rfp-487-26--1-.pdf

THIS IS ONLY A PDF COPY OF THE RFP DOCUMENT.

BIDDERS MUST RESPOND TO THE ELECTRONIC RFP (eRFP)

LOCATED ON PROPOSALTECH.

TO ACCESS THE eRFP, REGISTER ON PROPOSALTECH AT:

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State of New Hampshire

REQUEST FOR PROPOSAL

For

ADMINISTRATION OF PRESCRIPTION DRUGS

RFP # 487-26

RESPONSE DUE BY:

April 22, 2026, at 2:00 PM Eastern Time (ET)

Department of Administrative Services Division of Risk and Benefits http://www.proposaltech.com/home/app.php/register

TABLE OF CONTENTS

1 Introduction

A. Background B. Objective C. Contract Term & Specifics

2 Bidding Instructions and Conditions

2.1 Proposal Conditions

2.2 Estimated RFP Timetable

2.3 Evaluation Process

2.4 Step #1 Minimum Qualifications

2.5 Step #2 Technical Questionnaire Scoring (25 Total Points)

2.6 Step #3 Financial Scoring (75 Total Points)

2.7 Step #4 Contract Award

2.8 Client References

2.9 Bidder Contacts

3 Required Plan Designs, Services and Programs 3.1.A Plan Design 3.1.B Services and Programs 3.1.C Ongoing Monitoring 3.1.D Market Check 3.1.E Implementation

4 Technical Questionnaire

4.1 General Questions

4.2 Implementation

4.3 Formulary Management

4.4 Retail Network Management

4.5 Formulary and Pharmacy Network Disruption

4.6 Clinical Programs

4.7 Audit Rights

4.8 Ongoing Monitoring

4.9 Member Services and Account Management

4.10 Performance Guarantees

4.11 Federal No Surprises Act and Final Transparency Rule Support

5 Financial

5.1 Financial Offer Template

5.2 Financial Contractual Questions

5.3 Financial Definitions

5.4 Financial Contractual Terms

5.5 Performance Guarantees Amount at Risk

6 Appendices – Group Information

Appendix A: Requested Plan Designs Appendix B: Plan Deviations Form Appendix C: Current Clinical Programs and Drug Exclusions Appendix D: SONH PBM RFP Data Appendix E: State of NH Transmittal Letter Appendix F: P-37 Form Contract Appendix G: Business Associate Agreement Appendix H: Required Protection of Confidential Information and Data Security Appendix I: Participating Bidder Agreement (PBA)

State of New Hampshire RFP for Administration of Prescription Drugs #487-

1 INTRODUCTION

1.1 This Request for Proposal (“RFP”) is issued by the Department of Administrative Services (DAS), acting through the Division of Risk and Benefits, for a contract for Pharmacy Benefits Manager (PBM) services as described herein.

A. Background The State of New Hampshire (“State”) provides prescription drug benefits through its Employee and Retiree Health Benefits Plan (HBP) for approximately 26,145 covered lives. The covered population consists of active employees/dependents located throughout New Hampshire and the surrounding New England states.

Included in the active enrollment is a “Special Group” of approximately 510 subscribers and their dependents from other organizations that have been either legislatively or traditionally covered under the State's HBP. In addition, the State provides prescription drug benefits to non-Medicare retirees/dependents located throughout the country. In this RFP document and the supporting information, the “Non-Medicare Retiree Plan” may also be referred to as the “Retiree <65 Plan”

The chart below outlines the February 2026 enrollment by population (subscribers / dependents) and plan options:

Plan Options Subscribers Dependents Total Members HMO Plan 7,822 11,263 19,085 POS Plan 2,148 2,922 5,070 Non-Medicare Retiree Plan 1,483 507 1,990 Total 11,453 14,692 26,145

Additional information about the State HBP plan designs, services and program can be found in Section 3 below.

Express Scripts, Inc. has been the State's PBM since January 1, 2014, and previously also administered an EGWP retiree plan, until January 1, 2024, when the retirees were transitioned to a fully insured MA-PD plan.

The current Commercial (Active and Non-Medicare Retiree) plans are based on pass-through pricing for retail and traditional pricing for mail order and specialty. For this RFP the State is requiring all proposals to be based on pass-through pricing for retail and acquisition cost plus pricing for mail order and specialty.

The current Commercial medical TPA service provider is Anthem, Anthem also administers the current MAPD plan.

Every two years, the State collectively bargains employee health benefits, including plan design, health promotion programs and employee-facing initiatives, with the State's unions. There are several unions represented, including the New Hampshire State Employees' Association of New Hampshire, SEIU 1984 (SEA), the New Hampshire Trooper's Association (NHTA), NHTA - Command Staff, Teamsters Local 633 and the New England Police Benevolent Association (NEPBA) with multiple Locals. Currently, all unions have agreed to the same plan designs and programs.

B. Objective The State has two main objectives for the RFP:

1. The State is seeking proposals to provide prescription drug administration services for its self-funded Employee and Retiree Health Benefit Plan (HBP), based on the current plan designs, services and programs described in Section 3 of this document

2. The State seeks to partner with its pharmacy benefits manager (PBM) to provide high quality, cost-effective and transparent prescription drug benefits to its participants and dependents. The partnership shall involve collaboration between the State and its PBM (and TPA) in all aspects of purchasing, pharmacy contracting and activating all members of the State's plan in support of its total population health goals.

