A19-J.4 – PBM DISCOUNT REBATE FEES WORKBOOK rev.xlsx
XLSX spreadsheet 48 KB Posted
- Attached to
- PHARMACY BENEFITS MANAGEMENT SERVICES (PBM)
- Solicitation number
- 1605C3-24-R-00011
About this file
This is a pricing workbook template (Attachment J.4) for offerors to submit their discount rates, rebates, and service fees for a Pharmacy Benefits Management (PBM) Services contract with the Department of Labor's Office of Workers' Compensation Programs (OWCP). The workbook contains multiple tabs for offerors to input their proposed discounts from AWP for drugs/supplies and discounts from OWCP fee schedules for DME and diagnostic services, as well as per-prescription rebates and service fees across the base period (15 months), four option periods, and an award term period (9 months).
The workbook includes government projections for prescription volumes and spending across different drug categories (brand retail, generic retail, mail order, specialty drugs, etc.) for various OWCP programs including Energy, Black Lung, FECA, and Longshore. It provides example discount rates ranging from 17-70% depending on drug category and timeline assumptions like 7% year-over-year increases for specialty drugs. The total evaluated price calculation spans approximately $1.93 billion across all periods. The workbook is designed to transparently show the impact of offerors' proposed pricing and allow consistent government evaluation, with instructions stating that if discrepancies exist between the workbook and narrative proposal pricing, the narrative proposal pricing will be used.
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Instructions
| INSTRUCTIONS FOR OFFERORS | |
| Purpose: | The purpose of this excel workbook is to: |
| 1. Display the Offeror's discounts, rebates, and service fees. | |
| 2. Transparently show Offerors the impact of those discounts, rebates, and service fees projected over the base period, all option periods, and the award term period. | |
| 3. Will be used as a reference point for the government when evaluating the price/discount proposals from various Offerors. If discrepencies exist between the discounts an Offeror includes in this excel workbook and the discounts an Offeror includes in their submitted proposal pricing volume, the government will utilize the pricing volume in the submitted narrative proposal. The Offerors can not change the Government's pricing model in this excel workbook. | |
| 4. The prices and volumes are categorized based on a historical brand and generic classification system. Offerors should refer to requirement 5.6.6 for more information on OWCP's brand/generic classifcation process. | |
| Step | |
| 1 | On the "Discounts.Rebates.Fee" Tab: |
-Insert discount percentages into the appropriate rows and columns (yellow cells).
-Discounts should be inserted as negative numbers.
-Discounts for drugs and supplies should be represented as discounts from AWP.
-Discounts for DME and Diagnostic Testing and Services should be represented as discounts from the OWCP fee schedule allowed amounts.
*For example, if an Offeror would like to input a 25% discount (AWP - 25%) for retail brand name drugs for the base year, place "-25" in cell B2. Excel will automatically convert it to a percentage.
2 On the "Discounts.Rebates.Fee" Tab:
-Place the total rebate per prescription in terms of negative dollars for the (orange cells).
*For example, if an Offeror would like to input a $5 rebate per prescription for brand name retail drugs for the base year, place "-5" in cell B16. Excel will automatically convert it to a dollar amount.
3 On the "Discounts.Rebates.Fee" Tab:
-Place the total service fee per prescription in terms of positive dollars for the (blue cells).
*For example, if an Offeror would like to input a $3 service fee per prescription for the base year, place "3" in cell B22. Excel will automatically convert it to a dollar amount.
4 View the "Total Evaluated Price" tab as needed to continue to improve your overall offeror to the government. This tab will update as the "Discounts.Rebates" tab updates.
*The "Total Evaluated Price" tab is populated using estimates from the "GOV Projections" tab. These projections are further described in the RFP under Instructions, Conditions, and Notices to Bidders.
5 Double check your discounts, rebates, and service fees for accuracy and ensure they meet any go/no go requirements set forth in the RFP. The Government has provided example tabs ("Discounts.Rebates.Fee - Example", and "Total Evaluated Price - Example") to further show Offerors an example of how their discounts and rebates may appear.
