Attachment_6_-_PBM_Discount_Calculation_Workbook.xlsx
XLSX spreadsheet 48 KB Posted
- Attached to
- Office of Workers' Compensation Programs (OWCP) Pharmacy Benefits Management (PBM) Services
- Solicitation number
- 1605DC-18-R-00020
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Instructions
| INSTRUCTIONS FOR OFFERORS | |
| Purpose | The purpose of this excel workbook is to: |
| 1. Provide a means for the offers to submit their net discounts proposed. | |
| 2. Transparently show Offerors' the impact of their discounts projected over all option periods. | |
| 3. Shall be used as a reference point for the government when evaluating the net discounts proposed and resulting cost to the government from various Offerors. The Offerors can not change the Government's pricing model in this excel workbook. | |
| Step | |
| 1 | In "Tab 1 - Discounts": |
-Insert discount percentages into the appropriate rows and columns (yellow cells).
-Discounts should be inserted as negative numbers.
-Discounts for drugs should be represented as discounts from AWP.
-Discounts for DME and Diagnostic Services and Testing should be represented as discounts from the FECA 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 In "Tab 1 - Discounts":
-Place the total amount in terms of dollars for the Optional Services of Patient Compliance Program and Disease Management Program (orange cells).
3 View "Tab 2 - Projected Price":
-The overall cost to the program is shown in "Table 1 -OVERALL COST TO PROGRAM". Continue to improve your discount as necessary on "Tab 1 - Discounts" and this will update.
*"Table 1 - OVERALL COST TO PROGRAM" is populated using "Table 2 - DOL BASELINE VALUES AND ESTIMATES" and "Table 3 - PROJECTION ADJUSTER (Year over Year Reductions or Increases)" as described in the Future Spend and Price Evaluation Guidance document provided to Offerors.
"Tab 3 - Discounts Example" and "Tab 4 - Projected Price Example" are provided for example purposes.
Tab 1 - Discounts
| Base Period | Option Period 1 | Option Period 2 | Option Period 3 | Option Period 4 | |
| Brand Name Retail | |||||
| Generic Name Retail | |||||
| Brand Name (mail order or 90 day supply) | |||||
| Generic Name (mail order or 90 day supply) | |||||
| Durable Medical Equipment (DME) | |||||
| Diagnostic Services and Testing | |||||
| Compound Medications (3 or fewer ingredients) | |||||
| Compound Medications (more than 3 ingredients) | |||||
| OPTIONAL: Specialty Brand Name Retail | |||||
| OPTIONAL: Specialty Generic Name Retail | |||||
| OPTIONAL: Specialty Brand Name (mail order or 90 day supply) | |||||
| OPTIONAL: Specialty Generic Name (mail order or 90 day supply) | |||||
| OPTIONAL: Patient Compliance Program | |||||
| OPTIONAL: Disease Management Program |
Tab 2 - Projected Price
| TABLE 1 - OVERALL COST TO PROGRAM | Base Period | Option Period 1 | Option Period 2 | Option Period 3 | Option Period 4 | Base + 4 Option Periods | TABLE 2 - DOL BASELINE VALUES AND ESTIMATES | Baseline Data | Base Period | Option Period 1 | Option Period 2 | Option Period 3 | Option Period 4 | TABLE 3 - PROJECTION ADJUSTER (Year over Year Reductions or Increases) | ||||
| Brand Name Retail | $ 65,765,561.04 | $ 54,044,527.51 | $ 48,005,307.29 | $ 40,926,747.00 | $ 35,121,280.94 | $ 243,863,423.78 | Categories | Base Period | Option Period 1 | Option Period 2 | Option Period 3 | Option Period 4 | ||||||
