AddendumTwo.pdf

Addendum #2

PEBB RFP for Medical and Pharmacy Benefit Services

OregonBuys Bid No. S-44300-00014758

This is Addendum #2 to Public Employees’ Benefit Board’s (PEBB) Request for Proposals (RFP) for comprehensive medical and pharmacy benefit services. Part A of this Addendum includes answers to questions received by the RFP’s Single Point of Contact through September 22, 2025 and at the September 16, 2025, Pre-Proposal Conference. Part B of this Addendum includes all formal changes in language and specifications to the RFP, including any of its corresponding attachments and exhibits.

Part A. Questions and Answers

Item No. Question / Request for Clarification Answer / Clarification Answer /

Clarification

Delivered by…

1 Hi. Please advise when Attachment "D" will be available. Thank you. Attachment D is currently marked as "Reserved". At this time, PEBB does not plan on issuing an Attachment D but rather plans on keeping it marked as "Reserved". If this changes and PEBB does add an Attachment D to the RFP, it will be done via formal Addendum, which will be publicly posted.

Addendum #2

2 Can you tell me what lines of business this is for? Assuming

Commercial. Any others? Also, how many lives? Go live date? RFP due date?

All of the answers to these questions are located in the Main RFP document. The

Main RFP documents include the key milestones and dates as well as the rules and processes governing this RFP. PEBB encourages Proposers to read and review the

Main RFP document before reviewing the other RFP documents that have been posted.

Addendum #2

3 Could you please advise when Attachment I (Sample Group Benefits

Contract) will be made available? This attachment is listed on page 4 of the Main RFP document, but I don't see it posted yet.

PEBB has posted Attachment I documents with Addendum #2. Addendum #2

4 What is the structure of the procurement/solicitation? Will the

State/PEBB entertain carveout solutions for navigation and clinical care management solutions outside of the medical carrier?

Please see the Main RFP document for information about how this RFP is structured.

As described in the Main RFP document, this RFP may result in various types of benefit Contracts including combined medical and pharmacy, medical only, and pharmacy only benefit Contracts.

This RFP does not currently contemplate awarding Contracts for other types of services, including the point solutions and various carve out programs that are part of

PEBB's current plan design.

Clarification

Delivered by…

5 Can you please describe how to respond to multiple proposal scenarios (i.e., medical only, pharmacy only, medical and pharmacy, regional, statewide)?

If you wish to submit multiple Proposals (based on the many toggles), please email

Heather Hein at hhein@proposaltech.com. Please also provide the identifying name for each invitation variation you are requesting.

Please note that every invitation requires the completion of the entire RFP (based upon your toggle selections).

Addendum #2

6 Can you confirm all redaction will occur in a process outside of

ProposalTech? At this time, ProposalTech displays an option for redaction.

Proposers should ignore the confidential answer button in Proposal Tech until it is removed or otherwise deactivated.

All Proposal and document redactions should follow the process that PEBB will outline in the near future. Please see Section 4.1 of the Main RFP document for a list of key dates and milestones, including the expected instructions for redacting

Proposals and other submitted documents.

Addendum #2

7 In the RFP it states the coastal region is from the coast to the cascades.

Can you please clarify whether it extends to the coastal range or the cascades?

The RFP's Oregon Coast region is located from the coast to the coastal range. Addendum #2

8 Are proposals accepted for partial regions or do they have to provide services to the entire region?

The RFP does not require that Proposers serve an entire region to be considered for that region.

Addendum #2

9 When was the last time that PEBB released an RFP for a carved out

PBM separately from medical?

The last time this business went out to bid was in 2013 for contracts effective in

2015; however, in that Procurement, the pharmacy only bid was reserved for the

Oregon Prescription Drug Program (OPDP).

Addendum #2

10 The scoring seems complex, is the intent to choose the highest medical and the highest pharmacy proposals?

Please see subsections 4.14 and 5.1.1 of the Main RFP document for information on how different types of Proposals are matched up and compared against one another as well as how PEBB will select the ASPs.

