Proposer Questionnaire

Personal Importation Provider

1. Describe the organization submitting the proposal:

a. Name of Firm:

b. Address:

c. Contact Person:

d. Telephone Number:

e. Year Founded:

2. Describe Personal Importation Prescription Drug experience:

a. Number of Clients:

b. Tier-One Countries utilized:

c. Pharmacy in Tier-One Country: ______________________________________________

3. Provide five (5) client references:

Name of Client Contact Person Telephone Number Number of Employees

4. Services:

a. Will your proposal provide real-time software free of charge? Yes ____ No ____

Will Standard monthly reports contain all dispensing data? Yes____ No ____ Is there a copy of that report attached? Yes ____ No ____

b. Does the vendor certify that the city will not be required to pay any additional fees, costs, or expenses other than those outlined in the proposal? Yes ____ No ____

c. Do you provide cold chain medications? Yes _____ No_______

a) Describe the cold chain shipment method & packing instructions:

b) Describe the cold chain medication temperature safeguarding and equipment:

c) Describe your firm's process for reaching out to eligible members to access the program:

d) Describe what tools members would be able to access to track their shipment:

5. Prescription Drug Costs:

Complete re-pricing schedule, utilizing a cost based on a 30-day supply. Include administration fees, or any other fees associated with this proposal. (Re-pricing analysis must be completed)

a. Are the costs associated with filling scripts and mailing of the medications covered by the company, the member, or both?

b. Are there any administration fees? Yes ____ No ____

c. Will there be any fluctuation in the cost of drugs? Yes ____ No ____ If yes, please explain:

6. Other:

a) Will you agree to allow third-party audits of the City’s costs? Yes ____ No ____

b) Has your firm been a defendant in any lawsuit in any state or federal court in the last five (5) years? Yes ___ No ___ If yes, explain:

c) Do you have any claims filed against your company that are unresolved and presently pending before any state or federal agency? Yes ____ No ____ If yes, explain:

d) Are you offering a (3) three cost guarantee on your proposed formulary list? Yes ____ No ____

e) Do you meet the Minimum Quality Assurance Standards provided in the RFP? Yes ____ No ____

f) Do you agree with the Scope of Services provided in the RFP? Yes ____ No ____

g) Can you attach a copy of your agreement with your response? Yes ____ No ____

h) Describe your firm's member outreach program below:

Company Name Address

Type Signatory’s Name and Title Authorized Signature

MINIMUM QUALITY ASSURANCE STANDARDS

• All prescription drug products shipped through Vendor supply chains meet or exceed all safety concerns that have been addressed by the Food and Drug Administration (“FDA”).

• The Active Pharmaceutical Ingredients (“API”) of any product being sourced internationally are comparable to the United States (“U.S.”) FDA version. Vendor uses the following ways and means to demonstrate similarity:

• Vendor warrants that it only ships drugs whose product monograph is substantially similar to the FDA-approved version of that particular product monograph. The chemical name, chemical description, empirical formula, molecular weight, and molecular structure of the active pharmaceutical ingredient are identical but may be presented in different sections of the product monograph. Drug manufacturers are required by regulatory bodies in each country to attest to the monographs annually and produce a monograph for every country in which the particular drug is sold.

• Vendor only sources drug products from Good Manufacturing Process (“GMP”) countries whose regulatory environments are comparable to, or more robust than, the U.S.

• Vendor warrants that it only ships drug products when purity and dissolution tests confirm absolute similarity based on the standards set by the United States Pharmacopeia (“USP”). To determine whether a particular drug meets this expectation, Vendor shall contract with an approved Good Laboratory Practices (“GLP”) certified prescription drug testing lab to test FDA-approved drugs compared to their locally regulated and approved international counterparts.

• Vendor affirms that all prescription medications shipped will only be manufactured in accordance with

FDA manufacturing standards in facilities that maintain the designation, "FDA Approved Manufacturing Facility."

• Vendor assures that prescriptions dispensed through Vendor and Vendor networks are labeled similarly to those dispensed in the US.

• Vendor network is fully Health Insurance Portability and Accountability Act (“HIPAA”) compliant.

• Utilizing Drug Utilization Reviews (“DUR”) at multiple points, a pharmacy administration management system, and the dispensing pharmacist will red flag a contraindicated medication after reviewing a patient's drug history and current drug profile. Both the U.S. attending physician and the local dispensing pharmacist must complete a DUR process before prescribing or dispensing a drug to a patient.

• Multilingual phone support to eligible Members will be provided through a call center during U.S. business days and standard business hours, at a minimum.

• Members will be advised of potential prescription or non-prescription drug reactions, interactions, and adverse side effects or appropriate precautions, based on current information available to the dispensing pharmacist at the time the prescription is fulfilled. If available, a drug information sheet will be provided with every prescription fulfilled through the Vendor Network to the covered Members.

• Members and/or the U.S. attending physician will be contacted when a prescription item may be unduly delayed. In the event a delay occurs, the employee could obtain a limited quantity short-fill prescription through a local pharmacy.

• The vendor will create and maintain full medication profiles for all Members.

• Vendor will conduct both retrospective and prospective DUR’s including current non-prescription/over the counter ("OTC") medications, and for herbal or nutraceutical type preparations, before dispensing the prescribed pharmaceutical medication.

• Vendors will ensure that all pharmaceuticals are maintained in accordance with appropriate temperature, light, and humidity standards, during warehousing, shipping, and storage, by our fully licensed, regulated licensed pharmacy networks.

• Vendor will notify Members of any relevant prescription drug recalls or any regulatory alerts associated with any prescription drug fulfillments.

• Requirements for the fulfillment of pharmaceuticals will be anticipated on a best effort basis to secure adequate inventory of such pharmaceuticals for the Member on a timely basis. Vendors will always utilize the most cost-effective and competitive shipping rates.

• Vendor participating in pharmacy networks will always maintain fully secure supply chains, warehousing, and retail pharmacy facilities.

• Vendor will ensure that all legal, regulatory, and other relevant documentation, including customs declarations to allow for the personal importation of the pharmaceuticals by the Member into the U.S. diligently prepared, stored, and forwarded with all fulfilled prescription drug products

• Vendor will maintain Member confidentiality, protect Member identity, and safeguard Member participant-specific personal health information to meet and/or exceed both domestic and international privacy legislation guidelines.

• Any access to a member profile is limited to authorized personnel only, including the pharmacies/pharmacists/call center personnel and other designated Vendor contractors, employees, the Member who owns the personal health information, and the U.S. attending physician.

Re-Pricing Fee Schedule:

Please provide the proposed cost for each drug listed below. Cost should be based on a

(30) day supply for each drug.

A detailed fee schedule can be provided if the drug costs vary based on dosages.

Product/Drug Name Cost per Script

(30) day supply

OZEMPIC

JARDIANCE

ENBREL

HUMIRA

DUPIXENT

FARXIGA

SYNJARDY

RYBELSUS

XIGUDO

VRAYLAR

VELTASSA

REXULTI