Administrative Support Services for the State of Nebraska Employee Health Care Prescription Drug Benefit Plans

The State of Nebraska Department of Administrative Services is seeking a Pharmacy Benefit Manager (PBM) to provide comprehensive administrative support services for the state's employee health care prescription drug benefit plans. The solicitation, RFP #122436 O5, aims to secure a self-funded PBM administrator to serve approximately 13,600 enrolled members, including active employees, pre-65 retirees, COBRA participants, and their dependents. Required services encompass claims adjudication, member enrollment, formulary management, clinical management, pharmacy network management, and member services. The selected vendor must have at least five years of self-funded group experience, be licensed in all 50 states, and currently serve a public sector group health plan with a minimum of 15,000 lives. Evaluation criteria include a comprehensive scoring system with 25 points for Corporate Overview, 55 points for Technical Response, and 20 points for Cost, with potential additional points for vendor demonstrations. The RFP was released on June 9, 2025, with proposal responses due by July 18, 2025, at 2:00 p.m. Central Time, and an anticipated contract award in October 2025. The initial contract term will run through June 30, 2029, with options to renew for two additional one-year periods, with the benefit plan year commencing on July 1, 2026.

The solicitation does not explicitly mention specific set-aside designations or restrictions for disadvantaged enterprises. The RFP requires a comprehensive Business Associate Agreement to ensure HIPAA compliance and detailed performance guarantees with potential financial penalties ranging from $2,000 to $50,000 per occurrence. Performance metrics cover implementation, claims processing, member services, system performance, and administrative responsiveness, with a focus on transparency and accountability. While no incumbent vendor is specified, the state requires the selected PBM to provide a dedicated Account Management Team and own and protect member data. The cost structure includes per member per month (PMPM) administrative fees, with guaranteed pricing for pharmacy network services across retail, mail, and specialty medication channels. The estimated enrollment is consistently around 28,386 members throughout the contract period, with the state expecting transparent pricing, minimum AWP discounts for brand and generic medications, and comprehensive rebate guarantees. Administrative service fees will not be paid until the benefit plan year begins, emphasizing the state's commitment to a rigorous and performance-driven procurement process.