one, invites proposals (“Proposal(s)”) from qualified companies (“Proposer/Bidder”) to provide Prescription Benefit Management (“PBM” and “Services”) services for the Employer Group Waiver Prescription Drug Plan (“EGWP”) with Wrap for the self-insured Employee Medical Health Plan of Suffolk County (“EMHP”), a transparent pricing model, as described more fully in Section IV, entitled “Technical Requirements” and Section V, entitled “Technical Services Specifications (Detailed Scope of Services).

b. Proposers must submit a proposal to this RFP that includes the pricing model indicated in a.

above and consistent with the required terms included in Sections IV and V. Failure by the Proposer to comply with this requirement will result in disqualification of the Proposal.

c. The term Contractor (“Contractor”) shall mean the successful Proposer who may be awarded a contract pursuant to this RFP.

2. Coordinating Departments

a. Prior to Award of Contract

The Suffolk County Office of Central Procurement is responsible for coordinating with the Department regarding the issuance of this RFP:

Suffolk County Office of Central Procurement 335 Yaphank Avenue, Room 103 Yaphank, New York 11980 Main Tel: (631) 852-5196 Fax: (631) 852-5221

Contact: Kathleen Moosmueller, Contract Management Coordinator.

b. After Award of Contract

i. The Office of the County Executive, Division of Human Resources (“Department”) and the Suffolk County EMHP Labor/Management Committee (hereinafter the “EMHP Committee” or the “Committee”) are responsible for coordinating with the Suffolk County Attorney’s Office and the Contractor regarding the negotiation and execution of the contract.

ii. The County will execute a contract with the Contractor, based on the Model Contract included in this RFP. The Model Contract includes a required Business Associate Agreement (“BAA”) in the format set out in the Model Contract. The Proposal submitted by the Proposer in response to this RFP, including any Best and Final Offers (“BAFOs”) and supplemental material and representations including Proposer’s draft administrative services contract language (together “requested revisions”), as may be negotiated by the Department, all as may be negotiated by the Department may become directly incorporated into the final Contract and the contract terms. Such requested revisions will be taken into consideration, but shall not be deemed binding on the Department or Suffolk County.

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

iii. The County reserves the right to defer selection of a successful Contractor until after all terms of the proposed contract are negotiated and acceptable to the County. Note that the Model Contract is subject to negotiation and revision, based on the Department’s needs and the approval of the Committee, County Attorney’s Office.

c. After Execution of Contract

The Department and the EMHP Labor/Management Committee are responsible for management and supervision of the Contract.

3. Background Information

a. Suffolk County, with a population of 1.5 million, is Long Island's eastern-most county, and covers an area of approximately 900 square miles, 20 miles at its widest part and approximately 86 miles in length.

b. The County of Suffolk is a municipal corporation of the State of New York with an annual operating budget of approximately $4.3 billion. The County employs approximately 9,800 employees, with main offices located in Hauppauge, Yaphank, Riverhead, and several smaller locations.

4. Evaluation Committee and Award of Contract

a. The award of any contract will be made in the best interest of the County, taking into consideration cost as well as technical or other non-cost factors. The final selection of the Contractor will be made by the County Executive, upon recommendation by the EMHP Committee.

b. The contract between the County and Proposer will follow the format specified in this RFP.

However, the County reserves the right to negotiate provisions in addition to those contained in this RFP with the successful Proposer. The contents of this RFP, as revised and/or supplemented, and the successful Proposer’s proposal may be incorporated into and become part of the contract, at the option of the County.

5. Questions and Comments

a. Administrative Questions

Administrative questions (e.g., procedural questions on how to respond to this RFP) may be submitted by telephone or in writing (email acceptable) to the Office of Central Procurement staff member listed in paragraph 2 (a) of this section.

b. Technical Questions

Technical questions (questions which are specific to the service requested in this RFP) must be submitted on or before the date set forth on page one (1) of this RFP. Technical Questions must clearly identify the Section, paragraph and, if applicable, subparagraph of the RFP about which the question is posed. Responses to such technical questions will be developed by the Department and issued by the Office of Central Procurement in the form of an Addendum to this

RFP.

