Q A_Fourth_Set_Answers.pdf

SOLICITATION HT9402-13-R-0001

TRICARE PHARMACY PROGRAM, FOURTH GENERATION (TPHARM4)

QUESTION AND ANSWER (Q&A) SET #4

HT9402-13-R-0001

ID: Question: Answer:

58 In cases where a beneficiary reports to have not received his or her medication, but the contractor has evidence that the medication was in fact delivered to the proper address, does this satisfy the requirement of delivery to the beneficiary or alternate delivery location? If not, how does the GOV plan to resolve the differing information and in the interest of avoiding waste or stockpiling of medications? What is the anticipated volume of such occurrences? The volume is necessary in order for all offerors to properly calculate their price.

Per C.7.3.4, the Contractor is responsible up to the point of delivery or the alternate delivery location. The method to determine delivery is not specified in the RFP; therefore, the contractor determines the method, which can include the contractor’s evidence that medication was delivered to requested address.

59 With respect to C.6.1.3., please provide the number of DEERS outages along with the average outage duration during the last two years. Also, please provide the number of instances where MTFs have experienced outages associated with CHCS or any other system, including the frequency and duration of such instances. This information is necessary in order for offerors to accurately price their proposal.

CHCS reports 99.98% availability in the most recent reporting quarter and generally maintains availability over 99%. From June 2012 to June 2013, DEERS had 3 downtimes for a total of 4.5 hours. There was 22 other occurrence of slowness which did not result in downtime.

60 In accordance with C.7.12., when calculating the Contractor’s actual drug cost for un-replenished drugs, must the Contractor apply the FAR cost principles in determining actual drug cost?

This is a firm fixed priced, not a cost reimbursement contract line item (CLIN) consequently, the FAR cost principles do not apply in determining actual drug costs. See Section B, CLIN X010 and Section L.10.12.

61 Do MTF transfers apply both to the reporting requirement and the “100% of all transfers completed within 21 days” metric as detailed in C.7.7.2.? Is so, what event determines when a contractor has successfully converted a prescription from retail to the MTF? Since the Contractor does not have any influence to the processing timelines once the prescriptions are sent to the MTFs, do we correctly assume that the Contractor’s activity is complete once the prescription is sent to the MTF?

MTF transfers must meet the 21 day completion and the three other criteria as shown in H.2.2.1 for incentive purposes. Once transferred to the MTF the contractor’s activity is complete.

62 The support requirements listed in the clinical support services section C.7.9.5.2. are clear. We believe the clinical services and dispensing of these products should not be decoupled because decoupling the services could result in increased waste, beneficiary dissatisfaction, and reduced clinical outcomes. Since performing the clinical services can take longer than 10 days, we assume the metrics in C.7.1.2.

and C.7.1.4. do not apply to specialty products. Please confirm this is a correct assumption.

Specialty services under C.7.9.5.2. should span the length of the enrollment and may cover multiple prescription fills, so the metrics under C.7.1.2. and C.7.1.4. for mail order delivery do not exclude specialty products. Thus your assumption is not correct.

63 Regarding past performance questionnaires described at L.9.3., in instances where a major GOV client is precluded by policy or law from serving as a reference or completing a questionnaire, should the offeror provide its next largest client?

No. The RFP provides the necessary instructions on how offerors are to respond to the RFP.

Specifically, section L.9.3 states that “Offerors shall provide a verified point of contact for each contract (name, title, address, phone number) that will be available to discuss the offeror’s performance with the Government.” Please be aware that failure to provide the specified information may have a negative impact on the evaluation results.

64 Section M.3.6.1. states that “the GOV will evaluate past performance information provided in accordance with Section L, and other sources, to determine how well an offeror has performed in the past on recent relevant work.”

How will the GOV determine relevancy (e.g., scope of services provided, volume of services provided, number of lives covered, etc.)? Is there a specific prescription processing volume threshold that the GOV will deem relevant?

