Final_RFP_790_2700000038_2_SO_FORM.PDF

Document ID: RFP 790 2700000038 Page: 1

Commonwealth of Kentucky

SOLICITATION MODIFICATION

Modification: Yes Version #: 2

TITLE: Pharmacy Benefit Claims Monitoring

Date Issued:

09/04/2026 Record Date:

08/31/2026

Solicitation Closes Date:

09/11/2026 Time:

16:00

Solicitation No:

RFP 790 2700000038

Reason for Modification

Modification to answer vendor questions per section 7.00 regarding this RFP. Vendor questions posted on page 23 of the RFP. Section 4.00 schedule changed to reflect new proposal date.

Online Bidding Prohibited: No

For Information Call:

Alexa Perry 502-564-5682

Bid Receiving Location:

Personnel - Office of Administrative Services Admin Services 501 High Street, 3rd floor

Frankfort KY 40601

Vendor Customer Number:

Vendor Name:

Phone Number:

Fax Number:

Email Address:

Ordering

Address:

City, State, Zip:

Contact Name:

Contact Email:

Contact Phone Number:

Payment

Address:

City, State, Zip:

Contact Name:

Contact Email:

Contact Phone Number:

Ownership Type

__ Sole Proprietorship __ Partnership __ Corporation __ Other_________________________

SIGNATURE OF AUTHORIZED AGENT IS REQUIRED UNLESS RESPONSE

IS SUBMITTED ELECTRONICALLY. FAILURE TO SIGN SHALL RENDER

THE BID INVALID.

Signature X_________________________________________ FEIN#____________________ Date____________

All offers subject to all terms and conditions contained in this solicitation.

Document ID: RFP 790 2700000038 Page: 2

Line Items

Commodity Group: Default

Line CL Description Quantity UOM Unit Cost Line Total or Contract Amnt

1 Pharmacy Benefit Claims Monitoring

Comm Code Comm Description Manufacturer Model # Manuf Part #

91840PS PSC-Employee Benefits Consulting

Extended Description Pharmacy Benefit Claims Monitoring

Shipping Information Personnel - Office of Administrative Services persdfs@KYMSOffice.onmicrosoft.com 501 High Street, 3rd floor

Frankfort KY 40601

Billing Information Personnel - Office of Administrative Services

501 High Street, 3rd floor

Frankfort KY 40601

Document ID: RFP 790 2700000038 Page: 3

Submission Checklist

The following items will be required to be submitted with bid:

Item

Revised February 2026

PROPOSAL SUBMISSION CHECKLIST

The vendor MUST include the following with the proposal submission.

If the items highlighted below are not submitted with the proposal submission, the Commonwealth MUST deem the proposal non-responsive and SHALL NOT consider for award.

All other items MUST be submitted prior to award.

_____ SIGNED AND COMPLETED SOLICITATION –Section(s) 8.00 and 8.10 of this RFP

(not required if submitting electronically)

_____ *PROPOSED SOLUTION (TECHNICAL) UNDER SEALED COVER AND BY

CLOSING DATE --Section(s) 8.00 and 8.10 of this RFP

_____ *PROPOSED SOLUTION (COST) UNDER SEALED COVER AND BY CLOSING

DATE -- Section(s) 8.00 and 8.10 of this RFP

_____ TRANSMITTAL LETTER – Section 8.20 of this RFP

_____ PROOF OF REGISTRATION WITH SECRETARY OF STATE BY A FOREIGN

ENTITY -- Section 8.00 of the Personal Service Contract Terms and Conditions of this

RFP

_____ REQUIRED AFFIDAVIT(S) – Section 8.20 of this RFP

*The Commonwealth defines SEALED as “a closure that must be broken to be opened and that thus reveals tampering” (Merriam-Webster Dictionary, https://www.merriam-webster.com/ dictionary/seal

Addendum #1

Modification to answer vendor questions per section 7.00 regarding this RFP. Vendor questions posted on page 23 of the RFP. Section 4.00 schedule changed to reflect new proposal date.

REQUEST FOR PROPOSAL

FOR

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2700000038 Final Pharmacy Benefit Claims Monitoring Total Pages: 32 https://www.merriam-webster.com/dictionary/seal https://www.merriam-webster.com/dictionary/seal

PERSONAL SERVICE CONTRACT

Personnel Cabinet/Department of Employee Insurance Pharmacy Benefit Claims Monitoring

RFP 2700000038

This document constitutes a Request for Proposals for a Personal Service Contract from qualified individuals and organizations to furnish those services as described herein for the Commonwealth of Kentucky, Personnel Cabinet/Department of Employee Insurance.

Offerors are advised that any personal service contract resulting from this RFP must comply with all applicable provisions of KRS 45A and KRS 12.210 prior to becoming effective.

A contract, based on this RFP, may or may not be awarded. Any contract award from this RFP is invalid until properly approved and executed by the Finance and Administration Cabinet and filed with the Legislative Research Commission, Government Contract Review Committee.

1.00 Purpose and Background

This RFP is being issued in order to secure a vendor that will be responsible for monitoring all pharmacy benefit claims for every individual enrolled in the Public Employee Health Insurance Program, commonly referred to as the Kentucky Employees’ Health Plan or KEHP, in accordance with Ky. Acts Chapter 233 (SB 178, 22RS).

