Request for Proposal Pharmacy Benefit Management Services to the Self-Insured EMHP For the Employer Group Waiver Prescription Drug Plan with Wrap (“EGWP”)l - Template

The County of Suffolk, New York, is soliciting proposals from qualified pharmacy benefit management (PBM) firms through Request for Proposals No. 2026-03 to administer the Employer Group Waiver Prescription Drug Plan (EGWP) with Wrap coverage for the self-insured Employee Medical Health Plan (EMHP), serving approximately 46,500 covered lives including 21,000 enrollees and 12,500 Medicare-eligible retirees and dependents. Proposers must be full-service principal PBMs only; brokers and firms outside the scope of this requirement are prohibited. Key deliverables and objectives include full claims administration, provision of a transparent pricing model with 100% pass-through of all manufacturer rebates, discounts, and compensation, plus actual ingredient costs and dispensing fees, and comprehensive performance guarantees measured quarterly and subject to audit with penalties for non-compliance. Required qualifications include demonstrated expertise as a principal third-party claims administrator, HIPAA compliance capability, fiduciary authority, coordination of benefits administration, and the ability to maintain extensive audit rights for claims data and rebate contracts spanning up to 36 months of historical claims. Evaluation criteria allocate 25 points to pricing proposals, 20 points to general qualifications, and 55 points to proposed technical services; all submissions must include detailed financial schedules with AWP-based drug reimbursement guarantees, minimum rebate guarantees, generic dispensing rate guarantees, and specialty pharmacy pricing for all three contract years. Critical deadlines include the Intent to Propose Form submission by February 2, 2026, technical questions due by February 9, 2026, and proposal submission by March 12, 2026, all at 3:30 PM EST/EDT; the contract becomes effective January 1, 2027, with an initial three-year term through December 31, 2029, and optional renewal periods of up to two additional one-year terms at the County's discretion. All submissions must be made electronically through the Suffolk County Bonfire portal, and late proposals will be rejected.

The procurement documents do not identify any set-aside designations specifically for disadvantaged enterprises, minority-owned businesses, or other restricted bidder classifications; however, all proposers must comply with Suffolk County's Living Wage Law, non-discrimination requirements, lawful hiring practices under federal immigration law, and child sexual abuse reporting policies. No incumbent vendor or current contractor is identified in the solicitation materials. The model contract specifies comprehensive insurance requirements including Commercial General Liability of $2,000,000, Professional Liability of $2,000,000, and other coverage as specified, along with mandatory compliance with the Comptroller's Rules and Regulations for Consultant's Agreements and seven-year record retention following final payment. No specific award value or budget range is disclosed in the procurement documents, as pricing proposals will be evaluated based on the County's assessment of value and service quality relative to submitted bids. The contract is subject to annual appropriation of funds by the County Legislature, with payment due within thirty days of Comptroller approval of submitted vouchers, and the County reserves the right to terminate without cause upon thirty days' notice or for cause upon five days' notice in the event of default. All work product and intellectual property developed under the contract become the sole property of the County of Suffolk.