Nevada State Pharmacy Benefit Manager

The State of Nevada is seeking a single vendor (or potentially two) to serve as the Pharmacy Benefits Manager (PBM) for both the Nevada Medicaid program (covering both fee‑for‑service and managed‑care members) and the Public Employees Benefit Program (PEBP). The contract is a fixed‑price, six‑year multi‑year agreement with two optional one‑year extensions, beginning in June 2027 with service commencement dates in 2028‑2029. The vendor must provide end‑to‑end PBM functions—including claims adjudication, formulary and clinical management, financial operations, reporting, and transition/implementation services—while complying with extensive Nevada state insurance, data‑privacy, and cybersecurity requirements (e.g., GovRAMP‑compliant cloud hosting, HIPAA Business Associate Addendum, and a detailed insurance schedule). The solicitation requires extensive technical and cost proposals, mandatory references, and certification that the vendor holds a Nevada DOI TPA registration (or can obtain it within 45 days of award). All submissions must be made electronically through nevadaepro.com by the deadline. • Provide full PBM services for Nevada Medicaid (≈ 764,757 lives) and for Nevada public‑employee health plan (≈ 72,000 lives). • Deliver claims processing, formulary management, clinical oversight, financial administration, and required reporting for a six‑year term (04/01/2028 – 03/31/2032) with optional extensions. • Meet rigorous security and compliance standards: GovRAMP‑authorized cloud hosting, HIPAA Business Associate Addendum, $5 M+ insurance limits, and Nevada DOI TPA registration. • Submit separate technical and cost proposals, client‑reference questionnaires, and required certifications by 12/29/2026.