The KEHP is a self-insured group health plan administered by the Department of Employee Insurance (DEI), an agency within the Commonwealth of Kentucky’s Personnel Cabinet. (See KRS 18A.225 through KRS 18A.2287). The KEHP became a self-insured health plan effective January 1, 2006, for the benefit of the following public employees and retirees:

1. Commonwealth of Kentucky employees (19%);

2. Employees of other governmental agencies and health departments that participate in a retirement system administered by the Commonwealth (7%);

3. Employees and elected members of boards of education (53%); and

4. Retirees participating in a retirement system administered by the Commonwealth of Kentucky and who are under age sixty-five (21%).

The KEHP also provides health insurance benefits for the eligible dependents and beneficiaries of employees and retirees who are entitled to participate in the KEHP. As of February 2026, the KEHP insured approximately 150,000 eligible employees and retirees, and approximately 272,000 covered lives, including dependents and beneficiaries.

KEHP offers four plan options to employees and retirees:

1. LivingWell CDHP;

2. Living Well PPO;

3. LivingWell Basic CDHP; and

4. LivingWell HDHP.

As of February 2026, planholder enrollment counts, by plan option, were as follows:

1. 81,977 enrolled in the LivingWell CDHP;

2. 50,455 enrolled in the LivingWell PPO;

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2700000038 Final Pharmacy Benefit Claims Monitoring Total Pages: 32

3. 11,310 enrolled in the LivingWell Basic CDHP; and

4. 475 enrolled in the LivingWell HDHP.

The KEHP contracts with Caremark PCS Health (CVS Caremark) to administer the plan’s pharmacy benefits and pay pharmacy claims incurred by KEHP members as its pharmacy benefit manager. Prior authorization, step therapy, exception processes, and quantity limits are among the programs in place to control and manage prescription drug utilization through Caremark. In 2025, CVS administered and KEHP paid 4,505,977 claims.

In addition, the KEHP contracts with Anthem Health Plans of Kentucky (Anthem) to administer the plan’s healthcare benefits and pay medical claims incurred by KEHP members. In addition, Anthem administers and the KEHP pays for certain specialty drugs that require administration by providers, such as Botox, Remicade, and Xolair. The KEHP has a Medical Specialty Drug Management program, which includes Site of Care Utilization Management to control and manage specialty drug spend administered through Anthem.

Lastly, the KEHP contracts with AON to perform actuarial and consultant services, including consulting regarding pharmacy benefit management, annual pharmacy market checks, and other pharmacy audits upon request.

In plan year 2025, employee and employer premium contributions totaled $2.2 Billion, and medical and prescription drug claims costs exceeded $2.6 Billion (before drug rebates). Similar experience is expected for plan year 2026.

2.00 Scope of Work

Applicable Definitions:

For the purposes of this RFP, the following definitions shall apply:

1. “Accuracy of Pharmacy Benefit Claims” or “Accuracy of the Claims” means an analysis of whether or not KEHP was billed, charged, and paid pharmacy benefit claims in accordance with contractual terms and plan designs (copay/coinsurance/deductible) in effect at the time of the analysis.

2. “Errors” means issues identified during the Vendor’s analysis of pharmacy benefit claims regarding inaccurate claims billing, inaccurate fees charged to or paid by the Personnel Cabinet, inaccurate application of pricing in effect, or inaccurate KEHP member cost share applied,

3. “Near Real Time” means the later of either

a. Any time after the claim but prior to the payment due date of each claim or invoice submitted by a KEHP Contracted Entity; or

b. Within five (5) days of receipt of the claim or invoice.

4. “KEHP Contracted Entities” means:

a. Any insurer that KEHP may contract with pursuant to KRS 18A.225 to administer pharmacy benefits;

b. Anthem or any other third-party administrator that KEHP may contract with in the future pursuant to KRS 18A.2254 to administer medical benefits; or

c. CVS Caremark or any other pharmacy benefit manager that KEHP may contract with in the future to administer pharmacy benefits;

5. “Savings” means any identified overpayments of claims or fees paid by the Personnel Cabinet to a KEHP Contracted Entity, which are subsequently collected by, or otherwise reimbursed to, KEHP after identification.

Savings shall not include:

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a. Errors identified with respect to the inaccurate application of KEHP member cost share, whether the member underpaid or overpaid;

b. Any underpayments of claims or fees paid by the Personnel Cabinet to a KEHP Contracted Entity; and

c. Any disputed overpayment that has not been collected or otherwise resolved to the benefit of the Personnel Cabinet; and

d. Overpayments where the Vendor and a KEHP Contracted Entity disagree regarding the resolution of the overpayment of a pharmacy benefit claim that requires intervention by the Personnel Cabinet to resolve.

Vendor Eligibility:

A Vendor responding to this RFP:

1. Shall be capable of performing the analysis of pharmacy benefit claims to validate Accuracy of the Claims and identify Errors in Near Real Time as further described in this RFP.

2. Shall not be an entity that performs annual retroactive audits of pharmacy benefit claims for

KEHP.

3. For as long as the contract awarded pursuant to this RFP is in effect, shall not be affiliated by a common parent company or holding company, share any common members of the board of directors, or share managers in common with:

a. Any insurer that KEHP may contract with pursuant to KRS 18A.225;

b. Anthem, or any other third-party administrator that KEHP may contract with in the future pursuant to KRS 18A.2254;

c. CVS Caremark, or any other pharmacy benefit manager that KEHP had a contract with in the past, or may contract with in the future;

d. A pharmacy benefit manager contracted by an insurer pursuant to KRS 18A.225 or a third-party administrator contracted pursuant to KRS 18A.225.

4. Shall not be an entity that performs drug utilization reviews for the Personnel Cabinet, DEI or any other KEHP Contracted Entity.

