Nevada State Pharmacy Benefit Manager

The Nevada Health Authority, through the Nevada State Purchasing Division, is soliciting proposals under RFP 41NHA-S3992 for pharmacy benefit manager services covering Nevada Medicaid and the Public Employees' Benefits Program (PEBP), with questions due November 16, 2026 and proposals due December 29, 2026 at 2:00 p.m. Pacific Time. The solicitation identifies no set-asides. Vendors must hold a Nevada business license, maintain SAM.gov registration, and agree not to boycott Israel.

The State Pharmacy Benefit Manager (SPBM) scope covers approximately 764,757 Medicaid members, including 141,141 fee-for-service and 623,616 managed care organization recipients. Fee-for-service go-live is January 1, 2028, and managed care go-live is January 1, 2029. The PEBP scope covers approximately 72,000 active and retired employees and dependents, with go-live July 1, 2028. The State prefers one vendor for both scopes but may award each separately, and NVHA may carve out specialty, mail, utilization management, formulary, and prior authorization components without repricing retained services. Vendors serving PEBP must hold a Nevada Division of Insurance TPA registration or obtain one within 45 calendar days after notice of intent to award.

Required qualifications include five years of pharmacy management experience for a state Medicaid program (SPBM) and five years for a state employee program (PEBP), NCPDP membership, CMS certification, Nevada-licensed pharmacists, and a help desk operating 24 hours a day, 365 days a year. All personnel and subcontractors must be located in the United States. The business associate addendum requires breach reporting within five calendar days and prohibits AI or machine-learning use of PHI without written authorization. Vendors must submit three client references from the last five years, and reference questionnaires are due December 28, 2026 to Heather Moon at hmoon@admin.nv.gov.

Contract term for the SPBM is six years from June 8, 2027, subject to Board of Examiners approval, with two one-year renewal options. The PEBP cost schedule specifies July 1, 2028 through June 30, 2034, with optional add-on years through June 30, 2036. Pricing remains valid for 180 days after the due date. The source does not state a contract value. Required insurance includes $5 million in general liability, professional, cyber, and crime coverage, and $1 million in automobile liability.

SPBM technical scoring weights Implementation at 37 points, Financial Operations and Administration at 27, Clinical and Program Management at 26, and Contractor Experience at 10, with Cost at 35 points. A PEBP quality bonus may be applied to the Medicaid technical score based on PEBP performance. PEBP technical scoring weights Formulary and Clinical Management at 35 points, Financial Operations at 25, Operational Capabilities at 20, and Implementation and Transition at 20. Key performance measure credits run $2,000 per day per unmet Tier 1 measure, $1,000 for Tier 2, $250 for Tier 3, and $125 for Tier 4, with a multiplier of two for the third occurrence and three for the fourth and later occurrences within a rolling 12-month period. Downtime damages of $50 to $100 per minute, dollar-for-dollar rebate restitution, and data breach indemnification are uncapped.