MHCC 27-003 MHCC 27-003 Actuarial Consultant - Prior Authorization and Step Therapy Coverage of Nonopioid Drugs

The Maryland Health Care Commission is requesting proposals for actuarial consulting services to analyze the impact of limiting prior authorization and step therapy for coverage of nonopioid drugs, with proposals due August 14, 2026 at 4:00 p.m. via the eMaryland Marketplace Advantage system.

The scope encompasses social, medical, and financial impact analyses of coverage requirements for health insurers, nonprofit health service plans, HMOs, MCOs, and Medicaid in Maryland. Deliverables include a detailed work plan, bi-weekly progress reports, a framework and rationale outline (due August 28, 2026), a draft report (due October 30, 2026), a final report (due November 20, 2026), and a presentation to the Commission on December 17, 2026.

Minimum qualifications require five years of demonstrated experience providing actuarial estimates on coverage requirements, assessing clinical benefits of healthcare treatments, and analyzing healthcare claims data from Maryland's Medical Care Database or equivalent All-Payer Claims Database sources. The Principal Actuary must hold ASA certification or higher and possess an advanced degree in health economics, statistics, or health policy with at least ten years of experience, including at least five years estimating health benefits costs. Offerors may propose multiple Actuarial Analysts with ASA certification or near-ASA status and a minimum of three years' experience analyzing healthcare coverage costs.

The fixed-price contract value is $65,000 for a term from August 2026 through January 31, 2027. Financial proposals must be submitted separately using the provided Excel form (Attachment B) with all pricing excluded from the technical proposal. Payment follows within 30 days of invoice receipt and deliverable approval. Contractors must register with the State Department of Assessments and Taxation and the eMaryland Marketplace Advantage system prior to award. Evaluation prioritizes experience and qualifications of proposed staff, followed by contractor qualifications, proposed work plan, problem understanding, and conflict disclosures. The State reserves the right to conduct discussions, request best and final offers, or award without discussions.