PCS 550 HHS RFP Template RFP No. HHS0017240 Page 1 of 39 Version 2.30 Revision Date 02/27/2026

Stephanie Muth, Executive Commissioner

Request for Proposals (RFP) for

Pharmacy Benefits Management Services for Texas HIV Medications Program (THMP):

State Pharmacy Assistance Program (SPAP), Texas Insurance Assistance Program (TIAP), and

Texas Insurance Assistance Program-PLUS (TIAP-PLUS)

RFP No. HHS0017240

Date of Release: October 21, 2026

Responses Due: See Section 3.1, Schedule of Events

NIGP Class/Item Codes

915-20: Call Center Services

946-10: Accounting and Billing Services, Including Payroll Services, 3rd Party Reimbursement for Medicare, Medicaid, Private Insurance, etc.

948-07: Health Administration Services

948-72: Pharmaceutical Services

953-27: Claims Processing

958-56: Health Care Management Services (Including Managed Care Services)

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Table of Contents

Article I. Introduction, Definitions, and Authority

1.1 Introduction

1.2 Definitions

1.3 Authority

Article II. Scope of Work

2.1 Background

2.2 Description of Services

2.3 Contract Award, Term, and Historical Compensation

2.3.1 Contract Award and Execution

2.3.2 Contract Term

2.3.3 Historical Compensation

2.4 Data Use Agreement and Security Privacy Inquiry

2.5 No Guarantee of Volume, Usage, or Compensation

2.6 Governmental Entities

Article III. Administrative Information

3.1 Schedule of Events

3.2 Ambiguity, Conflict, or Discrepancy

3.3 Inquiries

3.3.1 Sole Point of Contact

3.3.2 Prohibited Communication

3.3.3 Exception to Sole Point of Contact

3.3.4 Solicitation Questions

3.4 Pre-proposal Conference

3.4.1 Attendance

3.4.2 Conference Logistical Information

3.4.3 Questions at Pre-Proposal Conference

3.5 Solicitation Response Composition

3.5.1 General Information

3.5.2 Page Limit and Supporting Documentation

3.5.3 Discrepancies

3.5.4 Exceptions

3.5.5 Binding Offer

3.6 Solicitation Response Submission and Delivery

3.6.1 Deadline

3.6.2 Submission Option

3.6.3 Submission Checklist

3.6.4 Labeling and Delivery for USB Submission and Other Materials

3.6.5 Modifications and Withdrawals

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Article IV. Solicitation Response Evaluation and Award Process

4.1 Conformance with State Law

4.2 Best Value Determination

4.2.1 Selection Methodology

4.2.2 Minimum Qualifications

4.2.3 Initial Compliance Screening

4.2.4 Written Solicitation Response Evaluation

4.2.5 Written Response Evaluation Criteria

4.2.6 Best and Final Offer (BAFO)

4.2.7 Final Written Response Score

4.2.8 Summary of Best Value Determination

4.3 Questions or Requests for Clarification

Article V. Narrative Proposal

5.1 Narrative Proposal

5.1.1 Executive Summary

5.1.2 Project Work Plan

5.1.3 Qualifications and Experience

Article VI. Required Respondent Information

6.1 Company Information

6.1.1 Company Narrative

6.1.2 Company Profile

6.2 Franchise Tax – Right to Transact Business in Texas

6.3 References

6.4 Major Subcontractor Information

6.5 Affirmations and Certifications

6.6 Financial Information

6.6.1 Dun and Bradstreet Reports

6.6.2 Financial Statements and Financial Solvency

6.6.3 Alternate Report

6.7 Corporate Guarantee

6.8 VetHUB Subcontracting Plan

6.9 TX-RAMP Documentation

6.9.1 TX-RAMP Certification Assessment

Article VII. Cost Proposal

7.1 Cost Proposal

Article VIII. General Terms and Conditions

8.1 General Conditions

8.1.1 Changes, Modifications, and Cancellation

8.1.2 Offer Period

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8.1.3 Costs Incurred

8.1.4 Contract Responsibility

8.1.5 Public Information Act - Respondent Requirements Regarding Disclosure

8.1.6 Respondent Waiver – Intellectual Property

8.1.7 Standards of Conduct for Vendors

8.1.8 Disclosure of Interested Parties

8.2 Insurance

8.2.1 Required Coverage

8.2.2 Alternative Insurability

8.3 Protest

Article IX. List of Exhibits

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ARTICLE I. INTRODUCTION, DEFINITIONS, AND AUTHORITY

1.1 INTRODUCTION

The Texas Department of State Health Services (DSHS) requests proposals from qualified entities to act as a Pharmacy Benefits Manager (PBM). The PBM will manage certain prescription drug benefits, premium payments, and copayments as a secondary payor to health insurers, including Medicare Part D drug plans through managed care organizations, self-insured companies, retail pharmacies, and government programs.

HHSC PCS will administer the procurement process for this Solicitation, which includes RFP publication, handling of communications from vendors, as well as managing the receipt of Solicitation Responses for review and evaluation.

To be considered for award, a Respondent must execute Exhibit A, HHS Solicitation Affirmations Version 2.10 and provide all other required information and documentation as set forth in this Solicitation.

Prior to award of the Contract, Respondent proposing a system using a SaaS solution must obtain TX- RAMP Level 2 certification. TX-RAMP Provisional Status does not satisfy the TX-RAMP Certification Level 2 requirement. For this Solicitation, HHSC shall not provide “agency-sponsored” TX-RAMP Provisional Status certification to any Respondent.

