RFP PUR-007-24 Addendum 2.docx.pdf

CONTRACT NUMBER ADDENDUM NO. 2

ISSUED BY:

PRINCE GEORGE’S COUNTY PUBLIC

SCHOOLS

OFFICE OF PURCHASING AND SUPPLY

13300 OLD MARLBORO PIKE

ROOM 20

UPPER MARLBORO,

MARYLAND 20772-9983

Date of this Addendum:

January 23, 2024

No. of Pages: 7 (Plus Attachments)

Proposal Submissions:

February 5, 2024

(10:00 AM) EST

RFP No.: PUR-007-24 RFP Issuance Date:

December 19, 2023

TITLE: PHARMACY BENEFIT MANAGEMENT

PROGRAM COMMERCIAL

AND EMPLOYER GROUP WAIVER PLAN (EGWP)

TO ALL PROSPECTIVE OFFERORS AND OTHER RECIPIENTS OF SOLICITATION DOCUMENTS

This Addendum is hereby made a part of the Contract Document which will be the basis of a Contract.

This Addendum is issued to modify the original Solicitation Documents issued December 20, 2023.

Prospective Offerors are requested to attach this Addendum to your Contract Documents. Receipt of this Addendum must be acknowledged in the Proposal Document (see Appendix A). Failure to do so may subject the Offerors disqualification.

The Purpose of this Addendum is to Extend the Due Date for Proposals, Provide Modifications and Clarifications to the RFP, as well as to Provide Responses to Questions

Proposals are now due on: February 5, 2024, at 10:00 a.m.

Modifications:

The following Attachments are provided with this addendum:

EGWP Formulary Indicator

Revised Appendix G

MBE Administrative Procedures 3325 and Forms

Clarifications:

1. The Zendto proposal link will be provided no later than January 29, 2024.

2. All proposals are to be submitted electronically via Zendto. Do not upload documents via eMMA.

Vendors shall upload each Volume (Volume I, II, III, IV) as four (4) separate files/uploads via Zendto (do not combine all volumes as one document upload). Hard copy submissions are not required.

De’Nerika.Johnson, Acting Director | DeNerika.Johnson@pgcps.org

13300 Old Marlboro Pike | Upper Marlboro, MD 20772 | 301-952 6560 mailto:DeNerika.Johnson@pgcps.org

Questions and Responses:

Item No. Questions Responses

Considering the size and scope of this request, would an extension on the 1/29 due date be available? See Addendum No. 2

Please advise who the current medical vendor is for Prince George’s County Public School Board.

See Medical RFP 008-24 for more details. There are two medical vendors: CareFirst (medical only) and Kaiser (medical+drug).

When an employee elects CareFirst medical coverage, their benefit includes a pharmacy drug benefit through CVS Caremark/SilverScript (RFP 007-24). Kaiser drug is not part of RFP 007-24.

Please advise is Prince George’s County Public School Board ERISA or Non-ERISA. Non-ERISA

The Technical questionnaire does not have EGWP split out, as answers will vary between commercial

vs. EGWP. Should a separate column be added for

EGWP?

Yes, to the extent your response differs between Commercial and EGWP, please add a column / section.

Otherwise, we will assume that your response is the same for Commercial and EGWP.

High Cost RX Financial Asst tab: Will client accept N/A for EGWP response, as assistance programs are not Medicare compliant? Yes.

RFP Business and Contract Rqmts tab, line 16:

The client reserves the right to offer a discount card to its members for drugs moved to a non-covered status as a result of the PBM's formulary strategy. Please acknowledge that discount cards are not Medicare compliant for Part D medications, including non-formulary Part D medications. Acknowledged.

RFP Business and Contract Rqmts tab, line 35:

PBM agrees to fulfill all Rx filing requirements under the Consolidated Appropriations Act Section 204 at no cost. Please acknowledge that this is not applicable to the EGWP line of business. "RFP Business and Contract Rqmts tab, line 117: PBM agrees the proposed pricing is for a guaranteed three (3) Year initial term effective January 1, 2020 with the option to renew up to two one-year periods. Confirm the date should be January 1, 2025".

Acknowledgement #1: CAA not EGWP applicable.

