A19-J.13 -PWS TECHNICAL EXHIBIT 5- EXAMPLES OF FORMULARY FILES AND THEIR REQUIRED DATA (1).xlsx

XLSX spreadsheet 16 KB Posted

Attached to
PHARMACY BENEFITS MANAGEMENT SERVICES (PBM) Federal contract opportunity
Solicitation number
1605C3-24-R-00011
Issued by
Department of Labor Office of the Assistant Secretary for Administration and Management

About this file

Written by GovTribe AI ·

This document appears to be a technical exhibit for a Performance Work Statement (PWS) related to a federal contract opportunity for Pharmacy Benefits Management (PBM) Services. The PWS technical exhibit provides examples of various formulary files and their required data elements, including information such as drug class, brand and generic names, units of measure, historical transaction counts, coverage and utilization management criteria, and quantity/day supply limits.

The related federal contract opportunity is a solicitation for a single-award, fixed-price contract for PBM services on behalf of the U.S. Department of Labor (DOL), Office of Workers' Compensation Programs (OWCP). The solicitation number is 1605C3-24-R-00011, and the due date for proposals will be provided in a future amendment. Questions regarding the RFP must be submitted by October 21, 2024, and responses will be provided as an amendment on the SAM.gov website.

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Other files for this federal contract opportunity

Other files attached to PHARMACY BENEFITS MANAGEMENT SERVICES (PBM), newest first.
File Type Posted
RFP PBM Amend 0004.pdf PDF
1605C3-24-R-00011 Amend 00003.pdf PDF
QAs Amend 0002- FINAL.pdf PDF
RFP PBM Amend 0002.pdf PDF
A19-J.17 - OWCP Award Term Plan-.docx DOCX document
PBM III QUESTION_AND_ANSWERS.xlsx XLSX spreadsheet
A19 - REVISED SOLICITATION 1605C3-24-R-00011.pdf PDF
A19-J.4 – PBM DISCOUNT REBATE FEES WORKBOOK rev.xlsx XLSX spreadsheet
A19-J.15 - DOL Cybersecurity Policy Portfolio.pdf PDF
A19-J16- DLMS 7 Chapter 1100.pdf PDF
A19-J.14 - PWS TECHNICAL EXHIBIT 6 - FULL PASS THROUGH PRICING EXAMPLES.docx DOCX document
A19-J.11-PWS TECHNICAL EXHIBIT 3E- DME AND DIAGNOSTICS BILLS FOR ALL PROGRAMS.xlsx XLSX spreadsheet
A19-J.6-PWS TECHNICAL EXHIBIT 2- DELIVERABLES SCHEDULE (1).docx DOCX document
A19-J.2 – SMALL BUSINESS SUBCONTRACTING PLAN TEMPLATE 9.29.24.xlsx XLSX spreadsheet
A19-J.9 -PWS TECHNICAL EXHIBIT 3C- CY2023 PHARMACY TRANSACTIONS FOR THE FECA PROGRAM.xlsx XLSX spreadsheet
A19-J.4 – PBM DISCOUNT REBATE FEES WORKBOOK.xlsx XLSX spreadsheet
A19-J.10-PWS TECHNICAL EXHIBIT 3D-CY2023 PHARMACY TRANSACTIONS FOR THE LS PROGRAM.xlsx XLSX spreadsheet
A19-J.12- PWS TECHNICAL EXHIBIT 4- STAFF PORTAL DATA ELEMENTS (2).docx DOCX document
A19-J.8 -PWS TECHNICAL EXHIBIT 3B- CY2023 PHARMACY TRANSACTIONS FOR THE DEEOIC PROGRAM.xlsx XLSX spreadsheet
A19-J.7-PWS TECHNICAL EXHIBIT 3A- CY2023 PHARMACY TRANSACTIONS FOR THE DCMWC PROGRAM (1).xlsx XLSX spreadsheet
A19-J.5-PWS TECHNICAL EXHIBIT 1- PERFORMANCE REQUIREMENTS SUMMARY.docx DOCX document
RFP 1605C3-24-R-00011.pdf PDF
A19-J.3 - QUESTION AND ANSWER SPREADSHEET.xlsx XLSX spreadsheet
A19-J.1 – PAST PERFORMANCE QUESTIONNAIRE.docx DOCX document
Show all 24

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Sheet1

FORMULARY TYPE (XXXXXXXXXX)
GPI-2GPI-2 DescriptionGPI-6GPI-6 DescriptionGPI-14GPI-14 DescriptionExample brand available on the market (if available)Example GenericBrand Type (MSB or SSB)SA/LA OpioidMaintenance IndicatorUnit of MeasureHistorical Transaction CountFDA IndicationsOfficial Disability Guidelines (ODG)ACOEM GuidelinesOther Nationally Recognized GuidelinesCoverage SummaryAllowed / Step Therapy / Reject 75 / Reject 70PA Required (Yes/No)Step Therapy Required (Yes/No)Quantity Per Day LimitQuantity Limit Per FillDay Supply per Fill LimitDollar Limit Per Fill LimitMaximum # of Fills per Unique Patient Claim #

File details come from the government source that posted it. Updated .