Q A_Eighth_Set_Answers.pdf

SOLICITATION HT9402-13-R-0001

TRICARE PHARMACY PROGRAM, FOURTH GENERATION (TPHARM4)

QUESTION AND ANSWER (Q&A) SET #8

HT9402-13-R-0001

ID: Question: Answer:

129 Section C.19.1.4. states: “the Contractor shall be responsible for processing claims for dates of service prior to the start of pharmacy services under this contract. This includes initial submission of claims and any adjustments, corrections, or cancellations necessary for claims previously processed to completion by the outgoing Contractor, including “run-off” claims.” Also, sections C.19.4.1. and C.19.4.2 requires the Contractor to backload two years’ worth of claims information and the OHI file.

QUESTION: Please confirm that to comply with the above requirements the Contractor will also need to load and timeline all MCPF files, Medi-span pricing, benefit design changes, and uniform formulary changes.

Can “run-off” claims include claims up to 24-months old? Please confirm that the build out associated with run off claims functionality should be included in CLIN 0001.

The RFP does not explicitly require loading of MCPF files, Medi-span pricing, benefit design changes, and uniform formulary design changes. The RFP does specify the outcome, which the contractor will need to achieve. How the contractor accomplishes the accurate and timely processing of claims is the responsibility of the contractor. Based on phase out requirements, and since most claims are done in real-time, the chances of the outgoing contractor to forward run-off claims are minimal. If any run-off claims are forwarded, they would most likely be paper claims which can be up to 24 months (or older). The contractor will be paid under the applicable Option Period 1 CLIN (1001-1004) price for each claim.

Sections L.10.2. through L.10.14.2 provide limited instructions the Government chose to prescribe regarding the pricing of individual CLINs. In the absence of specific instructions, offerors should use their best business judgment and may include, or not include, specific costs for any particular CLIN by considering risk, the competitive environment, and the offeror’s respective estimating and accounting practices.

130 Attachment L-1 & L.10.15. Network Reimbursement Offerors shall enter its guaranteed Average Price Adjustment Percentage (the percentage discount or addition to the Wholesale Acquisition Cost (WAC) price basis) and its Guaranteed Average Dispensing Fee Per Prescription for pharmaceutical items dispensed from retail network pharmacies in the retail network reimbursement table provided at exhibit L-1. We made a comparison of WAC prices with the TPharm3 Table L-1 Option Period 6, dates of 9/1/2014 to 11/3-2014 with the TPharm4 Table L-1 Option Period 1. Our findings are as follows:Non- Specialty Brand WAC increased 10.9%, Non-Specialty Generic WAC increased by 37%, Specialty Brand WAC decreased by 6.7%, Specialty Generic WAC increased by 198.5%.

QUESTION:

a. Considering the closeness of the two time periods, will the GOV provide comment and rational for these wide differences?

b. Table L-1 is paramount to the pricing evaluation for this procurement; therefore the importance for its accuracy can’t be misstated. The GOV has established the Average WAC pricing to be the same dollar values for each of the 7 years of the TPharm4 contract. Will the GOV explain and provide rational for the WAC pricing to remain the same dollar value for all 7 years?

See update to L-1 in Amendment 3.

With respect to your request that the government provide comment and rationale please be advised that the government will not provide comment nor rational.

In pricing and responding to proposals each offeror is expected to use their best business judgment and experience in interpreting the data and submitting a competitive proposal.

131 Draft Data Package 1 & 2 (Utilization Data) Will more detailed claims data be provided (including NDC, Metric Quantity, Date of Service, Days Supply and Delivery Method (Mail or Retail) or Pharmacy ID) so that all bidders have access to the same level of claims history as the incumbent?

See amendment 3 for additional historical data provided

132 Section C.12.5.1 in the solicitation and a variety of publicly-available documents including (1) Defense Health Information Management System (DHIMS) CHDR fact sheet, (2) Department of Veterans Affairs (DVA) CHDR User Guide, and (3) DVA slide set entitled “Clinical Data Repository / Health Data “Repository (CHDR) Vendor Solutions Symposium, dated July 26 & 27, 2011, all describe the Clinical Data Repository/Health Data Repository (CHDR) as an application that interfaces with the DoD’s Clinical Data Repository (CDR) and the VA’s Health Data Repository (HDR). The DVA slide set also includes a diagram of the high-level architecture showing a bi-directional interface between the Pharmacy Data Transaction Service (PTDS) and the CDR and a bi-directional interface between the CDR and the CHDR for transmitting and receiving information about medications dispensed by outpatient pharmacies.

Paragraph C.12.5.2 in the solicitation states that the Contractor shall develop and maintain a real-time bi-directional interface to the CHDR.

Question: Regarding the requirement for the Contractor to develop and maintain a real-time, bi-directional interface to the CHDR for transmitting and receiving information about outpatient medications, please confirm that the functionality related to outpatient prescriptions will move from the current bi-directional interface to the new interface developed by the TPharm4 Contractor. This information is necessary in order for all offerors to accurately estimate this requirement.