Information regarding DSHS and its programs is available online and can currently be accessed at DSHS http://www.dshs.texas.gov.

1.2 DEFINITIONS

Refer to Exhibit B, Health and Human Services (HHS) Uniform Terms and Conditions (UTCs)

– Vendor, Version 3.4 for additional definitions.

As used in this Solicitation, unless a different definition is specified or the context clearly indicates otherwise, the following terms and conditions have the meanings assigned below:

“Addendum” means a written clarification or revision to this Solicitation issued by HHSC PCS and posted to the ESBD.

“Award Consideration (AC) Documents” means documents Respondent must submit as part of the Solicitation Response to be considered for negotiations or award.

“CMS” means Centers for Medicare & Medicaid Services.

“COB” means Coordination of Benefits.

http://www.dshs.texas.gov/

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“Competitive Range” has the same meaning as the definition under Title 1 of the Texas Administrative Code (“TAC”) Part 15, Chapter 391, Subchapter A, Rule § 391.107(3).

“Contract Term” means the period of time beginning with the commencement date or Effective Date of a Contract and ending when the Contract expires in accordance with its terms, or when it has been terminated.

“Effective Date” has the same meaning as the definition in Exhibit B, Health and Human Services (HHS) Uniform Terms and Conditions – Vendor, Version 3.4.

“ESBD” means the Electronic State Business Daily, the electronic marketplace where State of Texas bid opportunities over $25,000 are posted. The ESBD may currently be accessed at https://www.txsmartbuy.gov/esbd.

“Final Written Response Score” refers to the final scoring of the written response as documented in the Solicitation.

“HHSC PCS” means Procurement and Contracting Services (PCS), a division of HHSC.

“HIPAA” means the Health Insurance Portability and Accountability Act of 1996.

“NCPDP” means the National Council of Prescription Drug Programs.

“Operational Start Date” means the first day on which the Contractor is responsible for providing Services under the operations phase of the Contract and occurs after the Transition Phase is completed.

“PBM” means Pharmacy Benefits Manager. Pharmacy Benefits Managers, or PBMs, are companies that manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers, and other payers.

“PCN” means the Pharmacy Benefit Processor Control Number.

“PHS” means Public Health Services.

“Respondent” means the individual or entity responding to this Solicitation.

“Software as a Service” or “SaaS” has the same meaning assigned by Special Publication SP 800-145 issued by the United States Department of Commerce National Institute of Standards and Technology, as the definition existed on January 1, 2015.

“Rx BIN” means the Prescription Benefit International Number.

“Solicitation Consideration (SC) Documents” means documents that must be submitted by Respondent with the Solicitation Response in order to be considered for evaluation and cannot be https://texas-sos.appianportalsgov.com/rules-and-meetings?$locale=en_US&interface=VIEW_TAC_SUMMARY&queryAsDate=04%2F14%2F2025&recordId=208793 https://texas-sos.appianportalsgov.com/rules-and-meetings?$locale=en_US&interface=VIEW_TAC_SUMMARY&queryAsDate=04%2F14%2F2025&recordId=208793 https://www.txsmartbuy.gov/esbd https://www.txsmartbuy.gov/esbd

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“SPAP” means the State Pharmacy Assistance Program.

“State” means the State of Texas and its instrumentalities, including HHSC or DSHS, and any other state agency, its officers, employees, or authorized agents.

“THMP” means the Texas HIV Medication Program. THMP operates the Texas HIV State Pharmacy Assistance Program, the Texas Insurance Assistance Program, and the Texas Insurance Assistance Program-PLUS.

“TIAP” means the Texas Insurance Assistance Program.

“TIAP-PLUS” means the Texas Insurance Assistance Program-PLUS.

“Transition Phase” means a period from Contract Effective Date to the Operational Start Date.

“Transition Plan” means a plan to transition all Deliverables, activities, materials, products, Services, and reports to be generated during the Contract Term, from the current, incumbent contractor to the selected Contractor in order to timely commence operations on the Operational Start Date.

“Turnover Plan” means a plan developed by Contractor that describes Contractor’s policies and procedures that will ensure the least disruption in the delivery of the Work during turnover to System Agency or its designee.

“TX-RAMP” means the Texas Risk and Authorization Plan established by the Texas Department of Information Resources (DIR) that provides a standardized approach for security assessment, authorization, and continuous monitoring of cloud computing Services that process the data of a state agency. To become TX-RAMP certified, entities must submit prescribed documentation to DIR.

Information regarding TX-RAMP is currently located at: https://dir.texas.gov/information-security/tx-ramp-eligibility-and-requirements.

“VetHUB Subcontracting Plan” or “SP” means written documentation regarding the use of subcontractors, which is required by Section 2161.252 of the Texas Government Code, for a purchase with an expected value of $100,000 or more when the state agency has determined subcontracting opportunities are probable. The SP subsequently becomes a provision of the Contract, and Contractor’s compliance with the SP will be monitored during the Contract Term.

“VPTS” means Vendor Performance Tracking System maintained by the Texas Comptroller of Public Accounts. The VPTS may be currently accessed at https://comptroller.texas.gov/purchasing/programs/vendor-performance-tracking/.

https://dir.texas.gov/information-security/tx-ramp-eligibility-and-requirements https://dir.texas.gov/information-security/tx-ramp-eligibility-and-requirements https://statutes.capitol.texas.gov/Docs/GV/htm/GV.2161.htm#2161.252 https://comptroller.texas.gov/purchasing/programs/vendor-performance-tracking/

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1.3 AUTHORITY

HHSC is soliciting the services stated in this Solicitation under the authority of Texas Government Code, Section 2155.144 (a), (b), (b-1)(2).

