NY State Insurance Fund (NYSIF) is seeking proposals for audit services for its Pharmacy Benefits Management (PBM) agreement. The contract period is five years. Proposals are due August 4, 2026, by 2:00 PM EST. Services include financial and performance audits of the PBM. Audits are expected to be conducted remotely. Bidders must have at least five years of experience in auditing PBMs and statutory accounting principles. A conflict of interest with the incumbent PBM (CVS Caremark) is prohibited. Award will be based on best value, with technical proposal (65%), financial proposal (30%), and quantitative factor for MWBE/SDVOB/SB (5%) as evaluation criteria. Bidders must submit mandatory requirements, technical specifications, and a fee schedule. Insurance requirements include professional liability and commercial general liability. Participation of Minority and Women-Owned Business Enterprises (MWBE) and Service-Disabled Veteran-Owned Businesses (SDVOB) is encouraged.
Proposals are due August 4, 2026, by 2:00 PM EST.
The audit agency shall submit itemized bills for payment of services to NYSIF on a monthly basis. NYSIF uses electronic funds transfer for payments.
Award will be made on the basis of best value, optimizing quality, cost, and efficiency. The evaluation criteria are: technical proposal (65%), financial proposal (30%), and a quantitative factor for NYS certified minority and women owned businesses, small businesses, and service disabled veteran owned businesses (5%).
Bidders must have a minimum of five years of experience in providing auditing services in accordance with statutory accounting principles and generally accepted auditing standards for group health or property casualty insurance companies with an emphasis on pharmacy benefits management. They must also have five years of experience in auditing services involving typical pharmacy pricing structures and brand/generic classification. A conflict of interest with the incumbent PBM is prohibited.
NYSIF reserves the right to penalize the contractor, including termination of the contract, if the contractor fails to adhere to any or all of the requirements of this contract. Penalties may include withholding payment.
Audits are expected to be conducted remotely.
Provide an example of the work product of a previously performed PBM audit with proprietary information redacted or deidentified.
Failure to meet mandatory requirements, failure to disclose the use of generative AI, failure to properly complete and provide MWBE participation documents, or not meeting minimum required data security levels can result in disqualification.