Attachment 1 - GIC 2026 RFR for PBM Services_Final.pdf

THE COMMONWEALTH OF MASSACHUSETTS

GROUP INSURANCE COMMISSION

ONE ASHBURTON PLACE, SUITE 1413

BOSTON, MA 02108

Request for Response (RFR) Procuring a Pharmacy Benefit Manager for the Group Insurance

Commission

COMMBUYS Bid #: BD-26-1049-GIC00-07GIC-130036

Agency Document Number: GICPND2604

July 8, 2026

Please Note: This is a single document associated with a complete Bid (also referred to as

Solicitation) that can be found on COMMBUYS (www.COMMBUYS.com). All Bidders are responsible for reviewing and adhering to all information, forms and requirements for the entire Bid, which are all incorporated into the Bid. Bidders may also contact the COMMBUYS Helpdesk at

COMMBUYS@state.ma.us or the COMMBUYS Helpline at 1-888-MA-STATE. The Helpline is staffed from 8:00 AM to 5:00 PM Monday through Friday eastern standard or daylight savings time, as applicable, except on federal, state and Suffolk county holidays.

http://www.commbuys.com/ mailto:COMMBUYS@state.ma.us

The Group Insurance Commission GICPND####

GICPND2604 i

Table of Contents

1. Table of Contents ............................................................................................................ i

2. RFR Introduction

• Notice of Intent to Release

• RFR General Description and Background

─ Procurement Scope and Description ─ Applicable Procurement Law ─ Number of Awards ─ Eligible Entities ─ Acquisition method(s) ─ Contract duration

3. Required RFR Specifications

• General Provisions

─ Estimated Procurement Calendar ─ Inquiries ─ Detailed Claims Data and Census File ─ Bidders’ Conference ─ Proposals ─ Finalist Interviews

4. Request for Response

• Overview of GIC Benefits and Goals

• Minimum Qualifications Agreement

• Essay Questions

• Technical Proposal

• Financial Proposal

• COMMBUYS Market Center – Submitting a Quote

─ Quote Submission Method ─ COMMBUYS Quote Submission Training and Instructions ─ COMMBUYS Support ─ Bid Opening Date/Time

The Group Insurance Commission GICPND####

GICPND2604 ii

─ Quote Contents ─ Electronic Signatures ─ Acceptable Forms of Signature

• Supplier Diversity Program (SDP)

─ Program Background ─ Financial Commitment Requirements ─ Eligible SDP Partner Certification Categories ─ Eligible Types of Business-to-Business Relationships

─ Program Flexibility ─ SDP Plan Form Requirements ─ Evaluation of SDP Forms

─ SDP Spending Reports & Compliance ─ SDP Spending Compliance ─ SDP Spending Verification ─ Program Resources and Assistance

• Bid Specification and Submission Process

─ RFR Submission Checklist

• Instructions for Execution and Submission of Commonwealth Standard Forms

─ Electronic Signatures ─ Ink Signatures ─ Commonwealth Standard Contract Form ─ Commonwealth Terms and Conditions ─ Request for Taxpayer Identification Number and Certification (Mass. Substitute W9

Form) ─ Contractor Authorized Signatory Listing ─ Supplier Diversity Program Plan ─ Prompt Payment Discount Form

The Group Insurance Commission

GICPND2604

RFR Introduction

Notice of Intent to Release

Notice of Intent to Release Pharmacy Benefit Manager RFR (Commercial & EGWP)

May 29, 2026

The Commonwealth of Massachusetts Group Insurance Commission (the GIC) intends to post a combined Request for Response (RFR) to procure a Pharmacy Benefit Manager

(PBM) for both its Commercial and Employer Group Waiver Plan (EGWP) populations. The

GIC’s objective is to secure best-in-class clinical, financial, and operational PBM capabilities that deliver high-quality member care and sustainable cost management.

Important instructions for prospective bidders

• Do not contact the Purchaser about the content of the anticipated RFR prior to its release. Bidders are solely responsible for monitoring the COMMBUYS posting for the complete RFR and any subsequent amendments.

• Bidders may monitor the posting using COMMBUYS public search and browse tools or by subscribing to COMMBUYS email notifications and record tracking. To receive notifications for this RFR, ensure the following commodity codes are included in your COMMBUYS profile: 80-10-00-00 (Management Advisory Services) and/or 84-13-00-00 (Insurance and Retirement Services). To subscribe, select Register at commbuys.com and complete the online registration process.

About the GIC

The GIC was established by the Massachusetts legislature in 1955 to provide and administer health insurance and other benefits for Commonwealth employees, retirees, their dependents and survivors. The GIC also provides coverage for participating municipalities, certain housing and redevelopment authority personnel, and certain retired municipal employees and teachers. The GIC is a quasi‑independent state agency governed by a

17‑member Commission appointed by the Governor; the Commission approves most GIC initiatives, benefit changes, and rates. Currently, the GIC provides health insurance coverage for over 260,000 enrollees, covering more than 420,000 people in total, including over

120,000 Medicare participants.

