SLED Opportunity · OHIO · MONTGOMERY COUNTY
AI Summary
Montgomery County seeks proposals for Third-Party Administrator and Pharmacy Benefit Manager services for employee medical plans. Proposals due by April 1, 2026.
The Montgomery County Purchasing Department is issuing a Request for Proposal (RFP) for vendor(s) to submit proposals for a Third-Party Administrator (TPA) for the employee medical plan claims administrative services and/or Pharmacy Benefit Manager services. Montgomery County is requesting responses from highly qualified firms with extensive experience in providing Administrative Services for a public sector employer in order to obtain a competitive net cost. All submissions are due before 1:30 pm on Wednesday, April 1, 2026.
For all questions about the RFP itself, or the contents herein, Proposers must use the OpenGov Question and Answer portal.
For OpenGov questions or issues, please reach out to Jessica Shirley at shirleyj@mcohio.org or call the Montgomery County Purchasing Department at 937-225-4699.
Please note that on Proposal Section 6, Question 1.1 (Non-Disclosure Agreement), a required Cover Letter has been added to the question. This must be completed to properly submit proposal.
Please use the See What Changed link to view all the changes made by this addendum.
• Ingredient cost management, generic dispensing rates, rebate guarantees and pass-through transparency
• Specialty drug cost controls, prior authorization savings, step therapy effectiveness
• Pricing methodology disclosure – AWP discounts, MAC pricing, dispensing fees
• Financial guarantees and performance-based fee structures
• Retail pharmacy network adequacy, geographic coverage, 24/7 access
• Mail-order pharmacy services, 90-day supply options
• Specialty pharmacy network and access to high-cost medications
• Network disruption analysis and transition support
• Formulary design and clinical appropriateness, prior authorization processes and turnaround times
• Step therapy protocols, quantity limits, drug utilization review
• Clinical programs for chronic conditions, medication therapy management
• Formulary updates and communication processes
• Specialty drug management and cost containment, patient support programs
• Clinical oversight for high-cost medications, adherence monitoring
• Site-of-care optimization (medical vs pharmacy benefit)
• Specialty network adequacy and patient access
• Call center performance, pharmacy help desk support, member portal functionality
• Prescription cost transparency tools, formulary lookup capabilities
• Mobile app features, digital ID cards, pharmacy locator tools
• Member education and medication adherence programs
• Implementation timeline and project management, data migration capabilities
• Account team structure, meeting frequency, escalation processes
• Change management support, formulary transition communications
• Integration with medical TPA and other vendors
• Standard reporting (utilization, cost trends, generic rates, rebates)
• Ad-hoc reporting capabilities, self-service analytics platforms
• Data integration with medical claims, real-time reporting access
• Predictive analytics, drug trend forecasting, clinical outcomes reporting
• Claims processing accuracy and turnaround times, electronic prescribing capabilities
• Coordination of benefits, Medicare Part D integration
• Compliance with regulatory requirements (HIPAA, state regulations)
• System reliability, disaster recovery, security protocols
• Service level agreements and financial penalties for non-performance
• Claims processing accuracy guarantees, customer service standards
• Clinical program performance metrics, cost savings guarantees
• Rebate guarantee structures and audit rights
• Public sector references, client retention rates
• Performance history with similar-sized groups, union/civil service experience
• Client satisfaction scores and testimonials
Claims Accuracy & Auto‑Adjudication – financial accuracy %, procedural accuracy %, auto‑adjudication rate; edit logic; resubmission controls.
Turnaround Times – clean claims, appealed claims, coordination of benefits (COB), subrogation effectiveness.
Appeals & Grievances – compliance to timelines, member advocacy, escalation paths, independent review processes.
Coordination Programs – COB, subrogation recoveries, Medicare integration (ESRD, MSP rules), workers’ comp overlap.
Quality Controls & Audit Readiness – internal QA, external audit history, corrective action management.
Network Adequacy & Geo‑Access – time/distance standards, PCP/specialist coverage, rural/underserved coverage. Access to key hospitals and physician, Telehealth/virtual care access
Disruption Analysis – current provider match, out‑of‑network exposure, transition mitigation.
Discounts & Methodology Transparency – allowed amounts methodology, OON repricing
Call Center Performance – speed to answer, abandonment, first call resolution, hours, language access.
Digital Experience & Accessibility – web/mobile app usability, ID cards (digital/physical), provider directory accuracy.
Care Navigation & Advocacy – concierge support, pre‑service estimates, steerage to high‑value providers.
