36C79123R0007 0002 9-25-23.docx

5. PROJECT NUMBER (if applicable)

CODE

7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO.

1. CONTRACT ID CODE

FACILITY CODE

CODE

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:

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

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office.

is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

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 letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

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.

15A. NAME AND TITLE OF SIGNER

16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30

PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

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

None

Department of Veterans Affairs Commodities & Services Acquisition Svc (003B6E) 555 Corporate Circle Golden CO 80401-5621

Department of Veterans Affairs Commodities & Services Acquisition Svc (003B6E) 555 Corporate Circle Golden CO 80401-5621 To all Offerors/Bidders

36C79123R0007 09-25-2023

X

10/10/2023 at 12:00 PM Mountain Time

Pharmacy Benefit Management Services for Veteran Family Member Programs The purpose of this solicitation amendment is to address the following:

1.) Address questions, revise solicitation language, revise Attachment 12

2.) Add Attachments 15 and 16

All other terms and conditions remain the same.

Sandra McAnany Contracting Officer

Amendment 0002 is hereby issued to answer the following questions, edit the Performance Work Statement (PWS), revise Attachment 12, add Attachment 15 – Reversal Payment Reconciliation and Attachment 16 NASP Definition of Specialty Pharmacy and Specialty Medications.

Questions and Answers:

Question 1: It is standard practice for PBM RFPs to include detailed, historical drug utilization data so that offerors can accurately estimate value/savings to include in their proposals and to assess/minimize disruption to existing programs. The accuracy of the estimate increases the confidence the offeror has in their price (resulting in less risk), and the mitigation of unnecessary risk leads to better pricing for the Government. Can the Government provide a more detailed history of drug utilization under the existing program that includes as many of the following data elements as possible?

· NDC Number – 11-digit National Drug Code of product dispensed

· Metric Quantity – Number of metric units of product dispensed

· Date of Service – Dispensing Date of Rx

· Script Count – Number of prescriptions included in this claim (SINGLE Rx Transaction per Record is Preferred)

· Member ID Number – Unique Patient ID, may be de-identified due to HIPAA requirements.

· Physician Identifier – DEA Number or NPI number of prescribing Physician

· Pharmacy Identifier – Seven-digit NABP number or NPI number assigned to pharmacy.

· Days Supply – Estimated number of days the prescription will last.

· Transaction Date – Date claim was adjudicated.

· Member Date of Birth – Date of birth of patient

· Member Gender – Gender of patient (Male, Female, Unspecified)

· Member Zip Code – Zip code of the patient's home address

· Compound Indicator – Indicates if the prescription is a compound. NCPDP standard is: 0=not specified, 1=not a compound, 2=compound.

· Formulary Flag – Formulary Flag - Formulary status of drug dispensed.

Answer 1: The Government has provided Attachment 6 – FY22 NDC Listing and Attachment 4 – FY22 Zip Codes which includes NDC Number, Metric Quantity, Script Count, and Member Zip Code. The Government will not provide the rest of the data.

Question 3: Medications can have different specialty designations across different PBMs, manufacturers and plan sponsors based on a variety of factors. To ensure a consistent basis for specialty discount offers (and consistency throughout performance of the contract), can the Government provide a list of drugs it designates as specialty drugs? Further, can the Government provide the process for communicating updates to that list throughout contract performance?

Answer 3: No. After award the Contractor shall provide the Government a list of drugs designated as specialty drugs. The Contractor shall be responsible for communicating updates to that list throughout contract performance. Specialty drugs are defined by the National Association of Specialty Pharmacies, see Attachment 16 – NASP Definitions of Specialty Pharmacy and Specialty Medications.

Question 4: The process of defining medications as brand or generic has become more complex with the existence of Biosimilars and Authorized Generics in the marketplace. To ensure a consistent basis for brand and generic discount offers (and consistency throughout performance of the contract), can the Government provide its criteria for defining brand and generic drugs?

Answer 4: 4.17 states that VFMP utilizes MediSpan® for identifying NDC’s and drug pricing. See added definition of Brand and Generic later in amendment.

Question 5: Adjudication and Recoupment Process Maps: Will the claims status response file be pass or fail or will it include any dollar amount changes?

Answer 5: This will be pass/fail.

Question 6: Small Business Subcontracting Plan: As offerors are developing their small business plans, are there minimum goal percentages for particular small business categories they should consider?

Answer 6: Subcontracting Goals: Service-Disabled Veteran Owned Small Business (SDVOSB) 5% / Veteran Owned Small Business (VOSB) 7% / HubZone 3% / Small Disadvantaged Business (SDB) 5% / Women Owned Small Business (WOSB) 5% / Small Business (SB) 17.5%

Question 7: Do offerors need to include Wage Determinations if they are using other locations (beyond Attachment 12)? If so, which volume should the information be included?

Answer 7: A Wage Determination should be included for all locations that have staff working on the contract and include in Volume 1.

Question 8: Can the Government clarify which volume the Organizational Conflicts of Interest statements should be included?

