Q A_Seventh_Set_Answers.pdf

SOLICITATION HT9402-13-R-0001

TRICARE PHARMACY PROGRAM, FOURTH GENERATION (TPHARM4)

QUESTION AND ANSWER (Q&A) SET #7

HT9402-13-R-0001

ID: Question: Answer:

103 In compliance with C.4.3; C.10.3.1; and TOM Chapter 11, Section 1, the Contractor will obtain multiple addresses, email addresses, and phone numbers through DEERS and other sources throughout the life cycle of the contract.

QUESTION: Is the Contractor required to maintain the most current record and if so, how?

The RFP is outcome based, so the RFP does not specify how a contractor will accomplish the outcomes, which are dependent on reliable and current beneficiary contact information. There are multiple ways to obtain the most reliable information based on beneficiary contact. The Government will not specify how the contractor will maintain the most accurate information to meet the requirements of the contract. As specified in C.4.3, only addresses are provided quarterly by the Government. The contractor has the ability to use their own information if it is more accurate than most recent DEERS update. Per TSM Chap 3 Section 1.4, the contractor should update DEERS when possible. Per C.10.3.1, if the contractor collects emails, they must have a plan to maintain accuracy. Per C.7.3 and C.10.4.6, the contractor shall not mail to known bad addresses.

104 Section C.6.7.3. states: “the Contractor shall not reject MTF claims, but will instead provide ProDUR warning messaging.”

Section C.11.3.3 states “the Contractor shall provide a daily report of rejected MTF claims (CDRL D010).” The requirement further indicates that “after allowing three (3) business days for the MTF to correct any errors, the Contractor shall undertake retroactive claims correction in their system to correct the remaining errors and ensure that the claims reflect a paid status. This shall be completed within two (2) business days.

QUESTION: Please clarify the apparent inconsistency between section C.6.7.3 and C.11.3.3. Is the Contractor required to reject MTF claims? In addition, to help offerors accurately price their bid, please provide the estimated volume over the last two years in monthly increments of rejected MTF claims requiring retroactive correction."

See forthcoming amendment regarding the cited paragraphs. Historical data for MTF integrity has been provided as an update to data package 9. The data provided is reported from April, May, and June of 2013.

Estimates are not provided.

This 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.

105 With respect to C.6.1.1., which requires the Contractor to adjudicate MTF claims to include ProDUR and the application of MCPF pricing, please tell us all data fields that are required to adjudicate MTF claims in real time so that all offerors can accurately develop their system and price their offer.

See forthcoming amendment.

106 Should the Contractor use the TOM Chapter 23, Addendum A or the DoD-designated specialty drug list in Exhibit L-6 when determining the offeror’s specialty guarantees to be listed in Table H-1?

For purposes of responding to the RFP, the offerors should only use Exhibit L-6 for their offered guarantees in Exhibit L-1.

ID: Question: Answer:

107 C.7.11.1 (Under Pharmaceutical Agents and Supplies) Item C.7.11.1 states that “The Contractor shall provide inventory of pharmaceutical agents and supplies for TMOP for dispensing to TRICARE beneficiaries. The Government shall replenish that inventory…”

QUESTION: Does the Contractor continue to provide inventory for dispensing for the duration of the contract or just the initial fill? Can the replenished inventory be used for dispensing to any of the Contractor’s clients beneficiaries?

The contractor will provide the initial layer of inventory to maintain adequate inventory levels to meet TRICARE prescription volume with consideration that the government will replenish the inventory dispensed for TRICARE prescriptions set forth by C.7.11. The replenished inventory received by the contractor belongs to the contractor. The Government is not in the position to advise what a contractor does with their own inventory.

108 Section C.12.5.2 states “the CHDR will submit transactions to the Contractor for prescriptions dispensed to dual-eligible beneficiaries at VA pharmacies.” and that “the Contractor shall adjudicate these claims using business rules specified by the Government.”

Question: Please provide (1) the expected volume of these transactions, (2) all of the data fields that are required to adjudicate VA claims and (3) additional details about the business rules that the Contractor will be required to follow in adjudicating these claims. This information is necessary in order for offerors to accurately price their proposals.

Regarding (1), See Data Package 13, Tab 13.02 for transaction historical data. This 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.

See forthcoming amendment regarding (2) and (3).

109 L.10.15.1 states “Offerors shall prepare the table in exhibit L-1 in accordance with the instructions provided as “Instructions and Notes for Completing Retail Network Reimbursement Table L-1” immediately following the table.”

QUESTION: Where can the offerors find the referenced instructions?

See forthcoming Amendment for the referenced instructions.

110 Understanding that frequent back-orders and discontinuations of products are realities in the pharmaceutical supply chain, is the Government willing to provide offerors with guidance as to how to handle these complexities while attempting to meet the replenishment requirements described in C.7.11?

