MHCC 27-004 Attachment B Financial Proposal Form.xlsx

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Attached to
MHCC 27-004 Actuarial Consulting - Limiting Prior Authorization for Coverage of Direct-Acting Antivirals for Hepatitis C
Solicitation number
BPM058087
Issued by
Maryland

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Written by GovTribe AI ·

This is a Financial Proposal Form for MHCC 27-004, a contract opportunity issued by the State of Maryland for actuarial consulting services related to limiting prior authorization requirements for direct-acting antiviral (DAA) coverage for hepatitis C treatment. The form serves as Attachment B to the solicitation and establishes the structured format through which prospective vendors must submit their pricing and financial proposals. Proposals are due by July 23, 2026. The solicitation seeks actuarial expertise to evaluate and analyze the impact of reducing or eliminating prior authorization barriers for hepatitis C medications, which represents a clinical and financial policy matter for the state's health insurance program.

The Financial Proposal Form specifies the required format and line items vendors must complete when submitting their bids, ensuring standardized presentation of costs, staffing rates, and other financial components for evaluation purposes. The form establishes uniform pricing terms and conditions applicable to all bidders. No incumbent information, specific funding amounts, renewal options, or set-aside program details are evident from the form itself; however, vendors responding to this solicitation must adhere to the financial submission requirements outlined in this attachment to be considered for award.

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MHCC 27-004 Actuarial Consulting - Limiting Prior Authorization for Coverage of Direct-Acting Antivirals for Hepatitis C.pdf PDF

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Sheet1 MHCC 27-004 Financial Proposal Form

Key DeliverablePrincipal ActuaryActuarial ConsultantActuarial Consultant
HoursRate$Total$HoursRate$Total$HoursRate$Total$Total Fixed Price
3.2.B. Work Plan$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
3.2.C.1. Framework and Rational Outline$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
3.2.C.2. Framework and Rationale Report$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
3.2.D Commission Meeting Presentation$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
Total Contract Price$ - 0
Submitted by:
Offeror:
Offeror Name (please print or type)
By:
Signature of Authorized Representative
Printed Name:
Printed Name
Title:
Title
Date:
Date:
Address:
Company Address

File details come from the government source that posted it. Updated .