Label
Pharmacy Benefit Manager-Carelon
Human Resources
Michael Niedzielski (x2182)
Revised
Title
Authorizing the Mayor to enter into an Agreement for pharmacy benefit management (PBM) services for the City's self-funded prescription drug plans, to include administering the prescription drug benefit, optimizing network access, managing formulary and rebate programs, delivering transparent reporting, and other related services for covered employees and their dependents, for a term of three (3) years with two (2), one (1) year optional renewals; and further authorizing the expenditure of funds from the Healthcare Internal Service Fund; and declaring an emergency.
Body
SUMMARY & BACKGROUND:
The Department of Human Resources sought competitive proposals for pharmacy benefit manager services from October 3, 2025 through November 18, 2025. Ten (10) proposals were received. Five (5) finalists were invited to present their proposals for further review: Optum Rx, Carelon, Medical Mutual of Ohio, True Rx, and Prime Therapeutics. Hylant, the City's benefit consultant, reviewed and analyzed the proposals and presented these results to the Healthcare Cost Containment Committee (HCCC) and the administration. Pursuant to this review and their presentations, two (2) of the finalists presented their proposals to the HCCC. Based on this thorough process, we recommend Carelon as the City's PBM. Optum is the City's current PBM, with the current contract term ending June 1, 2026. It is estimated that the administrative cost associated with this agreement will be approximately $190,000 per year.
Summary
NOW THEREFORE Be it ordained by the Council of the City of Toledo:
SECTION 1. That the Mayor is authorized to enter into a three (3) year agreement with two (2), one (1) year optional renewals to provide pharmacy benefit management services. Such Agreement shall contain terms and conditions deemed proper and requisite according to the Director of Law and Director of Hu...
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