Pharmacy Benefits 2025-2026
Closed State & local contract opportunity Posted
- Solicitation number
- 2025-011
- State
- Texas
- Responses due
Opportunity facts
- Jurisdiction
- Points of contact
-
- Lorena Fuentes lfuentes@cityofedinburg.com (956) 388-8972
- Ian Hernandez ian.hernandez@seattle.gov (206) 684-0128
- Evan Markewich emarkewich@ci.zephyrhills.fl.us (813) 780-0000
Opportunity details come from procurement.opengov.com. Updated .
About this opportunity
The City of Edinburg, located in Hidalgo County, Texas, is seeking proposals for a Pharmacy Benefit Management (PBM) services contract through RFP #2025-011, with a specific requirement for 100% Pass-Through Modeling. The procurement is designed to provide comprehensive pharmacy benefits management for approximately 1,300 full-time employees, 60 part-time employees, and 118 retirees under the city's fully insured plan. The contract term is initially one year, with options to renew for two additional one-year terms, contingent on no changes in terms, conditions, or insurance rates not exceeding a 5% annual increase. Proposals are due electronically by 3:00 p.m. on July 29, 2025, with a deadline for questions set for July 21, 2025, at 5:00 p.m. The city will evaluate proposals based on seven weighted criteria: vendor experience working with cities (10 points), completed questionnaires and rate sheets (15 points), plan design and contract language (20 points), cost (20 points), multi-year rate guarantees (15 points), management reporting and services (10 points), and staff experience (10 points).
Proposing companies must be licensed by the Texas Department of Insurance and permitted to contract with the state or its subdivisions, with insurance carriers required to be rated by AM Best Company. While the RFP does not explicitly mention set-aside designations for disadvantaged enterprises, the evaluation criteria include a category that considers the impact of contracting with historically underutilized businesses. The city reserves the right to award the contract to the bidder providing the best value, emphasizing that price alone will not be the sole determining factor. Based on the historical claims data provided in the supporting documents, the annual medical and pharmacy premiums range from approximately $8.7 million to $9.6 million, with total paid claims typically around $7.3 million to $7.9 million. The current pharmacy benefits are managed through Blue Cross and Blue Shield of Texas, and the new contract will require seamless integration with existing healthcare infrastructure and reporting systems.
Opportunity text
This RFP is to provide minimum requirements, solicit proposals and gain adequate information from which the City may evaluate the vendor's products and services which include Pharmacy Benefit Management services. Only 100% Pass-Through Modeling will be considered; no Traditional Modeling.
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