RFP HR-24-380.pdf

Workers’ Compensation Pharmacy Benefit Network | RFP - HR-24-380 | Template v11.30.23 | 1

City of

Long Beach Request for Proposals RFP - HR-24-380

Workers’ Compensation Pharmacy Benefit

Network

Workers’ Compensation Pharmacy Benefit Network | RFP -

HR-24-380 | Template v11.30.23 | 1

Overview

Summary

The City of Long Beach (City) Department of Human

Resources’ Workers’ Compensation Division is soliciting proposals from qualified contractors to provide Workers’ Compensation Pharmacy Benefit

Network Services.

Key Dates

Release Date: August 26, 2026

Questions Due to the City: 11:00 AM (PST), September 9, 2026

Proposals Due: 11:00 AM (PST), October 7, 2026

The City reserves the right to modify these dates at any time, with appropriate notice to prospective Contractors.

Proposal Information

Instructions for what to include in your proposal and how to submit it are detailed in Section 4.

Proposals must be submitted electronically via

LongBeachBuys.com.

This is a competitive process, and the City intends to award the opportunity based on the information submitted in the proposal that best meets the needs of the City.

Official Contact

William Reyes rfppurchasing@longbeach.gov

All communication with the City related to this RFP must be directed to the contact listed above.

mailto:rfppurchasing@longbeach.gov

HR-24-380 | Template v11.30.23 | 2

Assistance & Resources For assistance using Long Beach Buys, please contact us directly

Customer Service Form rfppurchasing@longbeach.gov

(562) 570-6200

Additional support available for small businesses in Long Beach

BizCare

BizCare staff connect business owners and nonprofit leaders to important resources and information, such as grants, loans, technical assistance, information on City policies, and more.

562-570-4BIZ (4249)

4Biz@longbeach.gov

Request Assistance Form file:///C:/Users/casinoh/Downloads/longbeachbuys.com https://forms.office.com/Pages/ResponsePage.aspx?id=wxE_MWhCak-NO8fmUBg-eJhZqE0zY4JHucmtLMnWlxRUMzlJTVpROTNONUpZQ0tPMzVIQU5WQkk2Uy4u mailto:rfppurchasing@longbeach.gov https://longbeach.gov/economicdevelopment/business-development/bizcare-program/bizcare-request/ mailto:4Biz@longbeach.gov https://longbeach.gov/economicdevelopment/business-development/bizcare-program/bizcare-request/

HR-24-380 | Template v11.30.23 | 3

Contents

Assistance & Resources

1 The Opportunity

1.1 Project Summary

1.2 Background

1.3 Goals

1.4 Award Terms

2 Scope of Work

2.1 Description of Services

2.2 Performance Metrics & Contract Management

2.2.1 Performance Metrics

2.2.2 Contract Management

2.2.3 Contract Payment

3 How We Choose

3.1 Minimum Qualifications

3.2 Evaluation Criteria

3.3 Local Preference

4 Proposal Instructions & Content

4.1 Timelines & Instructions

4.2 Proposal Content

4.3 Narrative Proposal Template

5 Terms & Conditions

5.1 Acronyms/Definitions

5.2 Solicitation Terms & Conditions

5.3 Contract Terms & Conditions

5.4 Additional Requirements

5.5 Protest Procedures

v11.30.23 | 4 v11.30.23 | 5

1 The Opportunity

1.1 Project Summary

The City of Long Beach is seeking proposals from qualified contractors for Workers’

Compensation Pharmacy Benefit Network services (PBN). The qualified contractors should demonstrate the ability to incorporate industry best practices in the area of Pharmacy

Benefit Management adopted by the Administrative Director of the Division of Workers

Compensation in the State of California. The services provided will ensure that eligible City employees receive the best medical prescription benefits available at the earliest indicated time while achieving cost containment goals.

1.2 Background

The City self-insures and self-administers the Workers’ Compensation (WC) program. The

City’s structure is unique; the WC functions are currently administered through the joint involvement and cooperation of the City Attorney’s Office, Human Resources, and individual

City departments. Occupational Health Services, housed within the Department of Human

Resources, is responsible for the provision of the initial care to City employees for work related injuries and/or illnesses. The clinic is staffed by full-time City employees that are dedicated to the provision of Occupational Health services and a variety of other functions for the City. In addition to treating industrial injuries, the Occupational Health Clinic provides the following services:

• Pre-placement physicals

• OSHA-required surveillance and periodic physicals

• Disability retirement exams

• Consultation with City Departments regarding medical issues

• Monthly case reviews with Risk Management, WC, and the City Attorney.

• ADA compliance and workplace accommodation assistance.

• Consultation with City legal department and expert witness testimony

• Vaccines (influenza, Hepatitis A, B, C, Rabies,etc.)

1.3 Goals

The goal of this Request for Proposal (RFP) is to secure a qualified Pharmacy Benefit

Management (PBM) contractor with demonstrated expertise in delivering comprehensive pharmacy services and regulatory compliance within a workers’ compensation environment. The selected contractor shall incorporate industry best practices, innovative solutions, and effective cost-containment strategies while ensuring timely access to v11.30.23 | 6 medically necessary medications and all applicable pharmacy benefits for injured employees.

