MainRfp_UpdatedByAddenda1-6_Final.pdf

STATE OF OREGON

COVER PAGE

Public Employees’ Benefit Board is issuing this Request For Proposals

(RFP) under OregonBuys Bid Number S-44300-00014758 for

MEDICAL AND PHARMACY BENEFIT SERVICES

Date of Issue: September 9, 2025

Opening Date and Time: 5:00 pm on November 2114, 2025

Single Point of Contact (SPC) Information:

See RFP Section 4.2

The State of Oregon promotes equal opportunity for all individuals without regard to age, color, disability, marital status, national origin, race, religion or creed, sex or gender, sexual orientation, or veteran status.

Style Definition: TOC 1: Right: -0.3"

Main RFP Document Updated by Addenda 1-6

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TABLE OF CONTENTS

SECTION 1: GENERAL INFORMATION

1.1 INTRODUCTION

1.2 PEBB BACKGROUND INFORMATION

1.3 PEBB’S EXPECTATIONS FOR FUTURE PARTNERS/SCOPE OF WORK

SECTION 2: AUTHORITY, DEFINITIONS, AND SAMPLE CONTRACT

2.1 AUTHORITY AND METHOD

2.2 DEFINITION OF TERMS

2.3 SAMPLE CONTRACT

SECTION 3: EXPECTATIONS OF Proposers – Minimum Requirements……………………16

SECTION 4: SOLICITATION PROCESS…………………………………………………………………….18

4.1 SCHEDULE

4.2 SINGLE POINT OF CONTACT (SPC)

4.3 PUBLIC NOTICE

4.4 CONFERENCES

4.5 QUESTIONS / REQUESTS FOR CLARIFICATIONS

4.6 SOLICITATION PROTESTS

4.7 PROPOSAL SUBMISSION INSTRUCTIONS

4.8 PROPOSAL MODIFICATION OR WITHDRAWAL

4.9 PROPOSAL DUE

4.10 PUBLIC OPENING

4.11 PROPOSAL REJECTION

4.12 EVALUATION PROCESS

4.13 SCORING / WEIGHTING

4.14 RANKING OF PROPOSERS

4.15 NEXT STEP DETERMINATION

SECTION 5: AWARD AND NEGOTIATION

5.1 AWARD NOTIFICATION PROCESS

5.2 INTENT TO AWARD PROTEST

5.3 APPARENT SUCCESSFUL PROPOSER SUBMISSION REQUIREMENTS

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5.4 CONTRACT NEGOTIATION

SECTION 6: ADDITIONAL INFORMATION…………………………………………………………….4140

6.1 GOVERNING LAWS AND REGULATIONS

6.2 OWNERSHIP/PERMISSION TO USE MATERIALS

6.3 CANCELLATION OF RFP; REJECTION OF PROPOSAL; NO DAMAGES

6.4 COST OF SUBMITTING A PROPOSAL

6.5 CHECKLIST DISCLAIMER

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LIST OF ATTACHMENTS

ATTACHMENT A QUESTIONNAIRE AND OTHER RESPONSE ITEMS

ATTACHMENT B DEFINITIONS

ATTACHMENT C PLAN DESIGNS

ATTACHMENT D RESERVED

ATTACHMENT E CERTIFICATION OFFICE FOR BUSINESS INCLUSION AND DIVERSITY

(COBID)/OUTREACH PLAN

ATTACHMENT F RESPONSIBILITY INQUIRY

ATTACHMENT G FINAL SUBMISSION FORM

ATTACHMENT H DISCLOSURE EXEMPTION AFFIDAVIT

ATTACHMENT I SAMPLE GROUP BENEFITS CONTRACT

ATTACHMENT J DATA WAREHOUSE FILE LAYOUT

ATTACHMENT K POINT SOLUTION GUIDELINES

ATTACHMENT L CENSUS DATA

ATTACHMENT M MEDICAL CLAIMS DATA

ATTACHMENT N PROVIDER DISRUPTION DATA

ATTACHMENT O PROVIDER DISCOUNT DATA

ATTACHMENT P PHARMACY PLAN DESIGN SUMMARY

ATTACHMENT Q PHARMACY CLINICAL PROGRAMS

ATTACHMENT R PHARMACY GEOACCESS ANALYSIS TEMPLATE

ATTACHMENT S PHARMACY DATA TABLES

ATTACHMENT T PHARMACY PRICING TERMS

ATTACHMENT U PHARMACY CLAIMS DATA

ATTACHMENT V DETAILED WEIGHT COMPONENT INFORMATION

ATTACHMENT W PHARMACY DATA WAREHOUSE FILE LAYOUT

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SECTION 1: GENERAL INFORMATION

1.1 INTRODUCTION

The State of Oregon, acting by and through the Public Employees’ Benefit Board (“PEBB”), is issuing this Request for Proposal (RFP) under the provisions of ORS 243.125 for medical and pharmacy benefit services.