3. Bidders are encouraged to identify and suggest / offer features or enhancements that provide additional value

As mentioned above, all unions have independently agreed to the same plan design and programs. The State requires Bidders to duplicate the current plan design for the active plans. (See Appendix A for the current active plan design.) The current Collective Bargaining Agreements (CBA) are effective through June 30, 2027;

however, each CBA has an evergreen provision. Pharmacy benefit changes are typically implemented on a calendar year basis

The State's contract with its pharmacy benefits manager requires the PBM to implement any changes in plan design or coverage resulting from collective bargaining throughout the term of the contract. In addition, the PBM shall provide financial modeling to assist the State with consideration of plan changes. It is possible for the State to be required to manage multiple plan designs to comply with each of the collectively bargained units. The State reserves the right within any contract awarded under this RFP to re-negotiate elements of the contract as required under collective bargaining agreements.

The State's also requires Bidders to duplicate the current non-Medicare retiree's health benefits plans to current legislative authorization. (see Appendix A for the current non-Medicare retiree plan design).

Additionally, the State's contract with a PBM requires the PBM to implement any changes in plan design or coverage resulting from legislative authorization throughout the term of the contract. In addition, the PBM shall assist the State with considerations of plan changes. The State reserves the right within any contract awarded under this RFP to re-negotiate elements of the contract as required by legislative changes.

It is essential that the Bidder “duplicate” plan design and provide similarity in services and access to pharmacy network for plan members. See section 3 and Appendix A for plan design, services and Appendix C for clinical programs and excluded drugs.

C. Contract Term and Specifics The contract shall commence upon approval of the Governor and Executive Council (the “effective date”), through December 31, 2029, with the option for up to three one-year extensions, exercised individually or combined, as mutually agreed by the parties and approved by the Governor and Executive Council (G&C).

The implementation period shall commence within seven days of Governor and Executive Council approval but in no event earlier than August 1, 2026. The administrative services outlined in this RFP shall commence on January 1, 2027. Payments for contractual services shall commence January 1, 2027, and shall not be made during the implementation period.

2 BIDDING INSTRUCTIONS AND CONDITIONS

2.1 PROPOSAL CONDITIONS

2.1.1 Mandatory Instructions for Bidders

Interested bidders must read the entire RFP, complete all sections of the RFP and submit the required documents in the manner specified in the RFP by the stated proposal submission deadline. Electronic responses must be completed and submitted through ProposalTech. Bidders are responsible for reviewing the most updated information related to this RFP before submitting proposals.

Each bidder is required to provide an electronic copy of the State of New Hampshire's Transmittal Letter (see Appendix E), signed by a person authorized to bind the company to all commitments made in the RFP response.

The legal entity that would be entering into a resulting contract with the State must be the same legal entity submitting a proposal and signing the Transmittal Letter (e.g., no trade names).

Failure to follow these instructions may be grounds for rejection of your RFP response.

2.1.2. Bidders Request for Plan Data

Appendix I is a Participating Bidder Agreement (PBA) which must be filled out and sent to Nathan Mathews through the messaging feature in Proposal Tech to obtain data referred to in Appendix D. Upon receipt of a Bidder's signed PBA (Appendix I), Segal will review its files for a current Global or Bid-Related Non-Disclosure Agreement (NDA) on file with Segal. If there is no NDA on file with Segal, an NDA document will be issued to the Bidder for signature. Verbiage is non-negotiable.

No data will be issued without first having a signed NDA on file.

Upon receipt of the newly signed NDA, or confirmation of an existing NDA on file, Segal will establish a secure workspace and upload the data files. A system-generated email with instructions for accessing the workspace will be sent to Bidder's designated data recipient.

2.1.3. RFP Inquiries

Detailed instructions for the completion and submission of your proposal will be found in the electronic RFP (eRFP) on ProposalTech. ProposalTech will be available to assist you with technical aspects of utilizing the system. Any questions regarding how to use ProposalTech should be directed to Proposal Tech Support at 877- 211-8316 x84.

All other questions regarding this RFP, including questions related to the form contract P-37, must be submitted to Ryan Fuller, the State's point of contact, at Christopher.R.Fuller@das.nh.gov. All questions must be submitted in writing prior to the deadline for Bidder Inquiries and/or Requests for Clarification (April 2, 2026, at 3:00 ET). The questions will be consolidated and/or paraphrased and responded to via a written addendum, or addenda that will be posted on the State's website on or before April 8, 2026. Note that this date is subject to change at the State's discretion. In addition, the bidder inquiry addenda will be visible in ProposalTech.

In response to requested exceptions to the P-37, the State will review requested exceptions and accept, reject or note that it is open to discussion of the proposed exception at its sole discretion. Questions about or requested exceptions to the RFP, P-37, and/or any relevant attachments not raised during the inquiry period are waived. Oral statements, representations, clarifications, or modifications concerning the RFP shall not be binding upon the State.

The State may, at its discretion, amend this RFP on its own initiative or in response to issues raised by inquiries as it deems appropriate. Bidders are responsible for reviewing the most updated information related to this RFP as outlined in the Addenda section below, including State responses to Bidder inquiries, before submitting a proposal.