1.4 Award Terms

This contract will be for a period of two years with the option to renew for three additional one-year periods. The total contract term will not exceed five years.

2 Scope of Work

2.1 Description of Services

The City is committed to providing eligible employees with all workers’ compensation benefits to which they are entitled. The City strives to ensure that injured employees receive timely access to the highest quality medical care available, accompanied by all appropriate indemnity benefits necessary to support their recovery and return to work.

At the same time, the City has a fiduciary responsibility to its residents to effectively manage and control workers’ compensation costs. Partnering with an experienced and established

PBM provider is critical to ensuring appropriate oversight of prescription drug utilization, promoting evidence-based treatment, maintaining regulatory compliance, and achieving cost-containment objectives.

The City seeks to partner with a PBM provider that demonstrates expertise in applying industry best practices in pharmacy benefit management within a workers’ compensation environment. The selected contractor shall provide innovative solutions, exceptional customer service, clinical oversight, and comprehensive program management designed to improve outcomes for injured employees while controlling pharmacy-related expenditures.

At a minimum, the selected PBM provider shall demonstrate the ability to provide the following:

• Process and adjudicate prescription drug claims;

• Incorporate the State of California formulary last updated April 30, 2026;

• Offer customized formularies;

• Present an extensive pharmacy network;

• Incorporate an aggressive program to convert brand medications to generic;

• Provide portal access and training to the claims department;

• Extensive pharmacy usage and cost reporting outcome capabilities; and

• Complete State of California reporting requirements for all pharmacy services extended to City of Long Beach injured workers.

v11.30.23 | 7

Contractors should demonstrate a thorough understanding of California workers’ compensation laws and regulations, as well as the unique needs of public-sector employers, when developing and describing their proposed services. Proposals should reflect knowledge of public-sector workforce environments, including civil service requirements, return-to-work considerations, and the statutory presumptions applicable to public safety personnel. Contractors should further demonstrate expertise in managing pharmacy benefits associated with presumptive injury and illness claims common to law enforcement, fire service, and other safety-sensitive classifications.

APPENDICES

Pro-Forma Agreement: Non-Design

2.2 Performance Metrics & Contract Management

2.2.1 Performance Metrics

The table below highlights the targets that will be tracked and reviewed collaboratively with the Awarded Contractor during the contract. This list is an indication of the performance metrics of interest to the City, and is not exhaustive or final. As a part of a response to this

RFP, Proposers may propose additional or alternative performance metrics to be tracked on a regular basis. The final set of performance metrics and frequency of collection will be negotiated by the successful Proposer and the City prior to the finalization of an agreement between parties, and may be adjusted over time as needed.

METRIC DESCRIPTION TARGET DATA SOURCE

1. Timeliness of authorization and provision of medications.

This measures how quickly the

PBM reviews and issues decisions on medication requests, including prior authorizations, formulary exceptions, and other utilization management reviews. The metric typically

The PBM should meet or exceed the following performance standards:

• Urgent/Emergent

Medication

Requests:

Authorization decisions issued within 24 hours of receipt of all required clinical information.

PBM Operational

Performance

Reports showing:

• Number of authorization requests received.

• Date and time request received.

• Date and time decision issued.

v11.30.23 | 8 tracks the elapsed time between receipt of a complete medication request and the communication of an approval, modification, or denial decision.

This is important because delays in medication authorization can result in interruptions to treatment, prolonged recovery, increased disability duration, reduced employee satisfaction, and potentially higher overall claim costs.

• Standard Prior

Authorization

Requests:

Authorization decisions issued within 72 hours of receipt of all required clinical information.

• Communication of Decisions:

Authorization, modification, or denial decisions communicated promptly to the prescribing provider, injured worker, and claims administrator upon determination.

• Escalation

Process:

Documented procedures for expedited review when treatment delays could adversely impact the injured worker's health, recovery, or return-to-work status.

The PBM should also demonstrate compliance with all

• Turnaround time by request type

(urgent vs.

standard).

v11.30.23 | 9 applicable state workers' compensation regulations and utilization review timelines.

2. Brand vs

Generic and

Dispensed as

Written medications

This metric measures the proportion of prescriptions filled as generic versus brand-name drugs and tracks the frequency of

Dispensed-As-

Written (DAW) claims. Generic drugs generally provide equivalent therapeutic outcomes at substantially lower cost. High generic utilization is one of the most important drivers of pharmacy cost savings.

Monitoring DAW prescriptions helps identify opportunities where brand drugs are being used despite the availability of clinically appropriate

Our generic dispensing rate(GDR) of all eligible prescriptions should be over 90%. Our brand dispense rate should be consistent with industry benchmarks.

Medications dispensed as written should be lest that 5% or all eligible claims excluding medically necessary exceptions.

Show documented annual savings from generic conversion initiatives.

Financial reports showing brand-versus-generic spend, utilization, and savings achieved through substitution programs.

v11.30.23 | 10 generic alternatives.

