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Sheet1
| Table 1: Schedule of Services | | | | | |
| LIN Item | Description | Quantity | Unit | *** Unit Price | *** Total Price |
| Base Year: 4/1/2024 to 3/31/2025 | | | | | |
| 0001 | Administration Fee | 5,996,383 | each | | $ |
| 0002 | Transaction Fee | 5,996,383 | each | | $ |
| 0003 | Drug Utilization Review Fee | 5,996,383 | each | | $ |
| n/a | * Estimated Administration Total | 5,996,383 | n/a | | $ - 0 |
| 0004 | Estimated Specialty Dispensing Fee | 30,761 | each | | $ |
| 0005 | Estimated Brand Dispensing Fee | 703,016 | each | | $ |
| 0006 | Estimated Generic Dispensing Fee | 5,262,606 | each | | $ |
| n/a | **Estimated Dispensing Fee Total | 5,996,383 | n/a | n/a | $ - 0 |
| 0007 | Estimated Discounted Specialty Drug Cost | 30,761 | each | Auto Populates from Table 2 | $ |
| 0008 | Estimated Discounted Brand Drug Cost | 703,016 | each | Auto Populates from Table 2 | $ |
| 0009 | Estimated Discounted Generic Drug Cost | 5,262,606 | each | Auto Populates from Table 2 | $ |
| n/a | ** Estimated Drug Cost Total | 5,996,383 | n/a | n/a | $ - 0 |
| n/a | Base Year Grand Total | n/a | n/a | n/a | $ - 0 |
| Option Year One: 4/1/2025 to 3/31/2026 | | | | | |
| 1001 | Administration Fee | 6,236,239 | each | | $ |
| 1002 | Transaction Fee | 6,236,239 | each | | $ |
| 1003 | Drug Utilization Review Fee | 6,236,239 | each | | $ |
| n/a | * Estimated Administration Total | 6,236,239 | n/a | n/a | $ - 0 |
| 1004 | Estimated Specialty Dispensing Fee | 31,992 | each | | $ |
| 1005 | Estimated Brand Dispensing Fee | 731,137 | each | | $ |
| 1006 | Estimated Generic Dispensing Fee | 5,473,110 | each | | $ |
| n/a | **Estimated Dispensing Fee Total | 6,236,239 | n/a | n/a | $ - 0 |
| 1007 | Estimated Discounted Specialty Drug Cost | 31,992 | each | Auto Populates from Table 2 | $ |
| 1008 | Estimated Discounted Brand Drug Cost | 731,137 | each | Auto Populates from Table 2 | $ |
| 1009 | Estimated Discounted Generic Drug Cost | 5,473,110 | each | Auto Populates from Table 2 | $ |
| n/a | ** Estimated Drug Cost Total | 6,236,239 | n/a | n/a | $ - 0 |
| n/a | Option Year One Grand Total | n/a | n/a | n/a | $ - 0 |
| Option Year Two: 4/1/2026 to 3/31/2027 | | | | | |
| 2001 | Administration Fee | 6,485,688 | each | | $ |
| 2002 | Transaction Fee | 6,485,688 | each | | $ |
| 2003 | Drug Utilization Review Fee | 6,485,688 | each | | $ |
| N/A | * Estimated Administration Total | 6,485,688 | n/a | n/a | $ - 0 |
| 2004 | Estimated Specialty Dispensing Fee | 33,272 | each | | $ |
| 2005 | Estimated Brand Dispensing Fee | 760,382 | each | | $ - 0 |
| 2006 | Estimated Generic Dispensing Fee | 5,692,034 | each | | $ - 0 |
| n/a | **Estimated Dispensing Fee Total | 6,485,688 | n/a | n/a | $ - 0 |
| 2007 | Estimated Discounted Specialty Drug Cost | 33,272 | each | Auto Populates from Table 2 | $ |
| 2008 | Estimated Discounted Brand Drug Cost | 760,382 | each | Auto Populates from Table 2 | $ |
| 2009 | Estimated Discounted Generic Drug Cost | 5,692,034 | each | Auto Populates from Table 2 | $ |
| n/a | ** Estimated Drug Cost Total | 6,485,688 | n/a | n/a | $ - 0 |
| n/a | Option Year Two Grand Total | n/a | n/a | n/a | $ - 0 |
| Option Year Three: 4/1/2027 to 3/31/2028 | | | | | |
| 3001 | Administration Fee | 6,745,116 | each | | $ |
| 3002 | Transaction Fee | 6,745,116 | each | | $ |
| 3003 | Drug Utilization Review Fee | 6,745,116 | each | | $ |
| n/a | * Estimated Administration Total | 6,745,116 | n/a | n/a | $ - 0 |
| 3004 | Estimated Specialty Dispensing Fee | 34,602 | each | | $ |
| 3005 | Estimated Brand Dispensing Fee | 790,797 | each | | $ |
| 3006 | Estimated Generic Dispensing Fee | 5,919,716 | each | | $ |
| n/a | **Estimated Dispensing Fee Total | 6,745,116 | n/a | n/a | $ - 0 |
| 3007 | Estimated Discounted Specialty Drug Cost | 34,602 | each | Auto Populates from Table 2 | $ |
| 3008 | Estimated Discounted Brand Drug Cost | 790,797 | each | Auto Populates from Table 2 | $ |
| 3009 | Estimated Discounted Generic Drug Cost | 5,919,716 | each | Auto Populates from Table 2 | $ |
| n/a | ** Estimated Drug Cost Total | 6,745,116 | n/a | n/a | $ - 0 |
| n/a | Option Year Three Grand Total | n/a | n/a | n/a | $ - 0 |
| Option Year Four: 4/1/2028 to 3/31/2029 | | | | | |