RFP inquiries must be submitted by an individual authorized to commit the organization to provide the services necessary to meet the requirements of this RFP. Inquiries should be submitted as questions, not as redlines to the RFP or any attachments. The Bidder must include complete contact information including the Bidder's name, telephone number, and e-mail address.

2.1.4. Addenda

In the event it becomes necessary to add to or revise any part of this RFP prior to the scheduled proposal submittal deadline, the Division of Risk and Benefits shall post any Addenda on ProposalTech and the State's Bidder website. In the event of an addendum/addenda to this RFP, the State, at its sole discretion, may extend the proposal submission deadline. Before submission and periodically prior to the RFP closing, check the ProposalTech platform and the State website for any addenda or other materials that may have been issued affecting the RFP. The website address is https://www.das.nh.gov/purchasing/vendorresources.aspx.

2.1.5. Bidder Certifications

All Bidders must be duly registered as a Bidder authorized to conduct business in the State of New Hampshire.

Bidders shall comply with the certifications below at the time of submission and through the term of any resulting contract. Failure to comply shall be grounds for disqualification of proposal and/or the termination of any resultant contract.

o STATE OF NEW HAMPSHIRE VENDOR APPLICATION: Prior to bid award, Bidders must have a completed Bidder Application Package on file with the NH Bureau of Purchase and Property.

See the following website for information on obtaining and filing the required forms (no fee):

https://DAS.NH.Gov/Purchasing o NEW HAMPSHIRE SECRETARY OF STATE REGISTRATION: A bid award, in the form of a contract(s), will ONLY be awarded to a Bidder who is registered to do business AND is in good standing with the State of New Hampshire. The Certificate of Good Standing submitted during the contract approval process must be dated on or after April 1 of the contracting year. Please visit the following website to find out more about the requirements for registration with the NH Secretary of State: https://sos.nh.gov/corporation-division/

2.1.6. PUBLIC DISCLOSURE

The identification of confidential responses has been turned on for this RFP. If you feel that a response to a question contains proprietary/confidential information, click the “Disclosure” tab located underneath the question and check the box for “Exemption from Disclosure.” Provide a reason for the exemption in the text field provided. If you do not provide a reason for exemption, the question will not be considered answered. DO NOT make every response confidential. If you have any questions regarding this process, please contact ProposalTech Support at 877-211-8316 x84. See also the additional Public Disclosure information below.

A. DISCLOSURE OF INFORMATION SUBMITTED IN RESPONSE TO RFP

Information submitted in response to this RFP (including all materials submitted in connection with it, such as attachments, exhibits, addenda, etc.), any resulting contract, and information provided during the contractual relationship may be subject to public disclosure under the Right-to-Know, RSA 91-A.

Confidential, commercial or financial information may be exempt from public disclosure under RSA 91-A:5, IV.

If you believe any information submitted in response to this RFP should be kept confidential, you must https://www.das.nh.gov/purchasing/vendorresources.aspx https://das.nh.gov/Purchasing https://sos.nh.gov/corporation-division/ specifically identify such information for the State by following the redaction designation instructions in ProposalTech. Marking or designating an entire proposal, attachment or section as confidential shall neither be accepted nor honored by the State.

A Bidder that does not believe any information in its proposal to be exempt from disclosure must also provide a letter indicating as such to the Point of Contact indicated herein.

Submissions which do not conform to these instructions by failing to include redactions and related reasons for redaction, or a letter indicating the proposal does not include any confidential information, or by including redactions which are contrary to these instructions or operative law may be rejected by the State as not conforming to the requirements of the proposal.

Pricing, which includes but is not limited to administrative costs and performance guarantees, in your proposal or any subsequently awarded contract shall be subject to public disclosure regardless of whether it is marked as confidential.

Notwithstanding a Bidder's designations, the State is obligated by the Right-to-Know law to conduct an independent analysis of the confidentiality of the information submitted in a proposal. If a request is made to the State by any person or entity to view or receive copies of any portion of your proposal, or if the State otherwise wishes to make your proposal public, the State shall first assess what information it is obligated to release. If you have not provided redactions in your proposal the State will release the proposal in its entirety with only the redactions the State deems necessary (if any). If you have provided redactions to your proposal, the State will notify you that a request has been made or that the State wishes to make your proposal public.

The State will indicate what, if any, information it has assessed is confidential and will not be released, and specify the planned release date of the remaining portions of the proposal. To halt the release of information by the State, a Bidder must obtain and provide to the State, prior to the date specified in the notice, a court order valid and enforceable in the State of New Hampshire, at its sole expense, enjoining the release of the requested information.

By submitting a proposal, you acknowledge and agree that:

o The State may disclose any and all portions of the proposal or related materials which are not marked as confidential and/or which have not been specifically explained in the letter to the person identified as the point of contact for this RFP;

o The State is not obligated to comply with your designations regarding confidentiality and must conduct an independent analysis to assess the confidentiality of the information submitted in your proposal; and o The State may, unless otherwise prohibited by court order, release the information on the date specified in the notice described above without any liability to you.

B. ELECTRONIC POSTING OF RFP RESULTS AND RESULTING CONTRACT

Pursuant to RSA 21-G:37, all responses to this RFP shall be considered confidential until the award of a contract. At the time of receipt of proposals, the State will post the number of responses received with no further information. No later than five (5) business days prior to submission of a contract to the Department of Administrative Services, the State will post the name and rank or score of each Bidder.