Current program and contract scope

• The GIC contracts with four carriers to offer twelve health plans across their active/non‑Medicare and Medicare eligible retiree populations

• Current PBM administration: CVS Health (Caremark) for Commercial (active employees and non‑Medicare retirees) and a separate EGWP contract for Medicare plan members

• Additional plan information is available on the GIC website mass.gov/GIC http://www.mass.gov/anf/employee-insurance-and-retirement-benefits/ http://www.commbuys.com/ https://www.mass.gov/orgs/group-insurance-commission http://www.mass.gov/anf/employee-insurance-and-retirement-benefits/

Estimated membership and annual gross costs

• Commercial (active/non‑Medicare): ~305,133 members; annual pharmacy gross costs ≈ $830,613,273

• EGWP (Medicare eligible retirees): ~120,011 members; annual pharmacy gross costs ≈ $736,708,269

• Contract start date for both Commercial and EGWP services: July 1, 2027

Interested vendors may bid on either or both of the Commercial and EGWP contracts:

however, each contract will be priced and evaluated separately.

• Bidders must demonstrate substantial, documented experience managing large‑scale pharmacy benefit programs, including:

- Proven clinical programs and outcomes.

- Robust financial controls, transparent reporting, and effective cost‑management strategies.

- Operational excellence in network management, pharmacy operations (retail, mail, specialty), and member/customer service.

- Experience implementing and administering large EGWP arrangements.

• Bidders must confirm compliance with Massachusetts’ 2025 PBM law and Division of Insurance (DOI) licensing.

The full RFR will be available via COMMBUYS on or about Wednesday, July 8, 2026, at commbuys.com.

• RFR file number: BD-26-1049-GIC00-07GIC-130036

• RFR title: “GICPND2604 Procuring a Pharmacy Benefit Manager for the Group Insurance Commission.”

• Tentative schedule (please note the RFR will state the definitive submission deadline and final schedule)

- RFR release: on or about Wednesday, July 8, 2026

- Bidders’ conference: Wednesday, July 29, 2026

- Response deadline (tentative): Wednesday, August 5, 2026

Questions regarding the RFR should be directed to:

• Jannine Dewar at Jannine.Dewar@mass.gov (GIC)

• Jasmyn Plasencia at Jasmyn.Plasencia@mercer.com (Mercer, advising the GIC)

The GIC reserves the right to reject any or all responses, or to accept any proposal or portion thereof, as deemed to be in the best interest of the Commonwealth and its insured.

Matthew Veno Executive Director Group Insurance Commission

RFR General Description and Background

Procurement Scope and Description

The Commonwealth of Massachusetts Group Insurance Commission is soliciting Bidders for the acquisition of vendor(s) to provide Pharmacy Benefit Management (PBM) services to approximately 420,000 GIC managed active employees/non-Medicare retirees and Medicare retirees, with coverage to begin on July 1, 2027.

Applicable Procurement Law

This Bid is issued under the following law(s):

MGL c. 7, § 22; c. 30, § 51, § 52; and 801 CMR 21.00 (Goods and Services)

Number of Awards

Interested vendors may bid on either or both of the Commercial and EGWP contracts;

however, each contract will be priced and evaluated separately. The GIC is prepared to award more than one Contract if it is in the best interest of the Commonwealth to do so.

Eligible Entities

Any contract resulting from this Bid will be open for use to the Issuing Entity Only.

Acquisition method(s)

The acquisition method to acquire services from this Bid is rate-based (including but not limited to: guaranteed discounts, dispensing fees, rebates, admin fees, etc.).

Contract duration

The expected duration of this contract is as follows:

CONTRACT DURATION NUMBER OF YEARS/MONTHS

Initial Duration The Contract will be executed for the Initial Duration of three years and will run from the Contract Effective/Start Date

(execution date) for this Initial Duration.

Renewal Options Two options to renew for one year each at the GIC’s sole discretion.

Total Maximum

Contract Duration

Maximum duration of this contract is five years.

No goods may be ordered and no new leases, rentals, maintenance, or other agreements for services may be executed after the Contract has expired.

Required RFR Specifications

General Provisions In general, most of the required contractual stipulations are referenced in the Standard

Contract Form and Instructions and the Commonwealth Terms and Conditions. However, the following RFR provisions must appear in all Commonwealth competitive procurements conducted under 801 CMR 21.00.

The terms of 801 CMR 21.00: Procurement of Commodities and Services are incorporated by reference into this RFR. Words used in this RFR shall have the meanings defined in 801

CMR 21.00. Additional definitions may also be identified in this RFR. Other terms not defined elsewhere in this document may be defined in OSD’s Glossary of Terms. Unless otherwise specified in this RFR, all communications, responses, and documentation must be in English, all measurements must be provided in feet, inches, and pounds and all financial proposals or figures in U.S. currency. All responses must be submitted in accordance with the specific terms of this RFR.

Best Value Selection and Negotiation. The GIC may select the response(s) which demonstrates the best value overall, including proposed alternatives that will achieve the procurement goals of the GIC. The GIC may negotiate a change in any element of an original

RFR response which results in lower costs or a more cost effective or better value than was presented in the selected bidder’s or contractor’s original response.

Bidder Communication. Bidders are prohibited from communicating directly with any employee of the procuring department or any member of the SST regarding this RFR except as specified in this RFR, and no other individual Commonwealth employee or representative is authorized to provide any information or respond to any question or inquiry concerning this

RFR. Bidders may contact the contact person for this RFR in the event this RFR is incomplete or the bidder is having trouble obtaining any required attachments electronically through COMMBUYS.

Contract Expansion. If additional funds become available during the contract duration period, the department reserves the right to increase the maximum obligation to some or all contracts executed as a result of this RFR or to execute contracts with contractors not funded in the initial selection process, subject to available funding, satisfactory contract performance and service or commodity need.

