TPharm5 Draft Section L 20191202.docx

SECTION L

INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS

L.1. Provisions.

FAR 52.204–7 System for Award Management (OCT 2018)

FAR 52.204–16 Commercial and Government Entity Code Reporting (JUL 2016)

FAR 52.204–22 Alternative Line Item Proposal (JAN 2017)

FAR 52.211–7 Alternatives to Government–Unique Standards (NOV 1999)

FAR 52.215–1 Instructions to Offerors – Competitive Acquisition (JAN 2004)

***FAR 52.215–3 Request for Information or Solicitation for Planning Purposes***

FAR 52.215–16 Facilities Capital Cost of Money (JUN 2003)

FAR 52.215–22 Limitations on Pass–Through Charges––Identification of Subcontract Effort (OCT 2009)

FAR 52.216–1 Type of Contract (APR 1984)

The Government contemplates award of a hybrid contract type; with contract line items which are firm-fixed-price and fixed–price along with award fee and performance incentives and guarantees, resulting from this solicitation.

(End of provision)

FAR 52.222–24 Preaward On–Site Equal Opportunity Compliance Evaluation (FEB 1999)

FAR 52.222–46 Evaluation of Compensation for Professional Employees (FEB 1993)

FAR 52.233–2 Service of Protest (SEP 2006)

(a) Protests, as defined in Section 33.101 of the Federal Acquisition Regulation, that are filed directly with an agency, and copies of any protests that are filed with the Government Accountability Office (GAO), shall be served on the Procuring Contracting Officer (PCO) (addressed as follows) by obtaining written and dated acknowledgment of receipt from the PCO, address in Block 7 of the Standard Form 33.

(b) The copy of any protest shall be received in the office designated above within one (1) day of filing a protest with the GAO.

(End of provision)

FAR 52.252–1 Solicitation Provisions Incorporated by Reference. (FEB 1998)

This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the PCO will make their full text available. Offerors are cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, offerors may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this address: http://www.acquisition.gov

(End of provision)

FAR 52.252–5 Authorized Deviations in Provisions. (APR 1984)

(a) The use in this solicitation of any Federal Acquisition Regulation (48 CFR Chapter 1) provision with an authorized deviation is indicated by the addition of "(DEVIATION)" after the date of the provision.

(b) The use in this solicitation of any (48 CFR Chapter) provision with an authorized deviation is indicated by the addition of "(DEVIATION)" after the name of the regulation.

(End of provision)

DFARS 252.215–7008 Only One Offer (JUN 2019)

DFARS 252.215–7009 Proposal Adequacy Checklist (JAN 2014)

DFARS 252.215–7010 Requirements for Certified Cost or Pricing Data and Data Other Than Certified Cost or Pricing Data (JUL 2019)

DHA PROCEDURES, GUIDANCE AND INFORMATION (PGI) 233.103–90, AGENCY LEVEL PROTESTS NOTICE OF AVAILABILITY OF INDEPENDENT REVIEW (April 14, 2014)

An interested party filing a protest with Defense Health Agency (DHA) has the option of requesting review by either the PCO or an independent review official (IRO), who is a DHA official at a level above the PCO. Alternatively, an interested party may request IRO review as an appeal of the PCO’s protest decision.

Where applicable, an interested party must clearly state in the protest that IRO review is requested, and must specify the nature of the independent review sought – whether as an alternative to the PCO review or as an appeal of the PCO’s decision.

Regardless of which review is requested, all protests must be complete and submitted to the PCO within the timeframes specified in FAR 33.1.

L.2. General Instructions. This section provides general guidance for preparing proposals as well as specific instructions on the format and content of proposals. Offerors are cautioned to follow the instructions provided in this section carefully to ensure the Government receives consistent information in a format that will facilitate proposal evaluation. The offer shall be compliant with the requirements as stated in the solicitation and applicable attachments. Nonconformance with the instructions provided in the solicitation and this section may result in an unfavorable proposal evaluation or rejection of the proposal. The written proposal shall be clear, concise, and include sufficient detail for effective evaluation and for substantiating the validity of stated claims.

L.2.1. Cross Reference Table. The Government has provided Table L-6, Solicitation Cross-Reference Table, to assist offerors in proposal preparation. The cross-reference table provides a general cross-reference between solicitation sections and is not intended to be a substitute for the offeror’s reading and complying with the solicitation requirements. The risk remains on the offeror to ensure its proposal complies with all solicitation requirements regardless of the table’s contents, and any error or omission in the table will not excuse an offeror from compliance with solicitation requirements.

L.2.2. Initial Proposals. The Government will evaluate proposals based on the written information submitted by offerors. The Government reserves the right to award without discussions. Therefore, the offeror’s initial offer should contain the offeror’s best terms from a price and technical standpoint. The PCO may find the proposal unacceptable, which could make the offeror ineligible for award, if an offeror:

L.2.2.1. fails or refuses to assent to any of the terms and conditions of the solicitation, L.2.2.2. proposes additional terms and conditions of this solicitation excluding those permitted in paragraph L.5.3, L.2.2.3. fails to submit any of the information required by this solicitation.