Discounts.Rebates.Fee
| Base Period | Option Period 1 | Option Period 2 | Option Period 3 | Option Period 4 | Award Term Period | |
| Discount CLINS | ||||||
| Brand Name Retail | ||||||
| Generic Name Retail | ||||||
| Brand Name (Mail order or 84 or more day supply) | ||||||
| Generic Name (Mail order or 84 or more day supply) | ||||||
| Compounded Drugs | ||||||
| Specialty Drugs (Brand Name Retail) | ||||||
| Specialty Drugs (Generic Name Retail) | ||||||
| Specialty Drugs (Brand Name Mail order or 84 or more day supply) | ||||||
| Specialty Drugs (Generic Name Mail order or 84 or more day supply) | ||||||
| Rx Supplies | ||||||
| Durable Medical Equipment (DME) | ||||||
| Diagnostic Services and Testing |
| Rebate CLINS |
| Brand Name Retail |
| 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) |
Service Fee per Paid Transction
Total Evaluated Price
| Base Period | Option Period 1 | Option Period 2 | Option Period 3 | Option Period 4 | Award Term Period | Base + All Option Periods | |
| Discount CLINS | |||||||
| Brand Name Retail | $ 36,702,232.55 | $ 62,241,792.39 | $ 59,203,107.23 | $ 62,163,262.59 | $ 65,271,425.72 | $ 51,401,247.75 | $ 336,983,068.22 |
| Generic Name Retail | $ 49,555,646.02 | $ 111,395,760.12 | $ 107,950,652.88 | $ 110,109,665.93 | $ 112,311,859.25 | $ 88,445,589.16 | $ 579,769,173.36 |
| Brand Name (Mail order or 84 or more day supply) | $ 18,226,410.68 | $ 21,972,417.65 | $ 18,809,283.92 | $ 19,749,748.11 | $ 20,737,235.52 | $ 16,330,572.97 | $ 115,825,668.85 |
| Generic Name (Mail order or 84 or more day supply) | $ 29,227,634.52 | $ 45,957,342.04 | $ 41,663,092.01 | $ 42,496,353.85 | $ 43,346,280.93 | $ 34,135,196.23 | $ 236,825,899.59 |
| Compounded Drugs | $ 697,905.44 | $ 167,554.80 | $ 33,510.96 | $ 6,702.19 | $ 1,340.44 | $ 201.07 | $ 907,214.90 |
| Specialty Drugs (Brand Name Retail) | $ 58,804,960.47 | $ 78,125,386.83 | $ 83,594,163.91 | $ 89,445,755.38 | $ 95,706,958.26 | $ 76,804,834.00 | $ 482,482,058.86 |
| Specialty Drugs (Generic Name Retail) | $ 8,558,943.83 | $ 11,280,018.21 | $ 12,069,619.48 | $ 12,914,492.85 | $ 13,818,507.35 | $ 11,089,352.15 | $ 69,730,933.87 |
| Specialty Drugs (Brand Name Mail order or 84 or more day supply) | $ 6,489,041.49 | $ 10,473,481.12 | $ 11,206,624.80 | $ 11,991,088.53 | $ 12,830,464.73 | $ 10,296,447.95 | $ 63,287,148.62 |
| Specialty Drugs (Generic Name Mail order or 84 or more day supply) | $ 2,042,838.69 | $ 2,769,701.64 | $ 2,963,580.76 | $ 3,171,031.41 | $ 3,393,003.61 | $ 2,722,885.40 | $ 17,063,041.50 |
| Rx Supplies | $ 1,301,499.49 | $ 1,657,177.22 | $ 1,673,748.99 | $ 1,690,486.48 | $ 1,707,391.34 | $ 1,370,181.55 | $ 9,400,485.07 |
| Durable Medical Equipment (DME) | $ 1,004,026.35 | $ 1,657,938.01 | $ 1,740,834.91 | $ 1,827,876.66 | $ 1,919,270.49 | $ 1,133,569.13 | $ 9,283,515.56 |
| Diagnostic Services and Testing | $ 370,622.87 | $ 1,102,599.11 | $ 1,157,729.07 | $ 1,215,615.52 | $ 1,276,396.30 | $ 753,871.56 | $ 5,876,834.44 |
| Total Discount CLINS = | $ 212,981,762.40 | $ 348,801,169.16 | $ 342,065,948.91 | $ 356,782,079.51 | $ 372,320,133.94 | $ 294,483,948.93 | $ 1,927,435,042.86 |
| Rebate CLINS | |||||||
