KYRx Pharmacy Claims Data Analytics and Auditing Services

Description: REQUEST FOR PROPOSAL ATTENTION: This is not an order. Read all instructions, terms and conditions carefully. PROPOSAL NO.: UK-2632-27 RETURN ORIGINAL COPY OF PROPOSAL TO: Issue Date: 11/03/2026 UNIVERSITY OF KENTUCKY Title: KYRx Pharmacy Claims Data Analytics and Auditing PROCUREMENT SERVICES Purchasing Officer: David D. Stefanic 411 S LIMESTONE ROOM 322 PETERSON SERVICE BLDG. LEXINGTON, KY 40506-0005 Phone: 859-257-5792 Email: david.stefanic@uky.edu IMPORTANT: PROPOSALS MUST BE RECEIVED BY: 11/24/2026 3 P.M. LEXINGTON, KY TIME. NOTICE OF REQUIREMENTS 1. The University's General Terms and Conditions and Instructions to Bidders, viewable at the University procurement website, apply to this RFP. When the RFP includes construction services, the University's General Conditions and Special Conditions for Construction and Instructions to Bidders, viewable at the University procurement website, apply to the RFP. 2. Contracts resulting from this RFP must be governed by and in accordance with the laws of the Commonwealth of Kentucky. 3. Any agreement or collusion among offerors or prospective offerors, which restrains, tends to restrain, or is reasonably calculated to restrain competition by agreement to bid at a fixed price or to refrain from offering, or otherwise, is prohibited. 4. Any person who violates any provisions of KRS 45A.325 shall be guilty of a felony and shall be punished by a fine of not less than five thousand dollars nor more than ten thousand dollars or be imprisoned not less than one year nor more than five years, or both such fine and imprisonment. Any firm, corporation, or association who violates any of the provisions of KRS 45A.325 shall, upon conviction, be fined not less than ten thousand dollars or more than twenty thousand dollars. AUTHENTICATION OF BID AND STATEMENT OF NON-COLLUSION AND NON-CONFLICT OF INTEREST I hereby swear (or affirm) under the penalty for false swearing as provided by KRS 523.040: 1. That I am the offeror (if the offeror is an individual), a partner, (if the offeror is a partnership), or an officer or employee of the bidding corporation having authority to sign on its behalf (if the offeror is a corporation); 2. That the attached proposal has been arrived at by the offeror independently and has been submitted without collusion with, and without any agreement, understanding or planned common course of action with, any other Contractor of materials, supplies, equipment or services described in the RFP, designed to limit independent bidding or competition; 3. That the contents of the proposal have not been communicated by the offeror or its employees or agents to any person not an employee or agent of the offeror or its surety on any bond furnished with the proposal and will not be communicated to any such person prior to the official closing of the RFP: 4. That the offeror is legally entitled to enter into contracts with the University of Kentucky and is not in violation of any prohibited conflict of interest, including, but not limited to, those prohibited by the provisions of KRS 45A.330 to .340, and164.390; 5. That the offeror, and its affiliates, are duly registered with the Kentucky Department of Revenue to collect and remit the sale and use tax imposed by Chapter 139 to the extent required by Kentucky law and will remain registered for the duration of any contract award; 6. That I have fully informed myself regarding the accuracy of the statement made above. SWORN STATEMENT OF COMPLIANCE WITH CAMPAIGN FINANCE LAWS In accordance with KRS45A.110 (2), the undersigned hereby swears under penalty of perjury that he/she has not knowingly violated any provision of the campaign finance laws of the Commonwealth of Kentucky and that the award of a contract to a bidder will not violate any provision of the campaign finance laws of the Commonwealth of Kentucky. CONTRACTOR REPORT OF PRIOR VIOLATIONS OF KRS CHAPTERS 136, 139, 141, 337, 338, 341 & 342 The contractor by signing and submitting a proposal agrees as required by 45A.485 to submit final determinations of any violations of the provisions of KRS Chapters 136, 139, 141, 337, 338, 341 and 342 that have occurred in the previous five (5) years prior to the award of a contract and agrees to remain in continuous compliance with the provisions of the statutes during the duration of any contract