COLB - Cost Proposal Template .xlsx
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- Attached to
- Pharmacy Benefits Management Services
- Solicitation number
- HR-24-389
- Issued by
- Los Angeles County, California
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INTERNAL RFP Builder
| Variable Requirement | RFP Fact: | One Time | |
| Core Client Details | Client Name (Full Legal Name) | City of Long Beach | |
| Client Name (SHORT) | COLB | ||
| Industry | Muncipality | ||
| About Company | Long Beach is a city in Los Angeles County, California. It is the 42nd-most populous city in the United States, with a population of 466,742 as of 2020. A charter city, Long Beach is the seventh-most populous city in California. |
Incorporated in 1897, Long Beach lies in Southern California in the southern part of Los Angeles County.Long Beach is approximately 20 miles (32 km) south of downtown Los Angeles, and is part of the Gateway Cities region. The Port of Long Beach is the second busiest container port in the United States and is among the world's largest shipping ports. The city is over an oilfield with minor wells both directly beneath the city as well as offshore.
The city is known for its waterfront attractions, including the permanently docked RMS Queen Mary and the Aquarium of the Pacific. Long Beach also hosts the Grand Prix of Long Beach, an IndyCar race and the Long Beach Pride Festival and Parade. California State University, Long Beach, one of the largest universities in California by enrollment, is within the city.
| Plan Design(s) Description | Detailed plan designs have been provided in the attached SPDs for your reference. | |
| Demographic Summary and Headcount | Active, Early Retirees and 65+ Medicare Retiress| 5,200 enrolled subscribers and 13,200 members | |
| Current PBM | CVS Caremark | |
| Current Medical Vendor | Anthem Blue Cross | |
| Timezone | Pacific | |
| Plan Effective Date | January 1, 2025 | |
| RFP Release | ||
| Decision Deadline | ||
| Pharmacy Consultant Reporting | ||
| Timeline | Release RFP | |
| Intent to bid due | ||
| PBM questions in writing via e-mail | ||
| Alliant Respond to Questions to all Service Providers | ||
| RFP responses due from Service Providers | ||
| RFP Evaluations and Selection of Finalists | ||
| Final Negotiations | ||
| Finalist Presentations | ||
| Notification to Service Providers (or earlier) | ||
| Implementation Begins | ||
| Plan Effective Date | 1/1/25 | |
| Plan Details | Deal Type | Both Traditional and Transparent |
| Network | Broadest National | |
| Formulary | Formulary without Exclusions | |
| Mail Order | Open Mail Order (no restrictions) | |
| Clinical Management | Clinically Managed (most edits) | |
| Specialty | Open Specialty |
Financial Questionnaire
| City of Long Beach | Effective Date: | January 1, 2025 | ||||||||||||
| PBM RFP Questionnaire | ||||||||||||||
| Provide response and confirm agreement to each standard as requested in the yellow shaded cells. Please include all required attachments as requested in the body of the RFP Questionnaire. | ||||||||||||||
| PBM Questionnaire | Service Provider Respondent 1 [Enter NAME] | Please Select | Rebate Payment | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | |||
| Article No. | Question/Prompt | Scored Response | Notes & Explanations | Yes (Explanation Required) | Please Select | Please Select | Attached | Confirmed | Yes | Yes, Explain | Yes | Confirmed | Yes | Included |
| No | 30 days | 60 Days Post Earned Quarter | Not Provided | Not Confirmed | No | No, Explain | No | Not Confirmed | No | Excluded | ||||
| Financial Information and Fee Quotation | ||||||||||||||
| 1 | The purpose of this request is to outline and define the pricing parameters and request your pricing proposals for City of Long Beach, which is interested in evaluating Traditional & Transparent financial proposals. | |||||||||||||
| 2 | The goal is to structure the pricing and related contract language to ensure all parties are clear as to how drugs are classified and related pricing. It is our intent to audit this contract (claims and rebates); therefore, all pricing components need to be clearly defined, identifiable and auditable. Your pricing should assume all requirements as outlined in this RFP. It is our objective for you to comply with all these parameters. If there are any deviations from this request, a detailed explanation as to why the request cannot be met must be provided. |
The Respondent's pricing proposal should assume the following general guidance:
| 3 | Broadest National participating pharmacy network | ||
| 4 | Open Mail Order (no restrictions) | ||
| 5 | Exclusive Specialty (including client owned pharmacies) | ||