| Brand Name Retail | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Brand Name (mail order or 84 or more day supply) | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Specialty Drugs (Brand Name Retail) | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Specialty Drugs (Brand Name Mail order or 84 or more day supply) | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| Total Rebate CLINS = | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
Service Fee per Paid Transction (Prescription Volume) $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0 $ - 0
Total Evaluated Price= $ 212,981,762.40 $ 348,801,169.16 $ 342,065,948.91 $ 356,782,079.51 $ 372,320,133.94 $ 294,483,948.93 $ 1,927,435,042.86
Discounts.Rebates.Fee - Example
| Base Period | Option Period 1 | Option Period 2 | Option Period 3 | Option Period 4 | Award Term Period | |
| Discount CLINS | ||||||
| Brand Name Retail | -17.00% | -17.50% | -18.00% | -18.50% | -19.00% | -19.50% |
| Generic Name Retail | -65.00% | -66.00% | -67.00% | -68.00% | -69.00% | -70.00% |
| Brand Name (Mail order or 84 or more day supply) | -20.00% | -20.50% | -21.00% | -21.50% | -22.00% | -22.50% |
| Generic Name (Mail order or 84 or more day supply) | -67.00% | -68.00% | -69.00% | -70.00% | -71.00% | -72.00% |
| Compounded Drugs | -70.00% | -70.00% | -70.00% | -70.00% | -70.00% | -70.00% |
| Specialty Drugs (Brand Name Retail) | -11.00% | -12.00% | -13.00% | -14.00% | -15.00% | -16.00% |
| Specialty Drugs (Generic Name Retail) | -25.00% | -26.00% | -27.00% | -28.00% | -29.00% | -30.00% |
| Specialty Drugs (Brand Name Mail order or 84 or more day supply) | -11.00% | -12.00% | -13.00% | -14.00% | -15.00% | -16.00% |
| Specialty Drugs (Generic Name Mail order or 84 or more day supply) | -25.00% | -26.00% | -27.00% | -28.00% | -29.00% | -30.00% |
| Rx Supplies | -40.00% | -40.00% | -40.00% | -40.00% | -40.00% | -40.00% |
| Durable Medical Equipment (DME) | -5.00% | -5.00% | -5.00% | -5.00% | -5.00% | -5.00% |
| Diagnostic Services and Testing | -10.00% | -11.00% | -12.00% | -13.00% | -15.00% | -16.00% |
| Rebate CLINS | ||||||
| Brand Name Retail | $ (3.00) | $ (4.00) | $ (5.00) | $ (6.50) | $ (7.50) | $ (8.00) |
| Brand Name (mail order or 84 or more day supply) | $ (1.00) | $ (2.00) | $ (3.00) | $ (4.00) | $ (5.00) | $ (6.00) |
| Specialty Drugs (Brand Name Retail) | $ (8.00) | $ (9.00) | $ (10.00) | $ (11.00) | $ (12.00) | $ (13.00) |
| Specialty Drugs (Brand Name Mail order or 84 or more day supply) | $ (9.00) | $ (10.00) | $ (11.00) | $ (12.00) | $ (13.00) | $ (14.00) |
Service Fee per Paid Transction $ 5.00 $ 4.00 $ 2.50 $ 2.50 $ 2.50 $ 1.50
Total Evaluated Price - Example
| Base Period | Option Period 1 | Option Period 2 | Option Period 3 | Option Period 4 | Award Term Period | Base + All Option Periods | |
| Discount CLINS | |||||||
| Brand Name Retail | $ 30,462,853.01 | $ 51,349,478.73 | $ 48,546,547.93 | $ 50,663,059.01 | $ 52,869,854.83 | $ 41,378,004.44 | $ 275,269,797.94 |
| Generic Name Retail | $ 17,344,476.11 | $ 37,874,558.44 | $ 35,623,715.45 | $ 35,235,093.10 | $ 34,816,676.37 | $ 26,533,676.75 | $ 187,428,196.21 |
| Brand Name (Mail order or 84 or more day supply) | $ 14,581,128.55 | $ 17,468,072.04 | $ 14,859,334.29 | $ 15,503,552.27 | $ 16,175,043.70 | $ 12,656,194.05 | $ 91,243,324.90 |
| Generic Name (Mail order or 84 or more day supply) | $ 9,645,119.39 | $ 14,706,349.45 | $ 12,915,558.52 | $ 12,748,906.16 | $ 12,570,421.47 | $ 9,557,854.94 | $ 72,144,209.94 |
