RFP_revised_9_14_21_0001.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

CAS

S-4307 200 Constitution Ave, NW Customer Acquisition Services US Department of Labor

OWCP DC NAT SHIP CODE 16. ADMINISTERED BYCODE

X

X

524298

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED ORCAS

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

09/23/2021 04:00 P.M. ES

08/24/2021

202-693-7168Helen Williams (No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBERa. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

1605C3-21-R-00011

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 155 1638-DEC-21-NAT-0024OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

Washington DC 20210

TELEPHONE NO.

17a. CONTRACTOR/

WASHINGTON DC 20210

ROOM S3524

200 CONSTITUTION AVE, NW

US DEPARTMENT OF LABOR

15. DELIVER TO

Washington DC 20210 S-4307 200 Constitution Ave, NW Customer Acquisition Services

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$16.50

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULEX

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

US Department of Labor

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

The Government anticipates a single award fixed priced contract for Non-FECA Pharmacy Benefits Management (PBM) Services on behalf of the U.S.

Department of Labor (DOL), Office of Workers' Compensation Programs (OWCP).

Effective upon date of award, the term of this contract is as follows: One twelve month base period with four twelve month option periods.

Question and Answer Closing: August 31, 2021 at (Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

X

XX

DATED

Jubner J. Severe

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

4:00pm (ET)

Solicitation Closing: October 19, 2021 at

5:00PM (ET)

Period of Performance: 04/29/2022 to 04/28/2023

Base Period

OWCP-Non-FECA Pharmacy Benefits Management (PBM)

Services-All basic services in this requirement will be included in the price below.

Services include but are not limited to, formulary management, fee schedule, PBM utilization review, durable medical equipment

(DME), customer support, assistance with business rules, eligibility verification and processing claims for payment, electronic funds transfer (EFT) enrollment checks, fraud/waste/ abuse monitoring, reporting, and information management.

Product/Service Code: G008

Delivery: 04/29/2022

Base Period

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

Williams-Helen-A Highlight

Williams-Helen-A Highlight

Williams-Helen-A Highlight

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 155

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

1605C3-21-R-00011

OWCP-Non-FECA Pharmacy Benefits Management (PBM) Services

Guaranteed Rebates: All guaranteed rebates should be in terms of dollars per prescription. All rebates shall be paid in full on a quarterly basis by the second month after any given quarter. Offerors may propose a $0/Rx rebate in return for greater AWP discounts.

Product/Service Code: G008

Delivery: 04/29/2022

Base Period

Administrative CLIN-this CLIN is created only to facilitate award in the DOL Contract Writing System. The value of this CLIN is $1 and not separately priced (NSP).)

Product/Service Code: G008

Delivery: 04/29/2022

Option Period One

OWCP-Non-FECA Pharmacy Benefits Management (PBM) Services-All basic services in this requirement will be included in the price below.

Services include but are not limited to:

formulary management, fee schedule, PBM utilization review, durable medical equipment

(DME), customer support, assistance with business rules, eligibility verification and processing claims for payment, electronic funds transfer (EFT) enrollment checks, fraud/waste/abuse monitoring, reporting, and information management.

(Option Line Item)

(Anticipated Option Exercise Date)02/27/2023 Product/Service Code: G008

Delivery: 04/29/2023

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

4 155

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

1605C3-21-R-00011

Period of Performance: 04/29/2023 to 04/28/2024

Option Period One

OWCP-Non-FECA Pharmacy Benefits Management (PBM) Services

Guaranteed Rebates

All guaranteed rebates should be in terms of dollars per prescription. All rebates shall be paid in full on a quarterly basis by the second month after any given quarter. Offerors may propose a $0/Rx rebate in return for greater AWP discounts.

(Option Line Item)

(Anticipated Option Exercise Date)02/27/2023 Product/Service Code: G008

Delivery: 04/29/2023

Period of Performance: 04/29/2023 to 04/28/2024

Option Period One

Administrative CLIN-this CLIN is created only to facilitate award in the DOL Contract Writing System. The value of this CLIN is $1 and not separately priced (NSP)

(Option Line Item)

(Anticipated Option Exercise Date) 0 Days After Award

Product/Service Code: G008

Delivery: 04/29/2023

Option Period Two

OWCP-Non-FECA Pharmacy Benefits Management(PBM) Services-All basic services in this requirement will be included in the price below.

Services include but are not limited to:

formulary management, fee schedule, PBM utilization review, durable medical equipment

(DME), customer Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

5 155

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

1605C3-21-R-00011 support, assistance with business rules, eligibility verification and processing claims for payment, electronic funds transfer (EFT) enrollment checks, fraud/waste/abuse monitoring, reporting, and information management.

(Option Line Item)

(Anticipated Option Exercise Date)02/29/2024

Product/Service Code: G008

Delivery: 04/29/2024

Period of Performance: 04/29/2024 to 04/28/2025

2002 Option Period Two

OWCP-Non-FECA Pharmacy Benefits Management (PBM)

Services

Guaranteed Rebates: All guaranteed rebates should be in terms of dollars per prescription. All rebates shall be paid in full on a quarterly basis by the second month after any given quarter. Offerors may propose a $0/Rx rebate in return for greater AWP discounts.

