GIC PBM RFR 2026 Bidder QA_Final 07312026.pdf

Services provided by Mercer Health & Benefits LLC.

Procuring a Pharmacy Benefit Manager for the Group Insurance Commission (GIC)

Bidder Q&A

Bid Solicitation: BD-26-1049-GIC00-07GIC-130036

The Bidders’ Conference was held virtually via Microsoft Teams on Wednesday, July 29th 9:30 am eastern time.

Representatives from the following organizations were in attendance: CVS Health, InscriptRx, Judi Rx, LucyRx, Point32, Medicalincs, Navitus Health and Zelus Consulting Group

This document addresses two sets of inquiries – the questions submitted by potential bidders by July 15, 2026, and those raised live during the Bidders’ Conference.

Additional information regarding this procurement can be found in the RFR and on the Commonwealth’s procurement website COMMBUYS Solicitation Page

In Attendance:

Group Insurance Commission Mercer Consulting Team Vendor Participants

Margaret Anshutz Eveline Case Cristina Keiner, CVS Health

Jannine Dewar Ryan Casper Lindsey Thompson, CVS Health

Jennifer Hewitt Sara Drake Lonnie Caiafo, InscriptRx

Cameron McBean Mary Magagna Dave Zimmerman, InscriptRx

Jang Soo Lee Jasmyn Plasencia Jessin Joseph, Judi Rx

Rachelle Mercier Mark McCoy, Judi Rx

Donna Wortman Lisa Campeau, Judi Rx

Matthew Veno Cameron Lunz, LucyRx

Liam Hall, LucyRx

John De Joie, LucyRx

Andrea Grych, Point32

Steven Moccia, Point32

Oluchi Allen, Medicalincs

Mhari Snell, Medicalincs

Derek Daggett, Navitus Health

Sarah Moran, Zelus Consulting https://www.commbuys.com/bso/external/bidDetail.sda?docId=BD-26-1049-GIC00-07GIC-130036&external=true&parentUrl=close

Page 2: Procuring a Pharmacy Benefit Manager for the Group Insurance Commission (GIC) Bidder Q&A

# Question Answer

1 One clarifying question as we go through our pre-proposal process…what is the current pricing structure (meaning is this a traditional or pass through pricing model). If traditional, is the Commonwealth looking to move away from traditional/spread pricing and only entertain pass through pricing bids?

The prescription drug benefits for all plans are carved out from the medical coverage, on a self-insured basis, through a direct, pass-through contract.

Bidders are asked to submit their most financially competitive 3-year offer. The RFR does not prohibit spread pricing and the GIC will consider traditional, pass-through and other models, unless it is explicitly prohibited in the RFR.

That said, the GIC requires full disclosure of any spread pricing used, including historical average spreads, claim-level detail, and total revenue disclosure across all channels. The GIC also requires disclosure of all revenue streams tied to drug pricing and fulfillment, as well as pass-through of 100% of rebates collected by the PBM and/or GPO on behalf of the GIC, including manufacturer administrative fees. Please review Attachment 1 – GIC 2026 RFR for PBM Services_Final.pdf for complete details around minimum qualifications requirements.

2 We are reviewing the Commonwealth's PBM RFR Procuring a Pharmacy Benefit Manager for the Group Insurance Commission (GICPND2604) and would appreciate clarification regarding bidder eligibility and PBM licensure requirements under our proposed arrangement.

Specifically, we would like to understand whether a proposer that administers the program, but subcontracts PBM functions to a PBM licensed in the Commonwealth of Massachusetts, would satisfy the licensing requirements.

[Potential Bidder] is considering submitting a proposal for the [bidder’s program] program, a state-sponsored public prescription purchasing program administered by [Potential Bidder]. Under this model:

• [Potential Bidder] would serve as the proposing and contracting entity and would be responsible for the administration and oversight of the program.

• [Potential Program] is the prescription drug program being offered.

Under the applicable Massachusetts regulations, Pharmacy Benefit Management Services include services performed by a PBM or any affiliated entity, including but not limited to:

• negotiating the price of prescription drugs, including rebates, discounts, or other price concessions;

• managing any aspect of a prescription drug benefit, including formulary administration, mail-order and specialty pharmacy services, clinical/safety/adherence programs, claims processing and payment, drug utilization review, prior authorization, appeals/grievances related to the prescription drug benefit, pharmacy contracting, cost control, and related data management;

• performing administrative, managerial, clinical, pricing, financial, reimbursement, reporting, billing, or similar services related to a health benefit plan’s prescription drug benefit; and

• any other services defined by the Division in applicable regulation.

The regulations further define a Pharmacy Benefit Manager as an entity that, directly or through a subsidiary, provides Pharmacy Benefit Management Services for prescription drugs and devices on behalf of a health benefit plan sponsor.

With that framework in mind, it is the proposer’s responsibility to assess its own business model and determine whether, under Massachusetts law and regulation, it is performing PBM services and therefore must be licensed in the Commonwealth.

If a proposer determines that it is not performing PBM services

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• [PBM name] would serve as the PBM subcontractor and would perform PBM services, including claims adjudication, pharmacy network administration, and related PBM operational services.

