RFP 26-019 Pharmacy Benefits Management

Request for Proposal
Request for Proposal
for
Prescription Drug Management
RFP# 26-019
Russellville Arkansas
Advisors:
Tom Kane, Executive Vice President, Director - Tom.Kane@stephens.com
Tyler Runnells, Senior Vice President - Tyler.runnells@stephens.com
Stephens Insurance, LLC 111
Center Street
Little Rock, AR 72201
May 8, 2026
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Request for Proposal
TABLE OF CONTENTS
Section I : General Information on RFP and CLIENT
A. Introduction to CLIENT
B. Intent of Proposal
C. Contract Rate Guarantee Period
D. Proposal Confidential Information
E. Right of Refusal
F. Proposal Process Information
G. Contact Information
Section II: Questionnaire
A. General Information
B. Clinical Programs
C. Pharmacy Network
D. Claims Processing, Benefit Plan Design and Implementation
E. Reporting
F. Member Services
G. Eligibility
H. Rebates
I. Disease Management / Provider Initiatives
J. High Deductible & HSA Type Plans
K. Medicare Part D
L. Formulary
M. Performance Objectives
N. Audit Rights Agreement
O. Additional Fees to Consider
P. File Distribution to Consultant
Section III: Pricing
A. Pricing Quotes
B. Transparency Questions
Section IV: Contracting
Specific contract given for review
Section V: Summary of Attachments
A. Required Attachments
B. Summary of Information Given
Section VI: Appendix List
1. Current Benefit Plan
2. Transparency Pricing Request
3. Specialty Drug Pricing Form
4. Pass-Through Contract
5. ATU Preferred Contractual Provisions
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Request for Proposal
SECTION I
A. INTRODUCTION TO Arkansas Tech University (ATU)
Arkansas Tech University is a state university established in 1909 with programs at the technical
certification, associate, baccalaureate and graduate levels. The University has campuses in
Russellville, Arkansas, and Ozark, Arkansas. The institution also operates Arkansas Tech Career
Center (ATCC), a career and technical training initiative headquartered in Russellville with satellite
locations at Clarksville, Danville, Ozark and Paris.
ATU Russellville-Offers 120 undergraduate degree programs and more than 25graduate degree
options.
ATCC-Serves over 1,000 students from 19 school districts across 9 program areas.
ATU Ozark-Serves over 2,100 students in 29 technical and associate programs.
ATU has approximately 780 full-time employees located on three campuses -Russellville, Ozark
and the Arkansas Tech Career Center (ATCC). ATU also provides benefits to pre-65 Retirees and
post-65 Retirees.
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Request for Proposal
A. INTENT OF PROPOSAL:
Arkansas Tech University (CLIENT) has the desire to provide its approximate 980 eligible
employees a "Pass-Through Pricing" pharmacy program. Respondents need to consider this
solicitation is for a two (2) year transparent contract. By offering this, CLIENT will be able to
better direct its members in controlling their pharmacy expense. With this goal, CLIENT is
seeking the best service and net value through this RFP process. With the intent of a more
open arrangement, CLIENT is requesting quotes with a total Transparent and "Pass-Through"
Pricing strategy.
B. CONTRACT RATE GUARANTEE PERIOD:
The period concerning this RFP begins January 1, 2027 and ends December 31, 2028. There
will be potential for continuation of the contract through subsequent periods.
C. PROPOSAL CONFIDENTIAL INFORMATION:
This is a confidential marketing effort. All information, including the RFP questions and
spreadsheets should be treated as confidential business documents and may not be shared
with outside parties without the prior written approval of STEPHENS INSURANCE. Do not
contact CLIENT or any employee of CLIENT regarding this RFP or the selection process.
D. EVIDENCE BASED FORMULARY MANAGEMENT
Plan Sponsor or Stephens Insurance may implement an evidence based formulary
management program using custom drug exclusions, step therapy, prior authorization and dose
optimization to save money without sacrificing patient safety.
Coordinated implementation of clinical recommendations includes, but is not limited to:
- Applying approved changes into PBM adjudication system and testing for accuracy
- Supplying physician/prescriber addresses for physicians of affected members
- Providing NCPDP post-adjudicated claims files
- Providing prior authorization placement and claims history review functionality via online access
to prescription claims adjudication system
E. RIGHT OF REFUSAL:
CLIENT reserves the right to accept or reject any and all responses submitted to this RFP.
CLIENT reserves the right to withdraw the RFP at any time. This RFP document should in no
way be construed as a commitment to purchase on the part of CLIENT. All decisions are
made by CLIENT and are final.
F. PROPOSAL PROCESS INFORMATION:
ATU must receive an electronic copy and hard copy no later than June 8, 2026, at 5:00 p.m.