| Compounded Drugs | $ 209,371.63 | $ 50,266.44 | $ 10,053.29 | $ 2,010.66 | $ 402.13 | $ 60.32 | $ 272,164.47 |
| Specialty Drugs (Brand Name Retail) | $ 52,336,414.82 | $ 68,750,340.41 | $ 72,726,922.60 | $ 76,923,349.63 | $ 81,350,914.52 | $ 64,516,060.56 | $ 416,604,002.55 |
| Specialty Drugs (Generic Name Retail) | $ 6,419,207.88 | $ 8,347,213.48 | $ 8,810,822.22 | $ 9,298,434.85 | $ 9,811,140.22 | $ 7,762,546.50 | $ 50,449,365.14 |
| Specialty Drugs (Brand Name Mail order or 84 or more day supply) | $ 5,775,246.92 | $ 9,216,663.39 | $ 9,749,763.57 | $ 10,312,336.14 | $ 10,905,895.02 | $ 8,649,016.28 | $ 54,608,921.32 |
| Specialty Drugs (Generic Name Mail order or 84 or more day supply) | $ 1,532,129.01 | $ 2,049,579.22 | $ 2,163,413.95 | $ 2,283,142.62 | $ 2,409,032.56 | $ 1,906,019.78 | $ 12,343,317.14 |
| Rx Supplies | $ 976,124.61 | $ 1,226,311.14 | $ 1,221,836.76 | $ 1,217,150.27 | $ 1,212,247.85 | $ 959,127.09 | $ 6,812,797.73 |
| Durable Medical Equipment (DME) | $ 953,825.03 | $ 1,575,041.11 | $ 1,653,793.17 | $ 1,736,482.83 | $ 1,823,306.97 | $ 1,076,890.68 | $ 8,819,339.78 |
| Diagnostic Services and Testing | $ 333,560.59 | $ 981,313.21 | $ 1,018,801.58 | $ 1,057,585.51 | $ 1,084,936.85 | $ 633,252.11 | $ 5,109,449.85 |
| Total Discount CLINS = | $ 140,569,457.56 | $ 213,595,187.05 | $ 209,300,563.34 | $ 216,981,103.02 | $ 225,029,872.50 | $ 175,628,703.50 | $ 1,181,104,886.98 |
| Rebate CLINS | |||||||
| Brand Name Retail | $ (157,738.25) | $ (336,358.40) | $ (414,323.86) | $ (538,621.02) | $ (621,485.79) | $ (497,188.63) | $ (2,565,715.95) |
| Brand Name (mail order or 84 or more day supply) | $ (9,843.67) | $ (25,389.60) | $ (37,164.89) | $ (49,553.18) | $ (61,941.48) | $ (55,747.33) | $ (239,640.15) |
| Specialty Drugs (Brand Name Retail) | $ (28,515.33) | $ (43,144.08) | $ (48,332.65) | $ (53,604.51) | $ (58,960.91) | $ (48,302.31) | $ (280,859.79) |
| Specialty Drugs (Brand Name Mail order or 84 or more day supply) | $ (2,692.05) | $ (4,949.09) | $ (5,476.99) | $ (6,011.25) | $ (6,551.96) | $ (5,324.41) | $ (31,005.76) |
| Total Rebate CLINS = | $ (198,789.30) | $ (409,841.18) | $ (505,298.39) | $ (647,789.97) | $ (748,940.14) | $ (606,562.69) | $ (3,117,221.66) |
Service Fee per Paid Transction (Prescription Volume) $ 1,895,648.50 $ 3,178,448.39 $ 1,977,558.10 $ 1,977,615.36 $ 1,977,711.18 $ 890,015.89 $ 11,896,997.42
Total Evaluated Price = $ 142,266,316.76 $ 216,363,794.26 $ 210,772,823.06 $ 218,310,928.41 $ 226,258,643.55 $ 175,912,156.71 $ 1,189,884,662.74
GOV Projections
| Energy | Black Lung | FECA | Longshore | Total | Total | Total | Total | Total | Total | Total | Total | Projection Assumptions | |
| Discounts (100%AWP for Drugs, and Paid Amounts for DME and Diagnostic Services and Testing) | CY2023 - Baseline | CY2023 - Baseline | CY2023 - Baseline | CY2023 - Baseline | CY2023 - Baseline | Base Period (15 months) | Option Period 1 | Option Period 2 | Option Period 3 | Option Period 4 | Award Term Period (9 months) | Base + All Option Periods | Assumptions Year over Year |