Costs. Costs which are not specifically identified in the bidder’s response, and accepted by a department as part of a contract, will not be compensated under any contract awarded pursuant to this RFR. The Commonwealth will not be responsible for any costs or expenses incurred by bidders responding to this RFR.

Electronic Funds Transfer (EFT). All bidders responding to this RFR must agree to participate in the Commonwealth Electronic Funds Transfer (EFT) program for receiving payments, unless the bidder can provide compelling proof that it would be unduly burdensome. EFT is a benefit to both contractors and the Commonwealth because it ensures fast, safe and reliable payment directly to contractors and saves both parties the cost of processing checks. Contractors are able to track and verify payments made electronically through the Comptroller’s Vendor Web https://www.mass.gov/info-details/glossary-of-terms-for-osd system. Additional information about EFT is available on the VendorWeb site

(www.mass.gov/osc). Click on Vendors.

Successful bidders, upon notification of contract award, will be required to enroll in EFT as a contract requirement by completing and submitting the Authorization for Electronic Funds

Payment Form to this department for review, approval and forwarding to the Office of the

Comptroller. If the bidder is already enrolled in the program, it may so indicate in its response.

Because the Authorization for Electronic Funds Payment Form contains banking information, this form, and all information contained on this form, shall not be considered a public record and shall not be subject to public disclosure through a public records request.

The requirement to use EFT may be waived by the SST on a case-by-case basis if participation in the program would be unduly burdensome on the bidder. If a bidder is claiming that this requirement is a hardship or unduly burdensome, the specific reason must be documented in its response. The SST will consider such requests on a case-by-case basis and communicate the findings with the bidder.

HIPAA: Business Associate Contractual Obligations. Bidders are notified that any department meeting the definition of a Covered Entity under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will include in the RFR and resulting contract sufficient language establishing the successful bidder’s contractual obligations, if any, that the department will require in order for the department to comply with HIPAA and the privacy and security regulations promulgated thereunder (45 CFR Parts 160, 162, and 164) (the

Privacy and Security Rules). For example, if the department determines that the successful bidder is a business associate performing functions or activities involving protected health information, as such terms are used in the Privacy and Security Rules, then the department will include in the RFR and resulting contract a sufficient description of business associate’s contractual obligations regarding the privacy and security of the protected health information, as listed in 45 CFR 164.314 and 164.504 (e), including, but not limited to, the bidder's obligation to: implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the protected health information (in whatever form it is maintained or used, including verbal communications);

provide individuals access to their records; and strictly limit use and disclosure of the protected health information for only those purposes approved by the department. Further, the department reserves the right to add any requirement during the course of the contract that it determines it must include in the contract in order for the department to comply with the Privacy and Security Rules. Please see other sections of the RFR for any further HIPAA details, if applicable.

Minimum Quote (Bid Response) Duration. Bidders Quotes made in response to this Bid must remain in effect for at least 90 days from the date of quote submission.

Prompt Payment Discounts (PPD). All bidders responding to this procurement must agree to offer discounts through participation in the Commonwealth Prompt Payment Discount (PPD) initiative for receiving early and/or on-time payments, unless the bidder can provide compelling proof that it would be unduly burdensome. PPD benefits both contractors and the

Commonwealth. Contractors benefit by increased, usable cash flow as a result of fast and efficient payments for commodities or services rendered. Participation in the Electronic Funds

Transfer initiative further maximizes the benefits with payments directed to designated accounts, thus eliminating the impact of check clearance policies and traditional mail lead time https://massfinance.state.ma.us/VendorWeb/vendor.asp http://www.mass.gov/osc or delays. The Commonwealth benefits because contractors reduce the cost of products and services through the applied discount. Payments that are processed electronically can be tracked and verified through the Comptroller’s Vendor Web system. The PPD form can be found as an attachment for this Bid on COMMBUYS.

Bidders must submit agreeable terms for Prompt Payment Discount using the PPD form within their proposal, unless otherwise specified by the SST. The SST will review, negotiate or reject the offering as deemed in the best interest of the Commonwealth.

The requirement to use PPD offerings may be waived by the SST on a case-by-case basis if participation in the program would be unduly burdensome on the bidder. If a bidder is claiming that this requirement is a hardship or unduly burdensome, the specific reason must be documented in or attached to the PPD form.

Public Records. All responses and information submitted in response to this RFR are subject to the Massachusetts Public Records Law, M.G.L., c. 66, s. 10, and to c. 4, s. 7, ss. 26. Any statements in submitted responses that are inconsistent with these statutes, including marking by bidders of information as confidential during the quote submission process in

COMMBUYS, shall be disregarded.

Reasonable Accommodation. Bidders with disabilities or hardships that seek reasonable accommodation, which may include the receipt of RFR information in an alternative format, must communicate such requests in writing to the contact person. Requests for accommodation will be addressed on a case by case basis. A bidder requesting accommodation must submit a written statement which describes the bidder’s disability and the requested accommodation to the contact person for the RFR. The SST reserves the right to reject unreasonable requests.

Restriction on the Use of the Commonwealth Seal. Bidders and contractors are not allowed to display the Commonwealth of Massachusetts Seal in their bid package or subsequent marketing materials if they are awarded a contract because use of the coat of arms and the

Great Seal of the Commonwealth for advertising or commercial purposes is prohibited by law.

