Group Medical and/or Pharmacy Benefit Management (PBM)

The Provo City School District (PCSD) in Utah is seeking proposals for Group Medical and/or Pharmacy Benefit Management (PBM) Services through a Request for Proposal (RFP) to be effective September 1, 2026. The procurement allows for three potential contract award configurations: a combined Medical and PBM proposal offering fully integrated administrative and pharmacy services, Medical Administration Only for claims administration, or PBM Only for pharmacy benefit management services. Vendors must meet mandatory requirements including Utah business licensure, HIPAA compliance, public-sector plan administration experience, and URAC accreditation for PBM services. The evaluation criteria will allocate 700 points to technical responses and 300 points to cost proposals, with vendors scoring a minimum of 750 points invited to in-person presentations. The RFP requires electronic submission through Utah Public Procurement Place (Bonfire/Euna) by the deadline of Friday, December 23, 2025, at 2:00 PM MST. The initial contract term is three years, with options to extend for two additional one-year periods and potential year-to-year renewals for up to five additional years, contingent on satisfactory performance and available funding.

Currently, PCSD operates under a self-funded model administered by UnitedHealthGroup, with UMR serving as the medical third-party administrator and Optum Rx as the pharmacy benefit manager. The district serves approximately 13,956 students across 18 school facilities and has 2,039 eligible employees, with 824 currently enrolled. While no specific set-aside designations or restrictions for disadvantaged enterprises are explicitly mentioned, the RFP requires vendors to participate in the RingmasterRx PBM repricing process and provide monthly claims data feeds. The existing medical coverage includes three plan options: a $1,500 PPO, $1,500 Dual PPO, and $2,500 HDHP, with renewal rates ranging from $734.33 to $2,454.10 depending on coverage tier. The district requires networks through UMR/UHC with specific stop loss specifications, including an individual deductible of $200,000 and an aggregate corridor of 125% for medical and prescription drug coverage. Although a specific award value is not disclosed, the comprehensive nature of the services and the district's current enrollment suggest a significant contract opportunity for the selected vendor(s).