Medical TPA & Pharmacy Benefit Management Services

Northside Independent School District (NISD), the fourth-largest public school district in Texas based in San Antonio (Bexar County), is issuing a Request for Proposal (RFP 2026-076) for Medical Third Party Administration (TPA) and Pharmacy Benefit Management (PBM) Services. The District seeks to procure comprehensive administrative services for its self-funded employee health benefit program serving approximately 18,000 covered members and over 13,000 employees. Vendors may submit proposals for Medical TPA Services Only, Pharmacy Benefit Management Only, or a Fully Integrated Solution (Bundled TPA/PBM), with the District reserving the right to award contracts independently or in combination. Key deliverables and service requirements include a full-time, on-site dedicated Member Services Representative fluent in English and Spanish; a credentialed Wellness Team; an annual communications budget of $100,000; an annual wellness budget of $650,000; network adequacy reports; claims processing with specified turnaround time metrics; utilization and disease management services; and seamless integration with the District's stop loss provider and data warehouse systems. Pricing must be submitted using Form C Price Sheet and the 2026-076 Medical TPA & Pharmacy Benefit Management Services Workbook in Excel format, with proposers required to provide fully transparent, pass-through pricing for all pharmacy services including ingredient costs, dispensing fees, and rebates with no spread pricing or undisclosed revenue streams permitted; medical premiums must be net of commissions with guaranteed rates for the contract period. Evaluation criteria include purchase price (30%), reputation and experience (5%), quality of goods and services (15%), extent to which services meet District needs (25%), past relationship with the District (5%), total long-term cost (10%), and other relevant factors such as financial guarantees and staffing models (10%). The RFP was posted on April 14, 2026, with a mandatory pre-proposal conference scheduled; vendor questions must be submitted in writing through the Bonfire portal by Thursday, April 23, 2026, at 12:00 PM (CT); sealed proposals are due on Wednesday, May 6, 2026, at 11:00 AM (CT) via the Bonfire Portal (Euna Procurement); and selected finalists may be required to participate in face-to-face interviews or facility tours. The contract term is three (3) years effective January 1, 2027, with an option to renew for two (2) additional one-year periods.

This RFP replaces the expiring RFP 2023-024 for Fully-Insured and Self-Funded Managed Health and Consumer Driven Health Plans, which expires December 31, 2026; all vendors are required to respond to this new RFP, and failure to do so will impact their opportunity to continue business with the District. All proposals must include proof of insurance, vendor certifications, conflict of interest disclosures, and compliance with federal (EDGAR) and state requirements. Confidential information contained within the solicitation materials is restricted to authorized representatives of bidding organizations and may only be used for preparing a response to solicitation 2026-076; offerors must complete a Certificate of Non-Disclosure Agreement and submit it via email to John.Shores@Alliant.com to gain access to secure data. The District maintains an agreeable balance in a claims payment account and will self-bill and pay selected carriers on a net 30-day basis from invoice receipt; no minimum volume of business is guaranteed. No specific set-aside designations for disadvantaged enterprises are identified in the available documentation. The RFP documents do not disclose specific award values or budget ranges; however, the scope of services and size of the covered population (approximately 18,000 members) indicates a substantial contract opportunity typical of major health benefits administration programs in large school districts.