The purpose of this Request for Proposals (RFP) is to solicit proposals from interested and qualified vendors who can administer pharmacy benefits as the Pharmacy Benefit Manager (PBM) for the State of Wisconsin Group Health Insurance Program (GHIP) and the Wisconsin Public Employer (WPE) program for Local Government Employees.
The Wisconsin Department of Employee Trust Funds (Department or ETF) intends to use the results of this solicitation process to award a contract for the services described in the RFP and its attachments. The contract will be administered and managed by the Department, with oversight by the Group Insurance Board (Board). The RFP document, its appendices, forms, and the awarded Proposal will be incorporated into the contract.
A contract may be awarded pursuant to the RFP. The Department expects the Contract to be executed in April of 2025, after contract negotiations have been successfully completed. The initial Contract term will be approximately three years beginning January 1, 2026, through December 31, 2028. The Board retains the option to renew the Contract for two (2) additional two (2)-year terms, subject to the satisfactory negotiation of terms, including pricing.
Note: The 2026 benefit period will begin January 1, 2026. The Contractor will assist the Department with the implementation, transition, and Member communications prior to the Services being made available for the 2026 plan year. This implementation and transition period will begin after a Contract is executed and continue until implementation and transition are completed prior to open enrollment in September 2025.
The RFP documents can be viewed at the links provided below. The RFP details the procedures proposers must follow to submit a proposal, and the minimum requirements that proposers must meet to be eligible for consideration.
May 1, 2024 by 2:00 PM CDT is the deadline to submit Appendix 10 – NDA, to ETFSMBProcurement@etf.wi.gov (required to receive Cost Proposal Documents)
May 15, 2024 by 2:00 PM CDT is the deadline to submit vendor questions to ETFSMBProcurement@etf.wi.gov
August 1, 2024 by 2:00 PM CDT is the deadline for submit vendor proposals.
Unredacted Proposal, and any Redacted Proposal, must be submitted electronically to ETF through BOX.
Cost Proposal Workbook must be submitted to the Board’s Actuary. See the RFP for submission details. Late submissions will not be considered.
This solicitation is authorized under Chapter 40 of the Wisconsin State Statutes. All decisions and actions regarding this solicitation are solely under the authority of the Board. Procurement statutes and rules that govern other State of Wisconsin agencies may not be applicable.
Any news releases or release of broadcast e-mails pertaining to this solicitation, any resulting contract, or the acceptance, rejection, or evaluation, or review of vendor proposals shall not be made without the prior written approval of the Department.
Note: All modifications and other information associated with the RFP will be posted on the Department’s web site at https://etf.wi.gov/node/35431. Interested vendors are encouraged to check this site for updates frequently. No other notification regarding modifications will be provided.
Uploaded Documents
Group Insurance Board Meeting 11.15.2023RFP Administrative Services for the State of Wisconsin Pharmacy Benefit Manager Program
Appendix 1 - State of Wisconsin Pharmacy Benefit Program Agreement (Program Agreement)
Appendix 2 - Pharmacy Benefit Program Performance Guarantee Workbook
Appendix 3 - 2024 Functional Specification Drug
Appendix 4 - GHIP Employer Information
Appendix 5 - 834 Overview and Companion Guide
Appendix 6 - Data Supplier Agreement (sample)
Appendix 7 - Non-Disclosure Agreement (NDA) (Data Out) (sample)
Appendix 8 - Pro Forma Contract (sample)
Appendix 9 - Department Terms and Conditions v. 12.1.2023
Appendix 10 - NDA Among Vendor, Department, and Board Actuary
Appendix 11 - Merative - Data Supplier Agreement (sample)
Appendix 12 - NDA and Data Supplier Agreeement with Benefitfocus (sample)
Form A - Proposer Checklist
Form B - Mandatory Requirements and Qualifications
Form C - Subcontractor Information
Form D - Request for Proposal Signature Page
Form E - Vendor Information
Form F - Vendor References
Form G - Designation of Confidential and Proprietary Information