RFP 26-008 Alabama PEEHIP Medicare Part D EGWP PBM Services

Alabama PEEHIP Medicare Part D EGWP PBM Services RFP
In order to participate in this procurement, follow the process below:
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regarding the registration process, contact Proposal Tech Support at 877-211-8316 x84.
1 PURPOSE/ INTRODUCTION
1.1 INTRODUCTION
Through the issuance of this Request for Proposal (RFP), Alabama's Public Education Employees' Health
Insurance Plan (PEEHIP) is soliciting proposals from qualified Offerors that can provide fully insured Medicare
Part D EGWP PBM services to its Medicare-eligible retirees and Medicare-eligible dependents of retirees. If
interested and able to meet the requirements described in this RFP, PEEHIP appreciates and welcomes your
offer.
The contract term is for a one year period, with three one-year optional renewals, beginning January 1, 2027
with Implementation to begin at contract award.
PEEHIP expects all Offerors to be familiar with, and all proposals to comply with, the Additional Terms and
Conditions for Retirement Systems of Alabama RFPs, which are located at:
https://www.rsa-
al.gov/uploads/files/RSA_Reservation_of_Rights_and_Requirements_for_ITBs_and_RFPs_REV_6_18_2026.pdf
https://www.rsa-
al.gov/uploads/files/RSA_Standard_Terms_and_Conditions_for_Solicitations_and_Contracts_Rev_10_30_2024
.pdf
https://www.rsa-
al.gov/uploads/files/RSA_Procedures_for_Resolution_of_Controversies_%28rev._9_29_2025%29_.pdf
PEEHIP reserves the right to award any service in whole or in part, to one or more Offerors, if submitted
proposals suggest that doing so would be in PEEHIP's best interest. PEEHIP also reserves the right to issue
multiple awards, no award or cancel or alter the procurement at any time. In addition, PEEHIP reserves the
right to extend the proposed RFP period, if needed. Proposals containing the lowest cost will not necessarily be
awarded as PEEHIP recognizes that factors other than costs are important to the ultimate selection of the
provider or providers of their benefit plan. Proposals provided in response to this RFP must comply with the
submittal requirements set forth in later sections, including all forms and certifications, and will be evaluated
in accordance with the criteria and procedures described herein. Based on the results of the evaluation,
PEEHIP will award the contract(s) to the most advantageous Offeror(s), based on cost and the technical
evaluation factors set forth in the RFP. Any contract awarded hereunder shall be subject to the approval of the
PEEHIP Board of Control and all appropriate PEEHIP and governmental officials in accordance with applicable
state laws and regulations.
Please read the entire solicitation package and submit an offer in accordance with the instructions. All forms
contained in the solicitation package must be completed in full and submitted along with the Technical
Response and Price Proposal, which combined, will constitute the offer. This RFP and your response, including
all subsequent documents provided during this RFP process will become part of the contract terms and
policy between the parties.
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Alabama PEEHIP Medicare Part D EGWP PBM Services RFP
PEEHIP has retained Segal to assist in the evaluation of the proposals for completeness and responsiveness to
the RFP and to review such proposals with them. Each proposal shall be evaluated in accordance with the
company's selection criteria and other relevant factors listed below:
* Cost of the proposed benefits and/or services
* Demonstration of lowest net cost formulary and utilization management strategy
* Value of the benefit plans and services, taking into consideration the requirements of the RFP,
proposed services and any "value-added" terms, conditions and service levels
* Programs provided by the firm designed and proven to minimize claim cost through pharmacy
management strategies
* Qualifications of the firm including financial capacity and staffing, and availability of staff to work with
PEEHIP during Open Enrollment and continue to support PEEHIP throughout the contract
* Offeror's experience with fully insured Medicare Part D EGWP PBM services, commitment to such
services, and experience offering such plans to large public sector employers
* Network access and network management (pharmacy)
* Offeror's ability to educate, communicate with and support provider entities
* Offeror's ability to educate and communicate with retirees and families/caretakers
* Offeror's ability to avoid enrollee clinically harmful disruption
* Offeror's ability to coordinate with a third party administering the MA benefit
All Offerors must meet the general conditions set forth in this RFP and are asked to respond only to the
specific questions asked.