that may be established. Final determinations of violations of these statutes must be provided to the University by the successful contractor prior to the award of a contract. CERTIFICATION OF NON-SEGREGATED FACILITIES The contractor, by submitting a proposal, certifies that he/she is in compliance with the Code of Federal Regulations, No. 41 CFR 60-1.8(b) that prohibits the maintaining of segregated facilities. SIGNATURE REQUIRED: This proposal cannot be considered valid unless signed and dated by an authorized agent of the offeror. Type or print the signatory's name, title, address, phone number and fax number in the spaces provided. Offers signed by an agent are to be accompanied by evidence of his/her authority unless such evidence has been previously furnished to the issuing office DELIVERY TIME: NAME OF COMPANY: DUNS # PROPOSAL FIRM ADDRESS: Phone/Fax: THROUGH: PAYMENT TERMS: CITY, STATE & ZIP CODE: E-MAIL: SHIPPING TERMS: F. O.B. TYPED OR PRINTED NAME: WEB ADDRESS: DESTINATION PREPAID AND ALLOWED FEDERAL EMPLOYER ID NO.: SIGNATURE: DATE: Revised 10-12-2026 Table of Contents and Sections included in the RFP (high level): 1 DEFINITIONS 2 GENERAL OVERVIEW 2.1 Intent and Scope 2.2 Background Information 2.3 University Information 2.4 Economic Engagement and Procurement 3 PROPOSAL REQUIREMENTS 3.1 Key Event Dates 3.2 Offeror Communication 3.3 Offeror Presentations 3.4 Preparation of Offers 3.5 Proposed Deviations from the RFP 3.6 Proposal Submission and Deadline 3.7 Modification or Withdrawal of Offer 3.8 Acceptance or Rejection and Award of Proposal 3.9 Rejection 3.10 Addenda 3.11 Disclosure of Offeror's Response 3.12 Restrictions on Communications with University Staff 3.13 Cost of Preparing Proposal 3.14 Disposition of Proposals 3.15 Alternate Proposals 3.16 Questions 3.17 Section Titles in the RFP 3.18 No Contingent Fees 3.19 Proposal Addenda and Rules for Withdrawal 3.20 Requirement to Perform Vendor Onboarding and Registration 4 PROPOSAL FORMAT AND CONTENT 4.1 Proposal Information and Criteria 4.2 Signed Authentication of Proposal and Statements of Non-Collusion and Non-Conflict of Interest Form 4.3 Transmittal Letter 4.4 Executive Summary and Proposal Overview 4.5 Criteria 1 - Offeror Qualifications 4.6 Criteria 2 - Services Defined 4.7 Criteria 3 - Financial Proposal 4.8 Criteria 4 - Evidence of Successful Performance and Implementation Schedule 4.9 Criteria 5 - Other Additional Information 5 EVALUATION CRITERIA PROCESS 6 SPECIAL CONDITIONS 6.1 Contract Term 6.2 Effective Date 6.3 Competitive Negotiation 6.4 Appearance Before Committee 6.5 Additions, Deletions or Contract Changes 6.6 Contractor Cooperation in Related Efforts 6.7 Entire Agreement 6.8 Governing Law 6.9 Kentucky's Personal Information Security and Breach Investigation Procedures and Practices Act 6.10 Termination for Convenience 6.11 Termination for Non-Performance 6.12 Funding Out 6.13 Prime Contractor Responsibility 6.14 Assignment and Subcontracting 6.15 Permits, Licenses, Taxes 6.16 Attorneys' Fees 6.17 Royalties, Patents, Copyrights and Trademarks 6.18 Indemnification 6.19 Insurance 6.20 Method of Award 6.21 Reciprocal Preference 6.22 Confidentiality 6.23 Conflict of Interest 6.24 Personal Service Contract Policies 6.25 Copyright Ownership and Title to Designs and Copy 6.26 University Brand Standards 6.27 Printing Statutes 6.28 Payment Terms 7 SCOPE OF SERVICES 7.1 Detailed Services Defined 8 FINANCIAL OFFER SUMMARY 8.1 Alternate Pricing Selected full-text excerpts and the core description of the solicitation (cleaned to remove direct web links): 2.1 Intent and Scope The University of Kentucky is issuing this RFP to solicit proposals from qualified, financially sound, responsible firms to provide a secure, scalable, and auditable data analytics platform. The successful contractor will aggregate, normalize, and analyze multi-year pharmacy claims data, alongside medical claims and eligibility data where available, for its covered populations. The primary objective is to deliver independent decision support, actionable financial insights, and robust analytics that drive Pharmacy Benefit Manager (PBM) oversight, clinical program evaluation, contract enforcement, and strategic cost containment. 