Texas DIR/ESBD #HHS0017240

Texas DSHS seeks a Pharmacy Benefits Manager for HIV medication assistance programs

Texas DSHS is seeking a Pharmacy Benefits Manager to administer prescription benefits for its HIV medication assistance programs. - Government buyer: Texas Department of State Health Services (DSHS), through the Texas HIV Medication Program (THMP); procurement administered by Health and Human Services Commission Procurement and Contracting Services (HHSC PCS). Texas Health and Human Services is also identified in the materials. - Services requested: One PBM to manage prescription benefits, premium payments, and copayments for SPAP, TIAP, and TIAP-PLUS, acting as a secondary payor alongside insurers, Medicare Part D plans, self-insured companies, pharmacies, and government programs. - Estimated workloads and pricing units: 101,460 medication claims per year (equivalent to 8,455 per month), priced per claim; 334 premium-payment participants per month, priced per member per month. The pricing model also includes fixed-fee transition and turnover work and an optional blended hourly rate for supplemental services. - Notable requirements: Real-time point-of-sale claim adjudication; pharmacy network management; claims-level data, reporting, cost-containment controls, training, and administrative coordination; English- and Spanish-speaking help-desk staff; coordination with CMS and SPAP; and transition, disaster-recovery, and turnover planning. A SaaS portal provider must obtain TX-RAMP Level 2 certification before award. - OEMs and vendors: No commercial OEMs, vendors, or specific products are named; this is a services procurement. - Estimated value: The notice estimates $120 million. The attachments cite historical compensation of approximately $15 million per state fiscal year for similar contracts.

Description

The Texas Department of State Health Services requests proposals from qualified entities to provide pharmacy benefits management services for the Texas HIV Medications Program, including SPAP, TIAP, and TIAP-PLUS. The selected Pharmacy Benefits Manager will manage certain prescription drug benefits, premium payments, and copayments as a secondary payor to health insurers, managed care organizations, self-insured companies, retail pharmacies, and government programs. The solicitation lists an estimated value of $120,000,000 and a response deadline of November 19, 2026, at 10:30 AM.

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