Oregon has a long history of innovative health reform efforts. Even with this history, Oregon has faced a number of challenges in recent years that are familiar: health care costs that are increasingly unaffordable for individuals, for the state and federal government and businesses; cost growth that far outpaces the growth in state general fund revenue and personal income; and a health care system that rewards volume, not value.

PEBB is organizationally located within the Oregon Health Authority (OHA) and purchases healthcare for its Members; however, the Board has its own statutory authority to procure services for certain Benefit Plans, including those within this RFP. As the largest public purchaser of healthcare services, OHA is seeking to transform the health care system in Oregon and fundamentally improve how care is paid for and delivered. This transformation process involves focusing on health and preventive care, providing care for everyone, and reducing waste in the health care system to meet three overarching goals: to provide better care, resulting in better health, and at a lower cost This RFP supports this mission.

PEBB anticipates, but does not guarantee, either awarding one statewide combined Medical/Pharmacy contract or a combination of only one Medical only contract joined with a Pharmacy only contract. Additionally, PEBB anticipates, but does not guarantee awarding multiple regional contracts. Those regional contracts awarded may be comprised of combined Medical/Pharmacy contracts or a combination of Medical only contracts joined with a Pharmacy only contracts. Proposers shall not interpret anything in this RFP as a guarantee by PEBB that any Proposer will be selected as an Apparent Successful Proposer, or ASP (as such term is defined in Attachment B, Definitions). PEBB desires, if an ASP is selected, to have any resulting contract negotiated and executed by or closely around June 23, 2026. The initial term of any resulting contract is anticipated to begin on or about the date of Contract execution and continue through December 31, 2029. That said, the Successful Proposer will not actually begin delivering Medical and Pharmacy services to eligible PEBB Members until January 1, 2027, unless otherwise negotiated in the resulting Contract.

Thereafter, PEBB shall have the option, but not the obligation, to extend the term of any resulting Contract for either additional one or multiple 12-month terms. In addition, PEBB reserves the right to amend the Contract for changes in PEBB’s funding, changes to the Scope of Work needed by PEBB that are reasonably related to the then-current Contract and the Scope of Work described in this RFP, changes in applicable law, and Contractor rate changes as permitted in the Sample Group Benefits Contract, which is attached to this RFP as Attachment I.

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1.2 PEBB BACKGROUND INFORMATION

PEBB designs, contracts and administers a program of benefits for the state as the employer and state employees. The benefits include medical and dental coverage; life, accident, disability and long-term care insurance; and flexible spending accounts. The Board also offers healthcare insurance options for retirees not yet eligible for Medicare and individuals in other participating groups.

The PEBB pool is made up of 160,000 individuals. These include:

• 62,000 subscribers - principally employees of state agencies and universities, along with eligible retirees

• 98,000 covered dependents

The individuals live and work in every county in the state. PEBB also has at least one member in all 50 states.

PEBB currently has the statewide medical plan through Providence Health Plans which is offered across the country, and more localized health plans with Kaiser Permanente, Providence Health Plans, and Moda Health.

PEBB also has a suite of point solutions which includes:

• Behavioral Health: Calm, Headspace, Meru, Spring Health, Talkspace

• Behavioral Health/Employee Assistance Program: Canopy

• Behavioral Health (Children with Autism Spectrum Disorder): Geminii

• Musculoskeletal/Chronic Pain Management: Kaia Health, SWORD

• Diabetes Prevention: Livongo /Teladoc, Omada, Virta

• Exercise: Active & Fit, OnePass Select

• Fertility: Progyny, Kindbody

• Hearing Aids: Tru Hearing

• Spending Accounts: ASI Flex

• Tobacco Cessation: Quit for Life

• Virtual Care (Telehealth, On-Demand): ExpressCare, CirrusMD, Teladoc

• Weight Management: WW/WeightWatchers

• Worksite Wellness: Sprout/TELUS Health

• Health Risk Assessment: PDHI

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1.3 PEBB’S EXPECTATIONS FOR FUTURE PARTNERS / SCOPE OF WORK

PEBB expects greater value from its health care partners through a health care delivery system that is accountable for costs and outcomes. By eliminating waste and controlling costs, PEBB will ensure that its Members have the care they need today and in the future.

