TPharm5 Draft Section M 20191202.docx

SECTION M

EVALUATION FACTORS FOR AWARD

M.1. Provisions.

FAR 52.217-5 Evaluation of Options (JUL 1990)

The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement, except for the transition-out options; for the transition-out options, the Government will evaluate only the highest priced transition-out option. Evaluation of options will not obligate the Government to exercise the option(s).

(End of Provision) M.2. Basis of Evaluation.

M.2.1. General. This is a competitive source selection and will be conducted in accordance with the Federal Acquisition Regulation (FAR) subpart 15.3, Source Selection, and applicable supplements. The Government has established a Source Selection Evaluation Board (SSEB) to evaluate proposals submitted in response to this solicitation. Proposals will be evaluated by the SSEB using the evaluation factors and subfactors identified below. The Source Selection Advisory Council (SSAC) will provide a recommendation to the Source Selection Authority (SSA). The SSA will determine which proposal represents the best value to the Government.

M.2.2. Award. The Government anticipates award of a single contract to the responsible offeror whose proposal represents the best value to the Government. The Government may make trade-offs when determining which offer constitutes the best value to the Government. This trade-off process may result in an award to other than the lowest-priced offer or the highest-rated technical proposal.

M.2.2.1. Eligibility. To be eligible for award, offerors are required to meet the solicitation requirements, including but not limited to instructions to offerors, terms and conditions, technical requirements, and the evaluation factors and criteria below. Failure to comply with the terms and conditions of the solicitation may result in the offeror being removed from consideration for award.

M.3. Evaluation Factors. The Government shall evaluate each proposal against the following factors and subfactors. Each proposal will be evaluated separately and will be evaluated solely on its own merits.

M.3.1. Factor 1 — Technical M.3.1.1. Subfactor 1 — Pharmacy Benefit Management Services M.3.1.2. Subfactor 2 — Mail Order Pharmacy M.3.1.3. Subfactor 3 — Enhanced Care Programs M.3.1.4. Subfactor 4 — Management Controls and Quality M.3.2. Factor 2 — Past Performance M.3.3. Factor 3 — Small Business Participation M.3.4. Factor 4 — Price

M.3.5. Relative Importance of Factors. Price is the most important individual factor. For purposes of this procurement, the technical factor and the past performance factor are the non-price factors and they are of equal importance. When non-price factors are combined, they are greater than price. The small business participation factor is to be rated as acceptable or unacceptable. If any factor is rated as unacceptable, the proposal is unawardable.

M.4. Factor 1 — Technical.

M.4.1. Consolidated Rating. The Government will evaluate each of the subfactors under the technical factor to determine a separate technical/risk rating for each subfactor. Each technical subfactor are equal in value. Subfactor ratings will then be rolled up into an overall technical/risk rating for the technical factor. Proposals are not eligible for award if any subfactor has a rating of “Unacceptable.” The technical/risk rating will be considered in determining the best value to the Government.

M.4.2. Technical Ratings. The technical rating evaluates the quality of the offeror’s technical solution to meeting the Government’s requirements. In reviewing the technical proposal, the Government will review the offeror’s compliance with the solicitation and whether the offeror demonstrates that it understands the requirements and whether the offeror demonstrates a sound approach, procedures, methods, and delivery of services to accomplish the requirements. The Government will consider whether an aspect of an offeror’s proposal that has merit or exceeds specified requirements that would be advantageous to the Government during contract performance. If such an aspect of the proposal is found to be advantageous, the Government may assess it to be a strength. If the Government deems part of the proposal to be a strength, the strength will be credited to only one subfactor. The Government will have the sole discretion in determining to which subfactor a strength best fits.

M.4.3. Combined Rating. The offeror’s technical solution will be evaluated using a combined technical/risk ratings. The combined technical/risk ratings will be assigned as described in Table M1.

M.4.3.1. Table M-1 — Combined Technical/Risk Rating Method.

M.4.3.2. Definitions. The following definitions will apply when assigning technical ratings (See FAR 15.001):

· Strength - An aspect of an offeror’s proposal that has merit or exceeds specified performance or capability requirements in a way that would be advantageous to the Government or beneficiaries during contract performance.

· Weakness - A flaw in the proposal that increases the risk of unsuccessful contract performance.

· Significant Weakness - A flaw in the proposal that appreciably increases the risk of unsuccessful contract performance.

· Deficiency - A material failure of a proposal to meet a Government requirement or a combination of significant weaknesses in a proposal that increases the risk of unsuccessful contract performance to an unacceptable level.