Please note that subsection 5.1.1 describes the instances where the Board may select a lower scoring Proposal over a higher scoring Proposal that is in direct competition with it.

Addendum #2

11 From a networks perspective, can you confirm if it's a narrow network that removes any major chains at this time?

PEBB's current Benefit Plans maintain a broad network. In 2026, the Board is introducing mandatory mail order or retail 90-day fills; however, the network will remain largely the same.

Addendum #2

12 For the pharmacy analytics and pricing, should we only include the claims data for the plans we are bidding on or for all 3 plans?

Proposers should provide the most competitive pricing Proposal possible for the population they intend to win. For the pharmacy analytics and contractual terms, please respond using all claims data in Attachment S, Pharmacy Data Tables, on the

Clarification

Delivered by… tab "Pricing Detail," including populations you do not intend to cover. When developing pricing for premiums, please only use claims data for the populations you are bidding on.

13 Will all addendums be available in ProposalTech and OregonBuys or just one or the other?

Addenda should be available in both places. Addenda are first posted on OregonBuys and then posted in Proposal Tech. Please note, however, that when Attachment A, Questionnaire, is updated, there will likely be a delay of two to three days between when the updated Attachment A document itself is posted with the Addendum to

OregonBuys and Proposal Tech and when the online questionnaire on the Proposal

Tech website will reflect those changes.

Addendum #2

14 Is it required to fill out the OregonBuys quote site before submitting in ProposalTech?

No submissions are required on OregonBuys. All proposal submissions must go through Proposal Tech.

Addendum #2

15 Will PEBB entertain protests that allow for a different plan structure? Please see Section 4.6 of the Main RFP document for information related to protesting the RFP process, Specifications, Scope of Work, and the proposed Sample

Group Benefits Contract.

Addendum #2

16 Is there a certain format that we wanted to submit questions in

ProposalTech and do they need to be consolidated and sent all at once?

There is no specific required format. Questions can be submitted on an ongoing basis, as they arise, using the process described in Section 4.2 of the Main RFP document.

Addendum #2

17 With regards to the list of the point solutions, are they all subcontracts to the Medical plans or are some of them directly contracted by

PEBB?

PEBB's current point solutions are provided through its current Medical Benefit

Plans. At this time, PEBB has no direct contracts with the various point solution

Vendors providing services to its Members.

Addendum #2

18 Based on the description in the main RFP document around goals and focus areas for PEBB, with the understanding that member experience and other areas are of key importance to PEBB, and also with the understanding that PEBB is planning to launch several solutions for the 2026 plan year that are being put in place without a procurement process, is there an opportunity to bid on those components as well

(specifically Garner and Collective Health)?

Please see the response to Item. No. 4 above. Addendum #2

19 Looking at Attachment C, it looks like there aren't regional solutions for the plans. Based on the current plan and the regions of the document, it's unclear if PEBB prefers a regional or a statewide approach or if that is to be determined?

This RFP allows Proposers to submit Proposals for numerous types of Benefit Plans, including statewide and various regional Benefit Plans.

Please see the fourth paragraph of subsection 1.1 of the Main RFP document for the

RFP's expected outcomes.

Clarification

Delivered by…

20 In the RFP it states that we can't talk to the Board, Staff, or Mercer about this procurement. Is there anyone else in the State of Oregon government we cannot talk to? For example, (ex) Governor

Kitzhaber?

Please do not divulge the contents of your Proposal or have any conversations related to this RFP with any current State of Oregon employee, public official, or contractor unless specifically authorized by this RFP.

Addendum #2

21 Can you please advise if we submit redactions before or after the proposal submission deadline?

Please see the response to Item No. 6 above. Redactions will be submitted after the

Proposal submission deadline per the key milestones and dates described in Section

4.1 of the Main RFP document.

Addendum #2

22 Does the RFP allow for the submission of a separate executive summary document that would include supplementary information about our proposed programs and benefits for PEBB, or would such additional documentation fall under the restriction stated regarding unsolicited additional documents (1.1 Introduction)?