As we review Massachusetts' PBM licensure requirements, we would appreciate guidance regarding whether this structure would be eligible to respond to the RFR.

Specifically:

1. Would the Commonwealth consider this structure eligible to submit a proposal under the RFR?

2. Does Massachusetts require the proposing or contracting entity to hold a PBM license, or would licensure of the PBM subcontractor performing the PBM services satisfy that requirement?

3. If a licensed PBM subcontractor performs all PBM functions, must the proposing entity also be licensed as a PBM in Massachusetts?

4. Are there any licensing, organizational, contractual or statutory requirements that would affect eligibility under this structure?

We are seeking this guidance to confirm our eligibility before proceeding further with the procurement process.

itself, and that those services are instead being performed by appropriately licensed subcontractor(s), it may submit a proposal under the RFR.

If a proposal is submitted, the GIC will review the proposer’s submission, including the proposed business structure, contractual arrangements, and the manner in which the proposer intends to meet the RFR requirements, and will make its own determination as part of the procurement review process. Bidders are encouraged to include any information that demonstrates or elucidates the business structure to assist the GIC’s evaluation.

Accordingly, in response to your specific questions:

1. Would the Commonwealth consider this structure eligible to submit a proposal under the RFR?

If a proposer determines that it is not performing PBM services itself, and that those services are instead being performed by appropriately licensed subcontractor(s), it may submit a proposal under the RFR.

2. Does Massachusetts require the proposing or contracting entity to hold a PBM license, or would licensure of the PBM subcontractor performing the PBM services satisfy that requirement?

The Commonwealth cannot make that determination for a bidder in advance. Bidders are encouraged to include clarifying or additional information regarding whether the contracting entity meets the standards of a PBM or not, under Massachusetts laws and regulations, if they feel it is necessary for the GIC to make such a determination.

It is the proposer’s responsibility to assess its own business model and determine whether, under Massachusetts law and regulation, it is performing PBM services and therefore must be licensed in the Commonwealth.

3. If a licensed PBM subcontractor performs all PBM functions, must the proposing entity also be licensed as a PBM in Massachusetts?

Please refer to question 2.2 for this answer.

4. Are there any licensing, organizational, contractual, or statutory requirements that would affect eligibility under this structure?

Proposers are responsible for ensuring compliance with all

Page 4: Procuring a Pharmacy Benefit Manager for the Group Insurance Commission (GIC) applicable legal, regulatory, organizational, and contractual requirements. Please refer to Attachment 1 – GIC 2026 RFR for PBM Services_Final.pdf for further details around the scope of services required and related requirements.

Please note that neither Mercer nor the GIC is providing legal advice or an advance determination regarding licensure status or bidder qualifications. Proposers should consult their own counsel and make their own assessment under the applicable Massachusetts statutes and regulations.

3 Does the data provided with the RFP reflect all current GLP-1 strategies that have been implemented? If not, please provide the details of changes and effective dates of those changes to the plan coverage for each line of business.

Bidders should rely on the RFR materials and the data released for this procurement for current-state analysis.

The GIC currently uses utilization management (UM) tools including prior authorizations, quantity limits, step therapy, a mandatory generic cost-difference program, and mandatory mail-order fills for maintenance medications.

Regarding the Commercial Plan; please note that starting July 1, 2026:

- The GIC is no longer contracting with Vida Health to prescribe GLP-1s

- Medicines used only for weight loss will no longer be covered by the GIC’s pharmacy benefit. However, in some instances, coverage may be approved (via a clinical review) if the individual has a certain BMI threshold and a concurrent FDA approved indication which could qualify them for coverage of a GLP-1 medication. Additionally, GIC covers GLP-1 medication for MASH/NASH with moderate to advanced fibrosis.

Regarding the EGWP Plan; please note that starting January 1, 2027:

- GLP-1s used only for weight loss will no longer be covered by the GIC’s pharmacy benefit. However, in some instances, coverage may be approved (via a clinical review) if the individual has a certain BMI threshold and a concurrent FDA approved indication which could qualify them for coverage of a GLP-1 medication. Additionally, GIC covers GLP-1 medication for MASH/NASH with moderate to advanced fibrosis.

- The GIC covers non-GLP-1 anti-obesity medications and will continue to cover them after GLP-1 coverage under the wrap is terminated on 1/1/27.

GLP-1s used for diabetes (like Ozempic or Mounjaro) remain covered – members are not required to enroll in any special program.

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4 For GLP-1s, are any changes planned for this coverage strategy for the coming year?

• Weight Loss

• Diabetes

• Cardiovascular

• Other – please specify.

The RFR does not identify specific future coverage changes for GLP-1 products by indication.

However, bidders should submit proposals based on the materials released and may describe their recommended future-state approach – including those for the management of GLP-1s.

The RFR’s essay questions specifically ask bidders to address their philosophy on GLP-1 medications and a feasible path toward re-instituting obesity-treatment coverage within the GIC’s budget limitations.

5 For GLP-1s, Anti-Obesity and Anti-diabetic products, please provide any relevant UM or PA documentation. or benefit design/coverage documentation.

