RFP 30-2026-002-DHB Pharmacy Analytical and Clinical Support Services

STATE OF NORTH CAROLINA
Department of Health and Human Services
Division of Health Benefits
Pharmacy Analytical and Clinical Support Services
Request for Proposal #30-2026-002-DHB
RFP #30-2026-002-DHB Pharmacy Analytical and Clinical Support Services
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STATE OF NORTH CAROLINA
Request for Proposal
#30-2026-002-DHB
_______________________________________________
For internal State agency processing, please provide your company's Federal Employer Identification
Number or alternate identification number (e.g., Social Security Number). Pursuant to NCGS 132-1.10(b)
this identification number shall not be released to the public. This page will be redacted before the
procurement file is made available for public inspection.
This page is to be filled out and returned with your Proposal.
ID Number:
______________________________________________________
Federal ID Number or Social Security Number
______________________________________________________
Offeror Name
RFP #30-2026-002-DHB Pharmacy Analytical and Clinical Support Services
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STATE OF NORTH CAROLINA
Department of Health and Human Services
Refer ALL Inquiries regarding this RFP to: Request for Proposal: # 30-2026-002-DHB
Date RFP Issued/Posted: June 4, 2026
Kimberly Lozada
Date RFP Submissions due to the Department: August 6, 2026 by 2:00 p.m. EST
Contract Development Specialist
Medicaid.Procurement@dhhs.nc.gov Proposals will be opened: August 6, 2026
Contract Type: Open Market
Commodity Number: 8510 - Comprehensive Health Services
Description: Pharmacy Analytical and Clinical Support Services
Using Agency: Department of Health and Human Services, Division of Health Benefits
Requisition No.: N/A
EXECUTION
In compliance with this Request for Proposal (RFP), and subject to all the conditions herein, the undersigned Offeror offers and agrees to furnish
and deliver any or all services proposed, at the cost proposed and within the time specified herein. By executing this proposal, the Offeror
confirms it has read, understands, and will comply with all specifications and requirements in the RFP and any addenda in the event of contract
award. By executing this proposal, the undersigned Offeror certifies that this proposal is submitted competitively and without collusion (NCGS
143-54), that none of its officers, directors, or owners of an unincorporated business entity has been convicted of any violations of Chapter 78A
of the General Statutes, the Securities Act of 1933, or the Securities Exchange Act of 1934 (NCGS 143-59.2), and that it is not an ineligible
Contractor as set forth in NCGS 143-59.1. False certification is a Class I felony. Furthermore, by executing this proposal, the undersigned
certifies to the best of Offeror's knowledge and belief, that it and its principals are not presently debarred, suspended, proposed for debarment,
declared ineligible or voluntarily excluded from covered transactions by any Federal or State department or agency. As required by NCGS
143-48.5, the undersigned Offeror certifies that it, and each of its subcontractors for any Contract awarded as a result of this RFP, complies with
the requirements of Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer with more than 25 employees
in North Carolina to verify the work authorization of its employees through the Federal E-Verify system. NCGS 133-32 and Executive Order
24 (2009) prohibit the offer to, or acceptance by, any State Employee associated with the preparing plans, specifications, estimates for public
Contract; or awarding or administering public Contracts; or inspecting or supervising delivery of the public Contract of any gift from anyone with
a Contract with the State, or from any person seeking to do business with the State. By executing this proposal, you attest, for your entire
organization and its employees or agents, that you are not aware that any such gift has been offered, accepted, or promised by any employees
of your organization. Failure to execute/sign proposal prior to submission shall render proposal invalid and it WILL BE REJECTED. Late
proposals will not be accepted.
OFFEROR:
STREET ADDRESS: P.O. BOX: ZIP:
CITY & STATE & ZIP: TELEPHONE NUMBER: TOLL FREE TEL. NO:
PRINCIPAL PLACE OF BUSINESS ADDRESS IF DIFFERENT FROM ABOVE
PRINT NAME & TITLE OF PERSON SIGNING ON BEHALF OF FAX NUMBER:
OFFEROR:
OFFEROR'S AUTHORIZED SIGNATURE: DATE: EMAIL:
Offer valid for at least 240 Calendar Days from date of proposal opening unless extended by the State in writing. After this time, any withdrawal
of offer shall be made in writing, effective upon receipt by the agency issuing this RFP.
ACCEPTANCE OF RESPONSE
If any or all parts of this proposal are accepted by the State of North Carolina, an authorized representative of the Department of Health and
Human Services shall affix their signature hereto and this document and all provisions of this Request for Proposal along with the Offeror's
proposal, and the written results of any negotiations shall then constitute the written agreement between the parties. A copy of this acceptance
will be forwarded to the successful Offeror.