2.2 Background Information KYRx Pharmacy Coalition ("KYRx") is a public-sector pharmacy benefit coalition that administers prescription drug benefits for approximately 10 client groups, covering commercial and Medicare populations across Kentucky and Ohio with over 200k lives. KYRx oversees pharmacy benefit manager (PBM) performance, formulary strategy, and drug spending for its members, and it receives pharmacy claims data from multiple sources in a range of formats. KYRx currently lacks a single, consolidated view of claims data across clients and benefit types. As drug costs rise, state PBM reform (including Kentucky SB 188) takes effect, and value-based programs such as pharmacogenomics expand, KYRx needs a reliable analytics platform to verify PBM contract performance, identify savings, and support decisions for its members and Board of Directors. 3.1 Key Event Dates Release of RFP: 11/03/2026 Deadline for Written Questions: 3 p.m. Lexington Time on 11/10/2026 RFP Proposals Due: 3 p.m. Lexington Time on 11/24/2026 3.2 Offeror Communication Offerors must provide primary contact information and transmit via fax or e-mail to the purchasing officers listed: David D. Stefanic and Elijah Green, Procurement Services, University of Kentucky, 322 Peterson Service Building, Lexington, KY 40506-0005. Phone: (859) 257-9100 Fax: (859) 257-1951 Email: david.stefanic@uky.edu, Elijah.Green@uky.edu. All communication regarding this RFP should only be directed to the purchasing officers listed and should include the solicitation number in the subject line. 3.6 Proposal Submission and Deadline Offeror must provide the following materials prior to 3 p.m. (Lexington, KY time) on the date specified in Section 3.1 and addressed to the purchasing officer listed in Section 3.2: • Technical Proposal: Two (2) copies on electronic storage devices (USB) (1 copy per storage device) each clearly marked with the proposal number and name, firm name and what is included (Technical Proposal) and two (2) printed original copies. • Financial Proposal: Two (2) copies on electronic storage devices (USB) (1 copy per storage device) each clearly marked with the proposal number and name, firm name and what is included (Financial Proposal) and two (2) printed original copies. Note: Proposals received after the closing date and time will not be considered. In addition, proposals received via fax or e-mail are not acceptable. Proposals should be enclosed in sealed envelopes to the above referenced address and should show on the face of the envelope: the closing time and date specified, the solicitation number and the name and address of the offeror. The technical proposal should be submitted in a sealed envelope and the financial proposal should be submitted in a sealed envelope under separate cover. Both sealed envelopes should have identical information on the cover, with the addition that one will state "Technical Information," and the other, "Financial Proposal." Note: In accordance with the Kentucky Revised Statute 45A.085, there will be no public opening. 3.16 Questions All questions should be submitted by e-mail to the purchasing officer listed in Section 3.2 no later than the date listed in Section 3.1. 4.1 Proposal Information and Criteria Proposals should be organized to address the following items: Signed Authentication of Proposal and Statement of Non-Collusion and Non-Conflict of Interest Form; Transmittal Letter; Executive Summary and Proposal Overview; Criteria 1 - Offeror Qualifications; Criteria 2 - Services Defined; Criteria 3 - Financial Proposal; Criteria 4 - Evidence of Successful Performance and Implementation Schedule; Criteria 5 - Other Additional Information. 6.1 Contract Term The contract resulting from this RFP should be effective for one (1) year from effective date and is renewable for up to four (4) additional one-year renewal periods. The total contract period will not exceed five (5) years. 7.1 Detailed Services Defined (Summary of required capabilities) The Contractor should provide services and capabilities including, but not limited to: 1. Data Aggregation, Integration, and Data Integrity: ingest pharmacy claims, eligibility, and other applicable data from multiple PBMs and client organizations; integrate medical claims where available; support industry-standard formats and secure data-transfer methods; validate incoming data; provide reconciliation processes; maintain traceability between source and processed data; describe processing frequency and times; support addition of new clients and PBMs. 2. PBM Contract and Pricing Validation: ongoing analysis of adjudicated pharmacy claims against PBM contractual pricing and financial terms; validation of contracted discount guarantees, dispensing fees, fee schedules, exclusion lists, rebate guarantees, network pricing provisions, various pricing classifications, regulatory reimbursement requirements; identify and quantify pricing variances and overpayments; support recurring contract-performance monitoring and identify when additional audit engagements are required. 