2 GENERAL INFORMATION
2.1 BACKGROUND
PEEHIP was established in 1983 by the Alabama legislature to provide quality health care insurance benefits for
employees of public institutions of education within the State of Alabama which provide instruction at any
combination of grades K through 14, exclusively under the auspices of the State Board of Education, the
Alabama Community College System Board of Trustees, or the Alabama Institute for Deaf and Blind. These
health care benefits are available to all full-time, permanent part-time, and retired employees, and their
eligible dependents.
Local employer units consist of all city school systems, county school systems, and community colleges in the
State of Alabama. These entities are not allowed to opt out of the PEEHIP program. All 13 state four-year
colleges and universities offer the PEEHIP program to their retirees, with only three institutions offering the
program to the active population. However, others may join the program subject to meeting applicable
requirements.
PEEHIP offers coverage through a self-insured hospital-medical plan and a self-insured prescription drug plan
to its actively employed members and to its members who are early retirees. In addition to the benefits
provided to active members and early retirees, PEEHIP currently provides medical and pharmacy benefits
through a fully insured stand-alone Medicare Advantage plan and a fully insured stand-alone Medicare Part D
Prescription Drug plan to approximately 81,000 members including Medicare-eligible retirees and Medicare-
eligible dependents of retirees. The number of members typically increases by approximately 2,000 members
per year. Humana is the current provider of the stand-alone MA and PDP services.
If an enrollee or dependent is Medicare-eligible due to age or disability at the time of the enrollee's
retirement, the MA/MA-PD will become effective on the member's date of retirement for the Medicare-
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Alabama PEEHIP Medicare Part D EGWP PBM Services RFP
eligible member and any Medicare-eligible dependents. The Medicare-eligible retiree's other covered
dependents who are not Medicare eligible will remain in the PEEHIP (non-Medicare) hospital-medical and
prescription drug plans.
2.2 CONTRIBUTION INFORMATION
For all Medicare-eligible retirees and all Medicare-eligible dependents of retirees receiving coverage through
PEEHIP, PEEHIP pays over 89% of the cost of the premium for individual coverage for a Medicare-eligible
retiree and over 71% of the cost of the premium for the Medicare-eligible retiree plus one Medicare-eligible
dependent. The PEEHIP website includes additional details on the retiree premium shares. For the purposes of
this RFP, assume that the contribution strategy will not change; however, proposals cannot be conditional on
any cost sharing arrangement. PEEHIP reserves the right to change their cost sharing and contribution
strategies.
2.3 OBJECTIVES
PEEHIP seeks to provide high quality, cost-effective benefits to its Medicare-eligible retirees and their
Medicare-eligible dependents. PEEHIP is soliciting offers on a fully insured Medicare Part D EGWP
program. The proposed plan should provide a formulary that matches as closely as possible to PEEHIP's
current formulary, as well as an alternative, cost-effective formulary, within CMS guidelines. For this second
formulary, bidders should select a formulary which they believe provides the lowest fully insured rate while
considering potential significant disruption such as exclusion of drugs with no covered therapeutic alternative
or the up-tiering of drugs with no therapeutic alternative in a lower tier. The current cost-sharing benefits are
outlined in the Member Handbook. The Member Handbook can be found on the PEEHIP website
at: https://www.rsa-al.gov/peehip/publications/#medicareadvantageplan
Offerors are encouraged to identify and offer features or enhancements that provide additional value without
adding cost as well as any creative solutions that will achieve PEEHIP's goals.
2.4 SCOPE OF WORK
Provide fully insured Medicare Part D EGWP PBM services with respect to such group insurance coverages,
plans and programs as listed in this RFP.