| Brand Name Retail | $ 26,035,025.56 | $ 8,097,945.39 | $ 25,980,810.23 | $ 60,648.68 | $ 60,174,429.86 | $ 36,702,232.55 | $ 62,241,792.39 | $ 59,203,107.23 | $ 62,163,262.59 | $ 65,271,425.72 | $ 51,401,247.75 | $ 336,983,068.22 | Base year 5% increase for all programs. Option period 1, Energy 10% decline, 5% increase on other programs. Option period 2, Energy 20% decline, 5% increase on other programs. Option period 3, option period 4, and the award term period a 5% increase is estimated. |
| Generic Name Retail | $ 28,089,831.87 | $ 5,513,853.98 | $ 76,682,160.70 | $ 88,966.54 | $ 110,374,813.09 | $ 49,555,646.02 | $ 111,395,760.12 | $ 107,950,652.88 | $ 110,109,665.93 | $ 112,311,859.25 | $ 88,445,589.16 | $ 579,769,173.36 | Base year 2% increase for all programs. Option period 1, Energy 10% decline, 2% increase on other programs. Option period 2, Energy 20% decline, 2% increase on other programs. Option period 3, option period 4, and the award term period a 2% increase is estimated. |
| Brand Name (Mail order or 84 or more day supply) | $ 18,039,173.00 | $ 2,072,522.81 | $ 2,394,959.43 | $ - 0 | $ 22,506,655.24 | $ 18,226,410.68 | $ 21,972,417.65 | $ 18,809,283.92 | $ 19,749,748.11 | $ 20,737,235.52 | $ 16,330,572.97 | $ 115,825,668.85 | Base year 5% increase for all programs. Option period 1, Energy 10% decline, 5% increase on other programs. Option period 2, Energy 20% decline, 5% increase on other programs. Option period 3, option period 4, and the award term period a 5% increase is estimated. |
| Generic Name (Mail order or 84 or more day supply) | $ 25,814,007.09 | $ 1,671,849.41 | $ 19,710,469.29 | $ 13,378.66 | $ 47,209,704.45 | $ 29,227,634.52 | $ 45,957,342.04 | $ 41,663,092.01 | $ 42,496,353.85 | $ 43,346,280.93 | $ 34,135,196.23 | $ 236,825,899.59 | Base year 2% increase for all programs. Option period 1, Energy 10% decline, 2% increase on other programs. Option period 2, Energy 20% decline, 2% increase on other programs. Option period 3, option period 4, and the award term period a 2% increase is estimated. |
| Compounded Drugs | $ 16,747,266.39 | $ - 0 | $ 880.63 | $ 7,333.46 | $ 16,755,480.48 | $ 697,905.44 | $ 167,554.80 | $ 33,510.96 | $ 6,702.19 | $ 1,340.44 | $ 201.07 | $ 907,214.90 | 95% decline during base period, then a 80% decline YoY |
| Specialty Drugs (Brand Name Retail) | $ 63,172,457.91 | $ 1,796,351.84 | $ 3,268,928.77 | $ - 0 | $ 68,237,738.52 | $ 58,804,960.47 | $ 78,125,386.83 | $ 83,594,163.91 | $ 89,445,755.38 | $ 95,706,958.26 | $ 76,804,834.00 | $ 482,482,058.86 | 7% year over year increase |
| Specialty Drugs (Generic Name Retail) | $ 9,079,533.82 | $ 410,600.59 | $ 362,270.35 | $ - 0 | $ 9,852,404.76 | $ 8,558,943.83 | $ 11,280,018.21 | $ 12,069,619.48 | $ 12,914,492.85 | $ 13,818,507.35 | $ 11,089,352.15 | $ 69,730,933.87 | 7% year over year increase |
| Specialty Drugs (Brand Name Mail order or 84 or more day supply) | $ 6,459,503.29 | $ 16,277.42 | $ 2,672,163.32 | $ - 0 | $ 9,147,944.03 | $ 6,489,041.49 | $ 10,473,481.12 | $ 11,206,624.80 | $ 11,991,088.53 | $ 12,830,464.73 | $ 10,296,447.95 | $ 63,287,148.62 | 7% year over year increase |
| Specialty Drugs (Generic Name Mail order or 84 or more day supply) | $ 2,202,275.01 | $ 33,845.90 | $ 183,043.77 | $ - 0 | $ 2,419,164.68 | $ 2,042,838.69 | $ 2,769,701.64 | $ 2,963,580.76 | $ 3,171,031.41 | $ 3,393,003.61 | $ 2,722,885.40 | $ 17,063,041.50 | 7% year over year increase |