FOR STATE USE ONLY: Offer accepted and Contract awarded this _______ day of _______________, 20______, by
_____________________________________________________________________________
(Authorized Representative of NC Department of Health and Human Services)
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Table of Contents
EXECUTION .................................................................................................................................................. 3
I. INTRODUCTION ...................................................................................................................................... 6
A. Intent .................................................................................................................................................... 6
B. Background and Program Information ................................................................................................ 6
II. GENERAL PROCUREMENT INFORMATION AND NOTICE TO OFFERORS ............................................... 6
A. Important Notices ................................................................................................................................ 6
B. General Procurement Information and Instructions........................................................................... 7
C. Request for Proposal Functionality and Related Notices .................................................................... 8
D. Schedule and Important Events ........................................................................................................ 10
E. Submission of Proposal and Offeror's Response .............................................................................. 12
F. Confidentiality and Prohibited Communications During Evaluation ................................................ 15
G. Evaluation Process and Contract Award ........................................................................................... 16
III. DEFINITIONS, CONTRACT TERM, GENERAL TERMS AND CONDITIONS, OTHER PROVISIONS &
PROTECTIONS ............................................................................................................................................ 21
A. Definitions .......................................................................................................................................... 21
B. Acronyms and Abbreviations ............................................................................................................. 25
C. Contract Term .................................................................................................................................... 26
D. General Terms and Conditions .......................................................................................................... 26
E. Confidentiality, Privacy and Security Protections ............................................................................. 44
F. Public Records and Trade Secrets Protections .................................................................................. 50
IV. MINIMUM QUALIFICATIONS ................................................................................................................ 52
A. Acceptance of Terms and Conditions ................................................................................................ 52
B. Eligibility to Contract .......................................................................................................................... 52
C. Financial Stability and Legal Disclosure ............................................................................................. 52
D. Experience Requirements .................................................................................................................. 52
V. SCOPE OF SERVICES AND PERFORMANCE REQUIREMENTS ............................................................... 53
A. Pharmacy Analytical and Clinical Support Services Objectives ......................................................... 53
B. General Requirements ....................................................................................................................... 53
C. Qualifications and Program Administration Requirements .............................................................. 54
D. Pharmacy Analytical and Clinical Support Services Requirements ................................................... 54
E. Technology Specifications ................................................................................................................. 66
F. Customer Support .............................................................................................................................. 67
G. Staffing ............................................................................................................................................... 67
H. Training .............................................................................................................................................. 69
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I. Reports ............................................................................................................................................... 70
J. Implementation ................................................................................................................................. 72
K. Quality Assurance .............................................................................................................................. 74
L. Business Continuity Plan .................................................................................................................... 74
VI. CONTRACT PERFORMANCE ................................................................................................................. 75
A. Contract Violations and Noncompliance ........................................................................................... 75
B. Notice of Deficiency ........................................................................................................................... 75
C. Remedial Actions and Corrective Action Plans .................................................................................. 75
D. Liquidated Damages .......................................................................................................................... 76
E. Process to Appeal a Contract Performance Action and Dispute Resolution .................................... 77
F. Performance Standards and Liquidated Damages ............................................................................ 77
VII. Attachments to the RFP ................................................................................................................. 80
Attachment A: Minimum Qualifications Response .................................................................................. 81
Attachment B: Offeror's Response to Technical Evaluation Questions ................................................... 83
Attachment C: Cost Proposal .................................................................................................................... 97
Attachment D: Contract Administrators ................................................................................................. 103
Attachment E: Certification of Financial Condition and Legal Action Summary .................................... 105
Attachment F: State Certifications .......................................................................................................... 107
Attachment G: Federal Certifications and Disclosures ........................................................................... 108
Attachment H: Disclosure of Litigation and Criminal Convictions ......................................................... 114
Attachment I: Location of Workers Utilized by Contractor .................................................................... 116
Attachment J: Offeror Request for Proposed Modifications to the Terms and Conditions .................. 117
Attachment K: Business Associate Agreement ....................................................................................... 118
Attachment L: Subcontractor Identification Form ................................................................................. 122
Attachment M: Legal Grounds for Marking Information Confidential .................................................. 123
Attachment N: Evaluation Methodology ................................................................................................ 124
Attachment O: GenAI Disclosure and Fact Sheet ................................................................................... 127
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I. INTRODUCTION
A. Intent
The North Carolina Department of Health and Human Services ("NCDHHS" or "Department"),
Division of Health Benefits ("DHB" or "NC Medicaid") seeks to procure an experienced and
qualified partner with actuarial pharmacy expertise on a federal, state and commercial level to
support analytical and clinical services for the Department. The selected Offeror shall be
responsible for assisting the Department in the evaluation of all value-based clinical program
initiatives including quality improvement and cost containment strategies, as well as provide
analysis related to the pharmacy, durable medical equipment, and medical coverage component
of managed care in accordance with 42 C.F.R. Part 447; Section 340B of the Public Health Service
Act; Section 1927 of the Social Security Act [42 U.S.C. 1396r-8]; and the North Carolina State Plan.
