Attachment_C_-_Pharmacy_Drug_Plan_Formulary.xlsx
XLSX spreadsheet 24 KB Posted
- Solicitation number
- Y26-151
- Issued by
- Orange County, Orlando City, Florida
About this file
This is a Pharmacy Drug Plan Formulary attachment for Orange County, Florida's Medicare Supplemental Plans and Medicare Part D Employer Group Waiver Plans procurement (Y26-151). The formulary worksheet requires respondents to classify 100 pharmaceutical drugs across two plan tiers—Low Plan and High Plan—using four formulary categories: Generic, Preferred Brand, Non-Preferred Brand, and Specialty. The drugs listed represent a comprehensive range of therapeutic classes including biologics (HUMIRA, ENBREL, STELARA), specialty medications (POMALYST, GILENYA), diabetes treatments (HUMALOG, TRESIBA, OZEMPIC), cardiovascular drugs (ELIQUIS, XARELTO, ENTRESTO), and other chronic condition therapies. Sealed responses for the Medicare Supplemental and Part D plans were due by 4:00 pm EST on Thursday, May 7, 2026, and all submissions were required to be made electronically through the OpenGov e-Procurement Platform, with hand-delivery, mail, telephone, fax, and email submissions being prohibited.
The formulary worksheet does not specify pricing terms, co-payment structures, or out-of-pocket maximums within the attachment itself. The document appears to be a template requiring bidders to populate their specific formulary tier classifications based on their current formulary lists, indicating that pricing and benefit design details would likely be addressed in other sections of the solicitation. No incumbent information, set-asides, or funding amounts are documented in this formulary attachment, as it serves primarily as a technical specification tool for evaluating and comparing how each respondent's drug coverage aligns with the County's requirements for both Low and High plan options.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Medicare_Supplemental_Plans_and_Medicare_Part_D_Employer_Group_Waiver_Plans_(Addendum_#1_Revision).pdf | ||
| Medicare_Supplemental_Plans_and_Medicare_Part_D_Employer_Group_Waiver_Plans.pdf | ||
| RFP_Y26-151-KK.pdf | ||
| Attachment_F_-_Census.xlsx | XLSX spreadsheet | |
| Attachment_E_-_Fee_Schedule_Worksheet.docx | DOCX document | |
| Attachment_D_-_Pharmacy_Directory_.xlsx | XLSX spreadsheet | |
| Attachment_B_-_Proposal_Worksheet.docx | DOCX document | |
| Attachment_A_-_Mandatory_Features_Checklist.docx | DOCX document |
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Text version
Sheet1
| Company Name: | |||
| INSTRUCTIONS: Complete the worksheet below by providing the specific formulary tier for each drug listed. Use your current formulary list . Use "Generic", "Preferred Brand" or "Non-Preferred Brand", "Specialty". Do not re-sort. | |||
| Low Plan | High Plan | ||
| NDC | Drug Name | Classification | Classification |
| 59572050221 | POMALYST CAP 2MG | ||
| 57894006103 | STELARA INJ 90MG/ML | ||
| 00078060715 | GILENYA CAP 0.5MG | ||
| 58468021002 | AUBAGIO TAB 14MG | ||
| 00074433902 | HUMIRA PEN INJ 40MG/0.8 | ||
| 00074379902 | HUMIRA KIT 40MG/0.8 | ||
| 58406043504 | ENBREL INJ 50MG/ML | ||
| 00003089421 | ELIQUIS TAB 5MG | ||
| 58468021004 | AUBAGIO TAB 14MG | ||
| 61958200201 | DESCOVY TAB 200/25 | ||
| 00006027782 | JANUVIA TAB 100MG | ||
| 62559052101 | INDERAL LA CAP 80MG | ||
| 00002879959 | HUMALOG KWIK INJ 100/ML | ||
| 00002143480 | TRULICITY INJ 1.5/0.5 | ||
| 00173088710 | TRELEGY AER ELLIPTA | ||
| 00169266015 | TRESIBA FLEX INJ 100UNIT | ||