Pursuant to RSA 91-A and RSA 9-F:1, the Secretary of State will post to the public any document submitted to G&C for approval, including any resulting contract, on its website (https://sos.nh.gov/administration/miscellaneous/governor-executive-council/). By submitting a proposal, Bidder acknowledges and agrees that, in accordance with the above-mentioned statutes and policies, (and regardless of whether any specific request is made to view any document relating to this RFP), any contract resulting from this RFP that is submitted to G&C for approval will be made accessible to the public online.

2.1.7. TERMS OF SUBMISSION

The State assumes no responsibility for understandings or representations made by its officers or employees prior to and in the event of the execution of a contract, unless such understandings or representations are specifically incorporated into this RFP. Verbal discussions pertaining to modifications or clarifications of this RFP shall not be considered part of this RFP unless confirmed in writing. Any information provided by the Bidder verbally shall not be considered part of that Bidder's response. By submitting a proposal, a Bidder agrees that in no event shall the State be either responsible for or held liable for any costs incurred by a Bidder in the preparation of or in connection with the proposal, or for work performed prior to the effective date of a resulting contract. Proposals must be valid until the effective date of any resulting contract.

2.1.8. SUBMISSION FORMAT

Instructions, formats, and approaches for the development of RFP information contained within the RFP are designed to ensure that the submission of data essential to the understanding of the Bidder's response is received in a consistent and comparable format.

Bidder RFP response must be submitted using the ProposalTech platform. Paper submissions, or submissions in any other format, will not be accepted.

Detailed instructions for the completion and submission of your proposal will be found in the electronic RFP (eRFP) on ProposalTech. ProposalTech will be available to assist you with technical aspects of utilizing the system.

All sections must be answered completely and as outlined in the RFP, using ProposalTech. It is not acceptable to use the term “See Attached” as a response to any of the questions, fee quotation forms, plan or network comparisons. Such a response may jeopardize your chances for consideration.

The State reserves the right to ask Bidders follow‐up clarifying questions through ProposalTech as may be necessary to fully evaluate bidder capabilities.

2.1.9. PROPOSAL SUBMISSION DEADLINE

All RFP submissions must be submitted electronically, using the ProposalTech platform no later than 2:00 PM ET on Wednesday, April 22, 2026. A complete RFP submission will include responses to all sections of the RFP, including a complete response to the financial section. Incomplete submissions or submissions received after the date and time specified will be marked as late and will not be considered.

A Bidder's disclosure or distribution of proposals other than to the Department of Administrative Services, Bureau of Purchase and Property, or ProposalTech shall be grounds for disqualification. No more than one (1) proposal per respondent shall be submitted.

Include one complete proposal with pricing as a separate document.

2.1.10. RFP DELIVERY

This RFP is being conducted electronically using the ProposalTech platform. A Bidder will not be able to submit their proposal until all required sections have been completed in their entirety. ProposalTech provides Bidders with a status of their proposal listed at the top of the page. Once a Bidder submits their proposal, the submission will be confirmed by the status changing to “Posted”. Bidders must submit (or “post”) their proposal by the specified deadlines indicated in Section 2.1.9.

The State shall not be held liable for any costs incurred by the Bidder in preparing or submitting an RFP response.

2.1.11. ADDITIONAL INFORMATION

The State reserves the right to:

o Make a written request for additional information from a Bidder to assist in understanding or clarifying a proposal response o Waive minor or immaterial deviations from the RFP requirements, if determined to be in the best interest of the State o Omit any planned evaluation if, in the State's view, the step is not needed o Reject all proposals, or any part thereof. Note that participating in this RFP process in no way obligates the State to pursue a contract with any of the Bidders participating in the RFP o Make independent investigation in evaluating a proposal.

o Consider available information regarding the Bidder, whether gained from the Bidder's proposal, question and answer conferences, references, or any other source during the evaluation process. This may include, but is not limited to, information from the New Hampshire Department of Insurance, as well as any other state or federal regulatory entity

2.1.12. RESTRICTION OF CONTACT WITH STATE EMPLOYEES

From the release date of this RFP, all contact with the State regarding this RFP, except the point of contact specifically mentioned in Section 2.1.3 of this RFP, is prohibited. This prohibited contact includes personnel employed by or under contract with the State. Improper contact is grounds for rejection of your response.

2.1.13. CANCELLATION

Notwithstanding any other provision of this RFP, this RFP does not commit the State to award a contract. The State reserves the right, at its sole discretion, to reject any and all proposals, or any portions thereof; to cancel all or any part of this RFP at any time. Cancellation of this RFP, in whole or in part, shall not bar the State from issuing an RFP for the same services or from purchasing the same services through other means.

2.1.14. ETHICAL REQUIREMENTS

From the time this RFP is published until a contract is awarded, no Bidder shall offer or give, directly or indirectly, any gift, expense reimbursement, or honorarium, as defined by RSA 15-B, to any elected official, public official, public employee, constitutional official, or family member of any such official or employee who will or has selected, evaluated, or awarded an RFP, or similar submission. Any Bidder that violates RSA 21-G:38 shall be subject to prosecution for an offense under RSA 640:2. Any Bidder who has been convicted of an offense based on conduct in violation of this section, which has not been annulled, or who is subject to a pending criminal charge for such an offense, shall be disqualified from bidding on the RFP, or similar request for submission and every such Bidder shall be disqualified from bidding on any RFP or similar request for submission issued by any state agency.