Acknowledgement #2: Effective date 1/1/25.

RFP Business and Contract Rqmts tab, line 117:

PBM is required to maintain a CMS compliant network for Montgomery College / Montgomery County’s EGWP population. Confirm this should read Prince George County Public Schools. Acknowledged.

Financial Questions tab, Line 46-59, these appear to be duplicative of lines 31-44. This appears to be the case on the Commercial questionnaire as well.

Acknowledged. Please complete lines 31-44. Lines 45-59 can remain blank.

Given this RFP was released during the holiday week, can you grant a due date extension in order for us to provide the best quote possible? See Question and Response No. 1

On page 14 of the RFP there is a reference to envelopes. Can you clarify what is meant by envelope one and envelope two? Is PGCSD requesting hard copies in addition to the electronic submission?

Please disregard all references to submission of proposals via envelopes. Hard copy submissions are not required.

Submissions via eMMA is not required. All proposal documents are to be submitted via Zendto. See Addendum 2 Clarifications section for additional instructions and clarifications.

P. 11 of the RFP indicates that Volume I - Technical Proposal must include a table of contents with consecutive numbering. Please confirm that consecutive page numbering is necessary given that this proposal is being electronically submitted as multiple files of differing types (Excel, PDF, etc.).

Page numbering is not required.

The Technical Proposal Excel workbook must be completed and returned electronically in original format (XLSX, XLSB).

Consecutive numbering is not required for the Excel format.

Do not alter the worksheet relative positions or labels.

Each worksheet contains form-labels in the upper-right corner and it contains numbering / content for each question.

On pages 15, 23, and 30 of the RFP, offerors are instructed to submit Appendices electronically in eMMA. However, other areas of the RFP instruct that the entire proposal is to be submitted via ZendTo. Please clarify. See Question and Response No. 11.

We request that the Network Name field, which is column CJ in the original source file, be added back to the repricing files.

Not applicable to RFP 007-24 Pharmacy Benefits Management Program . Please refer to RFP 008-24 Self- Insured and Fully Insured Medical Plans for a response to this question.

We also request that the HSCRC indicator field, which is column CM in the original source file, be added back to the repricing files.

Not applicable to RFP 007-24 Pharmacy Benefits Management Program . Please refer to RFP 008-24 Self- Insured and Fully Insured Medical Plans for a response to this question.

Please advise if there be an extension to the due date based upon the additional data provided/requested for the census and repricing to allow time for appropriate analysis. See Question and Response No. 1.

P. 14 of the RFP indicates that Volume I - Technical Proposal must include a table of contents with consecutive numbering. Please confirm that consecutive page numbering is necessary given that this proposal is being submitted in volumes consisting of multiple files of differing types (Excel, PDF, etc.)?

The Technical Proposal Excel workbook must be completed and returned electronically in original format (XLSX, XLSB).

Consecutive number is not required for the Excel format. Do not alter the worksheet relative positions or labels.

Each worksheet contains form-labels in the upper-right corner and it contains numbering / content for each question.

On pages 18, 23, 30, of the RFP, offerors are instructed to submit Appendices electronically in eMMA. However, other areas of the RFP instruct that the entire proposal is to be submitted via ZendTo. Please clarify. See Question and Response No. 11.

On p. 23 of the RFP, evaluation is contingent on proposals being submitted in eMMA. However, other areas of the RFP instruct that the entire proposal is to be submitted via ZendTo. Please clarify. See Question and Response No. 11.

Can you please clarify what the designations “HSCRC Regulated Claims” and “Non HSCRC Regulated claims” represent on the claim repricing summary exhibit? Can you please also clarify why that is not included in the 2nd chart on the same form?

Not applicable to RFP 007-24 Pharmacy Benefits Management Program . Please refer to RFP 008-24 Self- Insured and Fully Insured Medical Plans for a response to this question.

Can you please provide more detail regarding the intent of the Discount Guarantee as % of the Medicare Fee Schedule? Can you please provide an example of how you would expect a bidder to configure the guarantee?

Not applicable to RFP 007-24 Pharmacy Benefits Management Program . Please refer to RFP 008-24 Self- Insured and Fully Insured Medical Plans for a response to this question.