(Option Line Item)

(Anticipated Option Exercise Date)02/29/2024

Product/Service Code: G008

Delivery: 04/29/2024

Period of Performance: 04/29/2024 to 04/28/2025

2003 Option Period Two

Administrative CLIN-this CLIN is created only to facilitate award in the DOL Contract Writing

System. The value of this CLIN is $1 and not separately priced (NSP)

(Option Line Item)

(Anticipated Option Exercise Date) 0 Days After

Award

Product/Service Code: G008

Delivery: 04/29/2024

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

6 155

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

1605C3-21-R-00011

Option Period Three

OWCP-Non-FECA Pharmacy Benefits Management (PBM) Services-All basic services in this requirement will be included in the price below.

Services include but are not limited to:

formulary management, fee schedule, PBM utilization review, durable medical equipment

(DME), customer support, assistance with business rules, eligibility verification and processing claims for payment, electronic funds transfer (EFT) enrollment checks, fraud/waste/abuse monitoring, reporting, and information management.

(Option Line Item)

(Anticipated Option Exercise Date)02/28/2025 Product/Service Code: G008

Delivery: 04/29/2025

Period of Performance: 04/29/2025 to 04/28/2026

Option Period Three

OWCP-Non-FECA Pharmacy Benefits Management (PBM) Services

Guaranteed Rebates: All guaranteed rebates should be in terms of dollars per prescription. All rebates shall be paid in full on a quarterly basis by the second month after any given quarter. Offerors may propose a $0/Rx rebate in return for greater AWP discounts.

(Option Line Item)

(Anticipated Option Exercise Date)02/28/2025 Product/Service Code: G008

Delivery: 04/29/2025

Period of Performance: 04/29/2025 to 04/28/2026

Administrative CLIN-this CLIN is created only to facilitate award in the DOL Contract Writing System. The value of this CLIN is $1 and not Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

7 155

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

1605C3-21-R-00011 separately priced (NSP)

(Option Line Item)

(Anticipated Option Exercise Date) 0 Days After Award

Product/Service Code: G008

Delivery: 04/29/2025

Option Period Four

OWCP-Non-FECA Pharmacy Benefits Management Services-All basic services in this requirement will be included in the price below.

Services include but are not limited to:

formulary management, fee schedule, PBM utilization review, durable medical equipment

(DME), customer support, assistance with business rules, eligibility verification and processing claims for payment, electronic funds transfer (EFT) enrollment checks, fraud/waste/abuse monitoring, reporting, and information management.

(Option Line Item)

(Anticipated Option Exercise Date)02/27/2026 Product/Service Code: G008

Delivery: 04/29/2026

Period of Performance: 04/29/2026 to 04/28/2027

Option Period Four

OWCP-Non-FECA Pharmacy Benefits Management (PBM) Services

Guaranteed Rebates: All guaranteed rebates should be in terms of dollars per prescription. All rebates shall be paid in full on a quarterly basis by the second month after any given quarter. Offerors may propose a $0/Rx rebate in return for greater AWP discounts.

Rebates shall be as follows:

Item Description/Rebates in Terms of Dollars/Rx

Brand Name Retail

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

8 155

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

1605C3-21-R-00011

Brand Name (mail order or 84 or more day supply)

Specialty Drugs (Brand Name Retail)

Specialty Drugs (Brand Name Mail order or 84 or more day supply)

(Option Line Item)

(Anticipated Option Exercise Date)02/27/2026

Product/Service Code: G008

Delivery: 04/29/2026

Period of Performance: 04/29/2026 to 04/28/2027

4003 Administrative CLIN-this CLIN is created only to facilitate award in the DOL Contract Writing

System. The value of this CLIN is $1 and not separately priced (NSP)

(Option Line Item)

(Anticipated Option Exercise Date) 0 Days After

Award

Product/Service Code: G008

Delivery: 04/29/2026

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Solicitation No. 1605C3-21-R-00011 DOL/ Office of Workers’ Compensation Programs (OWCP) Non-FECA Pharmacy Benefits Management Services

SECTION B – SCHEDULE OF SUPPLIES/SERVICES AND PRICES/COSTS

B.1. General

The contractor shall furnish Non-FECA Pharmacy Benefits Management (PBM) services for the U.S. Department of Labor, Office of Workers’ Compensation Programs (OWCP), for the Division of Coal Mine Workers’ Compensation (DCMWC) Program and the Division of Energy Employees Occupational Illness (DEOOIC) Compensation Program in accordance with the terms and conditions set forth in the solicitation document (including all amendments/modifications), and the resulting contract.

B.2 Discounts

Offerors shall factor in all costs and any applicable discounts of performing the requirements under this Solicitation.

BASE PERIOD

Item No Supplies/Services Quantity Unit Unit Price Amount 0001 Pharmacy Benefits Management (PBM)

Services: All basic services in this requirement will be included in the price below.

Services include, but are not limited to, formulary management, fee schedule, PBM utilization review, durable medical equipment (DME), customer support, assistance with business rules, eligibility verification and processing claims for payment, electronic funds transfer (EFT) enrollment checks, fraud/waste/abuse monitoring, reporting, and information management.