The following services are the minimum services requested to be performed by the Offeror(s):
* Member Services, including quality and functionality of member website and mobile app
* Clinical Programs
* Claims Adjudication
* Data Reporting (standard and ad-hoc reporting)
* Member Enrollment and Eligibility Maintenance
* Provider Advocacy and Assistance with Claims Issues
* Medicare Part D EGWP Administrative Assistance
* Medication Therapy Management
* Effective Member Communications
* Patient and Family/Caretaker Education and Assistance
* Ability to Integrate PBM services with other vendors (e.g. Disease Management, Care Management,
Medical), if applicable
* Patient and Provider Education
* Systematic Prospective, Concurrent, and Retrospective Drug Utilization Review
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Alabama PEEHIP Medicare Part D EGWP PBM Services RFP
* Network Pharmacy Management
* Formulary Management
* Clinical Program Management
* Distribution of ID Cards and Pharmacy Directories
* Specialty Pharmacy Program
* Complete Availability of IT services, including Online/Real Time Availability to PEEHIP and/or its
designee(s)
* Pricing Administration
* Coordination and collaboration with third-party vendor administering the MA only benefit
2.5 CONTRACT TERM
The contract term will be for one (1) year, with three one-year optional renewals, starting January 1, 2027.
3 RESPONSE INSTRUCTIONS
3.1 INSTRUCTIONS FOR SUBMITTING OFFERS
Detailed instructions for the completion and submission of your proposal will be found in the electronic RFP
(eRFP) on ProposalTech. ProposalTech will be available to assist you with technical aspects of utilizing the
system.
All sections of the eRFP must be answered completely and as outlined in the RFP, using ProposalTech.
Final submissions must be posted with ProposalTech at www.proposaltech.com no later than the due date and
time cited. Access to the eRFP will be locked after that time. Offerors will not be able to post or change their
responses. Late proposals will not be considered. PEEHIP reserves the right to ask Offerors follow-up
questions through ProposalTech as may be necessary to fully evaluate offeror capabilities.
Please note that these instructions are to be read and followed by each Offeror and that failure to follow these
instructions may result in rejection of a proposal offer for non-responsiveness or cancellation of contract if
already awarded. Any mention of "days" in this RFP will refer to calendar days unless noted otherwise.
In order for your proposal to be considered and accepted, you must provide answers to the questions
presented in this RFP. Each question must be answered specifically and in detail. Be sure to review this entire
RFP before responding to any of the questions, so that you have a complete understanding of PEEHIP's
requirements with respect to the proposal.
1. Provide answers to all questions in your submission.
2. Provide an answer to each question even if the answer is "not applicable" or "unknown."
3. Answer the question as directly as possible.
If the question asks "How many...", provide a number.
o
If the question asks, "Do you...", indicate Yes or No followed by any additional narrative
o
explanation.
4. If you desire to provide additional information to assist the reader in more fully understanding a response,
you can do so by referring the reader of your RFP response to your appendix/attachments. However, you must
first provide direct responses to all of the RFP questions.
5. Offeror will be held accountable for accuracy/validity of all answers.
If your RFP response is different in any way (whether more or less favorable) from what is requested in this
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Alabama PEEHIP Medicare Part D EGWP PBM Services RFP
RFP, clearly indicate and explain the difference in the response to that particular question and in the Proposal
Exceptions & Deviations Form - Attachment 1. If you do not, the submission of your proposal will be deemed a
certification that you will comply in every respect (including, but not limited to, services provided, funding
method requested, all costs for printed materials and mailings, benefit exclusions and limitations, underwriting
provisions, etc.) with the requirements set forth in this RFP.
If you are unable to perform any required service, indicate clearly: a) what you are currently unable to do, and,
b) what steps will be taken (if any) to meet the requirement, the timetable for that process and who will be
responsible for the implementation, along with that person's qualifications.
All products should be priced individually. If pricing terms are provided contingent upon combining some
services, show the pricing terms as a separate line item.
Intent to Propose Form and Non-Disclosure Agreement (NDA): If your company intends to submit a proposal
for this procurement, and wishes to access the secure data (e.g., claims, demographics, etc.), please complete
the Intent to Propose Form with Minimum Requirements posted to ProposalTech.
Instructions for submission of Intent to Propose Form: Click on the Messaging/History in the left-hand side
menu and on the following page create a "New" message and select "Individual User" (Jennifer Slutzky) to
send to. Once your attachment is uploaded, be sure to check the box to include your attachment with the
email and then click "Send."
Single, Radio group.
