Pharmacy Benefit AdministratorBid Documents

The Indiana Department of Administration, on behalf of the Family and Social Services Administration, is requesting proposals for Pharmacy Benefit Administrator services to administer the State's fee-for-service Medicaid pharmacy benefit, with proposals due January 8, 2027 at 3:00 PM Eastern Time and a pre-proposal conference on October 28, 2026. Respondents must demonstrate a minimum of six years of combined experience supporting State Medicaid PBA services for at least two states. An Indiana Veteran Owned Small Business (IVOSB) participation goal of 3% and an Indiana Small Business Program (INSBP) subcontracting goal of 10% apply; IVOSB and INSBP subcontractors must be State-certified by the proposal due date and provide Valuable Scope Contribution directly related to solicitation requirements.

The PBA will assume comprehensive responsibility for administering pharmacy claims processing, prior authorization management, pharmacy audits, drug utilization review, rate setting for State Maximum Allowable Cost rates, preferred drug list management, and federal and state supplemental drug rebate administration. The contractor must maintain an Indianapolis office within walking distance of the Indiana Government Center and integrate with the State's MuleSoft API Gateway, OAuth 2.0 security protocols, and GoAnywhere Managed File Transfer systems. The contractor must develop and execute comprehensive disaster recovery and business continuity plans with maximum tolerable downtime not exceeding 24 hours and interface with multiple state systems including the Enterprise Data Warehouse and State MMIS. Twenty percent of monthly maintenance and operations costs allocate to a performance incentive pool earned through achievement of Key Performance Measures, with deductions ranging from $500 to $15,000 monthly per missed KPM. The contractor must perform seven years of historical medical and pharmacy claims data conversion and provide comprehensive staff training.

The contract is awarded for an initial four-year term with two optional one-year renewals available at the State's discretion. Evaluation criteria: mandatory requirements (pass/fail), management assessment and quality (50 points), price (30 points), IVOSB commitment (5 points with 1 bonus point), and INSBP participation (5 points with 1 bonus point). Pricing must remain firm for a minimum of 180 days from award issuance. The State reserves the right to request Best and Final Offers and may conduct oral presentations, demonstrations, and site visits. Respondents must comply with HIPAA, ARC-AMPE security controls, 42 CFR 438 Medicaid Managed Care rules, the Americans with Disabilities Act, and submit separate electronic proposal files for Executive Summary, Business Proposal, Technical Proposal, Cost Proposal with narrative, Attestation Form, Infrastructure Overview, and AI Technical Proposal Questions. Cloud-based solutions must deploy within a State of Indiana-owned cloud tenant provisioned through Microsoft Azure or Amazon Web Services; exception-based vendor-hosted solutions require demonstrated significant value and NIST 800-53 Revision 5 compliance justification.