Standard & Ad‑hoc Reporting – monthly/quarterly dashboards; enrollment, claims, utilization, high‑cost claimants, trend, risk scoring, cohorts (conditions/DM).
Self‑Service Analytics – drill‑down dashboard usability, export, data dictionary; scheduled distribution.
Data Integration & Interoperability – integration with payroll/HRIS (UKG), PBM, WellWorks, Omada, Optum (HSA and FSA/COBRA), stop‑loss (TBD).
Data Governance & Ownership – timeliness (e.g., ≤10 business days), quality checks, PHI controls, data residency/segmentation, data ownership language.
Regulatory Coverage – HIPAA/HITECH, MHPAEA, ACA reporting support (as applicable to ASO), NSA (IDR, CAA transparency files), COBRA handoffs.
Public Sector Requirements – open records support, subpoena response, records retention schedules.
Privacy/Security Program – SOC 2 Type II/HITRUST recency & scope; incident response, breach notification SLAs.
Implementation Plan & Timeline – ability to meet OE timeframes, project governance; testing (eligibility, claims feeds to 3rd parties, accumulators); blackout risk mitigation.
Change Management & Communications – member and department leader comms, union stakeholder engagement, onsite presence initial year and ongoing years.
Account Team & Governance – named roles, executive escalation, meeting frequency – onsite and virtual cadence.
Utilization Management & Clinical Case Management – prior auth timeliness, concurrent review, complex case management, social determinants coordination.
Disease & Population Health – diabetes, cardiac, maternity/pre-natal, MSK, oncology; evidence‑based protocols.
Behavioral Health Integration – parity operations, access, crisis lines, collaborative care.
Administrative Fees & Guarantees – PEPM/PEPY fees, run‑out, renewal rate caps, fee at‑risk for performance.
Cost of Care Controls – fraud/waste/abuse (SIU), OON cost controls, site‑of‑care optimization.
Billing Transparency – clear pass‑through vs. spread, disclosure of all revenue streams.
Public Sector References – outcomes, service level history, (preferably unions/civil service environments).
Innovations & Enhancements – virtual care, second opinions, price‑transparency tools, employee education, local economic participation, and DEI commitments.
When was organization established?
Style
01/01/1991
For how many years has the Proposer engaged in services under its present business name?
Has this business operated under a different name?
Please list all former names and the dates during which they were used.
Please provide Federal Employer Identification Number (FEIN)
Please provide Unique Entity Identifier (UEI) Number. If none, please provide reason.
Please provide Workers Compensation Account Number. If none, please provide a reason.
Please provide Unemployment Insurance Account Number. If none, please provide reason.
Are you registered to do business in the state of Ohio?
As stated within the previous question, the Proposer is required to furnish a Certificate of Good Standing from the Ohio Secretary of State showing the right of the proposer to do business in the State. Or, in the case that the proposer is an individual or partnership, the proposer shall certify it has filed, with the Ohio Secretary of State, a Power of Attorney designating the Ohio Secretary of State as the proposer agent for the purpose of accepting service of summons in any lawful legal action.
Please upload the applicable proof based on your current status at the time of this submittal.
Will you be using Subcontractors to carry out the work covered under this project.
Please list the full business name of all anticipated subcontractors, including dba names.
Do Federal, State, or local Affirmative Action or Equal Employment Opportunity rules bind the Proposer?
If yes, has the Proposer filed all required EEO reports to the necessary agencies?
Has Proposer ever filed for reorganization under the bankruptcy laws of Ohio or any other state?
Have you, or any of your principals, within a three-year period preceding award of this agreement been convicted of or been subject to a civil judgment rendered for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property?
Please provide detailed information about the existence of such instances in your organization.
Are you, or any of your principals, presently indicted for or otherwise criminally charged by a governmental entity (Federal, State, or Local) within commission of any of the offenses enumerated in the previous question?
Please provide detailed information about the existence of such instances in your organization.
Are you, or any of your principals, within the three-year period preceding this proposal date had one or more public transactions (Federal, State, or Local) terminated for cause or default?
Are you, or any of your principals, presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency?
Please provide detailed information about the existence of such instances in your organization.
Please download the below documents, complete, and upload.
Please download the below documents, complete, and upload. Please note, this form must be notarized
If you are proposing on the Medical TPA please respond to the following questions. Is your company proposing on the Medical TPA RFP?