To contact the Suffolk County Office of Central Procurement or submit questions in relation to this RFP, respondents register with the Office’s Procurement Portal at https://suffolkcountyny.bonfirehub.com/portal (the “Portal”) and initiate communication https://suffolkcountyny.bonfirehub.com/portal

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County electronically through the “Messages” tab in the left column on Bonfire, then click “Vendor Discussions” to enter your question(s). The County will not accept any Proposer’s communications by any other means, except as specifically stated in this RFP.

Need Help? Please contact Bonfire directly at Support@GoBonfire.com for technical questions or issues related to your submission. You can also visit their help forum at https://bonfirehub.zendesk.com/hc

c. No Direct Contact

Proposers are prohibited from directing questions or comments regarding this RFP to any County employee or its contractors or any firm currently in contract with the County, or any EMHP Committee member, or official leader or member of any existing union or other recognized Suffolk County bargaining unit, except as set forth in sub-paragraphs 5.a and 5.b above or as may be requested or permitted by the Suffolk County Office of Central Procurement and/or the Suffolk County Department of Law. Failure to comply may result in immediate disqualification.

6. Due Date for Proposals

Proposals must be received by 3:30 p.m. EDT on the date set forth on page one of this RFP.

In the interest of fairness to all Proposers, no extensions or exceptions will be permitted, unless issued as an Addendum to this RFP and applicable to all Proposers.

7. Submission of Proposals

Suffolk County no longer will accept hard copies of RFP proposals. All submissions must be done online at the Portal https://suffolkcountyny.bonfirehub.com/portal/.

8. RFP Policies and Procedures

a. It is the County’s intent to select the Proposer that provides the best solution for the County’s needs. In order for the County to conduct a uniform review process of all Proposals, Proposals must be submitted in the format set forth below in the paragraph entitled “Proposal Format.”

Failure to follow this format may be cause for rejection of a Proposal because adherence to this format is critical for the County’s evaluation process.

b. At any time during the RFP process the County retains the right to unilaterally determine a Proposer’s qualification to participate in this RFP as a full service, principal PBM. In the event the County determines a Proposer is not so qualified, the Proposer shall be notified of said disqualification in writing, by the County.

c. The contract will be in the general format set forth in Section VII entitled “Model Contract,” but will be subject to final contract negotiations. All requested edits to the Model Contract should be submitted with your proposal. Proposers should also provide a copy of their Administrative Services Only agreement for evaluation and consideration of terms that may be integrated into the final agreement. All terms of each are subject to negotiation with the County and the final agreement will be in a form consistent with the Model Contract included within the RFP.

d. This RFP is not intended, and shall not be construed, to commit the County to pay any costs incurred in connection with any proposal or to procure or contract for any services.

https://bonfirehub.zendesk.com/hc

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

e. As a preliminary step, each Proposal will be examined to determine whether it is responsive to the requirements of this RFP. After such preliminary review, all responsive proposals will be evaluated.

f. The decision to award a contract shall be based on the ability of the Proposer to provide quality and needed services and products and to comply with all applicable laws, rules, and regulations, including without limitation the local preference and other Suffolk County local laws referenced in the Section entitled “Suffolk County Required Compliance Forms in Accordance with County Laws.”

g. While the County is under no obligation to contact Proposers for clarifications, it reserves the right to do so. Depending on the number and quality of the proposals submitted, the County, at the sole discretion of the RFP Evaluation Committee, may elect to interview all or some of the Proposers during the selection process and to request presentations. Proposers must be available for a possible finalist evaluation meeting and/or interview with the County and its agents, as determined by the County (date to be determined).

h. After evaluating proposals, the County may enter into negotiations with one proposer or multiple proposers. The primary purpose of negotiations is to maximize the County’s ability to obtain the best value based on the mandatory requirements, evaluation criteria, and cost. Multiple rounds of negotiations may be conducted with one proposer or multiple proposers. Negotiations will be structured by the County to safeguard information and ensure that all proposers are treated fairly.

i. The County may invite one or more proposers to submit one or more “Best And Final Offers” (“BAFOs”). Such invitation will establish the time and place for submission of the BAFO. Any BAFO that is not equal to or lower in price than the pricing offered in the proposer’s previous proposal may be rejected as non-responsive and the County may revert to consideration and evaluation of the proposer’s original pricing. Proposers must timely submit BAFO(s), in compliance with the County’s request. BAFO(s) submitted after the County’s deadline may be rejected.

j. If required, after review of the BAFO(s), clarification may be sought from the Proposer(s). The County may conduct more than one round of negotiations and/or BAFO submissions in order to attain the best value for the County.

k. The County will not necessarily choose the Proposer(s) with the lowest rates for Services.

