RFP # ETJ0007

To: Whom It May Concern:

The purpose of this document is to provide interested and qualified parties with information to enable them to prepare and submit competitive proposals to administer pharmacy benefits for the State of Wisconsin (State) and Wisconsin Public Employers (WPE) group health insurance programs as the Pharmacy Benefits Manager (PBM). The Group Insurance Board (Board) and the Department of Employee Trust Funds (ETF) intend to use the results of this process to award a contract that will begin January 1, 2011 and shall extend through December 31, 2013. The vendor who is awarded the contract will be responsible for Plan Year 2011 PBM program enrollment activities that begin in the fall of 2010. The implementation start date will be approximately July 1, 2010. The Board retains the option by mutual agreement of the Board and the vendor to renew the contract for two (2) additional two (2)-year periods extending the contract through December 31, 2017 For more information about pharmacy benefits under the State and WPE group health insurance programs, please refer to the health insurance section on ETF's Internet site at:

Pharmacy benefits for the State and WPE group health insurance programs are self-funded and managed by the PBM for more than 220,000 participating members associated with total drug costs in excess of $300 million. Functions of the PBM include, but are not limited to, negotiating drug prices and rebates with vendors, maintaining the drug formulary, maintaining the pharmacy network, and managing and processing claims for the pharmacy benefit program. The PBM also provides claim and cost reporting services for the State's participation in the Medicare Retiree Drug Subsidy (RDS) program. This involves more than 24,000 Medicare eligible State retirees and more than $10 million in Federal subsidy.

This procurement is authorized under Chapter 40 of the Wisconsin State statutes. All decisions and actions under this Request For Proposal (RFP) are solely under the authority of the Group Insurance Board. Statutes and rules relating to procurement by other state agencies may not be applicable.

The RFP, and all the associated information is posted on ETF's Internet site at All modifications will also be posted on this web site. As such, interested vendors are encouraged to check this web site for updates frequently. No other notification regarding modifications will be provided.

The deadline for receipt of proposals for the RFP is March 3, 2010 at 3:00 PM CST. Late submissions may not be considered. Questions may be emailed to Jeff Bogardus at RFP number and title should be referenced in your email.

Process Updates

1/30/13 Posting of Contract Document Updates with Navitus Health Solutions, LLC
12/29/10 Posting of Contract Documents with Navitus Health Solutions, LLC
12/29/10 Posting of Abstract
12/29/10 Posting of PBM Vendor Evaluvations
12/29/10 Vendor Proposals are being prepred for posting
4/15/10 Issue Intent to Award to Navitus Health solutions, LLC
2/18/10 Posting of Responses to Vendor Questions - Set 2
2/16/10 Posting of Responses to Vendor Questions - Set 1
2/12/10 Posting of Updated Copy of Current PBM Contract
2/05/10 AppendixF - Vendor Reference for Medicare Part D Coverage is Required
2/05/10 Section C Administrative Capabilities - New Reference to PBM Contract Exhibit 2


Navitus Contract Amendment 6 Signed 1/7/2016
Navitus Contract Amendment 5 Signed 5/24/2015
Navitus Contract Amendment 4 Signed 2/02/2015
Navitus Contract Amendment 3 Signed 4/07/2014
Navitus Contract Amendment 2 Signed 11/06/2012
Navitus Contract Amendment 2 Effective 4/1/2012
Navitus Contract Medicare Part D Effective 1/01/2012
Navitus Contract 1/01/2010 thru 12/31/2013
Navitus Contract Amendment 1 12/08/2010
Navitus Contract Business Associate Agreement

RFP and Associated Documents

Document Web Address
PBM RFP Main Document
Includes Sections A., B., C., & E. and Appendices
PBM RFP Section D.Cost Proposal PBM_RFP_SecD_Cost Proposal.docx
CY 2009 Claims File Extract PBM_RFP_CY2009 Claims File Extract Dictionary.docx
PBM_RFP_CY2009 Claims File
PBM RFP - Exhibit 1 PBM_RFP_Exhibit 1_Staffing.xlsx
PBM RFP - Exhibit 2 PBM_RFP_Exhibit 2_Formulary Review.xlsx
PBM RFP - Exhibit 3 PBM_RFP_Exhibit 3_GeoAccess.xlsx
PBM RFP - Exhibit 4 PBM_RFP_Exhibit 4_Pharma-Claims.xlsx
AppendixF_MedPtD_VendorRef.docx AppendixF_MedPtD_VendorRef.docx

Reference Materials

DocumentWeb Address
Employee Trust Funds Internet Site
WI State Statutes Ch. 40
State of Wisconsin Pharmacy Benefit Program Information (Fact Sheet)
Prescription Drug Benefit/PBM Program Specifics

"It's Your Choice" Group Health Insurance Booklets:
2010 State Decision Guide
2010 State Reference Guide
Incl. Guidelines/Uniform Benefits
2010 WPE Decision Guide
2010 WPE Reference Guide
Incl. Guidelines/Uniform Benefits
Navitus Health Solutions web site
Navitus Member Handbook PBM_RFP_ETF_MemberBooklet_2010.pdf
PBM Contract PBM_Contract_Main_112441-00002-364915-11.pdf
Retiree Drug Subsidy Program
CMS - Medicare Section
DeanCare Rx web site
Pharmacy Network:
ALL Contracted Pharmacies
PBM_RFP_2009_ALL Contracted Pharmacies.xlsx
Pharmacy Network:
Contracted Independent Pharmacies
PBM_RFP_2009_Contracted Independent Pharmacies.xlsx
Top 30 Independent Pharmacies PBM_RFP_2009_Top 30 Contracted Independent Pharmacies.xlsx
Eligibility File Format & Layout Documents PBMAuditFlatFileFormat.doc
Member Census Data - Zip Codes PBM RFP_Member Census Data Zip Codes_April 2009_.xlsx
Member Census Data - Coverage PBM RFP_Member Census Data Coverage_April 2009_.xlsx