Administration of prescription drugs

The State of New Hampshire Department of Administrative Services, Division of Risk and Benefits, issued Request for Proposal 487-26 to procure Pharmacy Benefits Manager (PBM) services to administer prescription drugs under the State's Employee and Retiree Health Benefits Plan. The procurement covers approximately 26,145 covered lives, including active employees, dependents, a Special Group of approximately 510 subscribers from other organizations, and non-Medicare retirees and dependents throughout New Hampshire and surrounding New England states and across the nation. The successful bidder must provide comprehensive formulary management, retail network management, clinical programs, member services, account management, and compliance with federal regulations including the No Surprises Act and Final Transparency Rule. Required deliverables include administering a broad formulary with standard exclusions covering retail 30-day supplies (1-31 days), mail order (up to 90 days), and specialty pharmacy (30 days) services, with optional retail 90-day pricing proposals for potential future implementation. Proposals must address day supply limits, pass-through methodology for retail claims, acquisition cost plus pricing for mail and specialty distribution channels, administrative fees, rebate guarantees, and dispensing fee guarantees across all contract years (CY2027, CY2028, and CY2029). Evaluation occurs in four steps: minimum qualifications review, technical questionnaire scoring (25 points), financial scoring (75 points), and contract award, with technical proposals scored on general operations, implementation, formulary management, retail network management, clinical programs, audit rights, ongoing monitoring, member services, performance guarantees, and federal regulatory support. The proposal deadline is April 22, 2026, at 2:00 PM Eastern Time, with submissions required electronically through the ProposalTech platform.

The RFP does not specify set-aside designations or restrictions limiting participation to particular organization types or disadvantaged enterprises based on the available documentation. No incumbent vendors or current contractors are identified in the solicitation materials provided. Bidders must incorporate biosimilar utilization shifts to preferred low WAC products, include all known 2026 pricing impacts such as Maximum Fair Price and biosimilar changes, and may exclude vaccines and prescribed antivirals from discount, dispensing fee, and rebate guarantees, while 340B claims must be included in all guarantees. The successful bidder will execute the State's standard P-37 contract form with exhibits and associated Business Associate Agreements and data security requirements rather than substitute proprietary contract terms. Financial proposals must follow the provided financial offer template and include pass-through retail pricing, minimum rebate guarantees as a percentage of total Average Wholesale Price for brand drugs, maximum dispensing fee guarantees per script, PMPM cost guarantees with annual maximum caps, and guaranteed maximum annual PMPM trend rates for subsequent contract years. While specific award values or budget ranges are not explicitly stated in the available documentation, the scope encompasses three years of pharmaceutical benefit administration services for a substantial covered population with detailed pricing guarantees and performance metrics subject to amount at risk components.