Pharmacy Benefits Manager

The Nevada Department of Health and Human Services (DHHS), specifically the Office of HIV (OoH), is soliciting proposals for a Pharmacy Benefits Manager (PBM) to support the AIDS Drug Assistance Program (ADAP) and Nevada Medication Assistant Program (NMAP). The procurement targets a comprehensive PBM contract to manage pharmacy benefits for three client groups: uninsured, insured, and Medicare-eligible individuals living with HIV/AIDS. Vendors must demonstrate at least ten years of PBM experience and provide services including claims processing, pharmacy network management, formulary management, medication therapy management, electronic prescribing, prior authorization, and reporting capabilities. The RFP evaluation will weight vendor experience at 30%, familiarity with AIDS Crisis Task Force (ACTF) at 35%, RFP term conformance at 40%, clinical expertise at 20%, and key personnel availability at 20%, with cost representing 45% of the total evaluation. Proposals are due on April 21, 2025, at 2:00 PM Pacific Time, with a planned five-year contract term including one year of implementation and transition planning.

The procurement offers a 5% preference for Nevada-based businesses and requires vendors to have an active Nevada business license and sam.gov registration. Mandatory vendor qualifications include compliance with state procurement regulations and familiarity with federal Ryan White Part B program resources. The current client utilization demonstrates approximately 727 uninsured clients, 1,224 insured clients, and 574 Medicare clients annually. Insurance requirements are comprehensive, including Commercial General Liability ($5,000,000 aggregate), Technology Errors & Omissions/Professional Liability ($5,000,000 per claim), Network Security and Privacy Liability ($5,000,000 per occurrence), and a Fidelity Bond of $1,000,000. While no specific budget range is explicitly stated, the contract will be funded through Ryan White Part B program resources, with reimbursement following a "lesser of" cost calculation using metrics like National Average Drug Acquisition Cost (NADAC), Wholesale Acquisition Cost (WAC), and Federal Upper Limit (FUL).