Net Discount Proposed shall be as follows:

Item Description Net Discount Proposed

10 Months

Brand Name Retail AWP - __% Generic Name Retail AWP - __% Brand Name (Mail order or 84 or more day supply)

AWP - __%

Generic Name (Mail order or 84 or more day supply)

AWP - __%

Compounded Drugs AWP - __%

Specialty Drugs (Brand Name Retail)

AWP - __%

Specialty Drugs (Generic Name Retail)

AWP - __%

Specialty Drugs (Brand Name Mail order or 84 or more day supply)

AWP - __%

Specialty Drugs (Generic Name Mail order or 84 or more day supply)

AWP - __%

Supplies dispensed from a pharmacy

AWP - __%

Durable Medical Equipment

(DME)

OWCP fee schedule - __%

Item No Supplies/Services Quantity Unit Unit Price Amount 0002 Guaranteed Rebates: All guaranteed rebates should be in terms of dollars per prescription. All rebates shall be paid in full on a quarterly basis by the second month after any given quarter. Offerors may propose a $0/Rx rebate in return for greater AWP discounts.

Rebates shall be as follows:

10 Months

Item Description Rebates in Terms of Dollars/Rx

Brand Name retail $ ______/Rx Brand Name (mail order or 84 or more day supply)

$ ______/Rx

Specialty Drugs (Brand Name Retail)

$ ______/Rx

Specialty Drugs (Brand Name Mail order or 84 or more day supply)

$ ______/Rx

0003 Administrative CLIN-this CLIN is created only to facilitate award in the DOL Contract Writing System.

The value of this CLIN is $1 and not separately priced.

$1.00

*Base Period versus Optional Periods:

The Government factored in 10 months of operations in the base period spend, in case Offerors propose Go-Live at fewer than 180 days after contract start. That is why the base period spend under the PBM is less than the first option year.

OPTION PERIOD ONE (1)

Item No Supplies/Services Quantity Unit Unit Price Amount 1001 Pharmacy Benefits Management (PBM)

Services: All basic services in this requirement will be included in the price below.

Services include, but are not limited to, formulary management, fee schedule, PBM utilization review, durable medical equipment (DME), customer support, assistance with business rules, eligibility verification and processing claims for payment, electronic funds transfer (EFT) enrollment checks, fraud/waste/abuse monitoring, reporting, and information management.

Net Discount Proposed shall be as follows:

Item Description Net Discount Proposed

12 Months

Brand Name Retail AWP - __% Generic Name Retail AWP - __% Brand Name (Mail order or 84 or more day supply)

AWP - __%

Generic Name (Mail order or 84 or more day supply)

AWP - __%

Compounded Drugs AWP - __%

Specialty Drugs (Brand Name Retail)

AWP - __%

Specialty Drugs (Generic Name Retail)

AWP - __%

Specialty Drugs (Brand Name Mail order or 84 or more day supply)

AWP - __%

Specialty Drugs (Generic Name Mail order or 84 or more day supply)

AWP - __%

Supplies dispensed from a pharmacy

AWP - __%

Durable Medical Equipment

(DME)

OWCP fee schedule - __%

Item No Supplies/Services Quantity Unit Unit Price Amount 1002 Guaranteed Rebates: All guaranteed rebates should be in terms of dollars per prescription. All rebates shall be paid in full on a quarterly basis by the second month after any given quarter. Offerors may propose a $0/Rx rebate in return for greater AWP discounts.

Rebates shall be as follows:

12 Months

Item Description Rebates in Terms of Dollars/Rx

Brand Name retail $ ______/Rx Brand Name (mail order or 84 or more day supply)

$ ______/Rx

Specialty Drugs (Brand Name Retail)

$ ______/Rx

Specialty Drugs (Brand Name Mail order or 84 or more day supply)

$ ______/Rx

1003 Administrative CLIN-this CLIN is created only to facilitate award in the DOL Contract Writing System.

The value of this CLIN is

OPTION PERIOD TWO (2)

Item No Supplies/Services Quantity Unit Unit Price Amount 2001 Pharmacy Benefits Management (PBM)

Services: All basic services in this requirement will be included in the price below.

Services include, but are not limited to, formulary management, fee schedule, PBM utilization review, durable medical equipment (DME), customer support, assistance with business rules, eligibility verification and processing claims for payment, electronic funds transfer (EFT) enrollment checks, fraud/waste/abuse monitoring, reporting, and information management.

Net Discount Proposed shall be as follows:

Item Description Net Discount Proposed

12 Months

Brand Name Retail AWP - __% Generic Name Retail AWP - __% Brand Name (Mail order or 84 or more day supply)

AWP - __%

Generic Name (Mail order or 84 or more day supply)

AWP - __%

Compounded Drugs AWP - __%

Specialty Drugs (Brand Name Retail)

AWP - __%

Specialty Drugs (Generic Name Retail)

AWP - __%

Specialty Drugs (Brand Name Mail order or 84 or more day supply)

AWP - __%

Specialty Drugs (Generic Name Mail order or 84 or more day supply)

AWP - __%

Supplies dispensed from a pharmacy

AWP - __%

Durable Medical Equipment

(DME)

Item No Supplies/Services Quantity Unit Unit Price Amount 2002 Guaranteed Rebates: All guaranteed rebates should be in terms of dollars per prescription. All rebates shall be paid in full on a quarterly basis by the second month after any given quarter. Offerors may propose a $0/Rx rebate in return for greater AWP discounts.

