Columbus Public Records Disclose Pharmacy Benefit Terms, Rebates and Offshore Staffing
Public records released under Request 26-303 reveal CVS Caremark's coalition contract terms, GLP-1 utilization rules and overseas call centers for municipal employees.
Newly released municipal bidding documents have detailed the commercial pricing framework, rebate calculations, drug utilization rules and offshore staffing arrangements governing the City of Columbus employee prescription drug plan.
The records, published June 26, 2026, through the city's public records portal under Request 26-303, outline the contractual mechanisms underlying the city's municipal healthcare program following its 2025–2026 administrator transition. The city's Department of Human Resources originally launched competitive procurement RFP030095 on April 1, 2025. Columbus City Council approved Ordinance 3369-2025 on Dec. 15, 2025, authorizing a $139.67 million contract with Community Insurance Company, doing business as Anthem Blue Cross and Blue Shield, for medical and tobacco cessation administration covering Feb. 1, 2026, through Dec. 31, 2026, which Mayor Andrew J. Ginther signed on Dec. 17, 2025. In tandem with that medical coverage, CVS Caremark took effect Feb. 1, 2026, as the city's new pharmacy benefit administrator.
The procurement disclosures reveal that the city accessed CVS Caremark's pricing through a coalition arrangement negotiated by Employers Health. Bidding files show that CVS Caremark and Employers Health finalized their pricing commitment and redlined service terms on Oct. 16, 2024. Under that agreement, the financial terms took effect Jan. 1, 2025, and are scheduled to run through Dec. 31, 2027.
Commercial Pricing and Coalition Structure
The disclosed pricing commitment establishes a pass-through pricing model for the municipal workforce. Under the contract specifications, the amount billed to the city equals the amount paid to participating network pharmacies. The contract incorporates CVS Caremark's Retail-90 network for non-specialty maintenance medications filled for 84 days or more, as well as the CVS Caremark Cost Saver program to evaluate network pricing against third-party contracted rates.
The coalition structure also incorporates specific inter-entity financial transactions. Under the agreement, CVS Caremark remits a credit of $0.90 per claim directly to Employers Health on the participating group's behalf, treated under the Federal Anti-Kickback Statute as a discount off the purchase price of dispensed drugs rather than an invoiced charge to the city. For contract continuity, either party holds the right to terminate the agreement without cause and without penalty upon 180 days' written notice.
In bid questionnaire filings, CVS Caremark noted that participating entities join under a pre-set structure, stating that CVS Caremark and Employers Health have a pre-negotiated contract with agreed upon contract terms and conditions that follow coalition rules rather than individual municipal contract negotiations.
Rebate Guarantees and Credit Adjustments
The pricing commitment sets an aggregate rebate structure while allowing specific financial adjustments based on drug market movements. The city is entitled to receive 100% aggregate minimum rebate guarantees. Furthermore, CVS Caremark is required to reconcile and pay 100% of rebate overperformance within 180 days of the conclusion of each contract year to Employers Health, which then distributes those funds among generating groups.
However, the agreement includes a contractual adjustment mechanism known as "Rebate Credit." Under this provision, CVS Caremark may add Rebate Credit to rebates when remitting and reconciling rebate guarantee payments. The terms specify that Rebate Credit is an adjustment that CVS Caremark may apply when remitting and reconciling Rebate guarantee payments, calculated from differences between baseline Wholesale Acquisition Cost (WAC) and updated WAC per unit.
This mechanism applies when list prices decline, offsetting the dollar value of guaranteed rebates against reductions in drug acquisition costs. Contractually defined rebate credit eligible claims include biosimilar products where Humira or Stelara serve as reference brand drugs, insulin products that have experienced wholesale acquisition cost decreases, and any other drugs mutually agreed upon between CVS Caremark and Employers Health.
The agreement also carves out specific categories from minimum rebate guarantees. Excluded categories include 340B claims, DAW 5 claims, vaccine administration, COVID-19 treatments and claims approved through formulary exceptions, although any rebates actually collected on those exclusions are passed through to the participating group.
GLP-1 Utilization Controls
Prescription management records specify clinical controls governing high-cost drugs, including glucagon-like peptide-1 (GLP-1) receptor agonists widely prescribed for diabetes and weight management.
The pricing commitment specifies mandatory clinical review mechanisms, including GLP-1 prior authorization under non-smart edit procedures and GLP-1 quantity limits. These protocols require manual clinician verification of patient medical criteria and enforce dosing ceilings before claims receive insurance approval, alongside enrollment in CVS Caremark's Transform Diabetes Care program to monitor adherence and therapeutic efficacy.
Offshore Call Center Disclosures
The RFP records also detail CVS Caremark's disclosures regarding foreign operational staffing.
In the RFP pharmacy questionnaire, the city asked bidders to describe any services that will be offshored.
While core services—such as customer service, claims adjudication, mail order and specialty pharmacy dispensing—remain domestic, CVS Caremark disclosed that secondary support operations rely on overseas call center vendors. Specifically, pharmacy help desk call center support for network retail pharmacies is conducted through United Call Center Solutions and Alorica in the Philippines as business-to-business interactions.
Additionally, specialty benefit verification, outbound member engagement and prescription rescheduling—which involve direct outbound phone calls to patients, doctors and pharmacies—are handled by United Call Center Solutions in the Philippines and Capgemini in Guatemala and India.
CVS Caremark confirmed in its submission that all protected health information remains within domestic infrastructure, stating that all PHI and data are stored and maintained on IT systems in the U.S. run by its IS department at its Shea Data Center in Scottsdale, Arizona.
How we know this
The sources and records behind this story, with the facts they support.