Based on the evaluation criteria, a competitive range consisting of those Proposals which are acceptable to the County, or which could be made acceptable following written or oral presentations, will be determined.

l. The award of any contract will be made as judged to be in the best interest of the County.

m. The County will not be bound by oral explanations or instructions given during the competitive process or after the award of the contract.

9. RFP Posted On Bonfire Portal

This RFP is available on-line at: https://suffolkcountyny.bonfirehub.com/portal/. By downloading documents for this RFP, you will be notified of all future addendums.

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

10. Reservation of Rights

The County expressly reserves the right to:

a. Unilaterally determine whether a Proposer is qualified as a full service, principal third party claims administrator to render the services outlined in this RFP;

b. Reject or cancel any or all proposals or any part thereof submitted in response to this RFP;

c. Withdraw the RFP at any time, at the County’s sole discretion;

d. Disqualify any Proposer whose conduct and/or Proposal fails to conform to the requirements of the RFP;

e. Use Proposal information obtained through site visits, management interviews, and the County’s investigation of a Proposer’s qualifications, experience, ability or financial standing, and any material or information submitted by the Proposer in response to the County request for clarifying information in the course of evaluation and/or selection under this RFP;

f. Prior to Proposal opening, amend the RFP specifications to correct errors, or oversights, or to supply additional information as shall become available.

g. Prior to Proposal opening, amend the RFP specifications by issuing an addendum to correct errors, or oversights, or to supply additional information as shall become available;

h. Prior to Proposal opening, direct Proposers to submit Proposal modifications addressing subsequent RFP addenda;

i. Change any of the dates concerning the RFP award schedule;

j. Eliminate any mandatory, not-material specification that cannot be complied with by all of the prospective Proposers;

k. Waive any requirements that are not material;

l. Award negotiated contract to the successful Proposer;

m. Negotiate with the successful Proposer(s) within the scope of the RFP, in the best interest of the County;

n. Conduct contract negotiations with the next most qualified Proposer should the County be unsuccessful in negotiations with the selected Proposer;

o. Require clarification at any time during the procurement process and/or require correction of arithmetic or other apparent errors for the purpose of assuring a full and complete understanding of a proposal and/or to determine a Proposer’s compliance with the requirements of the RFP.

11. Pre-Proposal Required Form

All potential Proposers must complete the Intent to Propose Form For the Self-Funded Employee Medical Health Plan (“EMHP”) of Suffolk County (within Appendix I) and submit through Bonfire by February 2, 2026 3:30PM in order to receive an Excel Data File which includes Claims Experience, Enrollee Census and Network Access Information to be provided upon receipt of the completed form through Bonfire.

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

12. Proposal Format

The following materials are required to be received by the County by the Proposal Due Date set forth on the first page of this RFP. The topics listed under these general headings are minimum standards and should not be viewed as limitations to the information provided by the Proposer in response to this

RFP.

Your company must provide answers to the questions presented in this RFP. Each question must be answered specifically and in detail. Reference should not be made to a prior response, or another document, or to a link embedded in your Proposal, unless the question involved specifically provides such an option. Be sure to review this entire RFP before responding to any of the questions, so that you have a complete understanding of all the Plan's requirements with respect to the proposal.

a. Transmittal Letter (PDF file uploaded to appropriate section of the Bonfire portal)

A transmittal letter is a letter on the Proposer’s stationery. A corporate officer or an authorized agent of the Proposer must sign the transmittal letter. The transmittal letter must state the contact person who will be responsible for answering all questions of the RFP Evaluation Committee. Include the telephone number and e-mail address for such contact person.

b. Required Compliance Forms (to be completed/signed by a corporation officer or an authorized agent of the Proposer with binding authority). Note: the substance of these forms are not negotiable.

i. Certification Letter

The Certification Letter is included as Appendix B of this RFP. A corporation officer or an authorized agent of the Proposer must complete and sign one (1) original letter.

ii. Disqualification of Non-responsible Bidders (LL 52-2012 Form) (2 pages)

LL 52-2012 Form is included in the Section entitled “Suffolk County Required Compliance Forms in Accordance with County Laws.”

iii. Suffolk County Form 22 -- Contractor’s/Vendor’s Public Disclosure Statement (2 pages)

SCEX Form 22 is included in the Section entitled “Suffolk County Required Compliance Forms in Accordance with County Laws.”