| Rx Supplies | $ 1,502,868.27 | $ 9,958.50 | $ 111,697.51 | $ - 0 | $ 1,624,524.28 | $ 1,301,499.49 | $ 1,657,177.22 | $ 1,673,748.99 | $ 1,690,486.48 | $ 1,707,391.34 | $ 1,370,181.55 | $ 9,400,485.07 | 1% year over year increase |
| Durable Medical Equipment (DME) | $ 19,646,233.44 | $ 248,597.62 | $ 10,181,141.96 | N/A | $ 30,075,973.02 | $ 1,004,026.35 | $ 1,657,938.01 | $ 1,740,834.91 | $ 1,827,876.66 | $ 1,919,270.49 | $ 1,133,569.13 | $ 9,283,515.56 | 5% Penetration Rate YoY assuming 5% increase YoY from baseline total |
| Diagnostic Services and Testing | $ 8,541,512.11 | $ 282,918.47 | $ 41,180,064.38 | N/A | $ 50,004,494.96 | $ 370,622.87 | $ 1,102,599.11 | $ 1,157,729.07 | $ 1,215,615.52 | $ 1,276,396.30 | $ 753,871.56 | $ 5,876,834.44 | 2% Penetration Rate YoY assuming 5% increase YoY from baseline total |
| Total Discount CLINS = | $ 225,329,687.76 | $ 20,154,721.93 | $ 182,728,590.34 | $ 170,327.34 | $ 428,383,327.37 | $ 212,981,762.40 | $ 348,801,169.16 | $ 342,065,948.91 | $ 356,782,079.51 | $ 372,320,133.94 | $ 294,483,948.93 | $ 1,927,435,042.86 |
| Rebates (Prescription Volume) | |||||||||||||
| Brand Name Retail | 41240 | 12681 | 30516 | 65 | 84502 | 52579 | 84090 | 82865 | 82865 | 82865 | 62149 | 385263 | Base period no change. Option period 1, 1% drop in the Energy Program, other programs are constant. Option period 2, 3% year over year drop in the Energy Program, other programs are constant. Option period 3, option period 4, and the award term period no change. |
| Brand Name (mail order or 84 or more day supply) | 10320 | 1070 | 1408 | 0 | 12798 | 9844 | 12695 | 12388 | 12388 | 12388 | 9291 | 59703 | Base period no change. Option period 1, 1% drop in the Energy Program, other programs are constant. Option period 2, 3% year over year drop in the Energy Program, other programs are constant. Option period 3, option period 4, and the award term period no change. |
| Specialty Drugs (Brand Name Retail) | 3870 | 164 | 682 | 0 | 4716 | 3564 | 4794 | 4833 | 4873 | 4913 | 3716 | 22978 | 1% increase year over year for the Energy Program. Other programs are constant. |
| Specialty Drugs (Brand Name Mail order or 84 or more day supply) | 294 | 5 | 190 | 0 | 489 | 299 | 495 | 498 | 501 | 504 | 380 | 2297 | 1% increase year over year for the Energy Program. Other programs are constant. |
| Total Rebate CLINS = | 55724 | 13920 | 32796 | 65 | 102505 | 66287 | 102073 | 100584 | 100627 | 100670 | 75536 | 470242 |
Service Fee per Paid Transction (Prescription Volume) 269592 47952 485298 602 803444 379130 794612 791023 791046 791084 593344 4140240 See Section L for "Goverment Assumptions Used for Attachment J.4 Volume Projections"
| DME Total (100%) | $ 30,075,973.02 | $ 31,579,771.67 | $ 33,158,760.25 | $ 34,816,698.27 | $ 36,557,533.18 | $ 38,385,409.84 | $ 30,228,510.25 |
| Diagnostic Services and Testing Total (100%) | $ 50,004,494.96 | $ 52,504,719.71 | $ 55,129,955.69 | $ 57,886,453.48 | $ 60,780,776.15 | $ 63,819,814.96 | $ 50,258,104.28 |
| Numbers used for Calculation Purposes: | |||||||||||
| Energy Brand Name Retail | 41240 | 41240 | 40828 | 39603 | 39603 | 39603 | 39603 | ||||
| Energy Brand Name (mail order or 84 or more day supply) | 10320 | 10320 | 10217 | 9910 | 9910 | 9910 | 9910 | ||||
