Attachment_2_-_Pricing_Schedule.xlsx

XLSX spreadsheet 28 KB Posted Jun 7, 2013

Attached to: Emergency Prescription Assistance Program (EPAP) Support
Solicitation number: 13-100-SOL-00016
Issued by: Department of Health and Human Services Immediate Office of the Secretary

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Price Schedule

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File	Type	Posted
ATTACHMENT_1_-_Statement_of_Work.pdf	PDF	Jun 7, 2013
RFP_13-100-SOL-00016.pdf	PDF	Jun 7, 2013
Attachment_3_-_Past_Performance_Questionnaire.docx	DOCX document	Jun 7, 2013

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Base Year Pricing

BASE YEAR	English only - Continental US (includes Alaska and Hawaii)	English & Spanish - Continental US (includes Alaska and Hawaii)	English & Spanish - Puerto Rico and U.S.Virgin Islands	English & Spanish - All Other Territories
Total Systems Activation/De-activation required per Event
Communication Center Expense*
Systems Activation**
Call Center/Systems Activation**
Systems Deactivation**
Call Center/Systems Deactivation**

Transactional Prices

Per Claim with Third Party Liability (TPL) Confirmation

Administrative Price Per Rx Claim - Paid or Denied

Per Paper Claim, as required

Per Prior Authorization

Per Call - Automated Phone System

Per Incoming Call

Per Outgoing Call

Spanish Translation Service - per minute

Faxes - per Page

Annual Retention Fee

EPAP Event Change Order (see Event Guide, Attachment I)

Brand and Single Source Generic/DME = Lesser of: average
wholesale price (AWP) minus ____ or usual and customary (U&C)	AWP - 15%	AWP - 15%	AWP - 10%	TBD

Multi-Source Generic/DME = Lesser of: average wholesale price
(AWP) minus ____, or maximum allowable cost (MAC), or usual
and customary (U&C);	AWP - 20%	AWP - 20%	AWP - 40%	TBD
(MAC Guaranteed Effective Rate of AWP minus 55%)			MAC n/a	MAC n/a

Durable Medical Equipment (DME): Medi-Span published pricing.	AWP - 15%	AWP - 15%	AWP - 10%	TBD
(Actual pricing to be determined at time of Task Order.)

Dispense Fee - Standard $4.00 $4.00 $4.00 TBD

* Communication Center expense: Creation and distribution (Phone/ Fax/ Email) of Provider Network information/ instructions,

process, covered DME items, PA processes, follow up coordination and communications.

** Systems Activation ...Program plan design validation, installation, testing, Eligibility installation and testing, network activation.

**Call center/systems activation…device (IVR, call center systems) programming, customer service activation, communication

and training, system testing.

**Systems Deactivation…Network notifications on final acceptable transaction dates, data archiving, event clean up ( final reporting

and system standby readiness.)

**Call center/systems deactivation…Device (IVR, call center systems) programming and messaging, event wrap up procedures,

final reporting.

OYI Pricing

OPTION YEAR I	English only - Continental US (includes Alaska and Hawaii)	English & Spanish - Continental US (includes Alaska and Hawaii)	English & Spanish - Puerto Rico and U.S.Virgin Islands	English & Spanish - All Other Territories
Total Systems Activation/De-activation required per Event
Communication Center Expense*
Systems Activation**
Call Center/Systems Activation**
Systems Deactivation**
Call Center/Systems Deactivation**

Transactional Prices

Per Claim with Third Party Liability (TPL) Confirmation

Administrative Price Per Rx Claim - Paid or Denied

Per Paper Claim, as required

Per Prior Authorization

Per Call - Automated Phone System

Per Incoming Call

Per Outgoing Call

Spanish Translation Service - per minute

Faxes - per Page

Annual Retention Fee

EPAP Event Change Order (see Event Guide, Attachment I)

Brand and Single Source Generic/DME = Lesser of: average
wholesale price (AWP) minus ____ or usual and customary (U&C)	AWP - 15%	AWP - 15%	AWP - 10%	TBD

Multi-Source Generic/DME = Lesser of: average wholesale price
(AWP) minus ____, or maximum allowable cost (MAC), or usual
and customary (U&C);	AWP - 20%	AWP - 20%	AWP - 40%	TBD
(MAC Guaranteed Effective Rate of AWP minus 55%)			MAC n/a	MAC n/a

Durable Medical Equipment (DME): Medi-Span published pricing.	AWP - 15%	AWP - 15%	AWP - 10%	TBD
(Actual pricing to be determined at time of Task Order.)