A corporate officer, or an authorized agent of the Proposer, must sign one (1) original of form and have it notarized.

Please note that any Proposers who are not-for-profit corporations are not required to complete this form.

iv. Non-Collusive Offer Certification (FTS Form) (1 page)

FTS Form is included in the Section entitled “Suffolk County Required Compliance Forms in Accordance with County Laws.”

v. Lawful Hiring Forms (LHE-1/2 Form) (1 page)

This form is included in the Section entitled “Suffolk County Required Compliance Forms in Accordance with County Laws.”

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

The Labor Department’s Lawful Hiring of Employees Unit may be reached at (631)-853- 6600 for specific questions.

vi. Living Wage Forms (LW1/38 Form) (1 page)

These forms are included in the Section entitled “Suffolk County Required Compliance Forms in Accordance with County Laws.”

If the Living Wage Law applies and Section 1 is checked the chart must be completed.

The Labor Department’s Living Wage Unit may be reached at (631) 853-6600 for specific questions.

vii. Suffolk County Union Organizing Certification/Declaration (LO1 Form) (2 pages)

LO1 Form is included in the Section entitled “Suffolk County Required Compliance Forms in Accordance with County Laws.”

(Note: this Form will be required only from the Apparent Successful Proposer)

viii. Lobbying Certification Form

This form is included in the Section entitled “Suffolk County Required Compliance Forms in Accordance with County Laws.”

ix. Contractor’s Statement of Applicability of Local Preference Law – Section A4-13 of the Suffolk County Administrative Code (Local Preference Law)

Local Preference Law - Section A4-13 of the Suffolk County Administrative Code establishes a preference program for Suffolk County consulting contracts. This preference program requires all contracts for professional consulting services (engineering, architectural, planning, legal, and accounting, etc.) to be awarded to firms located and doing business within Suffolk or Nassau County, except where no local consultant has the necessary expertise or credentials to provide the needed service, or where the local consultant's response to a Request for Proposals (RFP) exceeds the otherwise lowest response by more than 10%. The local law contains specific definitions and language relative to application of this law which interested parties should review.

The laws of Suffolk County are available free of charge at https://www.ecode360.com/SU0867.

If applicable, include a statement with the Proposal asserting the applicability of the Local Preference Law. The statement must include the reasons for assertion of the applicability of the Local Preference Law.

c. Proposer Profile/Response to Questions set forth in the RFP Section entitled “Proposer Profile”

Proposers’ responses will be used in the County’s evaluation of the Proposers’ general qualifications.

d. Proposer’s Proposed Technical Services/Response to items set forth in the RFP Section entitled “Technical Requirements”

This Section will be used in the County’s evaluation of the Proposer’s proffered technical services.

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RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

e. List (if applicable) of Subcontractors, Affiliates, Sister-Companies and/or External Vendors (collectively referred to herein as “Subcontractors”)

Identify all subcontractors the Contractor plans to use, the function for which such subcontractors will be responsible, and the location from which said subcontractor will render said services/function.

For those subcontractors who, in the County’s sole opinion, will render a significant portion of the required services herein, e.g., customer service, the County reserves the right to require you to provide the following for such subcontractors, at any time during this RFP process:

- Provide qualifications, including prior relevant experience, for all subcontractors anticipated to be used (refer to Section II and III).

- Complete all County forms listed above in paragraph 12(b).

- Responses to all questions set forth in the RFP Section entitled “Proposer Profile.” This includes financial statements.

- Responses to all requirements, to the extent such requirements are applicable to the services they will be providing, set forth in the RFP Section entitled “Technical Requirements” and the Section entitled “Technical Services Specifications (Detailed Scope of Services).”