3. First Fill Process The first fill process measures the PBM's ability to manage a member's initial prescription experience. This may include formulary review, prior authorization, specialty pharmacy onboarding, clinical outreach, generic or biosimilar alternatives, and patient education.

The first fill is often the most critical point in the medication journey because it influences treatment initiation, medication adherence, member satisfaction, and overall pharmacy costs.

First Fill Availability:

98% of eligible first-fill prescriptions processed at the point of service without unnecessary delays.

Pharmacy Network

Access: 95% of injured employees have access to a participating pharmacy within 10 miles in urban areas and 30 miles in rural areas.

First Fill Success Rate:

98% of eligible injured workers receive their first-fill medication on their initial pharmacy visit.

Network Participation:

99% of first-fill prescriptions filled through contracted network pharmacies when a network pharmacy is reasonably available.

Customer Support:

Pharmacist and/or help desk support available

24 hours a day, 7 days a week, 365 days a year to resolve first-fill issues.

Issue Resolution:

Urgent first-fill

PBM authorization reports documenting time-received and time-to-fill results.

Service-level agreement (SLA) performance reports provided quarterly or annually.

v11.30.23 | 11 dispensing issues resolved within 30 minutes of notification.

4. State of

California

Pharmacy

Formulary management

This metric measures the

PBM's ability to administer prescription drug benefits in accordance with the applicable

California formulary requirements and plan design. It evaluates whether covered drugs are available as required, formulary changes are managed appropriately, exceptions are handled consistently, and members have reasonable access to clinically appropriate medications.

Formulary management is one of the PBM's primary cost-control and clinical management tools, but it must be balanced against access, We should have 100% compliance with applicable California laws, regulations, and contractual formulary requirements. Provide updates for formulary changes timely to minimize the number of employees that may be affected by non-clinical formulary exclusions.

100% of formulary decisions should be supported by evidence-based review processes.

PBM formulary administration reports.

• Formulary change logs and implementation reports.

• Member disruption analyses following formulary changes.

• Pharmacy claims data showing formulary adherence, exception rates, and non-formulary utilization.

• Quarterly and annual PBM performance reports.

v11.30.23 | 12 continuity of care, and regulatory requirements.

2.2.2 Contract Management

The Department of Human Resources will collaborate with the contractor to track and monitor contract performance through regular reports. This will include assessing the timeliness, appropriateness and provision of all medications as prescribed by the approved physicians on the claim files. Contract management will be conducted based on periodic reports received from the Awarded Contractor. Exceptional customer service and prompt response to all WC staff and parties (examiners, doctors, employees, attorneys, etc.) is imperative.

2.2.3 Contract Payment

The City will compensate the Contractor for services performed in accordance with the terms of the executed contract. The Contractor shall submit invoices after services have been rendered and accepted by the City. Payment will be made within thirty (30) calendar days following the City's receipt and approval of a complete and accurate invoice.

3 How We Choose

3.1 Minimum Qualifications

The following are the minimum qualifications for proposers:

• Qualification to conduct business in the City

• Not having been debarred by Federal, State or local government

• Minimum of 5 years administering pharmacy benefit programs, including at least 3 years providing services for California workers' compensation programs.

• Must be licensed (or otherwise authorized, as applicable during the transition to the new licensing program) by the California Department of Managed Health Care

(DMHC) and remain in good standing throughout the contract.

• Ability to provide a statewide California retail pharmacy network with 24/7 access and mail-order services.

3.2 Evaluation Criteria

Proposals shall be consistently evaluated based upon the following criteria:

v11.30.23 | 13

CRITERIA Weight

1. Organizational Capacity & Experience

• Provide a brief history of the Organization including years in business, size of the organization, and the executive team/owners.

• Demonstrated experience with governmental agencies.

• Organization shall provide a complete summary and description of their PBM services provided. The summary shall include a description of how the proposed PBM will reduce costs and manage utilization of prescriptions for the City. The description shall also outline the PBM’s capability to integrate with all other managed care cost containment products used by the City of Long Beach. Those products are Medical

Bill Review, Utilization Review, Medical Provider Network and Medical

Case Management.

• Organization shall provide a summary of the qualifications, licenses/credentials, areas of expertise and years of experience maintained by professional staff.

• The Organization shall describe the on-going education program it has in place to keep staff up-to-date on industry and legislative changes that affect the delivery of the pharmacy services.

30%

2. Method of Approach

• A description of the process the Organization follows to convert brand prescriptions to generic, specifically addressing Dispense as

Written(DAW) challenges.

• A description of the Organization Pharmacist’s role in the program.

• The process in place to address provider requests for State of

California Pharmacy Formulary non-exempt drugs.

• An explanation of the clinical rules that are applied before and after a prescription is dispensed.

• A description of the Organization’s success with mail order conversion.

• The programs the Organization has in place to educate providers and examiners about State of California Pharmacy Formulary documentation requirements and regulations, particularly in the area of opioid prescribing.

• A description of the First Fill process and the level of success the

Organization has at capturing all newly-injured workers on the the date of injury.

• A description of the programs in place for the management of high-cost legacy claims.

40% v11.30.23 | 14

3. Communications & Reporting

• Organization shall provide a complete description of its technology and outcome reporting to include the following:

-A complete description of Organization’s web portal to include access, security levels and capabilities.

