Amendment_3_RFQ_16-100-SOL-00004_-_EPAP_Requirement.pdf

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16-100-SOL-00004

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1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT

THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

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ASPR-BARDA02

Washington DC 20201 330 Independence Ave, SW, Rm G640

ASPR-BARDA

ASPR-BARDA

Washington DC 20201 Room 640-G 200 Independence Ave., S.W.

ASPR-BARDA

10/08/2015000003

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

7. ADMINISTERED BY (If other than Item 6)CODE 6. ISSUED BY

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

10/08/2015

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

E. IMPORTANT: Contractor is not, is required to sign this document and return __________________ copies to the issuing office.

ORDER NO. IN ITEM 10A.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

The purpose of this Amendment is to respond to questions received on October 8, 2015.

The response deadline remains UNCHANGED.

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

ROSHAWN K. MAJORS

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

NSN 7540-01-152-8070

Previous edition unusable

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

10/09/15

AMENDMENT THREE (3) TO RFQ #16-100-SOL-00004 - Emergency Prescription Assistance Program (EPAP) - Emergency Claims Adjudication

Q-1: Reference is made to the RFQ, Page 5, Mandatory Requirements states:

“Implement or use existing systems that enables real-time point-of-sale eligibility checks and edits for claims where the pharmacist has found no coverage or limit coverage (co-payment) dispensing of EPAP covered drugs, specific medical supplies, and DME to eligible individuals.”

Reference is made to the Statement of Work, Page 4, states: “Contractor shall require participating pharmacies to verify patient’s eligibility prior to submitting the claim by inquiring if the patient is from the affected area and checking patient eligibility for other drug or DME coverage.”

The first passage implies that the contractor will be furnished with an eligibility file, while the second passage implies that there will be no eligibility file. Can the government clarify whether eligibility files will be provided as part of this program?

R-1: For our adjudication system to process a pharmacy claim, we must have the person in our system as an eligible member. That is the process used by every PBM. The pharmacy is screening customers for information on home of record so a cross reference check can be performed in the adjudication process.

Q-2: Does the Government expect the retail pharmacist to enter at the retail counter before adjudicating the claim?

R-2: The pharmacist will input the customer's information into existing electronic screening systems at the retail counter to adjudicate the claim.

Q-3: Do you expect the patient to call our call center from the retail pharmacy and give this information to a call center rep who will then enter it so the pharmacy can try to adjudicate the claim?

R-3: The call center is not a data entry service but simply a center for unique EPAP related questions during the event response.

Q-4: What is the expected TAT for adding eligibility and adjudicating the claim?

R-4: The Offeror should propose the processes to meet EPAP SOW objectives.

Q-5: If pharmacy coverage is found for a patient claiming not to have health insurance, do you expect the retail pharmacist to use the existing insurance and collect payment?

R-5: It is expected the primary payer will cover the cost for claims when third party coverage is available.

Q-6: Do you have a defined process your prior contractor followed so we can ensure we meet your expectations?

R-6: The offeror should propose the defined processes to meet objectives of SOW.

Q-7: How will we receive eligibility updates via fax or email from any source? If so, who will be sending these?

Q-7: An update shall be provided via fax/email for EPAP extensions during a response as well as deactivation of EPAP.

Q-8: If the contractor and retailer follow the defined process for determining eligibility, and after the fact if it is determined that other health insurance existed, will the retailer or contractor be held liable for the drug cost and loss of other revenue?

R-8: The post event audit by the contractor should redirect charges to the coverage plan for payment and reimburse the USG.

Q-9: What if the member has coverage already with ESI yet the pharmacy is calling to add member to program? Is it acceptable for ESI to pushback and alert the pharmacy to the correct Rx coverage?

R-9: Appropriate to direct pharmacy to appropriate TPL.

Q-10: Given the short response time for Tuesday, noon EST, and the fact that we cannot “force” our clients to meet a deadline imposed on them for the past performance deadline, can we provide other evidence of client satisfaction such as CPAR reports, annual client surveys, etc…?

R-10: Past performance is not a weighted evaluated factor, so your quotation will not be negatively impacted because of its absence.

Q-11: Please provide the list of medical supplies, immunizations, and DME we need to adjudicate.

R-11This information will be provided to the awarded contractor but the formulary is similar to Part D formulary.