Additional attachments will not be accepted, reviewed, or scored unless specifically requested in a questionnaire item or otherwise requested by PEBB during this RFP process.

Addendum #2

23 Can we submit both a medical only and a combined medical/pharmacy proposal? If we can, how do we do it?

Please see response to Item No. 5 above. Addendum #2

24 Does PEBB require us to offer/contract with particular point solution vendors, or are you seeking integration capabilities with your current vendor ecosystem?

Proposers are required to propose a plan design that is consistent with one of the plan designs described in Attachment C, Plan Designs, including offering the various point solutions or comparable programs either directly or through a subcontractor.

Please note that Questionnaire Item 2.5.2 of the questionnaire allows for Proposers to confirm whether they can contract with PEBB's current point solutions or propose a different solution.

Addendum #2

25 Question 2.6.1.6 in the Questionnaire document (page 154) indicates that the following data is contained in Attachment M:

•The number of admits by DRG for the time period excluding facilities subject to SB 1067

•The number of admits by DRG for the time period for facilities subject to SB 1067

•The total relative weights of the DRG admits by county using final version 42. DRGs without weights are not included.

•The total relative weights of the DRG admits by facility and county subject to SB 1067 using final version 42. DRGs without weights are not included.

Questionnaire items 2.6.1.4, 2.6.1.6, and 2.6.1.7 incorrectly reference Attachment M.

These questionnaire items should reference Attachment O, Provider Discount Data.

Clarification

Delivered by…

•Procedures by CPT code excluding all facilities subject to SB

•Allowed amount for all CPT codes by county

•Procedures by CPT code for all facilities subject to SB 1067

•Allowed amount for all CPT codes by facilities subject to SB

However, we do not see this data contained in Attachment M. Can you please advise where we can find this data?

26 Are Medical vendors that submit a combined (Medical + Rx) proposal also required to submit a Medical only proposal? Is there any way for a very strong Pharmacy Only proposal to win the business if no medical vendors submit strong Medical only proposals? I would think there is not much of an incentive for a Medical vendor to submit a strong Medical only proposal if it would only increase chances of

PEBB carving out the pharmacy benefit.

Proposers who submit a combined medical and pharmacy Proposal are not required to also submit a medical only Proposal. That said, PEBB highly encourages those

Proposers to do so.

Please see Sections 4.14 and 5.1.1 of the Main RFP document for a description of how various types of Proposals will be matched up and then compared.

While it is not guaranteed that a pharmacy only Proposal will be awarded a Contract under this RFP, PEBB believes that it is a real enough possibility that submitting medical only Proposals would hopefully be a worthwhile endeavor for Proposers.

Addendum #2

27 We have identified a discrepancy in the data between “Attachment U

Pharmacy Claims Data.xlsx” and the Data Summary in the first tab of file “Attachment S Pharmacy Data Tables.xlsx”. For example, the

Number of Rxs in the Data Summary tab of Attachment S is

1,358,167; whereas the Number of Rxs in the Claim Data File

(Attachment U) is 1,358,161. The Total Days' Supply in the Data

Summary tab of Attachment S is 61,495,331; whereas the Total Days'

Supply in the Claim Data File (Attachment U) is 61,495,325.

Additionally, the Undiscounted AWP in Attachment U is

$634,138,745.55; whereas in Attachment S' Data Summary tab is

$634,138,805.95.

Please confirm respondents should only use the data in "Attachment U

Pharmacy Claims Data.xlsx" to complete the information requested in the other tabs of Attachment S. If not, please provided an updated

Proposers should use the data in Attachment U to complete the information requested in other tabs of Attachment S.

Clarification

Delivered by… version of Attachment S with data summaries matching the data in

Attachment U.

Part B. Changes to RFP Language and Specifications

PEBB’s RFP for comprehensive medical and pharmacy benefits services, as posted under OregonBuys Bid no. S-44300-00014758, is hereby amended as follows:

1. The following documents for Attachment I, Sample Group Benefits Contract, have been posted:

a. Sample Medical and Pharmacy Group Benefits Contract

b. Sample Medical Only Group Benefits Contract

c. Sample Pharmacy Only Group Benefits Contract

Please note that each of the Attachment documents listed above contain numerous parts and exhibits.