M.4.4. Subfactor 1 — Pharmacy Benefit Management Services. The offeror’s proposal will be evaluated on its approach for accepting and processing claims submitted by network retail pharmacies, the TRICARE mail order pharmacy, MTF pharmacies, or by beneficiaries for direct reimbursement.

M.4.4.1. The Government will not assess a ‘strength’ for proposals to exceed any of the following standards:

· Telephone Answering by Beneficiary Service Representative (BSR) or Customer Service Representative (CSR)

· Telephone Call Blockage Rate

· Telephone Abandoned Call Rate

· Telephone Calls Resolved

· Routine and Priority Correspondence

· TEDS Edit Accuracy

M.4.4.2. The offeror’s proposal will be evaluated on its underlying technical capabilities to perform claims adjudication meeting minimum standards specified in Section C, how its proposed workflow manages the claims processing system and how it includes both commercial PBM practices and the flexibility to accommodate unique Government requirements, and its ability to support timely changes to its claims processing system in response to benefit design changes made by the Government.

M.4.4.2.1. The offeror’s proposal will be evaluated on 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.

M.4.4.2.2. The offeror’s proposal will be evaluated for its role as a fiscal intermediary and ability to comply with financial requirements, including but not limited to TRICARE Encounter Data System (TEDS) and recoupment.

M.4.4.2.3. The offeror’s proposal will be evaluated on how well the security program protects TRICARE beneficiary data according to the standards specified in this solicitation.

M.4.4.2.4. The offeror’s proposal will be evaluated on its current electronic claims processing metrics to include the number of clients served, the number of claims processed electronically for each of its largest clients (based on the number of electronic claims processed per year), its total aggregate [annual] electronic claims volume, the total claims processing capacity of its proposed claims processing system as compared to the TRICARE Pharmacy Program. The offeror’s proposal will be evaluated on any hardware /software /facility changes necessary to its electronic claims processing system to process the anticipated electronic claim volume under this contract, including identification of the magnitude of the change, facility additions/changes, and months required to accomplish the change, including the timeline with major milestones identified.

M.4.4.2.5. The offeror’s proposal will be evaluated on the 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 including the identification of any hardware/software/facility changes necessary to process the anticipated paper claim volume under this contract, including a timeline with major milestones identified.

M.4.4.2.6. The offeror’s proposal will be evaluated on the optimized pharmacy network, both in terms of cost and beneficiary access and how the proposed network meets or exceeds proposed access standards (drive time/distance, percentage of beneficiaries).

M.4.4.2.7. The offeror’s proposal will be evaluated on its approach to meeting the guaranteed minimum network access standards at the start of pharmacy services, while maintaining beneficiary satisfaction.

M.4.4.3. System Interfaces (both legacy, ongoing, and MHS Genesis). The offeror’s proposal will be evaluated for its strategy and capabilities for developing, implementing, and maintaining the required interfaces to legacy, ongoing, and future state systems, including knowledge and experience for various transaction types, network security, testing procedures, and identification of the level of effort required to build and maintain complex systems in both commercial and custom environments, including identification of 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.

M.4.4.4. Clinical Reviews. The offeror’s proposal will be evaluated on the technical and clinical expertise to establish, implement, and administer overrides, clinical reviews, and administrative reviews, meeting the performance standards specified in Section C.

M.4.4.5. Formulary and Benefit Design. The offeror’s proposal will be evaluated on 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 execute formulary changes, provide audit process for quality assurance of the benefit design, conduct continuous management, resolve issues, and maintain a communication plan across clinical counterparts and beneficiaries.

M.4.4.5.1. The offeror’s proposal will be evaluated on its utilization management strategy; how they demonstrate the ability to 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.

M.4.4.5.2. The offeror’s proposal will be evaluated on the solution for an accurate and agile public-facing formulary search tool consistent with the current benefit design.

M.4.4.6. Customer Service. The offeror’s proposal will be evaluated on its existing customer service workload 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 the offeror provides call center services, The offeror’s proposal will be evaluated on 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 for retail beneficiary call center, retail pharmacy help desk, specialty pharmacy help desk, and MOP as well as the actual performance for each SLA listed and any contracted call centers the offeror proposes to use to fulfill the requirements of this solicitation.

M.4.4.6.1. The offeror’s proposal will be evaluated on the demonstrated ability to meet the additional customer service complexity and volume of the TRICARE Pharmacy program.