In addition, PEBB would like to ensure that its Members’ care is coordinated across the continuum and that quality and financial incentives are more aligned throughout the delivery system. When making decisions about its health care partners, PEBB will look for better health outcomes and patient-centered programs with demonstrated success. PEBB believes the coordinated care model is essential for successful potential partners in achieving its goals through this RFP.

To that end, PEBB seeks a best-in-class partner who will deliver high-quality Medical and Pharmacy services in a manner that is accessible to its diverse membership.

Additional details on the scope of services are included in Section 2.3 below.

Mercer Health & Benefits (Mercer or Consultant) serves as PEBB’s Consultant. Except where this RFP specifically refers to the Board, any action taken during this RFP (through

Contract execution) or in support of this RFP may be taken either by the Board or by the

Board’s designees, including PEBB staff and Consultant. Furthermore, Consultant has retained a vendor (Proposal Tech) to provide the Proposal Submission Website. The vendor is not affiliated with PEBB or the State of Oregon.

PEBB’s Position Statements

PEBB strives to work collaboratively with participating Entities, Members, and Benefit

Plan Contractors to offer value-added Benefit Plans that support improvement in

Members’ health status, hold Benefit Plan Contractors accountable for outcomes, and provide affordable benefits and services.

Below are some position statements that describe what PEBB is looking for. These position statements reflect key themes from the questionnaire, Attachment A, and other key priorities. PEBB’s Position Statements include:

• Member Experience.

The healthcare system is difficult to navigate, with many PEBB Members unaware of the benefits available to them and how to access those benefits. Understanding and supporting Members’ healthcare and benefits needs requires knowledge, time and effort that people realistically do not have, especially if they are managing a health issue for themselves or a family member. These challenges often cause people to give up before they find resources, support, or information they need.

This can interfere with Member efforts to improve their health and well-being, such as locating and using an in-network provider or finding the exact benefits available to them. PEBB believes its Members deserve better.

PEBB provides its Members considerable resources, however, they often need help finding and utilizing them. The menu of options includes various condition-specific point solutions, the employee assistance program, alternative care providers, OregonBuys Bid Number S-44300-00014758 Page 9 of 42 community-based resources, wellness programs, and telemedicine providers in addition to traditional medical plan providers. PEBB is looking for a partner that can create a cohesive ecosystem that is easy for its Members to navigate.

A PEBB plan that offers a holistic Member experience, where a reliable, helpful, and easy to understand resource – like an advocate – is the main source of contact, will create high Member engagement and increase their confidence in the health and benefits system. This will also make them more likely to seek and find care that helps them get healthier. This system would also proactively identify Members’ needs and respond in a prompt and effective way.

Supporting Member well-being in its various dimensions – physical, emotional, social, financial, and purpose-spirituality – as well as addressing the social determinants of health and other population health factors will improve health and well-being and reduce the level of health disparities and inequities facing PEBB Members.

While information and ease of access are key components of improving the Member’s experience, the other elements of the Triple Aim are all part of PEBB’s goals and can be impacted by its partners. Quality can be achieved via an innovative delivery system for Members to access. The delivery system should provide clinical rigor, quality outcomes, and a better member experience. This approach will also include decision-making centered on equity, that would improve experience and outcomes for populations disproportionately burdened by health inequities.

Affordability will be achieved by keeping out of pocket costs low for Members and meeting the 3.4% trend limitation by directing them to higher-quality, lower-cost providers, and encouraging the right care at the right time and place.

A partner that has team members enabled with appropriate technology and internal and external resources can help PEBB reach its goals of optimal quality of care, assuring health equity, providing affordable care for Members and PEBB, and exceptional Member experiences.

• Behavioral Health.

PEBB believes behavioral healthcare is a fundamental right for its Members and a key part of the holistic care they deserve. Access to timely, comprehensive, and inclusive care should be available to each and every Member, no matter where they live or their life situation. Behavioral health should not a segmented portion of the care members receive but integrated across all facets.

Members have reported that finding the right behavioral health Provider is often difficult. PEBB is looking for a plan that will partner to develop and maintain a robust network of behavioral health Providers across the state and nation, and which reflects diverse Member needs. The plan should take pride in how it is expanding resources, access and improving the mental health of its members and the people in the regions where they serve. Partnership is crucial as the status quo has been insufficient.

Access to care requires providers, and finding the right behavioral health provider often is difficult for Members. PEBB is looking for a plan that will be a partner in helping PEBB develop and maintain a robust network of Providers across the state, OregonBuys Bid Number S-44300-00014758 Page 10 of 42 and nation, which reflects their diverse needs. The plan should take pride in how it is expanding and improving the mental health of its Members and the people in the regions where they serve. Partnership is crucial as the status quo has been insufficient.