All fees or charges related to services must be identified in the fee proposal. List must include but not limited to the following:
All implementation fees or charges must be included in the administration fees quoted. Monthly premium rates should be provided on a composite basis. Brokerage commission should be net of commission. Proposals should assume duplication of the current High-Deductible Health Plan (HDHP) benefit structure. Montgomery County reserves the right to request additional information and clarification.
*Price: The pricing proposal shall consist of the final Fee Schedule submitted. The proposed agreement will be for an initial three (3) year term. If mutually agreeable, the agreement may be extended for two (2) additional one (1) year terms. Please provide pricing for all 5 years. In no case will the combined term (including renewal) exceed five (5) years.
*All fees are assumed guaranteed unless otherwise noted
Please provide a table of organization for your company to include the team that would be working with Montgomery County.
Describe your company’s overall experience and qualifications, especially in the public sector, and include the following information:
Indicate how long your organization has administered health plans and how many clients you currently service in the public sector, with the total number of lives covered noted.
Indicate whether your organization has been known by any other names within the last ten years.
Is your organization anticipating any expansion or reorganization within the next year?
If yes, please explain.
List any characteristics of your organization that you feel distinguishes you from other health plan administrators.
Note: Additional information may be requested from your firm if it’s selected as a finalist.
Please provide the names and related experience for key personnel who would be assigned to manage and/or work directly with this account, in the roles/areas listed below. Please include education, professional work experience.
Account Management Team
Claims Processing
Customer Service
Data Management Systems and/or Information Technology
Please describe the software system used for claims adjudication and benefit/eligibility administration. Please indicate what functions, if any, are not automated and whether your programming/computer support is outsourced or managed internally. Your response should address the following:
Please indicate the physical location(s) of the claims processing facility that would handle/process claims for this group, and the customer service office that would service this account.
For the claims processing facility designated in question 3.1.6, please provide the following information:
Briefly discuss your proposed approach to providing customer service to this group and include the following information:
Provide samples of regular claim reports (detailed claims experience, eligibility, statistical and financial reports) lag reports, stop-loss reinsurance reports, large claim/case management reports, etc., provided to your clients on a regular basis, and indicate the frequency they are issued. Also, please provide examples of ad hoc reports that can be produced and indicate in what format these reports can be produced (i.e. Excel, PDF, etc.)
If a custom report is requested, is that possible? Are there any associated costs with custom reports?
Describe your disaster recovery program should the health plan records/data maintained in your system be adversely affected by earthquake, fire, flood, or another catastrophic event.
Describe any automated systems, and policies/procedures in place to ensure compliance with HIPAA Privacy and Security rules.
Please provide three list the accounts that you currently provide third party services, and include the following information for each:
• Client Name
• Contact Person
• Address
• Telephone Number
• Total Number of Lives Covered for the public entity within the past 3 years.
List two accounts that you have been terminated by the client within the last three years, and include the following information for each:
• Client Name
• Contact Person
• Address
• Telephone Number
• Reason for Termination
• Total Number of Lives Covered for the public entity within the past 3 years.
Please list any additional or value-added services your organization offers beyond standard medical claims administration. Examples include, but are not limited to:
For each service, please indicate:
Please submit your full proposal documents, including all requested materials. You do not have to duplicate information already submitted.
For any additional information requested or required by any of your previously provided answers please upload that additional documentation here.
If you are proposing on the Pharmacy Benefit Manager section of this RFP please respond to the following questions.
Please provide a table of organization for your company to include the team that would be working with Montgomery County.
Describe your company’s overall experience and qualifications, especially in the public sector, and include the following information:
Indicate how long your organization has administered Pharmacy Benefit Manager Services and how many clients you currently service in the public sector, with the total number of lives covered noted.
Indicate whether your organization has been known by any other names within the last ten years.
Is your organization anticipating any expansion or reorganization within the next year?
If yes, please explain.
List any characteristics of your organization that you feel distinguishes you from other Pharmacy Benefit Manager Services administrators.
Note: Additional information may be requested from your firm if it’s selected as a finalist.
Please provide the names and related experience for key personnel who would be assigned to manage and/or work directly with this account, in the roles/areas listed below. Please include education, professional work experience.
Account Management Team
Claims Processing
Customer Service
Data Management Systems and/or Information Technology
Please provide three list the accounts that you currently provide third party services, and include the following information for each:
• Client Name
• Contact Person
• Address
• Telephone Number
• Total Number of Lives Covered for the public entity within the past 3 years.
List two accounts that you have been terminated by the client within the last three years, and include the following information for each:
• Client Name
• Contact Person
• Address
• Telephone Number
• Reason for Termination
• Total Number of Lives Covered for the public entity within the past 3 years.