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ARTICLE II. SCOPE OF WORK

2.1 BACKGROUND

The Texas HIV Medication Program (THMP) provides medications for the treatment of HIV and its related complications for low-income Texans. The THMP is the official Acquired Immunodeficiency Syndrome (AIDS) Drug Assistance Program for the State of Texas. The THMP has been in existence since 1987 and provides medications approved by the Food and Drug Administration for the treatment of illnesses caused by the Human Immunodeficiency Virus (HIV) and other opportunistic infections in HIV-infected individuals, as prescribed by their doctor. THMP also operates the Texas HIV State Pharmacy Assistance Program (SPAP), the Texas Insurance Assistance Program (TIAP), and Texas Insurance Assistance Program-PLUS (TIAP-PLUS). The SPAP helps HIV-positive individuals that do not qualify for the full low-income subsidy with their out-of-pocket costs associated with Medicare Part D prescription drug plans, including co-payments, deductibles, coinsurance, and any gaps in coverage. The TIAP helps HIV-positive individuals with a qualified health insurance plan pay for medication copayments and coinsurance. TIAP also assists those already on COBRA to pay for health insurance premiums. TIAP-PLUS helps HIV-positive individuals with qualified private and federal-facilitated marketplace health insurance plans with insurance premiums, medication deductibles, and medication copayments. THMP pays these expenses through a Pharmacy Benefits Manager (PBM).

In State Fiscal Year 2025, the PBM spent approximately $4,105,061,86 in premium payments for 2,764 enrolled participants and approved approximately 15,023 medication claims. Monthly invoice premium payments processed ranged from $47,233.95 to $773,521.53, with an average of $349,129.83.

2.2 DESCRIPTION OF SERVICES

Refer to Exhibit J, Scope of Work (SOW).

2.3 CONTRACT AWARD, TERM, AND HISTORICAL COMPENSATION

2.3.1 Contract Award and Execution

DSHS intends to award one (1) Contract as a result of this Solicitation. Any award is contingent upon approval of the HHSC Executive Commissioner or their designee.

If, for any reason, a final Contract cannot be executed with a Respondent selected for award within forty-five (45) days of DSHS’s determination to seek to contract with that Respondent, DSHS may negotiate a Contract with the next highest-scoring Respondent or may withdraw, modify, or partially award this Solicitation.

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2.3.2 Contract Term

The initial term of any Contract resulting from this Solicitation will be one (1) year. DSHS, at its sole discretion, may extend any Contract awarded pursuant to this Solicitation for up to four (4) additional one (1) year terms.

Following the initial term and any allowable renewals or extensions, DSHS, at its sole discretion, may extend any resulting Contract for not more than one (1) additional option period to address immediate operational or service delivery needs. If the resulting Contract does not include a defined additional option period, the extension is limited to one (1) year.

2.3.3 Historical Compensation

Historical compensation under Contracts with a similar scope and size to this Solicitation has been approximately $15,000,000.00 per State Fiscal Year. Notwithstanding this section, DSHS reserves the right to adjust any projected amount based on State funding during the entire term of any resulting Contract.

2.4 DATA USE AGREEMENT AND SECURITY PRIVACY INQUIRY

a. By entering into a Contract, or purchase order with the System Agency as a result of this Solicitation, Respondent agrees to be bound by the terms of the Data Use Agreement attached as Exhibit D, Data Use Agreement (DUA) and Exhibit D-1, Attachment 2 to the DUA, Security and Privacy Inquiry (SPI).

b. The Respondent must complete and return Exhibit D-1, Attachment 2 to the DUA, Security, and Privacy Inquiry (SPI).

c. Contractor shall ensure that all Confidential Information (as defined in the DUA), including such information residing on back-up systems, remains within the United States. Confidential Information shall not be accessed by Contractor personnel located outside of the United States.

Furthermore, Confidential Information may not be received, stored, processed, or disposed via information technology systems located outside of the United States.

2.5 NO GUARANTEE OF VOLUME, USAGE, OR COMPENSATION

DSHS makes no guarantee of volume, usage, or total compensation to be paid to any Respondent under any awarded Contract, if any, resulting from this Solicitation. Any awarded Contract is subject to appropriations and the continuing availability of funds.

DSHS reserves the right to cancel, make partial award, or decline to award a Contract under this Solicitation at any time at its sole discretion.

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2.6 GOVERNMENTAL ENTITIES

If Respondent is responding to this Solicitation in its capacity as a governmental entity, certain terms and conditions found in this Solicitation, including all exhibits and attachments, may not be applicable.

Furthermore, to the extent permitted by law, if a Solicitation Response is received from a governmental entity, DSHS reserves the right to enter into an interagency or interlocal agreement with the governmental entity.

ARTICLE III. ADMINISTRATIVE INFORMATION

3.1 SCHEDULE OF EVENTS

EVENT DATE/TIME

Solicitation Posting Date to ESBD OCTOBER 21, 2026

Pre-proposal Conference and SP Training Attendance is Optional

OCTOBER 26, 2026, at 11:00 AM Central Time

Deadline for Submitting Questions or Requests for Clarification

OCTOBER 28, 2026, at 5:00 PM Central Time

Tentative Date Responses to Questions or Requests for Clarification Posted on ESBD

NOVEMBER 3, 2026

Deadline for courtesy SP review NOVEMBER 6, 2026, at 5:00 PM Central Time

Deadline for Submission of Solicitation Responses [NOTE: Responses must be RECEIVED by HHSC by the deadline.]