Networks must include access to various specialties and approaches with an acute focus on providers with expertise with children. Providers should be accepting new patients; too often the promise of network access is not fulfilled as the quality Providers are not accepting new patients or have no open appointments.

Innovative ideas to address the Provider shortages are needed and incentives and removal of barriers to entry are essential to enhancing the behavioral health network. Partnerships with community organizations and resources that are not part of a traditional behavioral health insurance network can support Members in accessing additional services, such as housing, food, and social support, as well as add to the diversity of the Providers for Members.

As part of the holistic care for the Members, the behavioral health services need to be fully integrated into the overall care management, creating clinical excellence and outcomes-driven practices as part of a person-centered framework. Ensuring equitable care is part of what PEBB is looking for in a partner, with the ability to address unique circumstances, cultural backgrounds, and personal goals. For behavioral health, this approach is particularly important as it fosters trust, engagement, and collaboration between Providers and patients.

Cultural and linguistic capabilities should not only include multiple languages spoken, but also providers who are able to speak on a culturally congruent basis with the members, whether that is driven by race, ethnicity, gender, orientation, or religious preference. When Members feel understood, valued, and respected, they are more likely to actively participate in their care, adhere to treatment plans, and seek help when needed. This engagement can lead to better health outcomes, reduced hospitalizations, and overall satisfaction with the healthcare system.

The health plan also plays a direct role in ensuring Members feel valued. A simple

Member experience that serves as single point of access for all behavioral health resources and programs, high-touch member support with advocacy and navigatin, personalized recommendations and vetted referrals is critical.

• Health Equity.

PEBB believes health equity is not merely an ideal but a fundamental right for all individuals. The commitment extends beyond providing health care services; it encompasses a holistic approach that addresses the diverse needs of our Members and strives to create an environment where all individuals, regardless of their background or circumstances, can access the care they need without facing discrimination or disadvantage.

To achieve this vision, PEBB is looking for partners to share this commitment to health equity across various dimensions of health care delivery.

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Identifying and effectively addressing health disparities within member populations is key. Data collection and analysis, as well as population-targeted interventions, can close gaps in care and improve health outcomes for underserved groups. Addressing member social determinants to reduce health inequities and improve clinical outcomes requires screening and referral for resources related to transportation food, housing, utilities, employment, and education.

Robust strategies are also needed to recruit and retain culturally and linguistically diverse providers, ensure geographic accessibility, and address any gaps in services that disproportionately affect populations. Providers should not only include the traditional service providers, but also those embedded within the community and those who support the whole family in navigating member health needs, not just the member with the condition. Inclusion, not exclusion, is what PEBB believes in.

Effective communication and improving health literacy are critical for ensuring that all members can access and understand their health care options to navigate the health care system effectively. A comprehensive and accessible provider directory is essential for members to make informed choices about their health care. PEBB encompasses the entire state as well as the nation and a provider directory that is inclusive and representative of the diverse communities included is needed. Quality care requires considerations for language access, cultural congruence, and the availability of providers who understand and address the unique needs of various populations.

PEBB is committed to advancing health equity for all its members. We believe by working collaboratively with our partners, we can create a health care system that is inclusive, equitable, and responsive to the diverse needs of our communities and which will make meaningful progress toward a healthier, more equitable future for all PEBB Members.

• Clinical Services.

PEBB believes its health plan partners play a key role in managing the health and care of its Members. Improving health outcomes plays a crucial role in ensuring that PEBB meets its 3.4% limitation. While the Providers and facilities utilized by the Members take a lead role in caring for its members, plans, via customer service, condition management, health promotion and prevention, utilization and case management can assist the providers.

Plans have multiple modalities and opportunities to communicate with the members to understand their clinical needs as well as to respond to those needs with information and connections. Utilizing those opportunities effectively can improve health and outcomes. Connection of the members with the most appropriate resources is part of the support that all members should receive regardless of their demographics or cultural or personal needs.

For Members going through an episode of complex medical care, early identification of cases that will be complex is a strategy to make the care more effective. When a member is faced with cancer care, high risk obstetrics, a disabled child or complex behavioral health issues, they can become overwhelmed. Assistance via tools and

OregonBuys Bid Number S-44300-00014758 Page 12 of 42 strategies to meaningfully engage the member and their family, expertise in clinical care, and knowledge of benefits and other programs would be invaluable to the member and their family. Care management also includes addressing barriers to care such as social determinants of health, providing resources and following up to ensure the member’s needs have been met. Too many times, PEBB has learned of situations where care gaps occurred for its members where taking the next step could have been impactful.

