Minnesota Supplier Systems #2000018078

Minnesota Seeks Pharmacy Benefit Manager Auditing Services for State Employee Insurance Programs

Minnesota Management & Budget (MMB) is seeking a qualified vendor to provide comprehensive auditing services for the State's Pharmacy Benefit Manager (PBM), currently CVS Caremark, supporting the State Employee Group Insurance Program (SEGIP) and Public Employees Insurance Program (PEIP). - Government Buyer: - State of Minnesota, Minnesota Management & Budget (MMB) - OEMs and Vendors Mentioned: - CVS Caremark (current PBM vendor) - Products/Services Requested: - Comprehensive PBM auditing services, including: - Plan design benefits audit - Financial and pricing audits - Eligibility audits - Manufacturer-derived revenue (rebate) audits - Performance guarantee audits - Fraud, waste, and abuse (FWA) audits - Analyses and reporting - Optional: Real-time claims monitoring, market checks, procurement assistance - Scope covers approximately 1.5 million pharmacy claims for 169,000 covered lives - Unique or Notable Requirements: - Vendor must have at least three years of experience evaluating rebate contracts and pass-throughs between PBMs and manufacturers - No conflict of interest with the current PBM (CVS Caremark) - Open to Minnesota-based small businesses, including those owned by minorities, women, veterans, and persons with disabilities - Annual audits required for up to five years, with an initial two-year term and options to extend - Attachments include sample contract, business associate agreement, and data privacy/security agreement

Description

Minnesota Management and Budget is seeking proposals to select a vendor to provide auditing services for the State's pharmacy benefit manager (PBM). The objective is to ensure the PBM accurately administers the State Employee Group Insurance Program (SEGIP) and the Public Employees Insurance Program (PEIP) pharmacy benefits according to contract terms. The selected vendor will perform traditional audits, manufacturer-derived revenue (rebate) audits, analyses, and reporting to verify financial and pricing terms, controls, and cost-containment measures. Additional services such as real-time claims monitoring, market checks, or procurement assistance may be proposed.

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