2.1.15. SUBCONTRACTING

Contractor may perform certain services hereunder through one or more of its subsidiaries or affiliates.

However, pursuant to Section 12 of the form contract P-37, subcontracting of services shall require prior approval by the State. If Bidder plans to utilize subcontractors, subsidiaries, or affiliates, for any portion of the services identified in this RFP, please include the subcontractor information, to include an outline of the services or functions in which Bidder would plan to subcontract, the length of your relationship with the subcontractor, and a brief company profile. A list of these subcontractors shall be attached to the contract with the selected Contractor and shall constitute prior approval by the State (of those subcontractors) consistent with Section 12 of the form contract P-37.

Contractor must also notify the State of any service provider or system change that differs from what is outlined in the RFP response, whether the new provider is, or the new system is run by, a subcontractor, subsidiary, affiliate, the Contractor itself, or another entity. Such notification shall be required during implementation and throughout the term of the Agreement.

Contractor may, without prior written approval, contract with third-party vendors to provide ancillary services, which are not medical benefit administration services hereunder, but rather are services that support Contractor's conduct of its business operations.

Contractor shall be accountable for the performance of all subsidiaries, affiliates, partner networks and subcontractors and shall be responsible for all performance guarantee penalties that may result from underperformance of the subsidiary, affiliate and/or subcontractor.

2.1.16. REQUIRED CONTRACT TERMS AND CONDITIONS

a. The form contract P-37 (attached hereto as Appendix F) shall form the basis for any resulting contract. The successful Bidder and the State, following notification of award, shall promptly execute the P-37 contract, to include Exhibits A, B, and C referenced below. In no event is a Bidder to submit its own standard contract terms and conditions as a replacement for one or all of the State's terms in response to this RFP.

In addition to the insurance requirements outlined in the P-37, Contractor will be required to obtain and maintain in force data security and cyber-liability insurance in an amount not less than $10 million as referenced in Appendix H, Required Protection of Confidential Information and Data Security.

The terms of this RFP and the selected Bidder's response will be used to form the terms of any resulting contract. References in the P-37 to Exhibits A, B, and C are references to the required structure of any resulting contract (Exhibit A - Special Provisions/Amendments to the P-37, Exhibit B - Scope of Services, and Exhibit C - Payment Terms) and are not references to sections of this RFP.

b. The Business Associate Agreement (attached hereto as Appendix G), is required to comply with the Health Insurance Portability and Accountability Act, Public Law 104-191 and with the Standards for Privacy and Security of Individually Identifiable Health Information, 45 CFR Parts 160 and 164 and those parts of the HITECH Act applicable to business associates, shall be promptly executed by the successful Bidder and the State, following notification of contract award.

c. In addition to the Business Associate Agreement, the Bidder will be required to comply with the Required Protection of Confidential Information and Data Security (attached hereto as Appendix H).

d. State data will not be sold or aggregated for external reporting purposes without first consulting the State.

e. The State intends to incorporate this RFP and the selected Bidder's response into the resulting contract by reference. In the event there is a conflict between the resulting contract and the selected Bidder's response to the RFP the term more favorable to the State shall control.

2.1.17. DEBARMENT

Vendors who are ineligible to bid on request for proposals, bids or quotes issued by the Department of Administrative Services, Division of Procurement and Support Services pursuant to the provisions of RSA 21- I:11-c shall not be considered eligible for an award under this RFP.

2.1.18. NON-COLLUSION

The Bidder's signature on a proposal submitted in response to this RFP guarantees that the prices, terms and conditions, and work quoted have been established without collusion with other vendors and without effort to preclude the State from obtaining the best possible competitive Proposal.

2.1.19. PROPERTY OF THE STATE

All material received in response to this RFP shall become the property of the State and will not be returned to the Bidder. Upon contract award, the State reserves the right to use any information presented in any proposal.

2.1.20. CHALLENGES TO IDENTIFICATION OF SELECTED VENDOR

Within five (5) business days of the State's posting of the rank or score on its website, Bidders may, in accordance with RSA 21-G:37, request that the agency review its selection process. The request must be in writing and must specify all points on which the Bidder believes the agency erred in its process and shall contain such argument in support of its position as the Bidder seeks to present. In its request for review, a Bidder shall not submit, and the State will not accept nor consider, any substantive information that was not included in the original proposal. The State will respond to the request within five (5) business days of its receipt.

2.1.21. NON-COMMITMENT

Notwithstanding any other provision of this RFP, this RFP does not commit the State to award a Contract. The State reserves the right, at its sole discretion, to reject any and all Proposals, or any portions thereof, at any time; to cancel this RFP; and to solicit new Proposals under a new acquisition process.