B. Background and Program Information
NC Medicaid uses state and federal funds to provide health benefits to eligible adults, children,
pregnant women, seniors, and people with disabilities under the North Carolina Medicaid
Program. It covers more than three (3) million people in North Carolina, including children, the
aged, blind, and/or disabled, and people who are eligible to receive federally assisted income
maintenance payments. Operating within NC Medicaid, the North Carolina Medicaid Pharmacy
Program ("Pharmacy Program") offers a comprehensive prescription drug benefit, ensuring low-
income North Carolinians have access to the medicine they need. Program management through
stakeholder collaboration, effective use of drug rebates, and careful selection of drugs to be
covered by NC Medicaid ensures the Pharmacy Program is able to provide access to the right
drugs while providing the overall best value to beneficiaries, providers, and the State.
II. GENERAL PROCUREMENT INFORMATION AND NOTICE TO OFFERORS
A. Important Notices
Offerors are Cautioned to Read Carefully
1. Read, Review, and Comply: It is the Offeror's responsibility to read this document in its
entirety, review all attachments, tables, charts, exhibits, diagrams, and appendices, and
comply with all instructions.
2. Execution of Proposal: Failure to sign the Execution Page in the indicated space and return
all attachments, tables, charts, exhibits, diagrams, and appendices completed and signed
where required, may render the proposal non-responsive, and the proposal may be rejected.
3. Resulting Contract: Under the State's procurement process, any contract resulting from this
RFP will consist of the RFP and the Offeror's response, along with any addenda to the RFP,
written clarifications, Best and Final Offers (BAFO), and negotiation documents. The
Contractor will be obligated to perform services as proposed in its offer, unless otherwise
modified by clarification, BAFO, negotiation, or Contract amendment, or superseded by a
document with higher order of precedence. See Contract Section III.D.21. ENTIRE
AGREEMENT AND ORDER OF PRECEDENCE for more information and the order of precedence
of the contract documents. See Section II.C. Request for Proposal Functionality and Related
Notices for more information on the RFP, changes in specifications, and instructions regarding
modifications to the terms and conditions.
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4. Potential Negotiations: The Department reserves the right to enter into negotiations with
one or more Offerors to establish a contract that is in the best interest of the Department.
Negotiations are specific to each Offer and shall be conducted to maximize the State's ability
to obtain the most advantageous offer based on the evaluation factors set forth in the RFP.
Such negotiations are at the Department's sole discretion and may result in modifications to
the RFP and/or Offeror's proposal/ response to the RFP.
5. Events and Deadlines:
a. Pre-proposal Conference will be hosted by the Department on June 11, 2026, at 2:00 p.m.
EST. See Section II.D.2. Pre-Proposal Conference for details and instructions.
b. Questions concerning this RFP must be submitted in writing by June 25, 2026, at 2:00
p.m. EST. See Section II.D.3. Questions Concerning this Request for Proposal for details
and instructions.
c. Submission of Proposals will be accepted until August 6, 2026, at 2:00 p.m. EST. See
Section II.E. Submission of Proposal and Offeror's Response for details and instructions.
B. General Procurement Information and Instructions
1. INFORMATION AND DESCRIPTIVE LITERATURE: The Offeror shall furnish all information
requested as part of this RFP. Each Offeror shall submit detailed information with their
proposal (e.g., narratives, diagrams, exhibits, examples, sketches, descriptive literature,
complete specifications) to support the services and products offered.
2. RECYCLING AND SOURCE REDUCTION: It is the policy of the State to encourage and promote
the purchase of products with recycled content to the extent economically practicable, and
to purchase items which are reusable, refillable, repairable, more durable, and less toxic to
the extent that the purchase or use is practicable and cost-effective. The State also
encourages and promotes using minimal packaging and the use of recycled/recyclable
products in the packaging of commodities purchased. However, no sacrifice in quality of
packaging will be acceptable. The Offeror remains responsible for providing packaging that
will adequately protect the commodity and contain it for its intended use. Offerors are
strongly urged to bring to the attention of purchasers those products or packaging they offer
which have recycled content and that are recyclable.
