Medical Third-Party Administrator and Pharmacy Benefit Manager Services
Overview
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SUMMARY
DESCRIPTION
The procuring organization is seeking a vendor to provide medical third-party administrator (TPA) and pharmacy benefit manager (PBM) services. Medical TPA responsibilities include claims intake, adjudication and payment, claims accuracy and quality control, discount and savings reporting, utilization management, case management, disease management, behavioral health integration, and coordination with an employee assistance program.
The selected vendor should describe contact center hours, supported languages, average speed of answer, abandonment rate, first-call resolution metrics, member portal or mobile application capabilities, supported file formats, data exchange frequency, implementation timelines, standard reporting offerings, data access methods such as SFTP or APIs, and data ownership or usage terms. Vendors should also provide a high-level implementation plan for the effective date and identify key implementation roles and responsibilities.
PBM services should address specialty management, site-of-care and biosimilar strategies, call center operations, retail pharmacy network options, specialty pharmacy capabilities and accreditation, patient support services, and pharmacy network adequacy for urban and rural populations. The vendor should also explain digital member tools, formulary change communications, disruption management, standard reporting cadence, and rebate reporting. Questions must be submitted by August 24, 2026.
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Frequently asked questions
- When is the submission deadline?
- Submissions are due August 31, 2026.
- Who is a good fit for this opportunity?
- Established healthcare benefits administrator offering both medical TPA and PBM services
- Demonstrated experience in claims administration, utilization management, case management, and disease management
- Comprehensive PBM capabilities including specialty pharmacy, retail networks, biosimilars, rebates, and formulary management
- Secure data exchange, member portal, mobile application, and analytics capabilities
- Proven implementation experience with strong reporting, contact center, and compliance operations
Analysis generated by Settle AI from the source RFP.
RFP Hunter shows what is open. Settle shows what is forming.
Settle pieces together buyer signals, budgets, contract activity, and the sources your team already monitors. See why an opportunity fits and what to do before the RFP posts.