2. The title page of the Main RFP document is amended so that the Opening Date and Time information reads as follows:

“5:00 pm on November 14, 2025”

3. Section 4.1, Schedule, of the Main RFP document is amended as follows:

a. The Schedule is updated to reflect that the Conference to Present Process for Public Record Redactions will be held 3:00pm-4:30pm on January 14, 2026.

b. The following meeting information related to the RFP Opening meeting and the Conference to Present Process for Public Record Redactions has been added to the end of Section

4.1, following the meeting information related to the pre-proposal conference:

“Please see the information below for attending the RFP Opening meeting as described above in the Section 4.1 schedule.

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Phone conference ID: 571 287 950#

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Please see the information below for attending the Conference to Present Process for Public Record Redactions as described above in the Section 4.1 schedule.

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Phone conference ID: 615 629 909#

For organizers: Meeting options | Reset dial-in PIN

For technical assistance, ODHS and OHA employees please contact the OIS Service Desk; guests, please click the "Learn more about Teams" link.

4. A third bullet is added to the list of Single Points of Contact included in Section 4.2 of the Main RFP document. This new third bullet reads as follows:

“If Proposers would like to submit multiple Proposals (for example, a combined medical and pharmacy Proposal in addition to a medical only Proposal), please email Heather Hein at hhein@proposaltech.com. Please also provide the identifying name for each Proposal invitation variation being requested.”

5. The last paragraph in Section 4.2 of the Main RFP document is amended to read as follows:

tel:+19712772343,,571287950 https://dialin.teams.microsoft.com/2df0f08c-5e2f-4516-b2d9-ce7dd2663420?id=571287950 https://teams.microsoft.com/meetingOptions/?organizerId=803ec649-d89a-41d3-9433-07fa2de17646&tenantId=658e63e8-8d39-499c-8f48-13adc9452f4c&threadId=19_meeting_MWVhOGFhOGQtYTk4OS00NDZjLTk0MzUtOTU1ZjBlZDdkNjcw@thread.v2&messageId=0&language=en-US https://dialin.teams.microsoft.com/usp/pstnconferencing https://aka.ms/JoinTeamsMeeting?omkt=en-US https://teams.microsoft.com/l/meetup-join/19%3ameeting_NWQ3NzdhNjYtMTg5Mi00NTNiLTg3MzAtNzRjYzljZTljYjdm%40thread.v2/0?context=%7b%22Tid%22%3a%22658e63e8-8d39-499c-8f48-13adc9452f4c%22%2c%22Oid%22%3a%22803ec649-d89a-41d3-9433-07fa2de17646%22%7d tel:+19712772343,,615629909 https://dialin.teams.microsoft.com/2df0f08c-5e2f-4516-b2d9-ce7dd2663420?id=615629909 https://teams.microsoft.com/meetingOptions/?organizerId=803ec649-d89a-41d3-9433-07fa2de17646&tenantId=658e63e8-8d39-499c-8f48-13adc9452f4c&threadId=19_meeting_NWQ3NzdhNjYtMTg5Mi00NTNiLTg3MzAtNzRjYzljZTljYjdm@thread.v2&messageId=0&language=en-US https://dialin.teams.microsoft.com/usp/pstnconferencing

“Please do not divulge the contents of your Proposal or have any conversations related to this RFP with PEBB personnel, including Board members and staff, unless specifically authorized by this RFP. In addition, please do not divulge the contents of your Proposal or have any conversations related to this RFP with any current State of Oregon employee, public official, or contractor unless specifically authorized by this RFP.”