Assisting Members with clinical decision-making support and access to second opinions when indicated is needed to ensure they can engage with the treating physician or team and to be sure issues like discharge planning and home care are addressed ahead of time and in a way that is clear to the members and their support systems. Plans can provide oversight to assure PEBB that case managers are following care guidelines and protocols including keeping the case open until issues are resolved from the perspective of the members.

Case management requires a high level of clinical resources and the teams providing the management needs a diverse set of expertise, including behavioral health and substance abuse specialists in addition to other medical specialties to treat the whole person, that have frequent interactions, including meetings with the medical director to consult on the most challenging cases. Comorbidities in these complex cases not only are medical, but may be behavioral, as well as impacted by social determinants, such as ability and resources to transition back home after discharge. Case management needs to address all these needs. As medical treatments evolve, continual training of case managers in ongoing clinical education as well as quality oversight function is required.

While the process is important, the value of that process can only be determined by the outcomes achieved with documentation and demonstration of the impacts of the care and case management programs on the wellbeing of the member and the functioning of the plan. Detailed description of how the care and case management programs are evaluated should include metrics of the outcomes as well as process documentation and data. Medicine is not a universal constant; plans should be introspective and craft and implement improvement plans and new offerings when needed.

• Provider Contracting.

Oregon has been at the forefront of Value Based Purchasing and PEBB desires to contract with carriers who embrace the concepts of quality, provider risk sharing, and development of approaches that provide meaningful incentives for providers to practice high-quality, equitable, and cost-effective care. In addition, Oregon has seen significant increases in unit costs, hospital ownership of physician groups and ambulatory surgical centers, and increasing variation in provider payments based on site of care. PEBB is concerned the negotiating power of the providers is outpacing the abilities or desires of carriers to control costs. PEBB desires to partner with carriers who have efficient contracts with positive provider incentives and are willing to address (for PEBB or more broadly for their book of business) status quo market inefficiencies, outlier site of care payments, and other inequities in the quality/cost spectrum.

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Provider contracting should also not be limited to the lowest cost. Fair and equitable payments to those who work in the health care system are a value of PEBB. Delivery of quality health care is not just the purview of the doctors or executives, but also the front-line workers and those behind the scenes that ensure quality is achieved throughout the process. Disruption of care can cause critical issues, especially for those in acute situations. Ideal PEBB partners would proactively assist in mitigating potential contracting issues rather than exacerbating them.

• Carrier Contracting.

PEBB is limited by law to 3.4% annual increases in health care spending. For several years this requirement was met (with some difficulty), but post-pandemic results have been disappointing. While PEBB understands the pressures of provider contracting and the need to maintain adequate network access, it believes there are unrealized opportunities for improvements in cost conscious care management, improvements in prevention, more efficient administration, better care pathways, and other approaches that are not related to provider contracting levels. PEBB seeks to contract with carriers that can maximize equitable and healthy outcomes by using the most effective care and reducing the cost impact of ineffective or unnecessary care. Meeting the 3.4% cost growth limit while maintaining solid provider networks with robust and equitable access for all members is one of PEBB’s highest priorities.

The role of the pharmacy benefit manager is to manage the prescription drug aspects of PEBB’s medical benefit. This includes development of the formulary, negotiation for drug prices and rebates, creating pharmacy access through mail order and retail network contracting, performing drug utilization review and management, and providing member service related to prescription drugs and drug benefits.

• Data and Reporting.

PEBB is looking for a partner who uses data and analytics to identify health issues proactively, find and address areas of inequity, and to coordinate and help providers treat the members to improve health outcomes. Similar to other public employees, PEBB members often choose to work in their profession due to the quality of the health benefits and PEBB wants to ensure these members get the care they deserve.

While utilization data and other HEDIS metrics can provide some insight into how providers are practicing, these statistics often cannot inform how well those providers are performing on their own. Recent audits have noted gaps where needed care has not been provided, particularly with behavioral health, and members of certain races and ethnicities may not be receiving the level of care commensurate with others. In addition, access to and the quality of the healthcare members receive is inequitable across its population.

PEBB believes managing the health and the associated episodes of these members is the role of a health plan, and that the plan can help assist the providers and members in that management. In addition, PEBB believes a health plan can and

OregonBuys Bid Number S-44300-00014758 Page 14 of 42 should provide data and reporting demonstrating how the plan is providing that management and the outcomes of the efforts.

• Services and Administration.