| 6 | Clinically Managed (most edits) or similar programs currently as elected | ||
| 7 | Formularies both with and without Exclusions | ||
| 8 | City of Long Beach's specific plan designs for all covered participants (as outlined in the RFP request) | ||
| 9 | All pricing should be "unbundled" | ||
| 10 | Three year pricing contract including the right to conduct an annual market check with annual pricing guarantee escalators | ||
| 11 | Drug classifications as exclusively determined by third party (Medispan) | ||
| 12 | Competitive clinical program fees (if any) with clear return on investment | ||
| Financial/Pricing Requirements | |||
| 14 | Vendor pricing proposals are guaranteed for a three year term (effective January 1, 2025) for City of Long Beach, with two successive one year optional renewal periods. | Please Select | |
| 15 | Respondent will allow 90 day mail order discounts at retail 90 channel if requested. If “Confirmed”, separately included another column within the Network Match Analysis in Attachment 12 identifying chains that are included in your 90 day retail network. | Please Select | |
| 16 | Average Wholesale Price (AWP) for individual claims will not be an average and will not in any way be calculated or adjusted or assigned an alternate NDC number or date. | Please Select | |
| 17 | Respondent will use one, consistent source for AWP, which will not be changed based on internal methodologies. Should a different AWP source be required to be implemented during a contract year, Respondent agrees to provide at least 90 day written notice as well as financial analysis confirming economic equivalence of the deal to these agreed upon terms to ensure there will not be any negative impacted as a result of the change. | Please Select | |
| 18 | Respondent will apply pricing based on the actual package size used to dispense at retail, mail, and specialty, using an NDC-11 code on the date of service as submitted by the provider. | Please Select | |
| 19 | Respondent will not use prices for repackaged pharmaceuticals for reimbursement calculations that result in a higher price per unit than the original product. | Please Select | |
| 20 | Retail prescriptions will be adjudicated such that the member always pays the lowest of the contracted price, U&C price (including the pharmacy's sale price, if any), or the plan copayment/coinsurance amount. | Please Select | |
| 21 | Mail order prescriptions will be adjudicated such that the member always pays the lower of the discounted ingredient cost or the contracted price of the prescription or the plan copay/coinsurance amount. | Please Select | |
| 22 | Pricing, guarantees, and reconciliations for all terms (discounts, dispensing fees, rebates, etc.) do not vary between plans. All of the client plan designs should be considered and included in your proposed pricing guarantee offer. Any variation in contracting terms or performance guarantees that are unique to these plan types should be explicitly explained both in this Questionnaire as well as in the Pricing Commitment Offer | Please Select | |
| 23 | Pricing guarantee (i.e., ingredient cost discounts, dispensing fees) performance at year- end will be measured and reconciled individually, there will not be any offsets within channel or in aggregate. | Please Select | |
| 24 | Respondent confirms that no element of the provided pricing offer(s) are contingent on participation in any proposed clinical management programs other than programs specifically requested or in place today for City of Long Beach. | Please Select | |
| 25 | Respondent confirms understanding that only selected finalists will submit a best and final offer; and acceptance of only one best and final offer is anticipated. Additional offers will not be accepted. | Please Select | |
| Generic Drug Pricing Requirements | |||
| 27 | Single Source Generics (SSG) should be defined as generic drugs manufactured by only ONE manufacturer, classified as generic by Medispan and commonly known in the marketplace as a generic drug. | Please Select | |
| 28 | The generic discount guarantees will not exclude any generic products, as provided in our definition of Generic Drug. Please note that “Generic Drug” includes all products involved in patent litigation, Single Source Generic Drugs, Multi-Source Generic Drugs, house generics and Generic Drugs that may only be available in a limited supply. Respondent acknowledges that all uses of the term “Generic Drug” throughout this RFP refer to this definition. | Please Select | |
| 29 | Respondent will include all prescription drugs subject to patent litigation in the respective guarantees (brand and generic discounts and dispensing fees, rebates). | Please Select | |