Humira is excluded from your formulary.
What is your preferred biosimilar for Humira?
Biosimilars for Humira are not subject to rebate credit values.
If biosimilars for Humira are subject to a rebate credit value then they are capped at the baseline rebate guarantee amount per claim.
What is your book of business biosimilar adoption rate for Humira on the submitted formulary?
Stelara is excluded from your formulary.
What is your preferred biosimilar for Stelara?
Biosimilars for Stelara are not subject to rebate credit values.
If biosimilars for Stelara are subject to a rebate credit value then they are capped at the baseline rebate guarantee amount per claim.
High WAC Humalog and/or Novolog are excluded from your formulary.
A low value drug exclusion list is available.
Please list any additional fees for formulary management that are not included elsewhere.
Proposed rates assume prior authorizations for GLP-1's.
Proposed rates assume the use of SmartPA or ePA logic for GLP-1's.
Proposed rates assume an independent prior authorization for GLP-1's.
GLP-1 prior authorization process requires chart notes to validate diagnosis.
GLP-1 prior authorization process requires patients to have an A1c over a minimum of 6.5.
At what BMI are weight loss medications approved in your submitted proposal?
Client is allowed to implement a cost exceeds max edit for claims greater than $1,000
If the cost of your utilization management is included in an overall package fee, what is the fee basis?
If the cost of your utilization management is included in an overall package fee, what is the fee amount?
What is the basis for your prior authorization fee?
What is the prior authorization fee amount?
What is the basis for your step therapy fee?
What is the step therapy fee amount?
What is the basis for your quantity limit fee?
What is the quantity limit fee amount?
Please list any additional fees for utilization management that are not included elsewhere.
If your fees for patient assistance are not on a percentage of savings please indicate the basis.
If your fees for patient assistance are not on a percentage of savings please indicate the fee amount.
If your fees for patient assistance are on a percentage of savings basis please indicate what percentage of the savings is taken as a fee?
If patient assistance program percentage of savings fees are capped, at what dollar amount are they capped?
Patient assistance program savings are calculated based on the AWP minus the contractually guaranteed discount percentage for the medication.
Patient assistance program claims will be included in reporting and claim files.
Please list any fees for international sourcing that are not included elsewhere.
International sourcing is optional for the client.
If your fees for copay assistance are not on a percentage of savings please indicate the basis.
If your fees for copay assistance are not on a percentage of savings basis please indicate the fee amount?
If your fees for copay assistance are on a percentage of savings basis please indicate what percentage of the savings is taken as a fee?
Describe the biosimilar strategies currently in effect
Do you maintain more than one MAC list? If so, will more than one MAC list be used for the County' s program? Please describe how more than one MAC list is utilized.
Provide the latest Net Promoter Score and year for the PBM
How many employer clients do you service?
What is your client retention rate as a percentage?
Note: Within the Ringmaster tool, bidders will note that the consulting fee will be $1 per Rx. Please note agreement and include this consulting fee in your pricing proposal and submission.
Please submit your full proposal documents, including all requested materials. You do not have to duplicate information already submitted.
For any additional information requested or required by any of your previously provided answers please upload that additional documentation here.
Proposer has read, understands, and accepts the General Terms and Conditions contained within the Bid documents?
Are there any exceptions to the details, requirements, or goals contained herein these project documents?
Please list all exceptions and the reason for such exceptions.
After reading the sample contract provided in Attachment A, does proposer have any exceptions to the contract terms?
Please list all contract exceptions and the reason for such exceptions.
Proposal will remain firm for acceptance for 90 days after proposal opening unless otherwise stated?
How long will the proposal remain valid?
Does your proposal include warranties?
Please provided detailed warranty information.
Prices proposed include any and all delivery/freight charges?
The Proposer certifies they will not use contract funds to lobby.
The Proposer certifies that they will not enter into contracts with subcontractors who are debarred or suspended from such transactions to complete work related to this Request for Proposals.
The Bidder certifies that they are neither debarred nor suspended under Federal and State rulings from receiving Federal funds.
Proposer hereby certifies that all information provided within this submittal is true, accurate and complete to the best of their knowledge. Submitting party or Proposer further acknowledges that they have authority and have provided proof of said authority to submit a proposal on behalf of the stated agency name committing them to the information and pricing contained within this Proposal Response.
Will there be a pre-proposal conference?
Is the pre-bid conference required/mandatory?
Please enter the advertisement date in the following style:
December 21, 2024.
Not: 12/21/2024.