Do co-pay structures for GLP-1, Anti- Obesity, and/or Anti-diabetic products differ from other products on the formulary? If so, please explain and provide detail.

As stated in the RFR, Attachment 1 - page 15, both the Commercial and EGWP plans use a three-tier member copay structure, and prescription drug copays are identical across the two plans, although the plans may have varying restrictions such as different formularies, step therapies, and mandatory generic policies.

6 Does GIC cover weight loss drugs (i.e.

GLP-1s) as part of their EGWP or Wrap?

If so, is there a program that restricts access based on specific criteria? Please describe if applicable.

Yes, the GIC currently covers weight loss drugs (i.e. GLP-1s) as part of the Wrap.

As stated above in Question #3, please note that following changes to the EGWP plan starting January 1, 2027:

- GLP-1s used only for weight loss will no longer be covered by the GIC’s pharmacy benefit. However, in some instances, coverage may be approved (via a clinical review) if the individual has a certain BMI threshold and a concurrent FDA approved indication

- which could qualify them for coverage of a GLP-1 medication. Additionally, GIC covers GLP-1 medication for MASH/NASH with moderate to advanced fibrosis

- The GIC covers non-GLP-1 anti-obesity medications and will continue to cover them after GLP-1 coverage under the wrap is terminated on 1/1/27.

GLP-1s used for diabetes (like Ozempic or Mounjaro) remain covered – members are not required to enroll in any special program.

7 For the EGWP, given the material impact that Federal price negotiations has had, and is expected to continue to have, on the rebate value of products subject to Maximum Fair Price (MFP) negotiations, please confirm bidders can exclude the 2027 and 2028 MFP drugs from Discount

The RFR does not provide advance approval for excluding specific drugs or categories of drugs from discount guarantees.

Bidders should submit their most financially competitive 3-year offer and clearly disclose any assumptions, exclusions, or alternative guarantee structures in the financial proposal. The

Page 6: Procuring a Pharmacy Benefit Manager for the Group Insurance Commission (GIC) guarantees, with the understanding that they will process at a pass through of CMS contracted rates?

GIC will evaluate proposals based on the completed RFR financial materials.

8 For the EGWP, given the material impact that Federal price negotiations has had, and is expected to continue to have, on the rebate value of products subject to Maximum Fair Price (MFP) negotiations, please confirm bidders can exclude the 2027 and 2028 MFP drugs from rebate guarantees, with the understanding that any supplemental rebates earned would still be passed through to GIC?

The RFR does not provide advance approval for excluding specific drugs or categories of drugs from discount guarantees.

Any proposed exclusions, assumptions, or alternative rebate guarantee approaches should be clearly set out in the bidder’s financial proposal. The RFR continues to require full disclosure of revenue streams and pass-through of 100% of rebates collected by the PBM and/or GPO on behalf of the GIC, inclusive of manufacturer administrative fees.

9 For any future Maximum Fair Price (MFP) drugs, i.e. those to be announced for 2029 and beyond, that GIC will work in good faith to address any pricing changes as a result of further negotiations by CMS for both pricing and rebates?

The RFR does not make advance commitments regarding future CMS Maximum Fair Price changes or future renegotiation treatment for specific drug categories.

Bidders should describe in their proposals how they would address future regulatory or market changes, including any assumptions, change-in-law concepts, or reconciliation approaches they believe are appropriate.

10 Please confirm that in addition to responses included in the Performance Guarantees section of Attachment 14, Mercer and the GIC will accept and evaluate a bidder’s submitted Performance Guarantee attachment, which may provide performance guarantees not specifically required or outlined in Attachment 14 or may provide additional context that more fully describes the bidder’s proposed offering.

Bidders must complete the required RFR attachments and questionnaires in the format specified by the RFR.

Supplemental information may be submitted if it is clearly labeled and consistent with the RFR, but it should not replace or modify the required responses. In the event of any inconsistency, the required RFR materials will control for evaluation purposes. Additionally, any missing RFR materials may deem a bid to be incomplete.

11 For the email submission to Mercer, please confirm that Mercer is requesting that the emailed submission be sent to both Mary Magagna with an email address of mary.magagna@mercer.com and Jasmyn Plasencia with an email address of jasmyn.plasencia@mercer.com.

If there are any other Mercer contacts that should receive the emailed RFP, please confirm those names and email addresses.

Note that it appears that Mary Magagna’s email address as provided on Page 12 of

Per the RFR Submission Checklist, one copy should be emailed to Jasmyn Plasencia (Jasmyn.Plasencia@mercer.com)

The references to Mary Magagna in the procurement calendar relate to written questions submitted before and after the bidders’ conference.

The email address shown for Mary Magagna in the calendar appears to contain a typographical error in the posted document, corrected contact information as follows:

Mary Magagna (Mary.Magagna@mercer.com) mailto:jasmyn.plasencia@mercer.com

Page 7: Procuring a Pharmacy Benefit Manager for the Group Insurance Commission (GIC) the GIC 2026 RFR for PBM Services document may have an inadvertent typo of mary.magagna.mercer.com as opposed to mary.magagna@mercer.com.