Subcontracting Policies. Prior approval of the department is required for any subcontracted service of the contract. Contractors are responsible for the satisfactory performance and adequate oversight of its subcontractors. Human and social service subcontractors are also required to meet the same state and federal financial and program reporting requirements and are held to the same reimbursable cost standards as contractors.

Estimated Procurement Calendar

(Next Page)

EVENT DATE

Notice of Intent to Procure Friday, May 29, 2026

Bid Release Date Wednesday, July 8, 2026

Deadline for Written

Questions Prior to the

Bidders’ Conference

Email questions to both:

Mary Magagna, Mercer

Email: mary.magagna.mercer.com

Jasmyn Plasencia, Mercer

Email: jasmyn.plasencia@mercer.com

No later than 12 pm eastern time on Wednesday, July 15, 2026

Virtual Bidders’

Conference

9:30 am on Wednesday, July 29, 2026

To be held virtually.

Please email Jasmyn Plasencia to request the meeting invitation.

Final Deadline for Written

Questions After the

Bidders’ Conference

Email questions to both:

Mary Magagna, Mercer

Email: mary.magagna.mercer.com

Jasmyn Plasencia, Mercer

Email: jasmyn.plasencia@mercer.com

No later than 12 pm eastern time on Thursday, July 30, 2026

Official Answers for Bid

Q&A published to

COMMMBUYS (Estimated)

Friday, July 31, 2026

Proposals must be submitted BOTH via COMMBUYS and to Mercer before the deadline.

mailto:jasmyn.plasencia@mercer.com

Deadline for Quotes/Bid

Responses (“Bid Opening

Date/Time” in

COMMBUYS)

To COMMBUYS: Complete proposals must be submitted via the

COMMBUYS website by the below date and time. Proposals to the

GIC will not be accepted unless an electronic version is received in

COMMBUYS by this deadline.

To GIC: For instructions on how to submit to the GIC, refer to the

Submission Checklist on page 32.

Attn: Jannine Dewar

Manager of Pharmacy and Ancillary Benefits

Group Insurance Commission

One Ashburton Place, 1413

Boston, MA 02108

Failure to submit your proposal to the GIC, COMMBUYS and

Mercer will result in the immediate disqualification of your bid.

5 pm eastern time on Wednesday, August 5, 2026

EVENT DATE

Finalist Interviews for Selected

Bidder(s) and Reference Checks

October 6-9, 2026

Bidders will be notified individually – but we’d advise holding and preparing in advance for this RFR milestone as soon as possible.

Presentation of Vendor Selection

Recommendation to Commission

November 2026

The apparent successful bidder will be notified the week of the Commission Meeting.

Contracting (Estimated) January 2027

Estimated Contract Start Date July 1, 2027

Times are eastern standard/daylight savings (US), as displayed on the COMMBUYS system clock displayed to Bidders after logging in. This schedule is subject to change. Bidders are responsible for checking the Bid record, including Bid Q&A, on COMMBUYS for Procurement

Calendar updates.

Inquiries

All inquiries concerning the content of this RFR must be made in writing to Mercer and must be received no later than 12 pm eastern time on Wednesday, July 30, 2026. No questions will be entertained after that date. Answers to questions will be posted on COMMBUYS. Only written inquiries regarding this RFR will be accepted. Questions should be sent to:

jasmyn.plasencia@mercer.com.

Detailed Claims Data and Census File

Detailed claims data and a census file may be obtained only by requesting it from Jasmyn

Plasencia (jasmyn.plasencia@mercer.com) at Mercer. Vendor request for claims data and census file will serve as a vendor’s intent to bid. Requests for the claims data and census information must be submitted with a request for a Non-Disclosure Agreement (“NDA”), which will also be provided by Jasmyn Plasencia. Mercer will release GIC claims data and/or census eligibility data only after Mercer confirms that a written Non-Disclosure Agreement

(“NDA”) has been mutually executed by Mercer and the requesting vendor and is in full force and effect, in a form acceptable to Mercer. If an NDA is not already in place, the vendor must execute Mercer’s NDA prior to any release of data. Claims data and census information will be distributed by Mercer, on behalf of the GIC, through Mercer’s secure large file transfer service.

Mercer requests that bidding declinations be formalized in writing, outlining the specific reason(s) for the decision not to propose.

Bidders’ Conference

A Bidders’ conference will be held virtually on July 29th, 2026 at 9:30 AM ET to respond to inquiries regarding the program and the bidding process. Note that all questions and answers reviewed at the Bidders’ Conference are estimated to be posted on COMMBUYS no later than July 31, 2026. Attendance is not required. Requests for the virtual meeting invite should be sent to Jasmyn Plasencia at the email below.

Bidders are encouraged to submit questions prior to the meeting by emailing Jasmyn

Plasencia (Jasmyn.Plasencia@mercer.com) no later than 12 pm eastern time on

Wednesday, July 15, 2026.

Bidders are responsible for entering content suitable for public viewing, since all of the questions are accessible to the public. Bidders must not include any information that could be considered personal, security sensitive, inflammatory, incorrect, collusory, or otherwise objectionable, including information about the Bidder’s company or other companies. The

GIC reserves the right to edit or delete any submitted questions that raise any of these issues or that are not in the best interest of the Commonwealth or this Bid.

All answers are final when posted. Any subsequent revisions to previously provided answers will be dated.

Proposals

Electronic Proposals (in the Proposal Format specified) must be received no later than 5 pm eastern time on Wednesday, August 5, 2026 through the COMMBUYS website. Proposals delivered to the GIC and Mercer will be considered only if the COMMBUYS electronic response is received by the deadline.

