Attachment L-19 Past Performance Questionnaire Template Tab F 20191120.docx
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- Attached to
- DRAFT RFP TRICARE Pharmacy Services, 5th Generation (TPharm5) Federal contract opportunity
- Solicitation number
- HT940220R0002
- Issued by
- Defense Health Agency
About this file
The attached documents include a draft request for proposals (RFP) for the TRICARE Pharmacy Services, 5th Generation (TPharm5) contract along with a past performance questionnaire template. The Defense Health Agency (DHA) is seeking industry feedback on the draft RFP, which contemplates an 18-month base period for transition, seven 1-year option periods for healthcare delivery, and a potential 6-month extension. Key services required include pharmacy benefit management, mail order pharmacy fulfillment, specialty pharmacy programs, and management controls. The DHA requests comments on sections addressing statements of objectives, specialty pharmacy, retail network access, compounded medications, care coordination, and patient safety notifications. Interested parties should submit any questions or comments on the draft RFP by January 17, 2020. The DHA estimates issuing a formal solicitation in mid-2020 and hosting an information session on the draft RFP on December 11, 2019. The past performance questionnaire is a template for offerors to provide to customers to evaluate their past performance on relevant contracts.
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Text version
TPharm5 - Section L Attachment 19 – Past Performance Questionnaire (PPQ) Solicitation Number: Click here to enter text.
Purpose: This PPQ is designed on behalf of the TRICARE Pharmacy (TPharm) Program for use by the offeror to retrieve past performance data. The Defense Health Agency (DHA) will use the information provided for the TPharm past performance evaluation.
Instructions:
1. The offeror shall complete Section 1 and save.
2. The offeror shall send the form to the point of contact (POC) for a customer to complete the performance evaluation in Section 2.
3. The customer shall complete Section 2, sign section 2, and save the document with the signature. The POC shall return to the completed PPQ to the offeror’s point of contact.
4. The offeror shall include the completed PPQ in Volume III of the proposal.
Part 1: (to be completed by the Offeror)
1. Company name: Click here to enter text.
2. Contractor performed as a: ☐Prime ☐First-Tier subcontractor:
3. Contractor identified as: ☐Commercial ☐Federal Government ☐State Government
3. Prime contractor name if different than above: Click here to enter text.
4. Point of Contract (POC) Name: Click here to enter text.
5. POC Phone Number: Click here to enter text.
6. POC Email: Click here to enter text.
7. Address: Click here to enter text.
8. Contract number: Click here to enter text.
9. Contract award date: Click here to enter a date.
10. Forecasted or actual contract completion date: Click here to enter a date.
11. Performance period being evaluated. From: Click here to enter a date. To: Click here to enter a date.
14. The offeror shall describe the magnitude of the contract.
· Total Dollar Value: Offeror data.
· Annual number of mail order claims: Offeror data
· Annual number of retail claims: Offeror data
· Beneficiary Lives Covered: Offeror data
15. The offeror shall describe contract relevance by providing:
· The scope (e.g. tasks, population size, costs, etc.) of the contract: Offeror to describe Scope here.
· The similarity of services as compared to the RFP’s section C: Offeror to describe services here.
· The complexity of the contract: Offeror to describe complexity Scope here.
Part 2 (to be completed by the customer)
1. Customer’s Company or Agency Name: Click here to enter text.
2. Customer’s Company or Agency Description: Click here to enter text.
3. Customer’s POC (Officer, PCO, PCO’s Representative): Click here to enter text.
5. POC Email: Click here to enter text.
6. POC Phone Number: Click here to enter text.
7. Please confirm that the contractor’s information provided by “Part 1” is accurate.
☐Yes ☐No If no, please describe the discrepancy.
Customer to describe discrepancy here (if needed).
Please indicate the performance level achieved by the contractor in performance of the tasks listed below based on the performance level descriptions provided.
| Performance Level |
| Performance Level Description |
| Exceptional |
| The contractor’s performance meets contractual requirements and exceeds many requirements to the customer’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. |
| Very Good |
| The contractor’s performance meets contractual requirements and exceeds some requirements to the customer’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective. |
| Satisfactory |
| The contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions appear or was satisfactory. |
| Marginal |
| The contractor’s performance does not meet some contractual requirements. The contractual performance reflects a serious problem for which the contract has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented. |
| Unsatisfactory |
| The contractor’s performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problems(s) for which the contractor’s corrective actions appear or were ineffective. |
| Not Applicable |
| Unable to provide a performance level. |
Performance Elements.
