Workers Compensation Pharmacy Benefit Network

The City of Long Beach Department of Human Resources' Workers' Compensation Division is soliciting proposals for pharmacy benefit network services under RFP HR-24-380, with proposals due October 7, 2026 at 11:00 a.m. PST and questions due September 9, 2026. Local preference points are available to qualified local businesses maintaining a principal place of business within Long Beach with current business license and seller's permit.

The scope encompasses prescription drug claims processing and adjudication incorporating California's Administrative Director formulary standards, customized formulary development, statewide 24/7 pharmacy network access, brand-to-generic conversion programs, portal access and training for claims departments, comprehensive usage and cost reporting, and completion of all State of California injured workers' pharmacy reporting requirements. The City's 2025 pharmacy data shows 5,927 transactions (4,263 retail, 396 home delivery) with total savings of $554,931 against $1.25 million reference price at 37.06% savings rate; the City covers approximately 6,000 employees with approximately 1,900 open workers' compensation claims.

Minimum qualifications require five years of pharmacy benefit program administration with at least three years of California workers' compensation experience, current California Department of Managed Health Care licensure in good standing, and statewide network capability. Cost proposals must itemize implementation, administrative, transaction, dispensing, and rebate fees on an annual basis with one-time startup costs separated; the City will not require use of a standardized cost template.

The contract term is two years initial with three optional one-year renewals, not to exceed five years. Evaluation weights are organizational capacity and experience (30 percent), method of approach (40 percent), communications and reporting (20 percent), and cost reasonableness (10 percent). Insurance requirements include commercial general liability ($1 million per occurrence / $2 million aggregate), professional liability ($1 million per claim), and California-mandated workers' compensation coverage. The incumbent contractor is Optum/Timesys; the claims system is Riskonnect. Addendum No. 1 (Q&A) was posted addressing 28 proposer questions; proposers must acknowledge receipt and submit it with proposals to remain responsive.