Amendment_5_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

10/08/2015000005

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.

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

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

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AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

10/09/2015

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

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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 9, 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 FIVE (5) TO RFQ #16-100-SOL-00004 - Emergency Prescription Assistance Program (EPAP) - Emergency Claims Adjudication

The additional information below is given to assist with preparing quotations.

See Attachment entitled “For Pharmacies”

Customer walks into pharmacy with a prescription to be filled then pharmacist enter customer information (name/ssn/address and other information BIN/etc) into electronic system for coverage screening. If customer has no record of TP coverage then EPAP electronically pays the prescription if the customer has a zip code from the affected area. We provide the zip codes of the affect areas/BIN/specific info for event to contractor at the point of activation and the contractor passes this information to the network pharmacies. This information is not a pharmacy manual but simply a two page information sheet (attached). Please feel free to provide this attachment if you believe Kevin needs this information to develop a proposal.

RESPONSES TO QUESTIONS RECEIVED OCTOBER 09, 2015

Q-1: DME – Durable Medical Equipment. We are assuming you are referring to equipment such as canes, walkers, wheelchairs, etc… commonly found in retail drug stores. PBMs are designed to adjudicate items with NDC codes and are typically part of the drug file. DME is typically purchased through the medical benefit. Medi-Span no longer publishes DME pricing and therefore we (and our fellow competitors) are unable to adjudicate DME.

Please explain if you want uninsured patients to be able to get replacement DME at retail drug stores. If so, what payment method are you directing your contractor to use?

R-1: It is expected EPAP will provide DME for uninsured patients and your proposal should contain mechanisms for DME coverage and a process for real time payment. EPAP DME is the standard items found in retail pharmacies such as canes, walkers, nebulizers, and wheelchairs.

Q-2: Medical supplies – are you limiting medical; supplies to insulin syringes, alcohol swabs, and other NDC based supplies associated with the pharmacy benefit? Please provide a representative list of medical supplies purchased in the past.

R-2: Medical supplies are limited to NDC supplies associated with pharmaceuticals provided by retail pharmacies.

Q-3: Vaccinations – Please provide a representative list of vaccinations you anticipate will be administered as a part of this program.

R-3: Vaccinations will be limited to vaccines typically provided by retail pharmacies.

Q-4: SOW, Page 2, 5. Technical Requirements – Programmatic Goals, bullet point #5:

“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.”

• Q-4a: Clarify vendor responsibility/liability to ensure EPAP eligibility. Is the vendor responsible for check/edits in addition to the pharmacist?

R-4a: The pharmacist should request proof of residency and a validated the prescription. The adjudication screening should determine if coverage exist for the customer and if no coverage exist, EPAP will be the payer of last resort when no coverage exist.

• Q-4b: Define “limit coverage” vs. “uninsured.”

R-4b: For EPAP services to be used by a customer, no coverage should exist thereby rendering the customers as uninsured for medication and DME. If limited coverage exists for medications and DME, then customer is responsible for the co-payments and is not eligible for EPAP services.

• Q-4c: In cases where an individual would have co-payment/co-insurance, would those dollar amounts be billed to EPAP or remain the responsibility of the eligible individual?

R-4c: Customers with co-payment/co-insurance are not eligible for EPAP services.

Q-5: Proof of residence - What will patients need to present at the pharmacy to prove residency in the disaster area? This is especially true if the relocate during the disaster.

R-5: Customers with proof of residency from zip code areas (zip codes will be provided) covered by the disaster declaration will be eligible for EPAP. Any government issued identification is acceptable proof of eligibility or a prescription container with the customer’s address indicating residency from the disaster affected area even if relocated as a result of the disaster.

Q-6: Price table: On the Brand and single source generic/DME = Lessor of average line and the Multi- Source generic/DME line, it asks for a unit price and an extended price in dollars. Do you want us to insert a percentage off of AWP, MAC, etc… Please confirm.

R-6: Propose a standard cost formula/approach to standard pricing for typical retail pharmacy medications/vaccinations and DME.

Q-7: Price Table: Since you say that DME pricing will be determined at the time of a task order, should we put a number here?

R-7: See response to Q-6.a.

Q-8: SOW, page 4, bullets 2, 3, 4

• Q-8a: If the contractor presently has connectivity to RxHub, is any other connectivity required?

R-8a: No other connectivity is required provided the coverage screening is accurate and efficient.

• Q-8b: When a patient enters a retail pharmacy with a prescription and the pharmacist asks if they live in the affected area and asks them if they have any pharmacy coverage, is anything else required to justify the use of the EPAP program for payment?

R-8b: The electronic screening/adjudication process should determine if customer is uninsured.

• Q-8c: What do you mean by “Applying the TPL services, contractor shall reject claims…”? For example, our adjudication system works based on the member plan number associated with the claim. So by definition, insurance is present and would be processed with the patient’s pharmacy insurance (a rejection by EPAP would not happen). The question leads us to believe you want something more to happen. Please explain as thoroughly as possible so a misunderstanding does not exist.

a. R-8c: If the customer indicates they have no coverage plan and the adjudication process has determined customer possesses an existing private coverage plan then the claim should be paid by the customer’s existing plan versus EPAP.

Q-9: Setting up EPAP eligibility: When a patient enters a pharmacy and states they are from the affected area and have no other insurance, eligibility will need to be setup in the adjudication system.

In order to have less confusion and ease of pharmacy administration for patient safety, we plan to have the patient call the contractor’s call center to give their personal information for eligibility setup. Then, the claim will process, have fewer errors and less frustration on the patients part. Is this technically acceptable? If not, what do you consider technically acceptable?

R-9: Technically acceptable but must be an effective process and practical.

Q-10: If we have additional questions identified over the weekend, can we submit those to you by noon EST Monday for a response?

R-10: No questions will be responded to after the deadline for questions of October 9, 2015, 5:00 pm ET.

Q-11: Request for one week extension on the due date of the proposal.

R-11: Due to the urgency of our response to the recent National crisis, we will not be able to extend the deadline for responses.

Q-12: Please verify that the response due date is October 13; only five (5) days from the issuance date of October 8.

R-12: October 13th is the response date.

Q-13: What happened to the small business designation? Please share the rationale from moving the EPAP Requirement from Small Business (for which we would informed that our original response was technically sound) to Unrestricted/Full and Order.

R-13: This requirement is Full and Open.

Q-14: Is the incumbent, Xerox, prepared to continue to provide the interim service?

R-14: All proposals are encouraged.

Q-15: Does the provider of the 90 day contract have any advantage in securing a long term award?

R-15: The Government cannot guarantee service needs.

Q-16: Does HHS/ASPR plan to put the long-term contract solicitation back into the Small Business category?

R-16: The Government cannot guarantee future service requirements.