- A description of available outcome reporting and indications for usage to aggressively manage pharmacy utilization and cost.

- An indication whether the City has the ability to access reports directly from the portal and whether report development training is available to management.

– Processing standards for PBM adjudication, payment to pharmacy, and invoicing process and timeframes. Describe the invoice cycle and explain how any disputes are managed.

– A commitment to quarterly stewardship meetings until the PBM program is well established, at which time the City of Long Beach shall agree to a modified calendar for stewardship meetings.

20%

4. Reasonableness of Cost 10%

3.3 Local Preference

• The City shall apply five extra credit percentage points to all local businesses operating a home-based, residential business.

• The City shall apply ten extra credit percentage points to all local businesses operating a non-residential, commercial, brick-and-mortar business.

• Local Business shall mean a business which maintains its principal place of business in a fixed office/place of business with the City of Long Beach, possesses a current

City of Long Beach business license and sellers permit if applicable.

• For a business to be eligible to claim preference, the business MUST request the preference in the Solicitation response (see Attachment C) and provide a copy of its current business license and seller’s permit if applicable.

• The local preference does not apply to solicitations that are funded in full or in part by tidelands funds. The local preference may not apply to solicitations that are funded in full or in part by certain grant, federal or State of California funds.

v11.30.23 | 15

4 Proposal Instructions & Content

4.1 Timelines & Instructions

MILESTONE

TIME

(PACIFIC) &

DATE LOCATION / ADDITIONAL INFORMATION

Release date August 26, Questions due to the

City

11:00 AM

(PST),

September

9, 2026

• Submit all inquiries via email to rfppurchasing@longbeach.gov

Posting of the Q&A September

23, 2026

• Responses to the questions will be posted on

LongBeachBuys.com.

Proposals due 11:00 AM

(PST),

October 7,

• Proposals should be submitted electronically via LongBeachBuys.com.

• Late proposals, or proposals submitted through other channels will not be accepted.

• Proposers are responsible for submitting their proposals completely and on time.

o Proposers will receive an e-bid confirmation number with a time stamp from LongBeachBuys.com indicating that the proposal was submitted successfully.

The City will only receive proposals that were transmitted successfully.

o For technical support, email or call the

City during normal business hours at

LBPurchasing@longbeach.gov or (562)

570-6200.

Evaluation of

Narrative & Cost

Proposals

October -

November

• An Evaluation Committee will review Narrative

& Cost Proposals to select the proposal that best meets the needs of the City.

• Evaluations will be conducted using a methodology derived from the evaluation criteria listed in Section 3.2.

Interviews/ Demos/

Site Visits

TBD • As part of the evaluation process, the City may, conduct interviews and request product mailto:rfppurchasing@longbeach.gov file:///C:/Users/meid/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/X47PW9A6/LongBeachBuys.com file:///C:/Users/meid/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/X47PW9A6/LongBeachBuys.com file:///C:/Users/meid/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/X47PW9A6/LongBeachBuys.com mailto:LBPurchasing@longbeach.gov v11.30.23 | 16 demonstrations to further evaluate a

Proposer's qualifications and ability to perform the required services.

Negotiation &

Contractor Selection

TBD • Selected Contractor(s) will be notified in writing.

• Any award is contingent upon the successful negotiation of final contract terms. If contract negotiations cannot be concluded successfully, the City reserves the right to negotiate a contract with another Contractor or withdraw the RFP.

• Negotiations shall be confidential and not subject to disclosure to competing Contractors unless and until an agreement is reached.

Estimated Contract

Execution

TBD

Proposer Debrief After

Contractor is Selected

• Successful and unsuccessful Proposers are encouraged to request phone call or in person meeting with the City to discuss the strengths and weaknesses of their proposal. The intent of the debrief is to provide the Proposer with constructive feedback to equip them with information to effectively meet the City’s needs and be successful in future proposals.

4.2 Proposal Content

Complete proposals will include the following. Proposers are encouraged to use this table as a checklist to ensure all components are included in their proposal. Please note proposals that are NOT complete will NOT be considered for the opportunity and will be deemed nonresponsive.

PROPOSAL

☐ Narrative

Proposal

The Narrative Proposal should provide a straightforward, concise delineation of capabilities to satisfy the RFP. Guidance on preparing a Narrative Proposal is detailed in Section 4.3.

☐ Cost Proposal Provide a detailed Cost Proposal that clearly identifies all costs associated with providing the services requested under this RFP.

At a minimum, the Cost Proposal shall:

v11.30.23 | 17

• Itemize all proposed fees, including implementation costs, administrative fees, transaction fees, dispensing fees, rebate arrangements, pass-through costs, and any other charges applicable under the contract.

• Identify the pricing methodology for each cost component

(e.g., per prescription, per claimant, percentage discount, fixed fee, or other unit of measure).

• Present all costs on an annual basis and include any one-time startup or transition costs separately.

• Describe any pricing guarantees, discounts, performance-based incentives, or value-added services included at no additional cost.

• Submit the Cost Proposal in a clear, itemized Excel format that allows for a comprehensive evaluation and comparison of all proposed costs.