2.2 ESTIMATED RFP TIMETABLE

2.2.1

Action Due Date (Eastern Time)

RFP Released March 20, 2026

Deadline for Bidder Inquiries and/or Requests for Clarification

April 2, 2026 at 3:00 PM ET

Response to Bidder Inquiries and/or Requests for Clarification

No later than April 8, 2026

Proposal Submission Deadline April 22, 2026 at 2:00 PM ET

Contract Effective Date Upon Governor & Executive Council (G&C) approval (no earlier than August 1, 2026)

Contract Implementation Period G&C Approval through December 31, 2026

PBM Services Effective Date January 1, 2027

2.3 EVALUATION PROCESS

2.3.1 Segal has been retained by the State to assist in the evaluation of each Bidder's responses for completeness and responsiveness to the RFP and to assist in the review of such responses. The State's designated evaluation team will review and score Bidder responses and select the highest ranking proposal. All proposals will be evaluated in accordance with the State procedures set forth in Steps #1 through #4 below.

The State will conduct an initial screening to verify Bidder compliance with the proposal submission requirements set forth herein. The State may waive or offer a limited opportunity to cure immaterial deviations from the RFP requirements if it is determined to be in the best interest of the State.

2.4 STEP #1: MINIMUM QUALIFICATIONS

Each proposal shall be evaluated initially to determine compliance with the State of New Hampshire’s Minimum Qualifications. Any proposal that fails to meet one (1) or more of the following five (5) qualifications shall be eliminated from further consideration for this contract. Any proposal that meets all the minimum qualifications shall be further evaluated in accordance with the State’s selection criteria. Therefore, to receive further consideration, a proposal must check “YES” to each of the following questions and, if applicable, comply fully with the “Submission Requirement(s)” for each such qualification

2.4.1 Is Bidder currently licensed to provide PBM services for large group health benefit plans in New Hampshire? Submission Requirements: Attach proof of licensure and good standing. The license shall remain current throughout the term of any resulting contract.

Single, Radio group.

1: Yes, 2: No

2.4.2 Is Bidder currently licensed to offer employer-sponsored, PBM services in all 50 states and U.S. territories where the State's members currently reside? Submission Requirements: Attach proof of licensure and good standing. The license shall remain current throughout the term of any resulting contract.

Single, Radio group.

1: Yes, 2: No

2.4.3 Is Bidder currently providing PBM services to at least three public sector group health plans with a minimum of 25,000 lives? Submission Requirements: Demonstrate such experience by providing the total number of PBM Services, with at least 25,000 lives.

Single, Radio group.

1: Yes, 2: No

2.4.4 Does Bidder have a minimum of five (5) years of providing PBM services? Submission Requirements:

Demonstrate such experience by providing detail on how long your organization has been providing these services to group health plans.

Single, Radio group.

1: Yes, 2: No

2.4.5 Is Bidder able and willing to demonstrate its financial stability?

Submission Requirements:

a) Bidder's most recent financial report;

b) most recent independent auditor's report; and

c) SSAE 16, SAS-70, or equivalent external audit of Bidder's operations. Attach to proposal.

Single, Radio group.

1: Yes, 2: No

2.4.6 Is Bidder able to administer the current plan designs for the Active and non-Medicare retiree health plans for January 1, 2027, effective date as outlined in Section 3.1.A?

Submission Requirements: Completion of Plan Deviation Form in Appendix B.

Single, Radio group.

1: Yes,

2.5 STEP #2: TECHNICAL QUESTIONNAIRE SCORING (25 TOTAL POINTS)

2.5.1 The Bidder's response to information requested in the Technical Questionnaire portion of the RFP will be evaluated based on the extent to which the Bidder documents conformance with specifications, as well as the completeness and soundness of the Bidder's response, all as evaluated by the State.

All answers, including comments, will be evaluated based on the Bidder's response being beneficial to the State, meeting State expectations, and/or adhering to the State's request. Minor and immaterial deviations may not impact score. Bidders are asked to limit comments as much as possible.

Responses to each question of the Technical Questionnaire will be scored based on the following evaluation scale:

• 0% - No answer or incomplete answer

• 25% - Least beneficial to the State; does not meet State expectations; does not agree with request

• 50% - Partially beneficial to the State; partially meets State expectations; generally, does not agree with request

• 75% - Mostly beneficial to the State; mostly meets State expectations; generally, agrees with request

• 100% - Most beneficial to the State; meets State expectations; agrees with request

2.6 STEP #3: FINANCIAL SCORING (75 TOTAL POINTS)

2.6.1 The financial offers will be scored based on the total projected costs (i.e., claims, administrative and other fees, net of rebates) as determined by the State for the three-year period from January 1, 2027, to December 31, 2029. The lowest cost proposal will receive 100% of the 60 points allocated for the “Total Projected Costs” (TPC) Financial Score. All other financial proposals will be scored on a sliding scale where the Bidder's score will be reduced by 1 point for every percentage point it is higher than the lowest cost proposal.

As the scale is sliding, scores will be adjusted for partial percentage differences.

The following exhibit illustrates how the “Total Projected Costs” (TPC) financial score will be calculated from the 60 points available:

Formula Example, where:

Lowest Bid TPC = $1,000 and Bidder TPC = $1,025

A Cost Difference = (Bidder's TPC / Lowest Bid TPC) - 1 ($1,025 / $1,000) - 1 = 0.025

B Convert Decimal to Percent Value

= A x 100 0.025 x 100 = 2.5

C 1 Point Reduction per Percentage Higher

= 1 x B 1 x 2.5 = 2.5

Bidder's TPC Score = 60 - C 60 - 2.5 = 57.5

The questions in the Financial Contractual Questions, Definitions and Terms sections in the financial section will be worth 13 points and added to 2 available points for Performance Guarantee Amounts at Risk and the 60 points available for Total Projected Costs for a total of 75 points allocated to the Financial Scoring.