L.2.2.4. submits more than one proposal. If an offeror submits more than one proposal, the Government will not evaluate any proposal from that offeror.

L.2.3. Applicability. Sections L and M apply to the solicitation phase only and will not be part of the resulting contract. Section K, Representations and Certifications, shall be incorporated into the contract by reference per FAR 52.204–19.

L.2.4. Period of Performance. The contract will reflect the actual period of performance dates.

L.2.5. Price Competition. The PCO has determined there is a high probability of adequate price competition in this acquisition. After receipt of proposals, if the PCO determines adequate price competition exists, no additional cost information will be requested; and offerors will not be required to provide certification under FAR 15.406–2. However, if the PCO determines adequate price competition does not exist, the PCO may require offerors to submit information to the extent necessary for the PCO to determine the reasonableness of the proposed prices.

L.2.6. Point of Contact. The PCO is the official point of contact for this solicitation. The PCO has assigned one or more contract specialists to coordinate with offerors for solicitation questions, receive past performance questionnaires, and proposal deliveries. All solicitation documents for this requirement are available on the System for Award Management (SAM) website at https://www.Beta.SAM.gov unless noted otherwise. Potential offerors are encouraged to register on SAM.gov to receive e–mails regarding Government notifications on the Beta.SAM.gov website.

L.2.7. Questions. The PCO encourages interested vendors to submit questions regarding the solicitation or other concerns via email to the PCO and Contract Specialist identified in Block 10 of the Standard Form 33 no later than 30 calendar days after the PCO issues the solicitation. Questions submitted later than 30 calendar days after the solicitation issue date may not be considered. The PCO will provide the answers to questions via the SAM website at https://www.beta.SAM.gov. Comments or questions regarding OCI will not be posted, but will be responded to individually.

L.2.8. Errors. If an offeror believes the requirements in these instructions contain an error, omission, or are otherwise unsound, the offeror shall immediately notify the PCO in writing with supporting rationale.

L.2.9. Solicitation Amendments. The remarks, explanations and answers provided by Government representatives whether orally or in writing, shall not change or qualify any of the terms or conditions of the solicitation. The solicitation can only be changed by a written amendment issued by the PCO.

L.2.10. Legal Name. Offerors shall use their legal name and not a shortened version that could be confused with a parent company or other corporation. Use of an acronym is permissible after the first usage of the full legal name in each of the five volumes. The offeror shall clearly state in its proposal whether it is speaking of itself, its parent company, or a subsidiary.

L.2.11. Data Files. Offerors may request files not posted at beta.SAM.gov at no cost. Offerors shall refer to the following to request this information: Attachments L–1, Ordering Instructions for Data Files, L-1.1, List of Data Packages, L-1.4, Detail Level Claims Data Fields, L-1.2, Non–Disclosure Agreement, and L-1.3, Business Associate Agreement.

L.2.12. TRICARE Manuals. The applicable TRICARE Manuals are incorporated in Section C and are the current versions for the purposes of this solicitation and resulting contract. Any revisions, changes, or updates to these manuals may be incorporated in an amendment or after contract award.

L.2.13. Organizational Conflicts of Interest. The offeror's attention is directed to FAR 9.5, Organizational and Consultant Conflicts of Interest.

L.2.13.1. Definition of Offeror. For the purpose of these provisions, the term offeror means the offeror, its subsidiaries, affiliates, partners, any of its successors or assignees or marketing consultants, as defined by FAR 9.501.

L.2.13.2. Actual Conflicts of Interest. It is the position of DHA that certain companies, due to the nature of their contract performance with the Department of Defense (DoD), have an actual or potential organizational conflict of interest, which must be avoided, neutralized, or mitigated. The companies that would have an actual conflict of interest and may not serve as the prime contractor, subcontractor, or market consultant in the development of a response to the solicitation include, but are not limited to: Unissant, GDIT, ITSC Secure Solutions LLC, and Johns Hopkins University/Applied Physics Laboratory, Dine Source. The following companies may have a potential conflict of interest: McKesson Corporation, Xicon, Akoya, Axiom Resource Management; any company or individual with a DHA support contract; and any other company or individual supporting the following DoD pharmacy systems: Defense Enrollment Eligibility Reporting System (DEERS), Pharmacy Data Transaction Service (PDTS), Legacy Electronic Prescribing Solution (LEPS), Composite Health Care System (CHCS), Armed Forces Health Longitudinal Technology Application (AHLTA), Integrated Electronic Health Record (iEHR), Clinical Data Repository/Health Data Repository (CHDR), and Theater Medical Data Store (TMDS).

