Emergency Notice Pharmacy Benefit Management System

The State of Illinois Department of Healthcare and Family Services (HFS) is seeking to establish an emergency 90-day contract for a Pharmacy Benefit Management System (PBMS) to ensure continuity of medical and pharmaceutical care for the state's Medicaid population of 3.9 million recipients. The current proprietary PBMS system, which is used to process and adjudicate pharmacy claims, facilitate prior authorizations, and manage the Preferred Drug List, is set to expire on March 16, 2024. HFS is declaring an emergency to establish a contract with Change Healthcare Pharmacy Solutions, Inc. from March 17, 2024 through June 15, 2024 at an estimated cost of $1,512,162. This PBMS is essential for the health and safety of Medicaid recipients, as the absence of a functioning system would result in Medicaid customers being unable to access life-saving medications and pharmacies being unable to submit claims for payment. HFS relies on $2.4 billion in annual revenue from the drug rebate program, which is crucial for funding Medicaid programs.

While HFS made best efforts to include Business Enterprise Program (BEP) vendors, the vendor was unable to provide BEP participation due to the proprietary, customized nature of the PBMS applications. An existing state contract does not meet the immediate need, as the current contract will expire. The estimated cost of the emergency contract is $1,512,162, and there is no indication of any incumbent vendors or current contractors.