Q A_Second_Set_Answers.pdf

SOLICITATION HT9402-13-R-0001

TRICARE PHARMACY PROGRAM, FOURTH GENERATION (TPHARM4)

QUESTION AND ANSWER (Q&A) SET #2

HT9402-13-R-0001

Question: Answer:

In accordance with C.7.11.3., does the most economical package size apply to all dosage forms such as tablets, capsules, pills, creams, inhalers, ointments, liquids, etc.?

The contractor shall select the most economical package size that can support TMOP utilization for replenishment within each drug, strength, and dosage form.

In accordance with C.7.4, please provide an initial list of medications and claim volume that would be targeted for partial shipments at start of contract to assist all offerors in estimating their price.

This list is not available at this time. The contractor is paid per transaction in accordance with G.8.1.1.

In reference to C.7.9.1., it is customary for specialty pharmacies to define their own list of specialty products.

Please clarify whether the Contractor should use the DoD-designated specialty drug list in Exhibit L-6; the specialty drug list in the TOM, Chapter 23, Addendum A; or the Contractor’s own list when defining specialty products?

For purposes of responding to the RFP, the offerors should only use Exhibit L-6.

Section H.2.2. states “the Contractor shall receive this incentive fee one time per beneficiary/drug.” There are likely scenarios in which a beneficiary using retail is converted to the MOP, but then reverts back to retail on their own at a point in the future. To convert a beneficiary that had reverted to retail back into the MOP requires the same level of effort from the Contractor, and the GOV achieves the same level of savings. Depending upon the interpretation of the language above, it is questionable whether the Contractor would receive payment for its effort to re-convert the prescription to the MOP and generate savings for the DoD. Please clarify that if there is any evidence a beneficiary reverted to retail for the same drug, but the Contractor converts them back to the MOP, the Contractor will receive an additional incentive fee.

The contractor will receive a financial incentive for each successful transfer.

Section H.4.1.2. provides for a stratified random sample for each claim category to determine the overall payment error amount. To help offerors accurately price their bid, please estimate the number of sample claims the Contractor can expect to receive each quarter.

Claim volumes are based on the specific sample type and distribution of that data. The estimated quarterly claim volumes are as follows and do not represent a commitment on the part of the Government that these estimates provided below will actually reflect the number of claims the Contractor will receive each quarter throughout the course of the contract. Offerors should make their own assessment of the projected volume of claims;

applying their own business judgment, knowledge of the TRICARE Pharmacy Program, assumptions of utilization, data provided by the Government, or any other data:

Question: Answer:

Retail Electronic: 1,000 - 1,400 Paper: 700 - 950 Denied: 300 - 450

TOTAL 2,000 - 2,800

Section B We are unable to locate CLIN’s and estimated Claim Volume for DVA beneficiaries.

QUESTION: Where did the GOV include the DVA beneficiary claim volumes?

Claims from DVA pharmacies, described under C.6.5.3, are processed as Electronic Retail Network Claims. See Data Package 13.

Section B We are unable to locate Section B CLIN Descriptions and Instructions.

QUESTION: Where can we find CLIN descriptions? Prior TPharm procurements provided detailed descriptions labeled as B.1.

The CLIN descriptions are in Section B. Where relevant to a specific CLIN, the other sections of the RFP refer to the CLIN description or CLIN number. For example, proposal instructions for pricing the Phase In CLIN are at L.10.2.

a. C.6.1.10. The Contractor shall conduct Prospective Drug Utilization Review (ProDUR) on dispensing transactions submitted by the three points of service: MTF, TMOP, and Retail network pharmacies. As part of the adjudication process, the ProDUR shall evaluate the new prescription against the patient’s current drug regimen and return appropriate clinical warnings or administrative alerts. The Contractor shall also perform other real-time edits (e.g., Prescription Restriction Program restrictions). The Contractor shall support ProDUR business rules specific to MTFs as outlined in C.6.7. The Contractor shall conduct Prospective Drug Utilization Review

(ProDUR) on dispensing transactions submitted by the three points of service: MTF, TMOP, and Retail network pharmacies. As part of the adjudication process, the

ProDUR shall evaluate the new prescription against the patient’s current drug regimen and return appropriate clinical warnings or administrative alerts. The

Contractor shall also perform other real-time edits (e.g., Prescription Restriction

Program restrictions). The Contractor shall support ProDUR business rules specific to MTFs as outlined in C.6.7.TPharm4 is making a major shift from the current

ProDUR and other process now operational in the PDTS. PDTS has been operational for many years and once was a finalist in the President’s Quality Award Program.

b. QUESTION: We ask the following:

c. a. Will the GOV explain and provide its reasoning and rational for moving the key functionality of PDTS to the PBM Contractor?

d. b. Does the GOV have higher expectations for using the

Contractors ProDUR systems?If so, will the GOV provide evidence of these expectations?

e. c. Does the Gvmt have other expectations with the transfer of these PDTS functions to the PBM contractor systems?

f. d. Does the GOV expect to reduce the cost of performing ProDUR and other PDTS processing?

g. e. Does the GOV foresee the Contractor to have two different

ProDUR processing routines: one for MTF rules per the GOV and a different set of rules for Retail, Paper, and Mail Order Claims established by the Contractor?

h.

The Government’s finalized requirements are specified in the RFP. This is not the forum for deliberations.

Question: Answer:

C.6.5.1 Retail Pharmacy Network The Contractor shall establish and maintain a retail pharmacy network throughout the 50 United States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam. The Contractor shall provide network retail pharmacy services in American Samoa and the Northern Mariana Islands when they become eligible.

QUESTION: Will the GOV allow the addition of Walgreens to the TRICARE Pharmacy network in this procurement?