5. Shall not be an entity that exercises any authority over the provision of health care benefits for Medicare eligible retirees.

Vendor Responsibilities:

With this RFP, the Personnel Cabinet is seeking a Vendor to perform the analysis of pharmacy benefit claims to validate the Accuracy of the Claims and identify Errors in Near Real Time which shall include:

1. An analysis of one hundred percent (100%) of pharmacy invoices or claims submitted for payment to the KEHP, including those submitted on or after July 1, 2026, by Caremark or any future PBM with which Personnel Cabinet may contract in the future while the contract awarded pursuant to this RFP is in effect. The Vendor shall not utilize statistical sampling methods in lieu of analyzing all pertinent pharmacy invoices and claims;

2. Identification and correction of errors in pharmacy benefit claims in order to avoid or reduce erroneous overpayments by KEHP through the KEHP Contracted Entities;

3. Identification of underpayments made by the KEHP Contracted Entities;

4. Identification of inappropriate or erroneous fees imposed by a KEHP Contracted Entity;

5. Submission of a quarterly report to the Personnel Cabinet and the Legislative Research Commission, which shall include the following:

a. A summary of the analysis conducted;

b. A statement of the errors identified pursuant to the Vendor’s responsibilities outlined herein;

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c. A statement of the resolutions of the errors identified pursuant to the Vendor’s responsibilities outlined herein; and

d. Savings realized by KEHP as a result of the Vendor’s analysis, validation, and resolutions of the Errors.

6. Negotiation with KEHP Contracted Entities when Errors are identified to resolve the Error;

7. Analysis that takes the following into consideration:

a. Compliance with all state and federal laws relating to or applicable to the KEHP;

b. Compliance with any contract between the Personnel Cabinet and KEHP Contracted Entities;

and

c. The market competitiveness of pharmacy benefit payments, including the adequacy of payments to pharmacies; and

8. Demonstration of the Vendor’s capability of performing the analysis of pharmacy benefit claims to validate Accuracy of the Claims and identify errors in Near Real Time.

The Vendor’s analysis required by this RFP shall not:

1. Interfere with a KEHP member’s ability to obtain prescribed medications;

2. Interfere with the Personnel Cabinet’s obligation to timely pay invoices or claims pursuant to contract, state law, or federal law;

3. Interfere with the Personnel Cabinet’s established processes for the timely payment of invoices or claims; or

4. Require system changes or the development or transmission of unique files by the Personnel Cabinet or the KEHP Contracted Entities that would result in a cost to the Personnel Cabinet.

Personnel Cabinet Responsibilities:

To assist the Vendor with the execution of its duties and responsibilities as outlined in this RFP the Personnel Cabinet:

1. Shall grant full access to the contract awarded to Caremark or any future pharmacy benefits manager with which the Personnel Cabinet may contract while this contract is in effect including all pertinent reference documents, price lists, specialty drug price lists, and updates of any pricing changes;

2. Shall grant full access to any other contract that defines a pharmacy benefit manager’s obligations and responsibilities as it relates to processing KEHP’s pharmacy benefit claims, including any contract between the pharmacy benefit manager and an insurer contracted pursuant to KRS 18A.225 or a third-party administrator contracted pursuant to KRS 18A.2254; and

3. Shall grant full access to invoices and unaltered claims files associated with KEHP’s pharmacy benefits.

4. In the event of a disagreement between the Vendor and a KEHP Contract Entity regarding an identified discrepancy, intervene to the extent necessary and at the option of the Personnel Cabinet to resolve the disagreement.

Minimum Mandatory Requirements:

The Vendor shall meet and confirm the ability to meet the following Minimum Mandatory Requirements and Vendor Responsibilities:

1. Demonstrate the Vendor’s capability to perform the analysis of pharmacy benefit claims to validate Accuracy of the Claims and identify Errors in Near Real Time.

2. The Vendor shall comply with all applicable federal and state laws and reporting requirements including compliance with the Health Insurance Portability and Accountability Act of 1996, as amended, and subsequent rules and regulations that define HIPAA compliance requirements (HIPAA). Vendor shall be willing to enter into a Business Associates Agreement, attached to this RFP at Appendix 1, with KEHP for the protection of personal health information and shall procure

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Business Associates Agreements with all subcontractors performing services under the contract on behalf of the Vendor;

3. The Vendor must have at least five (5) years of experience as of January 1, 2026, in providing the services required by this RFP;

4. The Vendor shall provide sufficient staffing resources, including a designated Account Manager, to ensure all services required by this RFP can be delivered to the Personnel Cabinet;

5. Vendor agrees that Personnel Cabinet decisions regarding whether an identified issue resulted in Savings and whether Vendor shall receive fees associated with a finding, are binding upon Vendor, and not subject to further appeal or review; and

6. Vendor shall meet the eligibility requirements outlined in this RFP.

3.00 Evaluation Criteria

The Personnel Cabinet shall conduct a comprehensive, fair, and impartial evaluation of all proposals. The Personnel Cabinet may reject any proposal that is incomplete or in which there are significant inconsistencies or inaccuracies. The Personnel Cabinet reserves the right to reject all proposals.

The Personnel Cabinet has established a Proposal Evaluation Committee to review, evaluate and verify information submitted by the offeror.

Each vendor is responsible for submitting all relevant, factual and correct information with their offer to enable the evaluator(s) to afford each vendor the maximum score based on the available data submitted by the vendor.

The Personnel Cabinet shall evaluate the proposals by assigning scores as indicated.