L.2.13.3. Covered DoD Officials. The offeror is hereby notified that an actual or potential conflict of interest may exist with Covered DoD officials, as defined by DFARS 252.203–7000. The offeror shall not knowingly provide compensation to a Covered DoD official within 2 years after the official leaves DoD service, without first determining that the official has sought and received, or has not received after 30 calendar days of seeking, a written opinion from the appropriate DoD ethics counselor regarding the applicability of post–employment restrictions to the activities that the official is expected to undertake on behalf of the offeror. In addition to the requirements stated in DFARS Clause 252.203–7000, the offeror shall disclose all intended employees participating on the proposal that are Covered DoD Officials, and get approval from the PCO prior to the involvement of Covered DoD Officials in the development of a response to the solicitation or a plan to address potential or actual conflicts of interest.

L.2.13.4. Potential Conflicts of Interest. It is the position of DHA that close business relationships between the offeror and other entities may pose a potential conflict of interest in the performance of the contract. This includes following business arrangements: Ownership, either direct or a majority stake, of pharmacies by the offeror; Ownership of the offeror and pharmacies under a mutual parent company; Any other financial interest or minority ownership; or a Partnership Agreement. This potential conflict includes, but not limited to, the Contractor’s performance as a fiscal intermediary for the Government and in its role in pursuing waste, fraud and abuse (TRICARE Operations Manual (TOM) Chapter 13). Such impaired objectivity, internal allegiances, or conflicting roles must be avoided, neutralized, or mitigated.

L.2.13.5. Submission of OCI Information Prior to Proposal. The Offeror shall represent in writing within Volume 1 the proposal that, to the best of the Offeror's knowledge, there are no relevant facts or circumstances concerning any past, present, or potential contracts or financial interest relating to the work to be performed, which could give rise to an organizational conflict of interest (OCI), as described in FAR, Subpart 9.5. In the event an actual or potential organizational conflict of interest exist, the Offeror shall submit an OCI plan to the PCO as soon as possible, but no later than 15 calendar days prior to the proposal due date, that effectively demonstrates how the Offeror will avoid, mitigate or neutralize any actual or potential organizational conflict of interest while supporting this contract and any other DHA contract. The Offeror shall also provide the PCO, no later than 15 calendar days prior to the proposal due date, with information of previous or ongoing work that is in any way associated with this solicitation. Any organizational conflicts of interest found after proposal submittals shall be disclosed to the PCO immediately. Failure to disclose a conflict of interest timely may result in an offeror being determined ineligible for contract award.

L.2.13.6. PCO Assessment. The PCO will review all OCI plans to determine whether award to the Offeror is consistent with FAR, Subpart 9.5. If the PCO determines that no conflict would arise or that the mitigation plan adequately protects the interest of the Government, the Offeror will be eligible for award. If the PCO determines that the organizational conflict of interest has not been avoided, mitigated, or neutralized, remedial actions will be considered, including elimination from the solicitation process, termination of related contract efforts already awarded, or negotiation of the OCI plan.

L.2.13.7. Flow Down. The above restrictions shall be included in all subcontracts, teaming arrangements, and other agreements calling for performance of work which is subject to the organizational conflict of interest restrictions identified in these provisions.

L.2.13.8. Offeror Acknowledgment. Each offeror shall acknowledges the full force and effect of these requirements. The Government reserves the right, in case of a breach, misrepresentation or nondisclosure, to terminate the resultant contract, disqualify the offeror from subsequent related contractual efforts, or pursue any remedy permitted by law, regulation or the terms and conditions of this solicitation.

L.2.14. Non–Government Advisors. The expertise of Non–Government advisors may be required to support the evaluation of technical proposals. When the identity of the Non–Government advisor(s) becomes known, DHA will immediately, provide the name(s) of the Non–Government advisor(s) by correspondence to the offerors. These advisors have broad and comprehensive knowledge of the civilian health care industry and pharmacy benefit management services, and will apply their expert knowledge of industry practices and standards to assist the Government in evaluation of technical proposals. Non–Government advisors are subject to the limitations of FAR 7.503 and FAR Part 37.2; and shall not determine ratings or rankings of offeror’s proposals or perform any inherently-governmental function.

L.2.14.1. Release of Proposal Information. The release of proposal information to Non–Government advisors: The release of proposal information to non–Government advisors will be subject to the controls of DHA. Non–Government advisors are not allowed access to past performance information or proprietary financial data (dollar figures) contained in the price proposal.

L.2.14.2. Prohibitions. Non–Government advisors are prohibited from proposal rating, ranking, or recommending the selection of a source, or accessing past performance information.

L.2.14.3. Access to proprietary information. Non–Government advisors that have access to proprietary information in performing their roles for the Government must agree to protect the information from unauthorized use or disclosure for as long as it remains proprietary, and refrain from using the information for any purpose other than that for which it was furnished. All non–Government advisors are required to sign a non–disclosure agreement, DHA Form 821. The PCO shall retain the signed agreements in the pre–award contract file.