12 Please confirm whether written questions should be addressed to Jasmyn Plasencia and Jannine Dewar as indicated on Page 2 of the GIC 2026 RFR for PBM services, Jasmyn Plasencia and Mary Magagna as indicated on Page 14 or if bidders’ questions should be addressed to Jasmyn, Jannine, and Mary collectively.

The formal Inquiries section of the RFR directs that written inquiries concerning the content of the RFR be made in writing to Mercer and sent to Jasmyn Plasencia (Jasmyn.Plasencia@mercer.com).

Accordingly, bidders should submit written questions to Jasmyn.

Mercer and the GIC will coordinate internally as needed.

13 For the print version requirement, may we submit the larger files on USB along with the printed version of the remainder of the responses?

Yes. The RFR Submission Checklist requires bidders to submit one bound signed original and one copy on an unsecured USB of the Technical and Financial Proposals to the GIC.

Physical copies must still be postmarked by Wednesday, August 5, 2026, and the required COMMBUYS submission must still be completed by 5:00 pm eastern time on that date.

14 As we are subcontracting some key components of our offering to a vendor, may we leverage our subcontractor for references to meet the requirement?

This question is unclear. The GIC interprets the question to be asking whether bidders can use subcontractors to meet bidding requirements. The GIC’s response based on this interpretation is as follows: The RFR states that the Bidder may meet requirements either directly or through affiliates, subcontractors, delegated service providers, contracted networks, carrier partners, or other related arrangements, as applicable. If a bidder relies on a subcontractor, the proposal should clearly identify the subcontractor, describe the services to be provided through that party, and make clear that the Bidder remains accountable for the contracted services.

15 Does GIC plan to use its own principal contract agreement or will the vendors be able to use their standard contracts?

The GIC will use required state forms and certain of its own additional forms, for example, the Business Associate Agreement. The GIC holds the discretion whether to use their own principal contract or evaluate implementing the bidder’s standard contract.

If providing a copy of your standard contract, please clearly indicate so in the file naming.

16 Since we are providing a redacted copy, please advise whether the redacted copy can be submitted electronically or in hard-copy format with the original submission?

Additionally, can the redacted copy be submitted after proposal submission at a later date?

This question is unclear, as no reference is given to the “redacted copy” and the GIC declines to answer it.

17 Based on this instruction for Attachment 15a and 15b, "Complete the Excel

For clarification, the current plan design and clinical program information is being provided for informational purposes to help

Page 8: Procuring a Pharmacy Benefit Manager for the Group Insurance Commission (GIC) workbook(s) in their entirety and provide the requested plan design and clinical program specifications associated with your financial proposal. Please note if bidding both lines of business, one workbook is expected for Commercial and a separate workbook for EGWP."

Where would you like us to complete the comparable clinical programs listed?

bidders understand the current program and mirror current state as appropriate.

The workbook should be used to inform bidders of current programs and plan design choices in place today.

18 Please provide monthly membership information to evaluate the possibility of a PMPM guarantee.

The GIC produced the requested monthly member count in Attachment 17-GIC Monthly Membership Information 2025 by Population accessible at COMMBUYS Solicitation Page.

19 The Group Insurance Commission (GIC) requires that the self-insured pharmacy benefit manager (PBM) pays claims from their own checking account. The PBM shall be reimbursed by the GIC within five

(5) business days of receipt of the weekly detailed claims data file (described below, in item #3). A grace period of up to ten

(10) days from the date of receipt of the detailed claims data file, or such longer grace period as the PBM may allow, shall be granted to the GIC for any claims payment due, subject to the terms of the Contract.

Is the GIC looking to have payment terms of 5 business days upon receipt on the claims file?

Confirming that the GIC expects to pay the PBM within five business days of receipt of the weekly detailed claims data file, and currently does so for existing vendors. The additional grace period is solely in the case of extraordinary circumstances.

If a bidder proposes a different funding or reimbursement approach, that approach should be clearly described in the proposal for the GIC’s review, and, if applicable, be reflected on the Prompt Payment Discount form.

20 Can you please clarify whether eligibility to respond to the GIC PBM RFR is limited to pharmacy benefit managers, or if an existing GIC health plan may also submit a bid, provided it meets all PBM qualifications and requirements?

The GIC will accept and evaluate complete bids on entire population from all qualified bidders.

21 If it is possible to get details about the Mercer Pharmacy Total Revenue Disclosure Statement. Do you have specific information that will be requested within this disclosure?

A template of Mercer’s Total Revenue Disclosure Statement (TRDS) will be made available upon request to interested bidders.

22 The Estimated Procurement Calendar indicates that the official Bid Q&A responses will be posted on July 31, 2026, less than one week prior to the proposal submission deadline of August 5, 2026. Could the GIC provide additional context regarding this timeline?

The GIC will not be posting answers to bidder questions on a rolling basis.

Per the RFR, answers to written questions received by July 15 will be presented at the Bidders’ Conference on Wednesday, July 29, 2026. Attendees will also have an opportunity to ask questions and receive responses during the conference.

https://www.commbuys.com/bso/external/bidDetail.sda?docId=BD-26-1049-GIC00-07GIC-130036&external=true&parentUrl=close

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Has the GIC considered issuing responses on a rolling basis or releasing responses earlier, as any material clarifications received on July 31 may require significant revisions to bidders' proposals within a compressed timeframe?