Technical Proposal Evaluation

Criteria Maximum Points Possible Mandatory Requirement

Requirements that include the words “Shall”, “Will”, “Must” indicate a mandatory requirement

Mandatory Requirement means a condition set out in the specifications or statement of work that must be met without exception.

PROPOSALS THAT DO NOT MEET

MANDATORY REQUIREMENTS WILL BE

DEEMED NON-RESPONSIVE AND WILL

NOT BE CONSIDERED.

Pass/Fail

General Vendor and Staffing Information 200 Vendor Capabilities 1,000 Reporting 900 Compliance, Interfacing, and Implementation Plan

Maximum Points Possible 2,500

A. General Vendor and Staffing Information

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In response to this RFP, the Vendor shall provide general vendor, account management, and staffing information by completing the questionnaire attached to the RFP as Appendix 2. Such information includes, but is not limited to, the following:

1. Contact information;

2. Vendor’s organizational structure and ownership information;

3. History of the Vendor’s organization;

4. Vendor’s experience providing analysis of pharmacy benefit claims to validate Accuracy of the Claims and identify errors in Near Real Time;

5. Vendor’s authority to transact business in Kentucky;

6. Vendor/Staff licenses and credentials;

7. Confirmation of willingness to meet all minimum mandatory requirements;

8. Ability to meet the statutory eligibility requirements and limitations;

9. Staffing; and

10. Subcontractors.

B. Vendor’s Capabilities

In response to this RFP, the Vendor shall provide information regarding the Vendor’s capabilities to perform the services requested by this RFP by completing the questionnaire attached to the RFP as Appendix 2. Such information includes, but is not limited to, the following:

1. Identify all information, data, and files needed to analyze pharmacy benefit claims to validate Accuracy of the Claims and identify errors in Near Real Time;

2. Identify the source of all information, data, and files needed to analyze pharmacy benefit claims to validate Accuracy of the Claims and identify errors in Near Real Time (Personnel Cabinet, KEHP Contracted Entity, Other);

3. Describe the process Vendor uses to analyze pharmacy benefit claims to validate Accuracy of the Claims and identify Errors in Near Real Time; and

4. Identify the resources needed from the Personnel Cabinet in order for the Vendor to perform the services required by this RFP.

C. Reporting

In response to this RFP, the Vendor shall provide information regarding the Vendor’s reporting capabilities by completing the questionnaire attached to the RFP as Appendix 2. Such information includes, but is not limited to, the following:

1. The standard reports available to the Personnel Cabinet;

2. The frequency of the Vendor’s reporting capabilities;

3. The ability of the Vendor to comply with the statutory mandate to submit a quarterly report to the Personnel Cabinet and the Legislative Research Commission, which shall include the following:

a. A summary of the analysis conducted;

b. A statement of the Errors identified pursuant to the Vendor’s responsibilities outlined herein;

c. A statement of the resolutions of the Errors identified pursuant to the Vendor’s responsibilities outlined herein; and

d. Savings recognized as a result of the Vendor’s analysis; and

4. Whether the Vendor can provide ad hoc reports at the request of the Commonwealth.

D. Compliance, Interfacing, and Implementation Plan

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In response to this RFP, the Vendor shall provide information regarding the Vendor’s compliance, interfacing, and implementation information by completing the questionnaire attached to the RFP as Appendix 2. Such information includes, but is not limited to, the following:

1. Acknowledgement of Vendor’s willingness to comply with HIPAA and enter into Business Associate Agreements;

2. Interfacing capabilities; and

3. Implementation plan and timeline.

Cost Proposal Evaluation

Criteria Maximum Points Possible Cost Form Attachment A 500 Maximum Points Possible 500

Payment to the Vendor for the services provided in accordance with this RFP shall be no more than thirty percent (30%) of the total Savings generated by the Vendor. In order to evaluate cost, the Vendor shall provide the percentage of Savings, as determined by the Personnel Cabinet and defined in this RFP, which shall be no more than thirty percent (30%) of Savings.

When bidding on the cost for this RFP use the statement provided in Attachment A. No cost or services may be bid other than the percentage of Savings, including but not limited to the following cost limitations:

a. The Vendor will not be compensated for travel time, regardless of the purpose of the travel.

b. The Vendor shall not charge for travel expenses in addition to the percentage of Savings.

c. The Vendor shall not include a consulting, legal, or accounting fee, in addition to the percentage of Savings as part of the Cost Proposal.

Oral Demonstration/Presentation Evaluation, if required

Criteria Maximum Points Possible

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Oral Demonstration/Presentation

The Commonwealth reserves the right to require Oral Presentations/Demonstrations to verify or expand on the Technical or Cost Proposals. Oral Presentations/Demonstrations may be conducted through videoconferencing or by conference call, if it is in the best interest of the Commonwealth to do so.

This is the opportunity for the vendor to present and demonstrate the solution and to answer questions or to clarify the understanding of the evaluation committee in accordance with the requirements of this RFP. The Commonwealth reserves the right to reject any or all proposals in whole or in part based on the oral presentations/demonstrations.

If required, the top two highest ranking vendors may be invited. Scheduling will be at the discretion of the Commonwealth. The Commonwealth reserves the right not to require oral presentations/demonstrations

Maximum Points Possible 500

Total Proposal Evaluation

Criteria Maximum Points Possible Technical Proposal 2,500

Cost Proposal 500

Oral Demonstrations/Presentations, if required 500

MAXIMUM POINTS POSSIBLE

3,500

4.00 Schedule of RFP Activities

The following schedule presents the major activities associated with the RFP distribution, written questions and proposal submission. The Commonwealth reserves the right at its sole discretion to change the Schedule of Activities, including the associated dates and times.