Failure to include this information in the Proposal may be grounds for disqualification.

f. Proposer’s Cost Proposal/Fee Schedule - Response to items set forth in the RFP Section entitled “Cost Proposal/Fee Schedule” (Section VI)

This Section will be used in the County’s evaluation of the Proposer’s proposed Cost Proposal/Fee Schedule.

g. Proposals shall be prepared avoiding the use of elaborate promotional materials beyond those sufficient to provide a complete, accurate, and reliable presentation. Each response in a Proposal shall clearly identify the section and paragraph number from the RFP to which it responds.

h. Do not alter the questions or question numbering.

i. Provide an answer to each question even if the answer is “not applicable” or “unknown.”

ii. Answer the question as directly as possible.

iii. If the question asks, “How many…” provide a number.

iv. If the question asks, “Do you…” indicate Yes or No followed by any additional narrative explanation.

v. If the question states “confirm”, indicate “confirmed” or “not confirmed”. If “not confirmed”, provide an explanation.

vi. Direct responses to all RFP questions must be provided and will be looked upon favorably.

vii. Proposer will be held accountable for accuracy/validity of all answers.

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

viii. The submission of your proposal will be deemed a certification that you will comply in every respect (including, but not limited to, coverage provided, funding method requested, benefit exclusions and limitations, underwriting provisions, etc.) with the requirements set forth in this RFP.

ix. If your proposal is different in any way (whether more or less favorable) from that indicated in this RFP, clearly indicate where and explain the difference. If you do not, the submission of your proposal will be deemed a certification that you will comply in every respect (including, but not limited to, coverage provided, funding method requested, benefit exclusions and limitations, underwriting provisions, etc.) with the requirements set forth in this RFP.

x. If you are unable to perform any required service, indicate clearly: a) what you are currently unable to do, and, b) what steps will be taken (if any) to meet the requirement, the timetable for that process and who will be responsible for the implementation, along with that person's qualifications.

ix. All products should be priced individually. If pricing terms are provided for combining services, show the pricing terms as a separate line item.

13. Award Criteria

a. General Qualifications: 20 points

Proposer’s history, expertise, experience, reliability, financial viability, and references. See RFP Section II, entitled “Proposer’s Profile” for specific requirements.

b. Proposed Technical Services/Products: 55 points

Strategies, methodologies, services offered by Proposer. See RFP Section IV, entitled “Technical Requirements” and Section V, entitled “Technical Services Specifications (Detailed Scope of Services)” for specific requirements.

c. Cost Proposal/Fee Schedule 25 points

Separate sealed envelope. See Section VI entitled “Cost Proposal/Fee Schedule Proposal” for specific requirements.

Total 100 points

14. Contract Terms and Conditions

a. As stated above in Section I, paragraph 2. b. ii., the executed contract will consist of the Model Contract and incorporation of significant terms and provisions of the Proposal in response to this RFP , inclusive of Proposer’s BAFO and supplemental materials submitted in conjunction with the Proposal and this RFP process, all as deemed acceptable to, and negotiated with the County.

b. If the Proposer has a concern or question regarding any of the terms and conditions included in the Model Contract, Section V, Technical Services Specification, 5. Additional Required

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

Contract Provisions and/or the BAA, the Proposer must identify such concerns or questions in the Proposal and itemize the proposed revisions to such terms for County’s review and consideration. Proposers are strongly encouraged to identify any objections to the standard terms and conditions of the Model Contract and the “Additional Required Contract Provisions” (included within Section VII and paragraph 3 of Section IV of this RFP) in their proposal. The County reserves the right to consider any such objections raised after submission as non-negotiable.

c. The Model Contract is subject to revision arising out of the terms and conditions imposed by law and/or deemed appropriate by the EMHP Committee and County Attorney’s Office.

d. If you are selected as a semi- or finalist, you will be expected to provide your draft administrative services contract (i.e., Technical Requirements/Technical Services Specifications/Detailed Scope of Work) specific or applicable to this retention and client for inclusion in Article I of the final contract (See Model Contract), both electronically and in a word document, with the most current proposed terms at that stage of the RFP process, which may be subject to modification as part of the negotiations with the County.

e. The County will execute a contract with principal contractors only. Any arrangements, including fee arrangements, brokerages, partnerships, or collaborations between the principal contractor and subcontractors that provide services as part of the Proposal, must be fully disclosed in the Proposal. No commissions are to be included and all proposals must be submitted directly from the contracting company, without any intermediary.

f. The Proposer should not return the Model Contract with the Proposal except for as provided above.

