The District is seeking proposals for a combined PPO/HMO program including prescription drug benefits for its employees and non-Medicare eligible retirees for the period from January 1, 2026 through December 31, 2028. This program must include a self-insured PPO plan, a fully-insured HMO plan, and self-insured prescription drug coverage. A self-insured HMO option may be considered if it maintains the current plan design of the District. Prescription Drug Coverage - The proposed prescription drug plan should assume duplication of the current plan design without modification. Proposals should include a broad national pharmacy network providing maximum access. The District prescription drug coverage currently includes a mail order program (voluntary) and a step therapy/prior authorization program. The District plan utilizes a Balanced Drug list option through Prime Therapeutics which is narrower than the standard formulary. Proposed formularies should seek to limit member disruption and maximize outcomes (clinically and financially). The District anticipates the successful proposer will be able to provide these products under a single contract; however, the District reserves the right to issue more than one contract if necessary to procure the desired coverage. All proposals are expected to quote the plan design for the medical and prescription drug coverage exactly as described in the reference documents included in Appendix B, unless mandated otherwise by PPACA or other government regulations. Any deviations from those designs must be clearly described in the proposal. The District reserves the right to change plan design features during the term of the agreement. The District is seeking a multi-year contract for these services.
