UMP Pharmacy Benefit RFI

The Washington State Health Care Authority (HCA) is issuing a Request for Information (RFI) to gather detailed data from experienced Pharmacy Benefit Administrators (PBAs), Pharmacy Benefit Managers (PBMs), and Third‑Party Administrators (TPAs) on how they would administer a self‑insured pharmacy benefit for the Uniform Medical Plan (UMP), covering roughly 435,000 members of the Public Employees Benefits Board and School Employees Benefits Board. The RFI seeks comprehensive responses covering implementation, network design, claims processing, data integration, clinical management, financial modeling, performance guarantees, and innovative value‑based approaches. HCA intends to use this information to shape a future competitive procurement, but no award will be made from this RFI alone. • Target population: ~435,000 members (commercial and Medicare Part D). • Scope includes end‑to‑end pharmacy benefit administration – from eligibility loading to claims payment, formulary management, reporting, and compliance. • Mandatory submission format: electronic PDF/Word ≤30 pages, due October 9 2026. • Key contacts: Jerry Nichols (RFI Coordinator) – (360) 725‑9545, [email protected].