| Generic Name Retail | $ 180,909,009.68 | $ 220,982,153.36 | $ 211,363,042.25 | $ 200,670,439.67 | $ 190,078,896.10 | $ 1,004,003,541.06 | ||||||||||||
| Brand Name (mail order or 90 day supply) | $ 6,397,259.49 | $ 5,308,574.36 | $ 4,601,525.70 | $ 3,738,793.12 | $ 3,038,681.05 | $ 23,084,833.72 | Brand Name Retail | $ 104,808,940.70 | $ 65,765,561.04 | $ 54,044,527.51 | $ 48,005,307.29 | $ 40,926,747.00 | $ 35,121,280.94 | -4.0% | -4.0% | -4.0% | -4.0% | -4.0% |
| Generic Name (mail order or 90 day supply) | $ 17,914,507.56 | $ 22,206,060.20 | $ 21,199,774.19 | $ 20,038,675.59 | $ 18,881,985.66 | $ 100,241,003.20 | ||||||||||||
| Durable Medical Equipment (DME) | $ 463,340.69 | $ 931,314.80 | $ 935,971.37 | $ 940,651.23 | $ 945,354.48 | $ 4,216,632.57 | Generic Name Retail | $ 216,191,506.01 | $ 180,909,009.68 | $ 220,982,153.36 | $ 211,363,042.25 | $ 200,670,439.67 | $ 190,078,896.10 | -4.0% | -4.0% | -4.0% | -4.0% | -4.0% |
| Diagnostic Services and Testing | $ 845,217.33 | $ 1,698,886.83 | $ 1,707,381.27 | $ 1,715,918.17 | $ 1,724,497.77 | $ 7,691,901.37 | ||||||||||||
| Compound Medications (3 or fewer ingredients) | $ 1,202.16 | $ 1,442.65 | $ 1,442.65 | $ 1,442.65 | $ 1,442.65 | $ 6,972.76 | Brand Name (mail order or 90 day supply) | $ 10,037,331.39 | $ 6,397,259.49 | $ 5,308,574.36 | $ 4,601,525.70 | $ 3,738,793.12 | $ 3,038,681.05 | -4.0% | -4.0% | -4.0% | -4.0% | -4.0% |
| Compound Medications (more than 3 ingredients) | $ 109,771.42 | $ 131,730.98 | $ 131,730.98 | $ 131,730.98 | $ 131,730.98 | $ 636,695.32 | ||||||||||||
| OPTIONAL: Specialty Brand Name Retail | $ 6,145,483.37 | $ 7,374,875.04 | $ 7,374,875.04 | $ 7,374,875.04 | $ 7,374,875.04 | $ 35,644,983.53 | Generic Name (mail order or 90 day supply) | $ 21,551,464.08 | $ 17,914,507.56 | $ 22,206,060.20 | $ 21,199,774.19 | $ 20,038,675.59 | $ 18,881,985.66 | -4.0% | -4.0% | -4.0% | -4.0% | -4.0% |
| OPTIONAL: Specialty Generic Name Retail | $ 596,546.75 | $ 715,884.73 | $ 715,884.73 | $ 715,884.73 | $ 715,884.73 | $ 3,460,085.67 | ||||||||||||
| OPTIONAL: Specialty Brand Name (mail order or 90 day supply) | $ 662,376.18 | $ 794,883.21 | $ 794,883.21 | $ 794,883.21 | $ 794,883.21 | $ 3,841,909.02 | Durable Medical Equipment (DME) | $ 926,681.39 |
Walter, William R - OWCP: Walter, William R - OWCP:
| See updated DME tab | $ 463,340.69 | $ 931,314.80 | $ 935,971.37 | $ 940,651.23 | $ 945,354.48 | 0.0% | 0.5% | 0.5% | 0.5% | 0.5% | ||||||||||||
| OPTIONAL: Specialty Generic Name (mail order or 90 day supply) | $ 26,727.43 | $ 32,074.20 | $ 32,074.20 | $ 32,074.20 | $ 32,074.20 | $ 155,024.23 | ||||||||||||||||
| OPTIONAL: Patient Compliance Program | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | Diagnostic Services and Testing | $ 1,690,434.66 | $ 845,217.33 | $ 1,698,886.83 | $ 1,707,381.27 | $ 1,715,918.17 | $ 1,724,497.77 | 0.0% | 0.5% | 0.5% | 0.5% | 0.5% | ||||
| OPTIONAL: Disease Management Program | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||||||||||||||||
| TOTAL = | $ 279,837,003.10 | $ 314,222,407.86 | $ 296,863,892.88 | $ 277,082,115.59 | $ 258,841,586.80 | $ 1,426,847,006.23 | Compound Medications Spend (3 or fewer ingredients) | $ 1,442.65 | $ 1,202.16 | $ 1,442.65 | $ 1,442.65 | $ 1,442.65 | $ 1,442.65 | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
Compound Medications Spend (more than 3 ingredients) $ 131,730.98 $ 109,771.42 $ 131,730.98 $ 131,730.98 $ 131,730.98 $ 131,730.98 0.0% 0.0% 0.0% 0.0% 0.0%
