Questions_and_Answers_-_PBM_Amd_0005_of_Solicitation_1605DC-18-R-00020.pdf

Questions and Answers Submitted For

Pharmacy Benefits Management (PBM) Services

Department of Labor (DOL) Office of Workers’ Compensation Programs (OWCP)

Amendment 0005 - Solicitation Number 1605DC-18-R-00020

Section

Page / Reference

Source Text Question / Comment Government Response

1 Attachment 4 of

Amendment

4 of 7 Once the PBM was awarded and the new vendor completed Phase 3 of the awarded contract (which includes the development of patient/provider portal and implementation of a formulary).

As this formulary impacted pricing, can the Government provide an electronic version of this formulary or a link to where it can be obtained as well as provide detail on brand medications targeted for generic conversion for your pricing assumptions.

There is currently no formulary in place, and thus, it is unavailable. Please see edited language within attachment 4.

As stated in the updated attachment 4, “OWCP found that a substantial amount of brand name drugs could be switched to a therapeutically equivalent generic alternative. This would result in a lower brand name drug spend over time, and an increase in generic spend as the brand to generic conversions occur. The Government had already planned to implement this policy in the future once the PBM was awarded and the new vendor completed Phase 3 of the awarded contract…Consequently, the general approach of the new generic policy was factored into its calculations.”

OWCP therefore factored in the general effect of brand to generic conversions after the completion of

Phase 3 in the base period into its best estimates.

Offerors will find baseline prescription volumes, including brand name drugs and a brand/generic indicator, within attachment 5.

2 Attachment 4 of

Amendment

4 of 7 - Non- Specialty

Brand and Generic Drugs and DME and

Diagnostic Services and

Testing Assumptions.

Understanding that pricing is based upon the provided assumptions, it should be noted that an Offeror’s ability to drive network penetration for generic utilization or mail order, as well as for voluntary programs like DME and Diagnostic Services and Testing is a critical component for the Government to realize significant cost savings.

For example, if an Offeror has the capability of increasing DME network/program utilization by 10% over the incumbent or other Offerors and the DME price discounts are deeper than others, it would increase savings significantly.

How is the Government

Due to Offerors’ inability to guarantee a penetration percentage for voluntary programs, the government is assuming a set penetration percentage for price calculation purposes, as discussed in attachment 4.

factoring that capability into the pricing evaluation?

3 Attachment 6 of

Amendment

Instructions Tab, Line 2

Requests a total amount in terms of dollars for “Discounts” for the Patient Compliance Program and Disease Management Program.

If this is a discount, what measure are Offerors discounting against?

This is not a discount. Instead offerors are instructed in the excel workbook to, "Place the total amount in terms of dollars for the Optional Services of Patient Compliance Program and Disease Management Program (orange cells)."

The basis for the total amount for the optional CLINs for Patient Compliance Program and Disease Management Program has not changed. The government will calculate the evaluated price for these CLINs based on the total amounts provided by the offeror for the 2000 cases specified under optional CLINs for Patient Compliance Program and Disease Management Program.

4 Attachment 4 of

Amendment

3 of 7 - Table 1 and 4-5 of 7 - Assumptions

The RFP states in Amendment 0004 on Page 100 of 102: Amounts for the Optional Services Contract Line Item Numbers (CLINs) for Patient Compliance Program and for Disease Management Program shall be calculated using the “Quantity” and “Unit” specified in the solicitation. The Quantity and Unit for these Optional Services CLINs are as follows:

Quantity – 2,000 Unit – Cases

Since there are no estimates provided in Table 1 on page 3 of 7 in Attachment 4, or assumptions on Pages 4-5 of 7 of Attachment 4 for these programs, how is the Government basing their evaluation on these services?

