Attachment 12 - Pricing Worksheet final 8-9-23.xlsx

XLSX spreadsheet 20 KB Posted Sep 5, 2023

Attached to: R408--FY24 IVC PHARMACY BENEFIT MANAGER
Solicitation number: 36C79123R0007
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 19

About this file

Written by GovTribe AI · Dec 21, 2023

This document is a pricing worksheet for a pharmacy benefit manager contract solicitation issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 19. The pricing worksheet provides estimated quantities and unit prices for administration fees, transaction fees, drug utilization review fees, dispensing fees for specialty, brand, and generic drugs, and discounted drug costs over a five year period from the base year through four option years. Offerors are instructed to complete the pricing worksheet by providing unit prices for administration in the base year and proposed discounts off average wholesale prices for specialty, brand, and generic drugs, with estimated drug costs then auto-populating in the worksheet based on the provided discounts.

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Other files

File	Type	Posted
36C79123R0007 0003 9-25-23.docx	DOCX document	Sep 25, 2023
36C79123R0007 0003.docx	DOCX document	Sep 25, 2023
Attachment 12 - Pricing Worksheet revised 9-25-23.xlsx	XLSX spreadsheet	Sep 25, 2023
Attachment 15 - Reversal Payment Reconciliation.xlsx	XLSX spreadsheet	Sep 25, 2023
Attachment 16 - NASP Definitions of Specialty Pharmacy and Specialty Medications.pdf	PDF	Sep 25, 2023
36C79123R0007 0002 9-25-23.docx	DOCX document	Sep 25, 2023
36C79123R0007 0001 9-11-2023.docx	DOCX document	Sep 11, 2023
36C79123R0007 0001_1.docx	DOCX document	Sep 11, 2023
Attachment 1 - Eligibility Primary Status Secondary Response Reversal and Reversal Response Formats updated 6-8-23.pdf	PDF	Sep 5, 2023
Attachment 9 - Quality Assurance Surveillance Plan 7-20-2023.pdf	PDF	Sep 5, 2023
Attachment 13- Labor Wage Determination 2015-5419 7-25-2023.pdf	PDF	Sep 5, 2023
Attachment 2 - Override Procedures updated 6-21-2023.pdf	PDF	Sep 5, 2023
Attachment 6 - FY22 NDC Listing.xlsx	XLSX spreadsheet	Sep 5, 2023
Attachment 3 - Excluded Items.pdf	PDF	Sep 5, 2023
Attachment 8- Small Business Subcontracting Plan.docx	DOCX document	Sep 5, 2023
Attachment 4 - FY22 Zip Codes.xlsx	XLSX spreadsheet	Sep 5, 2023
Attachment 14 - Authority to Operate.docx	DOCX document	Sep 5, 2023
36C79123R0007 9-05-23 final.docx	DOCX document	Sep 5, 2023
Attachment 5 - Adjudication and Recoupment Process Maps updated 6-8-2023.pdf	PDF	Sep 5, 2023
Attachment 7 - Business Associate Agreement updated 6-8-2023.pdf	PDF	Sep 5, 2023
Attachment 10 - Past Performance References.docx	DOCX document	Sep 5, 2023
Attachment 11 - Past Performance Questionnaire.docx	DOCX document	Sep 5, 2023

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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.
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

File details come from the government source that posted it. Updated Sep 5, 2023.