Section M.3.6.2 details the process for assigning a relevance rating and M.3.6.3 are the relevancy ratings. There are no prescription or thresholds specified in the RFP for each relevancy rating.

The more similar an offeror’s past work is to the requirements in the RFP the more relevant. For instance, past work with a claims volume that is significantly less than the volume anticipated in the RFP is less relevant than work with volumes at the levels anticipated in the RFP.

65 Section B CLINs x005 MTF Prescriptions, Adjudication Services is one total.

QUESTION:

a. Are we to assume this total includes both TRICARE Eligible and Medicare Dual Eligible?

b. Does this CLIN count for MTF Prescriptions as single transactions or as 30-day Rx supply transactions? (The 2011 MHS Conference report listed MTFs Rx at 48.6 million and the 30-day Rx (Normalized based on 30-day supply of Meds) as 82,120,773.)

The CLIN covers all MTF transactions. Each transaction will get an admin fee regardless of days supply.

66 Section B We have conducted a thorough analysis of the TPharm4 CLIN workload for Option Period 1 and made comparison to the TPharm3 CLIN workloads for Option Period 5. Assuming the TPharm3 workload was accurate, this analysis should compare favorably because of the closeness of the two time periods used in the analysis. However, we have discovered incredible net changes in almost every category. For example:Total Electronic Claims are reduced by 22% for TPharm4

Total Paper Claims are reduced by 65% for TPharm4, Mail Order for TRICARE Eligible Increased by 93% for TPharm4, Mail Order Medicare Dual Eligible decreased by 20% for TPharm4, Prior Authorizations & Medical Necessity for TRICARE Eligible Increased by 72% for TPharm4, Prior Authorizations & Medical Necessity for Medicare Dual Eligible increased by 210% for TPharm4, TPharm 3 had total PBM claims estimated at 118,695,700 for Option Year 5, while total TPharm4 has PBM claims estimated at 98,072,000 for Option Year 1; a reduction of 17.4%.

Considering claim volume is project to decrease from Option Year 5 of TPharm3 to

Option Year 1 of TPharm4, we find it most interesting to see Prior Authorizations and Medical Necessity with just huge TPharm 4 increases over the TPharm3 estimates.

The estimates in Section B are the government’s current estimates. As explained under Section L.10.1.3, the estimates are based on historical data and are not a commitment. Offers should use their own judgment in the development of proposals.

QUESTION:

Will the GOV review the TPharm4 CLIN workload volumes and provide Offerors with assurance that these workloads are accurate; or that the GOV will prepare revised CLIN workload volumes and issue the appropriate RFP

Amendment?

67 Section B Will the GOV provide the most recent 12 month Incumbent Contractor actual CLIN workload volumes that were used to estimate the TPharm4 CLIN volumes?

If this is not available, will the GOV provide it’s rational as to how all the TPharm4 CLIN workload volumes were determined?

As specified in Section L.10.1.3, the quantities in Section B are estimates based on the same historical data provided to offerors. The government has provided the most recent workload data it currently has for each CLIN.

68 C.9.1.4 (Under Clinical Reviews) Item C.9.1.4 states that “The Contractor shall check the patient’s profile to determine if a clinical review for necessary PA or MN has been completed as a result of an MTF dispensing or for a mail order or retail dispensing.”

QUESTION: Can the Government please clarify which system should be checked for this profile query?

C.19.4 states, “The incoming Contractor shall receive batch files containing all retail, mail and MTF claims and prior authorizations and medical necessity determinations for the past two year period from the previous Contractors.”

The incoming contractor will have the necessary information to review the profile.

69 Draft Data Package 1 –Utilization Data for Jan– Dec 2011;

Draft DataPackage 2 – Utilization Data for Jan – Dec 2012 What is the average number of prescriptions per claim?

Each claim equals one prescription.