Failure to provide a complete and itemized Cost Proposal may result in the proposal being deemed non-responsive.

PROPOSAL APPENDICES

☐ Financial

Stability

Proposers should include one or more of the following financial statements to provide the City with enough information to determine financial stability of the Proposer and subcontractor.

• Financial Statement or Annual Report

• Business tax return

• Statement of income and balance sheet

☐ Other Addenda

(if applicable)

Colored displays, promotional materials, and other collateral are not necessary or desired. However, if a complete response cannot be provided without referencing supporting documentation, it may be provided as an addendum clearly cited in the Narrative or Cost Proposal.

MANDATORY ATTACHMENTS | The following are included as Attachments in Long

Beach Buys. They must be signed by the individual legally authorized to bind the

Proposer.

☐ A. Authorization & Certification

☐ B. Equal Benefits Ordinance (EBO) Form

☐ C. Local Preference Program

Attachments Which May be Submitted Upon Award | Upon award, Awarded

Contractors will be required to submit the following. We encourage you to take note of v11.30.23 | 18 these requirements, and where possible, include available information as part of your proposal to expedite processing.

☐ D. W-9

☐ E. Business License

☐ F. Proof of Registration with the California Secretary of State

☐ G. Certificates of Insurance

☐ H. Proof of the contractor’s license or application status with the California

Department of Managed Health Care (DMHC)

☐ Contact Information | Ensure your organization’s profile is up to date in Long Beach

Buys, including an email address, phone number, and for any classifications you may qualify for.

Conformation of Attachments | Ensure you have checked ALL the attachments in

Long Beach Buys and have confirmed that all the required documents have been uploaded and labeled correctly.

4.3 Narrative Proposal Template

Proposers should develop a narrative proposal that includes all of the following information.

Organizational Capacity & Experience

PROPOSER CONTACT INFORMATION

Organization

Company Name

Company Address

Federal Tax ID Number

Website

Authorized

Representative

Name

Title

Email Address

Phone Number

Other Point of

Contact (if required)

Name

Title

Email Address

Phone Number

PROPOSER CAPACITY & EXPERIENCE

What type of enterprise is the organization?

☐ Non-Profit

☐ Sole Proprietorship v11.30.23 | 19

☐ General Partnership

☐ Corporation

State and Date of incorporation:

☐ Limited Liability Company

☐ Other _________________________________

Please describe why the organization is qualified to provide the services described in this RFP (1-2 paragraphs).

1) Describe your organization's experience providing pharmacy benefit network services for public agencies, municipalities, or other self-insured organizations. Include the number of years providing these services, the size and complexity of the clients served, and examples of contracts that are comparable in scope to the services requested in this RFP.

2) Describe your pharmacy benefit network, including the geographic coverage, number of participating pharmacies, and your ability to provide timely access to medications for injured workers.

3) Explain your experience managing workers' compensation pharmacy benefits, including formulary management, utilization controls, clinical oversight, and regulatory compliance.

How many employees does the organization have in total and residing in Long Beach?

Where are the representative(s) that would service the City’s account located?

Describe your proposed staffing plan for the services requested under this RFP. Identify the Project Manager and all key personnel who will be assigned to this contract, including their names, titles, roles and v11.30.23 | 20 responsibilities, relevant experience, and the estimated percentage of time each individual will be dedicated to this project. Explain how your organization will ensure sufficient staffing levels and continuity of service throughout the term of the contract, including your approach to managing staff absences, turnover, and workload fluctuations. Attach resumes for all key personnel or provide a summary of their qualifications.

REFERENCES

Reference 1

Company

Project Manager

Phone Number

Project Description

Project Start and

End Dates

Reference 2

Company

Project Manager

Phone Number

Project Description

Reference 3

Project Manager

Phone Number

Project Description

Reference 4

Project Manager

Phone Number

Project Description

Reference 5

Project Manager v11.30.23 | 21

Phone Number

Project Description

SUB-CONTRACTOR CONTACT INFORMATION

Does the proposal include subcontractors?

☐ Yes

☐ No

If applicable, provide the following for all subcontractors included in this proposal.

Organization Company Name

Company Address

Authorized

Representative

Name

Title

Email Address

Phone Number

Other Point of

Contact (if required)

Name

Title

Email Address

Phone Number

SUBCONTRACTOR CAPACITY & EXPERIENCE

What type of enterprise is the organization?

☐ Non-Profit

☐ Sole Proprietorship

☐ General Partnership

☐ Corporation

State and Date of incorporation:

☐ Limited Liability Company

☐ Other _________________________________

Which specific requirements of this RFP will the subcontractor perform?

Please describe why the organization is qualified to provide the services described in this RFP (1-2 paragraphs).

v11.30.23 | 22

Please describe the length of time the organization has been providing the services described in this RFP (1-3 sentences).

How many employees does the organization have nationally, locally, and residing in Long

Beach?

Where are the representative(s) that would service the City’s account located?

Please provide a plan of overview for how the account will be staffed and managed if awarded. Please include the percentage of time each employee will be allocated to the account, and the names and titles of principles. Or: Who are the key staff that will be working on the account if awarded? For each, please provide a name, title, and resume either as an attachment or 1 paragraph description.

