GICPND2604 Procuring a Pharmacy Benefit Manager for the Group Insurance Commission

The Massachusetts Group Insurance Commission is seeking responses for Pharmacy Benefit Manager services covering approximately 305,133 Commercial members and 120,011 EGWP (Employer Group Waiver Plan) members, with responses due August 5, 2026 and a bidders' conference tentatively scheduled for July 29, 2026. Vendors may bid on Commercial, EGWP, or both contracts separately, each evaluated independently. The RFR will be released on or about July 8, 2026 via COMMBUYS (file number BD-26-1049-GIC00-07GIC-130036).

Prospective bidders must demonstrate substantial experience managing large-scale pharmacy benefit programs, including proven clinical outcomes, robust financial controls, and operational excellence across retail and specialty pharmacy operations. EGWP experience is a required qualification. Compliance with Massachusetts' 2025 PBM law and Division of Insurance licensing requirements is mandatory.

The Commercial population generates approximately $830.6 million in annual pharmacy gross costs; the EGWP population generates approximately $736.7 million annually. The contract commences July 1, 2027. CVS Health (Caremark) is the incumbent, currently administering both Commercial and separate EGWP contracts.

The GIC is a quasi-independent state agency established in 1955 that provides health insurance coverage to over 260,000 enrollees representing more than 420,000 covered individuals, including over 120,000 Medicare participants across twelve health plans. Prospective bidders should monitor COMMBUYS for the full RFR and any amendments by subscribing with commodity codes 80-10-00-00 (Management Advisory Services) and/or 84-13-00-00 (Insurance and Retirement Services). Questions should be directed to Jannine Dewar at the GIC or Jasmyn Plasencia at Mercer, which is advising the GIC.