Release of RFP 8/19/2026

9/04/2026 Written Questions due by: August 26, 2026 4:00 PM 8/25/2026

Anticipated Commonwealth Response to Written Questions 8/28/2026 9/04/2026

Proposals Due by: September 11, 2026 4:00 PM 9/04/2026 09/11/2026

The Personnel Cabinet chooses to accept electronic proposals in lieu of hard copy proposals. See instructions in Section 8.00.

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*NOTE: ALL TIME REFERENCES ARE TO THE EASTERN TIME ZONE.

5.00 Offeror’s Conference

N/A. The Personnel Cabinet does not intend to hold an Offeror’s Conference.

6.00 Point of Contact

The Agency Contact named below shall be the sole point of contact throughout the procurement process. All communications, oral and written (regular mail, express mail or electronic mail), concerning this procurement shall be addressed to:

Alexa Perry 501 High St.

Frankfort KY 40601 502-564-5682 Alexaj.perry@ky.gov

From the issue date of this RFP until a Contractor(s) is selected and the selection is announced, Offerors shall not communicate with any other Commonwealth staff concerning this RFP.

7.00 Questions Regarding this RFP

Questions must be submitted in writing to the Agency Contact. The Commonwealth will respond to salient questions in writing by issuing an Addendum to the Solicitation. The Addendum shall be posted to the Commonwealth’s eProcurement page.

8.00 Proposal Submission

Electronic Proposals

Proposals shall be received by electronic submission in the eProcurement system, Kentucky Vendor Self Service System.

An electronic proposal shall be authorized by the proper agent of the firm by the act of submitting it electronically through the eProcurement system.

Proposal information MUST be completed online. Response must contain all required information for the Solicitation. All bidders MUST be registered in the Commonwealth eProcurement System via the Vendor Self Service System at https://vss.ky.gov .

Allow 24 – 48 hours to complete Vendor Registration. Vendors must be logged in to their Vendor Self Service (VSS) account in order to submit a response. Registrations completed the day of bid closing must be completed by the Vendor in the VSS portal. The Customer Resource Center is not able to complete registrations and activate accounts on the same day. Closing dates will not be extended for Vendors not registered by the date/time of the bid closing.

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All bidders are cautioned to begin their electronic submission in sufficient time to complete before the closing date and time. Delays due to technical difficulties or document upload impediments shall not be justification for acceptance of a late bid or proposal. Vendor attention to this advisory is encouraged. Instructions “How to Submit an Online Response for a Business Opportunity” are posted to Kentucky’s Vendor Self Service, https://vss.ky.gov . If you need assistance, please contact the Customer Resource Center (CRC) by email at Finance.CRCGroup@ky.gov or phone 502-564-9641 or toll-free 877-973-HELP (4357).

Proposals shall be submitted in three (3) parts: The Technical Proposal, the Cost Proposal, and Proprietary Information. Each part shall consist of one document attachment. Do not submit multiple document attachments as Technical, Cost or Proprietary. All files shall be labeled accordingly. Attachments may not exceed 65,000 KB.

Proposals submitted online must be in an “Accepted” status and shall be assigned a date and time stamp from the eProcurement system at the time of final acceptance and formal submission by the vendor. The system will not allow submission of an online proposal after the published date and time for closing.

A proposal may be modified or withdrawn by electronic or written notice ONLY if received prior to the bid closing date and time. An electronic offer may be modified by applying the appropriate electronic signature and following the procedure in the state’s eProcurement signature.

Acknowledgment of Addenda

It is the vendor's responsibility to check the web site for any modifications to this solicitation.

Vendors are encouraged to acknowledge each addendum by signing and submitting the latest addendum with their response. However, signing the face of the solicitation as indicated above constitutes the vendor’s acknowledgement of and agreement to be bound by the terms of all addenda issued.

Failure to specifically acknowledge addenda will not excuse the vendor from adhering to all changes to the requirements of the solicitation set forth therein nor provide justification for any pricing changes.

All submitted technical and cost proposals shall remain valid for a minimum of six (6) months after the proposal due date.

8.10 Format of Response

Electronic Proposals

Proposals shall be submitted in three (3) parts: the Technical Proposal, the Cost Proposal, and Proprietary Information. Each part shall consist of one document. Do not submit multiple documents as Technical, Cost or Proprietary.

1. Proposals must be submitted electronically in the eProcurement System, Kentucky Vendor Self Service site.

a. The Technical Proposal shall be submitted on one (1) document marked Technical (in Microsoft Word, Microsoft Excel or PDF format ONLY). Do not include

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2700000038 Final Pharmacy Benefit Claims Monitoring Total Pages: 32 mailto:Finance.CRCGroup@ky.gov embedded documents, hyperlinks or hyperlinks to videos. The document should be named in the following manner: Technical – Name of offeror RFP number

b. The Cost Proposal shall be submitted on one (1) document marked Cost (in Microsoft Word, Microsoft Excel or PDF format ONLY). Do not include embedded documents, hyperlinks or hyperlinks to videos. The document should be named in the following manner: Cost – Name of offeror RFP number

c. Any Proprietary Information shall be submitted on one (1) document marked Proprietary (in Microsoft Word, Microsoft Excel or PDF format ONLY). Do not include embedded documents, hyperlinks or hyperlinks to videos. The document should be named in the following manner: Proprietary – Name of offeror RFP number.

