Attachment_3_-_Pricing_Table.xlsx

XLSX spreadsheet 89 KB Posted Oct 8, 2015

Attached to: Emergency Prescription Assistance Program (EPAP) - Emergency Claims Adjudication - Short Term
Solicitation number: 16-100-SOL-00004
Issued by: Department of Health and Human Services Immediate Office of the Secretary

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MS Excel Version of Attachment 3 - Pricing Table

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Other files

File	Type	Posted
For_Pharmacies.pdf	PDF	Oct 9, 2015
Amendment_5_RFQ_16-100-SOL-00004_-_EPAP_Requirement.pdf	PDF	Oct 9, 2015
Amendment_4_RFQ_16-100-SOL-00004_-_EPAP_Requirement.pdf	PDF	Oct 9, 2015
Amendment_3_RFQ_16-100-SOL-00004_-_EPAP_Requirement.pdf	PDF	Oct 9, 2015
Amendment_2_-_RFQ__16-100-SOL-00004_-_EPAP_Requirement.pdf	PDF	Oct 8, 2015
Solicitation__16-100-SOL-00004(corrected).pdf	PDF	Oct 8, 2015
Amendment_1_-_RFQ__16-100-SOL-00004_-_EPAP_Requirement.pdf	PDF	Oct 8, 2015
Attachment_2_-_Past_Performance.docx	DOCX document	Oct 8, 2015
Attachment_2_-_Past_Performance.pdf	PDF	Oct 8, 2015
Attachment_1_-_Statement_of_Work.pdf	PDF	Oct 8, 2015
RFQ_EPAP_Requirement_Short_Term.pdf	PDF	Oct 8, 2015
Attachment_3_-_Pricing_Table.pdf	PDF	Oct 8, 2015

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(Pre-Activation Costs))

PROJECT TITLE:

PRE-Act. - Base Period 60 Day EPAP

Note: Certain items are one-time or annual

Contract Line Item Service Description

Base Period (60 Days)

Option Year Two

Option Year Three

Option Year Four

Option Year Five

Quantity

Unit

Unit Price

Total Price

Quantity

Unit

Unit Price

Total Price

Quantity

Unit

Unit Price

Total Price

Quantity

Unit

Unit Price

Total Price

Quantity

Unit

Unit Price

Total Price

Project/Program Manager

Hour

$ - 0

ERROR:#REF!

Certified Public Accountant

Hour

$ - 0

ERROR:#REF!

Formulary Upload (Annual)

Hour

$ - 0

ERROR:#REF!

Readiness Activation Test/Exercise (Annual)

Hour

$ - 0

ERROR:#REF!

System Subscriptions Cost/Integration

$ - 0

ERROR:#REF!

System Setup Fee (One Time)

$ - 0

ERROR:#REF!

Call Center Readiness/Exercise

Hour

$ - 0

ERROR:#REF!

Travel

$ - 0

ERROR:#REF!

TOTAL COST:

$ - 0

ERROR:#REF!

Contract Line Item Service Description Option Period (30 Days) Long T. Pham: Long T. Pham:

Option Year Two

Option Year Three

Option Year Four

Option Year Five

Quantity

Unit

Unit Price

Total Price

Quantity

Unit

Unit Price

Total Price

Quantity

Unit

Unit Price

Total Price

Quantity

Unit

Unit Price

Total Price

Quantity

Unit

Unit Price

Total Price

Project/Program Manager

Long T. Pham: Long T. Pham:

80	Hour		$ - 0		ERROR:#REF!
Certified Public Accountant	9	Hour		$ - 0		ERROR:#REF!
Formulary Upload (Annual)	32	Hour		$ - 0		ERROR:#REF!
Readiness Activation Test/Exercise (Annual)	64	Hour		$ - 0		ERROR:#REF!
System Subscriptions Cost/Integration	1	Ea		$ - 0		ERROR:#REF!
Call Center Readiness/Exercise	64	Hour		$ - 0		ERROR:#REF!
Travel	1	Ea		$ - 0		ERROR:#REF!
TOTAL COST:				$ - 0		ERROR:#REF!

TOTAL PRICE (BASE PLUS OPTION) $ - 0

System Setup Fee, do we need this again for the 30-day renewal?