PEBB’s expectations for services and administration center on delivering inclusive, member-first plan designs that are equity-centered and are supported by dedicated and strategic account management. PEBB’s plans go beyond the basic health services to include robust inclusive benefits, such as family building fertility benefits, advocates, doula care, and gender affirming care.

For PEBB, inclusive plan design includes coverage decisions that prioritize member needs over cost-shifting. For example, access to culturally appropriate providers and language access services must be standard. Plans should also demonstrate how their benefits reduce barriers for underserved populations, including low-income members, rural residents, and historically disadvantaged populations. Flexibility for benefit adjustments within the contract term to address emerging health equity issues or member feedback is also expected.

The Board expects a highly responsive and collaborative relationship with its health plans. Account teams must provide proactive communication and strategic partnership with PEBB leadership and staff, rapid resolution of operational issues and claims inquiries, focus on minimizing member disruption, and provide data-driven insights on utilization, member satisfaction, and cost trends to inform continuous improvement.

PEBB requires an integrated benefits experience – where PEBB vendors and point solutions integrate seamlessly and collaborate to further members’ health and well-being. A high level of service and competence is needed to provide healthcare for the over 60,000 employees and 150,000 members, many of whom have complex and/or chronic conditions. PEBB Members highly value their Plan Benefits and an ideal partner will prioritize members getting the care they need without issues or complaints.

• Financials.

The Oregon legislature has placed a 3.4% cost growth cap on PEBB and partners are expected to perform within these firm financial guardrails while avoiding benefit erosion. Savings to achieve the 3.4% should focus on achieving efficiencies and innovating on care delivery, without simply shifting the cost onto members.

While the legislature has provided relief in the form of a 200% of Medicare hospital cap, the savings from this cap have eroded, with signs that the cap is rapidly becoming a floor. PEBB should not be a price taker, and the ideal partner would help in achieving that goal, demonstrating cost-containment strategies.

Oregon has been a leader in reference-based pricing, value-based contracting, and trend guarantees to drive high-value care. PEBB partners would ideally align with these tenets. Plans must document quality benchmarks, member access standards, and cost and utilization trends demonstrating real value.

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Partners are expected to be fiscally responsible, helping restrain the increase in medical and specialty pharmacy costs, eliminate unnecessary spend and low value drug use, as well as incentivizing care management of the members via payments for meeting quality and efficiency metrics.

PEBB also values financial transparency – the Board knows what services they expect from their plans and what they are paying for. Too often medical plans and pharmacy benefit managers engage in variable fees, spread pricing, rebate retention, or other financial mechanisms that are opaque and detrimental to their customers. Ideal partners would provide detailed and transparent reporting, laying out the fees, retained savings, and the true value of the services that the fees are being charged for. Proposers will also be willing to demonstrate their willingness to partner by proposing performance guarantees that demonstrate their ability to excel and be best in class via delivery rather than promises. Those who deliver predictable pricing within these boundaries, with robust oversight and member-friendly practices, will be best positioned to help PEBB meet the 3.4% limitation.

• Pharmacy.

Pharmacy benefits represent the most frequently accessed subset of an employer medical plan. Many members rely on regular prescription fills to manage chronic diseases and maintain health status. Other members require intermittent access to prescription therapy but may require urgent access to treat an acute medical condition.

Obtaining prescriptions should not be challenging for members, including members who live in rural areas or with limited transportation options. The pharmacy benefit manager must demonstrate the ability to provide adequate pharmacy access in the entire service area – including both urban and rural areas. Limited or exclusive pharmacy networks for maintenance medications can provide cost efficiency, but only if adequate access is available for members. While mail order pharmacy is one viable solution, the pharmacy benefit manager should acknowledge and help mitigate the challenges inherent to this model, including equity challenges such as access to secure mailboxes and the impact of the higher mail order copays for those with limited access to funds.

Drug manufacturers continue to both innovate with new treatments and technologies and effectively market new treatments through direct-to-consumer advertising and clinician detailing. Costs for prescription drugs continue to increase, applying pressure both to members and employers. While members and clinicians seek coverage for the newest treatments, cost pressures limit the portion of budget available for paying for these new treatments.

The pharmacy benefit manager should be able to demonstrate the impact of formulary and utilization management processes and procedures that strike the right balance between member access and clinical cost effectiveness. PEBB is particularly interested in a vendor that has established successful efforts to minimize the influence of pharmaceutical manufactures on clinician prescribing.

The pharmacy benefit manager should be able to provide documentation to support

OregonBuys Bid Number S-44300-00014758 Page 16 of 42 the effectiveness of the formulary and utilization strategy and have the capability to provide robust reporting of cost savings initiatives over time.

