NV Medicaid RFI for Single PBM.docx

NEVADA HEALTH AUTHORITY

NEVADA MEDICAID

9850 DOUBLE R BLVD

RENO, NV 89521

NVHA.NV.GOV

Stacie Weeks, Director

Ann Jensen, Administrator Division of Medicaid

Joe Lombardo Governor

Request for Information for the Nevada Medicaid Single Pharmacy Benefit Manager Response Deadline: May 29, 2026, at 5:00 PM PST

Introduction:

Nevada Medicaid is soliciting informational responses from interested qualified vendors to inform the State’s upcoming procurement for the Nevada Medicaid Single Pharmacy Benefit Manager (sPBM).

Background:

Pursuant to Senate Bill 389, enacted during the 2025 Legislative Session, Nevada Medicaid is required to consolidate pharmacy benefit administration across both Fee-for-Service and Managed Care Organization (MCO) delivery models. This transition aims to enhance fiscal transparency, support a pass-through pricing model, and establish a consistent reimbursement methodology for providers across the state.

Currently, Nevada Medicaid serves approximately 800,000 recipients and has already taken significant steps toward clinical integration through the successful launch of a Single Preferred Drug List (sPDL) on January 1, 2026.

The State is also evaluating the technical and clinical capabilities required to manage a diverse range of state-sponsored populations. As the State moves toward a more centralized oversight model for pharmacy benefit, it is essential to identify a partner with demonstrated expertise in managing both high-volume public health programs and sophisticated public sector employer plans. This includes the ability to administer commercial-style benefit designs, tailored formulary management, and high-touch member engagement platforms. Consequently, this RFI seeks information on a vendor’s capability to deliver pharmacy benefit management with the regulatory rigor of a Medicaid program and the flexibility expected in the commercial-style public sector employer space. This dual-competency approach is critical to ensuring that the State’s chosen PBM infrastructure is scalable, transparent, and capable of supporting varied pharmacy benefit structures under a unified administrative-only framework.

Request for Information:

The Division is soliciting public input on certain innovations and strategies for a sPBM, including the types of requirements or expectations it should set through its procurement for, and future contractual arrangements with, qualified vendors.

This is only a Request for Information (RFI); no award will be made because of this solicitation. The Division invites comments, suggestions, and recommendations from potential vendors on any questions or issues raised in this RFI.

This RFI is solely for information and planning purposes and does not constitute a request for proposal or an invitation to bid. This solicitation will not lead to evaluation or award pursuant to NRS 333.335(7).

Response Instructions:

Vendors should answer the questions listed below for their RFI Response. Responses should be limited as follows:

· The length of responses should be limited to:

· Question #1, 2 pages

· Question #2, 2 pages

· Question #3, 2 pages

· Question #4, 1 page

· Question #5, 2 pages

· Question #6, 2 pages

· Question #7, 1 page

· Font size should be standard and readable with a minimum of 11-point Calibri or equivalent

· Margins should be no less than 1 inch on all sides

· Any diagrams or charts must be directly relevant to the technical requirement; marketing materials or stock photography will count against the page limit The State seeks concise, technical descriptions of capabilities and scalability of vendor products that meet the state’s goals for a centralized PBM contract. Respondents are encouraged to avoid general corporate overviews and focus specifically on the Nevada-specific requirements relevant to this RFI.

Below is a template for RFI Responses. Respondents should identify the questions for which they are responding to, restating the RFI question above their response. If a Respondent chooses to not answer a question under one of the RFI categories, the Respondent should state “no response” to that specific question. Submissions that do not follow the instructions for responses may be excluded by the Division for review and consideration.Response Template [Logo (as appropriate)] [Responder’s Name] [Organization or Company Name (as appropriate)]

Re: RFI for Nevada Medicaid sPBM

1. [Restate Question] Response: [Include response]

Respondents may submit questions about this RFI to the Division no later than May 17, 2026, at 5:00 PM PST at rxinfo@nvha.nv.gov. Answers to questions received will be posted on the Division’s website and the State of Nevada ePro system as an addendum to the RFI no later than May 22, 2026.

Response Submission:

Responders must submit their responses to the Division at rxinfo@nvha.nv.gov no later than Friday, May 29, 2026, at 5:00 PM PST.

RFI Questions:

1. Describe your organization’s capabilities and prior experience administering both Medicaid and public sector employer plans’ pharmacy benefits, including developing, maintaining, and administering a formulary for both Medicaid and public sector employer plan members, separately or as one centralized PBM product. Include any recommendations and insight into advantages and challenges.

2. Describe your organization’s ability to negotiate, administer, invoice, track, reconcile, and report on Medicaid Drug Rebate Program (MDRP) and pharmacy rebates in Medicaid and public employee sector plans. Include any recommendations and insight into advantages and challenges of having the sPBM as the responsible entity for both Medicaid and public sector employer plan rebates. If your organization manages or takes part in a rebate pool, describe how you would negotiate rebates and create a PDL outside of this pool.

3. Describe your organization’s ability to contract directly with and cooperate with multiple entities, such as Medicaid MCOs, to administer pharmacy benefits within an administrative-only contract. Include any recommendations and insight into advantages and challenges with such an approach. Include successes and challenges and how you collaborate with Medicaid MCOs to facilitate care coordination and care management activities.

4. Provide your organization's recommendations for the length of the implementation timeline from contract signing to go-live.

5. Nevada seeks to achieve greater efficiencies and value for the state with a sPBM across multiple markets (Medicaid and public sector employer plans). Provide any recommendations your organization is willing to share with respect to how Nevada should structure its sPBM and contract so that such efficiencies and value can be achieved.

6. Please provide feedback on the impact of Nevada utilizing a phased approach to scaling a new sPBM to serve both markets (Medicaid and then public sector employer plan). Include any insights into advantages and challenges with this approach to implementation.

7. Nevada seeks to understand the cost of a 5-year contract for a sPBM for Medicaid and public sector employer plan with a phased approach to implementation. Please provide your estimate at a high level with a low-to-high range and explain the differences on both ends of the scale in terms of what capabilities are available or unavailable within this range of costs.

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