70 M.3.7.1. states: The total evaluated price will include consideration of FAR 52.217-8, Option to Extend Services.

The Government will multiply the offered unit price of CLINs 7001-7009, 7011-7014 and 7018-7021 by one half of the estimated quantity of each respective CLIN, and then add that extended amount to the total evaluated price. The Government will also add one-half of the offered lot price of CLINs 7010 and 7015 to the total evaluated price. Will the government also multiply OP 7 in the Retail Network Reimbursement Table L-1 by one half and add that additional amount to get to the total evaluated price?

See forthcoming amendment.

71 The RFP requires having two bank accounts for each fiscal year for claim reimbursement purposes. If a TRICARE-Only Eligible beneficiary and a Medicare-Dual Eligible beneficiary both receive a filled prescription during a claims cycle, does the government expect that two checks will be sent to the pharmacy or can a single check be sent and a transfer of funds be a handled during a reconciliation process? We believe a single check and bank account would be more cost effective.

TMA receives two different funds, one for Tricare only and one for Medicare-Dual eligible beneficiaries. The need to track these funds is the reason for the two bank accounts. This also involves two sets of TEDs and separately tracking the wire transfer requests from the Federal Reserve that cover the payments against the accounts.

72 Does the government expect that during the first 60 days when the contractor is following recoupment procedures that conform to its network agreements, that those recoupments will be reported on the Accounts Receivable Report (M140)?

Any accounts receivable that are related to payments made under the contract are required to be included in the Accounts Receivable Reports at all applicable time periods.

73 In reference to C.1.6., we understand and agree with the GOV’s position that the payment for the drug costs and admin fees will not be paid until the TED record is approved.

QUESTION: In order to help all offerors accurately price their proposal, please confirm that the Contractor and its network pharmacies will not be paid until the TED is corrected, even if a contractor were to perform at a five percent failure rate during the first six months of the contract, which would meet the GOV standard in H.3.8.

Many failed TED edits will allow payment to the pharmacy or beneficiary but until the TED is corrected, the contractor will not receive its processing payment.

74 Section C.1.6. states: “upon verification of the patient’s eligibility and acceptance of the TRICARE Encounter Data (TED) record, the Contractor will forward payment using GOV funds to pay for each TRICARE prescription dispensed at retail network pharmacies.” Based upon public information, the size of the retail drug spend lists the FY 12 retail drug spend to be approximately $4 billion per year.

Using that public information, the Contractor could be waiting to reimburse pharmacies as much as $8.3 million per bimonthly payment cycle ($4 billion/24 weeks*0.05 performance failure).

QUESTION: Given the adverse impact on beneficiary satisfaction and impact to retail network relations, are offerors able to pay the pharmacies using their own funds?

No. Per Section G.11.1., the contractor is a fiscal intermediary. The contractor is in a position to facilitate disbursement to retail pharmacies with timely and accurate daily TED submittals and timely action upon government approval of the disbursement.

75 In reference to G.5.1 Contract Phase-In, TRICARE, what supporting documentation is needed to support the invoice/payment request for CLIN 0001?

No further documentation is specified in the RFP as being required. However, the Government may request additional information if needed to verify that services have been accepted and received.

76 In reference to G.5.3 MTF Prescription Services, what invoice/payment request for CLIN X005?

The supporting documentation for this requirement is any documentation which validates that services have been delivered and are acceptable.

77 In reference to G.5.4 Mail Order Unreplenished Agents, what invoice/payment request for CLIN X010?

No further documentation is specified in the RFP as being required. However, the Government may request additional information if needed to verify that services have been accepted and received.

78 In reference to G.5.6 Government Directed Mailings, what invoice/payment request for CLINs 0002 and X013?

For CLIN X0013 no further documentation is specified in the RFP as being required. However, the Government may request additional information if needed to verify that services have been accepted and received. For CLIN 0002, The supporting documentation for this requirement is any documentation which validates that services have been delivered and are acceptable.

79 In reference to G.5.7 Contract Data Requirements List (CDRLs), what supporting documentation is needed to support the invoice/payment request for CLINs 0003 and X015?

The contractor is not required to provide any additional documentation with the payment request.