AH084 – Solving Pharmacy Benefits: Inside the RFP Process, with Josh Golden & Nic Bolitho

Many plan sponsors are switching up how they approach the PBM procurement process. They’re asking harder questions, starting the process earlier, and looking beyond basic spreadsheets to understand how a potential PBM partner actually operates.

In this episode, host Justin Venneri sat down with Josh Golden (SVP, Strategy) and Nic Bolitho (Proposals Manager) to discuss what they are seeing on their respective sides of the PBM procurement frontlines.

They explore how the industry is moving away from simple discount evaluations and toward a more comprehensive evaluation of technology, member support, and fiduciary alignment.

If you are a benefits leader preparing to put out an RFP, understanding these emerging trends can help you identify a PBM partner that truly serves your members.

Why PBM Procurement Activity is Surging

The volume of RFPs in the pharmacy benefit space has accelerated rapidly. Josh notes that the number of bids Judi Health receives has increased roughly two times year over year since 2025, with expectations for further growth in 2026.

This surge is not happening in a vacuum. Powerful market forces are driving employers to reassess their PBM relationships. The FTC’s investigations into traditional PBM practices are making headlines, while class action ERISA lawsuits are highlighting the severe risks associated with shirking fiduciary obligations.

As a result of these pressures – along with concerns about cost trend – employers are taking their fiduciary responsibilities seriously.

Another clear trend is that plan sponsors are starting these evaluations earlier than ever. Building extra time into the schedule signals to the market that an employer is genuinely open to transitioning to a transparent PBM, which encourages bidders to engage more deeply with the process.

The Shift From Unit Cost to Holistic PBM Vendor Comparison

Historically, the PBM RFP process relied heavily on a unique cost spreadsheet. Consultants and employers would evaluate bidders based almost entirely on average rebate guarantees and discount rates per claim. While cost remains a vital factor, employers’ focus has expanded.  

"I'm seeing a shift away from just focusing on unit cost and an increased focus on the way that a PBM's behavior influences drug mix and total cost."—Josh Golden

This new approach examines the “M” in pharmacy benefit management – specifically how the vendor actually manages utilization and overall plan costs. In this context, PBMs are recognized for their high-intent, product-defining services that impact not only individual transactions by the strategic trajectory of an employer’s pharmacy benefit plan. Instead of just looking at the price of a drug, employers are asking critical questions to uncover potential conflicts of interest in PBM operations.  

Let’s look at three of those questions:

How does the PBM make money?

Plan sponsors want to know exactly how a PBM derives profit from their account. If a PBM retains a portion of the rebates, for example, there is a risk that they might steer patients toward higher-cost drugs simply to generate more rebate revenue. Understanding the underlying PBM rebate model is vital to truly evaluate a potential PBM partner.

Does the model provide fiduciary freedom?

Employers need the flexibility to pursue strategies that meet their fiduciary needs. If a plan sponsor decides to carve out a subset of drugs, or to pursue a different mail order vendor, they need to know if the core economics of their PBM contract will fall apart. Hidden PBM fees often rely on rigid structures, so identifying these constraints early is crucial.

Can the Technology Handle Customization?

Systems that were built three decades ago cannot accommodate the kind of creative plan design and fast interoperability expected in moder healthcare. That’s why next generation, flexible technology is required. Employers need to be able to handle complex customizations and third-party integrations smoothly.

Best Practices for the PBM RFP Process

So what goes into running a successful RFP? It requires more than a list of questions. The way a plan sponsor formats their request dictates the answers they receive. Nic shared several practical tips for getting the most out of the RFP process:

• ‍Provide specific data: Include detailed claims data so bidders can perform accurate analyses and spot specific pain points. ‍
• Name your third-party vendors: If you want your PBM to work with a specific clinical point solution, state it clearly in the RFP. This allows the bidder to explain exactly how that integration will work. ‍
• Allow flexible responses: Restricting answers to simple "confirm or non-confirm" checkboxes prevents transparent PBM vendors from explaining their unique value propositions. Open up the templates to allow for detailed narratives. ‍
• Share your current arrangements: Providing information about how your existing clinical programs are set up helps bidders craft a more comprehensive proposal. ‍
• Provide specific data: Include detailed claims data so bidders can perform accurate analyses and spot specific pain points. ‍
• Name your third-party vendors: If you want your PBM to work with specific point solutions, state it clearly in the RFP. This allows the bidder to explain exactly how that integration will work. ‍
• Allow flexible responses: Restricting answers to simple "confirm or non-confirm" checkboxes prevents transparent PBM vendors from explaining their unique value propositions. Open up the templates to allow for detailed narratives. ‍
• Share your current arrangements: Providing information about how your existing clinical programs and bells and whistles are set up helps bidders craft a more comprehensive proposal.

Evaluating Member Experience and Clinical Programs

Customer service has also been a major evaluation point during RFPs, but generic questions about the member experience won’t do. Employers have to get more sophisticated in how they assess service quality – and they have been.

We get a lot of questions around that day-to-day member experience, from calling in and asking questions, to using our portal and mobile app to check on prescriptions or check on prior authorization status. And then there's a lot of tie into working with our specialty pharmacy and mail order pharmacy partners as well, making sure that they have a smooth handoff and a smooth integration with those partners. So it's really important for us to have more of the storytelling aspect of RFP response there in terms of making sure that the client understands that their members are going to have a smooth experience and not get stuck on hold or have to chase a million dead ends before they get an answer to their questions. - Nic Bolitho

Instead of asking broad questions, plan sponsors are demanding discrete data points. They want to know the vendor's Net Promoter Score (NPS), whether the call center is offshored, and the average turnaround time for processing a prior authorization.

The same applies to clinical programs. While basic formularies and disease management are table stakes, consultants are heavily focused on high-cost categories. Almost every RFP now includes detailed questions about GLP-1 management strategies, biosimilar tiering, and medication adherence outcomes. IT security and AI capabilities also appear frequently as primary concerns.

The Data Embargo Problem

One of the most astonishing issues in the current pharmacy benefit landscape is the lack of data access for plan sponsors. Even as the market demands more transparency, some employers are locked into incumbent contracts that prevent them from sharing their own data with third parties.

These data embargoes make it incredibly difficult for a fiduciary to assess their own arrangement fairly or run an effective RFP.

"The fact that there are PBM contracts out there that prevent an employer from doing that in some cases is, to me, really astonishing. And I would encourage employers that find themselves in that circumstance to really push hard on getting access to that data, because that data is yours and that data is what powers the RFP process."—Josh Golden

Taking Control of Your Pharmacy Benefits

The process of selecting a pharmacy benefit manager has evolved from a basic pricing exercise into a comprehensive audit of technology, ethics, and operational behavior. By starting early, demanding precise data on member friction points, and prioritizing vendors with transparent pricing models, plan sponsors can secure partnerships that actively lower total costs.

The most important step any employer can take today is verifying they have unrestricted access to their own claims data. Without it, true fiduciary oversight is impossible.

Want to learn more about Judi Health’s transparent and aligned approach to health benefits? Reach out to our team today.

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