Administration of prescription drugs

The State of New Hampshire Department of Administrative Services, Division of Risk and Benefits, is issuing Request for Proposal (RFP) 487-26 to procure Pharmacy Benefits Manager (PBM) services for administration of prescription drug benefits. The procurement covers approximately 26,145 covered lives under the Employee and Retiree Health Benefits Plan, including active employees, dependents, a "Special Group" of approximately 510 subscribers from other legislatively or traditionally covered organizations, and non-Medicare retirees and dependents located throughout the country. The contract period spans three years covering calendar years 2027, 2028, and 2029. Required deliverables include comprehensive plan design options, clinical program offerings, formulary management strategies, retail network management, member services, specialty pharmacy services, utilization management services, claims processing, prior authorization reviews, appeals processing, and compliance with federal regulations including the Federal No Surprises Act and Final Transparency Rule. The evaluation process comprises four steps: minimum qualifications review, technical questionnaire scoring (25 points), financial scoring (75 points), and contract award determination, with financial considerations weighted at 75 percent of total scoring and technical capabilities comprising 25 percent. Bidders must respond electronically through ProposalTech by the deadline of April 22, 2026, at 2:00 PM Eastern Time.

The RFP does not explicitly identify set-aside designations or restrictions limiting responses to specific organization types based on disadvantaged enterprise status. The financial proposal requires bidders to provide transparent pricing across multiple service categories including administration fees, clinical program fees, pharmacy network management, and ancillary services, with pricing models utilizing either pass-through or Acquisition Cost Plus methodologies for retail 30-day, retail 90-day, and mail order pharmacy channels. Bidders must guarantee minimum rebates expressed as a percentage of total brand Average Wholesale Price (AWP) for each contract year and provide specialty drug pricing guarantees by drug type, maximum dispensing fee guarantees per script, and annual maximum Per Member Per Month (PMPM) cost guarantees. While specific award values or budget ranges are not explicitly stated in the available documentation, the proposal template mandates detailed cost estimates including ingredient costs, dispensing fees, administrative fees, clinical fees, and projected rebates based on enrollment and script count projections, which will inform the financial evaluation and ultimate contract award determination.