Pharmacy Benefits Management Services

The County of Orange Health Care Agency is seeking proposals for Pharmacy Benefits Management Services through Request for Proposal (RFP) No. 042-1616186-JFC. The primary objective is to provide medication distribution services to Orange County residents of all ages who meet medical necessity criteria and lack financial resources. Qualified organizations will be responsible for administering and processing pharmacy claims, managing network pharmacies, providing customer service, and generating comprehensive reports. The services will cover two distinct programs: Behavioral Health Services (BHS) and Managed Services Network (MSN), each with separate formularies. Key deliverables include comprehensive pharmacy benefits management, claims adjudication, and medication distribution across Orange County. The proposal is due on January 23, 2024, with services expected to commence on July 1, 2024. The initial contract term is one year, with potential renewals contingent on funding, contractor performance, and county policies. Evaluation criteria will likely include organizational experience, service capabilities, financial stability, and compliance with county requirements.

The RFP does not explicitly mention specific set-aside designations or restrictions for disadvantaged enterprises. The contract is structured as a hybrid actual cost and fee-for-service model, primarily funded by Net-County Cost funds, with monthly reimbursements to the selected proposer(s) up to a not-to-exceed contract amount. The County anticipates the possibility of multiple contract awards and has designed this as a cooperative contract that may be utilized by other Orange County departments and governmental entities. While specific budget ranges are not definitively stated in the documents, the budget forms provide templates for comprehensive financial reporting across fiscal years 2024-2026. The contract template indicates potential three-year duration from July 1, 2024, through June 30, 2027, though the maximum financial obligation is currently marked as "to be determined". Prospective bidders must demonstrate robust capabilities in pharmacy benefits management, including comprehensive insurance, compliance with federal and state regulations, and ability to handle confidential health information.