| Energy Specialty Drugs (Brand Name Retail) | 3870 | 3909 | 3948 | 3987 | 4027 | 4067 | 4108 | ||||
| Energy Specialty Drugs (Brand Name Mail order or 84 or more day supply) | 294 | 297 | 300 | 303 | 306 | 309 | 312 | ||||
| Baseline | |||||||||||
| Brand Name Retail | $ 26,035,025.56 | $ 8,097,945.39 | $ 25,980,810.23 | $ 60,648.68 | $ 63,183,151.35 | ||||||
| Generic Name Retail | $ 28,089,831.87 | $ 5,513,853.98 | $ 76,682,160.70 | $ 88,966.54 | $ 112,582,309.35 | ||||||
| Brand Name (Mail order or 84 or more day supply) | $ 18,039,173.00 | $ 2,072,522.81 | $ 2,394,959.43 | $ - 0 | $ 23,631,988.00 | ||||||
| Generic Name (Mail order or 84 or more day supply) | $ 25,814,007.09 | $ 1,671,849.41 | $ 19,710,469.29 | $ 13,378.66 | $ 48,153,898.54 | ||||||
| Base Period | |||||||||||
| Brand Name Retail | $ 27,336,776.84 | $ 8,502,842.66 | $ 27,279,850.74 | $ 63,681.11 | Rebates (Prescription Volume) | Base Period prescription volume if at a full year | |||||
| Generic Name Retail | $ 28,651,628.51 | $ 5,624,131.06 | $ 78,215,803.91 | $ 90,745.87 | Brand Name Retail | 84502 | |||||
| Brand Name (Mail order or 84 or more day supply) | $ 18,941,131.65 | $ 2,176,148.95 | $ 2,514,707.40 | $ - 0 | Brand Name (mail order or 84 or more day supply) | 12798 | |||||
| Generic Name (Mail order or 84 or more day supply) | $ 26,330,287.23 | $ 1,705,286.40 | $ 20,104,678.68 | $ 13,646.23 | Specialty Drugs (Brand Name Retail) | 4755 | |||||
| Option Year 1 | Specialty Drugs (Brand Name Mail order or 84 or more day supply) | 492 | |||||||||
| Brand Name Retail | $ 24,603,099.15 | $ 8,927,984.79 | $ 28,643,843.28 | $ 66,865.17 | Total Rebate CLINS = | 102547 | |||||
| Generic Name Retail | $ 25,786,465.66 | $ 5,736,613.68 | $ 79,780,119.99 | $ 92,560.79 | |||||||
| Brand Name (Mail order or 84 or more day supply) | $ 17,047,018.49 | $ 2,284,956.40 | $ 2,640,442.77 | $ - 0 | Service Fee per Paid Transction (Prescription Volume) | 796486 | |||||
| Generic Name (Mail order or 84 or more day supply) | $ 23,697,258.51 | $ 1,739,392.13 | $ 20,506,772.25 | $ 13,919.16 | |||||||
| Option Year 2 | Compounded Drugs | $ 837,774.02 | |||||||||
| Brand Name Retail | $ 19,682,479.32 | $ 9,374,384.03 | $ 30,076,035.44 | $ 70,208.43 | Specialty Drugs (Brand Name Retail) | $ 73,014,380.22 | |||||
| Generic Name Retail | $ 20,629,172.53 | $ 5,851,345.95 | $ 81,375,722.39 | $ 94,412.00 | Specialty Drugs (Generic Name Retail) | $ 10,542,073.09 | |||||
| Brand Name (Mail order or 84 or more day supply) | $ 13,637,614.79 | $ 2,399,204.22 | $ 2,772,464.91 | $ - 0 | Specialty Drugs (Brand Name Mail order or 84 or more day supply) | $ 9,788,300.11 | |||||
| Generic Name (Mail order or 84 or more day supply) | $ 18,957,806.81 | $ 1,774,179.97 | $ 20,916,907.69 | $ 14,197.54 | Specialty Drugs (Generic Name Mail order or 84 or more day supply) | $ 2,588,506.21 | |||||
| Option Year 3 | Rx Supplies | $ 1,640,769.52 | |||||||||
| Brand Name Retail | $ 20,666,603.29 | $ 9,843,103.23 | $ 31,579,837.21 | $ 73,718.85 | |||||||
| Generic Name Retail | $ 21,041,755.98 | $ 5,968,372.87 | $ 83,003,236.84 | $ 96,300.24 | |||||||
| Brand Name (Mail order or 84 or more day supply) | $ 14,319,495.53 | $ 2,519,164.43 | $ 2,911,088.16 | $ - 0 | |||||||
| Generic Name (Mail order or 84 or more day supply) | $ 19,336,962.94 | $ 1,809,663.57 | $ 21,335,245.85 | $ 14,481.49 | |||||||