The final deadline for written questions is July 30 at 12:00pm.

Official answers for Bid Q&A are estimated to be published to COMMBUYS on Friday, July 31, 2026.

23 Does the GIC currently operate or contract with any in-house, on-site, employer-owned, or health system-owned pharmacies that serve GIC members? If so, please provide the pharmacy name(s), locations, and approximate annual claim volume.

No. The GIC does not operate or contract with any in-house, on-site, employer-owned, or health system-owned pharmacies.

24 The procurement milestone schedule reflected on pages 9–11 identifies several key dates and also notes that the schedule is subject to change. Can the GIC confirm whether these milestones represent the final approved procurement schedule, or should bidders anticipate that certain dates may still be modified during the procurement process?

Unless otherwise noted or announced, the Procurement Calendar indicated within Attachment 1, PBM RFR, reflects the current scheduled milestones and expected timeframes.

In the event that there is a change in the Procurement Calendar, a memo will be posted to the COMMBUYS solicitation page.

25 Is there any possibility for additional time.

This opportunity is extremely important to our company and we would like to offer very thoughtful solutions. An additional week would help us to put our best foot forward.

Unfortunately – the Commonwealth has a strict decision-making timeline associated with this procurement. We appreciate your participation and adherence to the Procurement Calendar indicated within the RFR.

26 Can we get a list of group names for the commercial population (i.e RX22MA or RX22KB - are these the group names?)

The groupings reflect plan name and enrollment group and have no bearing on the RFR – all groups and plans will fall under the RFR.

27 [PBM] is asking for an extension on completing the RFP. Given the size of the file and the timing of the bidder’s conference, this will make the turnaround time pretty tight. Any extension that could be granted would be greatly appreciated.

Please refer to the response to Question #25.

28 In Attachments 16a and 16b, under the 1b) Pricing Terms tab, Line 81 does not provide sufficient space to list all the additional clinical programs we offer for both the Commercial and EGWP lines of business. Would it be acceptable to submit a separate Ancillary Fee Menu for each line of business to capture the full scope of these programs?

As also stated within Attachment 1 - While bidders may also submit separate financial proposals in their standard financial proposal format, any such separate financial proposals will be considered informational only and must be consistent with the definitions, assumptions, and requirements set forth in this RFR. In the event of any inconsistency or discrepancy between a Bidder’s standard financial proposal format and the completed RFR financial attachments, the completed RFR financial proposal shall control. Failure to complete the required financial attachments or comply with the

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RFR’s financial proposal requirements may result in disqualification from consideration.

29 In Attachment 1, page 29, it states that bidders may submit separate financial proposals in their standard financial proposal format. To confirm, would it be acceptable to provide separate Financial Proposals for the Commercial and EGWP with our response?

The GIC expects bidders who are bidding on both Commercial and EGWP populations to submit a distinct Financial Proposal for each. Please also refer to the response to Question #28.

30 Does the GIC own and operate its own pharmacies?

No. Please refer to the response to Question #23.

31 What is the average number of paper claims (direct member reimbursement requests) the GIC receives a year?

Beyond what is included in the claims data provided, we recommend that bidders looking for the average number of paper claims (direct member reimbursement requests) to "Direct" under Channel Dispensed (Column E) in order to gather an estimate of the annual paper/member submitted claims submitted to the GIC.

32 In Attachment 14 in the PBM RFR Questionnaire – The GIC tab for question

7.33.1. “Describe your experience in transitioning clients from a fiscal year to a calendar year and how you would manage that EGWP transition. Please provide your detailed approach and address how you would minimize risk and member disruption to the GIC.” Would this transition occur upon Implementation with [PBM]?

To clarify, we are asking that bidders describe how they would transition the EGWP PBM plan start date from July 1st to January 1st – we would expect the bidder to begin the transition upon award, and subsequent implementation.

33 In Attachment 16a and 16b the 3b) Pricing Detail tab (reprice task), there will be over 3 million claims for each LOB in each Excel document. Could you please advise how you would like us to complete this? We can create four separate tabs for each document; however, the file will be huge and difficult to navigate and use.

Please advise.

If needed, bidders may submit Excel files with multiple tabs.

Please clearly label and name the files accordingly when submitted.

34 To help ensure the GIC receives the most complete, accurate, and competitive response possible, would the GIC and its consultant consider extending the proposal due date by 10 business days?

o The RFP requires bidders to evaluate and prepare distinct technical and financial submissions across multiple modular award scenarios, creating a significantly more complex proposal

Please refer to the response to Question #25.

Page 11: Procuring a Pharmacy Benefit Manager for the Group Insurance Commission (GIC) effort than a traditional single-solution procurement.

o In addition, bidders' questions are scheduled to be answered in writing on July 31, leaving only three business days to analyze the GIC's responses, incorporate any resulting changes, finalize pricing assumptions across multiple award configurations, and complete required reviews prior to submission.

o Providing additional time would allow bidders to thoughtfully address the GIC's feedback, fully develop responses for each module pursued, and submit their strongest and most comprehensive solutions.

o Ultimately, an extension would best enable bidders to enhance their proposal quality and can also help improve comparability across submissions, enabling the GIC to make the most informed assessment of available solutions, innovation, and overall value in the marketplace.

