Pharmacy Benefits Management Services

The County of Orange Health Care Agency is conducting a Request for Proposals (RFP) for Pharmacy Benefits Management Services, seeking qualified organizations to provide medication distribution services to Orange County residents of all ages who meet medical necessity criteria and lack financial resources. The primary objective is to administer pharmacy claims for multiple populations, including children and youth with Serious Emotional Disturbance, transitional-aged youth, adults with Serious and Persistent Mental Illness, and clients with substance use disorders. Key deliverables include claims administration, maintaining a pharmacy network within Orange County, providing customer service, managing prior authorizations, processing coordination of benefits, and generating comprehensive management reports. The evaluation criteria will score proposals across categories such as provider experience, services, performance objectives, staffing, and budget. The RFP was released on February 5, 2024, with proposals due on February 26, 2024, and services expected to commence on July 1, 2024. The contract will have an initial term with potential renewals contingent on funding, contractor performance, and County policies.

The RFP does not explicitly specify set-aside designations or restrictions for disadvantaged enterprises. The contract will be a hybrid of actual cost and fee-for-service, with funding primarily from Net-County Cost funds, and the County anticipates reimbursing the selected provider(s) monthly in arrears for actual costs up to a not-to-exceed contract amount. While specific budget amounts are not clearly defined, the documentation includes comprehensive budget forms for fiscal years 2024-2025 and 2025-2026, with detailed worksheets for administrative and program costs, staffing, services and supplies, and potential revenue sources. Bidders must provide extensive documentation, including articles of incorporation, by-laws, financial statements, corporate organizational charts, and detailed information about their organization's experience and capabilities. The contract template indicates a potential three-year period from July 1, 2024, through June 30, 2027, with payment structured on a fee-for-service basis. Successful bidders will be required to comply with various regulations, including HIPAA privacy rules, minimum wage laws, and non-discrimination requirements.