3. Drug Pricing and Cost Opportunity Analysis: identify and quantify drug-pricing variations, emerging cost trends, and cost containment opportunities across brand/generic, specialty, biosimilars, formulary alternatives, site-of-care, network pricing variations, classification changes, mid-year price changes, utilization or unit cost changes; analyze relevant benchmarks and identify effects at drug and claim levels. 4. Payment Integrity, Fraud, Waste, and Abuse: analyze pharmacy and medical claims to identify anomalies and potential payment-integrity issues including member/prescriber/pharmacy/provider level patterns, duplicate or conflicting claims, unusual cost/quantity/frequency/use patterns, customizable claims edits, provider-administered drug and site-of-care analysis. 5. Pharmacy and Medical Claims Integration: support integrated analysis of pharmacy and medical claims, member-level linkage, analysis of clinical and financial outcomes across benefits, evaluate subsequent medical utilization following pharmacy or clinical interventions, and reporting at client and coalition levels. 6. Pharmacogenomic Analysis: support pharmacogenomic data ingestion and analysis, matching test results to adjudicated claims, identifying members on actionable therapies, generating clinically actionable information for authorized reviewers, evaluating alternative therapies, and tracking interventions and outcomes; identify dependencies on PBM configuration or third-party systems. 7. Forecasting, Risk Adjustment, and Predictive Modeling: provide prospective pharmacy and medical spending forecasts, client and coalition level forecasts, member-level risk and cost projections, drug trend and emerging-therapy analysis, benefit-design and formulary scenarios, membership change modeling, legislative/regulatory scenario analyses, and comparison of projected vs actual results. 8. Legislative and Regulatory Impact Analysis: analytical capabilities to assess financial/operational effects of state or federal changes on KYRx clients and the coalition. 9. Reporting and Analytics: provide client-level and coalition-level dashboards, standard and ad hoc reporting, executive/Board-ready reports, drill-down to supporting detail where authorized, data/report exports, trend and variance reporting, tracking of identified savings opportunities and contract discrepancies, and role-based access. 10. Vendor Independence and Conflicts of Interest: disclose relationships or financial arrangements that could create conflicts; disclose whether compensation is contingent upon identified or recovered savings. 11. Implementation, Account Management, and Support: implementation plan, data onboarding, PBM/client coordination, configuration, data validation, testing, training, account management, technical support, issue escalation, and ongoing updates. 12. Information Security, Privacy, and Data Governance: maintain appropriate safeguards for protected health information and other confidential/restricted data; comply with University information-security requirements and execute required privacy, security, and Business Associate documentation. 13. Data Ownership, Portability, and Transition: define ownership of source data, usage of derived data/results, ability to export client and coalition data (formats and fees), retention and destruction policies, transition assistance, availability of historical information post-termination, and restrictions on secondary use of KYRx/client data. 8 FINANCIAL OFFER SUMMARY Offerors are to propose a recurring fee for the services described in this RFP. Pricing methodologies include Per Member Per Month (PMPM), Per Entity Per Month, or Other. Identify any other fees (e.g., travel) not included in the base recurring price. Costs not identified in the Financial Proposal should not be considered separately compensable under the resulting Contract. (End of provided solicitation text.)