PROVO CITY SCHOOL DISTRICT

REQUEST FOR PROPOSAL # PCSD12232025WKT

Group Medical and/or Pharmacy Benefit Management (PBM)

PURPOSE OF REQUEST FOR PROPOSAL (RFP)

Provo City School District (the “District”) (PCSD) is soliciting proposals from qualified organizations to provide Group Medical and/or Pharmacy Benefit Management (PBM) Services, effective September 1, 2026. PCSD currently operates under a self-funded model administered by UnitedHealthGroup, utilizing UMR as the medical third-party administrator and Optum Rx as the pharmacy benefit manager.

PCSD, in partnership with its employee benefits consultant, GBS Benefits, Inc., is seeking proposals that deliver competitive pricing with three (3) year administrative rate guarantees, transparent financial arrangements, robust administrative capabilities, and innovative strategies to manage healthcare costs while maintaining a high level of service for employees and their families.

PCSD encourages Offerors to present proposals that demonstrate proven experience serving large public-sector clients, excellence in claims administration, data analytics, network management, clinical programs, and commitment to transparency and accountability.

Offerors may submit proposals in one of the following three ways:

1. Combined Medical and PBM Proposal – fully integrated administrative and pharmacy services.

1. Medical Administration Only – medical claims administration services, excluding PBM.

1. PBM Only – pharmacy benefit management services.

Offerors must clearly identify which model(s) they are proposing. If submitting a combined proposal, Offerors must specify whether they can sell medical and PBM services independently and outline any impact this would have on pricing, guarantees, or contractual terms.

Provo City School District will not be liable for any cost proposers may incur in the preparation or presentation of this proposal.

BACKGROUND

Officially organized in 1898, Provo City School District is one of 41 public school districts in Utah. Consisting of two traditional high schools, an alternative high school, two middle schools, thirteen elementary schools, and a K-12 web-based school with the largest selection of online courses in the state, the district serves approximately 13,956 students. The district also provides additional programs, including preschool, adult high school completion, concurrent enrollment, advanced placement, special education, music, career technology, elementary dual language, multicultural programs, and gifted and talented programs.

ISSUING OFFICE AND RFP REFERENCE NUMBER

The District’s Business Services Department is the issuing and the District’s Human Resources Department is the conducting office for this document and all subsequent addenda relating to it. The reference number for the request is Solicitation # PCSD12232025WKT. This number must be referred to on all proposals, correspondence, and documentation relating to the RFP.

SUBMITTAL DEADLINE

Submission packets will be accepted electronically through Utah Public Procurement Place (Bonfire/Euna).

RFP DUE DATE: Friday, December 23rd, 2025 at 2:00 PM MST RFP's received after the deadline will be late and ineligible for consideration.

Submittals should be concise and address the specific items listed in the Request for Proposal.

LENGTH OF CONTRACT

The initial term of the contract resulting from this Request for Proposals (RFP) shall commence on September 1, 2026, and continue for a period of three (3) years.

The District reserves the option to extend the contract for up to two (2) additional one-year periods under the same terms, conditions, and pricing, upon mutual agreement between the contractor and the District.

Following completion of the initial term and any exercised one-year extensions, the District may, at its sole discretion, renew the contract on a year-to-year basis for up to an additional five (5) years if it is determined to be in the best interest of the procurement unit.

In accordance with Utah Code 63G-6a-1204, any renewal or extension beyond the initial term shall be supported by a written determination from the District stating that such renewal is in the best interest of the procurement unit. All renewals are contingent upon satisfactory contractor performance, continued need for the services, and the availability and appropriation of funds.

The district reserves the right to review the contract(s) regularly regarding performance and cost analysis and may negotiate price and service elements during the term of the contract.

PRICE GUARANTEE PERIOD

Pricing shall remain the same and be guaranteed for the initial three (3)-year contract term. If the District exercises its renewal option, pricing shall remain firm for up to two (2) additional one-year extension periods.

Following the guaranteed pricing period, any request for a price adjustment must include a guarantee for each annual renewal period and must be submitted in writing no fewer than sixty (60) calendar days prior to the proposed effective date. All requests must include sufficient supporting documentation to substantiate the proposed adjustment.