Answer 8: Volume 1.

Question 9: Since Factor 6: Price/Discount is in Volume II, should the file name for Attachment 12 - Price/Discount Schedule be “[Offeror Name] Volume II, Price.xls (and pdf. if desired).”

Answer 9: The naming above is appropriate for the Price/Discount Schedule.

Question 10: Is there an email size limit for proposal submission?

Answer 10: 25 MB per email.

Question 11: How will the Small Business Subcontracting Plan be evaluated?

Answer 11: The Small Business Plan will be evaluated based on proposed subcontracting goals.

Question 12: Some of the fillable Attachments are not 12-point font, e.g., Past Performance References Attachment 10. In the case of Attachment 10, should offerors reformat to comply? Would the Government consider allowing graphics and tables to be a smaller font, e.g., 10?

Answer 12: 10 pt font is allowed for attachments, graphics, and tables.

Question 13: Can the Government provide volumes for the beneficiary and pharmacy help desk calls including call types, time of day, and call duration? Can the Government also provide an estimate of initial and annual replacement volume for ID cards?

Answer 13: The average monthly call volume over the last 2 Fiscal Years is 6,000. The estimated initial volume for ID cards is 350,000.

The estimated annual replacement volume for ID cards is 14,500.

Question 14: Can the Government clarify what evaluation credit will be given for Veteran Involvement, i.e., is it pricing credit and/or technical credit? If pricing credit, what are the specific percentages for each category, e.g., full, partial, some consideration?

Answer 14: Veteran Involvement will be evaluated in accordance with 52.212-2 Evaluation – Commercial Products and Commercial Services (Nov 2021) Question 15: 2. Program Objectives Bullet I. Establish and maintain weekly communication between VFMP, Contractor, and other appropriate parties. Can the Government please provide clarity on what "other appropriate parties" could be?

Answer 15: See edit for section 2.1 I later in the document.

Question 16: What is the expected timeline from when the claims are sent to VFMP to when the contractor will receive that claim's response?

Answer 16: Within 24 hours of batch file receipt.

Question 17: Can the Government clarify if daily files are required at 4 AM EST or 6 AM EST?

Page 13 Section F & Page 22 Section F = 4 AM Page 16 Section G = 6 AM

Answer 17: 4 AM Eastern Time Question 18: As requested in Section 4.11, should the rebate value as a percentage off the drug pricing be added to the drug cost discounts in Table 2 of the Pricing Worksheet or provided independently? Example, in Column F under Table 2 should the Proposed Discount off AWP be shown as: 20% Pharmacy Network discount off AWP + 30% Rebates as a discount of AWP = 50% Proposed Discount (Column F would show 50%)

Answer 18: The percentage off the drug pricing should be incorporated within the drug cost discounts in Attachment 12, Table 2 of the Pricing Worksheet.

Question 19: Can the Government please clarify the term "connection" in "When a caller requests to speak with a Customer Service Representative, the connection will be made within 10 seconds, 98% of the time." Does connection refer to transfer to the Contract Service Representative (CSR) que or acknowledgement of the request to speak with a CSR, or full connection to a live CSR representative? Would the Government consider aligning to the widely used, industry standard connection time of 30 seconds when the caller requests to speak to a customer service representative? This would lower administrative pricing to the Government and is widely accepted by beneficiaries in the commercial marketplace.

Answer 19: See edits for section 4.12 and 5.3.1 later in amendment.

Question 20: Can the Government clarify if 100% of the calls should be resolved within one working day or two working days? For this RFP, can the Government define working day?

Answer 20: See edits for section 5.3.1 for definition of two working days.

Question 21: Can the Government please confirm which reports are required specifically?

Answer 21: Reports outlined in PWS will be required during postaward conference. See edit for 4.19.

Question 22: The Contractor will submit reversal payment to https://www.pay.gov twice monthly with an Excel spreadsheet attachment for reconciliation purposes. Can the Government provide an example of this Excel file?

Answer 22: See edits for Section 4.8.C and added Attachment 15 – Reversal Payment Reconciliation.

Question 23: EDI Receipt Performance Guarantees The Contractor will guarantee the EDI delivery standards listed above are met for all required standard EDI file transfers, unless there is a technical problem that requires immediate resolution which causes a delay to the file being posted as stated. The reasons for the delay will be given to the COR via email as soon as the delay is realized and shall be documented and monitored. Does the 99% compliance metric refer to the contractor acknowledging receipt of files by 4AM EST the following day?

Answer 23: The 99% compliance metric refers to the contractor receiving and processing files received from the Government.

Question 24: 5.4 C: Network Size Standards: The PBM shall maintain the initial size of the retail pharmacy network; maximum decrease in size: 10% D: Network Size Performance Guarantees Greater than 18.0% but less than or equal to 20.0%; maximum decrease in size: 2.0% Greater than 20.0%; maximum decrease in size: 3.0% Can the Government explain the differing "maximum decrease in size" percentages between the Network Size Standard and the Performance Guarantee? Can the Government provide an example?