| Option Year 4 | |||||||||||
| Brand Name Retail | $ 21,699,933.45 | $ 10,335,258.40 | $ 33,158,829.08 | $ 77,404.79 | |||||||
| Generic Name Retail | $ 21,462,591.10 | $ 6,087,740.33 | $ 84,663,301.58 | $ 98,226.25 | |||||||
| Brand Name (Mail order or 84 or more day supply) | $ 15,035,470.30 | $ 2,645,122.65 | $ 3,056,642.56 | $ - 0 | |||||||
| Generic Name (Mail order or 84 or more day supply) | $ 19,723,702.20 | $ 1,845,856.84 | $ 21,761,950.77 | $ 14,771.12 | |||||||
| Award Term Period | |||||||||||
| Brand Name Retail | $ 17,088,697.60 | $ 8,139,015.99 | $ 26,112,577.90 | $ 60,956.27 | |||||||
| Generic Name Retail | $ 16,901,790.49 | $ 4,794,095.51 | $ 66,672,349.99 | $ 77,353.17 | |||||||
| Brand Name (Mail order or 84 or more day supply) | $ 11,840,432.86 | $ 2,083,034.09 | $ 2,407,106.02 | $ - 0 | |||||||
| Generic Name (Mail order or 84 or more day supply) | $ 15,532,415.48 | $ 1,453,612.26 | $ 17,137,536.23 | $ 11,632.26 |
| Base period with consideration of start at day 150 for DCMWC, DEEOIC, and start at day 365 for FECA and Longshore | |||||
| Brand Name Retail | $ 21,695,854.63 | $ 6,748,287.83 | $ 6,495,202.56 | $ 15,162.17 | $ 34,954,507.19 |
| Generic Name Retail | $ 23,408,193.23 | $ 4,594,878.32 | $ 19,170,540.18 | $ 22,241.64 | $ 47,195,853.35 |
| Brand Name (Mail order or 84 or more day supply) | $ 15,032,644.17 | $ 1,727,102.34 | $ 598,739.86 | $ - 0 | $ 17,358,486.37 |
| Generic Name (Mail order or 84 or more day supply) | $ 21,511,672.58 | $ 1,393,207.84 | $ 4,927,617.32 | $ 3,344.67 | $ 27,835,842.40 |
| Compounded Drugs | $ 13,956,055.33 | $ - 0 | $ 220.16 | $ 1,833.37 | $ 13,958,108.85 |
| Specialty Drugs (Brand Name Retail) | $ 52,643,714.93 | $ 1,496,959.87 | $ 817,232.19 | $ - 0 | $ 54,957,906.98 |
| Specialty Drugs (Generic Name Retail) | $ 7,566,278.18 | $ 342,167.16 | $ 90,567.59 | $ - 0 | $ 7,999,012.93 |
| Specialty Drugs (Brand Name Mail order or 84 or more day supply) | $ 5,382,919.41 | $ 13,564.52 | $ 668,040.83 | $ - 0 | $ 6,064,524.76 |
| Specialty Drugs (Generic Name Mail order or 84 or more day supply) | $ 1,835,229.17 | $ 28,204.92 | $ 45,760.94 | $ - 0 | $ 1,909,195.03 |
| Rx Supplies | $ 1,252,390.23 | $ 8,298.75 | $ 27,924.38 | $ - 0 | $ 1,288,613.35 |
| Durable Medical Equipment (DME) | $ 16,371,861.20 | $ 207,164.68 | $ 2,545,285.49 | $ - 0 | $ 19,124,311.37 |
| Diagnostic Services and Testing | $ 7,117,926.76 | $ 235,765.39 | $ 10,295,016.10 | $ - 0 | $ 17,648,708.25 |
| Total Discount CLINS = | $ 187,774,739.80 | $ 16,795,601.61 | $ 45,682,147.58 | $ 42,581.84 | $ 250,295,070.83 |
| Rebates (Prescription Volume) | 1% increase for Energy | |||||
| Brand Name Retail | 34367 | 10568 | 7629 | 16 | 52579 | |
| Brand Name (mail order or 84 or more day supply) | 8600 | 892 | 352 | 0 | 9844 | |
| Specialty Drugs (Brand Name Retail) | 3225 | 137 | 171 | 0 | 3532 | 3564 |
| Specialty Drugs (Brand Name Mail order or 84 or more day supply) | 245 | 4 | 48 | 0 | 297 | 299 |
| Total Rebate CLINS = | 46437 | 11600 | 8199 | 16 | 66252 |
Service Fee per Paid Transction (Prescription Volume) 224660 39960 121325 151 386095
| DME Total (100%) |
| Diagnostic Services and Testing Total (100%) |
File details come from the government source that posted it. Updated .