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Suffolk County, New York is soliciting proposals through Request for Proposals (RFP) No. 2026-04 for comprehensive Pharmacy Benefit Management (PBM) services to administer the Commercial Prescription Drug Plan for the County's self-insured Employee Medical Health Plan (EMHP), covering approximately 34,000 covered lives among active employees and non-Medicare retirees. The procuring entity is the Suffolk County Office of Central Procurement on behalf of the County Executive and the EMHP Labor/Management Committee. The selected PBM contractor must provide full-service pharmacy benefit management including claims adjudication, eligibility maintenance, utilization review, formulary management, rebate administration, specialty pharmacy management, clinical programs, and member services utilizing a fully transparent pricing model with 100% pass-through of manufacturer rebates and actual ingredient costs plus dispensing fees. Key deliverables include implementation of the plan by January 1, 2027, maintenance of comprehensive performance guarantees covering implementation, payment accuracy, system uptime, eligibility processing, reporting timeliness, and member service standards, and compliance with HIPAA, ERISA, and the Affordable Care Act requirements. Proposers must demonstrate qualification as a full-service principal PBM and agree to transparent, component-level pricing with guaranteed AWP discounts, dispensing fees, and minimum rebate guarantees on a dollar-for-dollar basis with no cross-channel offsets. The County reserves the right to conduct unlimited audits with 36-month historical lookback periods at no additional charge, requiring 100% claims audits off-site and on-site sampling of at least 350 claims. Critical procurement deadlines include an Intent to Propose Form deadline of February 2, 2026, at 3:30 PM EDT, technical questions due by February 9, 2026, and proposal submission deadline of March 12, 2026, at 3:30 PM EDT via the Bonfire portal. The contract is effective January 1, 2027, with an initial three-year term (January 1, 2027 through December 31, 2029) and two optional one-year renewal periods at the County's sole discretion.

The RFP documentation does not identify specific set-aside designations or restrictions limiting response to disadvantaged enterprises or particular organization types; however, all vendors must complete the Suffolk County Compliance Packet, which includes certification of non-collusion in bidding, disqualification statements, union organizing declarations, living wage certifications (requiring minimum $17.86 per hour with health benefits or $18.02 per hour without benefits for compensation exceeding $10,000), and compliance with federal employment law and non-discrimination policies. No incumbent contractor is identified in the available documentation. Proposers who submit an Intent to Propose Form will receive secured access to three years of monthly paid claims experience, enrollee census data stratified by active status, Medicare eligibility, gender, relationship, zip code, and year of birth, and network access information provided by the Plan's current Actuarial and Benefits Consultant, Segal. The contractor must execute a HIPAA Business Associate Agreement and maintain Commercial General Liability insurance of at least $2,000,000 per occurrence and Professional Liability insurance of $2,000,000. No specific award value or budget range is disclosed in the RFP documentation; however, administrative fees are structured on a per-member-per-month basis while dispensing fees apply per prescription paid, with detailed pricing guarantees and rebate reconciliation mechanisms subject to County audit and enforcement of performance guarantees with dollar amounts at risk to be determined during the procurement process.