Cost Sheet.docx
DOCX document 44 KB Posted
- Attached to
- Medicaid Drug Rebate System (MDR)
- Solicitation number
- 124528 ON
- Issued by
- Lancaster County, Nebraska
About this file
This Cost Sheet document is a pricing template for RFP #124528 issued by the State of Nebraska Department of Health and Human Services for the Medicaid Drug Rebate System (MDR). The RFP seeks a qualified vendor to design, develop, test, implement, and operate a comprehensive system to manage Medicaid drug rebates, including rebate calculations, claims processing, vendor management, and reporting with integration across eighteen defined data interfaces. The project is structured in two primary cost components: Part I encompasses five implementation milestones (Requirements and Design, Development and Testing, Data/File Conversion and Migration, Operational Readiness, and Certification), each allocated 20 percent of total implementation fees; Part II covers operational requirements for an initial five-year term and an optional three-year renewal period, with costs submitted on a monthly basis for Operations Requirements and Customer Support. Written questions are due June 23, 2026, and proposals are due July 23, 2026, at 2:00 p.m. Central Time. The evaluation period runs July 30 through August 13, 2026, with an Intent to Award expected August 27, 2026, and contract finalization targeted for September and October 2026 with a January 2027 start date.
All pricing submitted on the cost sheet must remain fixed for the first five years of the contract. Part III addresses optional services including System Enhancements-Change Orders, with associated labor costs utilizing hourly rates by title/role, material costs with vendor-specified markups, equipment costs, and administrative/overhead costs not to exceed 10 percent. Bidders must complete all yellow-highlighted fields and may insert additional line items if essential to meet RFP requirements; however, the total percentage allocation across all Part I categories cannot exceed 100 percent. The Cost Sheet explicitly prohibits the inclusion of fees outside those listed in the pricing table, with mathematical errors resolved in favor of the unit price. Part III costs are excluded from the Grand Total used for cost evaluation, which comprises only the sum of Part I (Project Requirements/Milestones Total) and Part II (Operations Requirements Total for both initial and renewal terms).
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Text version
Cost Sheet
RFP#124528 ON
Medicaid Drug Rebate System State of Nebraska, Department of Health and Human Services
Bidder Name: ________________________________
Important Instructions: Bidders are to complete all fields highlighted in yellow.
Do not alter existing format or content within the Cost Sheet. However, if Bidder identifies that other items are essential in Part I and/or Part II to create full functionality, and meet the requirements as outlined in the RFP document and any related attachments, then additional lines may be inserted as needed. Such additional lines must be included in Part I and Part II pricing and be reflected in the Total Overall Cost. Any inclusion of additional lines must still conform within the stated percentages as outlined in Part I and follow the prescribed format as provided. Important: In case of a mathematical error in extension of price, unit price shall govern.
Prices submitted on the cost sheet once accepted by the DHHS shall remain fixed for the first five years of the contract.
Please indicate the “Grand Total” for the Project Requirements / Milestones and Operation Requirements (Initial and Renewals), this amount shall equal the sum of the Total for both Part I and Part II. “Grand Total” $ _______________. Do not include any costs for Part III in the “Grand Total”, as these sections are not included in the cost evaluation.
Part I: PROJECT REQUIREMENTS / MILESTONES
Project section requirements as outlined in Section (V) of the Request for Proposal (RFP) document and any related attachments. Bidder to provide pricing for each of the project requirements/milestones categories listed. The sum of all project requirement categories listed directly below constitutes the Part I – Total. Important: Bidders are to ensure that allocation of their percentages is based on the % provided for each category and that the total of all categories within Part I does not exceed 100%.