Rebates shall be as follows:

12 Months

Item Description Rebates in Terms of Dollars/Rx

Brand Name retail $ ______/Rx Brand Name (mail order or 84 or more day supply)

$ ______/Rx

Specialty Drugs (Brand Name Retail)

$ ______/Rx

Specialty Drugs (Brand Name Mail order or 84 or more day supply)

$ ______/Rx

2003 Administrative CLIN-this CLIN is created only to facilitate award in the DOL Contract Writing System.

The value of this CLIN is

OPTION PERIOD THREE (3)

Item No Supplies/Services Quantity Unit Unit Price Amount 3001 Pharmacy Benefits Management (PBM)

Services: All basic services in this requirement will be included in the price below.

Services include, but are not limited to, formulary management, fee schedule, PBM utilization review, durable medical equipment (DME), customer support, assistance with business rules, eligibility verification and processing claims for payment, electronic funds transfer (EFT) enrollment checks, fraud/waste/abuse monitoring, reporting, and information management.

Net Discount Proposed shall be as follows:

Item Description Net Discount Proposed

12 Months

Brand Name Retail AWP - __% Generic Name Retail AWP - __% Brand Name (Mail order or 84 or more day supply)

AWP - __%

Generic Name (Mail order or 84 or more day supply)

AWP - __%

Compounded Drugs AWP - __%

Specialty Drugs (Brand Name Retail)

AWP - __%

Specialty Drugs (Generic Name Retail)

AWP - __%

Specialty Drugs (Brand Name Mail order or 84 or more day supply)

AWP - __%

Specialty Drugs (Generic Name Mail order or 84 or more day supply)

AWP - __%

Supplies dispensed from a pharmacy

AWP - __%

Durable Medical Equipment

(DME)

Item No Supplies/Services Quantity Unit Unit Price Amount 3002 Guaranteed Rebates: All guaranteed rebates should be in terms of dollars per prescription. All rebates shall be paid in full on a quarterly basis by the second month after any given quarter. Offerors may propose a $0/Rx rebate in return for greater AWP discounts.

Rebates shall be as follows:

12 Months

Item Description Rebates in Terms of Dollars/Rx

Brand Name retail $ ______/Rx Brand Name (mail order or 84 or more day supply)

$ ______/Rx

Specialty Drugs (Brand Name Retail)

$ ______/Rx

Specialty Drugs (Brand Name Mail order or 84 or more day supply)

$ ______/Rx

3003 Administrative CLIN-this CLIN is created only to facilitate award in the DOL Contract Writing System.

The value of this CLIN is

OPTION PERIOD FOUR (4)

Item No Supplies/Services Quantity Unit Unit Price Amount 4001 Pharmacy Benefits Management (PBM)

Services: All basic services in this requirement will be included in the price below.

Services include, but are not limited to, formulary management, fee schedule, PBM utilization review, durable medical equipment (DME), customer support, assistance with business rules, eligibility verification and processing claims for payment, electronic funds transfer (EFT) enrollment checks, fraud/waste/abuse monitoring, reporting, and information management.

Net Discount Proposed shall be as follows:

Item Description Net Discount Proposed

12 Months

Brand Name Retail AWP - __% Generic Name Retail AWP - __% Brand Name (Mail order or 84 or more day supply)

AWP - __%

Generic Name (Mail order or 84 or more day supply)

AWP - __%

Compounded Drugs AWP - __%

Specialty Drugs (Brand Name Retail)

AWP - __%

Specialty Drugs (Generic Name Retail)

AWP - __%

Specialty Drugs (Brand Name Mail order or 84 or more day supply)

AWP - __%

Specialty Drugs (Generic Name Mail order or 84 or more day supply)

AWP - __%

Supplies dispensed from a pharmacy

AWP - __%

Durable Medical Equipment

(DME)

Item No Supplies/Services Quantity Unit Unit Price Amount 4002 Guaranteed Rebates: All guaranteed rebates should be in terms of dollars per prescription. All rebates shall be paid in full on a quarterly basis by the second month after any given quarter. Offerors may propose a $0/Rx rebate in return for greater AWP discounts.

Rebates shall be as follows:

12 Months

Item Description Rebates in Terms of Dollars/Rx

Brand Name retail $ ______/Rx Brand Name (mail order or 84 or more day supply)

$ ______/Rx

Specialty Drugs (Brand Name Retail)

$ ______/Rx

Specialty Drugs (Brand Name Mail order or 84 or more day supply)

$ ______/Rx

4003 Administrative CLIN-this CLIN is created only to facilitate award in the DOL Contract Writing System.

The value of this CLIN is

Assumptions used in Offeror Discount Rebate Workbook (CY20)

Non-specialty Brand and Generic Drugs (including: Brand Name Retail, Generic Name Retail, Brand Name (mail order or 84 day supply), and Generic Name (mail order or 84 day supply):

Non-specialty brand drugs – The government is projecting a 5% year over year increase in non-specialty brand drug spend and utilization due to increases in cases over time and increases in

AWP.

Non-specialty generic drugs – The government is projecting a 2% year over year increase in non-specialty generic drug spend and utilization due to increases in cases over time.