See guidance found in C.7.11.2 and C.7.11.3 to seek the lowest cost available agents for replenishment. As explained, the contractor shall coordinate with the NPV and DLA-TS as necessary to accomplish replenishment of the lowest cost available agents per C.7.11.9.

In situations where an agent is considered unreplenishable (eg product discontinuation with no viable alternatives available), the terms of C.7.12 apply.

ID: Question: Answer:

111 With respect to C.7.12, there appears to be substantial (and unlimited) risk associated with unreplenished inventory. C.7.12 states “the Contractor understands that dispensed agents unreplenishable from the NPV are the responsibility of the Contractor.” There is much uncertainty associated with this requirement and unlimited risk due to unknown NPV supply chain issues, the indirect relationship with the NPV Contractor, high likelihood of future manufacturer back orders, growth of specialty pharmaceuticals, discontinued products, and many other risks. Additionally, offerors received a file (Exhibit L-10, Data Package 8) that shows approximately $732,000 of TMA unreplenished spend over the first three years of TPharm contract performance.

QUESTION: May offerors assume this level of unreplenished product will remain fairly constant over the seven years of TPharm4 performance? If not, what level of variability should all offerors expect over the next seven years (especially if the specialty drug spend continues its trend towards 50% of overall drug spend over the next few years)? If the unreplenished balance is greater than the amount listed in Exhibit L-10, Data Package 8, may the Contractor pursue an equitable adjustment via the Changes clause? If not, is the Government willing to cap the amount the Contractor is at risk for under C.7.12 and L.10.12?

The Government recognizes the risk to the contractor and offerors should consider that risk, and the competitive environment, in their proposed price under CLINs XX10. Any assumptions made regarding the level of un-replenished product or the level of variability over any given period should be based on an offerors best business judgment and experience. No equitable adjustment will be granted based on the data provided to offerors. The NPV is expected to meet all performance metrics in its contract (SPM2DX-13-D- 1000). The Government will not cap the amount the Contractor is at risk for under C.7.12 and L.10.12.

112 G.5.6.: For all of the Government Directed Mailings, the detailed descriptions of those mailings in Section C indicates “letters” to beneficiaries. We would like to know if e-mail distribution of the information would be an acceptable alternative – which would generate significant cost savings for the Government.

See forthcoming amendment.

113 Additional data is needed to allow offerors to develop their most competitive pricing. If available, please provide the following data and information:

a.The number of EOBs split by electronic and paper for CY 2011 and CY 2012?

b.The number of retail prescriptions transferred to mail order for CY 2011 and CY 2012?

c.The number of retail prescriptions transferred to MTF for CY 2011 and CY 2012?

a) This information is not currently reported by the incumbent. The ratio between electronic and paper EOBs is a function of a contractor’s processes.

b) See data package “18”.

c) Transfers of retail pharmacy prescriptions to MTFs are not within the scope of the current contract and no data is available.

114 Mail Order Pharmacy, Specialty Clinical Services. Can the government provide the percentage of beneficiaries refusing the specialty clinical services, in CY 2011 and CY 2012?

Percent of beneficiaries that have opted out of mail clinical specialty services as reported by the incumbent:

OY1 = 19.44%

OY2= 12.45%

OY3 = 12.44%

ID: Question: Answer:

115 Will we receive electronic communication or notice of the customer service issues referred to us in the Assistance Reporting Tool (ART)? What volume and types of customer service issues have been reported historically through ART?

The contractor will be notified electronically when they receive a referral through the ART system as referenced in Section C.10.1.6.. See Data package “19” for historical volumes.

116 Does the limitation in section C.6.1.13 on the Contractor negotiating or collecting any additional fees, rebates, discounts, premiums or charge backs of any nature from network pharmacies include “network access fees,” “provider network processing fees,” “administrative processing fees,” “processing fee”, “claim processing fee”, or “network transaction fees,”?

If not, please clarify what, if any, such fees may be negotiated or collected from network pharmacies.

Yes.

117 Section C.6.1.13 provides that the Contractor may not collect additional fees, rebates, discounts, premiums or charge backs. What fees, rebates, discounts, premiums or charge backs, if any, is the Contractor allowed to negotiate or collect from a network pharmacy.

The contractor may only negotiate network discounts related to H-1.

118 In reference to C.7.3.5, does the Government provide reimbursement or other protection associated with the risk of inventory excess & obsolescence?

The offeror assumes the risk of inventory excess and obsolescence. As such, it is incumbent on the successful offeror to manage their inventory.

119 In reference to C.7.11.3, what reconciliation does the Government provide to the Offeror regarding generic product changes at the NPV that leave the Offeror with partial bottle inventory (obsolescence risk)?