M.4.4.6.2. The offeror’s proposal will be evaluated on how calls will be triaged, managed, directed, escalated, resolved, and monitored to improve outcomes and prevent issues from reoccurring, including process adaptation. The offeror’s proposal will also be evaluated on how more complex and less common issues will be addressed, monitored, and resolved in a consistent manner.

M.4.4.6.3. The offeror’s proposal will be evaluated on its solution for comprehensive beneficiary services to include internal staffing, internal and external resources, TRICARE-specific training strategies, providing a beneficiary education services program that maximizes beneficiary understanding of the benefit, the approach to responding to beneficiary inquiries about all aspects of the TRICARE Pharmacy Program and the approach to offering a website maximizing the beneficiary’s experience, and the approach to providing timely direct and indirect communications to beneficiaries on an array of issues.

M.4.4.6.4. The offeror’s proposal will be evaluated on its solution for a Pharmacy Help Desk Service, including the offeror’s approach to providing timely support to MTF pharmacies.

M.4.5. Subfactor 2 — Mail Order Pharmacy Fulfillment Services.

M.4.5.1. The offeror’s proposal will be evaluated on its approach to providing a scalable process to meet anticipated volume from the start of pharmacy services through contract duration and its approach to provide timely, accurate delivery of prescriptions to beneficiaries (including deployed service members), which meet the performance standards specified in Section C.

M.4.5.2. The offeror’s proposal will be evaluated on its existing and proposed MOP operations and the degree of facility development and/or modification necessary to support the volumes anticipated under this contract, including the timeline specifying milestones for any facility development and/or modification.

M.4.5.3. The offeror’s proposal will be evaluated based upon its replenishment solution and its approach to replenishment tracking and reconciliation. The proposal will also be evaluated on its approach to rebaseline and continuous monitoring, as well as its approach to dispensing the lowest cost pharmaceuticals at TMOP. The proposal will be evaluated on how the offeror addressed possible situations where there is insufficient replenishment from the NPV.

M.4.6. Subfactor 3 — Enhanced Care Program.

M.4.6.1. Specialty Program. The offeror’s proposal will be evaluated based on their concept for fulfillment of specialty pharmacy medications and provision of clinical support services through specialty pharmacies accredited by a nationally recognized external accrediting body. The offeror’s proposal will also be evaluated on how their approach maximizes innovative management of the utilization of specialty pharmaceuticals to meet evolving patient care needs while maintaining and enhancing cost-effectiveness in the specialty pharmacy program.

M.4.6.1.1. The specialty pharmaceuticals identified by the offeror will be evaluated on the existing and proposed specialty pharmacy services offered; how it will receive orders, process orders, distribute specialty pharmaceuticals to beneficiaries, communicate with providers, communicate with beneficiaries, and educate beneficiaries in a manner that optimizes therapeutic outcomes, minimizes unnecessary and/or inappropriate usage, maximizes beneficiary compliance with prescribed drug regimens, minimizes waste, minimizes adverse clinical events, and achieves a high level of beneficiary satisfaction.

M.4.6.1.2. The offeror’s proposal will be evaluated on its approach for ensuring patient access to specialty pharmaceuticals and how it maximizes access to all specialty pharmaceuticals, including limited distribution through nationally accredited specialty pharmacies, at in-network cost shares.

M.4.6.1.3. The offeror’s proposal will be evaluated on its approach for providing support for beneficiaries who are prescribed specialty medications, ensuring network specialty pharmacies deliver care in accordance with nationally recognized specialty pharmacy accreditation standards (e.g. CPPA, URAC). The offeror’s proposal will be evaluated on how the offeror intends to provide medication administration support (e.g. patient education, call center support, managed delivery and therapy evaluation) that limits risk to the patient while maximizing adherence, well-being, and patient satisfaction. The offeror’s proposal will be evaluated on how it demonstrates beneficiaries will access accompanying supplies (e.g. for administration, use, disposal, etc.) for drugs dispensed at network specialty pharmacies.

M.4.6.1.4. The offeror’s proposal will be evaluated on how it demonstrates the offeror will optimize its specialty program, incorporate commercial best practices, and monitor key performance measures via standardized or Government-directed reporting and other tools.

M.4.6.1.5. The offeror’s proposal will be evaluated based upon its specialty replenishment solution and its approach to specialty replenishment tracking and reconciliation. The proposal will also be evaluated on its approach to rebaseline and continuous monitoring, as well as its approach to dispensing cost-effective TAA compliant pharmaceuticals replenished through the NPV. The proposal will be evaluated on how the offeror addressed possible situations where there is insufficient replenishment from the NPV.