L.2.14.4. Organizational Conflict Of Interest (OCI). OCI clauses are included in TRICARE contracts under which non– Governmental technical advisors are performing services for the Government. The OCI clauses require the companies and/or individual Non–Government advisors to protect an offeror’s proprietary data and Government source selection information and prohibit them from otherwise participating as an offeror, a subcontractor, or as a consultant to an offeror/subcontractor in relation to this acquisition.

L.2.14.5. Permission from Offerors. Upon review of the above limitations, and after the identity of the Non– Government advisor(s) is provided by letter to the offerors; any offeror having concerns/issues regarding the Non–Government advisors having access to their proposal information should notify the PCO of said objection; or obtain a written agreement between the Non–Government advisor and the offeror in accordance with FAR 9.505–4 (b), and submit to the PCO within 7 working days at time of notification. If said agreement / objection to the proposed non–Government advisor(s) have not been submitted within the 7 working days, offerors will be deemed to have consented to the limited access described above.

L.3. Proposal Preparation. All offerors shall submit an original proposal and associated copies with the minimum content as specified herein. Proposals will be received until the date and time indicated on Standard Form 33 at the address listed in block 10 of the solicitation. The offeror’s proposal shall consist of five physically separated volumes, individually titled as indicated below. Hard copies of each volume shall be contained in a separate three–ring binder and submitted to the PCO with the appropriate number of copies.

L.3.1. Page Limits. Offerors shall limit their proposal to the page limits listed below. Page limitations will be treated as maximums. If exceeded, any excess pages will not be considered in the evaluation. The Table of Contents and tabs separating the volumes will not be counted as long as they do not contain proposal content. If there is a requirement for information in the proposal not reflected in the following table, then a page limitation does not apply.

L.3.2. Table L-1 – Proposal Preparation Checklist. The following table is included to assist offerors in the preparation of their proposals.

L.4.

Page Limit

Overall: None

|_|TAB E – DCMA Form 1620 04–04 Guaranty Agreement for Corporate Guarantor

L.4.7.

Attachment L-2 None

L.5.

Page Limit

Overall:

100 Pages

L.6.

Page Limit

Overall:

None

Attachment L-4 Attachment L-5 Attachment L-6 None

|_|TAB H – Past Performance Information (PPI) Tool Access Database attached to SAM.gov posting labeled “PPI Tool”

PPI Tool

L.7.

Page Limit

Overall: None

Attachment L-7 None

L.8.

Page Limit

Overall: None

Attachment L-8

L.3.3. Other Companies. Information submitted about any company other than the Offeror, whether a predecessor company, affiliated company, key subcontractor, or other associated business, WILL NOT be evaluated for any factor unless the proposal contains a detailed narrative explaining why this submitted information is relevant for performance of this contract. The Government will consider the adequacy of this explanation in deciding the relevance and weight of the information to this procurement. Information about major subcontractors may not be given much weight unless the proposal contains some evidence that this subcontractor is committed to perform the work.

L.3.4. Proposal Submission. Offerors shall submit their proposals to the Contracting Officer at the address indicated in block 7 of the SF33.

Each CD label and the outside cover page of each hardcopy volume shall be marked as follows:

OFFEROR’s COMPANY NAME, e.g., XYZ Corporation

HT940220R0002

TRICARE Pharmacy Program, 5th Generation Volume Number CD number (e.g., 1 of 3) Identify if the data is protected information.

Date the CD was created.

Software and version used.

L.3.5. Electronic Copies. Electronic copies shall also be provided on one CD/DVD in PDF format or comma delimited file (CSV), or Microsoft Access (PPI Tool) and be Optical Character Recognition (OCR)* compatible. In the event of any conflict between the electronic submission and the hard copy submission, the hard copy submission will govern and will be the material upon which the Government bases its evaluation and ultimately, its decision. All text must be legible and easily read. The page size of the offeror’s proposal shall not exceed 8–1/2 by 11 inches. Diagrams, charts and tables shall conform to the paper size. All text shall be typed single–spaced with a minimum size 10 font. Margins (1–inch) shall be clean and clear. If fold–out charts are unavoidable, and are to be utilized, all sheets shall be reproduced on 11 by 17 inch, and folded to 8–1/2 by 11 inch size. A page is defined as text or information on one side of the paper. If it is printed double sided, each face will be counted as a page.

*OCR is a common method of digitizing printed texts so that they can be electronically searched, stored more compactly, displayed on–line, and used in machine processes such as machine translation, text–to–speech, key data extraction and text mining.

