SOLE ECONOMICALLY FEASIBLE SOURCE / Pharmacy Benefit Management System (PBMS)

The State of Illinois, through the Department of Healthcare and Family Services (HFS), is procuring a Pharmacy Benefit Management System (PBMS) as a sole economically feasible source contract. The PBMS will support the state's $37.65 billion Medicaid program, serving approximately 3.9 million customers through over 133,000 providers. The PBMS must provide a secure portal for accessing applications, claims data, drug formulary, and prior authorization management. Key requirements include real-time adjudication of pharmacy claims, coordination of benefits, formulary and rate maintenance, and drug rebate management. The current vendor, Change Healthcare Pharmacy Solutions, Inc., has been providing these services since 2014 and the state has determined they are the sole economically feasible source due to the extensive customization of the system for Illinois' unique Medicaid program requirements. The proposed one-year contract term, with no renewal options, has an estimated initial value of $5,357,822.75.

There are no set-aside designations or restrictions on the types of organizations that can respond, as this is a sole source procurement. The current vendor, Change Healthcare Pharmacy Solutions, Inc., is the incumbent and the state has determined their pricing to be fair and reasonable based on a review of other states' pharmacy benefit programs. The PBMS contract does not specify any pricing set-asides, but the state will allocate a block of hours at the start of each contract year for system modifications requested and approved by the state.