Dispense Fee - Standard $4.00 $4.00 $4.00 TBD

* Communication Center expense: Creation and distribution (Phone/ Fax/ Email) of Provider Network information/ instructions,

process, covered DME items, PA processes, follow up coordination and communications.

** Systems Activation ...Program plan design validation, installation, testing, Eligibility installation and testing, network activation.

**Call center/systems activation…device (IVR, call center systems) programming, customer service activation, communication

and training, system testing.

**Systems Deactivation…Network notifications on final acceptable transaction dates, data archiving, event clean up ( final reporting

and system standby readiness.)

**Call center/systems deactivation…Device (IVR, call center systems) programming and messaging, event wrap up procedures,

final reporting.

OYII Pricing

OPTION YEAR II	English only - Continental US (includes Alaska and Hawaii)	English & Spanish - Continental US (includes Alaska and Hawaii)	English & Spanish - Puerto Rico and U.S.Virgin Islands	English & Spanish - All Other Territories
Total Systems Activation/De-activation required per Event
Communication Center Expense*
Systems Activation**
Call Center/Systems Activation**
Systems Deactivation**
Call Center/Systems Deactivation**

Transactional Prices

Per Claim with Third Party Liability (TPL) Confirmation

Administrative Price Per Rx Claim - Paid or Denied

Per Paper Claim, as required

Per Prior Authorization

Per Call - Automated Phone System

Per Incoming Call

Per Outgoing Call

Spanish Translation Service - per minute

Faxes - per Page

Annual Retention Fee

EPAP Event Change Order (see Event Guide, Attachment I)

Brand and Single Source Generic/DME = Lesser of: average
wholesale price (AWP) minus ____ or usual and customary (U&C)	AWP - 15%	AWP - 15%	AWP - 10%	TBD

Multi-Source Generic/DME = Lesser of: average wholesale price
(AWP) minus ____, or maximum allowable cost (MAC), or usual
and customary (U&C);	AWP - 20%	AWP - 20%	AWP - 40%	TBD
(MAC Guaranteed Effective Rate of AWP minus 55%)			MAC n/a	MAC n/a

Durable Medical Equipment (DME): Medi-Span published pricing.	AWP - 15%	AWP - 15%	AWP - 10%	TBD
(Actual pricing to be determined at time of Task Order.)

Dispense Fee - Standard $4.00 $4.00 $4.00 TBD

* Communication Center expense: Creation and distribution (Phone/ Fax/ Email) of Provider Network information/ instructions,

process, covered DME items, PA processes, follow up coordination and communications.

** Systems Activation ...Program plan design validation, installation, testing, Eligibility installation and testing, network activation.

**Call center/systems activation…device (IVR, call center systems) programming, customer service activation, communication

and training, system testing.

**Systems Deactivation…Network notifications on final acceptable transaction dates, data archiving, event clean up ( final reporting

and system standby readiness.)

**Call center/systems deactivation…Device (IVR, call center systems) programming and messaging, event wrap up procedures,

final reporting.

OYIII Pricing

OPTION YEAR III	English only - Continental US (includes Alaska and Hawaii)	English & Spanish - Continental US (includes Alaska and Hawaii)	English & Spanish - Puerto Rico and U.S.Virgin Islands	English & Spanish - All Other Territories
Total Systems Activation/De-activation required per Event
Communication Center Expense*
Systems Activation**
Call Center/Systems Activation**
Systems Deactivation**
Call Center/Systems Deactivation**

Transactional Prices

Per Claim with Third Party Liability (TPL) Confirmation

Administrative Price Per Rx Claim - Paid or Denied

Per Paper Claim, as required

Per Prior Authorization

Per Call - Automated Phone System

Per Incoming Call

Per Outgoing Call

Spanish Translation Service - per minute

Faxes - per Page

Annual Retention Fee

EPAP Event Change Order (see Event Guide, Attachment I)

Brand and Single Source Generic/DME = Lesser of: average
wholesale price (AWP) minus ____ or usual and customary (U&C)	AWP - 15%	AWP - 15%	AWP - 10%	TBD

Multi-Source Generic/DME = Lesser of: average wholesale price
(AWP) minus ____, or maximum allowable cost (MAC), or usual
and customary (U&C);	AWP - 20%	AWP - 20%	AWP - 40%	TBD
(MAC Guaranteed Effective Rate of AWP minus 55%)			MAC n/a	MAC n/a

Durable Medical Equipment (DME): Medi-Span published pricing.	AWP - 15%	AWP - 15%	AWP - 10%	TBD
(Actual pricing to be determined at time of Task Order.)

