Request for Proposal for Pharmacy Benefit Management and Claims Administration Program

This Request for Proposal (RFP) is being released for a Pharmacy Benefit Management and Claims Administration Program. This RFP is an opportunity to allow qualified vendors to present proposals that will assist the County of Orange, HRS/Employee Benefits in selecting a contractor that will best meet the needs of the County for a three (3) year contract with two (2) optional one (1) year renewal terms. Services will be according to the Scope of Services stated in Attachment A of the Model Contract.

The County currently provides a carve-out pharmacy program through OptumRx, as the Pharmacy Benefits Manager (PBM) for its self-funded PPO (Preferred Provider Organization) health plans administered through Blue Shield of California (Blue Shield). The carve-out pharmacy program is available to members enrolled in the County’s two types of medical plans – Sharewell and Wellwise. A key differentiator between Wellwise and Sharewell is that Sharewell is a High Deductible Health Plan (HDHP) design, and medical and pharmacy expenses are combined for the deductible and out of pocket maximum. For the Wellwise plans, there are different deductibles and out of pocket maximums for medical and pharmacy benefits. Sharewell and Wellwise are offered to employees, non-Medicare and Medicare retirees, and their dependents. The Wellwise Retiree Medicare PPO pharmacy benefit program is an Employer Group Waiver Plan (EGWP). All Sharewell PPO plans are non-creditable coverage.