M.4.6.2. Care Coordination. The offeror’s proposal will be evaluated on its concept for mitigating adverse drug events, promoting appropriate use of medications, minimizing costs, and promoting adherence to achieve measurable healthcare outcomes for non-specialty drugs, including value-based initiatives. The offeror’s proposal will be evaluated on its program or concepts focused on promoting preferred agents within a therapeutic class, maximizing generic utilization, and medication regiment management.

M.4.7. Subfactor 4 — Management Controls and Oversight.

M.4.7.1. Quality Control and Assurance. The offeror’s proposal will be evaluated on its proposed quality control and quality assurance programs for both internal and public-facing operations.

M.4.7.2. Management. The offeror’s proposal will be evaluated on its approach to providing support for the management of the TRICARE pharmacy benefit in a proactive, collaborative manner, including the offeror’s management approach, organizational structure, solution to quality management and approach to evaluating its internal continuous improvement efforts. The offeror’s proposal will be evaluated on its approach to ensuring the integrity of the pharmacy benefit program. The proposal will be evaluated on its proposed approach to minimizing waste and on how management, organizational, and quality management will facilitate efficient Government oversight.

M.4.7.3. Contract Transition. The offeror’s proposal will be evaluated on its approach to transition-in, including how it identifies and plans to manage those challenges and risks specific to the TRICARE Pharmacy program.

M.5. Factor 2 — Past Performance.

M.5.1. General. The Government 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. The Government will only consider relevant past performance information for ongoing contracts and contracts concluded within the last three years from the proposal due date as stated in Block 9 off the Standard Form (SF) 33 of this solicitation. For contracts performed in, or concluded in the past three years, the Government will consider the entire period of performance of the contract, including any contract transition-in and transition-out periods. The evaluation of past performance information will result in an assessment of the offeror’s probability of meeting the solicitation requirements. A single performance confidence assessment rating will be assigned for each offeror after evaluating their past performance.

M.5.2. Relevance. The Government will first assess each offeror’s, or critical subcontractor’s contracts to determine how relevant an effort accomplished by the offeror is to the performance of the requirement as described in this solicitation, regarding the scope, including similarity of services, complexity, and magnitude, including size/dollar value.

M.5.2.1. Magnitude. The Government may determine magnitude of effort based upon total dollar value, the annual number of claims processed and covered lives. The current TRICARE Pharmacy contract (HT9402-14-D-0002) is valued at approximately $5.7 billion, processes approximately 115 million claims annually (44 million from Military Pharmacies, 44 million from Retail Network Pharmacies, and 27 million mail order pharmacy claims), and covers 9.5million lives.

M.5.2.2. Relevancy Rating. The Government will assign a relevancy ratings to each identified contract using the relevancy rating method in Table M-2.

M.5.2.2.1. Table M-2 — Past Performance relevancy Rating Method.

M.5.3. Quality. Once a relevancy rating has been determined, the Government will review all available information to determine the quality of performance quality of the offeror’s performance, execution of subcontracting plan, and general trends for consideration in the overall performance confidence assessment. If an individual contract has been assessed as “not relevant”, no performance review will be conducted. The Government will note any positive and/or negative findings during the review. If any negative findings are identified during the review in which the offeror has not had the opportunity to provide comments, the Government will notify the offeror of the findings and allow the offeror the option to provide comments on these negative findings.

M.5.4. Performance Confidence. The Government will then assess a performance confidence rating relative to the offeror’s ability to successfully perform the requirements of this solicitation. Past performance history rated as “not relevant” will not be considered for the purpose of determining the performance confidence rating. The information provided by the offeror per Section L of this solicitation will be considered. The Government may utilize information obtained from the clients listed in the proposal, other customers known to the Government, Past Performance Information Retrieval System (PPIRS), Federal Awardee Performance and Integrity Information System (FAPIIS), CPARS, Electronic Subcontract Reporting System (eSRS), public sources, and other sources that may have useful and relevant information. The Government may also utilize its own internal records and sources.

M.5.5. Utilization of Small Business. The Government will consider the offeror’s past performance in compliance with clause FAR 52.219-8, Utilization of Small Business Concerns; clause FAR 52.219-9, Small Business Subcontracting Plan, including all subcontracting goals; and any contract monetary targets for the Small Disadvantaged Business Participation Program, if any.

