The RFP outlines the requirements for the administration of the pharmacy benefit. The County will evaluate each Proposer’s ability to partner with the County for the long term and in alignment with our core principles. The successful Proposer will demonstrate its ability to administer the current plan and will offer the County long-term opportunities to design, implement, and administer the KingCare pharmacy benefit plan of the future along with our union partners. It will also demonstrate its ability to provide and maintain a best practice cybersecurity program. Proposers are requested to provide their proposal based on the current plan design, as detailed in Exhibit 1. Primary functions of the KingCare PBM are expected to include, but are not limited to, the following: Pharmacy network management Pharmacy claims adjudication Formulary design and management Pharmacy Maximum Allowable Cost (MAC) list that includes most generic drugs Rebate negotiations, management, and processing Data and reporting services Clinical programs/utilization management (prior authorization, step therapy, quantity limits, etc.) Mail order pharmacy management Specialty pharmacy management Eligibility information integration and management Member services and call center management Digital and printed member communications Appeals and complaints Account management Implementation services Current Enrollment and Plan Design Approximately 69% of the County’s employees are enrolled in the KingCare PPO and KingCare Select plans with a total of about 25,000 lives in these plans as of June 2024. The remaining 31% of employees (approximately 11,300 lives) are enrolled in a Kaiser Permanente plan.
