ATTACHMENT__3_PRICING_TABLE_.pdf

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Emergency Prescription Assistance Program (EPAP) - Long Term
Solicitation number
HHS-ASPR-16-100-SOL-00006
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RFP Attachment 3 - Pricing Table

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File Type Posted
Amend_3_-_RFQ__16-100-SOL-00006_-_EPAP_Long_Term.pdf PDF
proposal_intent_response_sheet_form1.doc DOC document
Amendment_2_-_RFQ__16-100-SOL-00006_-_EPAP_Long_Term.pdf PDF
ATTACHMENT__3_PRICING_TABLE_.xlsx XLSX spreadsheet
ATTACHMENT__2_CLIN_STRUCTURE_TABLE.docx DOCX document
Amendment_1_-_RFQ__16-100-SOL-00006_-_EPAP_Requirement.pdf PDF
ATTACHMENT__2_CLIN_STRUCTURE_TABLE.pdf PDF
ATTACHMENT__1_PAST_PERFORMANCE.pdf PDF
Appendix_A-HISTORICAL_DATA.pdf PDF
Appendix_D-Sample_Eligibility.pdf PDF
Appendix_E-Sample_Claim_Report.pdf PDF
Appendix_F-Pharmacy_Notification.pdf PDF
FINAL_RFP_16-100-SOL-00006.pdf PDF
Appendix_B-Sample_Work_Flow.pdf PDF
Appendix_C-Sample_DME.Formulary.pdf PDF
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ATTACHMENT #3 PRICING TABLE .xlsx12/23/20159:02 AM

ATTACHMENT #3

PRICING TABLE EPAP - Program Setup

RFP #HHS-ASPR-16-100-SOL-00006

Contract Line Item Description Quantity Unit Unit Price Total Price Quantity Unit Unit Price Total Price Quantity Unit Unit Price Total Price Quantity Unit Unit Price Total Price Quantity Unit Unit Price Total Price

Project/Program Manager 320 Hour -$ 320 Hour -$ -$ 320 Hour -$ -$ 320 Hour -$ -$ 320 Hour -$ -$ Certified Public Accountant 36 Hour -$ 36 Hour -$ -$ 36 Hour -$ -$ 36 Hour -$ -$ 36 Hour -$ -$ Formulary Upload (Annual) 32 Hour -$ 32 Hour -$ -$ 32 Hour -$ -$ 32 Hour -$ -$ 32 Hour -$ -$ Readiness Activation Test/Exercise (Quarterly) 256 Hour -$ 256 Hour -$ -$ 256 Hour -$ -$ 256 Hour -$ -$ 256 Hour -$ -$ System Subscriptions Cost/Integration (Quarterly) 4 Each -$ 4 Each -$ -$ 4 Each -$ -$ 4 Each -$ -$ 4 Each -$ -$ System Setup Fee (One Time) 1 Each -$ Call Center Readiness/Exercise (Quarterly) 256 Hour -$ 256 Hour -$ -$ 256 Hour -$ -$ 256 Hour -$ -$ 256 Hour -$ -$ Travel 1 Each -$ 1 Each -$ -$ 1 Each -$ -$ 1 Each -$ -$ 1 Each -$ -$

Line Item Subtotal -$ -$ -$ -$ -$ Fringe Benefits -$ -$ -$ -$ -$ Subtotal Line Item & Fringe -$ -$ -$ -$ -$ Overhead -$ -$ -$ -$ -$ Subtotal Line Items, Fringe and Overhead -$ -$ -$ -$ -$ ODC's Travel -$ -$ -$ -$ -$ Subcontracts -$ -$ -$ -$ -$ Consultants -$ -$ -$ -$ -$ Materials -$ -$ -$ -$ -$ CDs -$ -$ -$ -$ -$ Subtotal ODCs -$ -$ -$ -$ -$ Subtotal - All Costs -$ -$ -$ -$ -$ G&A -$ -$ -$ -$ -$ Total Cost -$ -$ -$ -$ -$ Fee/Profit -$ -$ -$ -$ -$ Total Estimated Yearly Values -$ -$ -$ -$ -$

TOTAL ESTIMATED VALUE OF

CONTRACT

Assumptions: Percent Inflation Rate Per Year 2.25% Fringe Benefits Rate 0.00% Overhead Rate 0.00% G&A Rate 0.00% Fee/Profit Percentage 0.00%

Option Year Three

Note: Certain items are one-time or

Option Year FourBase Period Option Year One Option Year Two

PRICE TABLE EPAP - Event Activation and Deactivation

RFP #HHS-ASPR-16-100-SOL-00006

Contract Line Item Description Quantity Unit Unit Price Total Price Quantity Unit Unit Price Total Price Quantity Unit Unit Price Total Price Quantity Unit Unit Price Total Price Quantity Unit Unit Price