15. Use of County Resources to Interfere with Collective Bargaining Activities - Local Law No. 26-

Proposers are advised that the efficient, timely, and non-disruptive provision of goods and services is a paramount financial interest of the County and, as such, the County requires the potential Contractor to protect the County’s financial interest by adopting non-confrontational procedures for the orderly resolution of labor disputes, including but not limited to, neutrality agreements, majority authorization card agreements, binding arbitration agreements, fair communication agreements, non-intimidation agreements, and reasonable access agreements.

16. Non-Responsible Bidder

It shall be the duty of the Proposer to read, become familiar with, and comply with the requirements of Article II of Chapter 189 of the Suffolk County Code.

The Proposer certifies that it has complied with the disclosure requirements under section 189-7 of the Suffolk Code, it is in compliance with all applicable licensing laws, and that it either has not engaged in a prohibited act covered under section 189-5 of the Suffolk County Code or is otherwise exempt from the provisions of Article II of Chapter 189 of the Suffolk County Code under section 189-9.

This certification shall be set forth on the LL52-2012 Form “Disqualification of Non-Responsible Bidder.”

17. Effective Period of Proposals

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

All proposals must state the period for which the proposal shall remain in effect (i.e., how much time the County has to accept or reject the proposal under the terms proposed). Such period shall not be less than twenty (20) months from the Proposal due date. However, should pricing components of your proposal improve in other similar client contracts (with similar plan design arrangements) to the benefit of the County before the effective date of the contract following this proposal, then the contract between the parties shall include these improved pricing terms. If selected as the awardee of the contract pursuant to this process, Proposer will be required to provide its summary letter confirming all pricing and acceptance of this process, as well as attest to its offerings to other similarly situated clients during the contract negotiations process.

18. NYS Freedom of Information Law (FOIL)

All submissions for the County’s consideration will be held in confidence pending final execution of the contract(s) unless disclosure is required by law or judicial order. However, fully executed contracts are subject to the New York State Freedom of Information Law (“FOIL”), codified at Public Officers Law Article 6. Therefore, if a Proposer believes that any information in its submission constitutes a trade secret or is otherwise information which, if disclosed would cause substantial injury to the competitive position of the Proposer’s enterprise, and the Proposer wishes such information to be withheld if requested pursuant to FOIL, the Proposer shall submit with its Proposal a separate letter addressed to the primary contact referenced in this RFP, specifically identifying the page number(s), line(s) or other appropriate designation(s) of the Proposal containing such information, explaining in detail why such information is a trade secret or is other information which if disclosed would cause substantial injury to the competitive position of the Proposer’s enterprise, and formally requesting that such information be kept confidential. Failure by a Proposer to submit such a letter with its submission will constitute a waiver by the Proposer of any interest in seeking exemption of this information under Article 6 of the Public Officers’ Law relating to protection of trade secrets. The proprietary nature of the information designated confidential by the Proposer may be subject to disclosure if it is requested and the County deems it subject to disclosure or if ordered by a court of competent jurisdiction. A request that an entire Proposal be kept confidential may not be considered reasonable since a submission cannot reasonably consist of all data exempt from FOIL.

End of Text for Section I

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

Section II Proposer Profile

1. General Information/Proposer’s History

a. Company name and address.

b. Describe company ownership including Parent Company name or other majority owners.

c. Year company was founded and history.

d. Location(s) and hours from which services will be performed.

e. Total number of employees in company, and the number of employees at servicing office(s).

f. Contact person and title.

g. Describe the nature of your company (e.g., business corporation, not-for-profit corporation, proprietorship, etc.).

h. Total Number of self-funded Group Plans for which you currently administer their EGWP plan.

i. Number of self-funded Group Plans Terminated in the past twenty-four (24) months.