L.3.6. Volume Content. Information does not need to be duplicated in its entirety in multiple locations, so the narrative may reference tables and charts. No part of a Volume shall incorporate by reference portions of other Volumes of the proposal except for Volume 1 (e.g., Volume 5 Pricing cannot be referenced in Volume2 Technical, but Volume 2, 3, 4, 5 may reference Volume 1). Information may be referenced within the same Volume rather than duplicating the information within that Volume. Offerors shall not include price information anywhere (else) in their package, except in the price proposal (Volume 5). In addition, within the Technical proposal, the offeror need not repeat information across subfactor tabs if information applies to more than one subfactor - information may be referenced across tabs. The technical evaluators are not bound by the subfactor tab designations in completing their evaluation of each sub-factor.

L.3.7. Proposal Content. The proposal should not simply rephrase or restate the Government's requirements, but it shall provide clear explanation that demonstrates understanding of the requirements and addresses how the offeror intends to meet the requirements. Offerors shall assume the Government has no prior knowledge of their facilities, capabilities and experience. The Government will base its evaluation on the information presented, plus any additional past performance information or data the Government obtains from other sources.

L.3.8. Incorporation of Proposal. An offeror’s proposal will not be incorporated into the awarded contract as a whole. However, the Government may incorporate portions of the proposal.

L.3.9. Clarifications. If the PCO determines that a written clarification is necessary, a request for clarification will be issued to the offeror. Offerors shall follow the instructions provided by the PCO.

L.3.10. Final Proposal Revisions. If final proposal revisions are required (if requested by the PCO), offerors shall follow the final proposal revision instructions provided by the PCO.

L.3.11. Records. In accordance with Federal Acquisition Regulation (FAR) Subpart 4.8 Government Contract Files, the agency’s contracting office will retain one copy of all unsuccessful proposals. Unless the offeror requests otherwise in writing, the agency’s contracting office will destroy extra copies of unsuccessful proposals.

L.4. VOLUME 1 – Administrative Documents.

L.4.1. Cover Letter. Offerors shall include a cover letter with their offer that includes the solicitation number; the legal name, mailing address, email, and telephone number of the offeror; the name, title, email, and telephone numbers of persons authorized to negotiate on the offeror’s behalf with the Government in connection with this RFP; the name, title and signature of the person(s) authorized to sign the proposal. A statement specifying agreement with all terms, conditions and provisions included in the solicitation; as well as CAGE code(s) and the DUNS number for the offeror.

L.4.2. Table of Contents. Each volume of the proposal should contain a detailed table of contents. All pages of each factor should be sequentially numbered. If more than one binder is used, the complete table of contents shall be included in each.

L.4.3. Tab A – SF33, Signed Offer. Offerors shall complete, sign, and date their offer at blocks 12 through 18 of the Standard Form (SF) 33 and shall acknowledge all amendments to the solicitation in accordance with instructions on the SF30. The proposal shall be signed by an authorized individual(s) of the offeror. Evaluation of offers received in response to the solicitation and the source selection procedures are projected to require up to 210 calendar days to complete. As a result of this, the Government requires that the minimum acceptance period identified in item 12 of the Standard Form 33 be a minimum of 210 calendar days.

L.4.3.1. Ownership Disclosure. Offerors shall include a statement of affiliation with their proposal detailing corporate ownership.

L.4.3.2. OCI Statement. See paragraph L.2.13 and associated subparagraphs for information about OCI and required statements and submissions.

L.4.3.3. Anticipated Location of Performance. In accordance with FAR 22.1009 and 29 CFR 4.4(a)(3)(i), where the place of performance of a contract for services subject to the Service Contract Act (SCA) is unknown at the time of solicitation, the offeror shall submit the intended location(s) of performance with their proposal (County and State). This location information will be used to determine which SCA wage determinations will apply to the resulting contract award.

L.4.3.4. Intended Performance Outside the US and Canada. Offerors shall report any intended performance outside the United States and Canada in accordance with DFARS Provision 252.225–7003, Report of Intended Performance Outside the United States and Canada—Submission with Offer. Please also see Section C.11. Privacy and HIPAA for restriction on removal of PII from the United States’ jurisdiction.

L.4.4. Tab B – Representations and Certifications. All representations and certifications, to include Section K, required by the solicitation shall be completed and provided in Volume 1. The offeror shall submit a completed Section K, FAR 52.204–8, Annual Representations and Certifications, with the proposal. An online Representations and Certifications Application is available at https://sam.gov/SAM.

L.4.5. Tab C – Teaming Agreement or Joint Venture Agreement. If applicable, the offeror shall submit a fully executed copy of the teaming arrangement or joint venture agreement and shall be signed in accordance with the terms and conditions specified in the entity formation documents.

L.4.6. Tab D – Financial Viability. Offerors must demonstrate adequate financial resources to perform the prospective contract or demonstrate an ability to obtain adequate financial resources. The financial information submitted will be used by the PCO in making a financial responsibility determination. Failure of an offeror to submit the required financial information could result in the PCO making a determination the offeror is not responsible.