The City requires that the Awarded

Contractor provide proof of payment of any subcontractors used for this account. If the proposal includes subcontractors, please describe the plan for how the City will be notified of such payments.

Method of Approach

1. Proposers shall provide a comprehensive narrative describing their proposed approach to delivering pharmacy benefit management (PBM) services for the City.

Responses should clearly demonstrate the Proposer's understanding of the City's objectives and its ability to provide high-quality, cost-effective, and clinically appropriate pharmacy benefit management services for the City's workers' compensation program. Include the primary features of your program, your approach to service delivery, and the value your organization will provide to the

City throughout the term of the contract.

2. Describe the overall strategy and methodology your organization will use to achieve the City's objectives. Explain how your pharmacy benefit management v11.30.23 | 23 program, clinical oversight, technology, pharmacy network, reporting capabilities, and customer service model work together to improve injured workers access to medically appropriate prescription medications.

3. Provide a detailed implementation and transition work plan that includes:

- Major implementation activities

- Key milestones and deliverables.

- Roles and responsibilities of both the Proposer and the City.

- Training provided to City staff, claims administrators, providers, and pharmacies.

- Post-implementation support and ongoing account management.

4. Describe how your clinical pharmacy program ensures injured workers receive medically necessary, evidence-based pharmaceutical care while minimizing inappropriate utilization, including opioid management, drug utilization review, medication safety monitoring, and compliance with California workers' compensation treatment guidelines.

Describe your customer service model, including hours of operation, staffing, escalation procedures, pharmacy support, injured worker assistance, provider support, claims examiner assistance, and dedicated account management resources. Describe your quality assurance program, including performance monitoring, service level tracking, corrective action procedures, client communication, and your process for continuously improving program performance throughout the contract term.

5. Describe your strategy for ensuring a seamless transition from the incumbent pharmacy benefit manager with no interruption in pharmacy services, prescription access, or claims processing.

Describe your cybersecurity program, including protections for confidential medical information, system security, incident response procedures, disaster recovery capabilities, and compliance with applicable privacy and security regulations.

Describe your approach to monitoring changes in applicable laws, regulations, treatment guidelines, and workers' compensation requirements. Explain how updates are implemented within your program to ensure ongoing compliance.

6. Describe the partnership you envision with the City to ensure successful implementation and ongoing contract performance. Include:

– Information, resources, or support required from the City.

v11.30.23 | 24

– Roles and responsibilities of both parties.

– Opportunities for collaborative program improvement and innovation throughout the contract term.

Communications & Reporting

1. Describe the data collection, reporting, and performance management systems your organization will utilize to monitor and evaluate the effectiveness of the pharmacy benefit management program. Your response should include:

– The key performance indicators (KPIs) and outcome measures you recommend for evaluating program success.

– Standard and customizable reports available to the City.

– Dashboard and data analytics capabilities.

– Methods for tracking pharmacy utilization, clinical interventions, formulary compliance, opioid utilization, network performance, cost savings, customer service metrics, and injured worker access to medications.

– Any additional or alternative performance metrics you recommend the City monitor.

2. Describe your organizational structure and supervisory model for personnel responsible for delivering services under this contract. Your response should include:

– The roles and responsibilities of key staff assigned to the City.

– Training and professional development programs for customer service representatives, clinical staff, account managers, and other personnel.

– Quality assurance processes used to monitor compliance with contractual requirements and service-level expectations.

3. Describe how your organization will communicate and coordinate with the City throughout implementation and ongoing contract administration. Your response should include:

– Designated points of contact and account management resources.

– Methods for reporting contract performance, service-level compliance, and program outcomes.

– Procedures for escalating and resolving operational issues, complaints, and service concerns.

v11.30.23 | 25

– Strategies for collaborating with City staff to identify opportunities for program improvements, cost containment, enhanced clinical outcomes, and increased customer satisfaction.

– Examples of reports, dashboards, or performance reviews that would be provided to the City.

4. Describe your approach to coordinating with other stakeholders involved in the administration and delivery of workers' compensation pharmacy services. Your response should include:

– Coordination with medical providers, pharmacies, utilization review vendors, case management vendors, and other stakeholders, as applicable.

– Methods for ensuring consistent communication and alignment of program goals.

– Strategies for supporting prescribing physicians and participating pharmacies.

– Procedures for handling disputes, service interruptions, or operational challenges involving stakeholders.

5. The City requires that the Awarded Contractor provide proof of payment of any subcontractors used for this project. If the proposal includes subcontractors, please describe the plan for how the City will be notified of such payments.

v11.30.23 | 26

5 Terms & Conditions

5.1 Acronyms/Definitions

1. Awarded Contractor: The organization/individual that is awarded a contract with the

City of Long Beach, California for the services identified in this RFP.

2. City: The City of Long Beach and any department or agency identified herein.

3. Contractor / Proposer: Organization/individual submitting a proposal in response to this RFP.

4. Department / Division: City of Long Beach, Workers’ Compensation Division/ Risk

Management Bureau/ Human Resources Department

5. Evaluation Committee: An independent committee comprised solely of representatives of the City established to review proposals submitted in response to the RFP, evaluate the proposals, and select a Contractor.

