RFP 26-006 PEEHIP Pharmacy Benefit Consulting Services for Fiscal Years 2027 – 2031

REQUEST FOR PROPOSALS
FOR
PHARMACY BENEFIT CONSULTING SERVICES
FOR
THE
PUBLIC EDUCATION EMPLOYEES' HEALTH INSURANCE
PLAN
FOR
FISCAL YEARS
2027 through 2031
RFP 26-006
Issue Date: April 17, 2026

This RFP Contains Information Under the Following Headings:
SECTION I
General Information for the Proposer
A. Purpose
B. Background
C. Other Information
D. Proposal Opening
E. Key Dates
F. Scope of Services
G. Payment Schedule
H. Selection of Firm(s)
I. Addenda to the RFP
J. Contact Point
K. Minimum Experience Qualifications
SECTION II
Submission Requirements
A. Technical Proposal
B. Cost Proposal
SECTION III
Criteria for Evaluation
A. General
B. PEEHIP's Rights
C. Termination
D. Cost and Price Analysis
E. Proposal Evaluation Form
SECTION IV
Additional Documents
A. State of Alabama Disclosure Statement
B. Sample PEEHIP State Contract
C. Immigration Compliance Certificate
D. Proposer Profile Form
E. Proposer References Form
F. PEEHIP Statement on HIPAA Compliance Documentation
G. Sample Business Associate Agreement
H. IRS Form W-9
I. Non-Disclosure Agreement
J. IT Security Questionnaire
K. Certification of Bidder or Proposer

SECTION I
General Information for the Proposer
A. Purpose:
This Request for Proposals (RFP) solicits proposals for the performance of pharmacy benefit consulting services
for a five-year period beginning October 1, 2026, and ending September 30, 2031, for the Public Education
Employees' Health Insurance Plan (PEEHIP). The services shall include both ongoing services performed on a
recurring basis and as-needed services performed upon request and approval by PEEHIP. The services will focus
on controlling PEEHIP's total drug spend on specialty and non-specialty drugs across the pharmacy and medical
benefits, with limited consulting support related to PEEHIP's retiree Medicare Advantage Prescription Drug Plan
(MAPDP). Proposers are expected to possess strong analytical capabilities, in-depth pharmacy benefit expertise,
and the ability to provide practical recommendations to assist PEEHIP in managing formularies, utilization, and
prescription drug spend.
B. Background:
The PEEHIP provides health insurance benefits for all full-time employees and certain part-time employees of the
Alabama public educational institutions, which provide instruction at any combination of grades K-14. These
insurance benefits are also available to retired employees with a portion of the retiree's cost paid through the
employer premium for active employees. Coverage is also offered to eligible dependents.
Members have the following choices for health insurance coverage as follows:
* Hospital medical administered by Blue Cross and Blue Shield of Alabama - Actives and Non-Medicare
eligible retirees and eligible dependents.
* Prescription Drug coverage administered by Express Scripts - Actives and Non-Medicare eligible retirees
and eligible dependents.
* Health Maintenance Organization - Viva - Actives and Non-Medicare eligible retirees.
* Medicare Advantage Prescription Drug Plan (MAPDP) - Humana - Medicare eligible retirees and
Medicare eligible dependents of retirees
* Optional Coverage administered by Southland Benefit Solutions, LLC, - consisting of Dental, Hospital
Indemnity, Vision, and Cancer.
* Supplemental Hospital Medical administered by Blue Cross and Blue Shield of Alabama-supplemental
coverage for Actives and Non-Medicare eligible retirees
Members electing one of the hospital medical plans must pay a small amount each month for single coverage plus
an additional amount if the member elects family coverage. Additionally, members may select the optional coverage
plans or supplemental plan in lieu of the hospital medical coverage. Members electing hospital medical coverage
may also elect to pay an additional amount to acquire one or more of the optional plans.

