Attachment 17-GIC Monthly Membership Information 2025 by Population.pdf

This is a membership projection document for the Massachusetts Group Insurance Commission (GIC) supporting a Pharmacy Benefit Manager (PBM) procurement. The document provides monthly commercial and EGWP (Employer Group Waiver Plan) member counts for calendar year 2025, showing relatively stable commercial membership ranging from approximately 300,167 to 304,658 members and EGWP membership ranging from approximately 118,138 to 120,543 members. The associated RFR (Request for Responses) will be released on or about July 8, 2026, with a bidders' conference tentatively scheduled for July 29, 2026, and responses due by August 5, 2026. Vendors may submit separate bids for Commercial, EGWP, or both populations, with each evaluated independently. The contract commences July 1, 2027, and prospective bidders must demonstrate substantial experience managing large-scale pharmacy benefit programs with proven clinical outcomes, robust financial controls, and operational excellence across retail and specialty pharmacy operations.

The Commercial population generates approximately $830.6 million in annual pharmacy gross costs, while the EGWP population generates approximately $736.7 million annually. CVS Health (Caremark) is the incumbent vendor currently administering both the Commercial and separate EGWP contracts. Prospective bidders are required to demonstrate EGWP experience and must comply with Massachusetts' 2025 PBM law and Division of Insurance licensing requirements. The GIC is a quasi-independent state agency established in 1955 that provides health insurance coverage to over 260,000 enrollees representing more than 420,000 covered individuals, including over 120,000 Medicare participants across twelve health plans. The RFR will be released via COMMBUYS (file number BD-26-1049-GIC00-07GIC-130036), and prospective bidders should monitor for updates by subscribing with commodity codes 80-10-00-00 and/or 84-13-00-00. Mercer Health & Benefits LLC is advising the GIC on this procurement.