No price adjustment or contract amendment shall be valid unless approved in writing by Provo City School District.

The District shall receive the immediate benefit of any published price reduction, market decrease, or allowable discount that occurs during the term of the contract, including any renewal or extension period.

STANDARD CONTRACT TERMS AND CONDITIONS

Any contract resulting from this RFP will include but not be limited to the District’s Standard Terms and Conditions. Exceptions and or additions to the District’s Standard Terms and Conditions are strongly discouraged.

Exceptions and additions to the Standard Terms and Conditions must be submitted with the proposal response. Exceptions, additions, service level agreements, etc. submitted after the date and time for receipt of proposals will not be considered. Website URLs or information on website URLs must not be requested in the RFP document and must not be submitted with a proposal. URLs provided with a proposal may result in that proposal being rejected as non-responsive. URLs are also prohibited from any language included in the final contract document.

The district retains the right to refuse to negotiate on exceptions should the exceptions be excessive, or not in the best interest of the district, negotiations could result in excessive costs to the disrtict, or could adversely impact existing time constraints.

If negotiations are required, the contractor must provide all documents in MS Word format for redline editing. The contractor must provide the name, contact information, and access to the person(s) who will be directly involved in legal negotiations.

SCOPE OF WORK

The successful Offeror(s) will be expected to provide services in accordance with the proposal type submitted. PCSD reserves the right to award separate contracts for Medical and PBM services or to a single entity for combined administration.

A. Medical Administration Services

- Process all medical claims accurately and in compliance with applicable laws and regulations.

- Maintain a robust provider network offering comprehensive access for District employees.

- Provide dedicated account management, implementation support, and responsive customer service.

- Integrate eligibility, enrollment, and claims data exchange with the PBM vendor as applicable.

- Deliver reporting and analytics on plan performance, cost containment, and utilization.

- Participate in the District’s claims repricing process for finalist consideration.

B. Pharmacy Benefit Management Services

- Provide URAC-accredited PBM services, including retail, mail-order, and specialty pharmacy management.

- Administer a transparent pricing model with rebate disclosure and clear definitions of all revenue sources.

- Deliver comprehensive formulary management, clinical programs, and member engagement tools.

- Coordinate with the medical administrator for eligibility, accumulator, and data exchange.

- Participate in the RingmasterRx PBM repricing process as detailed in this RFP.

C. Combined Proposals

- Integrate Medical and PBM functions to ensure seamless coordination of care and consolidated reporting.

- Provide unified eligibility and data interfaces.

- Deliver a single, combined ID card and consolidated member communications.

- Clearly identify cost impacts if Medical or PBM services are unbundled.

MINIMUM MANDATORY REQUIREMENTS CHECKLIST

Offerors must confirm compliance with each applicable requirement by completing the checklist corresponding to their proposal type. The Checklist can be found in the Files section in the Utah Public Procurement Place (Bonfire/Euna) Portal.

A. Medical Requirements

· Licensed to conduct business in the State of Utah.

· Demonstrated capability in administering self-funded public-sector plans.

· Compliance with HIPAA and other applicable privacy regulations.

· Ability to exchange eligibility with the District’s benefit administration platform (Employee Navigator).

· Ability to exchange eligibility and claims data with the selected PBM.

· Provide a Utah-based or regionally accessible Account Manager.

· Willingness to participate in a claims repricing process.

· Three-year rate guarantee from the effective date.

· Administrative renewals must be available to the District 210 days prior to renewal.

· Provide ongoing monthly medical claims data feeds to PCSD or its designee (currently Cedar Gate Technologies).

· Attend and participate in annual benefit fairs.

· Responsible for drafting Summary Plan Descriptions (SPDs); hard copies available upon request.

· Confirm review and acceptance of the current plan design.

· Must agree to coordinate with designated stop loss carrier (to be finalized).

B. PBM Requirements

· URAC-accredited PBM and Specialty Pharmacy.

· Licensed to conduct business in the State of Utah.

· Commitment to financial transparency, including clear definitions of all revenue sources and rebate disclosure.

· Provide standard NCPDP claims feeds and accumulator data to the Medical TPA.

