Delaware My Market Place #DHR25006A-PBM

The State of Delaware is seeking a qualified vendor to provide comprehensive Pharmacy Benefit Management (PBM) Services for its state employee health plans. - Government Buyer: - State of Delaware, Department of Human Resources, Statewide Benefits Office (SBO), on behalf of the State Employee Benefits Committee (SEBC) - Scope of Services: - Administration of pharmacy benefits for approximately 124,334 members, covering both commercial (non-Medicare) and Medicare Part D EGWP plans - Prescription claim adjudication, enrollment and eligibility management, formulary management, clinical programs, rebate administration, and integration with medical and wellness programs - Secure data transmission, patient and provider education, network pharmacy management, drug utilization review, fraud detection, mail order and specialty pharmacy services, and member support - Extensive reporting requirements: eligibility, enrollment, claims, rebate, subsidy, and financial reports delivered to multiple state offices and carriers (Aetna, Highmark, IBM Watson, CareVio, Delaware Health Information Network) - Performance guarantees with a portion of fees at risk, tied to claims accuracy, system uptime, data feeds, member communications, and issue resolution - Mandatory compliance with Delaware data storage regulations (no non-public data stored or transferred outside the US) - Transparency, audit rights, and detailed project/account management plans required - Notable Requirements: - Vendors must attend a mandatory pre-proposal meeting - Strict reporting and accuracy standards, with penalties for non-compliance - Open enrollment support and ongoing account management - OEMs and Vendors: - No specific OEMs are named; the PBM must interface with major carriers and reporting systems (Aetna, Highmark, IBM Watson, CareVio, DHIN) - Period of Performance: - Initial term: 2 years for commercial PBM (July 1, 2027 – June 30, 2029), 2 years for EGWP (Jan 1, 2028 – Dec 31, 2029) - Three one-year renewal options for each term - Place of Performance: - Statewide Benefits Office, 841 Silver Lake Boulevard, Suite 100, Dover, DE 19904 - Coordination with multiple Delaware state offices and carriers

The Delaware Department of Health and Social Services is soliciting proposals for Pharmacy Benefit Management Services to administer its pharmacy benefits program. The solicitation was released on March 25, 2026, with a mandatory pre-proposal meeting scheduled for April 2, 2026, and proposals due by April 27, 2026. The contract includes detailed performance guarantees, reporting requirements, and account management expectations. Interested vendors must submit proposals including any exceptions to the RFP requirements and participate in the mandatory pre-proposal meeting.