3. MISCELLANEOUS: Pronouns, whether masculine, feminine, or gender-non-specific, shall be
read to be inclusive of all genders and shall be read to include the plural and vice versa.
4. INFORMAL COMMENTS: The Department shall not be bound by informal explanations,
instructions or information given at any time by anyone on behalf of the Department prior to
or during the competitive process or after award, including but not limited to policy papers
or any written or verbal statements whatsoever made outside of this RFP and any formal
Addenda issued herewith. The Department is bound only by information provided in this RFP
and in formal Addenda issued.
5. COST FOR PROPOSAL PREPARATION: Any costs incurred by an Offeror in preparing or
submitting proposals are the Offeror's sole responsibility. The Department will not reimburse
any Offeror for any costs related to proposal preparation and submission, or protest of award.
6. OFFEROR'S REPRESENTATIVE: Each Offeror shall submit with its proposal the name, title,
email address, physical address, and telephone number of the person(s) with authority to
bind the Offeror and answer questions or provide clarification concerning the Offeror's
proposal. This information must be included in the Offeror's proposal/ response.
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7. INSPECTION AT OFFEROR'S SITE: The Department reserves the right to inspect, at a
reasonable time, the equipment/item, plant, or other facilities of a prospective Offeror prior
to Contract Award, and during the Contract Term as necessary for the Department to
determine that such equipment/item, plant or other facilities conform with the
specifications/requirements and are adequate and suitable for the proper and effective
performance of the Contract.
8. DISCLOSURE OF ARTIFICIAL INTELLIGENCE (AI) USE: The Offeror shall disclose whether
Artificial Intelligence (AI), including generative AI tools, was used in the preparation of any
portion of its response to this RFP. If AI tools were utilized, the Offeror affirms that it has
reviewed and verified the accuracy, completeness, and appropriateness of all AI-generated
content. The Offeror shall remain solely responsible for the content of its submission,
including any errors, omissions, or misrepresentations resulting from the use of AI.
C. Request for Proposal Functionality and Related Notices
1. RFP Functionality
a. This RFP serves two functions:
i. Define the specifications of the services sought by the Department; and
ii. Provide the requirements and terms and conditions of any contract resulting from this
procurement.
b. All Terms and Conditions in this RFP shall be enforceable. The use of phrases such as
"shall", "will", "must", "required", and "requirements" are intended to create enforceable
Contract conditions. In determining whether proposals should be evaluated or rejected,
the Department will take into consideration the degree to which the Offeror has proposed
or failed to propose solutions that are responsive to the Department's needs as described
in this RFP.
2. Notices Regarding RFP and Terms and Conditions
a. It is the Offeror's responsibility to read all instructions, terms and conditions,
specifications, requirements, attachments and appendices, and any other components
made a part of this RFP and comply with all instructions and directives. The Offeror is
responsible for obtaining and complying with all addenda and other changes that may be
issued relating to this RFP.
b. All questions and issues regarding any term, condition, instruction, or other component
within this RFP must be submitted in accordance with Section II.D.3. Questions Concerning
this Request for Proposal. If the Department determines that any changes will be made
because of the questions asked, then such decisions will be communicated in the form of
an Addendum posted on the North Carolina electronic Vendor Portal (NC eVP). The
Department may also elect to leave open the possibility for later negotiation and
amendment of specific provisions of the Contract that have been raised during the
question and answer period. Other than through this process, and except as provided in
RFP Section II.C.3. Proposed Modifications to Terms and Conditions, the Department
rejects and will not be required to evaluate or consider any additional or modified terms
and conditions submitted with Offeror's proposal. This applies to any language appearing
in or attached to the RFP document as part of the Offeror's proposal that purports to vary
any terms and conditions, or Offeror's Instructions therein to render the proposal non-
binding or subject to further negotiation.
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c. The Offeror's proposal to this RFP shall constitute a firm offer. By execution and delivery
of a proposal to this RFP, the Offeror agrees that any additional or modified terms and
conditions, whether submitted purposely or inadvertently, or any purported condition
to the offer, shall have no force or effect, and will be disregarded. Noncompliance with,
or any attempt to alter or delete, this paragraph shall constitute sufficient grounds to
reject the Offeror's proposal.