M.5.6. No Relevant Past Performance. If an offeror has no past performance history relevant to providing the services required by the solicitation, the offeror’s performance confidence rating will be neutral and will not be evaluated favorably or unfavorably. This rating is neither negative nor positive. Neutral is merely indicative of a lack of prior performance in providing the service required by this solicitation. If an offeror with no relevant past performance submits relevant past performance information from a predecessor company, parent organization, consortium member, key personnel or subcontractors, this information will be considered in rendering a performance confidence rating. This rating will be based on the relevance to providing the services required by this solicitation, and the amount of involvement the parent organization or consortium member will have in the operations of the offeror. When an offeror submits past performance information on its key personnel as stated in Section L, the Government will evaluate the key personnel information and then determine to what extent, if any, it will affect the performance confidence rating. This rating will be based on considerations such as the employee’s role in the company, the nature and quality of the services delivered, and the relevant amount of past performance the employee had related to providing the service required by this solicitation. Regardless of whether the past performance data relates to a parent organization, consortium member, or an employee or group of employees, the Government may still render a performance confidence level of neutral if adequate, convincing and relevant past performance information is not available.

M.5.7. Overall Rating. The Government will assign to the offeror an overall performance confidence rating using the rating scale in Table M-3.

M.5.7.1. Table M-3 — Overall Performance Confidence Rating.

Table M3. Performance Confidence Assessments Rating Method.

The offeror may not be evaluated favorably or unfavorably on the factor of past performance.

M.6. Factor 3 — Small Business Participation.

M.6.1. General. The Government will evaluate the small business subcontracting plan and small business participation plan on an acceptable/unacceptable basis. An acceptable plan meets the minimum requirements. Strengths are not assessed for this factor. An unacceptable plan does not meet the minimum requirements. The Contracting Officer will review the small business participation plan and subcontracting plan submitted under Volume 4 for the submission requirements identified under FAR 19.702, Statutory requirements; FAR 19.704, Subcontracting plan requirements; FAR 52.219-8 Utilization of Small Business Concerns, FAR 52.219-9 Small Business Subcontracting Plan, DFARS 252.219-7003, Small Business Subcontracting Plan (DoD Contracts), and DFARS 215.304.

M.6.2. Subcontracting Goals. The Government will assess how the offeror’s proposed subcontracting goals compare with the subcontracting goals identified below. If the offeror does not propose the subcontracting goals below, the Government will assess how well the offeror describes how and why their proposed goals are set at levels that are realistic and that the parties can reasonably expect. The Government will assess the extent the offeror identifies businesses in the Plan and demonstrated good faith efforts or plans to meet the below goals using small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business (which includes historically black colleges and minority institutions in its goal), and women-owned small business subcontractors to the maximum practicable. The subcontracting goals are detailed in Table L-5.

M.7. Factor 4 — Price.

M.7.1. Total evaluated price. The total evaluated price will consist of the sum of all extended Contract Line Items Numbers (CLINs) in Section B except for the Incentive CLINs, plus the total expected Government cost for reimbursement of retail network pharmacy costs from the table at Attachment L-1(g). The Government will perform price analysis by comparing competing prices per FAR 15.404-1(b)(2)(i). If necessary, the Government may utilize other price analysis or cost analysis techniques prescribed in FAR Part 15 utilizing information available to the Government or obtained from the offeror (when requested).

M.7.1.1. 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 7001-7007, 7009, 7012, 7013 and 7014 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 7015 and 7008, and one-half of the total expected Government cost for reimbursement of retail and specialty network pharmacy costs, from the tables at Attachments L-2 and L-3, for option year 7 to the total evaluated price.

M.7.1.2. Because contract transition-out occurs once during the life of a contract, only one set of CLIN prices for transition-out will be counted in the calculation of total evaluated price. The Government will add the Contract Phase-Out, Non-Incumbent CLIN and the Contract Phase-Out, Incumbent CLIN for each option period together and only the highest combined price will be included in the total evaluated price.

M.7.2. Reasonableness. The Government anticipates adequate price competition to establish price reasonableness per FAR 15.403-1(c)(1). Since price is the most important individual factor in the source selection, unless the price of the otherwise successful offeror is found to be unreasonable or unbalanced, award will be made at the offered prices.

M.7.3. Unbalanced pricing. The offer’s proposal will be reviewed for unbalanced pricing per FAR 15.404-1(g).

M.8. Financial Viability. As part of the Government’s responsibility determination (FAR 9.1), the Government will evaluate the Offeror’s financial viability to ensure the Offeror has adequate financial resources to perform the prospective contract or demonstrates an ability to obtain adequate financial resources. If an Offeror fails to submit the required financial information, the Government may make a determination the Offeror is not responsible and thus ineligible for award.

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