Communication Center Expense* 1.00 Each -$ 1.00 Each -$ -$ 1.00 Each -$ -$ 1.00 Each -$ -$ 1.00 Each -$ Systems Activation** 1.00 Each -$ 1.00 Each -$ -$ 1.00 Each -$ -$ 1.00 Each -$ -$ 1.00 Each -$ Call Center/Systems Activation** 1.00 Each -$ 1.00 Each -$ -$ 1.00 Each -$ -$ 1.00 Each -$ -$ 1.00 Each -$ Systems Deactivation** 1.00 Each -$ 1.00 Each -$ -$ 1.00 Each -$ -$ 1.00 Each -$ -$ 1.00 Each -$ Call Center/Systems Deactivation** 1.00 Each -$ 1.00 Each -$ -$ 1.00 Each -$ -$ 1.00 Each -$ -$ 1.00 Each -$

To be determined (TBD):

(Historical average claims processed per event: 35,000)

Transactional Prices (Estimated Quantity) Per Claim with Third Party Liability (TPL) Confirmation 1 Each TBD Administrative Price Per Rx Claim - Paid or Denied 1 Each TBD Per Paper Claim, as required 1 Each TBD Per Prior Authorization 1 Each TBD Per Call - Automated Phone System 1 Each TBD Per Incoming Call 1 Each TBD Per Outgoing Call 1 Each TBD Spanish Translation Service - per minute 1 Each TBD Faxes - per Page 1 Each TBD Brand and Single Source Generic/DME = Lesser of: average 1 Each TBD Multi-Source Generic/DME = Lesser of: average wholesale price (AWP) minus ____, or maximum allowable cost (MAC), or usual and customary (U&C); (MAC Guaranteed Effective Rate of AWP minus 55%)

1 Each

TBD

Durable Medical Equipment (DME): Medi-Span published pricing. (Actual pricing to be determined at time of Task Order.)

1 Each

TBD

Dispense Fee - Standard 1 Each TBD Vaccination Fee - Standard 1 Each TBD Vaccination Program Fee per claim 1 Each TBD Pharmacist (Drug Utlization Reviewer) 240 Hour -$ Claim Benefits Manager 240 Hour -$ Program Assistant 240 Hour -$ -$ -$ -$ -$ -$ -$ -$

Line Item Subtotal -$ -$ -$ -$ Fringe Benefits -$ -$ -$ -$ Subtotal Line Item & Fringe -$ -$ -$ -$ Overhead -$ -$ -$ -$ Subtotal Line Items, Fringe and Overhead -$ -$ -$ -$ ODC's Travel -$ -$ -$ -$ Subcontracts -$ -$ -$ -$ Consultants -$ -$ -$ -$ Materials -$ -$ -$ -$ CDs -$ -$ -$ -$ Subtotal ODCs -$ -$ -$ -$ Subtotal - All Costs -$ -$ -$ -$ G&A -$ -$ -$ -$ Total Cost -$ -$ -$ -$ Fee/Profit -$ -$ -$ -$ Total Estimated Yearly Values -$ -$ -$ -$

TOTAL ESTIMATED VALUE OF

CONTRACT

Assumptions: Percent Inflation Rate Per Year 2.25% Fringe Benefits Rate 0.00% Overhead Rate 0.00% G&A Rate 0.00% Fee/Profit Percentage 0.00%

LONG TERM

Option Year FourBase Period Option Year One Option Year Two Option Year Three

PRICE TABLE

RFP #HHS-ASPR-16-100-SOL-00006

Contract Line Item Description

Communication Center Expense* Systems Activation** Call Center/Systems Activation** Systems Deactivation** Call Center/Systems Deactivation**

To be determined (TBD):

(Historical average claims processed per event: 35,000) Transactional Prices (Estimated Quantity) Per Claim with Third Party Liability (TPL) Confirmation Administrative Price Per Rx Claim - Paid or Denied Per Paper Claim, as required Per Prior Authorization Per Call - Automated Phone System Per Incoming Call Per Outgoing Call Spanish Translation Service - per minute Faxes - per Page Brand and Single Source Generic/DME = Lesser of: average Multi-Source Generic/DME = Lesser of: average wholesale price (AWP) minus ____, or maximum allowable cost (MAC), or usual and customary (U&C); (MAC Guaranteed Effective Rate of AWP minus 55%) Durable Medical Equipment (DME): Medi-Span published pricing. (Actual pricing to be determined at time of Task Order.)

Dispense Fee - Standard Vaccination Fee - Standard Vaccination Program Fee per claim Pharmacist (Drug Utlization Reviewer) Claim Benefits Manager Program Assistant

Line Item Subtotal Fringe Benefits Subtotal Line Item & Fringe Overhead Subtotal Line Items, Fringe and Overhead ODC's Travel Subcontracts Consultants Materials CDs Subtotal ODCs Subtotal - All Costs G&A Total Cost Fee/Profit Total Estimated Yearly Values

TOTAL ESTIMATED VALUE OF

CONTRACT

Assumptions:

Inflation Rate Per Year Fringe Benefits Rate Overhead Rate G&A Rate Fee/Profit Percentage

Total Price r

Setup and Maintainance Costs
Event Act. and Deact. Costs

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