SOLE SOURCE / Pharmacy Benefit Management System (PBMS)

The State of Illinois Healthcare and Family Services (HFS) is pursuing a sole source procurement for a Pharmacy Benefit Management System (PBMS) from Change Healthcare Pharmacy Solutions, Inc. The contract is designed to provide a temporary bridge solution for pharmacy services while preparing for a future competitive procurement, triggered by a recent cybersecurity incident. The system must support critical pharmacy claims processing for approximately 3.9 million Illinois Medicaid customers, with comprehensive requirements including real-time claims adjudication, electronic prior authorization submissions, drug formulary management, and web-based interfaces. Key deliverables include operations and maintenance, national drug file services, state Maximum Allowable Cost (MAC) services, pharmacy claims switching, PBMS hosting services, and application support. The system must be hosted in a Tier II or above commercial data center within the United States, with dedicated infrastructure ensuring data segregation and confidentiality. The procurement timeline indicates a contract period from August 1, 2025, to March 31, 2027, with a critical deadline of June 25, 2025, at 4 p.m. for potential written comments or public hearing requests.

The sole source contract does not explicitly outline specific set-aside designations or restrictions on responding organizations. The procurement involves both State Appropriated Funds and Federal Funds, with a total estimated contract value of $14,536,291.65 and supports a $2.4 billion annual Drug Rebate program. The system must integrate with existing Medicaid Management Information Systems (MMIS) and Enterprise Data Warehouse (EDW) platforms, and support the State Pharmaceutical Assistance Program (SPAP) beginning January 1, 2024. The current system includes over 100 specialized features tailored to Illinois Medicaid program requirements, which justifies the sole source approach to prevent service disruption and maintain access to medications for vulnerable populations. The procurement emphasizes maintaining continuity of pharmacy services while preparing for a future competitive procurement process, with a focus on system customization and minimal operational interruption.