DME :

It is estimated that DOL’s PBM would achieve a 5% DME penetration for total allowed amounts for each program. This rate was multiplied by the baseline DME allowed amounts to provide the baseline values for each. The Government determined that the best proxy to estimate true penetration rates was 5%. Additionally, a 5% year-over-year increase in penetration was assumed from Option Period 1 and forward for both DME.

The allowed amounts for DME are based on the OWCP Fee Schedule and may be subject to adjustments based on locality, and pricing modifiers. OWCP uses the CMS Geographic Practice Cost Indices (GPCI) to calculate the values for locality adjustments. A listing of geographic practice cost indices by ZIP code is contained in the file https://www.dol.gov/sites/dolgov/files/owcp/regs/feeschedule/fee/feeOct1518/Effective_October _15_2018_Geographic_Practice_Cost_Indices_by_Zip_Codes.pdf located on the OWCP fee schedule website1.

OWCP acceptable modifiers will adjust allowable amounts by a modifier percentage using appropriate modifier levels. A listing of the Modifier Level Tables with the OWCP-designated fee schedule adjustment for each modifier are contained in the file https://www.dol.gov/sites/dolgov/files/owcp/regs/feeschedule/fee/feeOct1518/Effective_October _15_2018_Modifier_Level_Table_tab1.pdf on the OWCP fee schedule website.

For more information on the OWCP Fee Schedule, please see the OWCP Fee Schedule “Read Me First” document on the OWCP website at https://www.dol.gov/sites/dolgov/files/owcp/regs/feeschedule/fee/feeOct1518/Effective_October _15_2018_Read_Me_First.pdf.

1 For access to the OWCP Fee Schedule, first read and accept the AMA "License for Use of "Current Procedural Terminology", Fourth Edition ("CPT®")" at https://www.dol.gov/agencies/owcp/regs/feeschedule/license.

https://www.dol.gov/sites/dolgov/files/owcp/regs/feeschedule/fee/feeOct1518/Effective_October_15_2018_Geographic_Practice_Cost_Indices_by_Zip_Codes.pdf https://www.dol.gov/sites/dolgov/files/owcp/regs/feeschedule/fee/feeOct1518/Effective_October_15_2018_Geographic_Practice_Cost_Indices_by_Zip_Codes.pdf https://www.dol.gov/sites/dolgov/files/owcp/regs/feeschedule/fee/feeOct1518/Effective_October_15_2018_Modifier_Level_Table_tab1.pdf https://www.dol.gov/sites/dolgov/files/owcp/regs/feeschedule/fee/feeOct1518/Effective_October_15_2018_Modifier_Level_Table_tab1.pdf https://www.dol.gov/sites/dolgov/files/owcp/regs/feeschedule/fee/feeOct1518/Effective_October_15_2018_Read_Me_First.pdf https://www.dol.gov/sites/dolgov/files/owcp/regs/feeschedule/fee/feeOct1518/Effective_October_15_2018_Read_Me_First.pdf https://www.dol.gov/agencies/owcp/regs/feeschedule/license

Prescription Rx Supplies Dispensed from a Pharmacy:

Some supplies such as insulin syringes, needles, lancets, and other supplies from a pharmacy were projected to increase at a rate of 5% year over year.

Compound Medications:

OWCP is assuming a large compounding decrease of 80% during year one of the contract with the ability of new PBM controls. We also assume an additional 50% decline year over year in compound medication spend.

Specialty Drugs:

For brand and generic specialty drugs a pharmacist determined which of these medications were strictly specialty products. Product spend for injectable, chemotherapy, and/or monoclonal antibodies were included as specialty products and the totals were summed to provide a full year baseline value. A 7% year over year increase in brand and generic specialty drugs was assumed based on increases in AWP and utilization for the population.

Inflation/Deflation:

Future economic inflation/deflation in the values of average wholesale prices (AWPs) was not assessed separately although considered as part of the government’s overall projections. Each of the programs have a high utilization of brand only products including biologics. The percentage increases above account for the governments anticipated inflation for these products.

Base Period versus Optional Periods:

The Government factored in 10 months of operations in the base period spend, in case Offerors propose Go-Live at fewer than 180 days after contract start. That is why the base period spend under the PBM is less than the first option year.

Solicitation No. 1605C3-21-R-00011 DOL/ Office of Workers’ Compensation Programs (OWCP) NON-FECA Pharmacy Based Management Services

Section C-Description/Specification/Performance Work Statement

Performance Work Statement (PWS)

Non-FECA Pharmacy Benefits Management Services Department of Labor (DOL)

Office of Workers’ Compensation Programs (OWCP) Division of Coal Mine Workers’ Compensation (DCMWC) and Division of Energy Employees Occupational Illness

Compensation (DEEOIC)

1.1. Description of Services/Introduction:

In accordance with Federal Acquisition Regulation 37.401, the services required are for non-personal services to manage and provide comprehensive Pharmacy Benefits Management (PBM) services in accordance with this Performance Work Statement (PWS).

The Government will provide guidance within the general scope of the PWS and within contract terms and conditions but the Government will not exercise any supervision (or control) over the contractor’s employees. Such contract employees shall remain under the contractor’s direct supervision (and control) at all times during the entire performance period. This also applies to the subcontracted service providers utilized in performance of these services.

