Specifications include, but are not limited to: The State intends to secure a contract with a single Pharmacy Benefits Manager (PBM) for pharmacy benefit account management, network and Formulary management, utilization management, custom clinical programs as required, and an online Point-of-Sale (POS) pharmacy claims processing system. The PBM shall establish and maintain its broadest available national pharmacy provider network, a Mail Order network, and a statewide any willing pharmacy provider network of Retail-30 Pharmacies, 90-DayAt-Retail Pharmacies, Specialty Pharmacies, and vaccine network administering pharmacies. The POS system shall include prospective/concurrent Drug Utilization Review (DUR), retrospective Drug Utilization Review (Retro-DUR), reporting capabilities, adjudication capabilities, and full pharmacy benefit Member services for retail-30, 90-day-at-retail, Mail Order, Specialty, and vaccine Pharmacy benefits for Members of the Plans (Plan). The Contractor shall perform all services described in the Scope of the pro forma contract (RFP Attachment 6.6). The State is seeking a PBM partner who can help appropriately manage the State Group Insurance Program’s (SGIP) pharmacy spend, which continues to be a cost driver, by ensuring Members receive the most clinically appropriate treatment in the right setting at the lowest cost for both the Member and the State.