Pricing shall only be provided in the Cost Proposal. DO NOT SUBMIT ANY PRICING

INFORMATION IN THE TECHNICAL PROPOSAL.

All submitted Technical and Cost Proposals shall remain valid for a minimum of six (6) months after the proposal due date.

8.20 Format of Technical Proposal

The Technical Proposal must be arranged and labeled in the manner set forth below.

Transmittal Letter – a Transmittal letter shall be submitted on Offeror’s letterhead and signed by an agent authorized to bind the Offeror. The Transmittal letter shall include the following:

a. A statement that deviations are included, if applicable.

b. A statement that proprietary information is included, if applicable.

c. A statement that, if awarded a contract as a result of this Solicitation, the Offeror shall comply in full with all the requirements of the Kentucky Civil Rights Act, and shall submit all data required by KRS 45.560 to 45.640.

d. A sworn statement that, pursuant to KRS 11A.040, that Offeror has not knowingly violated any provisions of the Executive Branch Code of Ethics.

e. A statement certifying that the price in this proposal was arrived at independently without collusion, consultation, communication, or agreement as to any matter relating to such prices with any other Offeror or with any competitor.

f. A statement affirming that the Offeror is properly authorized under the laws of the Commonwealth of Kentucky to conduct business in this state and will remain in good standing with the Office of the Kentucky Secretary of State for the duration of any awarded contract resulting from this Solicitation.

g. The name, address, telephone number and email address and website address, if available, of the contract person to serve as a point of contact for day-to-day operations.

h. Subcontractor information to include the name of the company, address, telephone number and contact name, if applicable.

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i. Foreign entity’s organization number issued by the Secretary of State in a certificate of authority or a statement of foreign qualification, if applicable.

Completed and Signed Solicitation and Addenda – An authorized representative MUST complete and sign the Solicitation form and include the following:

a. “Vendor” box and “Payment” box should be completed.

b. Vendor shall indicate ownership type.

c. Vendor shall provide “FEIN” if applicable.

d. Vendor shall provide date the form is completed and signed.

e. Signed face of the most recent Addenda, if applicable.

Signed and Notarized Required Affidavit for Bidders or Offerors - available at the following link:

https://finance.ky.gov/office-of-the-secretary/Pages/finance-forms.aspx.

Signed and Notarized Required Affidavit for Bidders, Offerors and Contractors Claiming Resident Bidder Status – if applicable. Available at the following link:

https://finance.ky.gov/office-of-the-secretary/Pages/finance-forms.aspx.

*Offerors not claiming Resident Bidder Status need not submit this affidavit.

Signed and Notarized Required Affidavit for Bidders, Offerors and Contractors Claiming Qualified Bidder Status – if applicable. Available at the following link:

https://finance.ky.gov/office-of-the-secretary/Pages/finance-forms.aspx.

*Offerors not claiming Qualified Bidder Status need not submit this affidavit.

Response to the Technical Portion of the RFP – Please provide a detailed response to the technical requirements outlined in the Evaluation Criteria. No cost information shall be provided in the technical portion.

8.30 Format of Cost Proposal

The Cost Proposal must be submitted under separate cover from the Technical Proposal and must be arranged and labeled in the manner specified. The proposal with the lowest price receives the maximum score. The remaining proposals with the next lowest price receives points by dividing the lowest price by the next lowest price and multiplying that percentage by the available points.

8.40 Certification Regarding Debarment and Suspension

In accordance with Federal Acquisition Regulation 52.209-5, the Offeror shall certify, by signing the Solicitation, that to the best of its knowledge and belief, the Offeror and/or its Principals is (are) not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any state or federal agency.

For the purposes of this certification, “Principals”, means officers, directors, owners, partners, and persons having primary management or supervisory responsibilities within a business entity (e.g., general manager, plant manager, head of subsidiary, division, or business segment, and similar positions.

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2700000038 Final Pharmacy Benefit Claims Monitoring Total Pages: 32 https://finance.ky.gov/office-of-the-secretary/Pages/finance-forms.aspx https://finance.ky.gov/office-of-the-secretary/Pages/finance-forms.aspx https://finance.ky.gov/office-of-the-secretary/Pages/finance-forms.aspx

9.00 Rules of Procurement

To facilitate this procurement, various rules have been established. These are described in the following paragraphs.

Offerors should review and comply with the General Conditions and Instructions for Solicitation/ Contract listed under “Response to Solicitation” located on the eProcurement web page at https://finance.ky.gov/eProcurement/Pages/doing-business-with-the-commonwealth.aspx

The procurement process will provide for the evaluation of proposals and selection of the winning proposal in accordance with state law and regulations. KRS Chapter 45A of the Kentucky Model Procurement Code provides the regulatory framework for the procurement of services by state agencies.

9.10 Technical Proposal Evaluation

The Personnel Cabinet will evaluate the proposal based on the technical portion of the Evaluation Criteria. Each Offeror is responsible for submitting all relevant, factual and correct information with their offer to enable the evaluator(s) to afford each vendor the maximum score based on the available data submitted by the Offeror. Past Offeror Performance may be considered in the award of this Contract. Offerors with a record of poor performance in the last twelve (12) months may be found non-responsible and ineligible for award.

9.20 Cost Proposal Evaluation

The Personnel Cabinet will evaluate the proposal based on the cost portion of the Evaluation Criteria.

9.30 Right to Reject/Waiver of Minor Irregularities

The Commonwealth reserves the right at its discretion to reject any and all offers. The Commonwealth also reserves the right at its discretion to waive informalities and minor irregularities in offers received.

