Attachment_3_-_Pricing_Table.pdf
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- Attached to
- Emergency Prescription Assistance Program (EPAP) - Emergency Claims Adjudication - Short Term
- Solicitation number
- 16-100-SOL-00004
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Attachment 3 - Pricing Table
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ATTACHMENT 3 - PRICE TABLE
HHS/ASPR EPAP Requirement - Short Term
PROJECT TITLE: Act. and Deact. Contract - 60 Day
Contract Line Item Description Fixed Price (FP): Quantity Unit Unit Price Total Price Communication Center Expense 1 Ea -$ Systems Activation 1 Ea -$ Call Center/Systems Activation 1 Ea -$ Systems Deactivation 1 Ea -$ Call Center/Systems Deactivation 1 Ea -$ Total Systems Activation/De-activation required per event -$
Transactional Prices (Estimated Quantity) Per Claim with Third Party Liability (TPL) Confirmation 1 Ea -$ Administrative Price Per Rx Claim - Paid or Denied 1 Ea -$ Per Paper Claim, as required 1 Ea -$ Per Prior Authorization 1 Ea -$ Per Call - Automated Phone System 1 Ea -$ Per Incoming Call 1 Ea -$ Per Outgoing Call 1 Ea -$ Spanish Translation Service - per minute 1 Ea -$ Faxes - per Page 1 Ea -$ Brand and Single Source Generic/DME = Lesser of: average 1 Ea -$ Multi-Source Generic/DME = Lesser of: average wholesale price (AWP) minus ____, or maximum allowable cost (MAC), or usual and customary (U&C); (MAC Guaranteed Effective Rate of AWP minus 55%)
1 Ea -$
Durable Medical Equipment (DME): Medi-Span published pricing. (Actual pricing to be determined at time of Task Order.)
1 Ea -$
Dispense Fee - Standard 1 Ea -$ Vaccination Fee - Standard 1 Ea -$ Vaccination Program Fee per claim 1 Ea -$ Pharmacist (Drug Utlization Reviewer) 240 Hr -$ Claim Benefits Manager 240 Hr -$ Program Assistant 240 Hr -$
Contract Line Item Description Fixed Price (FP): Quantity Unit Unit Price Total Price Communication Center Expense 1 Ea -$ Call Center/Systems Activation 1 Ea -$ Systems Deactivation 1 Ea -$ Call Center/Systems Deactivation 1 Ea -$ Total Systems Activation/De-activation required per event -$
Transactional Prices (Estimated Quantity) Per Claim with Third Party Liability (TPL) Confirmation 1 Ea -$ Administrative Price Per Rx Claim - Paid or Denied 1 Ea -$ Per Paper Claim, as required 1 Ea -$ Per Prior Authorization 1 Ea -$ Per Call - Automated Phone System 1 Ea -$ Per Incoming Call 1 Ea -$ Per Outgoing Call 1 Ea -$ Spanish Translation Service - per minute 1 Ea -$ Faxes - per Page 1 Ea -$ Brand and Single Source Generic/DME = Lesser of: average 1 Ea -$ Multi-Source Generic/DME = Lesser of: average wholesale price (AWP) minus ____, or maximum allowable cost (MAC), or usual and customary (U&C); (MAC Guaranteed Effective Rate of AWP minus 55%)
1 Ea -$
Durable Medical Equipment (DME): Medi-Span published pricing. (Actual pricing to be determined at time of Task Order.)
1 Ea -$
Dispense Fee - Standard 1 Ea -$ Vaccination Fee - Standard 1 Ea -$ Vaccination Program Fee per claim 1 Ea -$
Pharmacist (Drug Utlization Reviewer) 240 Hr -$
Claim Benefits Manager 240 Hr -$ Program Assistant 240 Hr -$
TOTAL TRANSACTIONAL PRICES -$
TOTAL PRICE (BASE PLUS OPTION) -$
Option Period (30 Days)
Base Period (60 Days)
ATTACHMENT 3 - PRICE TABLE
HHS/ASPR EPAP Requirement - Short Term
PROJECT TITLE: PRE-Act. - Base Period 60 Day EPAP
Contract Line Item Service Description
Quantity Unit Unit Price Total Price Project/Program Manager 80 Hour -$ Certified Public Accountant 9 Hour -$ Formulary Upload (Annual) 32 Hour -$ Readiness Activation Test/Exercise (Annual) 64 Hour -$ System Subscriptions Cost/Integration 1 Ea -$ System Setup Fee (One Time) 1 Ea -$ Call Center Readiness/Exercise 64 Hour -$ Travel 1 Ea -$
TOTAL COST: -$
Note: Certain items are one-time or annual
Base Period (60 Days)
| (Act and Deact Costs) |
| (Pre-Activation Costs)) |
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