| 30 | Respondent will use the same MAC list and prices for both pharmacy reimbursement and charges to City of Long Beach, for both retail and mail order. | Please Select | |
| 31 | Respondent will employ the MAC list in conjunction with related generic drug pricing tactics to ensure the maximum aggregate generic drug discount is realized and not simply manage towards the overall effective generic discount guarantees. | Please Select | |
| 32 | Respondent will apply the “lower of” (discount price, or U&C) pricing provision to all drugs including those with a MAC price. “House generics” or any brand drug filled in lieu of a generic for supply or any other reasons will be classified and priced as a generic. | Please Select | |
| 33 | Respondent agrees to manage generic channel discount performance to no lower than a 1.5% shortfall of the aggregate generic guarantee in any given quarter. | Please Select | |
| 34 | Respondent agrees to provideCity of Long Beach/Alliant with an electronic file of the complete MAC list and price, with drugs listed by NDC or GCN sequence number, upon award of the business and at least two (2) times per year during the contract period. | Please Select | |
| 35 | Respondent agrees to apply MAC price cost controls to any single-source brand drugs after the second generic drug is available in the market. | Please Select | |
| 36 | Respondent will not use Zero Balance Logic in its retail pharmacy network, and the members will always pay the lowest of U&C, discounted ingredient cost, MAC price, or copay/coinsurance amount. | Please Select | |
| Transparent Pricing Provisions | |||
| 38 | Confirm to contractually agree and provide a proposal aligning with the following definition of transparency: Transparency is defined as a financial arrangement which represents a 100% direct and complete pass through of all elements of the PBM's financial arrangements including, but not limited to, discounts, dispensing fees, rebates, administrative service incentive fees, etc., for retail, mail order, and specialty pharmacies by the PBM for a fixed and guaranteed administrative fee. Rebates are defined as any element of compensation or credits received from any pharmaceutical manufacturer derived from plan utilization. The PBM will not retain any pricing differential or spread between the amount paid to the PBM by the plan and the payments made by the PBM to the pharmacies. | Please Select | |
| 39 | Agree to offer pricing guarantees that are considered “floor” or minimum guarantees and are to be calculated/reconciled with the excess value, including on maximum allowable cost (MAC) performance, to be passed along to City of Long Beach. | Please Select | |
| 40 | Respondent agrees that pricing is guaranteed on an annual basis, with annual measurement and reconciliation of actual results versus guarantees. | Please Select | |
| 41 | Respondent will true up eachCity of Long Beach component pricing guarantee on an annual basis by a written report within 45 days of each quarter end (with the exception of the rebate guarantee true up). | Please Select | |
| 42 | Respondent will true up City of Long Beach rebate guarantees on an annual basis within 120 post the contract year end. | ||
| 43 | Respondent agrees to not charge a minimum charge at retail. | ||
| 44 | Respondent agrees to not charge a minimum charge at mail. | Please Select | |
| 45 | Respondent agrees not to charge different prices at mail for day supplies less than 90. | Please Select | |
| 46 | Respondent will pass through changes to retail pharmacy network contracts at the time of the change directly to City of Long Beach for transparent pricing. | Please Select | |
| 47 | Respondent agrees to provide detailed guarantee reporting, including all supporting detail for all pricing reconciliations (inclusive of excluded claim reporting) at no additional cost. | Please Select | |
| 48 | Provide as Attachment 15 the Pricing Commitment Offer with all contract terms associated with pricing guarantees including, but not limited to, limits, exclusions, variances, and adjustments that can be applied by Respondent when calculating guarantee achievement. Any pricing contingency or requirement must align with RFP Questionnaire responses. | Please Select | |
| Drug Classification Requirements | |||
| 50 | All drugs will be included within the minimum guarantees. With the exception of compound drugs, Indian Health/VA Pharmacy claims, Vaccines, and Coordination of Benefit claims, there will be NO other drugs excluded from these guarantees. | Please Select | |
