Medicaid Pharmacy Benefit Management Services
New York State > Department of Health > Office of Health Insurance Programs
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Submission Instructions
Description
The New York State Department of Health is seeking one contractor to administer pharmacy benefit management services for the New York State Medicaid Pharmacy Program. The scope includes centralized prior authorization and utilization management for pharmacy claims, physician-administered drugs, diabetic and medical supplies; a web-enabled electronic prior authorization system; interfaces with eMedNY and related claims, eligibility, provider, and encounter data; and implementation of modern data exchange capabilities. The contractor must also provide a 24-hour, seven-day clinical contact center; clinical review and escalation by pharmacy technicians, pharmacists, and physicians; provider and member notifications; fair-hearing support; consulting, education, outreach, staffing, reporting, dashboards, security, transition, and system-change services. The expected contract term is six years with one optional 12-month renewal, with an anticipated December 1, 2027 start date and implementation leading to a June 1, 2028 or earlier go-live. Proposals must include separate administrative, technical, and cost submissions, with the cost proposal completed using the required Excel template.
Classification Codes
Smart Codes
Specifications
Timeline
Requirements
- Minimum 3 references
- Client point of contact required for each reference
Location
Documents
| Title | Date Posted |
|---|---|
| rfp101326w | Oct 13, 2026 11:50 AM |
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