Claims paid by third party administrators and payments to HMOs for Fiscal Years 2023-2025 are summarized as
follows (cash basis):
(Amount in Millions)
TPA 2023 2024 2025
Medical - BCBS of AL $ 1,013 $ 1,043 $ 1,119
Drug - ESI $ 254 $ 288 $ 247
MAPDP $ 77 $ 57 $ 203
HMO - VIVA $ 20 $ 18 $ 19
Optionals - CDIV - Southland $ 63 $ 60 $ 66
Flex $ 8 $ 9 $ 10
Other (e.g., ADPH) $ 5 $ 6 $ 5
Total Claims $ 1,440 $ 1,481 $ 1,669
Number of Members with medical contracts and number of dependents enrolled in PEEHIP Medical Coverage and
Optional Coverage as of January 31, 2026:
As of January 31, 2026 Active Retired Total Total Covered
Hospital/Medical Single Family Single Family Single Family Contracts Persons
Hosp/Med 35,297 52,286 3,753 5,580 39,050 57,866 96,916 230,639
Supplemental 188 1,537 546 770 734 2,307 3,041 8,596
Total Hosp/Med 35,485 53,823 4,299 6,350 39,784 60,173 99,957 239,235
Humana - - 40,442 20,437 40,442 20,437 60,879 80,907
Viva Health 727 518 133 90 860 608 1,468 2,747
Total Hospital/Medical 36,212 54,341 44,874 26,877 81,086 81,218 162,304 322,889
As of January 31, 2026 Active Retired Total Total Covered
Optional Plans Single Family Single Family Single Family Contracts Persons
Cancer 3,850 6,175 4,636 5,127 8,486 11,302 19,788 39,054
Dental 24,340 45,564 28,777 30,718 53,117 76,282 129,399 272,384
Vision 8,585 13,678 7,071 9,488 15,656 23,166 38,822 81,865
Indemnity 2,608 3,825 2,503 2,249 5,111 6,074 11,185 22,141
All optional plans are with
Southland
PEEHIP also implemented a MAPDP effective January 1, 2017. The member count for this program is approximately
81,000 (included above), and the plan is currently administered by Humana.

C. Other Information:
Additional terms and conditions applicable to, and hereby incorporated within, this RFP and all proposals
submitted in* response to this RFP are located at https://www.rsa-al.gov/about-rsa/itb-rfp/ and titled:
*
* RSA Reservation of Rights and Requirements for ITBs and RFPs
RSA Standard Terms and Conditions for Solicitations and Contracts
RSA Procedure for Resolution of Controversies
By submitting a proposal, all proposers are deemed to have agreed to all terms and conditions included
w ithin the above documents unless a proposer provides RSA with a document clearly stating its exceptions
tOot haenry d toecrumm oern tcso tnhdati taioren c, oanlosnidge wreidt ha sa p daertt aoifl etdhi jsu RstFifPi cmataiyo nb,e t hloecraetfeodr vei. a the internet as follows:
RSA's website - www.rsa-al.gov
PEEHIP information on RSA's website - www.rsa-al.gov/index.php/members/peehip/
Alabama Secretary of State's website - www.sos.alabama.gov
PEEHIP Law - Code of Alabama 1975, Title 16, Chapter 25A, Article 1
Flexible Benefits Plan Law - Code of Alabama 1975, Title 16, Chapter 25A, Article 2
D. Proposal Opening:
Please submit one printed non-redacted and one printed redacted copy of your proposal, and a digital copy (non-
redacted and redacted) on a USB drive in a sealed envelope with the following plainly marked on the front:
PEEHIP
Pharmacy Benefit Consulting Services Proposal
RFP 26-006
Opening June 11, 2026
Proposals sent via UPS or FedEx: Proposals sent via U.S. Mail:
Taylor Benefield Taylor Benefield
Accounting Dept. Accounting Dept.
Retirement Systems of Alabama Retirement Systems of Alabama
201 South Union Street P.O. Box 302150
Montgomery, AL 36104 Montgomery, AL 36130-2150
Proposals may be hand delivered to Taylor Benefield of the Retirement Systems Building, 7th floor, 201 South
Union Street, Montgomery, Alabama. Proposals will be accepted until 2:00 p.m. CST on June 11, 2026. Proposals
will not be accepted after this date and time. Proposals will be opened after 2:00 p.m. CST on June 11, 2026.
PEEHIP reserves the right to reject any and all responses to this RFP.
Any questions regarding this RFP must be submitted electronically via email by May 1, 2026, at 2:00 p.m. CST to
Taylor Benefield at Taylor.Benefield@rsa-al.gov.
All responses to this solicitation may be subject to public disclosure upon request. Proposers should be
aware of the Open Records Act (Ala. Code 36-12-40), the Alabama Trade Secrets Act (Ala. Code 8-27-1 and
8-27-6), and the Public Record Status of Certain Procurement Information statute (Ala. Code 41-4-115).