9.40 Clarification of Proposals

The Commonwealth reserves the right at its discretion to request additional information as may reasonably be required for selection and to reject any proposals for failure to provide additional information on a timely basis.

The Commonwealth reserves the right to conduct discussions with any Offeror who has submitted a proposal to determine the Offeror’s qualifications for further consideration. Such discussions shall not disclose any information derived from proposals submitted by other Offerors.

9.50 Best and Final Offers

The Commonwealth reserves the right at its discretion to request a Best and Final Offer (BAFO) for technical and/or cost proposals. Offerors are cautioned to propose their best possible offers at the outset of the process, as there is no guarantee that any Offeror will be allowed an opportunity to submit a Best and Final technical and/or cost offer.

9.60 Vendor Response and Public Inspection

This RFP specifies the format, required information and general content of proposals to be submitted in response to the RFP. The Personnel Cabinet shall not disclose any portions of the proposals prior to contract award to anyone outside the Personnel Cabinet, representatives of the

Document Phase Document Description Page 17 https://finance.ky.gov/eProcurement/Pages/doing-business-with-the-commonwealth.aspx agency for whose benefit the contract is proposed, representatives of the federal government, if required, and the members of the evaluation committee. After a contract is awarded in whole or in part, the Commonwealth shall have the right to duplicate, use, or disclose all proposal data submitted by Offerors in response to this RFP as a matter of public record.

Any and all documents submitted by an Offeror in response to the RP shall be available for public inspection after contract award pursuant to the Kentucky Open Records Act, KRS 61.870 to 61.884 (“the Act”). When responding to a request to inspect records submitted in response to this RFP, the Commonwealth will not redact or withhold any information or documents unless the records sought are exempt from disclosure pursuant to KRS 61.878 or other applicable law. Similarly, no such documents shall be exempt from public disclosure, regardless of the Offeror’s designation of the information contained therein as “proprietary,” “confidential,” or otherwise, except in cases where the requested documents (or information contained therein) would be excluded from application of the Act under KRS 61.878(1)(c).

The Commonwealth of Kentucky shall have the right to use all system ideas, or adaptations of those ideas, contained in any proposal received in response to this RFP. Selection or rejections of the proposal will not affect this right.

9.70 Reciprocal Preference for Kentucky Resident Bidders and Preferences for a Qualified Bidder The scoring of bids/proposals is subject to the reciprocal preference for Kentucky resident bidders and preferences for a Qualified Bidder or the Department of Corrections, Division of Prison Industries (See KRS 45A.490(1), (2), 45A.492, 45A.494 and KAR 200 5:410).

Vendors not claiming resident bidder or qualified bidder status need not submit the corresponding affidavit.

Determining the residency of a bidder for purposes of applying a reciprocal preference

Any individual, partnership, association, corporation, or other business entity claiming resident bidder status shall submit the attached Required Affidavit for Bidders, Offerors and Contractors Claiming Resident Bidder Status as part of its response. The Personnel Cabinet reserves the right to request documentation supporting a bidder’s claim of resident bidder status. Failure to provide such documentation upon request shall result in disqualification of the bidder or contract termination.

As part of its response, a nonresident bidder shall submit its certificate of authority to transact business in the Commonwealth of Kentucky, Secretary of State. The location of the principal office identified therein shall be deemed the state of residency for that bidder. If the bidder is not required by law to obtain said certificate, the state of residency for that bidder shall be deemed to be that which is identified in its mailing address as provided in its bid.

Preferences for Qualified Bidder or the Department of Corrections, Division of Prison Industries (200 KAR 5:410)

Pursuant to KRS 45A.470 and 200 KAR 5:410, Kentucky Correctional Industries will receive a preference equal to twenty (20) percent of the maximum points awarded to a bidder in a solicitation. In addition, the following “qualified bidders” will receive a preference equal to fifteen

(15) percent of the maximum points awarded to a bidder in a solicitation. New Vision Industries, Inc., any nonprofit corporation that furthers the purposes of KRS Chapter 163 and any qualified

Document Phase Document Description Page 18 nonprofit agencies for individuals with severe disabilities as defined in KRS 45A.465(3). Any bidder claiming “qualified bidder” status, other than New Vision Industries, Inc., shall submit a notarized affidavit affirming that it meets the requirements to be considered a qualified bidder as part of its response to the solicitation (affidavit form included as part of this RFP). If requested, failure to provide documentation proving qualified bidder status to a public agency, if requested, may result in disqualification of the bidder or contract termination.

9.80 Negotiation

After conducting the evaluation to determine the best proposal received, the Personnel Cabinet reserves the right to negotiate a fair and reasonable compensation based on the pricing submitted in the Offeror’s proposal. If the negotiations fail to reach an agreement on a fair and reasonable compensation rate, the Personnel Cabinet reserves the right to proceed to the next highest ranked proposal. Other terms and conditions relating to the technical and/or cost proposals may be negotiated at the sole discretion of the Commonwealth.

9.85 Best Interests of the Commonwealth

The Commonwealth will rank all proposals in the manner set forth in the Evaluation Criteria.

However, the Commonwealth reserves the right to reject any or all proposals in whole or in part before, during, or after negotiation based on the best interests of the Commonwealth.