Partial bottle inventory resulting from a generic product change is considered unreplenishable. See C.7.12 regarding unreplenishable agents.

120 In reference to C.7.11.8, is the Offeror assuming any financial risk associated with the reconciliation process that is outside of its control (e.g. not being replenished fully)?

The contractor assumes the risk on matters within its control. As such, it is incumbent on the contractor to manage their inventory. The offeror also assumes financial risk in case of unreplenished agents per C.7.12 and may consider that risk in the proposed prices for CLIN x010.

121 In reference to C.7.12, what responsibility is the Government expecting the Offeror to assume when the NPV cannot replenish the Offeror’s inventory? Are prescription processing commitments waived? What if there is an industry product shortage, etc.?

The contractor is expected to first establish, then maintain inventory through the replenishment process under C.11 to fill TRICARE prescriptions. In situations where a temporary delay in replenishment is expected, replenishment will be provided once inventory becomes available. National product shortages will be dealt with in accordance with C.7.1.6. In case of unreplenishable agents, the contractor is responsible to fill prescription orders, so contract standards will not be waived.

ID: Question: Answer:

122 Per section G.8.1: “…The Government will offset unit price payments based on the calculated copayment amounts (i.e., what was required to be collected by the Contractor from the beneficiary) to determine the net amount due the Contractor or Government.”

Accordingly, is it correct to assume that copayment offsets should not be reflected in Schedule B and/or the unit prices?

Correct. The Government will administratively collect the copay amount (offset) when making payment for CLINs x006/x007, so offerors should not adjust their offered prices.

123 In reference to F.2.4, please provide instructions for

CDRL M190.

Instructions will be administratively posted with M190.

124 Section C.7.12 states “The Contractor understands that dispensed agents unreplenishable from the NPV are the responsibility of the Contractor. When an agent that is normally available from the NPV becomes unavailable, the Contractor will utilize its inventory to fill prescriptions orders.” The NPVs contractual performance will have a direct impact on the TPharm4 contractor, and underperformance will financially impact the TPharm4 Contractor. Will the Government ensure the NPV does not miss any contractual requirements to limit the financial exposure being shifted the TPharm4 Contractor? If not, does the Government expect all offerors to build into their price the unknown risk associated with NPV under-performance?

The NPV is expected to meet all performance metrics as contractually required. As specified in C.7.12, the contractor is as risk when an agent becomes unavailable, not when the NPV is late or does not meet metrics.

125 It is our understanding that all Contractors and subcontractors are held to the ADP, NIST, SCA, and other Federal Acquisition Regulation (FAR) flow-down requirements. Are these requirements audited pre-award by DCAA and/or DCMA to ensure full compliance?

A contractor’s compliance with a contract can only be assessed during or after performance of the contract;

therefore, there will not be compliance audits before there is a contract. The government will assess an offeror’s capability via evaluation of the offeror’s proposal and may conduct a preaward survey per FAR

9.106 to assess responsibility.

126 Section C.10.2.2 states that “The Contractor shall provide a dedicated toll free number in support of MTF pharmacies and shall have staff specifically trained to support the MTFs." May the contractor rely on the volume estimates provided in Exhibit L-10, Data Package 10 when preparing their price offering? If not, what level of variability should the Contractor expect over the next 7 years of TPharm4 performance? Please confirm the estimated call volume reflects the volume of calls for all MTFs, and provide the top 5 call reasons with volume to ensure each offeror can appropriately price their offer.

The Government is not providing call volume estimates, but has provided all MTF call volume in data package

10. The Government does not have details regarding the top five call reasons. The historical volume provided in Exhibit L-10, Data Package 10, is historical data and does not represent a commitment on the part of the Government that historical trends, variables, etc., will continue in the future. These quantities will actually occur over the course of the contract. 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 comment on levels or variability.

ID: Question: Answer:

127 It is common in the PBM industry for companies to off-shore certain services such as call centers and PA/MN in an effort to reduce costs for their clients. However, C.14.1 states “The Contractor shall ensure that it does not use or disclose PHI or PII received for DVA or DoD beneficiaries in any way that will remove or transfer the PHI/PII from a jurisdiction subject to the laws of the United States.” Please confirm that call centers, PA/MN, or any other direct service required in Section C of the RFP are prohibited from being performed off-shore if those services will have access to PHI/PII?

TMA confirms that call centers, PA/MN, or any other direct service required in Section C of the RFP are prohibited from being performed off-shore if those services will have access to PHI/PII.

128 RFP Section L.8.2.1.3.2. requires offerors to provide a file identifying each pharmacy in their proposed network by NCPDP number. Should offerors include a hardcopy of the aforementioned file in Volume II in addition to an electronic copy of the file with the electronic copy of Volume II? A hardcopy version could be more than 1,000 pages depending on the print set-up.

See amendment 1