The pharmacy member services should include 24/7 support to assist members in navigating pharmacy benefits or respond to urgent prescription drug related inquiries. Member facing tools should be available via web and mobile phone app and should be intuitive to use and provide useful information including drug cost, pharmacy location services, and clinical information.

Over the last two years, prescription drug treatment for weight loss has been an important focus area for PEBB. While many members in the PEBB plan could potentially benefit from holistic weight management therapy including prescription drugs, the PEBB board and its existing carriers have yet to identify a mechanism to provide the treatment within the confines of the annual premium increase cap. The ideal pharmacy benefit manager would offer unique and innovative purchasing and management programs for weight loss medications that would allow for the addition of coverage, monitoring of effectiveness over time, and significantly improved pricing and/or rebate terms for weight loss medications.

SECTION 2: AUTHORITY, DEFINITIONS, AND SAMPLE CONTRACT

2.1 AUTHORITY AND METHOD

This Request for Proposal (RFP) is being conducted pursuant to Oregon Revised Statutes

(ORS) 243.125, which can be found at:

https://www.oregonlegislature.gov/bills_laws/ors/ors243.html, and Oregon Administrative

Rules (OAR), chapter 101, which can be found at:

https://secure.sos.state.or.us/oard/displayChapterRules.action?selectedChapter=36.

2.2 DEFINITION OF TERMS

Definitions governing this RFP are provided in Attachment B. In the event that a term included in this RFP is not defined in Attachment B, Proposers will refer to PEBB’s OARs.

2.3 SAMPLE CONTRACT

Please refer to Attachment I, Sample Group Benefits Contract.

SECTION 3: EXPECTATIONS OF PROPOSERS – MINIMUM REQUIREMENTS

In addition to the required submissions described further below, Proposals must also meet the Plan Design elements within Attachment C, section II.

In order to be considered under this RFP, Proposers must submit a complete and responsive Proposal that responds to all applicable questions and submits all required documents as further described in this RFP. One purpose of Attachment G, Final https://www.oregonlegislature.gov/bills_laws/ors/ors243.html https://secure.sos.state.or.us/oard/displayChapterRules.action?selectedChapter=36

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Submission Form, is to provide a submission checklist to Proposers that includes a list of the RFP requirements in one place.

Like other required submissions under this RFP, Proposers will confirm their compliance with the Mandatory Minimum Requirements provided in Attachment G, Final Submission

Form, by completing Part B of the Final Submission Form on the Proposal Submission

Website at: www.proposaltech.com. Specific instructions for completing this required checklist can also be found on the Proposal Submission Website.

By completing Attachment G, Final Submission Form, Proposers will also indicate that they have submitted all other required responses and documents. More specifically, Part B requires Proposers to not only agree to a number of statements and certifications, but also confirm that they have fully responded to the RFP by completing or submitting the following:

• All applicable responses to items included in Attachment A, including submitting supporting or supplemental documents or information where required; please note that required responses associated with the Sample Group Benefits Contract will be embedded in Attachment A, in a published addendum to Attachment A.

• All applicable responses to items included in Attachment E, Certification Office for Business Inclusion and Diversity (COBID) Outreach Plan;

• All applicable responses to items included in Attachment F, Responsibility Inquiry;

• All applicable responses to items included in Attachment N, Provider Disruption Data;

• All applicable response to items included in Attachment O, Provider Discount Data;

• All applicable responses to items included in Attachment R, Pharmacy GeoAccess Analysis;

• All applicable responses to items included in Attachment S, Pharmacy Data Tables; and

• All applicable response to item included in Attachment T, Pharmacy Pricing Terms.

By completing Attachment G, Final Submission Form, Proposers will also agree to follow the process for declaring portions of their Proposal as exempt from disclosure under Oregon’s Public Records Law, even though the process will occur after Proposals are submitted. Proposers will declare disclosure exemptions by submitting a completed Attachment H, Disclosure Exemption Affidavit, along with its claimed exemptions, by the date described in the Section 4.1. Please note that this submission is a requirement and failure to submit Attachment H, along with the claimed disclosure exemptions, may be grounds for disqualification. Please also note that PEBB, or its Consultant, will provide instructions for claiming disclosure exemptions after the Proposal due date but no later than January 16, 2026.

http://www.proposaltech.com/

OregonBuys Bid Number S-44300-00014758 Page 18 of 42

By completing Attachment G, Final Submission Form, Proposers will also agree to a number of representations and warranties described in Part C, such as agreeing that Proposer prepared its response to this RFP independently from all other Proposers, unless otherwise permitted by this RFP concerning subcontractors and collaborators, and without collusion, fraud, or other dishonesty.

