Worker's Compensation Cost Containment Service - Pharmacy Benefit Management

The City of Albuquerque is seeking a Pharmacy Benefit Management (PBM) provider for its Risk Management Division, specifically to administer prescription drug programs related to workers' compensation claims. This Request for Proposals (RFP) aims to establish a contract for comprehensive PBM services, including processing and payment of pharmacy claims, formulary development, pharmacy network contracting, and negotiating manufacturer discounts and rebates. The procurement will require a qualified vendor to develop an electronic interface with the City's Origami Risk claims management system while maintaining HIPAA compliance and data security protocols. Proposals are due on February 6, 2026, at 4:00 p.m. Mountain Time, with electronic submission required through the City's Bonfire eProcurement system. The evaluation will be weighted 80% on technical criteria (experience, performance, scope response, approach, and innovation) and 20% on cost, with the most advantageous proposal selected. The anticipated contract term is three years, with potential for two one-year extensions, not to exceed five years total, and service commencement expected by July 1, 2026.

No specific set-aside designations or restrictions for disadvantaged enterprises were explicitly mentioned in the available documentation. The contract will require the successful vendor to maintain specific insurance coverage, including $1,000,000 in cyber liability/professional liability, $2,000,000 in commercial general liability, and workers' compensation coverage. Historical pharmacy cost data suggests annual fee schedule amounts ranging from $253,715 to $275,933, with associated savings between $91,760 and $113,857 across approximately 1,091 to 1,231 annual transactions. Pricing proposals must be based on Average Wholesale Price (AWP) discounts using Medi-Span publication values as of October 1, 2025, with alternative publications permitted if they can demonstrate greater savings. The current pharmacy program demonstrates a 99% in-network penetration rate, with a prescription mix of 89% generic and 11% brand medications, which may provide context for potential bidders about the current service landscape.