Stephens Insurance must receive an electronic copy and one hard of your proposal no later
than June 8, 2026 at 5:00 p.m. This includes the completion of the following questionnaires
and exhibits:
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Request for Proposal
Timeline Process Event Target Date
Issue RFP with Data May 8, 2026
Questions due from PBMs by May 15, 2026
Response to PBM questions due May 20, 2026
Proposals Due June 8, 2026
Finalist Interviews As needed
Contract Effective Date January 1, 2027
All questions regarding this proposal should be directed to David Keisner.
David Keisner, PharmD
Vice President | Pharmacy Benefits Analyst
Stephens Insurance, LLC
111 Center Street, Suite 100 | Little Rock, AR 72201
Direct (501) 377-8208 | Toll Free (800) 852-5053
david.keisner@stephens.com | stephensinsurance.com
Secure Fax (501) 537-6059
Please provide an electronic copy of your response via email to:
David Keisner
Stephens
david.keisner@stephens.com
AND
Jennifer Warren
Director of Procurement
514 West M Street
Russellville, AR 72802
jwarren2@atu.edu
G. CONTACT INFORMATION:
Please provide the following responses about your organization. Provide separate responses for
retail, specialty and mail service if applicable.
Name
Street Address
City
State
Zip Code
Web Address
Contact for this Proposal
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Request for Proposal
Contact E-mail Address
Contact Phone Number
Please list any companies and complete contact information as outlined above to which you
subcontract services, this includes but is not limited to Specialty Pharmacy services, Rebate
Services and Mail-Order facilities.
SECTION II QUESTIONNAIRE
A. GENERAL INFORMATION:
1. List the information CLIENT is required to provide for implementation of an account.
2. Do you process your own claims? Please describe your claims adjudication process. What
software do you use to process claims? Do you own your own claims adjudication software?
If not please explain in detail who owns the software and what part you play in the plan set
up, changes in plan set up and where the software resides. If you do not own your claim
adjudication software please describe in detail what arrangement you have to access the
claims adjudication software and the claims data produced by the adjudicated claims.
3. Do you process your own rebates? Do you hold manufacturer rebate contracts with drug
manufacturers? Do you utilize a rebate aggregator to process rebates? If so, who is your
rebate aggregator? Are you able to provide NDC level rebate data? Please describe your
rebate collection and payment process. Please provide a detail timeline.
4. Do you own your mail order facility? If not, who do you contract with for that component?
5. How do you facilitate/implement the conversion from a group's current PBM to you?
6. Are you willing to pay an implementation fee to cover cost of implementation to be
determined at the discretion of CLIENT including but not limited to mailing of ID cards and
implementation packets?
7. You will be required to provide network and/or formulary disruption reports prior to award of
contract. Please outline in detail this process and the data necessary to perform the
disruption reports. Are you able to utilize Pharmacy NABP and/or NPI numbers?
8. Will you provide at no charge a member ID card where the medical and pharmacy is
combined? Will you allow CLIENT to print their ID Cards containing PBM information in-
house or via the TPA? If so, how do you assist in that process?
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9. Please describe your Account Team set-up and management hierarchy. Please include
names and contact information.
10. Post go-live implementation, please certify that you will provide a dedicated PBM
representative be available triaging calls the first 30 days.
11. Please confirm that you will assist with member communication materials including but not
limited to any SPD language requested by Sponsor at no additional charge.
12. How many clients and lives do you have under administration, broken down among client
type: employer, TPA, health plan etc?
B. CLINICAL PROGRAMS:
1. Provide a description of your Drug Utilization Review (DUR) programs to include
retrospective, concurrent, and prospective programs. Are there additional fees for any of
these services? Please be specific. Please include any additional fees in Exhibit B of the
services Agreement.
2. What other programs do you have that promote cost-effectiveness? Please provide sample
reports demonstrating your ability to substantiate savings and associated costs.
3. Can you develop a CLIENT specific formulary? Will you be able to conduct a formulary
disruption report prior to changes? This report must verify and communicate any changes
to rebate guarantees.
4. Can you provide online member access to a specific formulary?
5. Will a specific formulary change the rebate guarantees? If so, please explain. Are you able
to document relative rebate difference between medications within a therapeutic category?
6. What are the limitations to CLIENT's ability to customize quantity limits or days supply for
specific medications?
7. How will clinical criteria be applied to mail order?
8. What is your prior authorization approval percentage as it applies to your book of business?
If possible, provide approval percentage by type of PA (administrative, therapeutic, etc.)
9. Please list the clinical reports that are available and at what intervals they will be provided
to CLIENT and STEPHENS. Please provide sample Reports and include in Attachment
12. Are there additional fees for any of these services? Please be specific.
10. What programs are available to maximize saving to plan via manufacture coupons?
Please describe the program and any cost associated with it.
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11. What other programs are available to maximize cost savings? Provide a description and
estimated savings if possible.
C. PHARMACY NETWORK:
1. Describe your proposed pharmacy network in terms of size and nationwide
coverage.
2. Please detail the number of Arkansas pharmacies currently in the network. What
Percentage of Arkansas pharmacies are in your available networks?
3. Describe any unique network options, e.g., regional, nationwide, narrow, a
specific network for one client.
