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Base Period Pricing
| BASE YEAR | English only - Continental US (includes Alaska and Hawaii) | English & Spanish - Continental US (includes Alaska and Hawaii) | English & Spanish - Puerto Rico and U.S.Virgin Islands | English & Spanish - All Other Territories |
| Total Systems Activation/De-activation required per Event | | | | |
| Communication Center Expense* | | | | |
| Systems Activation** | | | | |
| Call Center/Systems Activation** | | | | |
| Systems Deactivation** | | | | |
| Call Center/Systems Deactivation** | | | | |
| Transactional Prices |
| Per Claim with Third Party Liability (TPL) Confirmation |
| Administrative Price Per Rx Claim - Paid or Denied |
| Per Paper Claim, as required |
| Per Prior Authorization |
| Per Call - Automated Phone System |
| Per Incoming Call |
| Per Outgoing Call |
| Spanish Translation Service - per minute |
| Faxes - per Page |
Annual Retention Fee
EPAP Event Change Order (see Event Guide, Attachment I)
| Brand and Single Source Generic/DME = Lesser of: average | | | | |
| wholesale price (AWP) minus ____ or usual and customary (U&C) | AWP - 15% | AWP - 15% | AWP - 10% | TBD |
| Multi-Source Generic/DME = Lesser of: average wholesale price | | | | |
| (AWP) minus ____, or maximum allowable cost (MAC), or usual | | | | |
| and customary (U&C); | AWP - 20% | AWP - 20% | AWP - 40% | TBD |
| (MAC Guaranteed Effective Rate of AWP minus 55%) | | | MAC n/a | MAC n/a |
| Durable Medical Equipment (DME): Medi-Span published pricing. | AWP - 15% | AWP - 15% | AWP - 10% | TBD |
| (Actual pricing to be determined at time of Task Order.) | | | | |
Dispense Fee - Standard $4.00 $4.00 $4.00 TBD
| * Communication Center expense: Creation and distribution (Phone/ Fax/ Email) of Provider Network information/ instructions, |
| process, covered DME items, PA processes, follow up coordination and communications. |
| ** Systems Activation ...Program plan design validation, installation, testing, Eligibility installation and testing, network activation. |
| **Call center/systems activation…device (IVR, call center systems) programming, customer service activation, communication |
| and training, system testing. |
| **Systems Deactivation…Network notifications on final acceptable transaction dates, data archiving, event clean up ( final reporting |
| and system standby readiness.) |
| **Call center/systems deactivation…Device (IVR, call center systems) programming and messaging, event wrap up procedures, |
| final reporting. |
Option Period 1
| OPTION Period I | English only - Continental US (includes Alaska and Hawaii) | English & Spanish - Continental US (includes Alaska and Hawaii) | English & Spanish - Puerto Rico and U.S.Virgin Islands | English & Spanish - All Other Territories |
| Total Systems Activation/De-activation required per Event | | | | |
| Communication Center Expense* | | | | |
| Systems Activation** | | | | |
| Call Center/Systems Activation** | | | | |
| Systems Deactivation** | | | | |
| Call Center/Systems Deactivation** | | | | |
| Transactional Prices |
| Per Claim with Third Party Liability (TPL) Confirmation |
| Administrative Price Per Rx Claim - Paid or Denied |
| Per Paper Claim, as required |
| Per Prior Authorization |
| Per Call - Automated Phone System |
| Per Incoming Call |
| Per Outgoing Call |
| Spanish Translation Service - per minute |
| Faxes - per Page |
Annual Retention Fee
EPAP Event Change Order (see Event Guide, Attachment I)
| Brand and Single Source Generic/DME = Lesser of: average | | | | |
| wholesale price (AWP) minus ____ or usual and customary (U&C) | AWP - 15% | AWP - 15% | AWP - 10% | TBD |
| Multi-Source Generic/DME = Lesser of: average wholesale price | | | | |
| (AWP) minus ____, or maximum allowable cost (MAC), or usual | | | | |
| and customary (U&C); | AWP - 20% | AWP - 20% | AWP - 40% | TBD |
| (MAC Guaranteed Effective Rate of AWP minus 55%) | | | MAC n/a | MAC n/a |
| Durable Medical Equipment (DME): Medi-Span published pricing. | AWP - 15% | AWP - 15% | AWP - 10% | TBD |
| (Actual pricing to be determined at time of Task Order.) | | | | |
Dispense Fee - Standard $4.00 $4.00 $4.00 TBD
| * Communication Center expense: Creation and distribution (Phone/ Fax/ Email) of Provider Network information/ instructions, |
| process, covered DME items, PA processes, follow up coordination and communications. |
| ** Systems Activation ...Program plan design validation, installation, testing, Eligibility installation and testing, network activation. |
| **Call center/systems activation…device (IVR, call center systems) programming, customer service activation, communication |
| and training, system testing. |
| **Systems Deactivation…Network notifications on final acceptable transaction dates, data archiving, event clean up ( final reporting |
| and system standby readiness.) |
| **Call center/systems deactivation…Device (IVR, call center systems) programming and messaging, event wrap up procedures, |
| final reporting. |
Task Order #1
| Task | Unit of Issue | Price |
| Establish electronic pharmacy claim adjudication system | | |
| 12 months sustainment and maintenance of the electronic pharmacy claim adjudication system | | |
Establish call center for use during activation
| Establish public website |
| 12 months sustainment and maintenance of public website |
| Total |
