Workers Compensation Pharmacy Benefit Network

The City of Long Beach is seeking a qualified Pharmacy Benefit Manager (PBM) to operate a Workers’ Compensation Pharmacy Benefit Network for its employees. The contractor will provide full prescription‑drug claim processing, formulary management, generic‑conversion programs, real‑time eligibility verification, and extensive reporting while complying with California workers’‑compensation regulations. The contract is a two‑year base agreement with up to three one‑year renewal options (maximum five years) and will be awarded to the firm offering the most cost‑effective solution that meets the City’s performance metrics. • Provide end‑to‑end PBM services: claims adjudication, formulary updates, network pharmacy access, and first‑fill protocols. • Meet performance KPIs such as ≥ 90 % generic dispensing, 24/7 help‑desk support, and rapid medication authorization (≤ 72 hrs standard, ≤ 24 hrs urgent). • Ensure full compliance with California workers‑compensation statutes, DMHC licensing, and electronic billing requirements, while delivering transparent, pass‑through pricing and returning all manufacturer rebates to the City.