Supporting evidence (1)
Columbus City Council approved Ordinance 3369-2025 on Dec. 15, 2025, authorizing a $139.67 million contract with Community Insurance Company, doing business as Anthem Blue Cross and Blue Shield, for medical and tobacco cessation administration covering Feb. 1, 2026, through Dec. 31, 2026, which Mayor Andrew J.
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To authorize the Director of the Human Resources Department to enter into a contract with Community Insurance Company dba Anthem Blue Cross and Blue Shield
Supporting evidence (1)
Bidding files show that CVS Caremark and Employers Health finalized their pricing commitment and redlined service terms on Oct. 16, 2024.
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Request 26-303 · Attachment 23 - 14-STANDARD Service Agreement OVER 50K REV Sept 2021 rev. 10.16.24 (redlines).docx
Request 26-303 · Attachment 17 - Pricing Commitment Document_Redacted.pdf
Supporting evidence (12)
Under that agreement, the financial terms took effect Jan. 1, 2025, and are scheduled to run through Dec. 31, 2027.
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This pricing and terms set forth in this document apply to the Employers Health agreement from 01/01/2025 through 12/31/2027
Under the contract specifications, the amount billed to the city equals the amount paid to participating network pharmacies.
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The amount billed to the Client will be equal to the amount paid to the participating pharmacies.
Under the agreement, CVS Caremark remits a credit of $0.90 per claim directly to Employers Health on the participating group's behalf, treated under the Federal Anti-Kickback Statute as a discount off the purchase price of dispensed drugs rather than an invoiced charge to the city.
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CVS Caremark will remit to Employers Health after the effective date of the agreement, on Participating Group’s behalf and at its direction a credit of $0.90 per claim.
For contract continuity, either party holds the right to terminate the agreement without cause and without penalty upon 180 days' written notice.
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either party may terminate the Agreement without cause, without penalty, with 180 days’ notice.
The city is entitled to receive 100% aggregate minimum rebate guarantees.
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Participating Group will receive 100% aggregate minimum rebate guarantees quoted herein.
Furthermore, CVS Caremark is required to reconcile and pay 100% of rebate overperformance within 180 days of the conclusion of each contract year to Employers Health, which then distributes those funds among generating groups.
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At the direction of the Participating Group, CVS Caremark shall reconcile and pay 100% of Rebate Overperformance for similarly sized Participating Groups to Employers Health within 180 days of the end of each Contract Year.
Under this provision, CVS Caremark may add Rebate Credit to rebates when remitting and reconciling rebate guarantee payments.
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CVS Caremark may add “Rebate Credit” to Rebates when remitting and reconciling each Rebate guarantee component.
The terms specify that Rebate Credit is an adjustment that CVS Caremark may apply when remitting and reconciling Rebate guarantee payments, calculated from differences between baseline Wholesale Acquisition Cost (WAC) and updated WAC per unit.
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“Rebate Credit” is an adjustment that CVS Caremark may apply when remitting and reconciling Rebate guarantee payments.
Contractually defined rebate credit eligible claims include biosimilar products where Humira or Stelara serve as reference brand drugs, insulin products that have experienced wholesale acquisition cost decreases, and any other drugs mutually agreed upon between CVS Caremark and Employers Health.
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(1) Any Biosimilar product processed where Humira or Stelara are the reference Brand Drug; (2) any Insulin product that experienced a WAC decrease;
Excluded categories include 340B claims, DAW 5 claims, vaccine administration, COVID-19 treatments and claims approved through formulary exceptions, although any rebates actually collected on those exclusions are passed through to the participating group.
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340B Claims; DAW 5 Claims; Vaccine and vaccine administration Claims; COVID treatment claims; Claims approved by formulary exception;
The pricing commitment specifies mandatory clinical review mechanisms, including GLP-1 prior authorization under non-smart edit procedures and GLP-1 quantity limits.
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GLP-1 PRIOR AUTHORIZATION (NON-SMART EDIT)
The pricing commitment specifies mandatory clinical review mechanisms, including GLP-1 prior authorization under non-smart edit procedures and GLP-1 quantity limits.
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GLP-1 QUANTITY LIMIT
Request 26-303 · City of Columbus HCA RFP Pharmacy Questionnaire (Q-38RZ)_Redacted.pdf
Supporting evidence (5)
In bid questionnaire filings, CVS Caremark noted that participating entities join under a pre-set structure, stating that CVS Caremark and Employers Health have a pre-negotiated contract with agreed upon contract terms and conditions that follow coalition rules rather than individual municipal contract negotiations.
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CVS Caremark and Employers Health have a pre-negotiated contract with agreed upon contract terms and conditions.
In the RFP pharmacy questionnaire, the city asked bidders to describe any services that will be offshored.
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Please describe any services that will be offshored, if applicable.
Specifically, pharmacy help desk call center support for network retail pharmacies is conducted through United Call Center Solutions and Alorica in the Philippines as business-to-business interactions.
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United Call Center Solutions and Alorica in the Philippines.
Additionally, specialty benefit verification, outbound member engagement and prescription rescheduling—which involve direct outbound phone calls to patients, doctors and pharmacies—are handled by United Call Center Solutions in the Philippines and Capgemini in Guatemala and India.
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Capgemini in Guatemala and India.
CVS Caremark confirmed in its submission that all protected health information remains within domestic infrastructure, stating that all PHI and data are stored and maintained on IT systems in the U.S. run by its IS department at its Shea Data Center in Scottsdale, Arizona.
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All PHI and data are stored and maintained on IT systems in the U.S. run by our IS department at our Shea Data Center in Scottsdale, Arizona.