NOVEMBER 19, 2026, at 10:30 AM Central Time

Evaluation Period DECEMBER 2026

Anticipated Notice of Award MAY 2027

Anticipated Contract Start Date MAY 2027

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Respondents must submit their Solicitation Responses to HHSC in accordance with the due date and time indicated in this Schedule of Events or, if applicable, as changed via an Addendum posted to the

ESBD.

NOTE: All dates are tentative and HHSC reserves the right to modify these dates at any time. At the sole discretion of HHSC, events listed in the Schedule of Events are subject to scheduling changes and cancellation. Scheduling changes or cancellation determinations made prior to the deadline for submission will be published by posting an Addendum to the ESBD. After the deadline for submission, if there are delays that significantly impact the anticipated award date, HHSC, at its sole discretion, may post updates regarding the anticipated award date to the Procurement Forecast on the HHS Procurement Opportunities web page. Each Respondent is responsible for periodically checking the ESBD and Procurement Forecast for updates.

By submitting a Solicitation Response, Respondent represents and warrants that any individual submitting the Solicitation Response and any related documents on behalf of the Respondent is authorized to do so and to bind the Respondent under any Contract that may result from this Solicitation.

3.2 AMBIGUITY, CONFLICT, OR DISCREPANCY

Respondent must notify the Sole Point of Contact (Section 3.3.1) of any ambiguity, conflict, discrepancy, exclusionary specification, omission, or other error in the Solicitation in the manner described in Section 3.3.4 (Solicitation Questions) and by the deadline described in Section 3.1 (Schedule of Events).

Respondent submits a Solicitation Response at its own risk.

If Respondent fails to properly and timely notify the Sole Point of Contact (Section 3.3.1) of any ambiguity, conflict, discrepancy, exclusionary specification, omission, or other error in the Solicitation, Respondent, whether awarded a Contract or not:

a. Waives any claim of error or ambiguity in the Solicitation and any resulting Contract;

b. Cannot contest the interpretation by HHSC or DSHS of such provision(s); and

c. Is not entitled to additional compensation, relief, or time by reason of ambiguity, conflict, discrepancy, exclusionary specification, omission, or other error, or its later correction.

https://apps.hhs.texas.gov/procurement-calendar/procurement-forecast.pdf https://apps.hhs.texas.gov/procurement-calendar/procurement-forecast.pdf

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3.3 INQUIRIES

3.3.1 Sole Point of Contact

All requests, questions, or other communication about this Solicitation shall be made in writing to HHSC PCS, addressed to the person listed below (Sole Point of Contact). Additionally, a phone number is provided for purposes such as instructing a potential Respondent through an IT system or website referenced in this Solicitation. Communications via telephone are not binding.

The Sole Point of Contact will authorize a secondary Sole Point of Contact in the event of their absence and, in such an event, will include the contact information for the secondary Sole Point of Contact in their automatic reply out-of-office e-mail message. Respondents seeking to contact the Sole Point of Contact should do so via e-mail in order to receive updated contact information.

Name Katrina Chester, CTCD, CTCM

Title Contract Specialist V

Address Procurement and Contracting Services Building 1100 W 49th St. MC: 2020 Austin, TX 78756

Phone 512-406-2539

Email Katrina.Chester@hhs.texas.gov

See Section 3.3.3 (Exception to Sole Point of Contact) below.

3.3.2 Prohibited Communication

Except as provided in Section 3.3.1 (Sole Point of Contact) and Section 3.3.3 (Exception to Sole Point of Contact), potential Respondents and Respondents are prohibited from any communication with HHSC regarding the Solicitation. HHSC, or DSHS, its representatives, or partners, will not answer any questions or otherwise discuss the contents of this Solicitation with any potential Respondent or its representatives. Attempts to ask questions by phone or in person will not be allowed or recognized as valid. Respondents shall rely only on written statements issued by or through an HHSC or DSHS designated staff member, as provided by Section 3.3 (Inquiries). This restriction does not preclude discussions between affected parties for the purposes of conducting business unrelated to this Solicitation. Failure to comply with these restrictions may result in disqualification of Respondent's Solicitation Response.

mailto:Katrina.Chester@hhs.texas.gov

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3.3.3 Exception to Sole Point of Contact

Exceptions to Section 3.3.1 are as follows:

a. Respondents with questions relating to the Subcontracting Plan are permitted to direct those questions to the VetHUB coordinator at Cheryl.Bradley@hhs.texas.gov.

b. Where it is expressly directed by the Sole Point of Contact that another designated HHSC representative may speak to the Respondent (for example, during Contract negotiations), Respondents may then communicate with such explicitly designated representative.

Respondents are required to ensure that communications have been authorized by the Sole Point of Contact before engaging in such communication. Failure to comply with this requirement may result in the disqualification of a Respondent’s Solicitation Response.

3.3.4 Solicitation Questions

HHSC or DSHS will allow written questions and requests for clarification regarding this Solicitation.

Questions must be submitted by e-mail to the Sole Point of Contact (Section 3.3.1) by the deadline established in Section 3.1 (Schedule of Events). Responses to questions or other written requests for clarification will be consolidated and posted to the ESBD and will not be provided individually to requestors.