2.7 STEP #4: CONTRACT AWARD

2.7.1 The State shall award a contract, if at all, to the Bidder submitting the highest ranked proposal.Formal and final selection of the Bidder, however, is contingent upon the successful negotiation and the proper execution of all contract documents (acceptable to the State) and the approval of the Governor and Executive Council and upon continued appropriation of funding for the contract. If the State is unable to reach agreement with the Bidder, the State may, at its sole discretion and at any time and without liability to the Bidder, immediately terminate such contract discussions with the Bidder and undertake discussion with the Bidder submitting the next highest ranked proposal, and so on.

Evaluation of the proposals shall include the criteria below. Bidders will receive scores up to the maximum points allocated to each item outlined below.

The proposals should be submitted with the most favorable terms the Bidder can offer. There will be no process (Best and Final Offer (BAFO) / Reverse Auction) where bidders will have an opportunity to offer improved terms.

Criteria Points Section(s)

TECHNICAL QUESTIONNAIRE 25

General / Implementation / Federal No Surprises Act and Final Transparency Rule Support

5 4.1, 4.2, 4.11

Formulary Management / Retail Network Management / Formulary and Pharmacy Network Disruption

5 4.3, 4.4, 4.5

Clinical Programs / Member Services and Account Management

5 4.6, 4.9

Audit Rights / Ongoing Monitoring 5 4.7, 4.8

Performance Guarantees 5 4.10

FINANCIAL PROPOSAL* 75

Total Projected Costs (TPC) 60 5.1

Financial Questions, Definitions and Terms

13 5.2, 5.3, 5.4

Performance Guarantees Amount at Risk 2 5.5

TOTAL POINTS 100

* All fees to be assumed by the State for all the requested services shall be included in the financial offer section of this RFP. Total Projected Costs will also be influenced by the Bidder responses to the requested contractual terms and definitions.

2.8 CLIENT REFERENCES

2.8.1 Bidder must provide the name of its five (5) largest public sector (states, municipalities, etc.) clients for which comparable services as requested in this RFP are provided.

For these five clients, provide:

• Key contact's name, including phone number and email address

• Address

• Number of active members (i.e., employees and dependents)

• Number of non-Medicare retiree members

• A summary of the services provided by the Vendor to the client

The State may check references at its discretion. Scoring shall not be applied to Client References; however, the State may use references to refine and finalize scores.

Additionally, the State also reserves the right to use itself as a reference and consider its own experiences with the Vendor during the selection process.

Reference #1

Reference #2

Reference #3

Reference #4

Reference #5

Name 5 words. 5 words. 5 words. 5 words. 5 words.

Email 5 words. 5 words. 5 words. 5 words. 5 words.

Phone 5 words. 5 words. 5 words. 5 words. 5 words.

Address 20 words. 20 words. 20 words. 20 words. 20 words.

Number of active members (i.e., employees and dependents)

Integer. Integer. Integer. Integer. Integer.

Number of non-Medicare retiree members (i.e., retirees and dependents)

Integer. Integer. Integer. Integer. Integer.

A summary of the services provided by the Bidder to the client

200 words. 200 words. 200 words. 200 words. 200 words.

2.9 BIDDER CONTACTS

2.9.1 Designate the individual(s) responsible for representing your company during the RFP process and day-to-day service if awarded the contract.

RFP Process Day-to-Day Service Representative Name 5 words. 5 words.

Phone 5 words. 5 words.

Email 5 words. 5 words.

2.9.2 Non-Exclusive Contract

Any resulting Contract from this RFP will be a Non-Exclusive Contract. The State reserves the right, at its discretion, to retain other contractors to provide any of the Services or Deliverables identified under this procurement or make an award by item, part or portion of an item, group of items, or total Proposal.

3 REQUIRED PLAN DESIGNS, SERVICES AND PROGRAMS

3.1 A. Plan Design

Due to existence of collective bargaining agreements and required legislative authorization, the State requires Bidders to duplicate the active and non-Medicare retiree plan designs.

Please review the Current Plan Designs (see links below Attachment A - Requested Plan Designs and Appendix C - Current Clinical Programs and Drug Exclusions) and complete the “Plan Deviations Form,” located in Appendix B. If no deviations are provided on this form, it will be assumed that your organization can administer the current plan designs exactly as written.

Active Plan https://www.das.nh.gov/riskmanagement/active/medical-benefits/pharmacy.aspx

Non-Medicare Retiree Plan https://www.das.nh.gov/riskmanagement/retiree/plan-non-medicare.aspx

Current Clinical Programs and Drug Exclusions https://www.das.nh.gov/riskmanagement/active/medical-benefits/pharmacy.aspx https://www.das.nh.gov/riskmanagement/retiree/plan-non-medicare.aspx

Current Clinical Programs and Drug Exclusions

Attachment C -Current Clinical Programs and Drug Exclusions

B. Services and Programs

Bidders are required to offer comprehensive PBM services with a full range of customer (account and member) services including, but not limited to:

Indicate the name and address of the legal entity providing any of the services below, if different than the bidding entity.