Finalist Interviews

Based on the initial review of the proposals, the GIC will select vendor finalists. Interviews are scheduled for the week of October 5, 2026. The purpose of these interviews will be to clarify and substantiate certain aspects of vendor finalists’ proposals, obtain supplemental information, and meet each vendor finalists’ proposed team members.

Bidders will be notified individually – but we’d advise holding and preparing in advance for this RFR milestone as soon as possible.

mailto:Jasmyn.Placencia@mercer.com

Request for Response

Overview of GIC Benefits and Goals

The Group Insurance Commission (GIC) is a quasi-independent state agency governed by a seventeen-member body (the Commission) appointed by the governor. The GIC, located administratively within the Executive Office of Administration and Finance, is responsible for providing health insurance and other benefits to employees, retirees, and their covered family members of the Commonwealth and other groups. The GIC designs, implements, and manages employee and retiree benefit plans, negotiates plan rates, and continually evaluates the nature, scope, and costs of its programs. Since employee benefits are not part of the state employee collective bargaining process, the GIC designs its benefit program within the parameters set by the Commission and the Legislature.

The GIC operates in conformance with the Commonwealth’s fiscal year, which begins on

July 1 and ends on the following June 30. For example, the GIC is currently in Fiscal Year

2027: this fiscal year began on July 1, 2026 and will end on June 30, 2027. There are currently more than 260,000 subscribers and over 420,000 participants covered by the GIC.

For all GIC benefits and services, GIC coordinators are not GIC employees but instead are typically employees of their respective state agencies and municipalities and are responsible for educating agency employees about the various benefits offered, walking them through the enrollment process, and entering the participants’ benefit enrollment and deductions into their payroll system. There are over 650 agency-level GIC Coordinators. The entities within the Commonwealth served by the GIC have multiple payroll systems (approximately 250), which can be grouped into three broad categories:

• HR/CMS, which is a PeopleSoft platform, runs bi-weekly payrolls for the majority of state employees;

• The University of Massachusetts’ (UMass) five campuses maintain their own bi-weekly payroll system to pay employees and students at the five locations across the

Commonwealth; and

• The remaining payroll systems, known as off-line agencies, do not participate in HR/CMS and each control their own payroll systems.

While the GIC provides a number of benefit offerings, the bulk of the agency’s efforts center on its health and prescription drug plans, given the substantial expense associated with these programs that is borne by members and taxpayers, and the agency’s need to constrain the growth in healthcare expenses while maximizing value for members.

The GIC is the largest commercial purchaser of health benefits in the Commonwealth of

Massachusetts, with overall FY2026 spending of more than $3.9 billion. The agency is responsible for designing, procuring, implementing, and managing health care and prescription drug benefits for over 260,000 subscribers and over 420,000 members currently covered under our benefit products. GIC members reside in every U.S. state and several foreign countries.

In addition to state and municipal enrollees, the GIC also covers personnel from state housing and redevelopment authorities and retired municipal teachers (RMTs).

The agency’s 17-member Commission must approve the vast majority of GIC initiatives, benefit changes, and rates. The Commission consists of individuals representing organized labor and retirees (8); the public interest (6); the administration (2), via statutory appointment;

and health economics (1). Commission seats that are not done by statutory appointment are selected by the Governor, by choosing from a pool of candidates put forth by the interest groups related to each seat. Collective bargaining does not apply to employee benefits and premium contribution ratios for state employees and retirees are established in state law, as is the framework for municipal groups’ entrance to and exit from the GIC.

The GIC has a proud history of advancing forward-thinking policies and data-driven health care initiatives – exercising its purchasing power to improve healthcare quality, slow healthcare cost growth, and deliver value to its members.

Widely acknowledged for its influence on healthcare policy, the GIC seeks to maintain its reputation as a leader in the local and national healthcare landscape. At the same time, the agency recognizes the need to strengthen initiatives, to revise or eliminate those that do not accomplish their objectives, and to aggressively forge new paths to maximize the value we bring to our members and the industry.

The GIC currently offers 12 health insurance products administered by four vendors. Non-

Medicare health coverage options include one managed indemnity product; one Preferred

Provider Organization (PPO) product; two PPO-type products; one Point-of-Service (POS) product; and three HMOs. Medicare offerings include three indemnity (Medicare

Supplement) products and one Medicare Advantage Plan (HMO).

Benefit offerings are actuarially comparable across plans, with the Non-Medicare products sharing similar or identical copays, deductibles, and out-of-pocket maximums. Per state statute, state subscribers contribute between 20-25% of premium, depending on date of hire;

retirees pay between 10-20%, depending on date of retirement. Municipal contribution ratios are determined at the municipal level and therefore vary accordingly.

The prescription drug benefits for all plans are carved out from the medical coverage, on a self-insured basis, through a direct contract. The GIC is currently contracted with CVS

Caremark and CVS SilverScript to administer pharmacy benefits for members enrolled in

Non-Medicare and Medicare plans, respectively.

The following chart lists the pharmacy products’ basic characteristics and their July 2026 enrollment.

VENDOR TYPE OF PLAN INSURANCE

TYPE

NUMBER OF

ENROLLED

LIVES

CVS Caremark (for Non- Medicare products)

PBM Self-insured 308,769

CVS Caremark SilverScript (for GIC Medicare products)

EGWP Self-insured 124,278

The EGWP and Commercial plans offer an unlimited dollar cap pharmacy benefit, incorporate both retail and mail order pharmacy options, and use a three-tier member copay structure. The prescription drug copays for each plan are identical, although the plans may have varying restrictions (e.g., different formularies, step therapies, mandatory generic policies, etc.).