| 51 | The reconciliation of all pricing guarantees will be reported and individually reconciled without offsets rather than in the aggregate with offsets of any one surplus or shortfall allowed, i.e., each pricing term shall stand on its own. | Please Select | |
| 52 | Specialty pharmacy claims dispensed at retail (not from the specialty pharmacy) will be included in the respective retail channel pricing guarantees. | Please Select | |
| 53 | The ingredient cost used in the claim adjudication (NCPDP D.0 format) shall be the exact ingredient cost used in the measurement and reporting of AWP discount guarantees in the contract without any adjustments to the surplus or shortfall reported after the discount achieved is calculated. | Please Select | |
| 54 | Measurement of retail and mail brand AWP discount guarantees will NOT include Generic Drugs | Please Select | |
| 55 | Retail and mail generic AWP discount guarantee includes: all Generic Drugs (including Single Source generics), either MAC or Non-MAC. | Please Select | |
| 56 | Compound drugs should be priced at the agreed upon discount off of AWP as stated per brand and generic drugs, but not included in the calculation of minimum brand and generic pricing guarantees. | Please Select | |
| 57 | Claims dispensed with a Dispense As Written (DAW) code 5 will be considered Generic Drugs for the purposes of discounts and dispensing fees and included within their respective Generic contractual guarantees. | Please Select | |
| 58 | No day supply limitations apply for claims at the mail order channel to be included at mail order pricing guarantees. | Please Select | |
| Formulary Rebate Requirements | |||
| 60 | Formulary rebates will be defined as being inclusive of all drug company revenues provided to the plan, plus any other revenues associated with other drug company or third-party payments, including, but not limited to, payments related to administrative fees, aggregate utilization rebates (e.g., book of business/market share fees/payments), educational payments, information sales. Confirm that this applies for all pricing offers provided. | Please Select | |
| 61 | Confirm that your definition of "Rebates" includes monies collected from drug manufacturers who have exceeded AWP price inflation protection thresholds in your contract, and that 100% of those monies will be passed on toCity of Long Beach. | Please Select | |
| 62 | Manufacturer administrative fees will be included in the definition of rebates, and will likewise be passed through 100% toCity of Long Beach. | Please Select | |
| 63 | City of Long Beach will receive all rebates earned up-through the period of termination of this Program. | Please Select | |
| 64 | Formulary rebates on specialty drugs will be passed on 100% to City of Long Beach as required in this RFP. | Please Select | |
| 65 | City of Long Beach will receive a prepayment of quarterly formulary rebate guarantees within 90 days of that quarter's close. | Please Select | |
| 66 | Indicate the rebate payment timing offered (note the payment timing preferred is 90 days post quarter's close). | Please Select | |
| 67 | Confirm that quarterly rebates will be paid at the minimum guarantee levels in your proposal, with annual true-up/reconciliation for full pass-through above the guarantees up to 100% of total rebates earned under a Transparency model. | Please Select | |
| 68 | All rebate reporting will be provided by the Account Team on a quarterly basis, with annual reconciliation provided within 120 days of quarter end. | Please Select | |
| 69 | Any adjustment in formulary rebates will be made with proper notice and will only be on a prospective basis, and that drug recalls, early patent expirations, etc. will not result in an adjustment of rebate guarantees unless you provide reports to substantiate impact to the plan of >10% impact on an individual drug basis. | Please Select | |
| 70 | Confirm that rebate reporting will include line item details of these additional "rebates" in the form of AWP price inflation protection clauses in your pharmaceutical manufacturer contracts. | Please Select | |
| 71 | When patient assistance programs are accepted or included as a part of your offer, Respondent confirms that rebates will not be debited to collect fees. All savings and fees for these programs will be itemized separately. | ||
| 72 | Provide your assumed brand claim count figures for the 12 months beginning for each of the three years on which your rebate proposal is based, for each of the following: Retail, Mail, Specialty. As applicable, show results split by two tier and three tier non-qualifying plan designs from qualifying three tier plan designs. | ||