1: Completed and sent via the instructions above,
2: Not provided
Attached Document(s): Intent to Propose Form.doc
3.2 It is the Offeror's sole responsibility to assure delivery by the designated deadline. The Intent to Propose
Form should indicate your organization's primary contact, direct telephone number, and e-mail address. The
form should also indicate the name and email address of the primary data contact.
Upon receipt of the Intent to Propose Form and confirmation that each Minimum Requirement will be met,
Segal will review its files for a current Global or Bid-Related NDA/Confidentiality Agreement. If there is a
NDA/Confidentiality Agreement on file with Segal, Segal will send the data securely to the interested Offeror,
as appropriate.
If there is no NDA/Confidentiality Agreement on file with Segal, an NDA document will be issued to the
interested Offeror for signature. Verbiage is non-negotiable. Upon receipt of the newly signed NDA, or
confirmation of an existing NDA on file, the data will be securely released to the Offeror via Segal's Secure File
Transfer (SFT) system.
Secure data will not be released until Offeror's Intent to Propose form is submitted and a signed NDA
between the Vendor and Segal is in place.
Offeror questions: Any questions regarding this RFP should be submitted directly via ProposalTech using the
"Ask Questions" feature to Jennifer Slutzky. Please submit your RFP related questions via ProposalTech to
Segal no later than the date and time as specified in this RFP. Questions from any potential Offeror that is
considering a response to this RFP will be answered. Questions sent via email or telephone will not be
accepted. PEEHIP reserves the right to provide a combined answer to similar questions. Any and all questions
and answers to this RFP will be posted on ProposalTech.
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Alabama PEEHIP Medicare Part D EGWP PBM Services RFP
Submission of proposals: Proposals are to be submitted electronically via the ProposalTech system by the
specific due date and time. Proposals posted later than the time and date specified in this RFP will not be
considered. If you choose not to offer a proposal, please confirm this in writing with the specific reason(s) for
your declination.
All decisions and evaluations will be determined from the proposals submitted electronically via ProposalTech.
Your completed proposal should be submitted in the following format:
* Cover Letter
* Completed Section 4: Information Required From Offerors
* Completed Section 5: Proposal Conditions
* Completed Section 6: Medicare Part D EGWP PBM Services Confirmations
* Signature Ready Contract that includes the sample contract in Exhibit 2 of Section 4.8 and addresses all
the items in Sections 5 and 6
* Completed Section 7: Financial Questionnaire
* Completed Section 8: Questionnaire - Medicare Part D EGWP PBM Services
In addition to the items outlined above, Offerors shall also provide a complete, electronic, redacted copy of
your proposal with your submission.
Proprietary Items Exempt from Disclosure: Offerors must follow the ProposalTech system when responding to
the RFP. If any items of this proposal are considered proprietary or confidential, Offerors must check the box
corresponding to that question's answer indicating it is exempt from disclosure. See Section 3.10 for additional
details. Failure to follow these directions will result in your responses being released as part of any open
records request made in compliance with Alabama state law.
Instructions for downloading a redacted proposal: Click on the Standard selection under the Reports / Print
heading in the left-hand side menu. On the following screen check the box for an External Report. Under the
filtered report options select Flagged and check the box under the Exclude Marked column for Confidential.
Once those selections have been made click Generate Report and attach the redacted proposal here.
Confirm you have attached a copy of your redacted proposal submission.
Single, Pull-down list.
1: Confirmed and attached,
2: Not confirmed
3.3 QUESTIONNAIRE INSTRUCTIONS
PEEHIP and Segal will review and evaluate each proposal carefully. Many questions within the RFP system do
not require lengthy responses. When a question does require a written response, please provide a response
that is clear and concise. DO NOT answer any of the questions by referring to a prior answer or by referring to
an attachment. Any such answers will not be considered and will constitute sufficient grounds for rejecting a
proposal.
ANSWERS TO THE QUESTIONS SHOULD BE AS SHORT AND CONCISE AS POSSIBLE TO FACILITATE OUR ANALYSIS
AND TO AVOID CONFUSION.
3.4 OFFERORS CONFERENCE
An Offerors Conference Call will not be held in connection with the RFP. Offerors should submit questions via
ProposalTech as outlined in this RFP.
