EXHIBIT__L-1_Table_L-1_TPharm4_-_Ammendment_5_(Sep_19 _2013).xls
XLS spreadsheet 60 KB Posted
- Solicitation number
- HT9402-13-R-0001
- Issued by
-
Defense Health Agency
About this file
EXHIBIT L-1 Table L-1 TPharm4 - Ammendment 5 (Sep 19 2013)
View the file
Other files
Show 40 more
Latest 50 of 101 listed here. See the rest on GovTribe.
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Sheet1
| Retail Network Reimbursement Table L-1 | |||
| Option Period | Type of Rx | Pricing | |
| Basis | Estimated Quantity | Average | |
| WAC/AWP | Guaranteed Average Price Adjustment Percentage | ||
| ( + / – ) to 2 places | Guaranteed Average Dispensing Fee | Average Drug Cost | Estimated Total |
Drug Costs
| (a) | (b) | (c) | (d) | (e) = [(b) x (1 + (c))] + (d) | (f) = (a) x (e) | |||
| 1 | Non-Specialty Brand | WAC | 15,100,000 | $ 280.00 | ||||
| AWP | 30,000 | $ 65.00 | ||||||
| 1 | Non-Specialty Generic | WAC | 41,800,000 | $ 40.00 | ||||
| AWP | 4,450,000 | $ 74.00 | ||||||
| 1 | Specialty Brand | WAC | 191,000 | $ 3,784.00 | ||||
| AWP | 35 | $ 1,290.00 | ||||||
| 1 | Specialty Generic | WAC | 26,000 | $ 569.00 | ||||
| AWP | 42 | $ 1,350.00 | ||||||
| Subtotal Option Period 1 | ||||||||
| 2 | Non-Specialty Brand | WAC | 16,200,000 | $ 292.00 | ||||
| AWP | 27,000 | $ 68.00 | ||||||
| 2 | Non-Specialty Generic | WAC | 43,100,000 | $ 42.00 | ||||
| AWP | 4,000,000 | $ 77.00 | ||||||
| 2 | Specialty Brand | WAC | 197,000 | $ 3,943.00 | ||||
| AWP | 31 | $ 1,344.00 | ||||||
| 2 | Specialty Generic | WAC | 27,000 | $ 593.00 | ||||
| AWP | 38 | $ 1,406.00 | ||||||
| Subtotal Option Period 2 | ||||||||
| 3 | Non-Specialty Brand | WAC | 17,400,000 | $ 304.00 | ||||
| AWP | 24,000 | $ 71.00 | ||||||
| 3 | Non-Specialty Generic | WAC | 46,100,000 | $ 44.00 | ||||
| AWP | 3,600,000 | $ 80.00 | ||||||
| 3 | Specialty Brand | WAC | 210,000 | $ 4,109.00 | ||||
| AWP | 28 | $ 1,400.00 | ||||||
| 3 | Specialty Generic | WAC | 29,000 | $ 617.00 | ||||
| AWP | 34 | $ 1,466.00 | ||||||
| Subtotal Option Period 3 | ||||||||
| 4 | Non-Specialty Brand | WAC | 17,700,000 | $ 317.00 | ||||
| AWP | 22,000 | $ 74.00 | ||||||
| 4 | Non-Specialty Generic | WAC | 47,400,000 | $ 46.00 | ||||
| AWP | 3,200,000 | $ 83.00 | ||||||
| 4 | Specialty Brand | WAC | 215,000 | $ 4,281.00 | ||||
| AWP | 25 | $ 1,459.00 | ||||||
| 4 | Specialty Generic | WAC | 29,000 | $ 643.00 | ||||
| AWP | 31 | $ 1,527.00 | ||||||
| Subtotal Option Period 4 | ||||||||
| 5 | Non-Specialty Brand | WAC | 18,100,000 | $ 330.00 | ||||
| AWP | 20,000 | $ 77.00 | ||||||
| 5 | Non-Specialty Generic | WAC | 48,900,000 | $ 48.00 | ||||
| AWP | 2,900,000 | $ 87.00 | ||||||
| 5 | Specialty Brand | WAC | 219,000 | $ 4,461.00 | ||||
| AWP | 23 | $ 1,520.00 | ||||||
| 5 | Specialty Generic | WAC | 30,000 | $ 670.00 | ||||
| AWP | 28 | $ 1,591.00 | ||||||
| Subtotal Option Period 5 | ||||||||
| 6 | Non-Specialty Brand | WAC | 18,400,000 | $ 344.00 | ||||
| AWP | 18,000 | $ 80.00 | ||||||
| 6 | Non-Specialty Generic | WAC | 50,300,000 | $ 50.00 | ||||
| AWP | 2,600,000 | $ 91.00 | ||||||
| 6 | Specialty Brand | WAC | 223,000 | $ 4,648.00 | ||||
| AWP | 21 | $ 1,584.00 | ||||||
| 6 | Specialty Generic | WAC | 30,000 | $ 699.00 | ||||
| AWP | 25 | $ 1,658.00 | ||||||
| Subtotal Option Period 6 | ||||||||
| 7 | Non-Specialty Brand | WAC | 18,800,000 | $ 358.00 | ||||
| AWP | 16,000 | $ 84.00 | ||||||
| 7 | Non-Specialty Generic | WAC | 51,800,000 | $ 51.00 | ||||
| AWP | 2,400,000 | $ 94.00 | ||||||
| 7 | Specialty Brand | WAC | 228,000 | $ 4,843.00 | ||||
| AWP | 18 | $ 1,651.00 | ||||||
| 7 | Specialty Generic | WAC | 31,000 | $ 728.00 | ||||
| AWP | 22 | $ 1,728.00 | ||||||
| Subtotal Option Period 7 | ||||||||
| (g) Total Expected Government Cost for Reimbursement of Retail Network Pharmacy Costs for Option Periods 1 through 7 | ||||||||
| See Exhibit L-12 "Instructions for Completing Retail Network Reimbursement Table L-1" and Exhibit L-13 "Background Information for Retail Network Reimbursement, Table L-1". |
&L&"-,Bold"&14Exhibit L-1&C&"-,Bold"&14TRICARE Pharmacy Program &LHT9402-13-R-0001&CPage &P of &N
Sheet2
Sheet3
File details come from the government source that posted it. Updated .