Pharmacy Benefit Manager System
Location:
Washington, DC, USA
Posted on:
Dec 20, 2025
Deadline:
Jan 30, 2026
Summary:
Washington, DC seeks a SaaS Pharmacy Benefit Manager System for Medicaid FFS, including claims adjudication, provider management, and support services.
(1) Vendor needs to provide pharmacy benefit manager system to the government authority located in Washington, DC.– Provide software–as–a–solution (SaaS) and related services for the Medicaid fee–for–service (“FFS”) Pharmacy Benefit Management. The Pharmacy Benefit Management System (PBMS) and associated services must also support the following: adjudication of valid pharmacy drug claims, management of pharmacy and prescribing provider networks, administration of certain District functions. Beneficiary and Provider Relationship Management Services. This platform is managed by the District’s Department of Human Services (DHS). Case management platform that serves as the primary case management platform. Responsible for pursuing the recovery of funds for claims is the primary responsibility of a third party. These areas include Casualty, Health Insurance, Absent Parent, Estates, and Third–Party Cost Avoidance. Beneficiary and Provider Relationship Management Services, including a Call Center, toll–free numbers, Help Desks, an automated call system, and a website; Other support services, including problem resolution/escalation, training, and reporting; and Medication Therapy Management Services.