L.4.6.1. Financial Statement Data. The offeror shall submit financial statement data for the 3 most recent and complete fiscal years and the most recent interim accounting period, if applicable. The offeror shall submit these data on the parent corporation, on the subsidiary offeror, and on any recent or prospective significant merger candidates.

L.4.6.2. Audit Information. The offerors shall clearly label all financial statements as audited or not audited, and include the date last audited, name and organization of the auditor, and the date, if applicable, of any certification of the financial statements by the responsible company official. The offeror shall disclose and explain all off–balance sheet arrangements and related party transactions.

L.4.6.3. Required Statements. The following financial statements on the parent corporation, on the subsidiary offeror, and on any prior or prospective significant merger candidates are required:

L.4.6.3.1. Annual Reports for the offeror’s 3 most recent fiscal years (including audit opinions) L.4.6.3.2. Balance Sheets and Income Statements, Statements of Retained Earnings, and Statements of Cash Flow L.4.6.3.3. Statements of projected quarterly cash flows for a one–year period beginning with the start of the contract (i.e., transition–in).

L.4.6.3.4. The most recent Dun and Bradstreet Comprehensive Report, or if not available, another rating company report that is essentially equivalent to Dun and Bradstreet (e.g., A.M. Best Company).

L.4.6.4. New Companies. Offerors that are start–up companies, or otherwise do not have annual reports, shall provide historical documents (e.g., tax returns), projected income statements and balance sheets, and narrative documentation supporting their ability to obtain the financial resources to perform the contract.

L.4.6.5. Adverse Financial Items. Offerors shall submit copies of adverse financial items uncovered in the last 3 years of State Insurance Department audits, if applicable. Offerors shall provide a supporting narrative, including a brief description of anomalies. The offeror shall submit State Insurance Department audits, if applicable. Offerors shall provide a supporting narrative, including a brief description of anomalies in the submitted financial data and a brief description of any projected increases and decreases in the offeror’s business base.

L.4.7. Tab E – Guaranty Agreement for Corporate Guarantor. The offeror shall include a guarantee from the offeror’s holding or parent company, or owner(s), if applicable, indicating their willingness to guarantee complete and faithful performance of the offeror and to provide the offeror all necessary and required resources, including financing, which are necessary to assure the full, complete and satisfactory performance of the contract. The format to be used for this guarantee is found in Attachment L-2, DCMA Form 1620 04–04 Guaranty Agreement for Corporate Guarantor. The offeror shall include a signed original in Volume 1. Failure to provide this guarantee, if applicable to the offeror, may result in the PCO determining the offeror is not responsible and is thus ineligible for award. The PCO shall consider the results of this review in the responsibility determination.

L.4.8. Tab F – Organization Charts. The offeror shall submit its anticipated organizational structure and shall include the prime contractor and first–tier subcontractors. In the case of a joint venture or other business structure (e.g., subsidiary relying upon its parent corporation and/or relying on other corporate subsidiaries of its parent), the offeror shall disclose a clear description of the organizational relationships. The organization chart shall not exceed 5 pages and will not count against any of the other page limitations.

L.5. VOLUME 2 – Technical Proposal. The offeror shall submit a technical proposal which demonstrates the offeror’s understanding of the requirements, and provides an effective and efficient technical solution for the prospective contract. The proposal should clearly describe the technical solution and overall approach to the solicitation requirements and address all of the subfactors identified in Section L, which the Government will evaluate against the criteria specified in Section M.

L.5.1. Content. The proposal shall not reflect a marketing or sales presentation. The Government does not desire unnecessarily elaborate proposals beyond those sufficient to present a complete and effective response to this solicitation. Note: The Government shall not be bound by an offeror’s assertion that a particular approach in its technical proposal is a “strength.” Notwithstanding an offeror’s assertion of the strengths and benefits in its proposal, the Government, at its sole discretion, will evaluate proposals to identify and assess strengths.

L.5.2. Proposal Assertions. The proposal may state information on the offeror’s experience (for this purpose, experience refers to what an offeror has done, not how well it was accomplished) in performing its proposed processes and procedures. This information may be considered in the evaluation of specific technical approaches and their associated risk. Any such information will not be considered in the past performance evaluation. The price proposal, past performance information, and financial information shall not be addressed in the technical proposal volume, and no part of the technical proposal shall incorporate by reference portions of other volumes of the proposal.

L.5.3. Exceeding Standards. An offeror may propose standards that exceed the Government’s minimum standards or propose additional standards or requirements. The offeror shall commit to these in the proposal and shall state the proposed standard/requirement in contractual language which the Government could incorporate into the contract as stated. The proposal shall clearly describe and explain how the offeror will meet these proposed standards that either exceed the Government’s minimum standard, or are additional standards or requirements. The proposal must clearly describe and explain how the offeror will meet these proposed standards that either exceed the Government’s minimum standard or are additional standards or requirements. If the Government determines these proposed standards or requirements will be advantageous to the Government, beneficiaries and/or providers during contract performance, the Government, at its sole discretion, will incorporate these into the contract.

