RFP - Pharmacy Benefit Managers Oversight and Reform Implementation Services

The State of Illinois Department of Insurance is requesting proposals for Pharmacy Benefit Manager (PBM) oversight and reform implementation services under RFP 26-446DOI-FINAD-B-50721, with proposals due September 30, 2026. The solicitation implements the Prescription Drug Affordability Act (H.B. 1697) and represents a new program with no incumbent contractor.

Illinois requires submission of a Business Enterprise Program (BEP) Utilization Plan demonstrating certified minority-owned, women-owned, and disadvantaged business enterprise participation; the plan establishes measurable BEP participation goals and becomes a binding commitment if the proposal is selected. Vendors not already registered in the Illinois Procurement Gateway must submit a Vendor Disclosure form (formerly Forms A) and, for contracts valued over $100,000 annually, must complete comprehensive Financial Disclosures and Conflicts of Interest sections. Vendors claiming Illinois procurement code preferences such as the Domestic Product Preference must provide supporting documentation.

The scope requires direct oversight and reform implementation services addressing PBM compliance with federal and state laws. Offerors must demonstrate at least five years of direct experience assessing PBM compliance and expertise in eliminating spread pricing, rebate pass-through, maximum allowable cost pricing, and appeals processes. This required experience must be held by the prime offeror; subcontractor experience does not satisfy the requirement unless the RFP explicitly permits it. All reports, findings, and recommendations generated under the contract are for internal use only, though they may be obtained through Freedom of Information Act requests.

The Department of Insurance plans to engage multiple vendors and will publicly disclose which vendors were awarded and their tier designation (primary, secondary, or tertiary) upon award. The procurement requires all services to be performed in the United States unless otherwise disclosed. Vendors must disclose all subcontracts valued at $100,000 or more and promptly report any changes to subcontractors during contract performance to the State Purchasing Officer or Chief Procurement Officer.