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Alabama PEEHIP Medicare Part D EGWP PBM Services RFP
3.5 KEY DATES
Event 2026 Due Date
Release of RFP June 30
Notification of Intent to Propose Deadline July 8
Written Questions from Offerors (by 5:00 p.m. ET) July 13
Technical Proposals (by 5:00 p.m. ET) July 27
Price Proposals (by 5:00 p.m. ET) August 7
Interviews & Final Strategy Discussions Week of August 10
Anticipated Contract(s) Award Date September 1
Implementation Begins Upon receipt of Contract
Award
Open Enrollment Period Support October 15 - December 7
Proposed Effective Date January 1, 2027
To avoid elimination from the RFP process, all proposals must be returned in the format and dates outlined in
this Response Instructions section.
PEEHIP reserves the right, at any time, to alter any deadlines or revise any part of the Key Dates table above by
notifying all offerors through the ProposalTech system.
3.6 SELECTION OF PARTNER(S)
All responding Offerors will be notified in writing within a reasonable length of time following the selection.
Prior to the selection of an Offeror partner, two or more Offerors may be requested to make oral
presentations in person to the evaluation committee. The proposal shall become the property of PEEHIP.
3.7 ECONOMY OF PREPARATION
The proposal should be prepared simply and economically and provide a concise description of Offeror's
response to the requirements of this RFP. Emphasis should be on clarity. PEEHIP will not be responsible for any
costs incurred by Offeror in the preparation, submission, or presentation of a proposal.
3.8 NEWS RELEASES
News releases pertaining to this RFP, or to any services to which it relates, will be made only with prior written
approval of PEEHIP, which may be withheld for any reason.
3.9 ADDENDA TO THE RFP
Any modifications made to this RFP prior to the proposal due date will be provided to all Offerors via the
ProposalTech system described in this RFP.
3.10 SOLICITATION CONTACT
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Alabama PEEHIP Medicare Part D EGWP PBM Services RFP
All questions regarding this RFP should be submitted to the Solicitation Contact, Jennifer Slutzky, through
ProposalTech. Questions regarding technical issues with the website should be directed to ProposalTech, by
calling (877) 211-8316, ext. #4, and asking for support.
Offerors are not allowed to communicate concerning this RFP with any PEEHIP member or employee except as
provided by existing work agreements. For violation of this provision, PEEHIP reserves the right to reject the
proposal of the violator.
3.11 DISCLOSURE OF PROPOSAL CONTENTS
Proposals and supporting documents are kept confidential until the evaluation process is complete, and a
contract has been awarded. Offerors should be aware that any information in a proposal may be subject to
disclosure and/or reproduction under Alabama law. Designation as proprietary or confidential may not
protect any materials included within the proposal from disclosure, if required by law; however, commercial or
financial information obtained in response to a solicitation that is not designated privileged or confidential in a
proposal may be considered a public record. Offerors should mark or otherwise designate any material that it
feels is proprietary or otherwise confidential by labeling the page as "confidential." Offerors shall redact this
information in a redacted copy provided to PEEHIP pursuant to Section 3.1 INSTRUCTIONS FOR SUBMITTING
OFFERS. Offerors shall also state any legal authority as to why that material should not be subject to public
disclosure under Alabama open records laws and is marked as proprietary information. Information contained
in the price proposal may not be marked confidential. It is the sole responsibility of the Offeror to indicate
information that is to remain confidential. If the Offeror identifies its entire proposal as confidential, PEEHIP
may deem the proposal non-responsive and may reject it.
Offeror agrees to intervene in and defend any lawsuit brought against PEEHIP for its refusal to provide
Offeror's alleged confidential and/or proprietary information to a requesting party. PEEHIP shall use best
efforts to provide Offeror written notice of any such lawsuit within ten (10) days of receipt of service by
PEEHIP. Offeror shall intervene within thirty (30) days of notice or will be deemed to have waived any and all
claim that information contained in the proposal is confidential and/or proprietary and any and all claims
against PEEHIP for disclosure of Offeror's alleged confidential and/or proprietary information.
