Attachment C - Prescription Drug Plan and Benefit Design Information.docx

This is a Prescription Drug Plan and Benefit Design Information attachment for the City of Houston's Pharmacy Benefits Management Services procurement. The document provides detailed specifications regarding the prescription drug benefits and plan design requirements that the selected PBM contractor must administer for the City's self-funded medical plans covering employees and their dependents. The contract term consists of an initial five-year period with two optional one-year renewal extensions, allowing for a maximum seven-year engagement. The attachment outlines the specific benefit design parameters, formulary requirements, copayment structures, deductibles, and other plan design elements that must be implemented and maintained throughout the contract period to ensure consistent, high-quality pharmacy benefits delivery.

The document serves as a critical reference for prospective bidders to understand the existing or desired prescription drug benefit structure and design specifications that will govern the PBM services. This attachment enables qualified pharmacy benefits management firms to accurately assess the scope of services required, including claims processing, formulary management, mail-order pharmacy services, specialty pharmacy coordination, and member support services. By providing comprehensive benefit design information upfront, the City of Houston ensures that all proposing firms have a clear understanding of the operational and clinical requirements necessary to deliver cost-effective prescription drug benefits while maintaining plan sustainability and member satisfaction throughout the five-year initial contract term and any subsequent renewal periods.