L.5.3.1. Offerors may propose an ability to exceed an Acceptable Quality Level (AQL). The higher AQL may be added, as proposed, to the successful contract. The new AQL will be the minimally accepted rate used for the purposes of incentive payments, performance guarantees, and will be used to determine contract performance assessment report (CPAR) rating. Meeting the revised AQL is typically considered satisfactory performance.

L.5.3.2. Offerors shall refer to Section M, paragraph M.4.5. for the list of performance standards/requirements for which the Government will not assess a strength if offerors propose to exceed.

L.5.4. Page Limits. The technical proposal shall not exceed 100 pages inclusive of the exhibits, illustrations, attachments, flow diagrams, data dictionaries, figures, charts, and any other non–narrative inclusion. Offerors may provide cross–references rather than resorting to redundancies in the presentation (i.e., a cross reference to another paragraph within the technical volume, cross references to the other volumes is not allowed). The Government will count the pages upon receipt of proposals beginning with the first piece of paper of the technical proposal (Volume 2), which shall be regarded as page one. Pages in excess of 100 (starting at page 101) will not be evaluated. The Government will not count the Table of Contents or tabs separating sections of the volume as long as they do not contain proposal content.

L.5.5. Tab A – Subfactor 1-1 – Pharmacy Benefit Management Services. Offerors shall describe its approach for the acceptance and processing of claims submitted by retail network pharmacies, the TRICARE Mail Order Pharmacy (MOP), MTF pharmacies, or by beneficiaries for direct reimbursement.

L.5.5.1.1. Offerors shall describe their underlying technical capabilities to performing claims adjudication that meets the minimum standards specified in Section C. Offerors shall describe its proposed workflow for management of this claims processing system and describe how it includes both commercial PBM practices and the flexibility to accommodate unique Government requirements. Offerors shall describe its ability to support timely changes to its claims processing system in response to benefit design changes made by the Government.

L.5.5.1.2. Offerors shall describe how the proposed claims processing system is scalable to meet the anticipated volume at the start of pharmacy services [and potential growth] throughout the duration of the contract.

L.5.5.1.3. Offerors shall provide a solution for serving as a fiscal intermediary and shall describe its approach to complying with financial requirements, including but not limited to TRICARE Encounter Data System (TEDS) and recoupment.

L.5.5.1.4. Offerors shall describe a comprehensive security program which protects TRICARE beneficiary data according to the standards specified in this solicitation.

L.5.5.1.5. Offerors shall provide its current electronic claims processing metrics to include the number of clients served, the number of claims processed electronically for each of its largest 10 clients (based on the number of electronic claims processed), and its total aggregate [annual] electronic claims volume. If an offeror does not have 10 clients, information will be provided for all of its clients. Offerors shall provide the total claims processing capacity of its proposed claims processing system. Offerors shall identify any hardware /software /facility changes necessary to its electronic claims processing system to process the anticipated electronic claim volume under this contract. Offerors shall specify the magnitude of the change, facility additions/changes, and months required to accomplish the change, including a timeline with major milestones identified.

L.5.5.1.6. The proposal shall describe the offeror’s approach to processing paper claims, including its ability to process coordination of benefit (i.e. OHI) claims, non–network claims and assignment of benefit claims. Offerors shall identify any hardware/software/facility changes necessary to process the anticipated paper claim volume under this contract, including a timeline with major milestones identified.

L.5.5.1.7. Offerors shall offer and guarantee an optimized pharmacy network, both in terms of cost and beneficiary access. The offeror shall describe how the network meets or exceeds proposed access standards (drive time/distance, percentage of beneficiaries).

L.5.5.1.8. Offerors shall describe their approach to meeting their guaranteed minimum network access standards at the start of pharmacy services, while maintaining beneficiary satisfaction.

L.5.5.2. System Interfaces (both legacy, ongoing, and MHS Genesis). Offerors shall describe their strategy and capabilities for developing, implementing, and maintaining the required interfaces to legacy (e.g. CHCS, CHDR, TMDS), ongoing, and future state systems. The description will include knowledge and experience for various transaction types, network security, testing procedures, and the level of effort required to build and maintain complex systems in both commercial and custom environments. Offerors shall specify the scope of the system changes required to support the required interfaces, including facility additions/changes, and months required to implement, including a timeline with major milestones identified.

L.5.5.3. Clinical Reviews. The proposal shall describe the offeror’s technical and clinical expertise to establish, implement, and administer overrides, clinical reviews, and administrative reviews, meeting the performance standards specified in Section C. The proposal shall include the offeror’s plan to maximize the use of electronic clinical reviews.