35 Would the GIC and its consultant consider revising the technical questionnaire to allow bidders to provide brief explanations or alternative approaches when a requirement cannot be met exactly as stated?

o While many responses may be “Yes,” the current Yes/No-only format limits bidders’ ability to describe partial compliance, equivalent solutions, or alternative approaches. Allowing limited explanatory responses would provide the GIC with a more complete understanding of available market capabilities and support a more informed evaluation of bidder proposals.

The technical questionnaire will not be revised. Please comply with the questionnaire format – Respond “Yes” only where you can fully comply with the statement; for “No” responses and where there is opportunity to explain, provide a brief explanation of any limitations, exceptions, or alternative capabilities that may demonstrate partial or conditional compliance.

36 Please confirm whether bidders are required to bid at minimum one fully integrated offering inclusive of all modules or if a bidder can elect to only bid on a select module or modules?

Bidders can submit a fully integrated offer or can submit a modular offer. The offers need to include an offering for each of the modules that would comprise all components of the pharmacy benefit. Bidders should describe in their proposals -capabilities on modular approach, contractual flexibility to

Page 12: Procuring a Pharmacy Benefit Manager for the Group Insurance Commission (GIC) o For example, in order to offer a Specialty pharmacy only offer, is a bidder also required to submit a fully integrated offer?

explore modular option throughout the contract term, as well as any financial implications.

37 Based on the GIC’s request for modular fee schedules and proposals as outlined in Section 4.12 of the RFP, we are submitting the following questions for additional clarification and understanding.

Does the GIC have a modular approach already established and in place for other benefits or service offerings it provides to its members?

- If so, can the GIC outline examples, references or specific learnings that it would ask its Pharmacy benefit vendors to contemplate in a modular approach?

No. The GIC does not have a modular approach already established and in place for other benefits or service offerings it provides to its members.

For clarification, the GIC intends to procure a full-service Pharmacy Benefit Manager (PBM) for both its Commercial and Employer Group Waiver Plan (EGWP) populations. The GIC is exploring vendor capability and willingness to support the GIC if it wishes to adopt a modular model in the future.

The modular questions in Section 4.12 are intended to assess whether the vendor can support a future model in which certain pharmacy benefit capabilities, services, or functions may be structured, evaluated, or administered as discrete components rather than solely through a fully bundled offering. Under such an approach, the PBM would remain responsible for overall contracting, operational integration, and accountability across the solution, while affording the GIC flexibility to select from multiple qualified vendor partners within a given module. While this is distinct from a PBA model, such a modular framework could also support a PBA-type arrangement if the GIC later chose to carve out certain components and contract independently with selected vendors.

The purpose of the modular questions in Section 4.12 is to understand the vendor’s ability to support a future modular pharmacy benefit model. The question is intended to clarify the requested capability and willingness, and vendors should respond within that framework.

Bidders should describe their own lessons learned and how their modular model would operate effectively in a public-sector environment, specific to the GIC’s population.

38 Additionally, based on any prior experience the GIC has with a modular approach or based on its expectations for its pharmacy vendors, please provide insight into the GIC’s expectations for the following situations, which may arise:

- Who is ultimately accountable when a member, client, or pharmacy issue spans multiple modules?

- How are disputes resolved between vendors?

The GIC has no prior experience with a modular approach.

Please also see the answer to Question #37.

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- What SLAs exist between modules?

- How are performance guarantees structured when performance depends on another module?

39 In a modular arrangement, which vendor is expected to serve as the implementation lead?

- What tools and resources will be available to modular vendors to effectively manage integration steps between necessary systems

- Can the GIC provide an illustration of the expected data flow between modular vendors?

- Who is responsible for funding and maintaining the data integrations amongst vendors

- What is the expected remediation plan if one vendor misses a milestone?

The GIC expects bidders to identify the implementation lead within their proposed model and describe how that party will coordinate all implementation activities.

- Bidders should describe the tools, staffing, technical resources, project governance, documentation, testing support, and integration management capabilities they would provide or require in order to execute a successful modular implementation for the GIC.

- The GIC expects assumptions regarding responsibility for building, funding, maintaining, updating, and supporting the data integrations to be clearly defined in the bidder’s proposal.

- Bidders should propose a remediation framework and communication protocol to reduce operational and member disruption.

- Please also see the answer to Question #37.

40 What expectations does the GIC have for vendors managing the member experience; specifically:

- What expectations does the GIC have for vendors to address or prevent members from being directed and redirected between vendors for issues that span multiple vendors?

- When members call with an issue that may span multiple vendors, who owns first-call resolution?

- What expectations does the GIC have for appeals routing and other critical processes that must adhere to narrow timeframes of response?

The GIC expects a coordinated, member-centered service model that minimizes hand offs and eliminates unnecessary redirection.