6. The description of the Oregon Coast region in Section 4.14 of the Main RFP document is amended to read as follows:

“From the coast to the coastal range”

7. The third paragraph of Section 5.4.1, Negotiation, of the Main RFP document, is amended to read as follows:

“PEBB considers the following terms and conditions and other Contract provisions as non-negotiable:

Main RFP Document. The following term or provision has been deemed non-negotiable across all iterations of the Sample Group Benefits Contract:

• Contract Term

Exhibit A, Legal Terms and Conditions. The following terms or provisions have been deemed non-negotiable across all iterations of the Sample Group Benefits Contract:

• 8. Representations and Warranties

• 10. Independent Contractor; Responsibility for Taxes and Withholding

• 11. Records Maintenance; Access

• 12. Oregon Law

• 14. Foreign Contractor

• 15. Compliance with Applicable Law

• 16. Privacy and Security

• 17. Confidential Information

• 18. Indemnity

• 19. Insurance

• 20. Subcontracts, Successors, and Assignments

• 23. Entire Contract

• 24. Order of Precedence

• 25. Waiver

• 27. Force Majeure

• 28. No Third Party Beneficiaries

• 29. Severability

• 30. Code of Conduct

• 31. Pay Equity

• 32. Certifications

Exhibit B, Definitions. This exhibit has been deemed non-negotiable in its entirety across all iterations of the Sample Group Benefits Contract.

Exhibit C, Statement of Work.

The following terms or provisions have been deemed non-negotiable in the Combined Medical and Pharmacy iteration of the Group Benefits Contract:

• V. Contract Duration and Termination

• XV. Record Access, Retention, and Audits

• XVI. Litigation

• XVII.a. Gag Clause Prohibition

• XVII.b. Gag Clause Prohibition Compliance Attestation

• XVII.c. RxDC Reporting

• XVII.d. IRS Form 1099

The following terms or provisions have been deemed non-negotiable in the Medical Only iteration of the Group Benefits Contract:

• V. Contract Duration and Termination.

• XIV. Record Access, Retention, and Audits

• XV. Litigation

• XVI.a. Gag Clause Prohibition

• XVI.b. Gag Clause Prohibition Compliance Attestation

• XVI.c. RxDC Reporting

• XVI.d. IRS Form 1099

The following terms or provisions have been deemed non-negotiable in the Pharmacy Only iteration of the Group Benefits Contract:

• III. Maintenance of Records

• IV. Audit Rights

Exhibit D, Reporting and Performance Requirements.

The following terms or provisions have been deemed non-negotiable in the Combined Medical and Pharmacy iteration of the Group Benefits Contract:

• I.b. Raw Claims Data Report

• III.b. RxDC Reporting

The following terms or provisions have been deemed non-negotiable in the Medical Only iteration of the Group Benefits Contract:

• I.b. Raw Claims Data Report

• III.b. RxDC Reporting

The following terms or provisions have been deemed non-negotiable in the Pharmacy Only iteration of the Group Benefits Contract:

• 1. Raw Claims Data Report

Exhibit E, Rates. Currently, there are no terms or provisions deemed non-negotiable across all iterations of the Sample Group Benefits Contract.

Exhibit F, Data Sharing. This exhibit has been deemed non-negotiable in its entirety across all iterations of the Sample Group Benefits Contract.

Exhibit G, Insurance Requirements. This exhibit has been deemed non-negotiable, except for specific coverage amounts, across all iterations of the Sample Group Benefits Contract.

Exhibit H, Independent Contractor Certification. This exhibit has been deemed non-negotiable in its entirety across all iterations of the Sample Group Benefits Contract.

Exhibit I, Companion Guide. This exhibit has been deemed non-negotiable in its entirety across all iterations of the Sample Group Benefits Contract.”

8. Attachment A, Questionnaire and Other Response Items, has been updated to correct or clarify numerous questionnaire items in addition to adding questionnaire items related to the various iterations of Attachment I, Sample Group Benefits Contract. While these updates have been posted in an updated Attachment A with Addendum #2, it is expected that the online questionnaire in Proposal Tech will not go live until around October 7, 2025. Proposers should receive a notice from Proposal Tech when these updates go live for the online questionnaire.