Medical and Prescription Drug Benefit Program

Saratoga County, New York, is seeking proposals for a comprehensive self-funded medical and prescription drug benefit program effective January 1, 2026. The procurement targets a preferred provider organization (PPO) medical network on an Administrative Services Only (ASO) basis, which includes vision coverage, and a self-funded Pharmacy Benefit Manager (PBM) proposal using a traditional pricing model with 100% pass-through of earned rebates. The county aims to provide healthcare benefits for approximately 1,100 eligible employees and 3,500 total covered participants. Key procurement dates include the RFP release on May 7, 2025, with proposals due by May 28, 2025, and an anticipated finalist selection between mid-June and mid-July 2025. The final vendor decision is expected by September 1, 2025. Evaluation criteria will likely focus on innovative approaches to chronic disease management, telehealth solutions, behavioral health initiatives, and strategies for controlling healthcare costs. Proposers must submit comprehensive responses addressing all specified requirements, including network capabilities, pricing models, and potential alternative network solutions.

Currently, Saratoga County partners with CDPHP for medical, vision, and prescription drug services, and MetLife for dental coverage. The proposed plan is a non-grandfathered medical benefit under the Affordable Care Act, with out-of-network claims to be reimbursed at the 80th percentile of FairHealth. While no specific set-aside designations are mentioned, vendors will need to demonstrate robust capabilities in comprehensive reporting, data mining, predictive modeling, and disease management. The county is seeking a solution that can seamlessly integrate with existing infrastructure and provide enhanced participant experience. Although a specific budget range is not disclosed, the scope of services covering 1,100 employees and 3,500 total participants suggests a significant potential contract value. Proposers should be prepared to offer flexible, cost-effective solutions that can adapt to the county's healthcare management needs while maintaining high-quality service delivery.