Request for Proposals: C043525 Pharmacy Benefit Management Services

The New York State Department of Health (Department), Office of Health Insurance Programs is announcing the release of Request for Proposals (RFP) C043525: Pharmacy Benefit Management Services. This RFP seeks proposals from qualified bidders to administer the Fee for Service (FFS) Pharmacy Benefit Management (PBM) program, including operation of the Preferred Drug Program (PDP), Clinical Drug Review Program and generic claims pricing via the administration of the State Maximum allowable Cost (SMAC) by which the State achieves significant savings and revenue. The resulting contract will provide Pharmacy Benefits Management services to the Medicaid Fee-for-Service (FFS) pharmacy program including prior authorization (PA) administration for the Preferred Drug Program, Preferred Diabetic Supply Program, the Clinical Drug Review Program, the Mandatory Generic Drug program, the Brand Less Than Generic program and development and maintenance of generic pricing files (also known as the State Maximum Acquisition Cost [SMAC] list). The full RFP listing can be found at: https://www.health.ny.gov/funding/rfp/c043525/ Questions must be submitted to [email protected] by November 3rd, 2026 by 4:30 PM EST. Responses to Written Questions will be Posted by the Department (on or about): November 24th, 2026. Deadline for Submission of Proposals: December 8th, 2026. Business enterprises awarded an identical or substantially similar procurement contract within the past five years: Contract # C020463 : Prime Therapeutics State Government Solutions LLC Minority / Women Business Enterprise contracting goals (MWBE) Total MWBE Goals: 30.00%