HHSC or DSHS reserves the right to amend answers previously posted, prior to the Solicitation response deadline (Section 3.1). Amended answers will be posted on the ESBD. It is the Respondent's responsibility to check the ESBD periodically. HHSC or DSHS also reserves the right to provide a single consolidated response to all similar questions at the agency’s sole discretion.

a. All questions and requests for clarification must include the following information:

1. Solicitation number;

2. Solicitation package reference (page number, section, and exhibit or attachment, if applicable) (if applicable, Respondent may also reference procurement library documents in this manner);

3. Question topic (e.g., “Schedule of Events,” “Exhibit M – Cost Proposal”); and

4. Question for HHSC or DSHS.

b. Requestor contact information below must be included in the body of the e-mail and submitted with question(s):

1. Company name;

2. Company representative name;

mailto:Cheryl.Bradley@hhs.texas.gov

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3. Phone number; and

4. E-Mail address.

Questions or requests for clarification received after the deadline in Section 3.1 (Schedule of Events) may be reviewed by HHSC or DSHS but may not be answered. Only answers to questions submitted to the Sole Point of Contact in writing, in accordance with this section, are binding.

3.4 PRE-PROPOSAL CONFERENCE

3.4.1 Attendance

HHSC PCS will conduct a pre-proposal conference and SP Training. Attendance is optional but highly recommended.

Attendees to virtual pre-proposal conferences are required to register for the webinar at the link provided in Section 3.4.2 (Conference Logistical Information). Attendees must provide their name, phone number, and name of the company they are representing.

3.4.2 Conference Logistical Information

HHSC will hold the pre-proposal conference and SP training webinar on the date and time set out in Section 3.1 (Schedule of Events).

People with disabilities who wish to attend the meeting and require auxiliary aid, or services should contact the Sole Point of Contact identified in Section 3.3.1 (Sole Point of Contact) at least seventy-two (72) hours before the meeting in order to have reasonable accommodations made by HHSC.

Teams Webinar Information:

Attendees must register for the webinar at the following link:

https://events.teams.microsoft.com/event/4f51f8cf-f263-43d1-a292-155910a2087f@9bf97732-82b9- 499b-b16a-a93e8ebd536b?source=copyLinkLegacyShareLinkDialog

After registration, participants will receive another email with the actual link to the webinar.

3.4.3 Questions at Pre-Proposal Conference

a. Reference Section 3.3.4 (Solicitation Questions) for the required format and information to be provided for submission of questions and requests for clarification.

b. Attendees may submit questions in writing at the conference. All questions must be in the required format and include the information as referenced in Section 3.3.4 (Solicitation Questions).

https://events.teams.microsoft.com/event/4f51f8cf-f263-43d1-a292-155910a2087f@9bf97732-82b9-499b-b16a-a93e8ebd536b?source=copyLinkLegacyShareLinkDialog https://events.teams.microsoft.com/event/4f51f8cf-f263-43d1-a292-155910a2087f@9bf97732-82b9-499b-b16a-a93e8ebd536b?source=copyLinkLegacyShareLinkDialog

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c. During the conference, HHSC or DSHS may provide responses to questions and requests for clarification, but only written responses posted by HHSC PCS as an Addendum to the Solicitation on the ESBD will be considered an official, binding update to the Solicitation.

d. HHSC or DSHS reserves the right to amend, prior to the Solicitation Response Deadline, answers previously posted. Amended answers will be posted on the ESBD. Notification of postings will be in accordance with Section 3.1 (Schedule of Events).

e. Conversations with HHSC or DSHS program area staff before or after the pre-proposal conference are prohibited.

3.5 SOLICITATION RESPONSE COMPOSITION

3.5.1 General Information

Failure to submit all required Solicitation Response documents in the required format(s) may result in disqualification of the Solicitation Response without further consideration (Section 3.6.3, Submission Checklist). Respondent shall prepare a Solicitation Response that clearly and concisely represents its qualifications and capabilities. Expensive bindings, colored displays, promotional materials, etc. are not necessary or desired. Respondent should focus on the instructions and requirements of the Solicitation.

3.5.2 Page Limit and Supporting Documentation

The narrative proposal must not exceed forty (40) pages and must be properly paginated, formatted as an 8 ½" x 11" page with 1-inch margins, and use a 12 point or larger font, except that a smaller font may be used for page headers and footers, footnotes, and illustrations such as tables, charts, diagrams, figures, graphs and other visual aids. If a font smaller than 12 point is used, the text when printed on 8 ½" x 11" paper must not require magnification to be legible. Large organizational charts, diagrams, or technical schematics may be formatted as an 11” x 17” page. Times New Roman font is preferred.

If complete responses cannot be provided without referencing supporting documentation, such documentation must be provided with the Solicitation Response, with specific reference made to the file, page, section, and/or paragraph where the supporting information can be found.

3.5.3 Discrepancies

In the event of any discrepancies or variations between copies, HHSC or DSHS is under no obligation to resolve the inconsistencies and may make its scoring and selection decisions accordingly, including the decision to potentially disqualify a Solicitation Response. If Respondent is required to designate an “Original” Solicitation Response but fails to do so, HHSC or DSHS, in its sole discretion, will determine the version to be used as the original or may disqualify the Solicitation Response. If the Respondent submits a redacted Solicitation Response as the “Original,” HHSC or DSHS will disqualify the Solicitation Response, and it will not be evaluated. HHSC or DSHS will not accept any

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3.5.4 Exceptions

If Respondent takes an exception to any provisions of this Solicitation, Respondent in its Solicitation Response must specifically and clearly identify each exception on Exhibit E, Exceptions Form and provide all information requested on the form. Any exception that is not submitted on the form and in the format prescribed by Exhibit E, Exceptions Form will be rejected without consideration.