6. May: Indicates something that is not mandatory but permissible.

7. RFP: Request for Proposals.

8. Shall / Must: Indicates a mandatory requirement. Failure to meet a mandatory requirement may result in the rejection of a proposal as non-responsive.

9. Should: Indicates something that is recommended but not mandatory. If the

Proposer fails to provide recommended information, the City may, at its sole option, ask the Proposer to provide the information or evaluate the proposal without the information.

10. Subcontractor: Third party not directly employed by the Proposer who will provide services identified in this RFP.

11. PBN - Pharmacy Benefit Network

12. PBM - Pharmacy Benefit Manager

13. DAW - Dispensed as Written

14. GDR - Generic Dispensing Rate

15. SLA - Service Level Agreement

16. KPI - Key Performance Indicators

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5.2 Solicitation Terms & Conditions

1. The City reserves the right to alter, amend, or modify any provisions of this RFP, or to withdraw this RFP, at any time prior to the award of a contract pursuant hereto, if it is in the best interest of the City to do so.

2. The City reserves the right to request clarification of any proposal term from

Proposers.

3. The City may contact the references provided; contact any Proposer to clarify any response; contact any current users of a Proposer’s services; solicit information from any available source concerning any aspect of a proposal; and seek and review any other information deemed pertinent to the evaluation process.

4. The level and term of documentation required from the Proposer to satisfy the City will be commensurate with the size and complexity of the contract and Proposers should submit accordingly. If the information submitted by the Proposer, or available from other sources, is insufficient to satisfy the City as to the Proposer’s contractual responsibility, the City may request additional information from the

Proposer or may deem the proposal non-responsive.

5. The City reserves the right to waive informalities and minor irregularities in proposals received.

6. The City reserves the right to reject any or all proposals received prior to contract award.

7. The City’s determination of the Proposer’s responsibility, for the purposes of this RFP, shall be final.

8. Unless otherwise specified, the City prefers to award to a single Contractor but reserves the right to award contracts to multiple contractors.

9. The City shall not be obligated to accept the lowest priced proposal, but will make an award in the best interests of the City of Long Beach after all factors have been evaluated.

10. If the City receives a single responsive, responsible proposal, the City may request an extension of the proposal acceptance period and/or conduct a price or cost analysis on such proposal. The Proposer shall promptly provide all cost or pricing data, documentation and explanation requested by the City to assist such analysis. By v11.30.23 | 28 conducting such analysis, the City shall not be obligated to accept the single proposal.

The City reserves the right to reject such proposal or any portion thereof.

11. Any irregularities or lack of clarity in the RFP should be brought to the Purchasing

Division designee’s attention as soon as possible so that corrective addenda may be furnished to Proposers.

12. Proposals must include any and all proposed terms and conditions, including, without limitation, written warranties, maintenance/service agreements, license agreements, lease purchase agreements and the Proposer’s standard contract language. The omission of these documents may render a proposal non-responsive.

13. Alterations, modifications or variations to a proposal may not be considered unless authorized by the RFP or by addendum or amendment.

14. Proposals which appear unrealistic in the terms of technical commitments, lack of technical competence, or are indicative of failure to comprehend the complexity and risk of this contract, may be rejected.

15. Proposals may be withdrawn by written notice received prior to the proposal opening time.

16. The price and amount of this proposal must have been arrived at independently and without consultation, communication, agreement or disclosure with or to any other

Contractor or prospective Contractor.

17. No attempt may be made at any time to induce any firm or person to refrain from submitting a proposal or to submit any intentionally high or noncompetitive proposal. All proposals must be made in good faith and without collusion.

18. Prices offered by Proposers in their proposals are an irrevocable offer for the term of the contract and any contract extensions. The Awarded Contractor agrees to provide the purchased services at the costs, rates and fees as set forth in their proposal in response to this RFP. No other costs, rates or fees shall be payable to the Awarded Contractor for implementation of their proposal.

19. The City is not liable for any costs incurred by Proposers prior to entering into a formal contract. Costs of developing the proposals or any other such expenses incurred by the Proposer in responding to the RFP, are entirely the responsibility of the Proposer, and shall not be reimbursed in any manner by the City.

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20. In the event a Proposer received assistance from City staff or a representative of the City (technical assistance provider), the City is not responsible for any mistakes, inaccuracies, delays, or any other impact that the assistance provided did to impact the Proposer’s final product. Available technical assistance support services are only intended to provide advice and does not constitute a basis for any protest to this contract opportunity. It is solely the Proposer’s responsibility to prepare and submit a response to the RFP.

21. Proposal will become public record after the conclusion of the negotiation process and before final approval by the awarding body unless the proposal or specific parts of the proposal can be shown to be exempt by law. Each Proposer may clearly label all or part of a proposal as "CONFIDENTIAL" provided that the Proposer thereby agrees to indemnify and defend the City for honoring such a designation. The failure to so label any information that is released by the City shall constitute a complete waiver of any and all claims for damages caused by any release of the information.

