Attachment_C_-_Pharmacy_Drug_Plan_Formulary.xlsx

This is a pharmacy drug plan formulary worksheet for Orange County, Florida's Medicare Supplemental Plans and Medicare Part D Employer Group Waiver Plans solicitation (Y26-151). The formulary document serves as a template requiring proposers to classify 100 specific pharmaceutical drugs across two plan levels—Low Plan and High Plan—using four tier designations: Generic, Preferred Brand, Non-Preferred Brand, and Specialty. The drugs listed span multiple therapeutic categories including diabetes management (Januvia, Trulicity, Jardiance, Synjardy XR), anticoagulation (Eliquis, Xarelto, Brilinta, Pradaxa), cardiovascular treatment (Entresto, Multaq, Crestor, Tribenzor), immunosuppression (Humira, Enbrel, Stelara, Gilenya), specialty medications (Pomalyst, Aubagio), and other chronic condition treatments (Lantus, Humalog, Levemir, Victoza). Proposers must complete this worksheet using their current formulary lists without resorting the drug order, providing the specific tier classification for each National Drug Code (NDC) listed for both the low and high plan options. The submission deadline for sealed proposals is 4:00 PM EST on May 7, 2026, with an alternate deadline of June 11, 2026, through the OpenGov e-Procurement Platform, and the contract term commences January 1, 2027, for three years with two optional one-year renewals.

The formulary worksheet reflects the County's requirement that qualified insurers demonstrate comprehensive pharmaceutical coverage across multiple disease states and medication classes to serve Orange County retirees and Medicare-eligible dependents across five Florida counties. Proposers must balance cost competitiveness with formulary breadth and accessibility, as the formulary submission directly impacts plan value and competitiveness in the evaluation process where fee schedules constitute 45 of 100 evaluation points. The reference plan pricing provided—$214.97 for the Low Plan and $377.00 for the High Plan—establishes the baseline for comparative cost evaluation. The formulary approach allows the County to assess each proposer's formulary design philosophy and network leverage while ensuring adequate coverage of specialty drugs, biologics, and maintenance medications essential for the Medicare population's complex medical needs.