| 4001 | Administration Fee | 7,014,920 | each | | $ |
| 4002 | Transaction Fee | 7,014,920 | each | | $ |
| 4003 | Drug Utilization Review Fee | 7,014,920 | each | | $ |
| n/a | * Estimated Administration Total | 7,014,920 | n/a | n/a | $ - 0 |
| 4004 | Estimated Specialty Dispensing Fee | 35,987 | each | | $ |
| 4005 | Estimated Brand Dispensing Fee | 822,429 | each | | $ |
| 4006 | Estimated Generic Dispensing Fee | 6,156,504 | each | | $ |
| n/a | **Estimated Dispensing Fee Total | 7,014,920 | n/a | n/a | $ - 0 |
| 4007 | Estimated Discounted Specialty Drug Cost | 35,987 | each | Auto Populates from Table 2 | $ |
| 4008 | Estimated Discounted Brand Drug Cost | 822,429 | each | Auto Populates from Table 2 | $ |
| 4009 | Estimated Discounted Generic Drug Cost | 6,156,504 | each | Auto Populates from Table 2 | $ |
| n/a | ** Estimated Drug Cost Total | 7,014,920 | n/a | n/a | $ - 0 |
| n/a | Option Year Four Grand Total | n/a | n/a | n/a | $ - 0 |
| Gtand Total | | | | $ - 0 |
| * The Administration Total (Administration Fee, Transaction Fee, and Drug Utilization Review Fee) will be invoiced under the contract. | | | | | |
| ** Dispensing Fee and Drug Costs will be invoiced separately via VFMP claims processing system. Adjudicated claims for Dispensing Fee and discounted Drug Cost will be paid by | | | | | |
| Electronic Funds Transfer (EFT) by the Treasury. | | | | | |
| *** Administrative fees are fees for the electronic processing of each claim. Transaction fees are fees for the electronic submission 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 . | | | | | |
| INSTRUCTIONS TO OFFERORS: A. Offerors shall complete the Solicitation Attachment 12, Pricing Worksheet in its entirety. Proposed pricing for line items (LINs) 0001-0009 shall be | | | | | | |
| entered in Table 1: Schedule of Services, Column E "Unit Price". Column F "Total Price" will poputate automatically. | | | | | | |
| B. Offerors Proposed Estimated Unit Cost of Drugs (before discount) shall be entered in Table 2: Drug Cost Discounts, Column E. Offerors Proposed Discount (% off Average Wholesale | | | | | | |
| Price) for Specialty, Brand, and Generic Type of Medicine shall be entered in Table 2: Drug Cost Discounts, Column F. Columns E "Unit Price" and Column F "Total Price" in | | | | | | |
| Table 1: Schedule of Services will populate automatically. | | | | | | |
| The proposed dicount in Table 2, column F will be used for evaluating the drug cost portion of pricing. | | | | | | |
| Table 2: Drug Cost Discounts | | | | | | |
| Contract Year | Type of Medicine (Drug) | Government Estimated Total Cost of Drugs (Average wholesale price before discount) | Quantity | Government Estimated Unit Cost of Drugs (before discount) | *** Proposed Discount (% off of Average Wholesale Price) | Estimated Total Cost of Drugs (after discount, dollar figure will change automatically when discount is entered) |
| | | | | | $ - 0 |
| Base Year | Specialty | $ 158,509,189.95 | 30,761 | $ 5,152.85 | | $ 158,509,189.95 |
| Brand Name | $ 328,481,167.29 | 703,016 | $ 467.25 | | $ 328,481,167.29 |
| Generic | $ 411,207,158.90 | 5,262,606 | $ 78.14 | | $ 411,207,158.90 |
| | | | | | $ - 0 |
| Option Year One | Specialty | $ 169,604,833.24 | 31,992 | $ 5,301.48 | | $ 169,604,833.24 |
| Brand Name | $ 351,474,849.00 | 731,137 | $ 480.72 | | $ 351,474,849.00 |
| Generic | $ 439,991,660.02 | 5,473,110 | $ 80.39 | | $ 439,991,660.02 |
| | | | | | $ - 0 |
| Option Year Two | Specialty | $ 181,477,171.57 | 33,272 | $ 5,454.42 | | $ 181,477,171.57 |
| Brand Name | $ 376,078,088.43 | 760,382 | $ 494.59 | | $ 376,078,088.43 |
| Generic | $ 470,791,076.22 | 5,692,034 | $ 82.71 | | $ 470,791,076.22 |
| | | | | | $ - 0 |
| Option Year Three | Specialty | $ 194,180,573.58 | 34,602 | $ 5,611.76 | | $ 194,180,573.58 |
| Brand Name | $ 402,403,554.62 | 790,797 | $ 508.86 | | $ 402,403,554.62 |
| Generic | $ 503,746,451.56 | 5,919,716 | $ 85.10 | | $ 503,746,451.56 |
| | | | | | $ - 0 |
| Option Year Four | Specialty | $ 207,773,213.73 | 35,987 | $ 5,773.64 | | $ 207,773,213.73 |
| Brand Name | $ 430,571,803.44 | 822,429 | $ 523.54 | | $ 430,571,803.44 |
| Generic | $ 539,008,703.17 | 6,156,504 | $ 87.55 | | $ 539,008,703.17 |
| | | | | | $ - 0 |
36C79123R0007 Attachment 12 - Pricing Worksheet