CONTRACT AWARD, TERMS, AND CONDITIONS

10.00 Notification of Award

To view the award of contract(s), including the contractor(s) receiving the award(s) for this solicitation, access the Kentucky Vendor Self Service Site at:

Offerors can search for the solicitation title or number in the keyword search field or filter their search for only awarded solicitations by clicking on “Advanced Search” and changing the status to “awarded.” The award(s) information can be accessed by clicking on the details button of the solicitation and clicking the “Notice of Award” tab. It is the Offeror’s responsibility to review this information in a timely fashion. No other notification of the results of an Award of Contract will be provided to unsuccessful Offerors.

10.10 Beginning of Work

This Contract is not effective and binding until approved by the Secretary of the Finance and Administration Cabinet and filed with the Legislative Research Commission’s Government Contract Review Committee. The Contractor shall not commence any billable work until a valid Contract has been fully executed. This Contract, including the components referenced in Section 10.20, shall represent the entire agreement between the parties. Prior negotiations, representations, or agreements, either written or oral, between the parties hereto relating to the subject matter hereof shall be of no effect upon this Contract.

10.20 Contract Components and Order of Precedence

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The Commonwealth’s acceptance of the Contractor’s offer in response to the Solicitation, indicated by the issuance of a Contract Award, shall create a valid contract between the Parties consisting of the following:

1. Procurement Statutes, Regulations and Policies

2. Any written Agreement between the Parties.

3. Any Addenda to the Solicitation.

4. The Solicitation and all attachments

5. Any Best and Final Offer.

6. Any clarifications concerning the Contractor’s proposal in response to the Solicitation.

7. The Contractor’s proposal in response to the Solicitation.

In the event of any conflict between or among the provisions contained in the Contract, the order of precedence shall be as enumerated above.

10.30 Contract Term and Renewal Option

The initial term of the Contract is anticipated to be from October 1, 2026 through June 30, 2028.

This agreement is not effective until the Secretary of the Finance and Administration Cabinet or his authorized designee has approved the Contract and until the Contract has been filed with the Legislative Research Commission, Government Contract Review Committee.

The Commonwealth reserves the right to renew this contract for up to two (2) additional two (2) year periods.

Renewal shall be subject to prior approval from the Secretary of the Finance and Administration Cabinet, or this authorized designee, and the LRC Government Contract Review Committee in accordance with KRS 45A.695 and KRS 45A.705.

10.40 Changes and Modifications to the Contract

Pursuant to 200 KAR 5:311, no modification or change of any provision in the Contract shall be made, or construed to have been made, unless such modification is mutually agreed to in writing by the Contractor and the Commonwealth, and incorporated as a written amendment by the Personnel Cabinet prior to the effective date of such modification or change. Modification shall be subject to prior approval from the Secretary of the Finance and Administration Cabinet, or this authorized designee, and the LRC Government Contract Review Committee. Memoranda of Understanding, written clarification, and/or other correspondence shall not be construed as amendments to the Contract.

10.50 Insurance Requirements

** Proof of all required insurances should be provided prior to award.**

A Certificate of Insurance (COI) on an ACORD form is required unless approved by the Commonwealth’s Office of the Controller.

A. Required Coverage The awarded vendor(s) shall be responsible for maintaining, and not reducing, the following insurance coverages, types, and limits of liability. Further awarded vendor

Document Phase Document Description Page 20 shall be able to produce evidence of insurance in compliance with part C of this section through the entire contract:

Commercial General Liability Insurance in accordance with minimum limits of liability of $1,000,000.00 per occurrence, $2,000,000.00 aggregate. The Commonwealth, in the Request for Solicitation, may require higher limits depending on the type of solicitation.

B. Additional Types of Insurance

(*The Commonwealth reserves the right to require higher coverage amounts if needed based on the type of contract and associated risk)

1. Automobile Liability Insurance (If Applicable) Automobile Liability Insurance is required for delivery, onsite training, services or events in all situations where the Contractor must drive to any property where Commonwealth operations occur. With regard to delivery, if the items requested in this solicitation will be delivered by the awarded Contractor or Subcontractor, proof of Automobile Liability Insurance must be provided prior to award. If items will be delivered by common courier (USPS, FedEx, UPS, Old Dominion Freight Line, etc.), this requirement does not apply.

The Contractor or Subcontractor must provide a certificate of insurance coverage for any vehicle used in performance of this contract, whether owned, non-owned, or hired, or other vehicles utilized by the Contractor or Subcontractor. Said policy of insurance to have a minimum coverage limit of $1,000,000.00 per occurrence combined single limit for bodily injury, including death, and property damage.

This requirement does not apply if the Contractor does not own, lease, or hire any automobiles to be used in connection with performance under any Contract resulting from this Solicitation.

2. Professional Liability Insurance (If Applicable) Professional Liability (Error & Omissions) Insurance shall be required for all professional services performed by licensed or certificated individuals or individuals working on behalf of licensed or certificated individuals. The required Professional Liability Insurance shall have a minimum limit of liability of $1,000,000.00 per claim for damages arising out of negligent acts, errors, and/or omissions in the performance of services.

C. Evidence of Insurance Coverage

The successful bidder shall provide evidence of insurance coverage as required.

Failure to do so shall constitute a material breach of this Contract and may result in immediate cancellation of the Contract.

For all required insurance coverages, during the course of the Contract, the awarded vendor shall not be self-insured or utilize a Captive Insurer or a fronting policy that shifts risk back to the awarded vendor without prior written approval by the Office of the Controller of the Commonwealth.

Further, the awarded vendor shall not utilize an insurer or similar entity not in good standing with the Insurance Commissioner to fulfill the insurance requirements of

Document Phase Document Description Page 21 the contract without prior written approval by the Office of…