- Bidders should describe how their modular framework will ensure seamless issue handling across vendors and reduce member abrasion.

- Bidders should define first-call ownership within their proposed modular framework.

- The GIC expects bidders to define compliant workflows for appeals and other time-sensitive, critical processes.

- Please also see the answer to Question #37.

41 What happens if one vendor is replaced?

- How portable are configurations, accumulators, formulary mappings, and historical claims data?

- What transition support is available to members moving to another vendor

- What transition support is available to other vendors who may need to rebuild integrations and processes?

Bidders should describe how their modular framework would support orderly transition if one vendor is replaced, including but not limited to: configurations, governance, data handoff, and transition support for the GIC, members, and remaining vendors.

Please also see the answer to Question #37.

42 With regard to performance guarantees

- How will performance guarantees be adjusted in situations where another

The GIC expects any bidder proposing a modular arrangement to define and stand behind its proposed modular PBM framework, including governance, accountability, Page 14: Procuring a Pharmacy Benefit Manager for the Group Insurance Commission (GIC) vendor/module contributes to failure to meet a guarantee?

- Does the GIC have a preferred design for a shared accountability framework?

- When responding to an individual module, confirm that a bidder can elect to propose a separate PG offering specific to that module and the services the bidder proposes to offer under that module implementation leadership, integrations, member experience, dispute resolution, performance guarantees, and transition support. Ultimately, it is the bidder proposing a modular option who is responsible and it is the bidder’s prerogative whether to share performance guarantee risks with other modular vendors.

Please also see the answer to Question #37.

43 With regard to financial offers

- Please confirm that the GIC's consultant will utilize a bidder’s completed tab 3b pricing detail for its Integrated Model for any modular offerings (with Mercer eliminating or ignoring any components not applicable to the proposed module), so long as the bidders' exclusions and assumptions do not change.

For clarification, the GIC intends to procure a full-service Pharmacy Benefit Manager (PBM) for both its Commercial and Employer Group Waiver Plan (EGWP) populations. The GIC is exploring vendor capability and willingness to support the GIC if it wishes to adopt a modular model in the future.

Bidders should complete the pricing proposal in accordance with the RFR instructions.

To the extent a bidder proposes a modular offering, pricing should be submitted in a manner that clearly identifies the applicable components, assumptions, exclusions, and module-specific pricing elements.

This is addressed in RFR Question 4.12.2. Vendors should complete their response based on whether their Modular Model is identical to or materially different from their Integrated Model in scope, pricing, and guarantees. Submissions will be evaluated accordingly based on the information provided in the required response fields and fee schedules.

The GIC and Mercer, reserve the right to evaluate pricing in the format necessary to support a fair and consistent comparison across all submitted bids.

44 There are inconsistencies between the submission checklist and the RFR instructions. Which forms require blue ink?

The only form that the GIC requests blue ink signatures on is the transmittal letter, as stated on p. 40 of the RFR.

45 The contractor authorized signatory listing form posted on COMMBUYS is for sole proprietors.

Thank you for bringing that to our attention. The GIC has replaced the CASL for Sole Proprietors with the CASL for Corporations (Attachment 4 - Contractor Authorized Signatory Listing Form~1).

46 Does the bidder have to be located in Massachusetts?

No.

Please see response to Question #2 specific to a bidding entity’s eligibility and PBM licensure requirements.

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47 Due to the size of the multiple claims repricing tabs, would it be acceptable for us to provide those items on the required USB drive instead of including printed copies in the hard-copy submission?

Please advise.

Yes, so long as the USB is not password protected, locked, or otherwise restricts access in any manner.

48 Page 23 of the RFR states: “While the GIC recognizes the need for commercially sensitive information, bidders should assume that contract terms and performance information may be subject to public record requests unless exempted by law.”

- Will GIC confirm that should a bidder designate information/pricing data contained in its RFP response (e.g., pricing guarantees, rebate guarantees, service fees, administrative fees, and similar price points and financial terms) and provide its legal basis for why such information is exempt under the Massachusetts Public Information Law, GIC will only release the bidder’s proposal with such information redacted?

As stated within page 23 of the RFR, the cover of the Technical Questionnaire, and clarified within Question 6.7 of the Technical Questionnaire - the GIC is subject to applicable public records laws. There are exemptions to public records law disclosures and the GIC would exercise discretion if certain information meets the exemption. However, bidder should assume that anything submitted is subject to public record law and will be produced if no exemption applies to withhold such information and documents.

Where bids include confidential material, identify the specific language or sections you claim is confidential, cite the legal basis for confidentiality, and provide a redacted public version if feasible. To the extent practicable, any such information should be segregated or otherwise clearly marked to facilitate review.

However, the GIC cannot guarantee that such information will be deemed exempt from Massachusetts public entity procurement and public records obligations.

49 Can you verify the 45-day payment window does not apply to claims payments?

Correct. While the Commonwealth has a standard 45-day payment timeframe, the corrected financial requirements document (Attachment 10, Item 1) establishes claims payment timing as 5 business days after receipt of detailed claims data.