Subfactor 1-1 Pharmacy Benefit Management Services. The customer should rate the offeror’s performance on the current contract between the customer and offeror. If the item listed below is not a contract requirement, please rate as not applicable (see drop down rating options). The offeror:
Rated Performance Level
| 1. Provided a Pharmacy Benefit Management Service |
| Choose a level |
| 1.1. Provided a technical capability to perform claims adjudication |
| Choose a level |
| 1.2. Provided a scalable claims processing |
| Choose a level |
| 1.3. Provided fiscal intermediary services |
| Choose a level |
| 1.4. Provided a comprehensive information security program |
| Choose a level |
| 1.5. Maintained the required electronic claims processing rate and approach |
| Choose a level |
| 1.6. Maintained the required paper claims rate and approach |
| Choose a level |
| 1.7. Optimized their pharmacy network in terms of cost and access. |
| Choose a level |
| 1.8. Met network access standards at start of contract. |
| Choose a level |
| 1.9. Established and maintained required system interfaces needed to execute their contract requirements. |
| Choose a level |
| 1.10. Maintained technical and clinical expertise for performance of clinical reviews |
| Choose a level |
| 1.11. Maintained an accurate formulary |
| Choose a level |
| 1.12. Maintained appropriate utilization management strategies |
| Choose a level |
| 1.13. Met customer service standards if included as a separate contract requirement(s). |
| Choose a level |
| 1.14. Provided customer service help desk services if included as a separate contract requirement(s). |
| Choose a level |
| 1.a Comments: Please provide comments for all Marginal or Unsatisfactory ratings. Please also provide positive or negative examples, explanations, problems and corrective actions taken. |
Performance Elements.
Subfactor 1-2 Mail Order Pharmacy (MOP) Fulfillment Services. The customer should rate the offeror’s performance on the current contract between the customer and offeror. If the item listed below is not a contract requirement, please rate as not applicable (see drop down rating options). The offeror:
Rated Performance Level
| 2. Provided MOP services throughout the duration of the contract |
| Choose a level |
| 2.1. Met MOP processing standards if included as a separate contract requirement(s). |
| Choose a level |
| 2.2. Provided a replenishment solution within the MOP |
| Choose a level |
| 2.a Comments: Please provide comments for all Marginal or Unsatisfactory ratings. Please also provide positive or negative examples, explanations, problems and corrective actions taken. |
Performance Elements.
Subfactor 1-3 Enhanced Care Programs. The customer should rate the offeror’s performance on the current contract between the customer and offeror. If the item listed below is not a contract requirement, please rate as not applicable (see drop down rating options). The offeror:
Rated Performance Level
| 3. Provided specialty care services if included as a separate contract requirements. |
| Choose a level |
| 3.1. Provided an approach that ensured patient access to specialty pharmacies as if included as a separate contract requirements. |
| Choose a level |
| 3.2. Provided specialty care services in accordance with nationally recognized accreditation standards if included as a separate contract requirement(s). |
| Choose a level |
| 3.3. Provided an approach to optimize specialty care if included as a separate contract requirement(s). |
| Choose a level |
| 3.4. Provided a process to replenish specialty pharmaceuticals if included as a separate contract requirement(s). |
| Choose a level |
| 3.a Comments: Please provide comments for all Marginal or Unsatisfactory ratings. Please also provide positive or negative examples, explanations, problems and corrective actions taken. |
Performance Elements.
Subfactor 1-4 Management Controls and Oversite. The customer should rate the offeror’s performance on the current contract between the customer and offeror. If the item listed below is not a contract requirement, please rate as not applicable (see drop down rating options). The offeror:
Rated Performance Level
| 4.1. Provided quality control and quality assurance programs for both internal and public-facing operations |
| Choose a level |
| 4.2. Provided proactive and collaborative contract and program management |
| Choose a level |
| 4.3. Performed transition-in activities |
| Choose a level |
| 4.a Comments: Please provide comments for all Marginal or Unsatisfactory ratings. Please also provide positive or negative examples, explanations, problems and corrective actions taken. |
Performance Elements.
Utilization of Small Business. The customer should rate the offeror’s performance on the current contract between the customer and offeror. If the item listed below is not a contract requirement, please rate as not applicable (see drop down rating options). The offeror:
Rated Performance Level
| 5. Met small business subcontracting plan or goals |
| Choose a level |
| 5.a Comments: Please provide comments for all Marginal or Unsatisfactory ratings. Please also provide positive or negative examples, explanations, problems and corrective actions taken. |
| 6. OVERALL – Performance rating. All things considered, how did the offeror perform? |
| Choose a level |
| 6.a Comments: Please provide comments for all Marginal or Unsatisfactory ratings. Please also provide positive or negative examples, explanations, problems and corrective actions taken. |
Customer POC, please digitally sign below and “save as Adobe PDF”. Signing will save the document and lock the document so that your ratings cannot be changed. If you are unable to digitally sign, please type your first name, last name, and date; then “save as Adobe PDF” and return the document to the offeror. Thank you for your time. Questions or concerns shall be addressed by the offeror.
HT940220R0002 L-19-1
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