Any confidential, trade secret, or proprietary commercial information contained in a proposal must be
clearly marked as such. Identification of an entire proposal as confidential is not acceptable unless the
p roposer states in detail the specific grounds and applicable laws which support treatment of the entire
pEr. o Kpoeysa Dl aatse ps:r otected from disclosure.
RFP 26-006 KEY DATES
Activity Date
RFP to be Issued/Posted on RSA's website April 17, 2026
Deadline to Submit Questions May 1, 2026 @ 2:00 p.m. CST
Responses to Questions posted to RSA's website May 6, 2026 @ 5:00 p.m. CST
Responses Due by June 11, 2026 @ 2:00 p.m. CST
Bid Opening Date June 11, 2026
Finalist Conferences Week of June 15, 2026
Award of Bid June 19, 2026
F. Scope of Services
The successful proposer shall provide pharmacy benefit consulting services to PEEHIP during the term of the
contract. Services shall include both ongoing services performed on a recurring basis and as-needed services
performed upon request and approval by PEEHIP.
A. Ongoing Services
In addition to any as-needed services requested by PEEHIP, the successful proposer shall provide certain
ongoing pharmacy benefit consulting services throughout the term of the contract. These services are expected
to be performed on a recurring basis as part of the successful proposer's regular support of PEEHIP's
pharmacy benefit strategy, clinical oversight, and cost-containment efforts. Ongoing services may include,
but are not limited to, the following:
1. Utilization Management and Prior Authorization Support
a. Assist PEEHIP with the ongoing development, review, and modification of prior authorization criteria
for specialty and non-specialty drugs.
b. Ensure prior authorization criteria are based on manufacturers' full prescribing information and are
designed to promote clinical appropriateness, adequate supporting documentation, and appropriate
renewal requirements.
c. Provide independent pharmacist consulting support to assist PEEHIP in making utilization
management decisions regarding drug exclusions, step therapies, quantity limits, and prior
authorizations under PEEHIP's customized Commercial Rx Drug Benefit.
2. PBM Oversight
a. Provide periodic oversight of PBM administration to help ensure that approved prior authorization
criteria and related utilization management rules are being administered as intended.

b. Conduct audits or reviews of PBM processes and determinations as requested by PEEHIP to confirm
compliance with PEEHIP-approved criteria.
3. Claims Monitoring and Savings Analysis
a. Analyze PEEHIP's pharmacy and medical drug claims on a periodic basis to identify significant and
immediate cost-savings opportunities.
b. Evaluate specialty drugs, brand drugs, and generic drugs across both the pharmacy and medical
benefits.
c. Use available data tools and reporting capabilities to identify utilization trends, cost drivers, and
opportunities for improved benefit management.
4. Dashboard and Data Access
a. Provide and maintain access to a web-based application that is fully operational and capable of
presenting integrated pharmacy and medical claims information through an easy-to-use dashboard
interface.
b. Ensure the dashboard includes drill-down capability and relevant medical claim diagnosis information,
where available.
c. Provide demonstrations, training, or walkthroughs of the dashboard upon request by PEEHIP.
d. To the extent the services require access to protected health information, personally identifiable
information, or other confidential data, the successful proposer shall comply with all applicable
privacy, security, and confidentiality requirements, including HIPAA and any business associate
requirements set forth in this RFP and the resulting contract.
5. Vendor Coordination and Formulary Review
a. Participate in recurring meetings or calls with PEEHIP's pharmacy, medical, and Medicare Advantage
Prescription Drug Plan (MAPDP) vendors, including bi-weekly, quarterly, or semi-annual meetings,
as applicable.
b. Assist PEEHIP in identifying cost and coverage efficiencies and in coordinating formularies across
vendors to the extent practicable.
c. Provide annual review of MAPDP vendor recommendations for the upcoming calendar year's drug
coverage, recognizing that CMS requirements may not always align with savings strategies applicable
to the pharmacy and medical benefits.
B. As-Needed Services
In addition to the ongoing services described above, the successful proposer may be asked to provide certain
consulting, analytical, and support services on an as-requested basis during the term of the contract. These
services shall be performed only upon request by PEEHIP and after authorization to proceed. As-needed
services may include, but are not limited to, the following:
1. Drug Pricing and Rebate Evaluation
a. Demonstrate familiarity with Alabama Average Acquisition Cost (AAC) pricing and related pharmacy
pricing methodologies.
b. Assist PEEHIP in evaluating PBM-proposed rebate opportunities for the purpose of identifying the
lowest net cost option.
c. Assist PEEHIP in reviewing and evaluating PBM rebate reports.
2. PBM Network and Contract Support
a. Assist PEEHIP with PBM network performance analysis, as requested.
b. Assist PEEHIP with PBM or other pharmacy benefit-related requests for proposals, as requested.
c. Assist PEEHIP with PBM contract development, review, and performance guarantee development, as
requested.

