PBM RFP Guide

A well-structured Request for Proposal is the foundation of a competitive PBM selection process. The RFP should generate comparable, binding proposals that allow apples-to-apples evaluation while surfacing the contract terms and operational capabilities that drive long-term value.

Pre-RFP Planning

Before issuing an RFP, define your plan's priorities, required capabilities, and non-negotiable contract terms. Compile current claims data, including at least 12 months of prescription-level detail, rebate reports, and utilization summaries. Clean, comprehensive data allows bidders to price accurately, reducing the risk of post-implementation surprises.

RFP Structure

An effective PBM RFP should include sections on pricing (discount guarantees, dispensing fees, rebate commitments), clinical programs (formulary management, utilization management, specialty management), operations (implementation plan, service levels, technology), network (retail, mail, specialty), contract terms (transparency provisions, audit rights, termination), and references from clients of similar size and complexity.

Pricing Comparability

Require bidders to price against your actual claims data using standardized pricing templates. Specify the pricing metric format (e.g., discount off AWP, effective rate) to ensure comparability. Request multi-year pricing guarantees rather than first-year-only commitments that may escalate. Ask for pricing across all dispensing channels: retail, mail, and specialty.

Evaluation and Finalists

Score proposals against your pre-defined evaluation criteria before conducting finalist presentations. Narrow to two or three finalists for detailed presentations and contract negotiations. During finalist presentations, focus on implementation experience, account team credentials, clinical outcome data, and technology demonstrations rather than repeating pricing discussions.