ATTACHMENT 3 - PRICE TABLE

HHS/ASPR EPAP Requirement - Short Term

(Act and Deact Costs) PROJECT TITLE: Act. and Deact. Contract - 60 Day

Contract Line Item Description

Base Period (60 Days)

Option Year Two

Option Year Three

Option Year Four

Option Year Five

Fixed Price (FP):

Quantity

Unit

Unit Price

Total Price

Quantity

Unit

Unit Price

Total Price

Quantity

Unit

Unit Price

Total Price

Quantity

Unit

Unit Price

Total Price

Quantity

Unit

Unit Price

Total Price

Communication Center Expense

$ - 0

Systems Activation

$ - 0

Call Center/Systems Activation

$ - 0

Systems Deactivation

$ - 0

Call Center/Systems Deactivation

$ - 0

Total Systems Activation/De-activation required per event

$ - 0

Transactional Prices (Estimated Quantity)				$ - 0
Per Claim with Third Party Liability (TPL) Confirmation	1	Ea	$ - 0	$ - 0
Administrative Price Per Rx Claim - Paid or Denied	1	Ea	$ - 0	$ - 0
Per Paper Claim, as required	1	Ea	$ - 0	$ - 0
Per Prior Authorization	1	Ea	$ - 0	$ - 0
Per Call - Automated Phone System	1	Ea	$ - 0	$ - 0
Per Incoming Call	1	Ea	$ - 0	$ - 0
Per Outgoing Call	1	Ea	$ - 0	$ - 0
Spanish Translation Service - per minute	1	Ea	$ - 0	$ - 0
Faxes - per Page	1	Ea	$ - 0
Brand and Single Source Generic/DME = Lesser of: average	1	Ea	$ - 0
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	$ - 0	ERROR:#REF!
Durable Medical Equipment (DME): Medi-Span published pricing. (Actual pricing to be determined at time of Task Order.)	1	Ea	$ - 0	ERROR:#REF!
Dispense Fee - Standard	1	Ea	$ - 0
Vaccination Fee - Standard	1	Ea	$ - 0
Vaccination Program Fee per claim	1	Ea	$ - 0	ERROR:#REF!
Pharmacist (Drug Utlization Reviewer)	240	Hr	$ - 0
Claim Benefits Manager	240	Hr	$ - 0	ERROR:#REF!
Program Assistant	240	Hr	$ - 0
				ERROR:#REF!

Contract Line Item Description	Option Period (30 Days)				Option Year Two		Option Year Three		Option Year Four		Option Year Five
Fixed Price (FP):	Quantity	Unit	Unit Price	Total Price
Communication Center Expense	1	Ea		$ - 0
Call Center/Systems Activation	1	Ea		$ - 0
Systems Deactivation	1	Ea		$ - 0
Call Center/Systems Deactivation	1	Ea		$ - 0
Total Systems Activation/De-activation required per event				$ - 0
						$ - 0		$ - 0		$ - 0		ERROR:#REF!
Transactional Prices (Estimated Quantity)						ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!
Per Claim with Third Party Liability (TPL) Confirmation	1	Ea		$ - 0		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!
Administrative Price Per Rx Claim - Paid or Denied	1	Ea		$ - 0		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!
Per Paper Claim, as required	1	Ea		$ - 0		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!
Per Prior Authorization	1	Ea		$ - 0
Per Call - Automated Phone System	1	Ea		$ - 0		$ - 0		$ - 0		$ - 0		$ - 0
Per Incoming Call	1	Ea		$ - 0		$ - 0		$ - 0		$ - 0		$ - 0
Per Outgoing Call	1	Ea		$ - 0		$ - 0		$ - 0		$ - 0		$ - 0
Spanish Translation Service - per minute	1	Ea		$ - 0		$ - 0		$ - 0		$ - 0		$ - 0
Faxes - per Page	1	Ea		$ - 0		$ - 0		$ - 0		$ - 0		$ - 0
Brand and Single Source Generic/DME = Lesser of: average	1	Ea		$ - 0		$ - 0		$ - 0		$ - 0		$ - 0
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		$ - 0		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!
Durable Medical Equipment (DME): Medi-Span published pricing. (Actual pricing to be determined at time of Task Order.)	1	Ea		$ - 0		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!
Dispense Fee - Standard	1	Ea		$ - 0		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!
Vaccination Fee - Standard	1	Ea		$ - 0		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!
Vaccination Program Fee per claim	1	Ea		$ - 0		ERROR:#REF!		ERROR:#REF!		ERROR:#REF!
Pharmacist (Drug Utlization Reviewer)	240	Hr		$ - 0
Claim Benefits Manager	240	Hr		$ - 0
Program Assistant	240	Hr		$ - 0
TOTAL TRANSACTIONAL PRICES				$ - 0

TOTAL PRICE (BASE PLUS OPTION) $ - 0

* Communication Center expense: Creation and distribution (Phone/ Fax/ Email) of Provider Network information/ instructions,

process, covered DME items, PA processes, follow up coordination and communications.

** Systems Activation ...Program plan design validation, installation, testing, Eligibility installation and testing, network activation.

**Call center/systems activation…device (IVR, call center systems) programming, customer service activation, communication

and training, system testing.

**Systems Deactivation…Network notifications on final acceptable transaction dates, data archiving, event clean up ( final reporting

and system standby readiness.)

**Call center/systems deactivation…Device (IVR, call center systems) programming and messaging, event wrap up procedures,

final reporting.

ATTACHMENT 3 - PRICE TABLE

HHS/ASPR EPAP Requirement - Short Term

File details come from the government source that posted it. Updated Nov 14, 2017.