Q A_Fifth_Set_Answers.pdf

SOLICITATION HT9402-13-R-0001

TRICARE PHARMACY PROGRAM, FOURTH GENERATION (TPHARM4)

QUESTION AND ANSWER (Q&A) SET #5

HT9402-13-R-0001

Question: Answer:

80 In reference to C.11.3.4, to help offerors most accurately price their bid, please provide the volume of the remaining claims on a monthly basis requiring contractor troubleshooting to determine the cause of the error and the number of errors that need to be corrected.

Regarding C.11.3, MTF data integrity review historical data provided in data package 9 on 1 August 2013.

81 Exhibit L-7 (Draft High Cost Medication List) lists each drug with a generic name followed by its brand name in parentheses. For example, Ipratropium/Albuterol Sulfate (Combivent Respimat). For purposes of the incentive at H.2.1. (Incentive for Savings on High Cost Medications), does the GOV intend for the Contractor to target the drugs that appear in parenthesis only? For some drugs on the list, the generic name could be interpreted with additional brand products (in this case, Combivent [not the Respimat form]). Please confirm the drugs that are eligible for the incentive are only the branded names that appear in parentheses.

See forthcoming amendment to Exhibit L-7.

82 Section B CLIN x003 and x0004 represents Paper Claims.

The total paper claims in Option Year 1 is 1,000,000 and decreases over the years until the last year which is project at 735,100 claims.

QUESTION:

a. Will the GOV explain the 7 year projected 26% decrease in paper claims volume and did that volume shift to electronic claims or mail order, if so please explain the rational for that assumption?

b. Are most paper claims generated because of OHI? If not, will the GOV explain the high volume of paper claims?

The quantities for the indefinite quantity CLINS in Section B are Government estimates based on historical data and do not represent a commitment on the part of the Government that these quantities will actually occur over the course of the contract. See Section L.10.1.3. The historical data has been provided to offerors for their information. Offerors should use their best business judgment and experience in formulating projections and in pricing the Section B requirements.

Consequently, the government will not provide the requested detailed information.

83 Section B CLIN x007 represents Mail Order Medicare Elig claims. Year 1 claim volume is 13,230,000 decreasing to 11,900,000 by the last year. The yearly estimated claim volumes have annual increases and decreases.

QUESTION:

Considering the Mandatory Mail Pilot does the GOV expect Mail Order Medicare Dual Elig Claim volume to reflect these changes?

The quantities for the indefinite quantity CLINS in Section B are Government estimates based on historical data and this historical data includes the mandatory mail pilot. Be aware that the Section B estimates do not represent a commitment on the part of the Government that these quantities will actually occur over the course of the contract. See Section L.10.1.3.

84 Section B CLINs x020 and x021 represent Transfers from New Retail to MTF for Contractor Incentive. This estimated claim volumes in total begins at 80,000 and ends in the final year of the contract at 107,200.

The quantities for these CLINs are estimated based on historical data with an adjustment for the Mandatory Mail Pilot, which is expected to be in place prior to the start of pharmacy delivery services. However, offerors should be aware that these CLIN estimates do not

QUESTION:

a. Have these estimated claim volumes been reduced from estimated claim volumes in CLINs x001 and x002?

Are these estimates based on TPharm3 History?

b. Will the GOV provide its analysis and/or rational for these estimates?

represent a commitment on the part of the Government that these quantities will actually occur over the course of the contract. Because the quantities are estimates and because the offerors are expected to use their best judgment and experience in pricing the requirements (see Section L.10.1.3.), the Government will not provide its analysis and/or rational for these estimates.

85 C.6.1.1. General Claims Processing: The Contractor shall provide mail order pharmacy (including specialty pharmacy) services, a retail pharmacy network, claims adjudication for MTF claims and Pharmacy Benefit Management (PBM) services as specified herein. Unless stated otherwise, claims adjudication includes processes outlined inC.6.1.4 - C.6.1.7 and C.6.1.10, consisting of eligibility check, application of the correct copayment, identification of other health insurance (OHI), benefit design edits, prospective drug utilization review and application of catastrophic cap updates.

QUESTION: Will the GOV provide an estimate or historical data of the number of Prescriptions that may have OHI?

OHI historical data had been provided under Data Package 1&2. This data was updated on 1 August 2013.

86 C.6.3.5 (Under Retail Network Claims) Item C.6.3.5 states: “The Contractor may authorize the dispensing of up to a 90-day supply prescription as a single transaction at a retail pharmacy…”, which indicates that the Contractor is allowed to dispense up to a 90-day supply prescription at a retail pharmacy.

QUESTION: Is the location and availability of 90-day dispensing of prescriptions at the Contractor’s discretion or the Government’s discretion?

See Amendment 1.

87 F.1.1 (Under Period of Performance) Item F.1.1 states that: “The Contractor shall begin contract phase-in activities and complete specific activities by the timelines specified in the TRICARE Operations Manual (TOM) Chapter 1, Section 8”.

Chapter 1 of the TRICARE Operations Manual found at http://manuals.tricare.osd.mil/Default.aspx contains only 7 sections and an Addendum.

QUESTION: Can the Government please clarify the reference to TRICARE Operations Manual (TOM) Chapter 1, Section 8?

See Amendment 1.

88 Draft Data Package 1 & 2 (Utilization Data) Can the Government explain the significant decrease in retail claims volume since the last RFP in 2008?

TMA has not conducted a comprehensive analysis to explain the decrease in retail claims volume since the last RFP in 2008. The historical data has been provided to offerors for their information. Offerors should use their best business judgment and experience in responding to the RFP.

http://manuals.tricare.osd.mil/Default.aspx

89 With respect to C.7.13.1, the Government’s preferred generic may be different than the offeror’s preferred commercial generic, which creates inventory swell and dispensing inefficiencies. This requires systems modifications and operational alterations, which drive up costs.

QUESTION: Should all such costs be associated with

CLIN 0001?

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. The RFP does not provide specific instructions for pricing performance with respect to C.7.13.1.

90 With respect to C.7.11 in the solicitation, is the Contractor required to build out a robust inventory-management system that is capable of tracking billions of transactions to ensure alignment with the NPV contract as well as efficient and effective management of the initial base-lining and continuous monitoring processes and reconciliation reporting?

Please confirm our understanding of the requirement as this information is necessary so that all offerors understand the complexity of the Government’s requirement and build out their systems and their pricing accordingly. Also, should these costs be included in CLIN 0001?

The RFP does not prescribe how offerors are to meet the requirements of C.7.11. The tracking of stock is a fundamental PBM service. 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. The RFP does not provide specific instructions for pricing performance with respect to C.7.11.

91 Third sentence of paragraph L.2.3. discusses companies with a potential conflict of interest: “any company or individual with a TMA support contract.” We do not believe that the quoted language was intended to apply to the TRICARE Managed Care Support Contractors.

Please clarify whether in the context of this paragraph TRICARE Managed Care Support Contractors are included in the definition of having a “TMA support contract.”

For the purposes of paragraph L.2.3. the Government does NOT consider TRICARE Managed Care Support

Contracts to be a “TMA support contract”. Thus, a mitigation plan is not required.

92 The RFP does not provide data on beneficiaries with other primary coverage (OHI). Please provide the approximate volume of beneficiaries with other primary commercial coverage and of beneficiaries with Medicare. This data will be necessary to determine staffing models for OHI investigations and recovery processes.

The historical data in Data Packages 1&2, and updated on 1 August 2013, provides all available data on beneficiaries with OHI.