Executive Office of Health and Human Services

The buyer is seeking to procure a new Pharmacy Benefit Administration solution, along with a Rebate Management service and system, and a data analytics and reporting system. The solution will replace the legacy system and processes. The buyer aims to identify a vendor or vendors who can deliver the vision and objectives of the new generation of Pharmacy Benefit Administration in Massachusetts. The procurement includes components for Claims Processing, Rebate Management, and Data Analytics and Reporting.

• 1/21/2025 - Bidders' Conference
• 1/24/2025 - Letter of Intent to Respond due
• 2/3/2025 - Bidders' Written Questions Due
• 3/10/2025 - Proposal Due Date
• 1/23/2027 - Expected Implementation End Date

• Implement claims processing system for pharmacy benefits
• Provide rebate management services and system
• Develop data analytics and reporting system
• Configure pricing system compliant with federal and state laws
• Integrate with other systems as shown in Concept of Operations
• Implement utilization management tools aligned with evidence-based medicine
• Provide 24/7 call center for providers and billing/technical issues
• Ensure CMS certification of implemented systems
• Support novel value-based contracting for rebates
• Develop interactive public-facing drug list reflecting coverage policies