Such service providers will be considered independent subcontractors responsible for performing the required services.

All subcontracted service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government to ensure services are managed and rendered in accordance with the general scope and within contract terms and conditions.

1.2. Background:

The U.S. Department of Labor’s (DOL) Office of Workers’ Compensation Programs (OWCP) administers four occupational illness/injury compensation programs which mitigate (through the provision of wage replacement, cash benefits, medical treatment, vocational rehabilitation and other benefits) the financial burden on certain covered workers or their dependents or survivors when resulting in work-related illness, injury, disease, or death. Although the OWCP administers four (4) Programs, The Division of Coal Mine Workers’ Compensation (DCMWC) and The Division of Energy Employees Occupational Illness Compensation (DEEOIC) are the sole programs included in this Performance Work Statement.

The Division of Coal Mine Workers' Compensation (DCMWC) also known as Federal Black Lung Program administers claims filed under the Black Lung Benefits Act. The Act provides compensation to coal miners who are totally disabled by pneumoconiosis arising out of coal mine employment and their survivors whose deaths are attributable to the disease.

The Act also provides eligible miners with medical coverage for the treatment of lung diseases related to pneumoconiosis;

The Division of Energy Employees Occupational Illness Compensation (DEEOIC) administers the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) which provides lump sum compensation and medical benefits to employees or survivors of eligible Department of Energy (DOE) nuclear weapons workers including employees, former employees, contractors and subcontractors as well as, certain survivors of deceased workers.

EEOICPA was enacted to provide compensation and medical benefits to employees who worked at certain Department of Energy (DOE) facilities, including contractors and subcontractors at those locations, and certain of its vendors. EEOICPA also covers individuals who received an award from the Department of Justice (DOJ) under the Radiation Exposure Compensation Act (RECA) and individuals that worked in a mine, mill, or as an ore transporter at a facility covered by the RECA; and

The Office of Workers’ Compensation Programs, National Office for each of the aforementioned programs coordinates the activities of all District Offices. These District Offices have direct responsibility for processing claims. The District Office functional operations include: adjudicating incoming claims to determine eligibility for compensation payments;

GENERAL INFORMATION

managing claims in which eligibility has been established; determining wage-loss compensation payments for covered disability; and processing payments for allowed medical and vocational rehabilitation services incurred in the treatment of injured workers covered under the Acts.

Each of the programs are unique and each of the programs have statutory requirements that cover medical care and compensation for wage loss and permanent physical impairment to employees who are injured in the performance of duty.. The medical evaluation of workers who submit compensation claims is part of the adjudication and case management process. A medical evaluation may be necessary: (1) to determine the causal relationship between work factors and the disease or injury; (2) to assess the extent and duration of the physical impairment or disability; (3) to determine the appropriateness of therapy, including some surgical procedures; or (4) to determine when recovery has occurred and a return to work is feasible.

The PBM Services requirement as defined in this Performance Work Statement (PWS) represents new services. As a result, there is no incumbent contractor currently providing full PBM Services to any of the two (2) compensation programs administered by DEEOIC, and DCMWC. The two programs do not have a formal formulary or have any formal prior authorization requirements currently in place. The two programs currently utilize a system that matches accepted conditions to drug uses. If a billed drug is not normally used for the accepted condition it will deny and the claimant’s prescribing physician would then have to request an exception. The DCMWC is the only program that has a covered drug list which it uses to make payments for pharmaceuticals.

1.3. Objectives:

The Government’s objective is to obtain Comprehensive PBM Management services the DEEOIC and DCMWC Programs administered by the Office of Workers’ Compensation Program (OWCP). This includes claimants that require prescription medications and durable medical equipment (DME) as a result of work related injuries or illnesses as stipulated under the statutes administered by DEEOIC or DCMWC.

1.4. Scope:

The contractor shall implement and operate a Pharmacy Benefit Management Program in the United States and surrounding territories for the DEEOIC and DCMWC Program Divisions administered by the Office of Workers Compensation Program (OWCP). This includes claimants that require prescription medications and durable medical equipment (DME) as a result of work related injuries or illnesses as stipulated under the statutes administered by DEEOIC or DCMWC.

Services required are as follows:

• Provide Comprehensive PBM Services;

• Provide full prescription coverage for accepted conditions;

• Provide DME for accepted conditions; and

• Provide a pharmacy card system to claimants once claim eligibility is determined by the programs

1.5. Period of Performance:

Period of Performance: The period of performance shall be for one (1) base period of 12 months with four (4) 12-month options. The Period of Performance are as follows:

Base Period: April 29, 2022 – April 28, 2023 Option Period I: April 29, 2023 – April 28, 2024 Option Period II: April 29, 2024 – April 28, 2025 Option Period III: April 29, 2025 – April 28, 2026 Option Period IV: April 29, 2026 – April 28, 2027

Milestone dates within the period of performance include:

• Contemplated Contract Start: April 29, 2022 (based on estimated contract award of April 28, 2022)

• Full Implementation: No later than 180 days after contract start date

1.5.1 Contract Type: The Government anticipates award of a fixed-price contract

1.6. Quality of Deliverables/Services:

The contractor’s quality control program is the means by which the contractor assures the government that all work performed will comply with the requirements of the PWS. Therefore, the contractor shall develop, maintain and implement quality control procedures that are consistent with the requirements of the PWS and that address the areas identified in Technical Exhibit 1, “Performance Requirements Summary” and Technical Exhibit 2 “Deliverables Schedule. As defined in Part 2 “Definitions and Acronyms” a written quality control plan (QCP) shall be submitted for government review and approval prior to implementation.

