New York State Department of Health RFP #C043525 Pharmacy Benefit Management Services 2026
New York State Department of Health | State of New YorkState · Albany, NY- Due
- Dec 8, 2026
- 39 days left
- Posted
- Oct 13, 2026
- Contract term
- 6 years
- Primary contact
- Andrew Lynch
- (518) 408-5330
The 30-second brief
The New York State Department of Health is seeking competitive proposals from qualified bidders to provide comprehensive Pharmacy Benefit Management services for the NYRx Medicaid Pharmacy Program, which serves over 7.5 million members and is valued at over $80 billion annually. The selected vendor will operate a vendor-managed prior authorization (PA) and utilization management (UM) solution across the Medicaid program, creating a single entry point for pharmacy and medical Practitioner Administered Drugs (PAD) claims. Services include maintaining a 24/7/365 clinical contact center with omnichannel capabilities, handling ePA processing, clinical consulting, provider and member education and outreach, and reporting. The contract term is six years with a 12-month optional renewal period. Proposals are due by December 8, 2026, at 4:30 p.m. ET.
Technical Proposal, 70%; Cost Proposal, 30%
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Summary
The New York State Department of Health is seeking competitive proposals from qualified bidders to provide comprehensive Pharmacy Benefit Management services for the NYRx Medicaid Pharmacy Program, which serves over 7.5 million members and is valued at over $80 billion annually.
The selected vendor will operate a vendor-managed prior authorization (PA) and utilization management (UM) solution across the Medicaid program, creating a single entry point for pharmacy and medical Practitioner Administered Drugs (PAD) claims. Services include maintaining a 24/7/365 clinical contact center with omnichannel capabilities, handling ePA processing, clinical consulting, provider and member education and outreach, and reporting. The contract term is six years with a 12-month optional renewal period. Proposals are due by December 8, 2026, at 4:30 p.m. ET.
EVALUATION CRITERIA
3- Technical Proposal
- 70%; Cost Proposal
- 30%
REQUIRED ATTACHMENTS
Attachment 1 - Bidder's Disclosure of Prior Non-Responsibility Determinations, Attachment 3 - Vendor Responsibility Attestation, Attachment 4 - Vendor Assurance of No Conflict of Interest or Detrimental Effect, M/WBE Forms, Attachment 6 - Encouraging Use of New York Businesses, Attachment 7 - Bidder's Certified Statements, Attachment 9 - References, Attachment 10 - Diversity Practices Questionnaire, Attachment 11 - EO 177 Prohibiting Contracts with Entities that Support Discrimination, Attachment 12 – EO 16 Contracting with Businesses Conducting Business in Russia, State Finance Law Consultant Disclosure, Sales and Compensating Use Tax Certification, Attachment 14 - Gender-Based Violence and the Workplace Certification, Attachment B- Cost Proposal
REQUIRED STAFFING
3- Submit to
- [email protected]
- Duration
- 72 months
- Scope location
- Albany, NY
- Reported agency
- New York State Department of Health
Questions about this RFP
How do I respond to this RFP from New York State Department of Health | State of New York?
Review the full solicitation document for submission requirements, evaluation criteria, and deadlines. The submission deadline is December 8, 2026. Be sure to include all required attachments as outlined in the solicitation. Submissions should be delivered to: [email protected]. For questions, contact Andrew Lynch.
Can small businesses or minority-owned firms bid on this RFP?
Most government agencies, including New York State Department of Health | State of New York in NY, encourage participation from small businesses, minority-owned, women-owned, and disadvantaged business enterprises (MBE/WBE/DBE). Check the full solicitation for any small business participation goals.
What happens after the RFP submission deadline?
After the deadline, the issuing agency reviews all submissions against the stated evaluation criteria. This typically includes a compliance check, technical evaluation, cost analysis, and may involve oral presentations with shortlisted vendors.
Can I ask questions about this solicitation before submitting?
Yes, most solicitations allow vendors to submit questions during a designated period. The primary contact is Andrew Lynch at (518) 408-5330. Questions and answers are typically shared with all prospective bidders.
What staffing is required for this project?
This solicitation outlines specific staffing requirements. The required roles include: Systems Analyst, Senior Systems Developer, Systems Developer. Proposers should demonstrate relevant qualifications and experience for each required role.
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What are the evaluation criteria for this solicitation?
This solicitation includes specific evaluation criteria that will be used to score proposals. The criteria include: "Technical Proposal, 70%; Cost Proposal, 30%" Vendors should carefully align their proposals with each criterion to maximize their score.
Where can I find more RFPs from New York State Department of Health | State of New York?
All active and historical solicitations from New York State Department of Health | State of New York are tracked and searchable. As a state agency, New York State Department of Health | State of New York regularly publishes solicitations. Visit the agency profile to see current open bids, past contracts, vendor relationships, and decision-maker contacts.
What is the contract term for this solicitation?
The anticipated contract term is 6 years. Contract terms may include renewal options.
Is this solicitation still open for submissions?
Based on the posted deadline of December 8, 2026, this solicitation appears to still be accepting submissions. Deadlines may change through amendments or addenda, so always verify the current status directly with the issuing agency before preparing your response.
What documents are required to bid on this RFP?
Requirements vary by solicitation, but common documents include a technical proposal, cost/price proposal, proof of insurance, relevant certifications, past performance references, and any forms specified in the solicitation. This solicitation specifically requires the following attachments: Attachment 1 - Bidder's Disclosure of Prior Non-Responsibility Determinations, Attachment 3 - Vendor Responsibility Attestation, Attachment 4 - Vendor Assurance of No Conflict of Interest or Detriment. Additionally, proposals should address staffing requirements as outlined in the solicitation. Review the full document from New York State Department of Health | State of New York for the complete list.
What is the scope of this project?
This solicitation defines a specific project scope. The scope covers the following locations: Albany, NY. Review the full solicitation for detailed scope requirements.