2. Qualifications and Experience of Personnel

a. Provide a brief biography and resumes of the senior officials responsible for the overall service of the account and for the day-to-day operations.

b. Provide resumes of the account manager and other key staff who will be assigned to this account (overall service and day-to-day operations).

c. For each professional listed above, describe his/her qualifications and provide information regarding:

i. Education;

ii. Professional licenses and other affiliations (copies of which shall be submitted with Proposals);

iii. Number of years engaged in services relating to the services requested in this RFP;

iv. Other relevant work experience or qualifications;

v. The role each identified person would play.

d. Describe other accounts involving similar services. Describe the role and experience of key personnel assigned to other similar accounts who will be assigned to this account.

e. Will temporary staff also be involved? If so, include details of their supervision and training.

f. In addition, Suffolk County may make such investigations as it deems necessary to determine the ability of the Proposer to perform the work. The Proposer shall furnish to the County, within five (5) business days of a request, all such information and data for this purpose as may be requested. The County reserves the right to reject any Proposal if the information submitted by, or investigation of such Proposer fails to satisfy the County that such Proposer is properly

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County qualified to carry out the obligations of the contract and to complete the work contemplated therein. Conditional Proposals will not be accepted.

3. Financial Viability

a. Financial Statements – Mandatory for Nongovernmental Agencies

Requirement specifications:

i. Current financial statement (if current year not available previous calendar year acceptable) prepared and certified by an Independent Certified Public Accountant (CPA) to include:

o Balance Sheet o Income Statement o Statement of Cash Flows o Opinion Letter

ii. If an independently audited financial statement is not available, the most current in-house Company financial statement is to include:

o Balance Sheet o Income Statement o Statement of Cash Flows o Financial Statement to be signed by one of the following attesting to the accuracy of the statement:

▪ Chief Executive Officer (CEO)/Chief Financial Officer (CFO)/Chief

Operating Officer (COO)

iii. Failure to submit complete, comprehensive documents may result in disqualification for consideration of an award.

b. Indebtedness to County, Liens, and Litigation

Submit a statement as to indebtedness, if any, to the County; and a listing of all outstanding liens, if any, against the Proposer. Submit a summary of all litigation, if any, against the Proposer and disposition or outcome of same.

c. Statement Regarding Bankruptcy

Include a statement disclosing any bankruptcy(ies) filed within the last seven (7) years. The statement must include the date the bankruptcy was originally filed, the current status, and, if applicable, the date the bankruptcy was discharged.

d. Insurance/Bond Coverage

Describe the fidelity and surety insurance or bond coverage you have carried in the past to protect clients. Specifically, describe the types and amounts insurance that has covered your employees and clients in the event of a loss in the past and provide copies if possible.

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

4. Client History

Provide a list of all clients for whom you have provided similar services within the last three (3) years.

For each client, provide the following:

a. Client name; and

b. Client address; and

c. Contact name, title, telephone # and e-mail address; and

d. Description of services provided, including type of plan administered, and time period;

e. Industry (if not obvious); and

f. Total number of members; and

g. Total number of covered lives under the prescription drug program.

5. References

a. From the list provided in response to paragraph 4, entitled “Client History,” provide a list of seven (7) client references (governmental or quasi-governmental agencies preferred), of which:

i. At least two (2) must be New York based;

ii. At least two (2) have participation between 10,000 and 25,000 employees; and

iii. At least two (2) must be new clients (with an effective date of January 1, 2024 or later) that can attest to their experience with your implementation capabilities.

b. If applicable, provide names, addresses and telephone numbers of two (2) clients with between 10,000 and 20,000 employees who terminated their relationship with your company in the last two (2) years.

c. Provide a list of all contracts with the County of Suffolk within the last five (5) years (regardless of type of service), the time period for those services and your primary County contact.

6. Conflicts of Interest and/or Potential Conflicts of Interest

Proposers must disclose to the County the existence of any conflicts of interest, whether existing or potential. If none exists, state so. Proposals shall disclose:

a. Relationships with Third Parties

Any Proposer to the County of Suffolk is charged with the continuing duty to disclose to the County the existence of any business relationship, financial or otherwise, that the Proposer, or any employee of the Proposer has with the County, any existing union or other recognized Suffolk County bargaining unit, or EMHP Labor/Management or RFP Evaluation Committee members or consultants, that may create a conflict of interest or the appearance of a conflict of interest in acting as a Contractor for Suffolk County.

