Medical Network and Pharmacy Administration Services

The State of South Dakota Bureau of Human Resources and Administration is seeking proposals for Medical Network and Pharmacy Administration Services through RFP #25RFP17863. This procurement targets an Administrative Services Organization (ASO) to provide comprehensive claims administration, enrollment services, provider network management, medical management, and Pharmacy Benefit Manager (PBM) services for the State Employee Health Plan. The current program covers approximately 12,435 active employees across four medical plans and one pharmacy plan, with CVS Caremark currently administering pharmacy services. Proposals are due by December 15, 2025, at 5:00 p.m. CDT, with a Letter of Intent and Offeror Privacy and Security Agreement required by November 7, 2025. The contract period spans five years from July 1, 2026, through June 30, 2031, with potential for two five-year renewals. Evaluation will be conducted on a 100-point technical scoring basis, considering factors such as specialized expertise (150 points), resources and availability (100-150 points), past performance, project management, cost, account management services, reporting capabilities, and network management adequacy. The State anticipates final vendor selection by January 16, 2026, with implementation to be completed 60 days prior to the FY27 Annual Enrollment period beginning April 15, 2026.

No specific set-aside designations or restrictions for disadvantaged enterprises are explicitly mentioned in the procurement documents. The State is self-insured for all medical plans and currently operates without stop-loss coverage, meaning the selected contractor will bear no specific or aggregate stop-loss risk. While the current pharmacy services are provided by CVS Caremark, the RFP does not definitively state they are the incumbent vendor for the comprehensive services being sought. The successful vendor must integrate with the State's existing technology infrastructure, including compliance with BIT Technology Standards, implementation of Single Sign-On integration with the State's OAuth 2.0 standard, and meeting web application vulnerability scan requirements. Although no specific award value or budget range is directly stated, the comprehensive nature of the services and the size of the employee population suggest a substantial contract value. Vendors must provide detailed implementation timelines, performance guarantees across five key areas, and demonstrate network adequacy through geoaccess reports showing provider access within specified distances.