Att 12 - Submittal Form M (Part 2 of 2) - Financial Requirements Narrative Response Form.docx
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- Solicitation number
- 2025-0200-0177 / 02-101-25
- Issued by
- Alaska
About this file
This document is a Submittal Form M (Part 2 of 2) Financial Requirements Narrative Response Form for the State of Alaska, specifically addressing pharmaceutical and pharmacy benefit management services. The form requires detailed responses from offerors on various financial and operational aspects of a potential pharmacy benefits contract, including requirements for MAC (Maximum Allowable Cost) lists, drug pricing, discounts, and administrative services.
The document outlines extensive financial and operational requirements, including provisions for brand and generic discount guarantees, data services, reporting capabilities, vaccine programs, specialty pharmacy classifications, and trend guarantees for different plan types (Commercial Plan for Active Employees, Pre-65 Retirees, and EGWP). Key focus areas include member cost-sharing calculations, pharmacy compliance procedures, online reporting systems, drug pricing mechanisms, and detailed financial guarantees for price inflation across different plan categories. The form seeks comprehensive information about how potential pharmacy benefit managers will manage pricing, reporting, and administrative services for the State of Alaska's pharmacy benefits program.
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SUBMITTAL FORM M (Part 2 of 2) Financial Requirements Narrative Response Form
Offeror must keep their response concise yet comprehensive. Offeror must provide their response directly under each requirement and may expand response area as needed.
1.3 Financial Requirements
1.3.15 b.) Offeror must explain, if they use multiple MAC lists and MAC drug price lists, how the multiple lists are used in relationship to the list(s) that will be used for the State.
1.3.16 Offeror must provide the discounts, dispensing fees, and logic associated with the compounds the offeror administers when it is clinically appropriate.
1.3.32 Brand and Generic Discount Guarantee Calculations
j.) Offeror must provide a complete listing of all proposed exclusions to the offeror's proposed brand and generic discount guarantees.
| 1.3.43 | All data related services must be included under the offeror’s base administrative fees, including ad hoc reporting, electronic claims files, plan design options, custom mailings, etc. |
| Offeror must detail any data-related service fees not included in their base administrative fees. |
1.3.47 If there will be any additional charges for plans/benefits that are restructured or new classes of eligible members that are added, the offeror must detail how these additional charges are determined and what is the additional charge.
1.3.51 Offeror must provide how they will be able to proactively provide analytical reports throughout the contract year (i.e., monthly, quarterly, semi-annually) indicating the actual performance versus the financial guarantees without a formal audit. This is in addition to the annual reconciliation reports that the offeror is expected to proactively provide to the State of Alaska.
1.3.83 Offeror must describe how they will calculate the “House Generics” or DAW 5 claims AWP that will be used in the generic guarantee financial reconciliation calculations and GDR guarantee calculations.
| 1.3.84 | Member Cost Share at the point-of-sale (for retail and mail) must be based on the lowest of the plan copay/coinsurance, U&C (usual and customary charges), MAC (maximum allowable cost), negotiated discounted ingredient cost plus dispensing fee or retail cash price. |
| b.) Offeror must provide what procedures the offeror has in place to ensure that the pharmacy is compliant with the above provision. |
1.3.87 b.) If the offeror offers a Vaccine Program, offeror must provide the cost for Influenza and other vaccines at participating pharmacies ensuring to include the Ingredient Cost, Dispensing Fee, Professional Service Fee, Program Fee and any other cost/fee in your description.
1.3.88 Offeror must provide how their system will ensure retail pharmacies will only charge members $0 for ACA vaccines and won't charge any additional administrative fees to the member.
1.3.91 Offeror provide information regarding the offeror's online system portal that is accessible to the State in order to run ad-hoc claims data reporting. Offeror must provide samples of the custom reporting accessible via this system as an attachment to their technical proposal.
1.4 Specialty Pharmacy Program
1.4.1 b.) Offeror must provide their process used to move drugs from a specialty drug classification to a non-specialty drug classification
1.4.4 b.) Offeror describe their process to move a drug, within six months, from the New-to-Market pricing to being discounted under the respective Overall Effective Discount (OED) guarantee.
1.7 Trend Guarantee
1.7.1 Offeror must describe the overall price inflation guarantee the offeror is proposing for the Commercial Plan for Active employees.
1.7.2 Offeror must describe the overall price inflation guarantee the offeror is proposing for the Commercial Plan for Pre-65 Retirees.
1.7.3 Offeror must describe the overall price inflation guarantee the offeror is proposing for the EGWP plan.
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