| 00088221905 | LANTUS SOLOS INJ 100/ML | ||
| 00051846233 | ANDROGEL GEL 1.62% | ||
| 58406002104 | ENBREL INJ 50MG/ML | ||
| 69865026501 | NUCYNTA ER TAB 250MG | ||
| 00169255013 | TRESIBA FLEX INJ 200UNIT | ||
| 50458057990 | XARELTO TAB 20MG | ||
| 00006057561 | JANUMET TAB 50-500MG | ||
| 00310621030 | FARXIGA TAB 10MG | ||
| 64764017530 | DEXILANT CAP 60MG DR | ||
| 00169406012 | VICTOZA INJ 18MG/3ML | ||
| 69097091402 | OMEPRA/BICAR CAP 40-1100 | ||
| 00023916330 | RESTASIS EMU 0.05% | ||
| 00078077720 | ENTRESTO TAB 49-51MG | ||
| 50458014130 | INVOKANA TAB 300MG | ||
| 67877049090 | EZETIMIBE TAB 10MG | ||
| 00310654004 | BYDUREON BC INJ 2/0.85ML | ||
| 45802075401 | TESTOSTERONE GEL 1.62% | ||
| 61958100301 | RANEXA TAB 500MG | ||
| 00002840001 | FORTEO SOL 600/2.4 | ||
| 00032301628 | CREON CAP 36000UNT | ||
| 00024576105 | SOLIQUA INJ 100/33 | ||
| 00032122401 | CREON CAP 24000UNT | ||
| 00597010061 | SPIRIVA SPR 2.5MCG | ||
| 00006027754 | JANUVIA TAB 100MG | ||
| 45802004475 | ACYCLOVIR CRE 5% | ||
| 66869020490 | LIVALO TAB 2MG | ||
| 00006027731 | JANUVIA TAB 100MG | ||
| 00597016061 | SPIRIVA AER 1.25MCG | ||
| 00456120130 | LINZESS CAP 145MCG | ||
| 00169643810 | LEVEMIR INJ FLEXTOUC | ||
| 00023320503 | LUMIGAN SOL 0.01% | ||
| 00169406013 | VICTOZA INJ 18MG/3ML | ||
| 00597015330 | JARDIANCE TAB 25MG | ||
| 00009519101 | DETROL LA CAP 4MG | ||
| 00006008131 | JANUMET XR TAB 100-1000 | ||
| 00078065920 | ENTRESTO TAB 24-26MG | ||
| 50458057830 | XARELTO TAB 15MG | ||
| 00024586903 | TOUJEO SOLO INJ 300IU/ML | ||
| 00173085910 | BREO ELLIPTA INH 100-25 | ||
| 61958100401 | RANEXA TAB 1000MG | ||
| 00186077760 | BRILINTA TAB 90MG | ||
| 00006057782 | JANUMET TAB 50-1000 | ||
| 72733590102 | PRALUENT INJ 75MG/ML | ||
| 00169413602 | OZEMPIC INJ 2/1.5ML | ||
| 69865026002 | NUCYNTA ER TAB 200MG | ||
| 00597036055 | PRADAXA CAP 150MG | ||
| 50458057930 | XARELTO TAB 20MG | ||
| 00002879759 | HUMALOG MIX INJ 75/25KWP | ||
| 24510029160 | NUCYNTA ER TAB 250MG | ||
| 00002771227 | HUMALOG KWIK INJ 200/ML | ||
| 00024414260 | MULTAQ TAB 400MG | ||
| 00069024430 | TOVIAZ TAB 8MG | ||
| 65597011630 | TRIBENZOR40- TAB 5-25MG | ||
| 00310075190 | CRESTOR TAB 10MG | ||
| 00173069500 | ADVAIR DISKU AER 100/50 | ||
| 00023614230 | RAPAFLO CAP 8MG | ||
| 00006057762 | JANUMET TAB 50-1000 | ||
| 65976010001 | ARESTIN MIS 1MG | ||
| 00186037020 | SYMBICORT AER 160-4.5 | ||
| 50458058030 | XARELTO TAB 10MG | ||
| 00597014030 | TRADJENTA TAB 5MG | ||
| 00456122830 | NAMZARIC CAP 28-10MG | ||
| 00310626060 | XIGDUO XR TAB 5-1000MG | ||
| 00456112030 | VIIBRYD TAB 20MG | ||
| 00002751001 | HUMALOG INJ 100/ML | ||
| 00597014090 | TRADJENTA TAB 5MG | ||
| 00078051205 | TEGRETOL-XR TAB 400MG | ||
| 64764075030 | TRINTELLIX TAB 20MG | ||
| 00173069600 | ADVAIR DISKU AER 250/50 | ||
| 00591292418 | TESTOSTERONE GEL 1.62% | ||
| 49884000702 | ASA/DIPYRIDA CAP 25-200MG | ||
| 00054033425 | CEVIMELINE CAP 30MG | ||
| 58160082311 | SHINGRIX INJ 50MCG | ||
| 00024590102 | PRALUENT INJ 75MG/ML | ||
| 57664066383 | CARVEDILOL CAP 10MG ER | ||
| 00173088210 | BREO ELLIPTA INH 200-25 | ||
| 00597028090 | SYNJARDY XR TAB 10-1000 | ||
| 00591352530 | LIDOCAINE PAD 5% | ||
| 24208060203 | PROLENSA SOL 0.07% | ||
| 00093301756 | TADALAFIL TAB 5MG | ||
| 55513080060 | CORLANOR TAB 5MG | ||
| 50458014030 | INVOKANA TAB 100MG | ||
| 00597029578 | SYNJARDY XR TAB 25-1000 | ||
| 68180022301 | NIACIN ER TAB 1000MG |
&"-,Bold"ATTACHMENT C
PHARMACY DRUG PLAN FORMULARY
File details come from the government source that posted it. Updated .