Project Information

Bid Title

Request for Proposal for Pharmacy Benefit Management and Claims Administration Program

Issuing Agency

Orange County

Location

California

Published Date

Jan 7, 2025

Closing Date

Feb 13, 2025

Government Level

State & Local

Status

Closed

Ref. #

017-202407-KA

Original Source

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Project Description

Project ID: 017-202407-KA

Title: Request for Proposal for Pharmacy Benefit Management and Claims Administration Program

Addenda: 0

Release Date: 1/7/2025

Due Date: 2/13/2025

Post Information

Posted At:Tue, Jan 7, 2025 4:00 PMSealed Bid Process:Yes (Bids Sealed / Pricing Sealed)Private Bid:No

Overview

Summary

This Request for Proposal (RFP) is being released for a Pharmacy Benefit Management and Claims Administration Program. This RFP is an opportunity to allow qualified vendors to present proposals that will assist the County of Orange, HRS/Employee Benefits in selecting a contractor that will best meet the needs of the County for a three (3) year contract with two (2) optional one (1) year renewal terms. Services will be according to the Scope of Services stated in Attachment A of the Model Contract.

Background

The County currently provides a carve-out pharmacy program through OptumRx, as the Pharmacy Benefits Manager (PBM) for its self-funded PPO (Preferred Provider Organization) health plans administered through Blue Shield of California (Blue Shield). The carve-out pharmacy program is available to members enrolled in the County’s two types of medical plans – Sharewell and Wellwise. A key differentiator between Wellwise and Sharewell is that Sharewell is a High Deductible Health Plan (HDHP) design, and medical and pharmacy expenses are combined for the deductible and out of pocket maximum. For the Wellwise plans, there are different deductibles and out of pocket maximums for medical and pharmacy benefits. Sharewell and Wellwise are offered to employees, non-Medicare and Medicare retirees, and their dependents. The Wellwise Retiree Medicare PPO pharmacy benefit program is an Employer Group Waiver Plan (EGWP). All Sharewell PPO plans are non-creditable coverage.

Timeline

Release Project Date:

January 7, 2025

Question Submission Deadline:

January 14, 2025, 4:00pm

Question Response Deadline:

January 21, 2025, 4:00pm

Proposal Submission Deadline:

February 13, 2025, 4:00pm

Evaluation of Proposals:

February – March 2025

Respondents Oral Presentations:

March 27, 2025

Evaluation of Financial Review:

March – April 2025

Submission for Approval of Final Contract by the Board of Supervisors:

August 12, 2025

Commodity Codes

• NAICS 541611Administrative Management and General Management Consulting Services

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