d. Assist PEEHIP with PBM contract monitoring, market checks, and performance guarantee penalty
calculations, as requested.
3. Variable Copay Program Support
a. Provide support for PEEHIP's established specialty variable copay program that utilizes manufacturer
revenue coupon programs.
b. Provide support for PEEHIP's established medical drug variable copay program that utilizes
manufacturer revenue coupon programs.
4. Communication and Education Support
a. Assist with provider and member communication and education regarding PEEHIP's efforts to reduce
drug spend without causing harm or undue inconvenience to members.
5. Additional Consulting and Data Analytics Services
a. Provide other clinical pharmacy consulting or data analytics services reasonably requested by PEEHIP
and agreed to be performed by the successful proposer during the term of the agreement.
6. Authorization Requirement
a. All as-needed services shall be provided only on an as-requested basis.
b. No work shall begin until PEEHIP has provided approval to proceed.
G. Payment Schedule:
Payments will be made no more frequently than monthly based upon approved invoices and the pricing structure
set forth in the proposer's Fee Schedule and resulting contract.
H. Selection of Firm(s):
PEEHIP reserves the right to make no award under this RFP. PEEHIP expects to enter into a contract with the
successful proposer(s). PEEHIP also reserves the right to award all or part of required services under this RFP to
one or more proposers, and this decision will be at the sole discretion of PEEHIP. PEEHIP makes no guarantee that
the successful proposer(s) will be the exclusive provider(s) of the services during the term of any resulting contract.
All firms submitting a proposal under this RFP will be notified in writing within a reasonable length of time
following the selection. Prior to an award of contract(s), two or more proposers who submit proposals determined
to be reasonably susceptible of being selected for award may be requested to make oral presentations to the
evaluation committee; however, proposals may be accepted, and a final selection made, without such oral
presentations. All proposals shall become the property of the PEEHIP.
Internet and/or website links may not be used in lieu of required narrative responses or required attachments under
this solicitation. Proposers may include links as supplemental information only, unless otherwise expressly
requested by PEEHIP. Unless stated elsewhere in this solicitation, PEEHIP will accept and evaluate alternate
submittals on this RFP provided that the response meets all published requirements. PEEHIP reserves the right to
waive minor discrepancies or errors within proposals or to request clarification from a proposer to the extent allowed
by law.
The failure of PEEHIP to require performance of any provision of the solicitation or resulting contract shall not
affect PEEHIP's right to require performance at any time thereafter, nor shall a waiver of any breach or default
constitute a waiver of any subsequent breach or default nor constitute a waiver of the provision itself.
I. Addenda to the RFP:
RSA may, at any time prior to the deadline for proposals, modify this RFP, including the timeline associated with
the RFP. Any modifications made to the RFP prior to the proposal's due date will be provided in writing to all
solicited proposers.