In addition, Attachment G Final Submission Form, also requires Proposers to complete Part A, which contains a number of state-required certifications.

Last, some responses to this RFP may be limited to a certain number of words. Such limitations will be described in Proposal Tech and will be considered requirements to this

RFP.

PEBB requires Proposals to be complete and comply with all RFP specifications. Any missing information could disqualify a Proposal. Unless a Proposer notes to the contrary, PEBB will assume the Proposer’s Proposal conforms to the specifications of this RFP in every way.

SECTION 4: SOLICITATION PROCESS

4.1 SCHEDULE

The table below represents a tentative schedule of events. Unless otherwise noted, all

Events will be due by 5:00 pm Pacific Time. All dates listed are subject to change. N/A denotes that event is not applicable to this RFP.

OregonBuys Bid Number S-44300-00014758 Page 19 of 42

Event Date Time

Pre-Proposal Conference September 16, 2025 3:00pm-4:00pm

Questions / Requests for Clarification Due October 240, 2025

Answers to Questions / Requests for

Clarification Issued (approx.)

November 073, 2025

RFP Protest Period Ends November 140, 2025

Opening (Proposal Due) See RFP cover page

Conference to Present Process for Public

Record Redactions (Mandatory)

January 14, 2026

TBD

3:00pm-4:30pm

PEBB to Provide Proposers with Instructions for Attachment H and Disclosure Exemptions January 16, 2026

Attachment H and Disclosure Exemptions Due January 28, 2026

Competitive Range Determination February 17, 2026 9:35am-12:35pm

Presentations, Demonstrations, or Interviews

(If needed)

Approximately March 30, 2026, to April 3, 2026

Selection of ASP April 29, 2026 9:30am-3:30pm

Issuance of Notice of Intent to Award (approx.) May 1, 2026 April 21,2026

Award Protest Period Ends May 8, 2026 April 28, 2026

Expected start date for resulting contract See Section 1.1

Please see the information below for attending the RFP pre-proposal conference as described above.

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For technical assistance, ODHS and OHA employees please contact the OIS Service Desk; guests, please click the "Learn more about Teams" link.

Please see the information below for attending the RFP Opening meeting as described above in the Section 4.1 schedule.

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Please see the information below for attending the Conference to Present Process for Public

Record Redactions as described above in the Section 4.1 schedule.

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OregonBuys Bid Number S-44300-00014758 Page 21 of 42

For technical assistance, ODHS and OHA employees please contact the OIS Service Desk; guests, please click the "Learn more about Teams" link.

Please see the information below for attending the public meeting where PEBB will determine the Competitive Range as described above in the Section 4.1 schedule. Please note that this will occur during a regularly scheduled PEBB Board meeting. As a result, the Board will also conduct other business, besides determining the Competitive Range.

Microsoft Teams meeting

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Or call in (audio only)

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Phone Conference ID: 662 852 168#

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For technical assistance, DHS and OHA employees please contact the OIS Service Desk;

guests, please click the "Learn more about Teams" link.

Learn More | Meeting options

Please see the information below for attending the public meeting where PEBB will select the

ASP(s) as described above in the Section 4.1 schedule.

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4.2 SINGLE POINT OF CONTACT (SPC)

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OregonBuys Bid Number S-44300-00014758 Page 22 of 42

Any and all questions from Proposers about this RFP, including questions relating to contractual requirements, clarification of specific information requested, the procurement process, or any other aspect of the project or needed services, shall be directed as follows:

• All technical questions related to the Proposal Submission Website, or how to submit responses shall be directed to the appropriate customer support team at

Proposal Tech at: support@proposaltech.com or via telephone at 877-211-8316 ext. 84;

• All questions, requests for clarification, and protests related to this RFP should be submitted via the Proposal Submission Website (www.proposaltech.com) using the

“Ask Question” feature located on the left-hand menu under “Help.1”

• If Proposers would like to submit multiple Proposals (for example, a combined medical and pharmacy Proposal in addition to a medical only Proposal), please email Heather Hein at hhein@proposaltech.com. Please also provide the identifying name for each Proposal invitation variation being requested.

In addition, pPlease do not divulge the contents of your Proposal or have any conversations related to this RFP with PEBB personnel, including Board members and staff, unless specifically authorized by this RFP. In addition, please do not divulge the contents of your

Proposal or have any conversations related to this RFP with any current State of Oregon employee, public official, or contractor unless specifically authorized by this RFP.

4.3 PUBLIC NOTICE

The RFP and attachments are published in the State of Oregon’s electronic procurement system OregonBuys at…