Pharmacy Benefit Manager Services

The Inland Empire Health Plan, a government authority located in Rancho Cucamonga, California, is seeking a pharmacy benefit manager to provide comprehensive pharmacy benefit administration services. The agency needs to solve the challenge of managing a compliant and adequate retail, mail, and specialty pharmacy network throughout its service area. The scope of work covers formulary development, coverage determinations, clinical programs such as opioid safety and Stars, ongoing clinical management, and real-time claims adjudication. The selected provider must manage eligibility integration, accurate claims processing, and coordination of benefits, including the appropriate handling of vaccines and pharmacy-medical benefit crossover claims. The agency requires transparent financial administration, which must include clearly defined pricing methodologies, rebate contracting and administration, inflation and Inflation Reduction Act or Maximum Fair Price-related rebate protection mechanisms, performance guarantees, and full audit rights for the agency. The contract period will span three years, and the agency is currently looking for proposals to establish the budget. Only onshore organizations based in the United States are eligible to bid on this opportunity. The agency requires the performance of the work to be conducted onsite. Bidders must submit all questions regarding this opportunity no later than June 30, 2026.