The GIC’s approach to the pharmacy benefit to date has been to manage pharmacy costs, where possible, with benefit management tools rather than through increases in members’ pharmacy copays. To that end, the GIC’s pharmacy program uses benefit management tools, including prior authorizations, quantity limits, step therapy programs, and a program in which members pay the cost difference between generic and equivalent brand medications.

Other steps taken to control costs include mandatory mail-order fills for maintenance medications.

The following chart shows key data from the close of calendar year 2025, which ended on

December 31, 2025.

GIC PBM Utilization and Cost Data

ACTIVE / NON-MEDICARE

CALENDAR YEAR 2025

EGWP

CALENDAR YEAR 2025

Gross Cost $1,151,713,003 $941,753,998

Net Cost (less member copays)

$1,095,231,926 $908,214,675

Member Cost Share 4.9% 3.6%

Total Number of

Prescriptions (not adjusted)

3,570,033 3,304,919

Average Members/Month 303,888 118,833

Percentage Retail

Prescriptions (90-day maintenance drugs)

27.4% 39.1%

Percentage Mail Order

Prescriptions

4.0% 5.9%

Percentage Retail

Prescriptions 30-day acute drugs)

30.2% 23.7%

Generic Dispensing Rate 80.2% 81.4%

Gross Cost PMPM Change from FY2024 to FY2025

11.4% 10.4%

Specialty Total Gross Cost $498,663,160 $374,804,589

ACTIVE / NON-MEDICARE

CALENDAR YEAR 2025

EGWP

CALENDAR YEAR 2025

Specialty Total Plan Cost

Net

$494,830,006 $374,464,313

Specialty as a percentage of

Total Gross Cost

43.3% 39.8%

Specialty as a percentage of

Plan Cost Net

45.2% 41.2%

Utilization data for Calendar Year 2025 for the GIC PBM are provided in the table below and key goals for this procurement are on the following page. Available for review on the GIC’s website www.mass.gov/gic is an overview of GIC health plan benefits contained in the GIC’s Benefit Decision Guides, as well as benefit details provided in each GIC health plan’s member handbooks.

For additional information, please reference the GIC’s Benefit Decision Guides, located online at https://www.mass.gov/lists/gic-benefit-decision-guides.

GIC UTILIZATION DATA (CY 2025)

ACTIVE/NON-MEDICARE

COMMERCIAL

MEDICARE / EGWP

Members 303,888 118,833

Average Age Insufficient Data 76.4

Total Plan Gross Cost $1,151,713,003 $941,753,998

Total Prescriptions 3,570,033 3,304,919

Generic Dispensing Rate 80.2% 81.4%

Member Cost % 4.9% 3.6%

Specialty % of Gross Cost 43.3% 39.8%

Importantly, the GIC has a group of retired individuals who are over age 65 but do not qualify for Medicare because they began working for the Commonwealth before Social Security and Medicare were available to public employees. This group has roughly 6,000 subscribers, totaling about 11,000 members, enrolled in the Non-Medicare plan.

The GIC also maintains a data warehouse storing up to 10 years of medical and pharmacy claims data. The data warehouse is currently hosted and maintained by Onpoint Health Data. The successful PBM bidder(s) must commit to providing claims data to the GIC’s data warehouse. The GIC’s medical and pharmacy consultants will have access to the data warehouse sufficient to complete their work.

https://www.mass.gov/gic https://www.mass.gov/lists/gic-benefit-decision-guides

The GIC seeks partnership with a PBM that:

• Can administer the plan designs as described in the plan documents and the ability to accommodate alternative plan designs in the future.

• Demonstrates effective utilization management. Is willing to provide full disclosure of its contracts and agreements with all pharmaceutical manufacturers to verify the agreed upon rebate sharing arrangements and undergo an audit by a third party of its contracts and agreements with all pharmaceutical manufacturers.

• Actively manages member's safety from a clinical perspective, promoting effective, efficient utilization while applying an integrated approach with medical, well-being, and behavioral health substance abuse programs.

• Offers flexibility and customization around utilization management strategies.

• Has a proven ability to turn data into actionable recommendations; and willingness to support the GIC with additional initiatives such as health equity, wellness, preventive care, etc.

• Is willing to coordinate with other vendors as appropriate through data sharing and integration including data warehousing, to support optimal medical outcomes and quality of care for members.

• Provides consumer-focused tools and resources and effectively minimizes disruption for the GIC and their members.

• Has the capacity to customize services and processes to meet the GIC’s unique needs.

The GIC also seeks PBM(s) who fully support the GIC’s Guiding Principles:

• Utilize buying power to make health care affordable by addressing underlying problems.

• Use buying power to improve quality and outcomes for GIC members and others.

• Improve access to mental health and substance use disorder services.

• Address diversity, equity and inclusion and social determinants of health.

• Improve member experience, including navigation.

• Play to the strengths of health plan partners and tap into specialized solutions to supplement weaknesses.

• Carefully consider and manage member disruption.

• Present low implementation risk.

The GIC is seeking vendor(s) that fully understands and embraces these concepts. The winning vendor(s) will be expected to work with the GIC team to help achieve these goals.

