RFP 260000000347 - Award Recommendation and Evaluation Synopsis.docx

Michigan.gov/MiProcurement

Michigan.gov/MiProcurement

AWARD RECOMMENDATION

The Department of Technology, Management, & Budget’s Procurement office has completed the evaluation of RFP 260000000347 for Pharmacy Claims Processing and Manufacturer Drug Rebate Administration Pharmacy Benefits Administrator (PBA) Services for the Michigan Department of Health and Human Services (MDHHS) and has recommended an award to Prime Therapeutics State Government Solutions LLC in the amount of $36,826,061.00, pending State Administrative Board approval, if applicable. More information on the State Administrative Board can be found at: State Administrative Board.

Bidders who were not recommended for the award are encouraged to schedule a debriefing session with the Solicitation Manager. The debriefing session will provide the bidder with the State’s rationale on why the bidder was not recommended for the award. The Solicitation Manager may be contacted as follows:

Marissa Gove, Solicitation Manager.

Govem1@michigan.gov 517-449-8952 Public copies of all bidder proposals can be found here: DTMB - Bid Proposals (michigan.gov) Background Information:

This Request for Proposal (RFP) was to solicit responses for selection of a Contractor to provide PBA services for MDHHS. The term of this contract is 3 years, with up to 4 renewal option years.

Bidders:

The RFP was posted on SIGMA VSS on December 15, 2025, for 49 days The following bidders submitted proposals by the published due date of February 2, 2026.

Eagan, Minnesota 55121

*SDVOB: Service-Disabled Veteran Owned Business **GDBE: Geographically Disadvantaged Business Enterprise

EVALUATION SYNOPSIS

I. Evaluation Process A Responsible Vendor is a vendor that demonstrates it has the ability to successfully perform the duties identified by the solicitation. A Responsive proposal is one that is submitted in accordance with the solicitation instructions and meets all mandatory requirements identified in the solicitation.

Proposal Instructions: Mandatory Minimum Requirements To avoid disqualification, the bidder must provide documentation to support the following:

1. Component 1 – Claims Processing and Related Services A. Medicaid Management Information Systems (MMIS) Certification – The Contractor must comply with all requirements for MMIS certification issued by CMS that govern the Contractor’s service, performance, work, or deliverables. (See the Streamlined Modular Certification available at https://www.medicaid.gov/medicaid/data-systems/streamlined-modular-certification).

2. Component 2 – PDL and Manufacturer Drug Rebate Administration:

A. Medicaid Management Information Systems (MMIS) Certification – The Contractor must comply with all requirements for MMIS certification issued by CMS that govern the Contractor’s service, performance, work, or deliverables. (See the Streamlined Modular Certification available at https://www.medicaid.gov/medicaid/data-systems/streamlined-modular-certification).

Bidders must sign and return Attachment 1 - Minimum Requirements for Component 1 – Claims Processing and Related Services and/or Attachment 2 - Mandatory Minimum Requirements for Component 2 – PDL and Manufacturer Drug Rebate Administration, certifying that the Bidder meets all minimum requirements.

Only proposals meeting the mandatory minimum requirements will be considered for evaluation.

Proposal Instructions: Evaluation Process Component 1 – Claims Processing and Related Services

Component 2 – PDL and Manufacturing Drug Rebate Administration

2.

Components 1 & 2 – Claims Processing and Related Services and PDL and Manufacturing Drug Rebate Administration

3.

Schedule A – Statement of Work, Section X, Pharmacy and Therapeutics (P&T) Committee through Section BB, Audit Trails for PDL and Manufacturer Drug Rebates

Proposals receiving 416 or more technical evaluation points for Component 1 or 416 or more technical evaluation points for Component 2 or 692 or more technical evaluation points for Components 1 & 2 will have pricing evaluated and be considered for award.

The full evaluation process is stated in the RFP Proposal Instructions.

II. Evaluation Method Responses to this solicitation were reviewed by a Joint Evaluation Committee, which consisted of the following individuals:

Marissa Gove, Category Management Specialist DTMB-Central Procurement-Services Sarah Oumedian, Departmental Specialist MDHHS-Bureau of Grants and Purchasing

Trish Bouck, State Division Administrator MDHHS-Pharmacy Management Division

Michael Melvin, Section Manager

Glenda England, MCO Common Formulary & Pharmacy Section Manager

III. Evaluation Results A. Prime Therapeutics State Government Solutions LLC The Evaluation Team determined that Prime Therapeutics State Government Solutions LLC based on a score of 849, did meet the requirements of this RFP. This determination was accomplished by evaluating their responses to the Technical Evaluation Criteria.

