Pharmacy Benefit Management Services

The State of Delaware’s Department of Human Resources is seeking a single prime Pharmacy Benefit Management (PBM) vendor (or a joint‑venture with a designated prime) to administer its statewide commercial pharmacy benefit and its Employer Group Waiver Plan (EGWP) Medicare Part D benefit for state employees, retirees, dependents, non‑payroll groups, and COBRA participants. The contract requires full‑scope PBM services—including claims adjudication, enrollment processing, network management, formulary and rebate administration, utilization review, clinical programs, fraud‑waste‑abuse detection, mail‑order and specialty pharmacy operations, member portal support, extensive reporting, and integration with medical TPAs—while retaining all decision‑making authority with the State. Performance guarantees cover claim‑payment accuracy, system uptime, data‑feed timeliness, member‑service metrics, and financial‑risk penalties. The contract period runs from July 1 2027 (commercial) and January 1 2028 (EGWP) for two years, with up‑to‑three optional one‑year extensions. • Full‑service PBM responsibilities: claims processing, enrollment, network and formulary management, rebate pass‑through, utilization management, clinical programs, and FWA detection. • Mandatory pre‑proposal meeting (April 2 2026) and strict submission deadline (April 27 2026 1 PM EST). • Performance‑guarantee framework tying up to 100 % of fees to specific service‑level metrics, with penalties and fee‑at‑risk provisions. • Required data‑security compliance (FIPS 140‑2 encryption, U.S. data residency) and a detailed NDA/Data Confidentiality Agreement.