ATTACHMENT__3_PRICING_TABLE_.xlsx

XLSX spreadsheet 91 KB Posted Jan 8, 2016

Attached to: Emergency Prescription Assistance Program (EPAP) - Long Term
Solicitation number: HHS-ASPR-16-100-SOL-00006
Issued by: Department of Health and Human Services Immediate Office of the Secretary

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Attachment 3 - MS Excel

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File	Type	Posted
Amend_3_-_RFQ__16-100-SOL-00006_-_EPAP_Long_Term.pdf	PDF	Jan 20, 2016
proposal_intent_response_sheet_form1.doc	DOC document	Jan 20, 2016
Amendment_2_-_RFQ__16-100-SOL-00006_-_EPAP_Long_Term.pdf	PDF	Jan 15, 2016
ATTACHMENT__2_CLIN_STRUCTURE_TABLE.docx	DOCX document	Jan 8, 2016
Amendment_1_-_RFQ__16-100-SOL-00006_-_EPAP_Requirement.pdf	PDF	Jan 8, 2016
ATTACHMENT__2_CLIN_STRUCTURE_TABLE.pdf	PDF	Jan 8, 2016
ATTACHMENT__1_PAST_PERFORMANCE.pdf	PDF	Jan 8, 2016
ATTACHMENT__3_PRICING_TABLE_.pdf	PDF	Jan 8, 2016
Appendix_A-HISTORICAL_DATA.pdf	PDF	Jan 5, 2016
Appendix_D-Sample_Eligibility.pdf	PDF	Jan 5, 2016
Appendix_E-Sample_Claim_Report.pdf	PDF	Jan 5, 2016
Appendix_F-Pharmacy_Notification.pdf	PDF	Jan 5, 2016
FINAL_RFP_16-100-SOL-00006.pdf	PDF	Jan 5, 2016
Appendix_B-Sample_Work_Flow.pdf	PDF	Jan 5, 2016
Appendix_C-Sample_DME.Formulary.pdf	PDF	Jan 5, 2016

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Event Act. and Deact. Costs

ATTACHMENT #3
PRICE TABLE	EPAP - Event Activation and Deactivation
RFP #HHS-ASPR-16-100-SOL-00006	LONG TERM

Contract Line Item Description	Base Period				Option Year One				Option Year Two				Option Year Three				Option Year Four
	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
Communication Center Expense*	1.00	Each		$ - 0	1.00	Each	$ - 0	$ - 0	1.00	Each	$ - 0	$ - 0	1.00	Each	$ - 0	$ - 0	1.00	Each	$ - 0	$ - 0
Systems Activation**	1.00	Each		$ - 0	1.00	Each	$ - 0	$ - 0	1.00	Each	$ - 0	$ - 0	1.00	Each	$ - 0	$ - 0	1.00	Each	$ - 0	$ - 0
Call Center/Systems Activation**	1.00	Each		$ - 0	1.00	Each	$ - 0	$ - 0	1.00	Each	$ - 0	$ - 0	1.00	Each	$ - 0	$ - 0	1.00	Each	$ - 0	$ - 0
Systems Deactivation**	1.00	Each		$ - 0	1.00	Each	$ - 0	$ - 0	1.00	Each	$ - 0	$ - 0	1.00	Each	$ - 0	$ - 0	1.00	Each	$ - 0	$ - 0
Call Center/Systems Deactivation**	1.00	Each		$ - 0	1.00	Each	$ - 0	$ - 0	1.00	Each	$ - 0	$ - 0	1.00	Each	$ - 0	$ - 0	1.00	Each	$ - 0	$ - 0
				$ - 0			$ - 0	$ - 0			$ - 0	$ - 0			$ - 0	$ - 0			$ - 0	$ - 0
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		$ - 0
Claim Benefits Manager	240	Hour		$ - 0
Program Assistant	240	Hour		$ - 0			$ - 0	$ - 0			$ - 0	$ - 0			$ - 0	$ - 0			$ - 0	$ - 0
				$ - 0			$ - 0	$ - 0			$ - 0	$ - 0			$ - 0	$ - 0			$ - 0	$ - 0
Line Item Subtotal				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Fringe Benefits				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Subtotal Line Item & Fringe				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Overhead				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Subtotal Line Items, Fringe and Overhead				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
ODC's
Travel				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Subcontracts				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Consultants				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Materials				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
CDs				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Subtotal ODCs				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Subtotal - All Costs				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
G&A				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Total Cost				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Fee/Profit				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Total Estimated Yearly Values				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
TOTAL ESTIMATED VALUE OF CONTRACT	$ - 0

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%

&F&D&T

Setup and Maintainance Costs

ATTACHMENT #3
PRICING TABLE	EPAP - Program Setup
RFP #HHS-ASPR-16-100-SOL-00006	Note: Certain items are one-time or annual

Contract Line Item Description	Base Period				Option Year One				Option Year Two				Option Year Three				Option Year Four
	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		$ - 0	320	Hour	$ - 0	$ - 0	320	Hour	$ - 0	$ - 0	320	Hour	$ - 0	$ - 0	320	Hour	$ - 0	$ - 0
Certified Public Accountant	36	Hour		$ - 0	36	Hour	$ - 0	$ - 0	36	Hour	$ - 0	$ - 0	36	Hour	$ - 0	$ - 0	36	Hour	$ - 0	$ - 0
Formulary Upload (Annual)	32	Hour		$ - 0	32	Hour	$ - 0	$ - 0	32	Hour	$ - 0	$ - 0	32	Hour	$ - 0	$ - 0	32	Hour	$ - 0	$ - 0
Readiness Activation Test/Exercise (Quarterly)	256	Hour		$ - 0	256	Hour	$ - 0	$ - 0	256	Hour	$ - 0	$ - 0	256	Hour	$ - 0	$ - 0	256	Hour	$ - 0	$ - 0
System Subscriptions Cost/Integration (Quarterly)	4	Each		$ - 0	4	Each	$ - 0	$ - 0	4	Each	$ - 0	$ - 0	4	Each	$ - 0	$ - 0	4	Each	$ - 0	$ - 0
System Setup Fee (One Time)	1	Each		$ - 0
Call Center Readiness/Exercise (Quarterly)	256	Hour		$ - 0	256	Hour	$ - 0	$ - 0	256	Hour	$ - 0	$ - 0	256	Hour	$ - 0	$ - 0	256	Hour	$ - 0	$ - 0
Travel	1	Each		$ - 0	1	Each	$ - 0	$ - 0	1	Each	$ - 0	$ - 0	1	Each	$ - 0	$ - 0	1	Each	$ - 0	$ - 0
				$ - 0			$ - 0	$ - 0			$ - 0	$ - 0			$ - 0	$ - 0			$ - 0	$ - 0
				$ - 0			$ - 0	$ - 0			$ - 0	$ - 0			$ - 0	$ - 0			$ - 0	$ - 0
Line Item Subtotal				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Fringe Benefits				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Subtotal Line Item & Fringe				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Overhead				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Subtotal Line Items, Fringe and Overhead				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
ODC's
Travel				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Subcontracts				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Consultants				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Materials				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
CDs				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Subtotal ODCs				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Subtotal - All Costs				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
G&A				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Total Cost				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Fee/Profit				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
Total Estimated Yearly Values				$ - 0				$ - 0				$ - 0				$ - 0				$ - 0
TOTAL ESTIMATED VALUE OF CONTRACT	$ - 0

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%

&F&D&T

Sheet1

File details come from the government source that posted it. Updated Nov 14, 2017.