41NHA-S3992 - sBPM - Attachment 4.5.1. - Cost Schedule.xlsx
XLSX spreadsheet 36 KB Posted
- Attached to
- Nevada State Pharmacy Benefit Manager
- Solicitation number
- 41NHA-S3992
- Issued by
- Nevada
About this file
This is a cost proposal instructions document for Nevada Health Authority's Request for Proposal (RFP) 41NHA-S3992 for a Nevada State Pharmacy Benefits Manager (sBPM). Proposers must submit comprehensive cost proposals across four tabs: a title page identifying the cost proposal for the Nevada State Pharmacy Benefits Manager, an implementation cost proposal in Excel format, an administrative cost proposal in Excel format structured according to Section 9.4 specifications, and a methodology and assumptions tab documenting the rationale behind bid calculations. The proposal deadline is December 29, 2026, at 2:00 P.M. PST. Implementation costs are structured across two phases: Year 0 (July 1, 2027 through December 31, 2027) for Medicaid Fee-for-Service (FFS) go-live beginning January 1, 2028, and Year 1 (January 1, 2028 through December 31, 2028) for Medicaid managed care go-live beginning January 1, 2029. Administrative costs must be provided for Contract Year 1 (FFS only) and Contract Years 2 through 6 (FFS plus managed care), along with two optional extension years, covering twenty programmatic areas including staffing, pharmacy networks, claims processing, clinical programs, and fraud prevention.
Implementation costs must be all-inclusive, one-time, and directly attributable to implementation and readiness activities, with contractors prohibited from shifting implementation costs exceeding the implementation cap to administrative fees or other charges. All costs must include travel, per diem, out-of-pocket expenses, and administrative overhead, with detailed backup documentation required for all cost schedules. Administrative costs must also be all-inclusive annual pricing that accounts for the distinction between Year 1 operations (FFS only) and subsequent years (FFS plus managed care), with each line item fully populated and supported by detailed methodology. All proposal terms, including pricing, remain valid for a minimum of 180 days following the proposal due date and, for awarded vendors, throughout the entire contract term.
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Cost Proposal Instructions
| COST PROPOSAL INSTRUCTIONS | ||||
| Contents of the Contractor's cost proposal shall be as follows: | ||||
| 1. | Tab I - Title Page | |||
| The title page shall include the following: | ||||
| A. | Cost Proposal for: | Nevada State Pharmacy Benefits Manager |
B. RFP: 41NHA-S3992
| C. | Proposer Information: | Name: |
| Address: |
D. Proposal opening date: December 29, 2026
E. Proposal opening time: 2:00 P.M. PST
2. Tab II - Implementation Cost Proposal
A. Proposers shall provide one (1) Excel Implementation Cost Proposal file.
| 3. | Tab III - Administrative Cost Proposal | |
| A. | Cost proposal shall be in the format identified in Section 9.4, COST SCHEDULE. |
B. Proposers shall provide one (1) Excel Administrative Cost Proposal file.
| 4. | Tab IIII - Methodology and Assumptions | |
| A. | Provide the methods and assumptions used to determine the calculated number. |
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Implementation Cost Proposal
| 41NHA-S3992 - COST SCHEDULE |
| INSTRUCTIONS FOR COMPLETING THE IMPLEMENTATION COST SCHEDULE |
Contractor Shall:
* Enter the proposed costs in the bid columns as follows: Column C reflects the Contractor's Year 0 implementation costs to successfully go-live with the Medicaid FFS for Year 1 (beginning January 1, 2028). Column D reflects the Contractor's Year 1 implementation costs to successfully go-live with the Medicaid managed care for Year 2 (beginning January 1, 2029).
* Provide the cost methodology for implementation costs.
Implementation costs proposed shall be all-inclusive and limited to reasonable and necessary one-time costs directly attributable to implementation and readiness for Contract Year 1 and Contract Year 2 responsibilities. The Contractor is prohibited from shifting implementation costs for which it is responsible, including costs exceeding the implementation cap, to other administrative fees, transaction fees, pass-through charges, or other amounts payable by the State under the contract.
The cost for each deliverable and activity shall be complete and include all expenses, including travel, per diem and out-of-pocket expenses as well as administrative and/or overhead expenses. Detailed backup shall be provided for all cost schedules completed. All proposal terms, including proposed cost, shall remain in effect for a minimum of 180 days after the proposal due date. In the case of the awarded vendor, all proposal terms, including proposed cost, shall remain in effect throughout the contract term.