4. Describe the function of your Customer Service Department, times available,
training, certified pharmacy techs and contact info for head of department.
5. What is your position on the following pharmacy network pricing criteria?
a. Do you use more than one source of AWP? What references are used and
what criteria are used to select a specific AWP among sources?
b. Can you support different pharmacy network pricing for the same employer
group?
c. Can you support unique contract parameters, i.e., $2.50 minimum
reimbursement or a 50% co-payment plan?
d. Are there any system limits to calculating lesser prices between?
i. AWP discount and dispensing fee
ii. Usual and Customary Pricing
iii. Maximum Allowable Cost (MAC) and dispensing fee
6. What options do you have for pricing prescriptions less than the member's copay?
7. Do you capture and compare the usual and customary charge with each retail
claims submission?
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8. How do your mail-order and retail prescription claims processing systems
integrate? Please be specific how retail and mail services integrate concerning
Refill Too Soon parameters.
9. Can you support non-traditional dispensing units, i.e., home infusion companies?
10. Is your specialty pharmacy program in-house or outsourced? If it is outsourced,
who is the provider? If multiple provides please list all providers.
11. Please describe any pricing advantages available by using an exclusive Specialty
Pharmacy.
12. Please describe the process a member would undergo to utilize the specialty
pharmacy program.
13. Describe the audit process of the provider pharmacies in your Retail Network. How
are discrepancies reported and CLIENT reimbursements made? Please verify that
you will audit at least 3% of your pharmacy network per year.
D. CLAIMS PROCESSING & BENEFIT PLAN DESIGN AND IMPLEMENTATION:
1. Describe how long it takes to set up a new benefit design with:
i. Initial benefit design
ii. One change compared to an existing plan
iii. Multiple changes
2. Can your system support maximum out-of-pocket per member and per family plan
designs? Please describe in detail how you work with TPA's or other third parties
to integrate medical and pharmacy out-of-pocket. Are there additional fees for any
of these services? Please be specific. Please include any additional fees in Exhibit
B of the services Agreement.
3. Can your system support maximum quantity edits for quantity or dose unit
limitations?
4. Can you maintain a tier co-payment for maintenance supply of 90 days?
5. How much paid history do you retain, for reporting, clinical editing and for third party
claims audit purposes?
6. Describe your use of MAC Lists. How many drugs are listed and what is the effective
percentage of all generics covered? Do you use multiple MAC Lists and if so, which
will be used for CLIENT? MAC List Name? Please be specific.
7. Please certify you are willing to implement one MAC Price Each for each GCN,
GSN or GPI for all network pharmacies and it will be utilized in all channels of
distribution. If not, please explain why.
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8. This response requires an estimated effective AWP % discount for MAC pricing and
an effective AWP % discount for generics. Verify you willing to guarantee an overall
generic discount.
9. Please certify that an historical MAC List including MAC price each, with GCN, GSN
or GPI will be available within 15 days of request for audit purposes as outlined in
Appendix 7.
11. Given CLIENT requests a total "Mandatory Generic" plan design, meaning CLIENT would
be responsible only for the generic cost of any substitutable brand claim, please describe
in detail your processing and pricing procedure for both retail and mail claims with the
following criteria:
a). DAW 0, 1 or 2 claim for a substitutable brand, not on the MAC List.
b). DAW 0, 1 or 2 claim for a substitutable brand on the MAC List.
c). DAW 0, 1, or 2 claim for a substitutable brand that will result in a "zero
net balance" to CLIENT.
11. With a Mandatory Generic Logic plan, does your system have the potential to reject
a DAW 0 submission for a substitutable brand, requiring the assignment of DAW 1
or 2?
12. After a new benefit plan is designed and implemented, what audit steps are taken
to verify proper design and how much will CLIENT be involved in this audit process.
13. Will CLIENT have the capability of viewing on-line how plans are configured? Are
there additional fees for any of these services? Please be specific.
14. Please certify that the pricing quote for this RFP utilizes the AWP values provided
by Medispan after September 26, 2009. Please verify Medispan is your current
AWP source and that you would use Medispan if awarded this contract.
15. Describe your pricing methodology for compounded medications. Please provide
detail of the fields provided to audit compound claims. Is compound ingredient detail
provided on clinical reports?
16. Please certify your acceptance of the methodology of calculating "Discount
Guarantees" as shown below and as outlined in the accompanying services
agreement.
The Guaranteed Average Retail 30 Rates, Guaranteed Average Retail 90 Rates, and
Guaranteed Average Mail Order Rates shall be calculated based on all drugs dispensed
through Participating Pharmacies except those: (i) priced based on U&C. Drugs shall only
be priced based on U&C if said U&C price is lower than the same drug's price based on
the contractually agreed discounted AWP for that pharmacy, or PBM's MAC; (ii) over-the-
counter products; (iii) compound drug products; and (iv) Specialty Drugs. Drugs shall only
be priced based on MAC if the MAC is lower than the same drug's price based on AWP
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