| 73 | Confirm that rebates are minimums and that pass-through of rebates above the guarantees can be expected. | Please Select | |
| Strictly based on the claims file provided and corresponding time period, provide your rebate-eligible “per brand Rx” claim count. | |||
| 75 | Retail 30 | ||
| 76 | Retail 90 | ||
| 77 | |||
| 78 | Specialty | ||
| Clarify whether the following are included/excluded from rebate guarantees: | |||
| 80 | $0 plan paid claims (deductible phase) | Please Select | |
| 81 | Specialty Brands dispensed at retail, including HIV & Transplant | Please Select | |
| 82 | Which guarantee applies for HIV? | ||
| 83 | Which guarantee applies for Transplant? | ||
| 84 | Multi-Source Brand claims | Please Select | |
| 85 | LDD or Exclusive Specialty products | Please Select | |
| 86 | Brand over Generic products | Please Select | |
| 87 | >50% member cost share claims | Please Select | |
| 88 | 100% member cost share claims | Please Select | |
| 89 | OTCs | Please Select | |
| 90 | Non-drug items (including diabetic supplies/insulin) | Please Select | |
| 91 | New-to-market specialty | Please Select | |
| 92 | New-to-market traditional | Please Select | |
| 93 | Copay coupon dollars (e.g. variable coupon program) | Please Select | |
| 94 | Specialty pharmacy claims that use manufacturer copay assistance and put plan spend below 50%. | Please Select | |
| 95 | Biosimilar products | Please Select | |
| 96 | Confirm that claims dispensed with a Dispense As Written (DAW) code 1 are included in the rebate guarantees. | Please Select | |
| 97 | Confirm that claims dispensed with a Dispense As Written (DAW) code 2 are included in the rebate guarantees. | Please Select | |
| 98 | Confirm that claims dispensed with a Dispense As Written (DAW) code 5 are included in the rebate guarantees. | Please Select | |
| 99 | Confirm that claims dispensed with a Dispense As Written (DAW) code 9 are included in the rebate guarantees. | Please Select | |
| 100 | Claims with ancillary charges (e.g. DAW, vaccine administration charges) | Please Select | |
| 101 | Any others not listed above: | ||
| 102 | Describe your policy regarding whether the brand guarantees assume any restrictions on grandfathering and if so, what the maximum days allowed are, if any. | Please Select | |
| 103 | Describe your efforts at implementing any type of discount or rebate enhancement tied to member clinical outcomes. Specify which therapeutic categories for which you have done this and provide an overview of the clinical measurement criteria and savings potential. How and when are they measured and reported? | ||
| Prescription Drug Pricing | |||
| Listed below is the required claims pricing logic to be applied in each category for your proposal. Please confirm your agreement with each component. Deviations from this claims pricing logic may result in disqualification of the Respondent and should be avoided at all cost. | |||
| 106 | Pass Through Pricing: Confirm, or Explain Deviation | Please Select | |
| 107 | Single Source Brand : Confirm, or Explain Deviation | Please Select | |
| 108 | Multi Source Brand : Confirm, or Explain Deviation | Please Select | |
| 109 | Single Source Generic : Confirm, or Explain Deviation | Please Select | |
| 110 | Multi Source Generic : Confirm, or Explain Deviation | Please Select | |
| 111 | Patent Litigated Claims : Confirm, or Explain Deviation | Please Select | |
| 112 | House Generics or DAW 5 : Confirm, or Explain Deviation | Please Select | |
| 113 | Limited Distribution Drugs : Confirm, or Explain Deviation | Please Select | |
| 114 | U&C : Confirm, or Explain Deviation | Please Select | |
| 115 | Zero Balance Logic/Zero Balance Due Claims: Confirm, or Explain Deviation | Please Select | |
| 116 | Compound : Confirm, or Explain Deviation | Please Select | |
| 117 | OTCs : Confirm, or Explain Deviation | Please Select | |
| 118 | Non-drug items (including diabetic supplies/insulin): Confirm, or Explain Deviation | Please Select | |
| 119 | Specialty : Confirm, or Explain Deviation | Please Select | |
| 120 | New to Market Traditional Drugs: Confirm, or Explain Deviation | Please Select | |
| 121 | New to Market Specialty Drugs: Confirm, or Explain Deviation | Please Select | |
| 122 | Biosimilar : Confirm, or Explain Deviation | Please Select | |
| 123 | Vaccines : Confirm, or Explain Deviation | Please Select | |
| 124 | Drugs in Limited Supply : Confirm, or Explain Deviation | Please Select | |
| 125 | Direct/paper claims : Confirm, or Explain Deviation | Please Select | |
| 126 | Out of network claims : Confirm, or Explain Deviation | Please Select | |
| 127 | Any other claims excluded (not listed above) - please specify and explain adjudication logic | Please Select | |