50 How are vendors supposed to demonstrate an unreasonable burden regarding the prompt payment requirements?

Bidders do not need to provide a written statement regarding the unreasonable burden requirement. If that is needed in the future, GIC will request it.

51 Can you confirm there is no aggregation present in provided claims data?

The vast majority of claims data is provided on a 1 row = 1 Rx basis.

However, there are a small number of rows that reflect more than one claim. Bidder may identify those instances using the “Rx Count” field.

52 For the Geo Access request on tab 4a please provide the zip code, city, state and plan (ie the standard census file with zip code for the Mercer template).

Mercer will provide the requested information via a secure file transfer platform directly.

53 Please confirm which forms require blue ink signatures?

Please refer to the response to Question #44.

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54 Some instructions reference point values as part of your evaluation; however, no comprehensive scoring criteria is included in the RFR. Could you provide?

No.

55 Confirm what is needed for this request in 6.4/6.5: "Provide anonymized, line level implementation data (per implementation) upon request for validation. If Yes, state typical turnaround time to produce it."

Regarding Question #6.4 (Technical Questionnaire),– we are asking: If the GIC needed to validate the summary provided by the bidder in Question #6.3 (Technical Questionnaire), could the bidder provide the detail behind it without revealing client identities?

Regarding Question #6.5 (Technical Questionnaire)- If bidder answered “Yes” to Question #6.4 (Technical Questionnaire), we’re asking for your typical turnaround time to produce that anonymized line-level file.

56 Please confirm GLP-1s are not covered for any weight loss indications for any reason for the Commercial effective 7/1/27?

Please see response to Question #3.

57 Please clarify the contract draft timeframe (different turnaround times listed below):

2.1.2 Bidder agrees that no later than 30

days after notification of a contract award, Bidder will provide an accurate draft of the contract for the GIC's review. For purposes of this requirement, accuracy will be defined as the inclusion of all final pricing, contractual and performance guarantees negotiated as part of this

RFP.

versus 5.3.1R14C1 Contract Turnaround Time:

Initial draft of contract will be provided within three weeks of provisional award of business, inclusive of all RFP commitments. Thereafter, comments will be reviewed and an updated version provided to the GIC for review within 10-business for each iteration thereafter.

Penalty of $500 per day if not met.

These two provisions address the same contract turnaround obligation. Please note that Question #2.1.2 is intended only as a general bid requirement, whereas Question #5.3.1R14C1 is a performance guarantee and therefore intended to be a more stringent requirement.

58 During our review of Attachment 16a – Financial Proposal (Commercial), Tab 4a, we identified numerous instances where the ZIP code provided does not appear to correspond with the associated city and state. As a result, a substantial portion of

Upon review, the GIC did not identify a material data-quality issue that would prevent bidders from completing the required geographic analyses. ZIP codes were provided as five-character values with leading zeroes preserved. Bidders should ensure that this field is imported and maintained in that

Page 17: Procuring a Pharmacy Benefit Manager for the Group Insurance Commission (GIC) the member file cannot be successfully geocoded, which limits our ability to perform geographic access analyses and evaluate pharmacy network coverage. For example, many members are assigned to Arlington, MA and Amesbury, MA using ZIP codes that are either invalid or do not correspond to those municipalities. Will the Commonwealth provide corrected ZIP code data or alternative geographic information that can be used to complete the required geographic analyses? If not, could you please clarify how bidders are expected to complete these analyses accurately given the data discrepancies?

format, as conversion to a numeric field may remove leading zeroes and produce invalid ZIP codes.

Bidders should use the Home ZIP Code as the primary geographic field. City values may reflect municipal, neighborhood, or alternate locality names and therefore may not exactly match a single preferred postal city name. The limited discrepancies identified do not warrant issuance of a corrected file, and no alternative geographic data will be provided.

59 Could the GIC please provide clarification regarding the file naming conventions beginning on page 32 of the RFP?

Specifically, could you confirm whether the Contract Form, Terms and Conditions, Signatory Listing Form, and Prompt Payment Discount Form are expected to be submitted as Microsoft Word (.doc/.docx) files, rather than in their original PDF format in which they were provided? In other words, should bidders convert these documents from PDF to Word prior to submission, or may they be submitted in their original PDF format?

Forms provided for bidders to complete should be submitted in their original format, unless the RFR specifically requires otherwise.

Based on the file naming conventions in the RFR, the Standard Contract Form, Commonwealth Terms and Conditions, Contractor Authorized Signatory Listing, and Prompt Payment Discount Form should be submitted in their original form/file type as provided for completion, rather than converted from PDF solely for submission purposes.

60 Could the GIC please provide clarification regarding Attachment 02 – Standard Contract Form, specifically the "Terms and Conditions" section? We received a single Terms and Conditions document (Attachment 03 – Terms and Conditions).

Could you please confirm that bidders should select the option on the Standard Contract Form that corresponds to Attachment 03, or are there additional Terms and Conditions documents that should be considered?

Bidders should use the Commonwealth Terms and Conditions document provided as Attachment 3 in connection with the Standard Contract Form.

61 Can you please clarify what is expected to be completed in Attachment 15 – Plan Design & Clinical Programs?