Dispense Fee - Standard $4.00 $4.00 $4.00 TBD

* Communication Center expense: Creation and distribution (Phone/ Fax/ Email) of Provider Network information/ instructions,

process, covered DME items, PA processes, follow up coordination and communications.

** Systems Activation ...Program plan design validation, installation, testing, Eligibility installation and testing, network activation.

**Call center/systems activation…device (IVR, call center systems) programming, customer service activation, communication

and training, system testing.

**Systems Deactivation…Network notifications on final acceptable transaction dates, data archiving, event clean up ( final reporting

and system standby readiness.)

**Call center/systems deactivation…Device (IVR, call center systems) programming and messaging, event wrap up procedures,

final reporting.

OYIV Pricing

OPTION YEAR IV	English only - Continental US (includes Alaska and Hawaii)	English & Spanish - Continental US (includes Alaska and Hawaii)	English & Spanish - Puerto Rico and U.S.Virgin Islands	English & Spanish - All Other Territories
Total Systems Activation/De-activation required per Event
Communication Center Expense*
Systems Activation**
Call Center/Systems Activation**
Systems Deactivation**
Call Center/Systems Deactivation**

Transactional Prices

Per Claim with Third Party Liability (TPL) Confirmation

Administrative Price Per Rx Claim - Paid or Denied

Per Paper Claim, as required

Per Prior Authorization

Per Call - Automated Phone System

Per Incoming Call

Per Outgoing Call

Spanish Translation Service - per minute

Faxes - per Page

Annual Retention Fee

EPAP Event Change Order

Brand and Single Source Generic/DME = Lesser of: average
wholesale price (AWP) minus ____ or usual and customary (U&C)	AWP - 15%	AWP - 15%	AWP - 10%	TBD

Multi-Source Generic/DME = Lesser of: average wholesale price
(AWP) minus ____, or maximum allowable cost (MAC), or usual
and customary (U&C);	AWP - 20%	AWP - 20%	AWP - 40%	TBD
(MAC Guaranteed Effective Rate of AWP minus 55%)			MAC n/a	MAC n/a

Durable Medical Equipment (DME): Medi-Span published pricing.	AWP - 15%	AWP - 15%	AWP - 10%	TBD
(Actual pricing to be determined at time of Task Order.)

Dispense Fee - Standard $4.00 $4.00 $4.00 TBD

* Communication Center expense: Creation and distribution (Phone/ Fax/ Email) of Provider Network information/ instructions,

process, covered DME items, PA processes, follow up coordination and communications.

** Systems Activation ...Program plan design validation, installation, testing, Eligibility installation and testing, network activation.

**Call center/systems activation…device (IVR, call center systems) programming, customer service activation, communication

and training, system testing.

**Systems Deactivation…Network notifications on final acceptable transaction dates, data archiving, event clean up ( final reporting

and system standby readiness.)

**Call center/systems deactivation…Device (IVR, call center systems) programming and messaging, event wrap up procedures,

final reporting.

Price Eval

Base Year

Option Year 1

Option Year 2

Option Year 3

Option Year 4

Unit of Issue

Rate

Total

Unit of Issue

Rate

Total

Unit of Issue

Rate

Total

Unit of Issue

Rate

Total

Unit of Issue

Rate

Total

Total Systems Activation/De-activation required per Event

5 months, 1 location

No activation

3 months, 3 states

7 months 1 state, 2 months second state

Communication Center Expense*

Systems Activation**

Call Center/Systems Activation**

Systems Deactivation**

Call Center/Systems Deactivation**

Transactional Prices	5 months, 1 location		No activation		No activation		3 months, 3 states		7 months 1 state, 2 months second state
Per Claim with Third Party Liability (TPL) Confirmation	1000	ea		ea		ea	6300	ea	7000	ea
Administrative Price Per Rx Claim - Paid or Denied	7500	ea		ea		ea	50000	ea	55000	ea
Per Paper Claim, as required	150	ea		ea		ea	0	ea	100	ea
Per Prior Authorization	20	ea		ea		ea	10	ea	15	ea
Per Call - Automated Phone System	250	ea		ea		ea	550	ea	650	ea
Per Incoming Call	850	ea		ea		ea	2700	ea	3300	ea
Per Outgoing Call	250	ea		ea		ea	450	ea	550	ea
Spanish Translation Service - per minute	0	min		min		min	20	min	100	min
Faxes - per Page	15000	pg		pg		pg	90000	pg	110000	pg

Annual Retention Fee

12 Months

Total Contract Value for this Scenario:
Base Year	0
Option Year I	0
Option Year II	0
Option Year III	0
Option Year IV	0
TOTAL	0

File details come from the government source that posted it. Updated Nov 14, 2017.