OPTIONAL: Specialty Brand Name Retail $ 7,374,875.04 $ 6,145,483.37 $ 7,374,875.04 $ 7,374,875.04 $ 7,374,875.04 $ 7,374,875.04 0.0% 0.0% 0.0% 0.0% 0.0%
OPTIONAL: Specialty Generic Name Retail $ 715,884.73 $ 596,546.75 $ 715,884.73 $ 715,884.73 $ 715,884.73 $ 715,884.73 0.0% 0.0% 0.0% 0.0% 0.0%
OPTIONAL: Specialty Brand Name (mail order or 90 day supply) $ 794,883.21 $ 662,376.18 $ 794,883.21 $ 794,883.21 $ 794,883.21 $ 794,883.21 0.0% 0.0% 0.0% 0.0% 0.0%
OPTIONAL: Specialty Generic Name (mail order or 90 day supply) $ 32,074.20 $ 26,727.43 $ 32,074.20 $ 32,074.20 $ 32,074.20 $ 32,074.20 0.0% 0.0% 0.0% 0.0% 0.0%
Tab 3 - Discounts Example
| Base Period | Option Period 1 | Option Period 2 | Option Period 3 | Option Period 4 | |
| Brand Name Retail | -16.00% | -17.00% | -18.00% | -19.00% | -20.00% |
| Generic Name Retail | -50.00% | -52.00% | -54.00% | -56.00% | -58.00% |
| Brand Name (mail order or 90 day supply) | -20.00% | -21.00% | -22.00% | -23.00% | -24.00% |
| Generic Name (mail order or 90 day supply) | -62.00% | -64.00% | -66.00% | -68.00% | -70.00% |
| Durable Medical Equipment (DME) | -5.00% | -6.00% | -7.00% | -8.00% | -9.00% |
| Diagnostic Services and Testing | -10.00% | -11.00% | -12.00% | -13.00% | -14.00% |
| Compound Medications (3 or fewer ingredients) | -50.00% | -52.00% | -54.00% | -56.00% | -58.00% |
| Compound Medications (more than 3 ingredients) | -70.00% | -72.00% | -74.00% | -76.00% | -78.00% |
| OPTIONAL: Specialty Brand Name Retail | -16.00% | -17.00% | -18.00% | -19.00% | -20.00% |
| OPTIONAL: Specialty Generic Name Retail | -50.00% | -52.00% | -54.00% | -56.00% | -58.00% |
| OPTIONAL: Specialty Brand Name (mail order or 90 day supply) | -20.00% | -21.00% | -22.00% | -23.00% | -24.00% |
| OPTIONAL: Specialty Generic Name (mail order or 90 day supply) | -62.00% | -64.00% | -66.00% | -68.00% | -70.00% |
| OPTIONAL: Patient Compliance Program | $ 250,000.00 | $ 225,000.00 | $ 200,000.00 | $ 175,000.00 | $ 150,000.00 |
| OPTIONAL: Disease Management Program | $ 275,000.00 | $ 250,000.00 | $ 225,000.00 | $ 200,000.00 | $ 175,000.00 |
Tab 4 - Projected Price Example
| TABLE 1 - OVERALL COST TO PROGRAM | Base Period | Option Period 1 | Option Period 2 | Option Period 3 | Option Period 4 | Base + 4 Option Periods | TABLE 2 - DOL BASELINE VALUES AND ESTIMATES | Baseline Data | Base Period | Option Period 1 | Option Period 2 | Option Period 3 | Option Period 4 | TABLE 3 - PROJECTION ADJUSTER (Year over Year Reductions or Increases) | ||||
| Brand Name Retail | $ 55,243,071.27 | $ 44,856,957.84 | $ 39,364,351.97 | $ 33,150,665.07 | $ 28,097,024.75 | $ 200,712,070.91 | Categories | Base Period | Option Period 1 | Option Period 2 | Option Period 3 | Option Period 4 | ||||||
| Generic Name Retail | $ 90,454,504.84 | $ 106,071,433.61 | $ 97,226,999.44 | $ 88,294,993.46 | $ 79,833,136.36 | $ 461,881,067.71 | ||||||||||||
| Brand Name (mail order or 90 day supply) | $ 5,117,807.60 | $ 4,193,773.74 | $ 3,589,190.05 | $ 2,878,870.70 | $ 2,309,397.60 | $ 18,089,039.68 | Brand Name Retail | $ 104,808,940.70 | $ 65,765,561.04 | $ 54,044,527.51 | $ 48,005,307.29 | $ 40,926,747.00 | $ 35,121,280.94 | -4.0% | -4.0% | -4.0% | -4.0% | -4.0% |
| Generic Name (mail order or 90 day supply) | $ 6,807,512.87 | $ 7,994,181.67 | $ 7,207,923.22 | $ 6,412,376.19 | $ 5,664,595.70 | $ 34,086,589.66 | ||||||||||||