The contracting officer will notify the contractor (in writing) upon government approval of the QCP or when there are proposed change(s) to the contractor’s proposed QC procedures. The contractor shall have the opportunity to correct all unsatisfactory services or deficiencies within five calendar days or another agreed upon timeframe. In no case shall the contractor invoice or bill for non-forming deliverables or services.

Work Plan/Project Plan: The contractor shall have a full work plan/project plan to meet and complete all available tasks and deliverables.

Quality Assurance:

The government will evaluate the contractor’s performance in accordance with the method of surveillance identified in the government’s Quality Assurance Surveillance Plan (QASP) to ensure deliverables and services are performed in accordance with the performance work standards and Technical Exhibits 1 and 2. The document defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s). In no case shall the government pay for non-forming deliverables or services.

1.7. Recognized Holidays:

The Department of Labor will be closed on the following holidays however, the contractor shall ensure services continue on each holiday in order to provide services 365 days per year:

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day

President’s Day Veteran’s Day Memorial Day Thanksgiving Day Independence Day Christmas Day Juneteenth National Independence Day

1.8. Hours of Operation/Place of Performance:

The contractor is responsible for conducting PBM services at contractor facilities. The contractor must at all times maintain an adequate work force for the uninterrupted performance of all tasks defined within this performance work statement. When hiring personnel, the contractor shall keep in mind that the stability and continuity of the work force are essential. The contractor’s system and web portal shall be available 24 hours per day, 7 days per week except for 5 hours of maintenance per week. Maintenance periods shall be coordinated to occur at off-peak times and must be approved by OWCP. The contractor shall provide notice when the system is down for maintenance (e.g. web portal message that system is temporarily down for maintenance).

1.8.1 Phase In/Phase Out Period

The Contractor shall develop and initiate a phase-in plan that minimizes any decreases in productivity and prevents possible negative impacts on additional services. The Contractor shall submit the phase-in plan to the COR within 15 business days of award.

During the phase-in period, the Contractor shall:

• Become familiar with performance requirements in order to commence full performance of services on the contract start date.

• Coordinate efforts with the COR, and Federal Program Manager (PM) to meet the requirements of the PWS.

Reference PART 5.2 of this PWS for additional information on basic requirements.

• Negotiate in good faith a plan with the incumbent (if applicable) to determine the nature and extent of the phase-in services required. For the purposes of this task order, an incumbent is defined as the predecessor company recently performing similar requirement services at the designated OWCP/WHD locations.

As directed by the Contracting Officer, the Contractor shall develop and initiate a phase-out plan that minimizes any decreases in productivity and prevents possible negative impacts on additional services. The Contractor shall submit the phase-out plan to the COR within 15 business days of request.

During the phase-out period, the Contractor shall:

• Coordinate phase-out efforts with the COR, and Federal PM.

• Negotiate in good faith a plan with the successor to determine the nature and extent of the phase-out services required.

These phase-in and phase-out plans will be subject to COR/Contracting Officer’s approval. The Contractor shall recognize that the services under this task order are vital to OWCP, and shall continue operations without interruption during the period of performance of this call order, and, upon call order expiration, a successor may continue them.

Notice to the Government of Delay

Performance delays are to be reported immediately to the CO or COR verbally, followed by a written notification within 24 hours of occurrence.

Support Contractor Agreement

The Contractor shall fully cooperate with other contractor (s) occupying the same workspace or collaborating on other projects (as identified by the Contracting Officer, COR/ other authorized government official) to support the agency’s mission.

Continuity Of Operations Planning (COOP)

The Contractor shall be prepared to continue the performance of essential services off-site during a natural, man-made or technological event that would disrupt or interfere with operations at, or access to, facilities where services ordinarily take place. The definition for essential services and natural, man-made or technological events can be found in Part 2.1.

Within 30 days of award, the Contractor shall submit a Continuity Of Operations Planning (COOP) to be approved by the CO and the COR. The COOP must consider, at a minimum, the continuity of all essential services for a period of between one and sixty days during a natural, man-made or technological event that would limit access to facilities where services ordinarily take place.

All basic services required under this PWS (Reference PART 5) and resulting contract are considered essential and paramount to support OWCP’s mission. However, some of the required services can only be performed on-site. Thus, the COOP plan should take into consideration the services’ compatibility with off-site/telework performance.

At a minimum, the COOP plan shall address the following outline elements:

• The Contractor shall identify suitable types of telework and off-site workplaces (i.e contractor employees’ homes, Contractor operated locations/offices, etc.).

• The Contractor shall identify the positions/labor categories that would become essential and potentially allowed to perform work off-site.

• The Contractor shall provide the alert and notification procedures for mobilizing and communicating with the Department and with the identified essential personnel, and for communicating expectations to its personnel regarding their roles and responsibilities during the event.

• The Contractor shall provide a list of telephone numbers and email addresses (with alternates if available) for all managers currently performing under the requirement.