See amendment 4

133 In reference to C.5.2, there are a substantial number of complex requirements in the TRICARE Operations Manual, the TRICARE Reimbursement Manual, the TRICARE Policy Manual, and the TRICARE Systems Manual that must be estimated and priced by all offerors. Combined, these four manuals include approximately 4,500 pages that are incorporated into the TPharm 4 contract. TOM Chapter 23, Section 1, Subsection 3 states “sections or language in these Manuals that obviously have no direct application to the pharmacy Contractor do not apply.”. This statement from TOM Chapter 23 is ambiguous and may cause prospective Contractors to either over bid (increasing the Government’s costs) or under bid (and under-perform) the TPharm4 contract.

QUESTION: To ensure all offerors understand which requirements apply to the pharmacy Contractor, is the Government able to provide any additional detail?

All items in the TRICARE Policy Manual, TRICARE Reimbursement Manual, and the TRICARE Systems Manual apply to all contractors unless the solicitation or manual states otherwise, so the Government will not provide additional detail than specified in the solicitation and manuals. The TRICARE Operations Manual provides overarching guidelines for operations and information on how to process claims for different TRICARE benefit groups. The pharmacy contractor must review those groups to understand how pharmacy claims can be impacted.

134 In reference to C.19.1.4 where the incoming contractor will process claims from the prior contract, how will copayments collected for MOP from previous contractor be passed through to the new contractor? We assume that the government will not deduct copayments from the administrative CLIN payment. Please confirm this assumption is correct.

Mail order fulfillment, or prescription processing, is not processing a claim as the question implies. Regarding mail order, if the outgoing MOP contractor starts the fulfillment process, they must complete the cycle from adjudication to shipment; therefore, copays have been collected by the outgoing contractor and the administrative offsets by the Government have been accomplished on the outgoing contract. Any prescriptions forwarded to the incoming contractor will not have started the fulfillment process; therefore, no copay will have been collected. The incoming contractor obviously will collect the copay, perform the cycle, and the Government will offset the copay from the incoming contractor. In summary, partially completed mail order fulfillments is not possible, so copays are not transferred between contractors as the question implies.

135 Can the government provide the number of recoupment cases set up in CY 2011 and CY 2012?

See historical data below:

453 recoupment cases were collected during CY 2011.

554 recoupment cases were collected during CY 2012.

136 C.6.7.3 states, "Adjudication of MTF claims shall be conducted in accordance with guidelines provided by Government after award." Since the level of effort is unknown by the bidder and we will not know the costs to be incurred, will the government issue a Change Order after award for the bidder to request equitable adjustment?

See amendment 4 for additional detail for offerors.

However, for security purposes, the Government will not provide certain documents or connectivity instructions prior to award. The Government does not intend to issue a change order after award for the successful offeror to request an equitable adjustment.

137 To provide a fair and accurate price for developing the interfaces outlined in section L.10.2, when will TMA consider sharing the technical specifications for these interfaces with all bidders? (The Technical and Interface documents listed under Exhibit L-10 only

See amendment 4 for additional detail for offerors.

However, for security purposes, the Government will not provide interface control documents, connectivity instructions, or technical specifications prior to award.

include information about the pricing file, the MTF to TMOP transfer file, and a high-level list of data in the PDTS data warehouse. The majority of the technical and interface documents are missing from this Exhibit.)

138 It appears that the volumes listed in Schedule B for CLINs X005 represent the number of prescriptions successfully adjudicated in the offeror’s claim adjudication system, which may result in either an approved or denied claim; however, the historical MTF prescription volumes in Exhibit L-10, Data Package 9 are materially less than the volumes provided in Schedule B for CLINs X005.Is the difference between the MTF prescriptions in Exhibit L-10, Data Package 9 and the claim volumes provided in Schedule B for CLINs X005 attributed to the number of claims that are successfully adjudicated but resulting in a denied claim? Additionally, please confirm that the volumes listed in Schedule B for CLINs X005 represent the number of prescriptions successfully adjudicated (i.e., approved and denied) in the offeror’s claim adjudication system and is not limited to only prescriptions that are approved.

The historical data package shows 48million successfully adjudicated claims per 12 month period.

The data package covers 15 months of time. These are successfully adjudicated paid claims only. Denied claims are not included. The estimated volumes for CLINS x005 in Section B are anticipated volume of successfully adjudicated claims per each 12 month option period. The Government’s estimates considered the historical data.

139 Section I incorporates by reference FAR 52.230-2, Cost Accounting Standards. Please confirm that the Contractor’s “methods of distinguishing direct costs from indirect costs and the basis used for allocating indirect costs,” applies to any service provided under the contract (i.e., Pharmacy Technicians, Call Center Staff, etc.). What criteria will the Government use in the pre-award audit to determine if the contractor is a responsible contractor?

We observe the clause at 52.230-2 does not exclude the cost elements or services identified in the question. It is the responsibility of the offeror to have an adequate CAS Disclosure Statement and for CAS compliance, as such, TMA is not in a position to advise offerors. See FAR 30.202-6 regarding the TMA contracting officer’s responsibilities.

Policy and standards regarding responsibility, and preaward survey information is described under FAR Part 9.1 and DFARS Part 209.1.