36C10X18R0134-0003001.xlsx

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Workmen's Compensation (WC), Pharmacy Benefits Management (PBM) Program
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36C10X18R0134
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36C10X18R0134 0003 ATTACHMENT B PRICE MODEL_REV.2.xlsx

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PRICE MODEL

ATTACHMENT B: PRICE MODEL -REV.2
Base Period: June 29, 2018 - December 29, 2018
TypeDiscount % off AWPEstimated Dollar VolumeNet Discount Rate (% Below FECA)Total Discounted Price
Brand Name Drugs - Retail$10,127,000.56$ 10,127,000.56
Brand Name Drugs - Mail Order$101,865.40$ 101,865.40
Generic Drugs - Retail$8,589,677.12$ 8,589,677.12
Generic Drugs - Mail Order$182,672.79$ 182,672.79
Durable Medical Equipment
(DME), Diagnostic Services and Testing$332,839.30$ 332,839.30
BASE PERIOD TOTAL DISCOUNTED PRICE$19,334,055.17$ 19,334,055.17
Option Period 1: December 30, 2018 - June 28, 2019
TypeDiscount % off AWPEstimated Dollar VolumeNet Discount Rate (% Below FECA)Total Discounted Price
Brand Name Drugs - Retail$10,127,000.56$ 10,127,000.56
Brand Name Drugs - Mail Order$101,865.40$ 101,865.40
Generic Drugs - Retail$8,589,677.12$ 8,589,677.12
Generic Drugs - Mail Order$182,672.79$ 182,672.79
Durable Medical Equipment
(DME), Diagnostic Services and Testing$332,839.30$ 332,839.30
OPTION PERIOD 1 TOTAL DISCOUNTED PRICE$19,334,055.17$ 19,334,055.17
Option Period 2: June 29, 2019 - December 29, 2019
TypeDiscount % off AWPEstimated Dollar VolumeNet Discount Rate (% Below FECA)Total Discounted Price
Brand Name Drugs - Retail$10,127,000.56$ 10,127,000.56
Brand Name Drugs - Mail Order$101,865.40$ 101,865.40
Generic Drugs - Retail$8,589,677.12$ 8,589,677.12
Generic Drugs - Mail Order$182,672.79$ 182,672.79
Durable Medical Equipment
(DME), Diagnostic Services and Testing$332,839.30$ 332,839.30
OPTION PERIOD 2 TOTAL DISCOUNTED PRICE$19,334,055.17$ 19,334,055.17
Option Period 3: December 30, 2019 - June 28, 2020
TypeDiscount % off AWPEstimated Dollar VolumeNet Discount Rate (% Below FECA)Total Discounted Price
Brand Name Drugs - Retail$10,127,000.56$ 10,127,000.56
Brand Name Drugs - Mail Order$101,865.40$ 101,865.40
Generic Drugs - Retail$8,589,677.12$ 8,589,677.12
Generic Drugs - Mail Order$182,672.79$ 182,672.79
Durable Medical Equipment
(DME), Diagnostic Services and Testing$332,839.30$ 332,839.30
OPTION PERIOD 3 TOTAL DISCOUNTED PRICE$19,334,055.17$ 19,334,055.17
Option Period 4: June 29, 2020 - December 29, 2020
TypeDiscount % off AWPEstimated Dollar VolumeNet Discount Rate (% Below FECA)Total Discounted Price
Brand Name Drugs - Retail$10,127,000.56$ 10,127,000.56
Brand Name Drugs - Mail Order$101,865.40$ 101,865.40
Generic Drugs - Retail$8,589,677.12$ 8,589,677.12
Generic Drugs - Mail Order$182,672.79$ 182,672.79
Durable Medical Equipment
(DME), Diagnostic Services and Testing$332,839.30$ 332,839.30
OPTION PERIOD 4 TOTAL DISCOUNTED PRICE$19,334,055.17$ 19,334,055.17
Option Period 5: December 30, 2020 - June 28, 2021
TypeDiscount % off AWPEstimated Dollar VolumeNet Discount Rate (% Below FECA)Total Discounted Price
Brand Name Drugs - Retail$10,127,000.56$ 10,127,000.56
Brand Name Drugs - Mail Order$101,865.40$ 101,865.40
Generic Drugs - Retail$8,589,677.12$ 8,589,677.12
Generic Drugs - Mail Order$182,672.79$ 182,672.79
Durable Medical Equipment
(DME), Diagnostic Services and Testing$332,839.30$ 332,839.30
OPTION PERIOD 5 TOTAL DISCOUNTED PRICE$19,334,055.17$ 9,105,189.21

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