22. A proposal submitted in response to this RFP must identify any subcontractors, and outline the contractual relationship between the Proposer and each subcontractor.

An official of each proposed subcontractor must sign, and include as part of the proposal submitted in response to this RFP, a statement to the effect that the subcontractor has read and will agree to abide by the Proposer’s obligations.

23. If the Contractor elects to use subcontractors, the City requires that the Awarded

Contractor provide proof of payment of any subcontractors used for this project.

Proposals shall include a plan by which the City will be notified of such payments.

24. Each Proposer must adhere to the City’s Vendor Code of Conduct, including, but not limited to, disclose any existing or potential conflict of interest relative to the performance of the contractual services resulting from this RFP. Any such relationship that might be perceived or represented as a conflict should be disclosed.

The City reserves the right to disqualify any Proposer on the grounds of actual or apparent conflict of interest. The Vendor Code of Conduct can be found at https://longbeach.gov/globalassets/finance/media-library/documents/business-info/purchasing-division/final-vendor-code-of-conduct-2023

25. Each Proposer must include in its proposal a complete disclosure of any alleged significant prior or ongoing contract failures, any civil or criminal litigation or investigation pending which involves the Proposer or in which the Proposer has been judged guilty or liable. Failure to comply with the terms of this provision will https://longbeach.gov/globalassets/finance/media-library/documents/business-info/purchasing-division/final-vendor-code-of-conduct-2023 https://longbeach.gov/globalassets/finance/media-library/documents/business-info/purchasing-division/final-vendor-code-of-conduct-2023 v11.30.23 | 30 disqualify any proposal. The City reserves the right to reject any proposal based upon the Proposer’s prior history with the City or with any other party, which documents, without limitation, unsatisfactory performance, adversarial or contentious demeanor, significant failure(s) to meet contract milestones or other contractual failures.

26. The City reserves the right to negotiate final contract terms with any Proposers selected. The contract between the parties will consist of the RFP together with any modifications thereto, and the Awarded Contractor’s proposal, together with any modifications and clarifications thereto that are submitted at the request of the City during the evaluation and negotiation process. In the event of any conflict or contradiction between or among these documents, the documents shall control in the following order of precedence: the final executed contract, the RFP, any modifications and clarifications to the Awarded Contractor’s proposal, and the

Awarded Contractor’s proposal. Specific exceptions to this general rule may be noted in the final executed contract.

27. The City will not be responsible for or bound by any oral communication or any other information or contact that occurs outside the official communication process specified herein, unless confirmed in writing by the City Contact.

28. Any contract resulting from this RFP shall not be effective unless and until approved by the City Council / City Manager, as applicable.

29. The City will not be liable for Federal, State, or Local excise taxes.

30. Execution of Attachment A of this RFP shall constitute an agreement to all terms and conditions specified in the RFP, including all contract terms and conditions therein, except such terms and conditions that the Proposer expressly excludes.

31. Proposer understands and acknowledges that the representations above are material and important, and will be relied on by the City in evaluation of the proposal.

Any Proposer misrepresentation shall be treated as fraudulent concealment from the City of the true facts relating to the proposal.

32. Proposals shall be kept confidential through the negotiation process.

33. No announcement concerning the award of a contract as a result of this RFP may be made without the prior written approval of the City.

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Proposers are advised that any contract awarded pursuant to this procurement process that exceeds $100,000 shall be subject to the applicable provisions of Long

Beach Municipal Code Section 2.73 et seq, the Equal Benefits Ordinance.

34. All Proposers shall complete and return, with their bid, the Equal Benefits Ordinance

Compliance form contained in Attachment B, if applicable. Unless otherwise specified in the procurement package, Proposers do not need to submit with their bid supporting documentation proving compliance. However, supporting documentation verifying that the benefits are provided equally shall be required if the proposer is selected for award of a contract.

35. Independent contractors or employees of a third-party employer who are CalPERS retirees are subject to provisions of the Government Code. A CalPERS retiree is an employee of a CalPERS employer who terminates active employment and receives a monthly CalPERS retirement allowance. Any individual qualifying as a CalPERS retiree doing business as an independent contractor or employee of a third- party employer is required to submit a CalPERS determination to ensure the services provided are considered that of a true independent contractor position. All third-party employers are required to notify any individual they are having work for the

City of Long Beach of this requirement. You may reach out directly to CalPERS at membership_reporting@calpers.ca.gov for a determination.

5.3 Contract Terms & Conditions

1. The Awarded Contractor will be the sole point of contract responsibility. The City will look solely to the Awarded Contractor for the performance of all contractual obligations which may result from an award based on this RFP, and the Awarded

Contractor shall not be relieved for the non-performance of any or all subcontractors.

2. The Awarded Contractor must maintain, for the duration of its contract, insurance coverages as required by the City. Work on the contract shall not begin until after the Awarded Contractor has submitted acceptable evidence of the required insurance coverages. As a condition precedent to the effectiveness of this contract, Contractor shall procure and maintain at Contractor’s expense for the duration of this contract from an insurance company that is admitted to write insurance in the

State of California or that has a rating of…