CHANGE ORDER NOTICE / NVP DCH0000136 Medicaid Enterprise Systems Pharmacy Benefit Services

The Illinois Department of Healthcare and Family Services is issuing a change order notice (not a solicitation) to extend its Medicaid Enterprise Systems Pharmacy Benefit Services contract with Gainwell Technologies LLC for one year through October 28, 2027, aligning with the NASPO Master Agreement extension; the notice was posted October 21, 2026, with an intent deadline of November 4, 2026.

This is a sole-source extension to the current contract, not an open competition. The revised total cost for the one-year extension is $18.226 million, consisting of $1.41 million for Change Management and $16.816 million for Design, Development, Implementation and Maintenance and Operations phases. The original contract term was July 1, 2026 through October 28, 2026, with an initial value of $8.517 million.

The scope comprises comprehensive Pharmacy Benefit Management services supporting Illinois Medicaid including 24/7/365 point-of-sale claims adjudication, prior authorization processing, provider and member support services, pharmacy drug rebate administration (federal, supplemental, and state-specific), Drug Utilization Review and prior authorization criteria development, fraud and waste detection, secure cloud-based infrastructure with disaster recovery, EDI transaction support, and web-based reporting and analytics. The contract implements a Change Management Process with a Change Control Board; four draft Change Requests totaling $142,719 have been received for custom data layout mappings and ETL transformations.

Funding carries federal financial oversight: the DDI phase is funded at 90% federal / 10% state cost share, while the Maintenance and Operations phase operates at 75% federal / 25% state split. All required approvals from the Agency Purchasing Officer, State Purchasing Officer, Unified Procurement Program representative, and Chief Procurement Officer were obtained as of October 20, 2026.