An exception includes any business, economic, legal, programmatic, or practical assumptions that underlie the Respondent’s Solicitation Response. Respondent must complete Exhibit E, Exceptions Form if Respondent takes an exception to any exhibit located in Article IX (List of Exhibits). When completing Exhibit E, Exceptions Form, Respondent must explain the basis for the exception as it relates to this Solicitation. Nonresponsive explanations include references to (1) a prior version of the exhibit published by System Agency and (2) different terms in a previous transaction with System Agency or another State agency.

Respondent represents that it takes no exceptions to any part of this Solicitation if the Solicitation Response does not include a completed Exhibit E, Exceptions Form.

A Solicitation Response that is not responsive to the Solicitation requirements may result in disqualification. No exception, nor any other term, condition, or provision in a Solicitation Response that differs, varies from, or contradicts, this Solicitation will be considered to be part of the Contract unless specifically identified and expressly accepted by System Agency in writing in the Contract.

Respondent is highly encouraged, in lieu of including exceptions in its Solicitation Response, to submit any inquiries regarding the Solicitation in accordance with Section 3.3.4 (Solicitation Questions).

3.5.5 Binding Offer

A Solicitation Response should be responsive to the Solicitation as worded and without any assumption that any or all terms, conditions, or provisions of the Solicitation will be negotiated.

Furthermore, all Solicitation Responses constitute binding offers. Any Solicitation Response that includes any type of disclaimer or other statement indicating that the response does not constitute a binding offer may be disqualified.

If a Respondent’s ability to enter into a Contract is contingent upon any exception provided in accordance with Section 3.5.4 (Exceptions), the Respondent may be disqualified from further consideration for Contract award.

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3.6 SOLICITATION RESPONSE SUBMISSION AND DELIVERY

3.6.1 Deadline

Solicitation Responses must be received at the address in Section 3.6.4 (Labeling and Delivery for USB Submission and Other Materials) and time-stamped by HHSC PCS no later than the date and time specified in Section 3.1 (Schedule of Events).

Solicitation Responses received after the deadline specified in Section 3.1 (Schedule of Events) will be rejected and not considered for Contract award.

3.6.2 Submission Option

a. Submission Option #1, USB Drive: Respondent shall submit two USB drives—one (1) labeled “Original Proposal” and one (1) labeled “Copy”—containing the following documents:

1. Each USB must contain one file named “Original” that contains the Respondent’s entire Solicitation Response (except the cost proposal and VetHUB Subcontracting Plan) in searchable portable document format (PDF), unless otherwise specified for a particular attachment or exhibit.

2. If applicable, in accordance with Section 8.1.5 (Public Information Act – Respondent Requirement Regarding Disclosure), each USB must contain one file named “Public Information Act Copy” that contains the Respondent’s entire Solicitation Response, including all exhibits and attachments, in a searchable PDF.

3. In accordance with Section 7.1 (Cost Proposal), each USB must contain one file named “Cost Proposal” that contains the Respondent’s cost proposal in Excel format with active formulas (compatible with Microsoft Office 2016).

4. In accordance with Section 6.8 (VetHUB Subcontracting Plan), each Response must contain one file named “VetHUB Subcontracting Plan” in searchable PDF that contains the Respondent’s VetHUB Subcontracting Plan and all supporting documentation.

b. Submission Option #2: Respondent shall submit the following through the Online Bid Room utilizing the procedures in Exhibit L, HHS Online Bid Room Information:

1. One file named “Original” that contains the Respondent’s entire Solicitation Response (except the cost proposal and VetHUB Subcontracting Plan) in searchable portable document format (PDF), unless otherwise specified for a particular attachment or exhibit.

2. If applicable, in accordance with Section 8.1.5 (Public Information Act – Respondent Requirements Regarding Disclosure), one file named “Public

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Information Act Copy” that contains the Respondent’s entire Solicitation Response, including all exhibits and attachments, in searchable PDF.

3. In accordance with Section 7.1 (Cost Proposal), the Response must contain one file named “Cost Proposal” that contains the Respondent’s cost proposal in Excel format with active formulas (compatible with Microsoft Office 2016).

4. In accordance with Section 6.8 (VetHUB Subcontracting Plan), the Response must contain one file named “VetHUB Subcontracting Plan” in searchable PDF that contains the Respondent’s VetHUB Subcontracting Plan and all supporting documentation.

3.6.3 Submission Checklist

Solicitation Consideration and Award Consideration Documents (Section 1.2, Definitions) must be submitted by the deadline for Solicitation Response submissions (Section 3.1, Schedule of Events).

Solicitation Consideration Documents will be reviewed as received, and Respondent will not have an opportunity to remedy missed requirements. At its sole discretion, HHSC may request a Respondent to remedy missing elements of Award Consideration Documents. Those marked “SC” are Solicitation Consideration Documents, and those marked “AC” are Award Consideration Documents.

The Solicitation Response must be submitted using one of the approved methods identified in Section

3.6 (Solicitation Response Submission and Delivery). Below are the documents required to be submitted with the Solicitation Response. Where searchable PDF files are required, submission of non-searchable (image only) PDF files may result in disqualification from further consideration for Contract award.