Given this RFP was released during the holiday week, can you grant a due date extension in order for us to provide the best quote possible? See Question and Response No. 1.

On page 14 of the RFP there is a reference to envelopes. Can you clarify what is meant by envelope one and envelope two? Is PGCSD requesting hard copies in addition to the electronic submission? See Question and Response No. 11.

On Exhibit 1 - DUR & Prior Auth tab, line 12, question 9 is blank. Is this intentional? Yes

Are the Audit and Market Check fees to be broken out separately between Commercial and EGWP populations? For example – Is the $25K market check fee used to cover both Commercial and EGWP or is it $50k for both? They seem to be duplicative in both Commercial and EGWP workbooks so we wanted to confirm.

The fees are independent for each plan: Commercial and EGWP. In other words, it would be $80,000 total for audits (= $40,000 commercial + $40,000 EGWP) and $50,000 total for the market checks (=$25,000 commercial + $25,000 EGWP). The same applies to the per member fees.

The monthly member counts were provided in “EXHIBIT 17 - RFP PUR 007-24 - Monthly Summary of Experience 2020- 2023 YTD.xlsx” for bidders to budget for these expenses.

Can you please describe when each of the underwritten fees are to be paid out?

Implementation Allowance in Year 1 (2025)

Clinical Allowance and PMF annually

Market Check and Audit Fees annually, starting year 2.

Please clarify if Tab C is an Executive Summary or Appendix B - Past Performance and References.

Vendors shall provide an overall summarization of their experience and qualifications, product quality, demonstrated capacity to perform, past performance and references to satisfy the requirements of the RFP.

With regard to the following provision, please confirm if Bidders are restricted from presenting multiple formulary offerings wherein different rebate guarantees would apply. Similarly, are bidders restricted from proposing more than one type of network offering for 30 day claims and more than one offering for 90 day claims. If yes, confirm if bidders are required to only provide offers based upon the formulary design and network arrangements in place today.

D. SINGLE PRICE: Unless otherwise specified in the General Terms and Conditions table attached to this RFP, the Vendor will not be allowed to offer

It is requested that the bidders propose network, formulary and pricing offers consistent with the current plan design.

more than one price on each item even though the vendor may feel that it has two or more types or styles that will meet specifications. Vendor must determine which to offer. If said Vendor should submit more than one price on any item, all prices for that item will be rejected.

Please confirm the required definition of 340B claims that bidders must align to for proposed offers.

340B claims are excluded from mail and retail discount guarantees and dispensing fee guarantees. Rebates do not apply to 340B claims.

Please confirm the definition of 90 days supply that bidders must align to for proposed pricing, i.e. 84+ days supply for all 90 day claims? If not 84+ days supply, please confirm the days supply for 90 day claims.

90 Day Retail pricing and rebates should apply to Retail claims with 84+ days supply. All claims incurred at Mail, regardless of day supply, receive mail discounts and mail rebates. All specialty claim discounts are not subject to minimum day supply requirements. Specialty rebates must be based on no more than a 30 day supply.

Main RFP, pg. 16, Letter B. Volume II - MBE: For PBM, what do you consider to be the “total contract value”? How is this defined?

Total Contract Value is the Estimated Annual Administrative Charges to administer the pharmacy program.

Main RFP, pg. Part V: General Terms and Conditions, #13 MBE: Confirm that if PBM is an MBE certified through the National Minority Supplier Development Council that it will fulfill the 15% MBE requirement.

PGCPS accepts MBE certifications from Maryland Department of Transportation (MDOT), Prince George's County Government Diversity Program, and Washington Metropolitan Area Transit Authority (WMATA).

Main RFP, pg. 16, Letter B. Volume II - MBE: Is there a specific form available to waive the MBE requirements? Where can we access this form?

See Addendum 2 attachment for MBE Administrative Procedures and Forms

Please provide monthly volume of calls handled by the call center. This will not be provided.

Please provide the average number of prior authorizations, appeals, and grievances per month (or annually). 2.19% commercial; 1.79% EGWP

36 What is the client's ERISA status? Non-ERISA

Please provide the average number of DMRs (direct member reimbursement) per month (or annually).

For Commercial, we estimate roughly 1,508 DMR claims annually. For EGWP, DMR information is unavailable at this time.