| Project Requirements / Milestones |
| % Breakdown by Milestone |
| Number of Units |
| Unit of Measure (UOM) |
| Cost (Unit Price) |
| Requirements and Design Milestone (Section V.(I)(1)(a)) |
| 20% of Implementation fees |
| 1 |
| Each |
| $ |
| Development and Testing Milestone (Section V.(I)(1)(b)) |
| 20% of Implementation fees |
| 1 |
| Each |
| $ |
| Data/File Conversion and Migration Milestone (Section V.(I)(1)(c)) |
| 20% of Implementation fees |
| 1 |
| Each |
| $ |
| Operational Readiness Milestone (Section V.(I)(1)(d)) |
| 20% of Implementation fees |
| 1 |
| Each |
| $ |
Certification Milestone (Section V.(I)(1)(e)
| 20% of Implementation fees |
| 1 |
| Each |
| $ |
| Project Requirements / Milestones – Total (Part I) |
| $ |
(Remainder of this page intentionally left blank)
Part II: OPERATION REQUIREMENTS AND RENEWALS Bidder’s price for annual operations shall include all associated costs or fees (including but not limited to subscriptions costs).
Important: Do not include statements in the RFP proposal submittals, attachments, etc. indicating that there will be additional fees which are not included in the table below. The sum of the extended cost (Unit of Measure x Monthly Price) constitutes the extended Annual Cost. Both the Initial Term and Renewal Totals will be evaluated for points associated with Cost.
A. OPERATION REQUIREMENTS (INITIAL TERM OF FIVE YEARS)
(Note: These items would be paid for on a monthly basis).
Part II Operations and Customer Support costs will begin in the first month following completion of Part I and remain fixed for the duration of the initial term of five years.
| Operations Requirements |
| Estimated Contract Term |
| Unit of Measure (UOM) |
| Cost |
(Monthly Price) Extended Annual Cost
| Operation Requirements (Section V.(I)(2)) |
| 48 months |
| Monthly |
| $ |
| $ |
| Customer Support Requirements (Section V.(I)(2)) |
| 48 months |
| Monthly |
| $ |
| $ |
| Operations Requirements – (Initial Term) |
| $ |
B. OPERATION REQUIREMENTS (RENEWAL PERIOD OF THREE YEARS)
(Note: These items would be paid for on a monthly basis).
| Operations Requirements |
| Contract Term |
| Unit of Measure (UOM) |
| Cost |
(Monthly Price) Extended Annual Cost
| Operation Requirements (Section V.(I)(2)) |
| 36 months |
| Monthly |
| $ |
| $ |
| Customer Support Requirements (Section V.(I)(2)) |
| 36 months |
| Monthly |
| $ |
| $ |
| Operations Requirements – (Renewals) |
| $ |
| Operations Requirements – TOTAL (Initial + Renewals) (Part II) |
| $ |
Part III: Optional Services Miscellaneous Support and Enhancements (Do not include these amounts in the “Grand Total” associated with Part I and Part II)
DHHS acknowledges that during the duration of the contract there may be state directed System Enhancements-Change orders necessary to comply with evolving federal or state regulations, as well as business needs. DHHS will provide a written request for any system changes. The vendor must provide a written scope of work which includes the technical and/or business requirement changes, inclusive of the schedule and costs associated with the system enhancement requested by the state, for the state’s consideration of approval. Once approved and after the system enhancement has been delivered, the vendor must submit a written request for deliverable acceptance of the system enhancement and obtain state approval prior to billing the system enhancement.
| Optional Services |
| Contract Term |
| Unit of Measure (UOM) |
| Cost |
(Unit Price) Extended Cost
| System Enhancements-Change order pool |
| Base |
| $ |
| $ |
| System Enhancements-Change order pool |
| Optional renewals |
| $ |
| $ |
| Labor Costs (Utilizing the Hourly Rates table below) |
| Breakdown from table below |
| Material Costs (markup from retail/wholesale) |
| _____% |
| Equipment Costs |
| _____% (can insert limits on this percentage) |
| Administrative/Overhead Costs |
| _____% (Markup cannot exceed 10%) |
Optional Services – Grand Total
Hourly Rates for Miscellaneous Support and Enhancements (beyond RFP/Contract requirements) *The Bidder should provide the Title/Role with each respective hourly rate to perform additional services as requested and approved by DHHS during the duration of the contract term and any applicable renewals.
| Title / Role such as, but not limited to: |
| Hourly Rate |
| (Example) Project Manager |
| $ |
*Bidder may add additional lines as needed.
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