RFP for Pharmacy Benefit Manager

The Office of Management and Enterprise Services (OMES) Central Purchasing division is requesting proposals for Pharmacy Benefit Manager services on behalf of the Oklahoma Health Care Authority Employees Group Insurance Division (EGID), with proposals due September 17, 2026, and questions due by August 24. A pre-proposal conference is scheduled for August 17, 2026 at 1:00 p.m. CST via Microsoft Teams.

Bidders must demonstrate a minimum of seven years of commercial and EGWP (Employer Group Waiver Plan) PBM experience, Medicare Part D operations with at least 20,000 covered lives, Oklahoma insurance commissioner administrator licensure, financial stability documentation, and three business references. The scope encompasses pharmacy claims adjudication, customer service, reporting, utilization management, formulary management, and specialty pharmacy administration across approximately 95,701 commercial members (151,316 total participants) and 25,821 primary Medicare Supplement members (28,762 total participants) across all 77 Oklahoma counties and contiguous states, processing approximately 3 million pharmacy claims annually. EGID maintains a transparent pricing model with 100% pass-through of pharmaceutical manufacturer revenue and Group Purchasing Organization fees, fully verifiable and auditable, and an open-network willing provider pharmacy structure. Bidders are encouraged to propose innovative specialty pharmacy solutions rather than exclusive arrangements.

The initial contract term is one year with four optional one-year renewals. Pricing must be firm fixed price for the contract term including optional renewals, with bids remaining firm offers for a minimum of 120 days after the due date. Bidders may propose early payment discounts in five-day increments from 10 to 30 days, expressed in half or whole percentages with a 0.5% minimum. All pricing must be EGID-specific rather than book-of-business averages and must include comprehensive performance guarantees with quarterly measurement and automatic penalty payments for non-compliance. All travel expenses must be included in the total bid price.

Evaluation employs a best value criterion considering experience, quality of response, pricing, data management capabilities, service quality, implementation guarantees, formulary programs, savings models, audits, and compliance with contract terms. EGID reserves the right to conduct Best and Final Offer rounds and reverse auction events, with discretion to eliminate bidders or retain all participants for additional rounds. The contracting officer is Samantha Fox (Samantha.fox@omes.ok.gov, 405-522-6266). All bids must be submitted exclusively through the Oklahoma Supplier Portal.

Bidders must execute a Non-Disclosure Agreement to access the pharmacy data file for pricing purposes and submit an Authority to Operate (ATO) or confirmation of an ATO request with their response. The contract requires compliance with HIPAA, FERPA, CJIS, IRS Publication 1075, SSA and child support data requirements, Oklahoma information security policies, the Drug-Free Workplace Act, Clean Air and Water Acts, Debarment and Suspension requirements, Civil Rights laws, Anti-Lobbying statutes, and E-Verify participation. Vendors must maintain commercial general liability of at least $2,000,000 per occurrence, automobile liability of at least $2,000,000 combined single limit, and security and privacy liability of at least $5,000,000 per occurrence if accessing state data. Payment terms are net 45 days from receipt of proper invoices. The contract may be terminated for convenience with 30 days' notice, for cause with 30 days' cure period, or immediately for security violations or administrative errors. Administrative review deadline is August 18, 2026.