Please confirm that all documents requiring notarization may be electronically signed for the purposes of submission, with notarization provided upon award.

All documents, inclusive of forms requiring the appropriate notarizations (including signatures and stamps/embossments), are to be submitted at the time in which proposals are due. Failure to submit all required documents at the time in which proposals are due may render your proposal non-responsive.

On Exhibit 3 for EGWP, the pricing and rebates tab does not include a space for a flat fee, which is how we price our EGWP plan offering. How ought we address that?

Attachment A refers to “all inclusive rates;”

however, Exhibits 2 and 3 provide for bidders to offer traditional PBM guarantees. Please confirm that an all-inclusive fee does not apply.

Likewise, Appendix G indicates “fixed labor rate and material discount” rather than traditional PBM guarantees. Please confirm that you will accept traditional PBM guarantees.

(1) On "Pricing & Rebate Offer" worksheet, see rows 49-52.

If an annual flat fee, consider using the "PBM Administrative Fee" or "Coalition Fee" fields, with supporting description; for EGWP, we often see a PMPM (row 50). In addition, please see attached Revised Appendix G

(2) Regarding Attachment A "all inclusive" - Confirmed, does not apply.

(3) Regarding Appendix G - The instructions involving "fixed labor rate and material discount" and "Paint and Paint Sundries" are not applicable. The intent of Appendix G was meant to address Financial Proposal Terms. Please continue to complete all applicable financial forms. Exhibits 2 through 5.

Is Attachment A meant to be filled in after the colon? Or is this an incomplete document? See Question and Response No. 39.

Confirm that Volume I Technical Proposal and Volume II MBE are to submitted under “Envelope One” (though in separate files) while Volume III and Volume IV are to be submitted under “Envelope Two.” Currently the instructions on page 18 indicate we should submit it as part of the Technical Proposal folder, though it also says to submit in Envelope Two. Please clarify submission procedure. See Question and Response No. 11.

Please provide a secure and authorized name and address who can receive audited financial statements. We will send under separate cover directly to the authorized person rather than submit as part of our proposal. Confirm this is acceptable.

Not an acceptable procedure. All documents, inclusive of financial statements, are to be submitted/uploaded via Zendto at the time in which proposals are due.

The contract length is defined as 5 years; however, there are only three years of financials requested on Exhibits 2 and 3 on the pricing tabs. Can you please clarify?

The PBM contract must be subject to a market check provision. During the first annual market check, pricing through years 4 and 5 will be established, but no less than proposed year 3 pricing.

The (EGWP) claims file does not seem to have formulary status provided, only tier. For Part D disruptions we are only able to run disruption based on formulary status. Would we be able to obtain an updated claims file with formulary status provided?

If not, would the client want us to consider all claims as formulary or would they like us to base formulary status off other parameters? See attached workbook in Addendum 2.

May we obtain rebate amounts paid for the most recent 4 quarters, by quarter?

Additional pricing information, other than what has already been provided, is unavailable.

Given this RFP was released during the holiday week, can you grant a due date extension in order for us to provide the best quote possible? See Question and Response No. 1.

On page 14 of the RFP there is a reference to envelopes. Can you clarify what is meant by envelope one and envelope two? Is PGCSD requesting hard copies in addition to the electronic submission? See Question and Response No. 11.

Please clarify the fees for both EGWP and Commercial populations combined? For example, are you asking for the $40k Audit allowance for both Commercial and EGWP or $80k ($40k for Commercial + $40k for EGWP)? I am asking because the set of fees to be underwritten are showing in both the Commercial and EGWP workbooks. Based on the RFP, below are the fees below:

$8 Per Member Implementation Credit $7 Per Member Per Year Annual Clinical Allowance $10 Per Member Per Year Annual Pharmacy Management Fund (PMF) - Any unused funds must carry forward into future years.

Annual Audit Allowance: $40,000 Annual Market Check Allowance: $25,000

The fees are independent for each plan: commercial and EGWP. In other words, it would be $80,000 total for audits (= $40,000 commercial + $40,000 EGWP) and $50,000 total for the market checks (=$25,000 commercial + $25,000 EGWP). The same applies to the per member fees.