3. Proposed Modifications to Terms and Conditions
a. Offerors are urged and cautioned to inquire during the question period, in accordance
with the instructions in this RFP, about whether the specific language proposed as a
modification is acceptable to or will be considered by the Department.
b. Identification of objections or exceptions to the terms and conditions in the proposal itself
shall not be allowed and shall be disregarded or the proposal rejected.
c. If the Offeror wishes to suggest changes to any of the terms and conditions included in
Sections III.D.-F. of this RFP, those must be submitted in Section VII. Attachment J: Offeror
Request for Proposed Modifications to the Terms and Conditions. The Department, in its
sole discretion, may consider any proposed modifications identified by the Offeror.
Where necessary, any modification(s) to the terms and conditions agreed upon by the
Department may be incorporated as part of an Addendum to the RFP, BAFO, negotiation
document, Execution of Contract, or Contract Amendment after award. Other than
through this process, the Department rejects and shall not be required to evaluate or
consider any additional or modified terms, conditions, or instructions included in the
Offeror's proposal.
4. Changes in Requirements and Specifications
a. The Offeror is cautioned that the requirements of this RFP can only be altered by written
Addendum or other document issued by the Department as described in this RFP, and
that oral or emailed communications from whatever source(s) are of no effect.
b. The Department reserves the right to modify any requirement or specification contained
herein without modifying the timelines in this RFP. Any modification will be specified in
an Addendum which shall be posted on the North Carolina electronic Vendor Portal (eVP)
prior to the opening of proposals or through Negotiation after the opening of proposals.
5. Rights Reserved
a. The Offeror is made aware, pursuant to 01 NCAC 05B .0501, that in soliciting offers, any
or all offers received may be rejected. The basis for rejection may include, but is not
limited to the following:
i. The offer is deemed unsatisfactory as to quantity, quality, delivery, price or service
offered;
ii. The offer fails to comply with conditions of the solicitation document or with the
intent of the proposed Contract;
iii. The Department determines there is a lack of competition;
iv. Error(s) in specifications or indication that revision(s) would be to the State's
advantage;
v. Cancellation of or changes in the intended project or other determination that the
proposed requirement is no longer needed;
vi. Limitation or lack of available funds;
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vii. Circumstances which prevent determination of the most advantageous offer and
selection in accordance with NCGS 143-135.9; or
viii. Any determination that rejection would be to the best interest of the State.
b. If all offers are rejected, the solicitation may be cancelled in its entirety, or the
Department may negotiate with one or more sources of supply that may be capable of
satisfying the requirements.
c. The Offeror is cautioned that this is a Request for Proposal, not a request to contract, and
the Department reserves the unqualified right to reject all offers deemed failing to meet
minimum qualifications, not responsive, incomplete, or non-compliant with the
requirements described herein; or when such rejection is deemed to be in the best
interest of the Department or the State of North Carolina.
d. The Department may also:
i. Modify provisions of this RFP in response to changes in law or as required by CMS;
ii. Waive any formality or informality;
iii. Waive a specification or requirement of the RFP if it is in the best interest of the
Department;
iv. Waive any undesirable, inconsequential, or inconsistent provisions of this RFP;
v. Negotiate directly with one or more Offerors, to achieve a contract that is in the best
interest of the Department, if the responses to this solicitation demonstrate a lack of
competition, or offers are found non-responsive; and/or
vi. Cancel this RFP at any time. Notice of Cancellation will be posted on the North
Carolina electronic Vendor Portal (eVP) website.
e. In the event all proposals are rejected, and the Department enters into negotiation,
pursuant to 01 NCAC 05B .0503, the Department reserves the right to award a contract
to the Offeror or Offerors, which, in its opinion, has (have) made the best proposal
through the negotiation process.
D. Schedule and Important Events
1. The Department will make every effort to adhere to the schedule detailed below in Section
II.D. Table 1: RFP Schedule. The Department reserves the right to adjust the schedule and will
post an Addendum on the North Carolina electronic Vendor Portal (eVP) for any schedule
changes occurring prior to the opening of proposals.
Section II.D. Table 1: RFP Schedule
Activity Responsible Party Due Date
Issue Request for Proposal Department June 4, 2026
Pre-proposal Conference Department June 11, 2026, at 2:00 p.m. EST
Deadline to Submit Written
Questions Offeror June 25, 2026, at 2:00 p.m. EST
Issue Addendum with Responses
to Questions Department July 23, 2026
Deadline to Submit Proposals Offeror August 6, 2026 at 2:00 p.m. EST
Conduct Evaluation of Proposals Department August 10, 2026 - November 3, 2026
Contract Award Department November 4, 2026
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