The solicitation does not specify how the Contractor meets the contract requirements for networks and the solicitation does not mandate which retail pharmacies must be in a network.

C.7.1.13. Mandatory Mail Pilot: The Contractor shall support the mandatory mail pilot at the TMOP point of service as required in NDAA 2013, Section 716. This pilot will end on December 31, 2017 unless extended by Congress. The pilot shall apply to TRICARE For Life (TFL) beneficiaries identified in DEERS when receiving medications identified on the GOV’s mandatory mail drug list.

QUESTION: Has the GOV made allowance in the CLIN Volume estimates to consider the Mandatory Mail Pilot Program?

Yes.

H.2.2. Transfer New Retail Prescription to MOP or MTF Incentives: The Contractor will receive an incentive fee for each new prescription, which due to the Contractor’s efforts and coordination, is successfully transferred from a retail pharmacy to the mail order pharmacy, or to the beneficiary’s designated MTF Pharmacy.

QUESTION: Considering the Mandatory Mail Pilot for TRICARE Medicare Dual Eligible beneficiaries, will the contractor receive finical incentives for prescription transfers under this Pilot?

See H.2.2. Prescription transfers associated with the mandatory mail pilot are not excluded from financial incentives.

L.4. Enhanced Safeguarding Information Requirements Offerors shall submit and include in Volume I of the proposal, a draft checklist and certification using the checklist and certification for minimum level of enhanced safeguarding for unclassified DoD information.

QUESTION: Will the GOV provide the “draft checklist and certification format” for use by the Offeror? Please clarify.

The Checklist and Certification for Minimum Level of Enhanced Safeguarding for Unclassified DoD Information is available as Attachment A to

CDRL A070.

L.6.11. Organization Chart Offerors shall submit their anticipated organizational structure and must include the prime Contractor and critical subcontractors.

QUESTION: Will the GOV provide additional clarification for submission of the Offerors anticipated organizational structure? Clarification to include its purpose and evaluation criteria would be helpful. Is this structure merely to understand the corporate structure and subcontractors? Or;

Because of the 3 page limit, is the GOV looking for more than a high level Organizational Structure?

Section M of the RFP provides all evaluation criteria. The organizational chart required by section L.6.11 is information to facilitate the evaluation as it may provide context between prime contractor, subsidiaries and subcontractors. The information is also utilized to identify any potential conflicts of interests evaluators may have in the prime or subcontractors. The page limit was established to ensure that only a high level identification of the organization is presented.

L.9.2. Major Commercial Clients For each client, offerors shall identify the customer, the functions performed under the cited contract, performance period, number of beneficiaries, dollar value of the contract (specifying administrative versus pharmaceutical dollars), and the number of prescriptions and claims (electronic and paper, reported separately) processed annually.Contractual Agreements an Offeror may have with Commercial Clients sometimes include non-disclosure of financial terms.

QUESTION: We ask the GOVs advice on how to handle such situations where a top 5 client has contractually included non-disclosure language in its Commercial PBM agreement?

The RFP provides the necessary instructions on how offerors are to respond to the RFP. The Government is not allowed to advise offerors on how to respond to the RFP. Please be aware that failure to provide the specified information may have a negative impact on the evaluation results.

General No reference to a Pre-Proposal Conference was found in the Solicitation notice or in the HT9402-13-R-0001 document.

No.

Question: Answer:

QUESTION: Does the Government intend to hold a Pre- Proposal Conference?

C.6.1 General Claims Processing How are real time claims adjudications handled today if one of the Government systems is not available?

If the eligibility system is not available, claims are not processed.

C.6.1.4 (Under General Claims Processing) Is the Government considering daily loading of eligibility data (including OHI and Copay/Deductible information) with the PBM Contractor instead of a real-time query through DEERS?

No.

C.9.1.1 (under Clinical Reviews) Are first-level appeals currently managed by the PBM Contractor?

Yes

C.9.1.1 (under Clinical Reviews) What percentage of medical necessity reviews are first-level (handled by the PBM Contractor) versus external review?

Medical Necessity reviews are done by the contractor.

C.10.2.2 (Under Pharmacy Help Desk Service) Item C.10.2.2 States: “…The Contractor shall provide a dedicated toll free number in support of MTF pharmacies and shall have staff specifically trained to support the MTFs…”.

QUESTION: Would the Governments consider transitioning the current 800 number for Pharmacy Help Desk to the Contractor in order to minimize disruption?

The Government does not own the current contractor’s phone number. Any arrangements of that nature would be between contractors.

F.1 Period of Performance, Section L.3.3 (Under General Instructions) Section F.1 states: “Base Period is no more than one year and will begin on the date of award” and L.3.3 states: “The estimated date of ward will be in February 2014.”

QUESTION: What is the expected start date for pharmacy services delivery?

See F.1.2

Section F.1.1.: “Base Period is no more than one year and will begin on the date of award. 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.” We have checked the TRICARE Operations Manual at change 100 and there isn’t a section 8 of Chapter 1. We believe this may be a typographical error.

Chapter 23, Section 5 references Transition procedures for TPharm. Is this the section of the TOM that we should be referencing?

See forthcoming amendment.

Section L.6.4. states: “The Table of Contents and tabs separating sections of the volumes will not be counted as long as they do not contain proposal content.” Section

Question: Answer:

L.8.1.2 states that “the Government will count the pages upon receipt of proposals beginning with the first piece of paper in the technical proposal (Volume II), which shall be regarded as page one.” As the table of contents will likely be the “first piece of paper in the technical proposal,” will the Government please reconcile these requirements to indicate that the table of contents will not be counted in the technical volume page limit? Or, alternatively, clarify that the table of contents and other reference materials should be included in Volume I.

Does C.7.12 apply to DoD specialty list identified in Exhibit L- 6?