Pharmacy Benefit Management Services Request for Proposals Number 270-20260216PBMS

The North Carolina State Health Plan for Teachers and State Employees is seeking a vendor to provide Pharmacy Benefit Management (PBM) services. The RFP is divided into three modules: Claims Processing, Customer Service, and Retail Network; Formulary Strategy, Utilization Management, and Rebate Administration; and Specialty and Mail Order Pharmacy Services. Vendors may respond to one, two, or all three modules. The contract term is 53.5 months, with an option to renew for up to two additional one-year terms. The Plan is looking for a vendor that can provide transparency, flexibility, and aligned incentives. Key aspects of the job include: • Providing PBM services to the Plan's approximately 572,000 self-funded members • Managing claims processing, customer service, and retail network • Developing and implementing formulary strategy, utilization management, and rebate administration • Providing specialty and mail order pharmacy services • Ensuring transparency and flexibility in the PBM program • Aligning incentives with the Plan's goals and objectives