Medical Plan Administration and Pharmacy Benefit Management for State Employees

The Rhode Island Department of Administration/Division of Purchases, on behalf of the Office of Employee Benefits, is seeking proposals from qualified firms to provide the administration of medical benefits and/or pharmacy benefits for the State of Rhode Island's approximately 13,400 enrolled employees and non-Medicare retirees. Vendors can submit separate proposals for medical and pharmacy plans, or a combined proposal. The solicitation covers administrative services for both medical and pharmacy benefit plans, with detailed requirements outlined for each. The medical plan administration includes providing nationwide coverage, administering wellness programs, managing finances, and improving the health of state employees and their dependents. The State currently offers three medical plans for active employees and three for non-Medicare retirees, with potential for future plan design changes. The pharmacy benefit management services include claims adjudication, formulary and rebate management, clinical programs, and network pharmacy management. The State's current pharmacy benefit plan utilizes a four-tier design with specific copayments and supply limits.