Will this RFP require the vendor to make pricing available to a Cooperative Purchasing Agreement?
Q (Point solutions): Good morning, Are you entertaining carved out point solutions for diabetes and/or weight management/GLP-1 management? I read that Omada is in place for diabetes and an established partner is preferred. A "weight management" program is mentioned, but it was unclear to me if you will consider a stand-alone offering. Abacus Health offers chronic condition management solutions for these populations. We do not have preferred partner integration with any carriers or PBMs. Thank you.
A: We are not soliciting at this time for point solutions that are not included with the bidding TPA or PBM.
Q (Census): Good afternoon, in order to evaluate access we need zips and current membership. Is this available? Or the NDA is needed to receive this data?
A: The NDA is required to receive this data.
Q (Subject: 5.5 Warranties): Question: Does your proposal include warranties? Please provide a definition of warranties as they apply to this medical Third Party Administrator (TPA) Request for Proposal (RFP).
A: For this RFP, “warranties” refer to the vendor’s assurances that the services proposed, including claims administration, customer service, systems performance, compliance, reporting, and data security will meet all contractual, legal, and industry standards, and that any errors or deficiencies will be corrected at no cost to the County.
Q (Banking/Billing): How often does the county wire for medical and RX claims? Daily? Weekly? If weekly, what day of the week is preferred?
A: Currently invoices are received on Mondays with payment due 10 business days from invoice date. Montgomery County is not able to pay late fees.
Q (Banking/billing): Does the county need any sort of grace period accommodations for their medical and RX claim wiring? Typically claim wire requests are answered in 1 day, so if additional days are needed to accommodate the accounting dept, please advise.
A: Yes - we currently have 15 calendar days to wire payment. Please note the county is not permitted to pay late fees under ORC.
Q (Wellness): Does the county plan to stay with wellness vendor Wellworks For You, or should the quoting medical carriers quote a replacement wellness program? If so, what are the main aspects of the wellness program that the county is looking for? (i.e. onsite biometric screenings, gift card incentives, etc?)
A: Montgomery County plans to stay with Wellworks For You.
Q (H.S.A. administration): Does the county plan to say with the same H.S.A. vendor, Optum Bank, or should the quoting medical carriers provide proposals for their affiliated banking partners?
A: Montgomery County plans to stay with Optum Bank.
Q (Reason for RFP): Why is the county out to bid? Any current service, network, or admin issues that the county is looking to address?
A: Our renewals with our current carrier have been exhausted and we are required under ORC competitive bidding regulations to go to bid.
Q (2027 Renewal pricing): Will 2027 renewal pricing be provided once available?
A: Not applicable. Incumbent is part of RFP; Our renewals with our current carrier have been exhausted and we are required under ORC competitive bidding regulations to go to bid.
Q (EAP offering): Should the quoting medical carriers provide an EAP quote to potentially replace Premier Health EAP?
A: Montgomery County plans to stay with Premier Health EAP.
Q (Diabetic program): Should the quoting medical carriers provide a diabetic support program to potentially replace the Omada Health, Inc. diabetic program?
A: Montgomery County is open to seeing options for diabetic support programs.
Q (Consultant commissions): We see the RX commissions should be $1 per prescription RX. What consultant commissions should be included in the medical administrative fee? Should it be net of commissions?
A: Yes, net of commissions for medical.
Q (Wellness fund): What amount is the county requesting for an annual wellness fund? We see the $225K specific request for RX, but what amount for medical? What has the county historically received from their carrier?
A: Current annual Medical TPA Wellness Fund is $105,000; $225,000 RX allowance
Q (H.S.A. employer funding): Does the county contribute to members’ H.S.A. accounts? If so, what amounts and with what frequency?
A: Yes. Frontloaded 50% of dollar for dollar match up to $1,000. Remainder of match is paid via payroll match. Wellness incentives are deposited annually, usually in March. Employees can receive up to $1,380 and spouses can receive up to $600.
Q (Stop loss marketing): Is stop loss being requested? If so, please advise on type of contract, requested ISL level, and requested ASL corridor.
A: Stop Loss is not being requested at this time.
Q (Retail pharmacy network): Are any retail pharmacies currently excluded from the pharmacy network? If so, which one(s)?
A: No.
Q (RX formulary): Is the current formulary open or closed?
A: The formulary is a closed formulary.
Q (GLP-1 RX coverage): How does the county handle Anti-obesity coverage? If it’s covered, does the category require prior authorization/clinical review?