*The identification of confidential responses has been turned on for this RFP. If you feel that a response to a
question contains proprietary/confidential information, click the "Disclosure" tab located underneath the
question and check the box for "Exemption from Disclosure." Provide a reason for the exemption in the text
field provided. If you do not provide a reason for exemption, the question will not be considered answered. If
you have any questions regarding this process, please contact ProposalTech Support at 877-211-8316 x84.
4 INFORMATION REQUIRED FROM OFFERORS
4.1 QUALIFICATIONS OF THE FIRM - BUSINESS ORGANIZATION
4.1.1 State the full name and address of your organization, and if applicable, the branch or local office or other
subordinate element that will perform or assist in performing the work hereunder.
500 words.
4.1.2 Indicate whether you operate as an individual, partnership, limited liability company, or corporation.
500 words.
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Alabama PEEHIP Medicare Part D EGWP PBM Services RFP
4.1.3 State the name of the state in which you are formed or incorporated.
500 words.
4.1.4 State whether you are currently in good standing in the state in which you are formed or incorporated
and provide a Certificate of Good Standing from that state.
500 words.
4.2 QUALIFICATIONS OF THE FIRM - MINIMUM REQUIREMENTS
To be considered a viable Offeror, the following minimum requirements for prior experience must be met:
4.2.1 Offeror must be currently providing Medicare Part D individual or group fully insured coverage or self-
insured PBM services to a minimum of 30,000 lives.
Confirm you meet this requirement.
Single, Radio group.
1: Agree,
2: Disagree, explain: [ 500 words ]
4.2.2 Offeror must have a minimum of five (5) years experience providing Medicare Part D individual or group
fully insured coverage or self-insured PBM services.
Confirm you meet this requirement.
Single, Radio group.
1: Agree,
2: Disagree, explain: [ 500 words ]
4.2.3 Offeror must be licensed to offer employer-sponsored, Medicare Part D EGWP fully insured coverage
and/or self-insured PBM solutions in all 50 states and U.S. territories where PEEHIP members currently reside.
Confirm you meet this requirement.
Single, Radio group.
1: Agree,
2: Disagree, explain: [ 500 words ]
4.2.4 Offeror must not have any bankruptcy filings within the last 5 years; and Offeror's senior officers, board
members, or directors must not have any felony convictions, and they must not have been excluded from
Medicare.
Confirm you meet this requirement.
Single, Radio group.
1: Agree,
2: Disagree, explain: [ 500 words ]
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Alabama PEEHIP Medicare Part D EGWP PBM Services RFP
4.3 QUALIFICATIONS OF THE FIRM - MANPOWER
4.3.1 Identify lead individuals by name and title. Include a resume for each and the proposed percent of time
dedicated to this account (based on 40-hour work-week).
500 words.
4.4 QUALIFICATIONS OF THE FIRM - AUTHORIZED OFFICIALS
4.4.1 Include the names, titles, e-mails and telephone numbers of personnel of the organization authorized to
execute the proposed contracts with PEEHIP.
500 words.
4.5 COST AND PRICE ANALYSIS
4.5.1 The information requested in this section and this RFP's financial questionnaire is required to support the
reasonableness of your price proposal. PEEHIP desires to enter a one-year contract for performing the
Medicare Part D EGWP PBM services for plan year 2027, with three one-year optional renewals. Offeror shall
complete all pricing tables in this RFP in the format provided. Failure to submit pricing as requested may
render Offeror's entire Offer non-responsive and ineligible for award.
4.6 SCORING CRITERIA
4.6.1 Proposals will be evaluated by an evaluation committee. Selection will be based on all factors listed
below and others implicit within the RFP and will represent the best performance and reasonable costs for
PEEHIP. PEEHIP reserves the right for site visits and to incorporate their results into the scoring evaluation if
deemed appropriate.
Technical Proposal Section Maximum Points
Proposal Conditions, Requirements and Confirmations 25
Minimum RFP Qualifications 25
Term/Termination 25
Medicare Part D EGWP PBM Services Questionnaire
Company, Overview, Open Enrollment and Staffing, Member 25
Services and Account Management
Formulary Management 75
Clinical Programs 75
Pharmacy Network Management 75
Audit Rights 10
Reporting 50
Implementation 50
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