1. General Services

• Claims adjudication

• Member enrollment and eligibility maintenance

• Integration of PBM services with the State's other bidders/programs, (e.g., medical, wellness)

• Patient and provider education

• Systematic prospective, concurrent and retroactive drug utilization review

• Network pharmacy contracting and management

• Mail order and specialty pharmacy services

• Clinical and cost management programs

• Formulary management and rebate administration, reporting and payment

• Data sharing* and reporting (standard and ad hoc reporting)

• Distribution of ID Cards

• Access to pharmacy directories

• Member and Account services including help desk/call center (including website, portal and mobile app)

• Online systems for the State, and its designee(s)

* Note: For the purpose of this analysis, “Data Sharing” is referenced in relation to requests for data and reports from either party (the State or the selected medical Bidder). This also refers to data sharing between the PBM, medical administrator health benefits plan consultant, and the State's other vendors, including a data warehousing vendor and may over the course of the contract.

2. Service Requirements The requirements set forth below shall be minimum service requirements to be provided by the successful Bidder:

• Administration of run-out claims for 12 months following termination of the contract. The cost of run-out administration must be included in Bidder proposed administration fees

• Acceptance of payment of claims and administrative expense invoices via Electronic Funds Transfer

• Report on a minimum of 9 group breakouts and a lesser number of COBRA breakouts, which may be adjusted during the term of the contract

• Interface with the State's eligibility systems. The State utilizes the Global Human Resources and Human

Resources Management modules of the Infor/Lawson ERP (enterprise resource planning) software for human resources, benefits and payroll functions to manage the State Plan's eligibility

• Ability to give credit for charges applied to out-of-pocket maximums that accumulated with a prior carrier

• Provide quarterly reports detailing plan performance and address account and member service issues, federal and state PBM and pharmacy legislation and legislative trends and development in the market.

At the State's discretion, attendance at a mid-year and annual plan performance review for each plan year in person. Additionally, attendance at an annual performance or "stewardship" meeting within 90 days after contract year-end at which time the Contractor will, as directed by the State, summarize activities and performance for the year ended.

• Provide monthly rebate estimates for Fund 60 financial reporting purposes.

• Provide a dedicated Account Executive and Clinical Account Executive. Both shall be accountable to the

State for proactive management of all aspects of the Bidder's performance to the State and its members. The Account Executive and Clinical Account Executive shall remain constant, within the Contractor's control, for at least the first 18 months of the contact period. The Bidder shall not change assignment of the Account Executive and Clinical Account Executive without written notice provided to the State with a minimum of fourteen (14) days prior to such change. The State reserves the right to request assignment of a new Account Executive and/or Clinical Account Executive, and the Bidder shall make such change within 30 days of receipt of written notice from the State.

• Attendance at annual open enrollment meetings as needed. Currently, the State requests that the PBM attend only one annual enrollment meeting. The Bidder shall attend other meetings as required by the State

• Production and distribution of ID cards and/or temporary proof of benefit letters in "real-time" as well as provide access to digital ID cards.

• Bidders shall provide designated customer service representatives that are knowledgeable of the State's plan via a toll-free phone number to be answered by a live person in the United States from, at a minimum, weekday hours from 8AM to 8PM ET Monday to Thursday and 8AM to 5PM ET on Fridays, year round and shall provide customer service on all dates that are recognized as work days for state employees. In addition, the State's members can email the Customer Service team at any time.

• Automated services, which are available 24/7

• Provide members with access to EOB statements at no cost to the State

• Ability to have an independent audit performed of the claim's operation at no cost to the State

• Guaranteed adherence to New Hampshire RSA 420-J:8-a regarding prompt pay. The law mandates timeframes for all claims [15 days electronic, 30 days paper claims, overdue (interest payment required if timeframes are not met), denied and pended (inform providers within 15 days (electronic claims) or 30 days (paper claims) and adjudicate with 45 days of receipt of additional]

• Vendor shall be responsible to collaborate with the State in the drafting, maintenance and updating all plan documents as required by the plan and applicable regulations, ensuring accuracy, compliance, and timely delivery of revisions.

• Provide dedicated Commercial plan staff in the following specialties:

1. Implementation Manager (dedicated)

2. Account Executive (dedicated)

3. Pharmacist Account Executive (dedicated)

4. Account Manager (designated)

5. Financial Analyst (designated)

6. Customer Service Manager (designated)

• The State shall own their claims detail and receive a detailed claims file (NCPDP, D.0 file format including all transactions, a unique pharmacy identifier, NDC11, ingredient cost, dispensing fee, and member cost-share).

o No post-termination fees, including data transfer fees o Upon termination of this Contract for any reason, the contracted PBM will provide all State data files (Open Refill, Prior Authorization, Accumulator, etc.) free of charge o Any adjustment or modification to any of the fees, network rates, Specialty prices, rebate values, or guarantees must be communicated to and approved in writing by the State prior to the implementation of any formulary or utilization management modifications, whether initiated by the State or the Contracted PBM o The State reserves the right to review, approve, edit, or customize any communication from the PBM to its membership

C. Ongoing Monitoring The State is currently contracted with a 3rd party vendor to perform ongoing monitoring of PBM claims adjudication. This includes performing ongoing and ad hoc verification, analysis and reporting of all financial terms at a claims detail level. Ongoing monitoring is not an audit but a proactive review of all claims to ensure the contract is being appropriately upheld and executed by the Bidder.