b. Relationships with County Departments/Agencies/Employees

Any Proposer to the County of Suffolk is charged with the continuing duty to disclose to the County the existence of any interests it may have, contractual or otherwise, ongoing or previous, with:

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

i. Any County department, agency or employee, EMHP Committee member, official leader or member of any existing union or other recognized Suffolk County bargaining unit. This duty continues for so long as the Proposer is retained on behalf of the County or its employees;

ii. Any family relationship that the Proposer or any employee of the Proposer has with any County employee or the EMHP Labor/Management Committee members or consultants that may create a conflict of interest or the appearance of a conflict of interest acting as a Contractor for Suffolk County; and/or

iii. Any other matter that the Proposer believes may create a conflict of interest or the appearance of a conflict of interest acting as a Contractor for Suffolk County.

7. Subcontractors

If the County determines that one of the subcontractors you intend to use is going to render a significant portion of the services required hereunder, then the County reserves the right to require that subcontractor provide all of the information as required in this Section II, as noted in Section I, paragraph 12 e.

Note that the County must pre-approve the use of any subcontractors.

End of Text for Section II

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County

Section III Background Information

1. Administration

a. The County of Suffolk (“County”), a municipal corporation, created the self-insured Employee

Medical Health Plan of Suffolk County (“EMHP” or “Plan”) in 1991, through collective bargaining with its then nine (9) municipal labor unions (there are currently ten (10) municipal labor unions), by legislative resolution, with an effective starting date of January 1, 1992. The EMHP Labor/Management Committee (“EMHP Committee” or “Committee”) is responsible for the oversight of the operation and administration of the EMHP. The County is self-insured for the EMHP that provides health benefits to eligible County employees and retirees (“Enrollees”) and their eligible dependents (collectively referred to as “Members”). The County and Committee have decided not to secure stop-loss insurance at this time, nor is it seeking proposals for this type of insurance. The level of benefits provided by the EMHP is subject, at all times, to collective bargaining between the municipal labor unions and Suffolk County. The Plan is non-grandfathered under PPACA. The EMHP is a governmental plan, not subject to ERISA.

b. After the initial full file, thereafter, on a weekly basis, the Department transfers a “changes only” eligibility file to the current medical/surgical benefits and hospital benefits TPA through a SFTP upload site in a HIPAA 834 file format. It is the Department’s intent for eligibility information to be accessible through a seamless integration between the Contractor’s system and the County’s electronic payroll and workforce management system developed by Workday, Inc.

c. Control of enrollment, eligibility, COBRA administration and coordination with third-party administrators (currently Aetna Life Insurance Company, Optum Behavioral Health and Express Scripts, Inc.) is the responsibility of the Department’s Employee Benefits Unit (“EBU”).

2. EMHP Current Enrollment

a. The EMHP covers an enrollee population of approximately 21,000 which includes active County employees, retirees, dependent survivors, employees on leave of absence, self-pay members (i.e., adjunct faculty at Suffolk County Community College, vested participants, union and benefit fund employees) and COBRA participants.

b. The total number of covered lives within the EMHP is approximately 46,500. Approximately

34,000 lives are covered under the commercial Prescription Drug Program. Approximately 12,500 lives are covered under the EGWP with Wrap program.

3. EMHP Benefits Overview

a. The EMHP offers participants a full range of benefits; including a comprehensive indemnity medical plan with either in or out of network access to providers, a prescription drug plan (which features several clinical programs, including but not limited to, a Step Therapy Program, Drug Quantity Management, a multi-tier co-payment plan, preferred drugs/formulary, mandatory generic requirements and a mandatory mail order segment for maintenance drugs), and a mental health/substance use disorder program compliant with the mental health parity rules.

Retirees eligible for health coverage and who are enrolled in Medicare are eligible to be

RFP for Pharmacy Benefit Management (PBM) Services for the Employer Group Waiver Prescription Drug Plan (EGWP Plan) with Wrap to the Self-Insured Employee Medical Health Plan (EMHP) of Suffolk County reimbursed for the Medicare Part “B” premium costs as well as the income-related surcharge.

Medicare-prime (enrolled) retirees receive their prescription drug benefits through an EGWP program currently administered by Express Scripts, Inc.

b. The description of the Plan is set forth in the below listed documents and should be carefully reviewed by all Proposers.