Minimum Qualifications Agreement

The GIC is seeking a pharmacy benefit manager (PBM) partner that can provide quality health care services in a cost‑effective and transparent manner and proactively manage future prescription drug cost inflation. Selection will be based on a history of excellent customer service, demonstrated ability to control trend increases, and provision of highly competitive pricing and strategic direction that aligns with the GIC.

The GIC seeks partnership with a PBM that:

• Can administer the plan designs as described in the plan documents and the ability to accommodate alternative plan designs in the future.

• Demonstrates effective utilization management. Is willing to provide full disclosure of its contracts and agreements with all pharmaceutical manufacturers to verify the agreed upon rebate sharing arrangements and undergo an audit by a third party of its contracts and agreements with all pharmaceutical manufacturers.

• Actively manages member's safety from a clinical perspective, promoting effective, efficient utilization while applying an integrated approach with medical, well-being, and behavioral health substance abuse programs.

• Offers flexibility and customization around utilization management strategies.

• Has a proven ability to turn data into actionable recommendations; and willingness to support the GIC with additional initiatives such as health equity, wellness, preventive care, etc.

• Is willing to coordinate with other vendors as appropriate through data sharing and integration including data warehousing, to support optimal medical outcomes and quality of care for members.

• Provides consumer-focused tools and resources and effectively minimizes disruption for the GIC and their members.

• Has the capacity to customize services and processes to meet the GIC’s unique needs.

For the purposes of this Agreement, the Bidder may be the entity that submits the proposal and signs the contract. The Bidder may meet the requirements either directly or through its affiliates, subcontractors, delegated service providers, contracted networks, carrier partners, or other related arrangements, as applicable.

To submit a bid for consideration, bidder must acknowledge possessing the minimum qualifications listed in this section by completing below signature section and returning it along with your proposal:

Plan Administration Requirements

1) Bidder agrees to have the capacity and demonstrated ability to administer a commercial public sector pharmacy benefit plans with at least 100,000 covered employees and non-

Medicare retirees combined (excluding eligible dependents).

2) Bidder acknowledges that the GIC has full ownership and unrestricted use of all claims, rebate and clinical data produced under the contract and agrees to provide timely data feeds and direct access for the GIC analytics and, if necessary or in dispute, Bidder agrees to irrevocably assign such ownership rights to the GIC, in full and without cost.

3) Bidder agrees to demonstrate a proven implementation and transition plan for a large public plan conversion including continuity of care measures for specialty/high-cost patients and a detailed transition plan.

4) Bidder agrees to demonstrate an information security program aligned with the

Commonwealth of Massachusetts Executive Office of Technology Services and Security

(EOTSS) Enterprise Information Security Policies and Standards and applicable NIST standards/guidance, as well as financial strength, insurance, and the ability to comply with Massachusetts public entity procurement and public records obligations. Bidder shall provide a copy of its CTR/EOTSS documentation (as applicable) evidencing acknowledgment/compliance with the foregoing IT security requirements. Bidder shall also provide copies of its Business Continuity Plan (BCP) and Disaster Recovery (DR) plan; if full documents cannot be released, Bidder must provide an executive summary or written assurance describing (i) Recovery Point Objective (RPO) and Recovery Time

Objective (RTO) targets (minimum/maximum timeframes) in the event of an outage, (ii) applicable service level agreements (SLAs) for availability, support, incident response and escalation, and (iii) whether any third-party providers are used for hosting, support, and/or recovery.

5) Bidder agrees to support a secure and configurable integration between the PBM data environment and the GIC’s data warehouse. Integrations must support scheduled bulk extracts and be included in the proposed offer.

6) Bidder agrees to accept and support the GIC designated secure transmission method(s) for eligibility files (as specified by GIC), including required encryption and authentication and connectivity requirements, without requiring GIC to adopt the PBM’s proprietary portal or alternate transfer process. In addition, the Bidder agrees to use the current GIC

Eligibility file format/record layout and processing requirements. There will be no additional cost associated with any related file transfers on behalf of the GIC.

7) Bidder agrees to apply all rebates, refunds, subsidies, discounts, reinsurance, and any other amounts due to the GIC as invoice credits on the next available invoice to offset ongoing expenses; the GIC expects these amounts to be remitted exclusively as invoice credits and not by check or other cash payment.

Network Access Requirements

8) Bidder agrees to having a retail, independent, specialty, and mail network sufficient to accommodate the GIC’s size and national membership with considerations for independent/rural pharmacies.

9) Bidder must offer a broad, national retail-30 pharmacy network that provides sufficient geographic access for GIC participants.

10) Bidder agrees to offer a retail-90 network allowing GIC participants to fill maintenance medications for a 90-day supply at mail order copays.

11) Bidder agrees to provide mail order services.

12) Bidder must have the ability to provide specialty drug prescription services through both specialty and retail network pharmacies (for grace fills), as appropriate.

13) Bidder agrees to prohibit the dispensing of 340B qualified prescriptions from their owned or contracted mail and specialty pharmacies.

Financial Requirements

14) Bidder will propose its most financially competitive 3-year pricing offer to the GIC;

including an annual market check with a 1% threshold.

a. Bidder agrees to disclose whether it uses spread pricing across any channels. If spread pricing is used, Bidder agrees to:

• Provide historical average spreads

• Commit to delivering claim-level detail showing plan paid, pharmacy paid, and any spread amounts on a defined cadence.

• Provide the GIC with Total Revenue Disclosure reporting that includes spread revenue disclosure across all channels.

