Attachment D - Formulary Disruption Reporting~1.xlsx
XLSX spreadsheet 11 KB Posted
- Attached to
- Pharmacy Benefit Manager
- Solicitation number
- S000000161
- Issued by
- Pulaski County, Arkansas
About this file
This document is an attachment titled "Formulary Disruption Reporting" related to a state and local contract opportunity for a Pharmacy Benefit Manager in Arkansas. The attachment provides a template for reporting the impact of changes to the formulary, including the percentage of members and scripts affected by no change, positive changes (lower-cost tier), negative changes (higher-cost tier), and drugs moving from covered to not covered/excluded. It requires the reporting of the top 3 drugs moving from covered to not covered/excluded, along with the member and script impact, and the name of the preferred alternative drug.
The contract opportunity is for a Pharmacy Benefit Manager service in the state of Arkansas. No other details about the contract, such as response dates, award dates, or contract term, are provided in this attachment.
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| File | Type | Posted |
|---|---|---|
| Attachment C - Retail Network Disruption Report~1.xlsx | XLSX spreadsheet | |
| Attachment G Arkansas Independents Network.xlsx | XLSX spreadsheet | |
| Contract and Grant Disclosure~17.pdf | ||
| Attachment A - Non-Disclosure Agreement~1.docx | DOCX document | |
| Attachment E - Financial and Formulary Scoring Examples~1.xlsx | XLSX spreadsheet | |
| Attachment F - Specialty Pharmacy Listing- Revised.xlsx | XLSX spreadsheet | |
| S000000161 - Drug Pricing Product Exclusions.xlsx | XLSX spreadsheet | |
| S000000161 Bidders Conference PPT.pdf | ||
| Attachment B - List of Exclusions~1.xlsx | XLSX spreadsheet | |
| S000000161 Cost Workbook.xlsx | XLSX spreadsheet | |
| S000000161 Pharmacy Benefits Manager.pdf | ||
| S000000161 Technical Proposal Packet.docx | DOCX document | |
| S000000161 Q and A.pdf |
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Text version
Sheet1
S000000161 ATTACHMENT D: FORMULARY DISRUPTION REPORTING
| Type of Change | Member Impact | % of Total Members | Number of Scripts Impacted | % of Total Scripts (including all brands and generics) |
| No Change | Integer. | Percent. | Integer. | Percent. |
| Positive (higher-cost tier to lower tier) | Integer. | Percent. | Integer. | Percent. |
| Negative (lower tier to higher-cost tier) | Integer. | Percent. | Integer. | Percent. |
| Moving from covered to not covered/Excluded | Integer. | Percent. | Integer. | Percent. |
| Total | Integer. | Percent. | Integer. | Percent. |
| #1 Drug that is Moving from Covered to Not Covered/Excluded based on impacted Members: [Indicate Member and Script Impact.] | #2 Drug that is Moving from Covered to Not Covered/Excluded based on impacted Members: [Indicate Member and Script Impact.] | #3 Drug that is Moving from Covered to Not Covered/Excluded based on impacted Members: [Indicate Member and Script Impact.] | |
| Name of Drug | 5 words. | 5 words. | 5 words. |
Member Impact Integer. Integer. Integer.
% of Total Members Percent. Percent. Percent.
Number of Scripts Impacted Integer. Integer. Integer.
| % of Total Scripts (including all brands and generics) | Percent. | Percent. | Percent. |
| Name of Preferred Alternative | 5 words. | 5 words. | 5 words. |
File details come from the government source that posted it. Updated .