Outpatient pharmacy cost containment

West Virginia Public Employees Insurance Agency (PEIA) is requesting proposals for outpatient pharmacy cost containment services under ARFP PEI2600000001, with proposals due July 31, 2026 at 4:00 p.m., a mandatory bidders' conference on June 24, 2026 at 3:00 p.m. via Google Meet, and vendor questions due by July 1, 2026.

The scope covers specialized pharmacy cost containment advisory services to generate savings and manage drug costs across PEIA's outpatient prescription drug benefit. The service population includes approximately 140,270 active commercial lives and 7,423 non-Medicare retirees, plus 200 to 2,200 Medicare retirees fluctuating throughout the plan year. PEIA currently uses Express Scripts as its PBM and UMR as its Third-Party Administrator. The vendor must maintain a Continental United States-based member and provider call center with 24/7 availability, provide weekly claims-level and monthly consolidated activity reports, and ensure all PEIA data remains within the Continental United States and is used solely for contract fulfillment.

The contract is effective January 1, 2027 and extends for three years with potential renewal upon mutual written consent with 30 days' notice prior to expiration. Compensation is flat administrative PMPM pricing only; no revenue may derive from rebate spreads, back-end commissions, or manufacturer service fees. The vendor must guarantee a savings return on investment ratio of at least 1.5:1, with all net savings exceeding total vendor costs and fees, and accept responsibility for the lowest net cost outcome incorporating all actual manufacturer rebates and copay assistance programs. Vendors must submit a litigation bond at 5% of annual administrative fees or execute a litigation waiver form, maintain comprehensive general liability insurance ($5 million per occurrence or $10 million aggregate) and cyber liability insurance ($5 million per occurrence or $10 million aggregate), and submit to annual financial audits by PEIA-selected independent auditors with refunds due if guaranteed savings are not achieved.

Technical proposals are evaluated on a 60-point scale with a 42-point minimum to advance; cost proposals on a 40-point scale. Finalist notifications are targeted for August 21, 2026, with finalist interviews on August 28, 2026, and vendor award notification by September 15, 2026. Direct inquiries to Samuel H. Revercomb at (304) 558-7850 or Samuel.H.Revercomb@wv.gov.