Specifications include, but are not limited to: The City is seeking proposals for the administration of its self-funded pharmacy benefits provided to the employees and their dependents of the City and Participating Entities. For the remainder of this solicitation, any reference to City includes the Participating Entities. The City currently provides unbundled pharmacy benefits to its employees and dependents with Express Scripts Inc. (ESI) as the Pharmacy Benefits Manager (PBM) and Presbyterian Health Plan (PHP) as the administrator of the medical benefits. The City currently has a managed formulary, a 90-day fill requirement on generic medications with select retail pharmacies or mail order option, and an exclusive specialty arrangement through ESI. The City is seeking a similar broad retail network that covers all major retail networks, a similar managed formulary, and PBM interfacing with PHP for medical purposes as well as stop loss reinsurance reporting for its upcoming contract. The coverage will be available for employees of the City during the fiscal year, which begins July 1, 2023, (Fiscal Year 24). The City will contribute eighty percent (80%) of the premium for all tiers of coverage regardless of differences in premium price. Participating Entities may elect different employer contribution percentages than the City.