L.5.5.4. Formulary and Benefit Design. The proposal shall describe how the offeror will implement the Government’s formulary design, manage new medications to market, provide recommendations on how to manage the formulary, accurately and timely execution of formulary changes, provide audit process for quality assurance of the benefit design, conduct continuous management, resolve issues, maintain a communication plan across clinical counterparts and beneficiaries.

L.5.5.4.1. The proposal shall describe the offeror’s utilization management strategy; how they efficiently manage the access to care or drug therapies utilizing available benefit design tools. These may include quantity limits, prior authorizations, step therapy, and other activities to ensure appropriate care while minimizing costs.

L.5.5.4.2. Offerors shall provide a solution for an accurate and agile public-facing formulary search tool consistent with the current benefit design.

L.5.5.5. Customer Service. Offerors shall identify its existing customer service workload and provide this information, where applicable, separately for retail, specialty and MOP services: number of beneficiaries served, annual beneficiary call volume and average handle time, annual pharmacy help desk call volume and average handle time, annual correspondence volume and average response time (hardcopy and electronic). For its three largest pharmacy benefit management accounts for which offerors provide call center services, offerors shall provide the information listed above including its Service Level Agreements (SLA), to include at a minimum: average speed of answer, blocked call rate, abandoned call rate, and initial call resolution rate. Offerors shall provide this information, where applicable, separately for retail beneficiary call center, retail pharmacy help desk, specialty pharmacy help desk, and MOP. Offerors shall also provide its actual performance for each SLA listed. Offerors shall provide these data for any contracted call centers the offeror proposes to use to fulfill the requirements of this solicitation.

L.5.5.5.1. Offerors shall describe the call and personnel capacities of its current systems and facilities. The offeror shall detail any modifications required to its existing or proposed facility, or facilities to support the projected beneficiary/pharmacy call center volume(s). Offerors shall include a timeline specifying the milestones for facility development and/or modification. Offerors shall demonstrate the ability to meet the additional customer service complexity and volume of the TRICARE Pharmacy program.

L.5.5.5.2. Offerors shall describe how calls will be triaged, managed, directed, escalated, resolved, and monitored to improve outcomes and prevent issues from reoccurring, including process adaptation. Offerors shall also describe how more complex and less common issues will be addressed, monitored, and resolved in a consistent manner.

L.5.5.5.3. Offerors shall provide a solution for comprehensive beneficiary services to include internal staffing, internal and external resources, and TRICARE-specific training strategies. Offerors shall include a solution for providing a beneficiary education services program that maximizes beneficiary understanding of the benefit, their approach to responding to beneficiary inquiries about all aspects of the TRICARE Pharmacy Program and their approach to offering a website maximizing the beneficiary’s experience. Offerors shall describe their approach to providing timely direct and indirect communications to beneficiaries on an array of issues.

L.5.5.5.4. Offerors shall provide a solution for a Pharmacy Help Desk Service, including the offeror’s approach to providing timely support to MTF pharmacies.

L.5.6. Tab B – Subfactor 1-2 – Mail Order Pharmacy Fulfillment Services. Each offeror shall describe its approach to providing a scalable process to meet anticipated volume at the start of pharmacy services and throughout the duration of the contract. Offerors shall describe their capabilities for supporting TRICARE Mail Order Pharmacy (TMOP) services. The proposal shall describe the offeror’s approach for providing timely and accurate delivery of prescriptions to beneficiaries, including deployed service members, meeting the performance standards specified in Section C.

L.5.6.1. Each offeror shall describe its existing and proposed MOP operations. Offerors shall identify the location(s) of their existing MOP(s) (if any), its operational parameters, including hours of operation, mail order prescription processing volumes, and performance standards equivalent to those listed in section C. Offerors with existing MOP facilities shall provide recent performance results to key performance indicators or metrics, including those that will be measured under Section C if the offeror utilizes the same. Offerors shall describe the degree of facility development and/or modification necessary to support the volumes anticipated under this contract. Offerors shall include a timeline specifying the milestones for any facility development and/or modification.

L.5.6.2. Offerors shall provide a solution for replenishment. Offerors shall demonstrate an understanding of the replenishment process and describe the offeror’s approach to replenishment tracking and reconciliation. Offerors shall provide a solution for performing annual rebaseline and continuous monitoring. The proposal shall describe the offeror’s approach to dispensing the lowest cost pharmaceuticals at TMOP. The proposal shall also discuss how to address possible situations where there is insufficient replenishment from the NPV. Additional information regarding the Government’s contract with the NPV is located at https://www.medical.dla.mil/Portal/PrimeVendor/PvPharm/NationalPV.aspx.

L.5.7. Tab C – Subfactor 1-3 – Enhanced Care Programs

L.5.7.1. Specialty Program. Offerors shall describe their concept for fulfillment of specialty pharmacy medications…