| 128 | Details | Please Select | |
| 129 | Please provide your pricing document supporting your completion of the above tables as Attachment 15, including any and all considerations and assumptions as well as complete the headline rate pricing outline. | Please Select | |
| 130 | Provide the guaranteed AWP discount rate for any MAC'd specialty drug. | ||
| 131 | For Specialty OED, do you allow a 100% pass-through above the guarantee or not? | Please Select | |
| 132 | How are specialty drugs outside of your exclusive specialty pharmacy accounted for in the pricing reconciliation? | ||
| 133 | How are new-to-market specialty drugs priced? Are they subject to OED, and if not, what rate? | ||
| 134 | How do you price a specialty drug that does not appear on Respondent's specialty drug list? | ||
| 135 | Does your specialty drug discount guarantee include all limited distribution products you consider specialty, even products for which you do not have distribution? | Please Select | |
| 136 | Confirm that Respondent will not adjust the therapeutic structure of the specialty list; i.e. moving therapeutic categories on or off. | Please Select | |
| 137 | Indicate for each 12 months of the three year period what, if any, shifts assumptions for channel, formulary, clinical, or headcounts that were assumed. Provide both on a percent of total Rx's and percent of total dollars basis. | % | |
| 138 | Confirm if there are any day supply or member cost share requirements in your offer that are required to be met in order to avoid future negative adjustments during the contract. | ||
| 139 | Describe any key market share shifts to preferred products that are required in order to support your offer. Confirm whether any of these would be new edits for City of Long Beach's membership. If so, provide the count and % of members affected by targeted drug, and the drug which is assumed to pick up the additional market share. | % | |
| Please indicate if the items below are included in your proposed pricing or supplemental. If they are priced separately, please provide a listing of all proposed fees in your proposal. | Confirm included in standard offering | Please indicate any applicable fees and the modality for such charges |
(per claim, per incidence, PMPM, PEPM, etc…)
| 141 | CDH administration | Please Select | $ - 0 |
| 142 | Integrated Rx and medical OOP maximum administration | Please Select | $ - 0 |
| 143 | Claim Re-Pricing to Medical Carrier | Please Select | $ - 0 |
| 144 | Paper Claims Processing | Please Select | $ - 0 |
| 145 | E-prescribed claims | Please Select | $ - 0 |
| 146 | ERISA Appeals Management | Please Select | $ - 0 |
| 147 | Formulary Management | Please Select | $ - 0 |
| 148 | High Utilization Management | Please Select | $ - 0 |
| 149 | Audit Recovery Fees | Please Select | $ - 0 |
| 150 | Opioid Management Fees | Please Select | $ - 0 |
| 151 | Annual EOB Statements | Please Select | $ - 0 |
| 152 | Ad-hoc coding or querying | Please Select | $ - 0 |
| 153 | Physician Profiling and Intervention | Please Select | $ - 0 |
| 154 | Retrospective Case Management | Please Select | $ - 0 |
| 155 | FULL Fiduciary Responsibility | Please Select | $ - 0 |
| 156 | Audits | Please Select | $ - 0 |
| 157 | COB Investigation | Please Select | $ - 0 |
| 158 | Pharmacy Directories (other than chain listing) | Please Select | $ - 0 |
| 159 | New Member Welcome Kits | Please Select | $ - 0 |
| 160 | Eligibility Verification | Please Select | $ - 0 |
| 161 | Government Forms | Please Select | $ - 0 |
| 162 | ID Cards: Standard Custom | Please Select | $ - 0 |
| 163 | Member Education Mailings | Please Select | $ - 0 |
| 164 | Plan Documents | Please Select | $ - 0 |
| 165 | Reports: Standard Management Reports including Specialty Pharmacy Customized Reports | Please Select | $ - 0 |
| 166 | Electronic Access to Reporting, Eligibility and Claims | Please Select | $ - 0 |
| 167 | Medicare B Claim Coordination/Subrogation Processing | Please Select | $ - 0 |
| 168 | DUR Interventions | Please Select | $ - 0 |
| 169 | Utilization Review Pharmacy Management | Please Select | $ - 0 |
| 170 | Concurrent Case Management | Please Select | $ - 0 |
| 171 | Medicaid Subrogation Processing | Please Select | $ - 0 |
| 172 | Banking Arrangement Setup | Please Select | $ - 0 |
| 173 | Actuarial Services (accrual rate development, estimates on benefit changes) | Please Select | $ - 0 |
| 174 | Mail Service Shipping | Please Select | $ - 0 |
| 175 | Mail Order Supplies for Specialty Pharmacy | Please Select | $ - 0 |
| 176 | Formulary Booklets for Members | Please Select | $ - 0 |
| 177 | Clinical/Utilization Management Programs | Please Select | $ - 0 |