A. Proposal and Respondent Information

1. Narrative Proposal (Section 5.1) SC ____

2. Company Information (Section 6.1) SC ____

3. Franchise Tax Information (Section 6.2) AC ____

4. References (Section 6.3) AC ____

5. Major Subcontractor Information (Section 6.4) SC ____

6. HHS Solicitation Affirmations (Section 6.5, Exhibit A)

SC ____

7. Assurances – Non-Construction Programs (Section 6.5, Exhibit I)

AC ____

8. Certification Regarding Lobbying (Section 6.5, Exhibit K)

AC ____

9. Exceptions (if applicable) (Section 3.5.4, Exhibit E)

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10. Financial Information (Section 6.6) SC ____

11. SPI (Section 2.4, Exhibit D-1)

12. TX-RAMP Certification Documentation (if applicable)

(Section 6.9) AC ____

B. Cost Proposal (Article VII) SC ____

C. VetHUB Subcontracting Plan (Section 6.8 and Exhibit H)

SC ____

3.6.4 Labeling and Delivery for USB Submission and Other Materials

Respondent must deliver Solicitation Responses submitted via USB by one of the methods below.

Overnight/Express/Priority Mail Hand Delivery

Health and Human Services Commission

ATTN: Response Coordinator Tower Building Room 108 1100 W. 49th St., MC 2020

Austin, Texas 78756

Health and Human Services Commission ATTN: Response Coordinator

Procurement & Contracting Services Building 1100 W. 49th St., MC 2020

Austin, Texas 78756

BE ADVISED: All Solicitation Responses become the property of HHSC after submission and will not be returned to the Respondent. It is the Respondent’s responsibility to appropriately mark and deliver the Solicitation Response to HHSC PCS by the specified date. A dated shipping label, invoice of receipt from a USPS or commercial carrier, or any other documentation in lieu of the on-site time stamp WILL NOT be accepted.

Each Respondent is solely responsible for ensuring its Solicitation Response is submitted in accordance with all Solicitation requirements, including, but not limited to, proper labeling of packages, sufficient postage or delivery fees, and ensuring timely receipt by HHSC. In no event will HHSC or DSHS be responsible or liable for any delay or error in delivery. Solicitation Responses must be RECEIVED by HHSC PCS by the Solicitation Response Deadline identified in Section

3.1 (Schedule of Events).

Solicitation Responses submitted via USB by mail or hand delivery shall be placed in a sealed package.

The sealed package and the USB drives shall be clearly labeled on the outside as follows:

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SOLICITATION NO: HHS0017240

SOLICITATION NAME Pharmacy Benefits Manager Services

SOLICITATION RESPONSE DEADLINE See Section 3.1 (Schedule of Events).

PURCHASER NAME: Katrina Chester, CTCD, CTCM

RESPONDENT NAME: [Respondent Name]

It is Respondent’s sole responsibility to ensure that packaging is sufficient to prevent damage to contents. HHSC or DSHS will not be responsible or liable for any damage, and damaged Solicitation Responses may not be considered at HHSC’s or DSHS’s sole discretion.

HHSC or DSHS will not be held responsible for any Solicitation Response that is mishandled prior to receipt by HHSC PCS. It is the Respondent’s sole responsibility to mark appropriately and deliver the Solicitation Response to HHSC PCS by the specified date and time. HHSC or DSHS will not be responsible for late delivery, inappropriately identified documents, or other submission errors that may lead to disqualification or nonreceipt of the Respondent’s Solicitation Response.

3.6.5 Modifications and Withdrawals

Prior to the Solicitation Response submission deadline in Section 3.1 (Schedule of Events), Respondent may: (1) withdraw its Solicitation Response by submitting a written request to the Sole Point of Contact identified in Section 3.3.1 (Sole Point of Contact), or (2) modify its Solicitation Response by submitting a written amendment to the Sole Point of Contact identified in Section 3.3.1 (Sole Point of Contact). When modifying its Solicitation Response, Respondent must include in writing the section(s) of its submission that will be replaced or removed by the amendment.

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ARTICLE IV. SOLICITATION RESPONSE EVALUATION AND AWARD

PROCESS

4.1 CONFORMANCE WITH STATE LAW

Solicitation Responses shall be evaluated in accordance with Texas Government Code Title 10, Subtitle D, Chapter 2155.144(d). HHSC or DSHS shall not be obligated to select the lowest priced Solicitation Response but shall make an award to the Respondent that provides the best value to the State of Texas.

4.2 BEST VALUE DETERMINATION

4.2.1 Selection Methodology

Solicitation Responses that meet the minimum qualifications will be submitted to the evaluation team for review and scoring. Each member of the evaluation team will receive a copy of each responsive Solicitation Response. The evaluators will review the Solicitation Responses considering the criteria listed in Section 4.2.5 (Written Response Evaluation Criteria).

Evaluators will individually score the Solicitation Responses. This procurement will utilize aggregated individual evaluation methodology as outlined by this section.

The following subsections describe the evaluation process, including any criteria for advancement to the various phases of evaluation, if applicable.

4.2.2 Minimum Qualifications

Respondents must meet the minimum qualifications listed below.

a. Respondents must have recently been in business for a minimum of five (5) years, or the principals/owners must have had recent ownership/executive management experience in a previous company that provided Pharmacy Benefits Management (PBM); and

b. Respondents must be financially solvent and adequately capitalized, as determined based on a review of documentation required by Section 6.6 (Financial Information); and

c. Respondents must have submitted the Solicitation Response in accordance with Section 3.6, (Solicitation Response Submission and Delivery), including all Solicitation Consideration and Award Consideration Documents (see Section 3.6.3, Submission Checklist).

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4.2.3 Initial Compliance Screening

HHSC will review Solicitation Responses for compliance with the Submission Checklist (Section 3.6.3) and for demonstrated ability to meet the Minimum Qualifications (Section 4.2.2) required to advance to evaluations. Failure to meet the Minimum Qualifications (Section 4.2.2) will result in the disqualification of the Solicitation Response.