J. Contact Point:
Any questions that arise concerning this RFP may be directed to Taylor Benefield at Taylor.Benefield@rsa-al.gov.
K. Minimum Experience Qualifications:
Proposals will be accepted from firms where both the firm and assigned consultants have the following
minimum experience qualifications:
1. Firm Qualifications
a. The firm shall have at least five (5) years of experience providing pharmacy benefit consulting services
to self-funded employer-sponsored or public employer health plans.
b. The firm shall have demonstrated experience in specialty and non-specialty drug cost management
under both the pharmacy and medical benefits.
c. The firm shall have completed at least three (3) engagements within the last five (5) years involving
pharmacy benefit consulting for large employer-sponsored health plans. For purposes of this RFP, a
large employer-sponsored health plan means a self-funded employer or public employer health plan
with at least 250,000 covered lives and at least $1 billion in annual medical and pharmacy claims or
health benefit expenditures.
d. The firm shall have demonstrated experience with PBM oversight, rebate evaluation, utilization
management strategy, pharmacy claims analytics, formulary management, and drug cost-containment
initiatives.
e. The firm shall have experience providing or supporting integrated pharmacy and medical claims
analysis, including identification of utilization trends, cost drivers, and savings opportunities.
f. The firm shall have experience supporting clients with vendor coordination, contract review,
performance guarantees, procurement support, or pharmacy benefit-related requests for proposals.
2. Lead Pharmacist or Clinical Consultant Qualifications
a. The lead pharmacist or supervising clinical consultant assigned to the engagement shall be a licensed
pharmacist in good standing in at least one state of the United States.
b. The lead pharmacist or supervising clinical consultant shall have at least five (5) years of experience
in pharmacy benefit consulting, clinical pharmacy management, PBM oversight, or a substantially
similar role.
c. The lead pharmacist or supervising clinical consultant shall have demonstrated experience in prior
authorization development, clinical criteria review, drug exclusions, step therapy protocols, and
quantity limit review.
d. The lead pharmacist or supervising clinical consultant shall have demonstrated experience with
specialty drug management, including specialty drug trend analysis, specialty drug utilization controls,
and channel or site-of-care management across the pharmacy and medical benefits.
e. The lead pharmacist or supervising clinical consultant shall have demonstrated experience supporting
large employer-sponsored health plans, as defined above, including at least one engagement involving
pharmacy benefit consulting services for such a plan.
3. Engagement Lead Qualifications
a. The engagement lead shall have at least five (5) years of experience leading pharmacy benefit
consulting or healthcare consulting engagements for self-funded employer-sponsored or public
employer health plans.
b. The engagement lead shall have demonstrated experience managing client relationships, coordinating
deliverables, and providing strategic recommendations related to PBM performance, pharmacy benefit
strategy, cost containment, and vendor oversight.
c. The engagement lead shall have experience with PBM procurement support, contract review,
performance guarantee development, implementation support, or ongoing contract monitoring.

d. The engagement lead shall have demonstrated experience supporting large employer-sponsored health
plans, as defined above, including at least one engagement involving pharmacy benefit consulting
services for such a plan.
4. Analytics and Reporting Qualifications
a. The firm shall have personnel with experience in pharmacy claims analysis, rebate analysis, pricing
analysis, and integrated pharmacy and medical data review.
b. The firm shall demonstrate familiarity with Alabama Average Acquisition Cost (AAC) pricing and
other commonly used pharmacy pricing and rebate methodologies.
c. The firm shall have experience producing reports, dashboards, analytical summaries, or similar tools
to support plan sponsor decision-making related to pharmacy and medical drug costs.
5. Documentation Requirements
a. The proposer shall provide documentation sufficient to verify that the minimum experience
qualifications have been met.
b. The proposer shall provide the resume or curriculum vitae of the primary consultant(s) who will be
assigned to the account, including the lead pharmacist or clinical consultant and the engagement lead.
c. The proposer shall also provide resumes or bios of other key personnel expected to support the contract.
SECTION II
Submission Requirements
A. Technical Proposal Requirements
To be considered, the proposal must respond to all requirements and questions in this section using the
numbering system below.
1. Statement of Understanding
State in succinct terms the proposer's understanding of the pharmacy benefit consulting services requested by
PEEHIP, including the proposer's understanding of the ongoing services and as-needed services described in
Section I.F.A and Section I.F.B.
2. Business Organization
State the full legal name and address of the proposer's organization and, if applicable, the branch office or
other subordinate element that will perform or assist in performing the work under the contract. Indicate
whether the proposer operates as an individual, partnership, limited liability company, corporation, or other
legal entity, and include the state in which the entity was formed or incorporated. State whether the proposer
is licensed to transact business in the State of Alabama. Proposers shall use the attached Proposer Profile Form
for this response.
3. High-Level Summary
Provide a narrative description of the proposed effort, including a summary of the services to be provided, the
proposer's overall service model, and the principal deliverables, tools, reporting capabilities, and support
functions the proposer expects to provide under the contract.