A: Covered with Prior Authorization
Q (RX coupon programs): Does the county have a Specialty Manufacturer Coupon Program in place currently ( if so , what is name of program or vendor?)
A: Yes, Specialty Cost Relief.
Q (RX clinical programs): What RX clinical programs do they have in place currently ( such as precert/step)?
A: Programs are listed in section 4.4 Scope of Services - Pharmacy
Q (90 day RX ): Do they have Mandatory Mail Order or a retail 90 program?
A: Yes, members can choose from both a 90 mandatory at Mail OR Retail 90 pharmacy for 90-day supply.
Q (RX rebates): What is current rebate arrangement ( are they receiving rebates / or kept by carrier to offset admin fees)?
A: We receive 100% of rebates quarterly, via check. Montgomery County is unable to accept rebates via invoice credit.
Q (Contracting): Is Montgomery County aware of the benefits of Direct Contracting with hospitals, health systems, and providers so that medical plan options can be offered alongside a PPO?
A: Yes.
Q (Plan Option(s)): Have you discussed internally how Montgomery County can offer another medical plan option alongside your current Anthem offerings that is NOT a PPO?
A: Montgomery County would be interested in seeing an HMO that could be offered opposite a PPO plan.
Q (Competitive Funds): I’d like to better understand a statement in the RFP on page 46: “Annual competitive funds must roll over if unused”… precisely what funds are being referenced here?
A: Montgomery County receives an annual Pharmacy Management Allowance Credit of $225,000 from the current PBM that must be used for legitimate, necessary, and commercially reasonable services directly related to administering and managing our pharmacy benefit and/or enhancing the value of our pharmacy program. County is requesting that funds like these roll-over from year to year if not used. Approved uses include plan communications, clinical programs, wellness programs, consulting fees (if pharmacy-related), IT programming, additional reporting/data feeds, vendor fees, and other pharmacy-related expenses pre-approved by the PBM.
Q (Rx & PBM Oversight): We have found that working with independent pharmacy partners extends oversight of PBM contracts and other Rx programs, would the County be open to discussing these programs further?
A: Yes.
Q (Participating membership - labor contract): What percentage of the participating membership is covered by a labor contract?
A: 40% of enrolled employees are covered by a CBA. 40% of the eligible employees are covered by a CBA.
Q (Number of Meetings and Locations Clarification): Please provide more detail around expectations around availability for union meetings, department sessions, and employee education events. Looking for more clarity on the number of meetings and number of locations.
A: Expectation is for vendor to participate in the 2026 Benefit Fair, 2 days 4 locations; Q1 2027 2 onsite meetings, additional virtual options; remaining years of agreement benefit fair attendance - 2 day, 4 locations
Q (Specialty Pharmacy Services): The RFP refences having is a flexible, non-exclusive specialty pharmacy model that allows for independent management of specialty pharmacy services. Is that what is currently in place today with the incumbent or will this be a chance for 1/1/27?
A: Currently exclusive to incumbent's specialty.
Q (Third Party Vendors): Is the reference to working with third-party vendors only intended for “spread” PBMs or also with 100% transparent , pass-through PBM and specialty pharmacy?
A: It would apply to all PBMs.
Q (Direct Contracting): Is Montgomery County aware of the benefits of Direct Contracting with hospitals, health systems, and providers so that medical plan options can be offered alongside a PPO?
A: Yes.
Q (No subject): Have you discussed internally how Montgomery County can offer another medical plan option alongside your current Anthem offerings that is NOT a PPO?
A: Montgomery County would be interested in seeing an HMO that could be offered opposite a PPO plan.
Q (No subject): I’d like to better understand a statement in the RFP on page 46: “Annual competitive funds must roll over if unused”… precisely what funds are being referenced here?
A: Montgomery County receives an annual Pharmacy Management Allowance Credit of $225,000 from the current PBM that must be used for legitimate, necessary, and commercially reasonable services directly related to administering and managing our pharmacy benefit and/or enhancing the value of our pharmacy program. County is requesting that funds like these roll-over from year to year if not used. Approved uses include plan communications, clinical programs, wellness programs, consulting fees (if pharmacy-related), IT programming, additional reporting/data feeds, vendor fees, and other pharmacy-related expenses pre-approved by the PBM.
Q (No subject): We have found that working with independent pharmacy partners and programs extends oversight of PBM contracts and other RX programs, would you be interested in learning more about this?
A: Yes.
SLED stands for State, Local, and Education. These are solicitations issued by state governments, counties, cities, school districts, utilities, and higher education institutions — as opposed to federal agencies.
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