| 178 | Collect and validate Medicare HICN | Please Select | $ - 0 |
| 179 | Medication Therapy Management (MTM) Program | Please Select | $ - 0 |
| 180 | Benefit Consultation and Actuarial Equivalence validation | Please Select | $ - 0 |
| 181 | Manual/paper enrollment for Medicare plans | Please Select | $ - 0 |
| 182 | Please list all clinical programs and their price if not included in base administrative fee | Please Select | $ - 0 |
| 183 | Accept medical claims information to track specialty pharmacy outcomes/savings and produce reports | Please Select | $ - 0 |
| 184 | Other fees or charges not mentioned above: Please list | Please Select | $ - 0 |
Exhibit 1 Pricing Outline
| City of Long Beach | Traditional Pricing Offer | Transparent Pass-Through Pricing Offer |
| Headline Summary Pricing Outline |
Provide guaranteed headline pricing guarantees and confirm agreement as requested in the yellow shaded cells for both the Traditional & Transparent Offers. Please supply your projections below for validation and include your full detailed Pricing Commitment Offers as Attachment 15 as requested in the RFP Questionnaire.
| Pricing Component | 2025 | ||
| Traditional | 2026 | ||
| Traditional | 2027 | ||
| Traditional | 2025 | ||
| Transparent Pass-Through | 2026 | ||
| Transparent Pass-Through | 2027 |
Transparent Pass-Through
| Reconfirm Pricing Terms are Guaranteed | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | ||||||
| Net Administrative Fee | $0.00 | Please Select | $0.00 | Please Select | $0.00 | Please Select | $0.00 | Please Select | $0.00 | Please Select | $0.00 | Please Select |
| Network Arrangement Quoted (Name and Pharmacies) | Network Name | - 0 | Network Name | - 0 | Network Name | - 0 | Network Name | - 0 | Network Name | - 0 | Network Name | - 0 |
| Pricing Reconciliation (non-rebate) Timing | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | ||||||
| Rebate Type | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | ||||||
| Rebate Payment Frequency | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | ||||||
| Rebate Reconciliation Timing | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | ||||||
| Rebate Payment Basis | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select |
| Channel Discounts | |||||||||||||||||
| (Headline Guarantees) | Guarantee Basis | Brand | Generic | Brand | Generic | Brand | Generic | Brand | Generic | Brand | Generic | Brand | Generic | ||||
| Retail 30 Discounts | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | |||||
| Retail 30 Dispensing Fees | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| Retail 90 Discounts | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | |||||
| Retail 90 Dispensing Fees | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| Mail Discounts | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | |||||
| Mail Dispensing Fees | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| Specialty Open Discounts | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | |||||
| Specialty Open Dispensing Fees | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| Specialty Exclusive Discounts | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | |||||
| Specialty Exclusive Dispensing Fees | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Rebate Guarantees | ||||||||||||||||||||||||
| (2 Tier /3 tier Non-Qualifying) | No exclusions | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | |||||||||||||||||
| Retail | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||||||||
| Retail 90 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | Guaranteed | Offsets | Deal Type | Retail Network | Specialty Arrangement | Design Type | Rebate Type | Payment Frequency | Reconciliation Frequency | Rebate Payment Basis | Y/N. | Include/Exclude | Lowest of Logic | ZBC/U&C | ||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | Please Select | |||||
| Specialty Retail (Open) | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | Guaranteed | Offset Rebates | Traditional | Broad National | Open Specialty | Integrated | No Rebates | N/A | N/A | PMPM | Yes | Included | Lower of Discount or Copay | Included at 100% discount or excluded | ||||
| Specialty Mail (Open) | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | Estimates Only | Offset within Channel | Transparent | Narrow | Exclusive Specialty | Rx Only | Estimated - Not Guaranteed | Monthly | Prepay Flat Guarantees Only | PEPM | No | Excluded | Lowest of Discount, U&C, or Copay | Included at run rate (not 100%) | ||||
| Specialty Retail (Exclusive) | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
File details come from the government source that posted it. Updated .