1. Vendor Questions Worksheet, (Excluding Experience) for Component 1 and 2 25/25 The Evaluation Team determined that overall, the responses were satisfactory.

2. Vendor Questions Worksheet, Experience for Component 1 and 2 517/520 The Evaluation Team determined that overall, the responses were mostly satisfactory, but the following deficiency was noted:

a. Bidder failed to identify 3.e Invoicing by program.

3. Schedule A – Statement of Work, Section A, General Requirements through Section I, Compliance with State and Federal Laws, Rules, Regulations, Policies, and Notifications 52/55 The Evaluation Team determined that overall, the responses were mostly satisfactory, but the following deficiencies were noted:

a. General Requirements, 2-7: Bidder failed to describe how they have met similar conditions in other contracts.

b. Statement on Standards for Attestation 16/Service Organization Controls Report: Bidder lacked a description of their experience with audit reports and bridge letters for existing clients.

c. Contractor Quality Assurance: Bidder failed to provide their experience on how they implemented fixes or feedback as a result of customer satisfaction surveys.

4. Schedule A – Statement of Work, Section J, Claims Processing through Section W, Claims Processing Corrective Action Plan 83/85 The Evaluation Team determined that overall, the responses were mostly satisfactory, but the following deficiencies were noted:

a. Paper Invoice Claims Processing: Bidder lacked details on their existing process and experience with processing paper pharmacy claims.

b. Children’s Special Health Care Services Program (CSHCS): The State does not currently deny CSHCS claims based on authorized prescriber yet while Bidder’s response states they currently do.

5. Schedule A – Statement of Work, Section X, Pharmacy and Therapeutics (P&T) Committee through Section BB, Audit Trails for PDL and Manufacturer Drug Rebates 80/85 The Evaluation Team determined that overall, the responses were mostly satisfactory, but the following deficiencies were noted:

a. Online Manufacturer Drug Rebate Management System, a-c: Bidder failed to provide documentation that demonstrated its drug management system houses all data elements and functionalities listed in the requirements.

b. Rebate Reporting Required by CMS, a-b: Bidder failed to provide a list of data elements.

6. Schedule A – Statement of Work, Section 1.2 Transition through Section 1.11 Products and Services 45/45 The Evaluation Team determined that overall, the responses were satisfactory.

7. Schedule A, Statement of Work, Section 2, Acceptance through Section 9, Service Level Agreements (SLA) 47/50 The Evaluation Team determined that overall, the responses were mostly satisfactory, but the following deficiency was noted:

a. 3.7 Key Personnel, I: Bidder’s resumes attachment was not accessible.

Total Score: 849/865 IV. Technical Evaluation Summary

V. Pricing Summary Pricing was evaluated for the bidders who passed technical. The following is a summary of their price proposals:

Prime Therapeutics State Government Solutions LLC - First Round

"Design, Development, Implementation (DDI) Total Fixed Price (from Pricing Schedule Tab B)"

Operations Phase

Prime Therapeutics State Government Solutions LLC - Second Round

"Design, Development, Implementation (DDI) Total Fixed Price (from Pricing Schedule Tab B)"

Operations Phase

VI. Negotiations Following completion of the technical evaluation, the single bidder was invited to submit second-round pricing. The bidder provided a reduction, as detailed in the Pricing Summary table above. The Bidder also provided additional estimated cost for identified option add-on services.

VII. Award Recommendation Award recommendation is made to the responsive and responsible Bidder who offers the best value to the State of Michigan. Best value is based on the proposal meeting the minimum point threshold and offering the best combination of the factors stated in the Proposal Instructions Evaluation Process section, and price.

Prime Therapeutics State Government Solutions LLC provided the best value to the State. Best value factors for Award Recommendation include: Experience, ability to provide both components, and pricing.

As part of the best value determination, overall economic impact to the State of Michigan was considered and is not a determinative factor in making this award.

Award Recommendation is made to Prime Therapeutics State Government Solutions LLC in the amount of $36,826,061.00.

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