| Durable Medical Equipment (DME) | $ 440,173.66 | $ 875,435.91 | $ 870,453.37 | $ 865,399.13 | $ 860,272.58 | $ 3,911,734.65 | Generic Name Retail | $ 216,191,506.01 | $ 180,909,009.68 | $ 220,982,153.36 | $ 211,363,042.25 | $ 200,670,439.67 | $ 190,078,896.10 | -4.0% | -4.0% | -4.0% | -4.0% | -4.0% |
| Diagnostic Services and Testing | $ 760,695.60 | $ 1,512,009.28 | $ 1,502,495.52 | $ 1,492,848.81 | $ 1,483,068.08 | $ 6,751,117.29 | ||||||||||||
| Compound Medications (3 or fewer ingredients) | $ 601.08 | $ 692.47 | $ 663.62 | $ 634.77 | $ 605.91 | $ 3,197.85 | Brand Name (mail order or 90 day supply) | $ 10,037,331.39 | $ 6,397,259.49 | $ 5,308,574.36 | $ 4,601,525.70 | $ 3,738,793.12 | $ 3,038,681.05 | -4.0% | -4.0% | -4.0% | -4.0% | -4.0% |
| Compound Medications (more than 3 ingredients) | $ 32,931.43 | $ 36,884.67 | $ 34,250.05 | $ 31,615.43 | $ 28,980.81 | $ 164,662.40 | ||||||||||||
| OPTIONAL: Specialty Brand Name Retail | $ 5,162,206.03 | $ 6,121,146.28 | $ 6,047,397.53 | $ 5,973,648.78 | $ 5,899,900.03 | $ 29,204,298.66 | Generic Name (mail order or 90 day supply) | $ 21,551,464.08 | $ 17,914,507.56 | $ 22,206,060.20 | $ 21,199,774.19 | $ 20,038,675.59 | $ 18,881,985.66 | -4.0% | -4.0% | -4.0% | -4.0% | -4.0% |
| OPTIONAL: Specialty Generic Name Retail | $ 298,273.37 | $ 343,624.67 | $ 329,306.98 | $ 314,989.28 | $ 300,671.59 | $ 1,586,865.89 | ||||||||||||
| OPTIONAL: Specialty Brand Name (mail order or 90 day supply) | $ 529,900.94 | $ 627,957.74 | $ 620,008.90 | $ 612,060.07 | $ 604,111.24 | $ 2,994,038.89 | Durable Medical Equipment (DME) | $ 926,681.39 |
Walter, William R - OWCP: Walter, William R - OWCP:
| See updated DME tab | $ 463,340.69 | $ 931,314.80 | $ 935,971.37 | $ 940,651.23 | $ 945,354.48 | 0.0% | 0.5% | 0.5% | 0.5% | 0.5% | ||||||||||||
| OPTIONAL: Specialty Generic Name (mail order or 90 day supply) | $ 10,156.42 | $ 11,546.71 | $ 10,905.23 | $ 10,263.74 | $ 9,622.26 | $ 52,494.37 | ||||||||||||||||
| OPTIONAL: Patient Compliance Program | $ 250,000.00 | $ 225,000.00 | $ 200,000.00 | $ 175,000.00 | $ 150,000.00 | $ 1,000,000.00 | Diagnostic Services and Testing | $ 1,690,434.66 | $ 845,217.33 | $ 1,698,886.83 | $ 1,707,381.27 | $ 1,715,918.17 | $ 1,724,497.77 | 0.0% | 0.5% | 0.5% | 0.5% | 0.5% | ||||
| OPTIONAL: Disease Management Program | $ 275,000.00 | $ 250,000.00 | $ 225,000.00 | $ 200,000.00 | $ 175,000.00 | $ 1,125,000.00 | ||||||||||||||||
| TOTAL = | $ 165,382,835.11 | $ 173,120,644.60 | $ 157,228,945.89 | $ 140,413,365.44 | $ 125,416,386.91 | $ 761,562,177.95 | Compound Medications Spend (3 or fewer ingredients) | $ 1,442.65 | $ 1,202.16 | $ 1,442.65 | $ 1,442.65 | $ 1,442.65 | $ 1,442.65 | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
Compound Medications Spend (more than 3 ingredients) $ 131,730.98 $ 109,771.42 $ 131,730.98 $ 131,730.98 $ 131,730.98 $ 131,730.98 0.0% 0.0% 0.0% 0.0% 0.0%
OPTIONAL: Specialty Brand Name Retail $ 7,374,875.04 $ 6,145,483.37 $ 7,374,875.04 $ 7,374,875.04 $ 7,374,875.04 $ 7,374,875.04 0.0% 0.0% 0.0% 0.0% 0.0%
OPTIONAL: Specialty Generic Name Retail $ 715,884.73 $ 596,546.75 $ 715,884.73 $ 715,884.73 $ 715,884.73 $ 715,884.73 0.0% 0.0% 0.0% 0.0% 0.0%
OPTIONAL: Specialty Brand Name (mail order or 90 day supply) $ 794,883.21 $ 662,376.18 $ 794,883.21 $ 794,883.21 $ 794,883.21 $ 794,883.21 0.0% 0.0% 0.0% 0.0% 0.0%
OPTIONAL: Specialty Generic Name (mail order or 90 day supply) $ 32,074.20 $ 26,727.43 $ 32,074.20 $ 32,074.20 $ 32,074.20 $ 32,074.20 0.0% 0.0% 0.0% 0.0% 0.0%
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