15) Bidder agrees to disclose all revenue streams tied to drug pricing and fulfillment

(including but not limited adjustments, and rebates and price concessions, Direct and

Indirect Remuneration (DIR) price concessions, manufacturer administrative fees, pharmacy price concessions, rebate arrears, retrospective adjustments, and commit in writing what will be retained versus passed through to the GIC commercial and EGWP business, including timing and reconciliation cadence.

16) Bidder agrees to pass through 100% of all rebates collected by the PBM and/or the GPO, on behalf of the GIC inclusive of manufacturer administrative fees.

17) Bidder agrees to fully disclose corporate ownership and all related party relationships

(ownership and financial ties to retail/specialty/PBM-owned pharmacies, labs, health plans) and describe arrangements that could create conflicts of interest.

18) Bidder agrees to grant the GIC, Mercer/MMC, State auditors, and other auditors designated by the GIC (collectively, “Auditors”) full audit rights to all records and systems necessary to verify Bidder’s performance, pricing, payments, concessions and compliance under this RFR, including but not limited to:

• financial statements

• billing, remittance and payment reconciliations

• claims-level adjudication data and supporting documentation

• subcontractor, manufacturer and Group Purchasing Organization (GPO) contracts, invoices and records necessary to validate pricing concessions and pass-throughs

• third-party vendor contracts

19) Bidder agrees to provide 100% of any network pharmacy audit recoveries to the GIC.

20) Bidder agrees that all discounts, fees, and miscellaneous program costs will be backed by auditable and proactively reconciled guarantees.

21) Bidder agrees to provide their full and timely cooperation with the GIC and their contracted auditors. The audits will occur no less than annually and will entail at minimum a review of rebates, financial guarantees, and plan benefits.

22) Bidder agrees to support the GIC’s Rx Data Collection (RxDC) reporting and compliance requirements by providing timely, complete, and auditable prescription-drug data extracts and interfaces in the format and cadence required by the RxDC authority or as specified by the GIC. Support must include production, secure transmission, ongoing validation, remediation of errors, and support for audits or inquiries related to reported RxDC data.

Employer Group Waiver Plan (EGWP) Experience Requirements – please note, in addition to the above requirements, the following minimum qualifications apply to

Bidders submitting offers for the GIC’s EGWP plan. Please also note that for Bidders who are solely bidding on the GIC’s EGWP plan, Plan Administration Requirement number 1, above, does not apply.

23) Bidder is an approved CMS-contracted prescription drug plan (“PDP”) sponsor for an

EGWP PDP in accordance with CMS regulations. The EGWP PDP may not be provided by or through a PBM subcontractor. (An insurance company relationship is allowed.)

24) Bidder currently administers at least five (5) employer-sponsored Group Waiver Plans, each with at least 5,000 covered retirees (excluding eligible dependents).

25) Bidder must have at least a 2.5-STAR rating from CMS.

26) Bidder must be able to fully support the GIC in providing all required information and filings to qualify for the retiree drug subsidy program.

27) Bidder agrees to have documented formulary governance, utilization management (PA, step therapy) and specialty management processes that align with CMS Part D rules for

EGWP and must provide clear member/provider appeal and exception processes with

SLAs.

Please provide signature below and submit this page with your bid proposal:

Name: _______________________

Signature: ____________________

Company: ____________________

Date: ________________________

Essay Questions

Introduction to Essay Questions

The GIC is seeking a pharmacy benefit manager (PBM) partner that can provide quality health care services in a cost-effective and transparent manner and proactively manage future prescription drug cost inflation. Selection will be based on a history of excellent customer service, demonstrated ability to control trend increases, and provision of highly competitive pricing and strategic direction that aligns with the GIC.

The following essay questions are intended to help the GIC evaluate each bidder’s operational, clinical, technical, financial, and compliance capabilities as they relate to the

GIC’s pharmacy benefit program. Bidders should answer each question fully and concisely, tailoring responses to the needs of a public-sector purchaser that must remain financially competitive, minimize member disruption, and comply with applicable state and federal legislative and transparency requirements.

Instructions for all essay responses

• Restate the question at the top of each response. The question text itself will not count toward the page limit.

• Observe the page limit shown for each question. Responses that exceed the stated page limit will be scored only on the portion that conforms to the limit.

• If you reference exhibits, include those exhibits within the page limit for that question unless the question explicitly states an exhibit may be submitted separately. Exhibits submitted outside of the page limit will not be scored unless specifically authorized.

• Use black ink 12-point typeface on white paper with 1-inch margins.

• Number each page and indicate the bidder’s name and question number in the header or footer.

• Where applicable, provide separate, clearly labeled responses for Active/non-Medicare retirees and Medicare retirees (Part D/Retiree Drug Subsidy interactions) if the question requests segmentation by population.

• When providing metrics, include the measurement period and the client context (plan size, demographics, and any special program features) so the GIC can assess comparability.

• For any claims of savings, quality improvement, or clinical outcomes, supply the methodology and source data used to calculate results or cite a supporting exhibit.

• The GIC may require third-party verification or audits of financial and contract disclosures. Indicate any confidentiality constraints and the legal basis for those constraints, if applicable.

Confidentiality and public-sector considerations

• The GIC is a public entity subject to transparency and procurement laws. While the GIC recognizes the need for commercially sensitive information, bidders should assume that contract terms and performance information may be subject to public record requests unless exempted by law.