• The Contractor shall provide the standard processes and requirements for the identification, training, and preparedness of essential personnel who would be capable of relocating to alternate facilities or performing work from home.

• The Contractor shall identify any additional measures to ensure quality control of staff performing off-site duties.

• The Contractor shall address if Contractor Employees’ approved to telework/perform services off-site, will need to keep or print hardcopy documents with PII information at the approved telework/off-site location.

If so, the Contractor shall provide additional protocols ensuring the appropriate handling of hardcopy documents with PII information.

• The Contractor shall identify if additional support or resources are required to allow Contractor employees’ to perform off-site duties (i.e. access to certain Government locations at least 24 hours before the contingency plan is activated to pick up materials, etc.).

• The Contractor shall identify if additional funds may be needed to comply with the contingency plans.

The Contractor shall comply with the CO and/or COR’s request to edit the contingency plans throughout the period of performance, as needed. All changes to the contingency plans require approval by the CO and/or COR.

During an event that merits the activation of the COOP plan, the Contractor shall work with each of the Program Directors or representatives and the COR to update the related plans per the particular event circumstances. The Contractor shall submit to the COR, at a minimum, an updated employee register/roster by task area and copies of signed telework agreements and related documents. Approval for telework/off-site performance is on a case-by-case basis as the request must demonstrate staff’s availability, readiness, and telework compatible duties in scope with the contract.

1.9. Security Requirements:

All references to keys include keys or key cards that may be required to gain access to data or material necessary in performance of this contract. The contractor shall develop a Quality Control Plan that includes security procedures to ensure no keys received from the Government shall be duplicated. Such procedures shall also include return of any key(s) issued to personnel who no longer require access to locked areas, data or material. The Contractor shall immediately report all occurrences of lost, stolen, damaged or duplicate keys to the COR.

Key Use - When applicable, the Contractor shall prohibit the use of Government issued keys/key cards by any persons other than the Contractor’s employees. The Contractor shall prohibit the opening of locked areas by Contractor employees to permit entrance of persons other than Contractor employees engaged in the performance of assigned work in those areas, or personnel authorized entrance by the Contracting Officer.

Physical Security - When applicable, the contractor shall be responsible for safeguarding all Government Furnished Property identified and provided for contractor use (See Part 3 – Government Furnished Property). At the close of each work period, all government facilities, equipment, and materials shall be secured appropriately (when applicable).

Key Control - When applicable, the Contractor shall establish and implement methods of making sure all keys/key cards issued to the Contractor by the Government are not lost or misplaced and are not used by unauthorized persons.

Lost Keys - In the event keys, other than master keys, are lost or duplicated, the Contractor shall, upon direction of the Contracting Officer, re-key or replace the affected lock or locks; however, the Government, at its option, may replace the affected lock or locks or perform re-keying. When the replacement of locks or re-keying is performed by the Government, the total cost of re-keying or the replacement of the lock or locks shall be deducted from the monthly payment due the Contractor. In the event a master key is lost or duplicated, all locks and keys for that system shall be replaced by the Government and the total cost deducted from the monthly payment due the Contractor.

Lock Combinations - When applicable, the Contractor shall establish and implement methods of ensuring that all lock combinations are not revealed to unauthorized persons. The Contractor shall ensure that lock combinations are changed when personnel having access to the combinations no longer have a need to know such combinations. These procedures shall be included in the contractor’s proposal.

All references1.10 to “days” shall be read as “calendar days”.

1.9.1 INFORMATION SECURITY: The contractor shall be responsible for safeguarding all government information provided for contractor use.

1.9.2 The contractor shall be responsible for ensuring compliance by its employees with the security regulations of DOL and other government installations or contractor facilities where work is performed under the resulting contract.

The contractor shall ensure the security of all DOL property, building ID badges, key cards and standard keys issued to contractor staff. For employees leaving the project permanently or for an extended period, the contractor shall return all badges, property, key cards, parking placards, and keys the same day the employees leave the project.

1.9.3 For any contract employees and/or sub-contractors who regularly work at government facilities, the contractor is responsible for the safekeeping and display of a government-provided photo ID badge while these employees are in federally owned or leased property as described in Section 4, Place of Performance.

1.9.4 PERSONAL INFORMATION AND PRIVACY: The contractor shall provide personal information and privacy support to ensure compliance to the Privacy Act and other Federal Privacy related policies including, but not limited to, OMB Memorandum M-06-16, Protection of Sensitive Agency Information, and M-07-16, Safeguarding Against and Responding to the Breach of Personally Identifiable Information. The contractor shall evaluate their existing privacy-related policies and procedures to ensure they comply with federal privacy-related policies – including the 1-hour notification timeframe for security incidents. Where the contractor’s policies and procedures do not comply, the contractor shall perform the necessary updates/revisions to bring the documents and/or system into compliance as requested by the Contracting Officer or COR at no additional cost to the Government. The contractor shall also ensure that all identified privacy vulnerabilities and areas of noncompliance have been documented and resolution tracked.

1.9.5 The contractor shall ensure conformance to the most recent DOL implementation of Federal information security guidelines, currently defined as:

• The Freedom of Information Act, as amended (5 USC 522), which provides for the disclosure of information maintained by Federal…