· Participate in the RingmasterRx repricing process.

· Three-year rate guarantee from the effective date.

· Renewals available 180 days prior to contract renewal.

· Provide ongoing monthly pharmacy claims data feeds to PCSD or its designee (currently Cedar Gate Technologies).

TECHNICAL RESPONSE QUESTIONS

Offerors must provide a point-by-point narrative response to each section that applies to their proposal type.

Medical Technical Questions Firm Qualifications and Value Adds – Schedule A - 175 Points Possible

· Describe your account management structure and key personnel.

· Describe your clinical programs (e.g., care management, wellness initiatives).

· What is the process to obtain certificate of coverage letters, does the employee have a portal that this would be available on?

· Are you available to come in person for an open enrollment benefit lab to aid employees with questions?

· Explain the support you would offer to Provo City School District’s Benefits Coordinator

Demonstrate Ability – Schedule B – 210 Points Possible

· Explain your claims adjudication accuracy and turnaround standards.

· Provide an overview of your reporting and data analytics capabilities.

· Explain how you coordinate with external PBM partners.

· Explain how ambulatory service claims are processed, do you outsource ambulatory services or any other services?

· Do you use a third party to review and audit high-cost claims? If so, what is the standard expected time for adjudication of the claim?

· Explain the process of a denial of a procedure, particularly if the member contests the denial.

· What is your standard time frame for claims processing?

Experience implementing self-funded plans – Schedule C – 140 Points Possible

· Describe your experience administering self-funded medical plans for school districts or similar public-sector clients.

· Outline your implementation process and timeline.

Strength of Provider Network – Schedule D – 140 Points Possible

· Provide details on your provider network in Utah, including access statistics.

· Confirm your ability to participate in the claims repricing project and identify your preferred format.

References - Schedule E – 35 Points Possible

· Offerors must provide at least three (3) client references, including at least two (2) municipal or school district clients and at least two (2) self-funded clients. For each reference, include organization name, contact person, title, phone number, email, services provided, and length of relationship.

Price Proposal Schedule F– 300 Points Possible The Price proposal can be found in the Files section in the Utah Public Procurement Place (Bonfire/Euna) Portal.

PBM Technical Questions Firm Qualifications and Value Adds – Schedule A-PBM – 210 Points Possible

1. Describe your organization’s structure, ownership, and PBM business model.

1. Are you available to come in person for an open enrollment benefit lab to aid employees with questions?

1. Explain the support you would offer to Provo City School District’s Benefits Coordinator.

Demonstrate Ability – Schedule B-PBM – 245 Points Possible

· Explain your formulary strategy, including specialty and limited distribution drugs.

· Describe your clinical programs and utilization management processes.

· Explain how you manage accumulator integration and coordination with medical carriers.

· Describe your reporting capabilities, including rebate, utilization, and savings reports.

· Explain how your PBM integrates with the medical plan?

· What is your standard time frame for claims processing?

Price Transparency and Ringmaster Submission – Schedule C-PBM – 210 Points Possible

· Provide your approach to rebate transparency and definitions of all revenue sources

· Confirm your participation in the RingmasterRx PBM repricing process.

References - Schedule D-PBM – 35 Points Possible

· Offerors must provide at least three (3) client references, including at least two (2) municipal or school district clients and at least two (2) self-funded clients. For each reference, include organization name, contact person, title, phone number, email, services provided, and length of relationship.

Price Proposal Schedule E– 300 Points Possible The Price proposal can be found in the Files section in the Utah Public Procurement Place (Bonfire/Euna) Portal.

RINGMASTERRX PBM REPRICING PROCESS

As part of this RFP, RingmasterRx will be used to:

- Centralize and streamline the proposal process by enabling direct submission and comparison of PBM bids within a single platform.

- Distribute detailed claims data and bid specifications to all participating PBMs to ensure proposals are tailored to the plan sponsor’s actual utilization and needs.

- Collect standardized responses through a structured RFP questionnaire that captures all relevant pricing guarantees, exclusions, specialty drug lists, and limited distribution drug lists.

- Apply a consistent evaluation methodology that enables objective comparison across bidders, accounting for both financial and contractual elements.