Answer 24: See edits for Section 5.4 later in amendment for explanation.

Question 25: Determining the size of retail pharmacy networks involves a tradeoff of access (at least one network pharmacy nearby), choice (multiple network pharmacies nearby that compete for market share based upon service to the membership) and cost (the reimbursement amounts pharmacies are willing to accept, which ultimately affects what plan sponsors pay). Does the Government have a minimum number of network pharmacies required to ensure a desired balance in access, choice, and cost?

Answer 25: The Contractor will create and maintain a pharmacy network sufficient to meet the Urban, Suburban, and Rural minimum beneficiary access standards outlined in Section 5.4.

Question 26: What percentage of the member population lives within Urban, Suburban, and Rural zip codes?

Answer 26: See Attachment 4 – FY22 Zip Codes Question 27: Can the Government provide definitions for Urban, Suburban, and Rural?

Answer 27: See edits for Section 5.4 Question 28: Can the Government provide definitions for Administrative Fees (LIN X001), Transaction Fees (LIN X002) and Drug Utilization Fees (LIN X003) so that offerors understand the distinction between them?

Answer 28: Administrative fees are fees for the electronic processing of each claim. Transaction fees are fees for the electronic submission of each claim. Drug Utilization Review fees are fees for the monitoring of appropriate drug use, medical necessity, and adverse reactions. DUR also includes clinical misuse, incorrect dosage, and duplicate prescriptions.

Amending Solicitation Language

2. Program Objectives I. Establish and maintain weekly communication between VFMP, Contractor, and other appropriate parties such as beneficiaries, Veterans, Contractors, and other departments within VA as determined by the CO or COR.

4.4 Claims Submission to the Contractor by Network Pharmacy Provider:

G. The Contractor will submit up to six separate NCPDP batch files daily to include but not limited to the following: Standard Business (where VFMP is primary) Billing and Reversal, CITI Billing and Reversal, and Coordination of Benefit (COB) (where VFMP is secondary) Billing and Reversal. Medicaid Subrogation (3.0) Billing and Reversal may be requested at a later agreed upon date. Files will be submitted by 6 am EST 4 am Eastern Time. The Contractor will be advised of all discrepancies via NCPDP batch or proprietary response files from VFMP.

4.8 Claim Reversal Submission to VFMP:

C. The Contractor will submit reversal payment to https://www.pay.gov twice monthly with an Excel spreadsheet attachment for reconciliation purposes. (See Attachment 15 – Reversal Payment Reconciliation)

4.12 Beneficiary Help Desk:

A. The Contractor will maintain a toll-free Beneficiary Help Desk telephone number at their own expense for use by VFMP beneficiaries to assist with questions regarding pharmacy submitted claims, routine coverage questions, or to determine which providers are located near them. This toll-free number will be staffed, at a minimum, daily from 6 am to midnight Eastern Standard Time (EST).

B. The Contractor may use an Automated Response Unit (ARU) to receive beneficiary calls. If calls are received by an ARU, 98% of all calls will be acknowledged within 10 seconds. The first menu choice available to the caller will allow the caller to be transferred to a Customer Service Representative. Each subsequent menu selection will be answered and transferred within 10 seconds of the menu selection being made, 98% of the time. If the caller requests to speak with a customer service representative, they will be connected within 10 seconds of the request, to a live Customer Service Representative within 30 seconds of the request, 98% of the time.

D. Telephone Response Standards: When a caller requests to speak with a Customer Service Representative, the connection will be made within 10 seconds, they will be connected to a live Customer Service Representative within 30 seconds, 98% of the time. The abandonment rate will not exceed 2%. The blocked call rate will not exceed 2%. The Contractor will fully resolve (meaning the caller understands the resolution) all customer service calls 95% of the time during the initial call and 100% of the time resolution within two working days of receiving the initial call.

4.13 Pharmacy Help Desk:

A. The Contractor will maintain a toll-free Pharmacy Help Desk telephone number at their own expense for use by the network pharmacies to assist with questions regarding pharmacy submitted claims or routine questions. This toll-free number will be staffed, at a minimum, daily from 6 am to midnight Eastern Standard Time (EST).

4.17 Databases:

A. The Contractor will ensure that all Contractor reference database files are maintained and updated weekly to include the most recently published information. Those files include, but are not limited to, DEA provider files, MediSpan, First DataBank, Micromedex, NCPDP pharmacy provider file, HCIdea, and the NPI.

B. VFMP utilizes MediSpan® for identifying NDCs and drug pricing.

· Brand drug is defined by the multisource code field in MediSpan. “M” (co-branded product), “O” (originator brand), or an “N” (single source brand). If the multisource code is “O” and the DAW code is 3, 4, 5, 6, or 9, then the drug shall be considered a generic drug.

· Generic drug is defined by the multisource code field in MediSpan®. “Y” (generic). If the multisource code is “O” and the DAW code is 3, 4, 5, 6, or 9, then the drug shall be considered a generic drug.

5.3.1 Beneficiary