| ITEM # | IMPLEMENTATION DELIVERABLES AND ACTIVITES | CONTRACT YEAR 0 - FFS IMPLEMENTATION | ||
| (07/01/27 - 12/31/27) | CONTRACT YEAR 1 - MCO IMPLEMENTATION |
(01/01/28 - 12/31/28)
IMPLEMENTATION DELIVERABLES AND ACTIVITIES FOR MEDICAID SPBM SOW:
SECTION 1 - General Expectations and Qualifications
SECTION 2 - Staffing
SECTION 3 - Single PBM
SECTION 4 - Help Desk, Website, and Portal
SECTION 5 - Training and Quality Management
SECTION 6 - Preferred Drug List
SECTION 7 - Drug Utilization Review, Utilization Management, and Care Coordination
SECTION 8 - Physician Administered Drug Program
SECTION 9 - Value Based Purchasing
SECTION 10 - Clinical Programs
SECTION 11 - Fraud, Waste, and Abuse
SECTION 12 - Reporting
SECTION 13 - Certifications
SECTION 14 - Security and IT Solutions
SECTION 15 - Price Files
SECTION 16 - Rebates
SECTION 17 - Claims Processing
SECTION 18 - Pharmacy Networks
SECTION 19 - Implementation
SECTION 20 - Offboarding
TOTAL $0.00 $0.00
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Operations Cost Proposal
| 41NHA-S3992 - COST SCHEDULE |
| INSTRUCTIONS FOR COMPLETING THE ADMINISTRATIVE COST PROPOSAL |
Contractor Shall:
* Enter the proposed costs in bid Columns C - J for services to be detailed in Contractor's Response for the Medicaid FFS and Medicaid Managed Care.
* Provide the cost methodology for each year.
The Contractor shall submit a cost proposal for annual, all-inclusive administrative pricing for each year of the Contract, including optional Contract extension years. The Contractor is prohibited from shifting implementation costs for which it is responsible, including costs exceeding the implementation cap, to the Contractor's administrative cost proposal.
The Contractor's proposal shall distinguish between Contract Year 1 (in which the sBPM will be providing services for the State’s Medicaid FFS program only) and Contract Years 2- 6, including Contract extension options (in which the sPBM will be providing services for the State’s Medicaid FFS and Medicaid managed care program).
Each line item must be filled out and include the all-inclusive administrative costs necessary to perform the requirements of the applicable section of the scope of work for that Contract Year, except for items the scope of work expressly identifies as separately payable or excluded.
The cost for each deliverable and activity shall be complete and include all expenses, including travel, per diem and out-of-pocket expenses as well as administrative and/or overhead expenses. Detailed backup shall be provided for all cost schedules completed. All proposal terms, including proposed cost, shall remain in effect for a minimum of 180 days after the proposal due date. In the case of the awarded vendor, all proposal terms, including proposed cost, shall remain in effect throughout the contract term.
| ITEM # | PROGRAM DELIVERABLES AND ACTIVITIES | CONTRACT YEAR 1 | |||||
| FFS ONLY | CONTRACT YEAR 2 | ||||||
| FFS + MANAGED CARE | CONTRACT YEAR 3 | ||||||
| FFS + MANAGED CARE | CONTRACT YEAR 4 | ||||||
| FFS + MANAGED CARE | CONTRACT YEAR 5 | ||||||
| FFS + MANAGED CARE | CONTRACT YEAR 6 | ||||||
| FFS + MANAGED CARE | ADDITIONAL OPTION YEAR 1 | ADDITIONAL OPTION YEAR 2 | |||||
| ERROR:#REF! | (05/01/27 - 06/30/27) | FFS + MANAGED CARE | FFS + MANAGED CARE | ||||
| PROGRAM DELIVERABLES AND ACTIVITIES FOR MEDICAID FFS AND FFS + MEDICAID MANAGED CARE SCOPES OF WORK: |
SECTION 1 - General Expectations and Qualifications
SECTION 2 - Staffing
SECTION 3 - Single PBM
SECTION 4 - Help Desk, Website, and Portal
SECTION 5 - Training and Quality Management
SECTION 6 - Preferred Drug List
SECTION 7 - Drug Utilization Review, Utilization Management, and Care Coordination
SECTION 8 - Physician Administered Drug Program
SECTION 9 - Value Based Purchasing
SECTION 10 - Clinical Programs
SECTION 11 - Fraud, Waste, and Abuse
SECTION 12 - Reporting
SECTION 13 - Certifications
SECTION 14 - Security and IT Solutions
SECTION 15 - Price Files
SECTION 16 - Rebates
SECTION 17 - Claims Processing
SECTION 18 - Pharmacy Networks
SECTION 19 - Implementation
SECTION 20 - Offboarding
TOTAL $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
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Methodology and Assumptions
| 41NHA-S3992 - COST SCHEDULE |
| INSTRUCTIONS FOR COMPLETING THE METHODOLOGY AND ASSUMPTIONS: |
Contractor Shall:
*Provide detail behind the bid totals to assist the State's understanding of the methodology driving the bid.
*Document any assumptions behind a given bid amount, and what the Contractor expects if the assumption is invalid.
| ITEM # | PROGRAM DELIVERABLES AND ACTIVITIES | Methodology and Assumptions |
| ERROR:#REF! |
SECTION 1 - General Expectations and Qualifications
SECTION 2 - Staffing
SECTION 3 - Single PBM
SECTION 4 - Help Desk, Website, and Portal
SECTION 5 - Training and Quality Management
SECTION 6 - Preferred Drug List
SECTION 7 - Drug Utilization Review, Utilization Management, and Care Coordination
SECTION 8 - Physician Administered Drug Program
SECTION 9 - Value Based Purchasing
SECTION 10 - Clinical Programs
SECTION 11 - Fraud, Waste, and Abuse
SECTION 12 - Reporting
SECTION 13 - Certifications
SECTION 14 - Security and IT Solutions
SECTION 15 - Price Files
SECTION 16 - Rebates
SECTION 17 - Claims Processing
SECTION 18 - Pharmacy Networks
SECTION 19 - Implementation
SECTION 20 - Offboarding
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