The basis for the total amounts for the optional CLINs for Patient Compliance Program and Disease Management Program has not changed. The government will calculate the evaluated price for these CLINs based on the total amounts provided by the offeror for the 2000 cases specified under optional CLINs for Patient Compliance Program and Disease Management Program. As stated in the excel workbook, "Place the total amount in terms of dollars for the Optional Services of Patient Compliance Program and Disease Management Program (orange cells)." The Excel workbook calculates the overall projected cost to the program in the base period and option periods based on the effect of all provided discounts (to include the total amounts for the optional CLINs for Patient Compliance Program and Disease Management Program).

The Government will evaluate price/discount quotes according to the last paragraph in attachment 4 regarding Section M – Evaluation Factors for Award, Factor III – Price/Discount.

5 Attachment 6 of

Amendment

Tab 2 - Projected

Price, Columns L-Q

A. Can the Government confirm that the numbers truly represent the full AWP value for 2018?

B. Are numbers the Government provided for Durable Medical Equipment (DME) and Diagnostic Services Imaging 100% of FECA or some variation of what the Government paid?

C. Can the Government provide clarification on what is causing the significant swing between the Baseline, Base Period, and Option Period data?

a. Yes, as stated in attachment 4, “…DOL created baseline values (FY2018) under each CLIN based on 100% of Average Wholesale Price (AWP) for drugs…”

B. As stated in attachment 4. “…DOL created baseline values (FY2018) under each CLIN based on 100% of Average Wholesale Price (AWP) for drugs and allowed values (maximum potential reimbursement amount) for DME and Diagnostic Services and Testing…” Attachment 4 additionally states: “The FY2018 allowed amounts for DME and DS&T are based on the OWCP Fee Schedule and may be subject to adjustments based on locality, and pricing modifiers.”

C. The variations from the FY2018 baseline to base period to the optional periods are driven primarily by estimated future brand to generic conversions as described in attachment 4. Additionally, as described in attachment 4, the government did not assume a full 12 months of claim processing for the base period, due to the phasing in of the PBM requirements. The option periods do reflect a full 12 months of claim processing with the continued improvements in formulary management and brand to generic conversions described in attachment 4.

6 Amendment

N/A Please confirm that the only submission response requirement for Amendment 0005 is a completed Attachment 6 (PBM Discount Calculation Workbook).

Offerors are only required to submit Attachment 6 -

PBM Discount Calculation Workbook. If necessary, an offeror may submit other narrative information that clearly supports exceptions, constraints, or methodologies used to create the Net Discount

Proposal. The narrative must be relevant to the PBM

Discount Calculation Workbook and not a revision to any other aspect of the proposal. If the narrative contradicts the Workbook, it will be the information in the Workbook that will control for consideration in the evaluation.

Offerors are required to provide the additional narrative information as a separate document from the PBM Discount Calculation Workbook (Attachment

6) in both Microsoft Word (.docx) and Adobe (.pdf) format and will be limited to 5 pages.

7 Amendment

N/A Can the Government provide the following:

A. An revised / updated contract "effective date".

B. A revised / updated Period of Performance for the RFP associated with Amendment 0005.

A. The revised / updated “Effective Date” for Contract Number 1605DC-19-C-0002 is August 19, 2019.

B. The revised / updated Period of Performance for Contract Number 1605DC-19-C-0002 is as follows:

Base Period: August 19, 2019 – August 18, 2020 Option Period I: August 19, 2020 – August 18, 2021 Option Period II: August 19, 2021 – August 18, 2022 Option Period III: August 19, 2022 – August 18, 2023 Option Period IV: August 19, 2023 – August 18, 2024

8 Amendment

N/A The claims data included in

Amendment 5 includes

NPI. However, it is

“prescribing physician NPI” and not “dispensing pharmacy NPI”. As a result, Offerors cannot determine if these are retail or mail order claims.

The dispensing pharmacy NPI has been added to attachment 5.

The total volume of mail order claims for pricing purposes can be found by limiting the GTE_90_DAYS_SUPPLY_INDICATOR to 1. These are the claims DOL considered under the mail order or 90 day supply CLINs.

What is the total volume of mail order claims for 2018?