HHSC will automatically disqualify any Solicitation Response that does not include one or more of the completed and signed (as applicable) Solicitation Consideration Documents listed in Submission Checklist (Section 3.6.3).

At its sole discretion, HHSC may disqualify any Solicitation Response that does not include all required Award Consideration Documents. See Section 3.6.3 (Submission Checklist).

HHSC may contact references provided in response to this Solicitation. HHSC may contact Respondent’s clients, or solicit information from any available source, including the Comptroller’s VPTS. Any information received may be grounds for disqualification if that information, in HHSC’s or DSHS’s sole discretion, suggests that the Respondent may perform poorly if selected.

4.2.3.1 Verification of Past Vendor Performance

By submitting a Solicitation Response, Respondent generally releases from liability and waives all claims against any party providing information about Respondent at the request of HHSC.

At its sole discretion, Respondents may be rejected as a result of unsatisfactory past performance under any contract(s) as reflected in vendor performance reports, reference checks, or other sources.

Respondent’s past performance may be considered prior to making an award determination.

a. Reasons for which a Respondent may be denied a contract include, but are not limited to:

1. Respondent has unfavorable reports or a grade less than a “C” on the CPA Vendor Performance Tracking System (VPTS);

2. Respondent is currently under a corrective action plan through HHSC;

3. Respondent has had repeated negative vendor performance reports for the same reason;

4. Respondent has a record of repeated non-responsiveness to vendor performance issues; or

5. Respondents have contracts or purchase orders that have been cancelled in the previous 12 months for non-performance or sub-standard performance.

b. HHSC may examine other sources of vendor performance, which may include information provided by any governmental entity, whether an agency or political subdivision of the State of Texas, another state, or the federal government. The performance information may include, but is not limited to:

1. Notices of termination;

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2. Cure notices;

3. Assessments of liquidated damages;

4. Litigation;

5. Audit reports; and

6. Non-renewals of contracts.

c. HHSC, at its sole discretion, may initiate investigations or examinations of vendor performance based upon media reports. Any negative findings, as determined by HHSC in its sole discretion, may result in HHSC’s removing Respondent from further consideration for award.

4.2.4 Written Solicitation Response Evaluation

Each member of the evaluation team will read the Solicitation Responses in preparation for evaluation.

The evaluation team will score all Solicitation Responses that pass initial screening (Section 4.2.3, Initial Compliance Screening). Solicitation Responses will be scored against the criteria in Section

4.2.5 (Written Response Evaluation Criteria).

Solicitation Responses will be evaluated utilizing aggregated individual scoring and any other methods outlined in Article IV, Solicitation Response Evaluation and Award Process. The individual evaluators’ scores will be aggregated and weighted, resulting in the Final Written Response Scores.

4.2.5 Written Response Evaluation Criteria

Solicitation Responses shall be consistently evaluated and scored in accordance with the following criteria. (See, also, Exhibit G, Evaluation Tool)

a. Project Workplan (45%)

b. Qualifications and Experience (20%)

c. Cost Proposal (35%)

4.2.6 Best and Final Offer (BAFO)

HHSC or DSHS may, at its sole discretion, following the execution of Section 4.2.1 (Selection Methodology), request BAFOs from all Respondents. The request for a BAFO will allow a Respondent the opportunity to revise its original Solicitation Response, including pricing, or leave its originally submitted Solicitation Response unchanged. Revisions must be submitted in the manner and form prescribed by the BAFO request. Requests will be sent to the point of contact provided by the Respondent. HHSC or DSHS is not responsible for a Respondent’s failure to timely receive the BAFO request.

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HHSC or DSHS reserves the right to request more than one BAFO from each of the selected Respondents. If a response is submitted to a request for a BAFO, the Final Written Response Scores will be revised in accordance with the stated criteria in Section 4.2.5 (Written Response Evaluation Criteria) as to any changes made to the Respondent’s original Solicitation Response. A request for a BAFO does not guarantee an award or further negotiations.

If BAFOs are requested by HHSC or DSHS and submitted by the Respondent, they will be evaluated using the criteria stated in the BAFO invitation, scored, and ranked by the evaluation committee. The award will then be granted to the highest scoring Respondent. However, a Respondent should provide its best offer in its original Solicitation Response. Respondents should not expect or assume that HHSC or DSHS will request a BAFO.

4.2.7 Final Written Response Score

A Respondent’s Final Written Response Score is the score from the Written Solicitation Response Evaluation (Section 4.2.4). If BAFOs are conducted, the Final Written Response Score may be adjusted in accordance with Section 4.2.6 (Best and Final Offer). The Final Written Response Score may not always determine best value or selection for negotiation and award. See Summary of Best Value Determination (Section 4.2.8) for more information.

4.2.8 Summary of Best Value Determination

The final selection for award will be based on best value, as determined by this section. This includes any scoring adjustments for outliers, interviews, best and final offers, oral presentations, demonstrations, site visits, or other additional considerations as specified by this solicitation.

Respondents are encouraged to thoroughly review the processes outlined in this section, as it documents the best value considerations to be made by HHSC or DSHS when selecting a Respondent for negotiation and Contract award.

4.3 QUESTIONS OR REQUESTS FOR CLARIFICATION

By submitting a Solicitation Response, Respondent grants HHSC or DSHS the right to ask questions, request clarifications, and to obtain any information from any lawful source regarding the past history, practices, conduct, ability, and eligibility of the Respondent to supply Goods or Services and to fulfill…