- Provide visibility into RFP status, allowing PBMs to track the progress of the RFP.

- Vendors are required to utilize the RRINGMASTERRX PBM Repricing Process when preparing their proposal. This platform does charge a usage fee. All costs associated with accessing or using this service are the sole responsibility of the vendor and may not be passed on to the District in any form.

Once a bidder confirms their intent to participate in the RFP process, they will receive an email invitation from RingmasterRx with instructions to access and respond to the bid. For bidders new to the platform, an activation email will be sent to create an account. Upon logging in, bidders can navigate the system and complete their RFP submission following the step-by-step guidance provided in the RingmasterRx PBM Response Guide. Please email Woody Turnbeaugh at woodyt@provo.edu if you intend to bid and would like to receive the email invitation.

QUESTIONS

All questions must be submitted through the Utah Public Procurement Place (“Bonfire/Euna”). Answers will be given via the Bonfire/Euna site.

SUBMITTING YOUR PROPOSAL

Proposals must be received by the posted due date and time. Proposals received after the deadline will be late and ineligible for consideration.

Both the technical and cost proposals must be received electronically through Bonfire/Euna.

All submitted proposals will consist of a technical proposal and a cost proposal. (Do not send extra materials, ancillary materials, or physical samples.) For the electronic proposal submission, you should attach two separate documents in Bonfire/Euna in the questions section: a question titled “Technical Proposal” and “Cost Proposal” will be available for submitting these items.

When submitting a proposal electronically through Bonfire/Euna, please allow sufficient time to complete the online forms and upload documents. The solicitation will end at the closing time listed in the RFP. If you are in the middle of uploading your proposal at the closing time, the system will stop the process and your proposal will not be received by the system.

Bonfire/Euna’s site will accept a wide variety of document types as attachments. However, the District is unable to view certain documents. Therefore, you MAY NOT submit documents that are embedded (zip files), movies, wmp, and mp3 files. All documents must be attached as separate files.

NOTICE: By submitting a proposal in response to this RFP, the offeror is acknowledging that the requirements, scope of work, and evaluation process, outlined in the RFP are fair, equitable, not unduly restrictive, understood, and agreed to. Any exceptions to the content of the RFP must be protested to the purchasing agent before the closing date and time for submission of the proposal.

PROPOSAL EVALUATION CRITERIA

The committee will evaluate proposals against the following weighted criteria. Each area of the evaluation criteria must be addressed in detail in the proposal. All proposals in response to this RFP will be evaluated in a manner consistent with the Utah Procurement Code, rules, policies, and the evaluation criteria established in the RFP.

POINTS EVALUATION CRITERIA

700 Technical Criteria

300 Cost Proposal

Understandability and comprehensiveness of the information supplied in this RFP will affect the evaluation of the above criteria.

Scoring by the evaluation committee will utilize the scoring rubric included in the uploaded documents in Bonfire/Euna.

Presentations/demonstrations

The evaluation committee will present its preliminary scores to the Purchasing Department after examining Schedules A through F for Medical Providers and Schedules A-E for PBM providers. At that point, in-person presentations/demonstrations will be required of all vendors who received a minimum of 750 points from totaling the appropriate schedules. The vendors will be informed of the presentations with at least one week's notice, along with the precise date and time. All presentations will be at the offeror’s expense.

To facilitate a focused and productive presentation, upon notice of invitation, vendors will be provided with a script of questions that the evaluation committee would like addressed during the presentation. This will enable vendors to thoroughly prepare and ensure that all relevant topics are covered. Presentations will be focused on the vendor’s submitted materials and the script provided.

The inclusion of presentations/demonstrations allows the evaluation committee to gain a deeper understanding of each vendor's capabilities, approach, and suitability for the project, enhancing the evaluation process. All preliminary scores may be adjusted after vendor presentations.

AWARD OF CONTRACT

Award shall be made to the offeror(s) whose proposal is the most advantageous to the District, taking into consideration price and the other evaluation factors outlined in this request for proposals. The District reserves the right to award the contract(s) to a technically qualified lower-cost offeror(s) in the event the high-scoring offer is determined not to be the best value offered to the District, based on a cost-benefit analysis.