S000000107 Official Solicitation Price Sheet.xlsx
XLSX spreadsheet 21 KB Posted
- Attached to
- Medicare Advantage Prescription Drug Services
- Solicitation number
- S000000107
- Issued by
- Pulaski County, Arkansas
About this file
This document is an Official Solicitation Price Sheet for a Medicare Advantage Prescription Drug (MA-PD) Services contract issued by the Employee Benefits Division on behalf of the TSS OSP in the state of Arkansas. The RFP requests pricing and a contract for MA-PD services for the state's Medicare-eligible retirees and dependents. Prospective contractors must complete the pricing sheet, which includes separate tables for the MA and PD components, breaking out the claims and non-claims costs. Submitted rates must be guaranteed for the first year (2023), and annual cap rates must be guaranteed for the following two years (2024-2025). The plan design to be used for pricing is outlined in the RFP.
The pricing sheet requires prospective contractors to provide all rates on a per member per month (PMPM) basis, excluding commissions. The total estimated cost of the initial contract term will be calculated based on the 2023 guaranteed rates and the 2024-2025 cap rates. The solicitation does not provide details on the specific number of members, though it notes 14,000 for the ASE group and 16,000 for the PSE group.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment C - Claims File Layouts.pdf | ||
| S000000107 Questions and Answers.pdf | ||
| Attachment B - Schedule of Benefits Revised 4.14.22.pdf | ||
| Attachment A - Non-Disclosure Agreement.docx | DOCX document | |
| S000000107 RFP Medicare Advantage Prescription Drug Services Revised.pdf | ||
| Attachment D - Formulary with NDC~2.xlsx | XLSX spreadsheet | |
| RFP Response Packet S000000107.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Instructions Official Solicitation Price Sheet S000000107 Medicare Advantage Prescription Drug Services
| Prospective Contractor Name: |
| Prospective Contractor CMS Contract #: |
| ∙ Prospective Contractors shall complete all yellow-highlighted cells on each tab. Cells not shaded in yellow will calculate. |
∙ Prospective Contractors shall break out the price between the medical (MA) and the drug (PD) components. Price must be broken out between the claims and non-claims components, with a further breakdown of each component. Do not enter $0 in any field unless that is truly accurate (e.g., do not enter $0 in the profit field and bury your profit elsewhere).
∙ Submitted rates on Tables 1 and 2 of the PMPM Costs tab must be guaranteed for the first year of a resulting contract, Calendar Year 2023.
∙ Submitted annual cap rates on Table 3 of the Totals tab must be guaranteed for corresponding Calendar Years 2024 and 2025.
∙ The plan design to be used for pricing is outlined in the RFP.
∙ Provide all rates on a per member per month (PMPM) basis.
∙ Exclude commissions from premium rates submissions.
&8
&8&A
2023 PMPM Rates
OFFICIAL SOLICITATION PRICE SHEET
S000000107 Medicare Advantage Prescription Drug Services
| TABLE 1: 2023 MA COMPONENT OF PREMIUM PMPM | TABLE 2: 2023 PD COMPONENT OF PREMIUM PMPM | ||||||
| ASE | PSE | ASE | PSE | ||||
| MA Star Rating | Part D Risk Score | ||||||
| Aggregate Benchmark (based on Star Rating) | Claims Component | $0.00 | $0.00 | ||||
| MA Risk Score | Projected Gross Pharmacy Claims | ||||||
| Claims Component | $0.00 | $0.00 | Other (describe below) | ||||
| Projected Gross Medical Claims | Total Drug Claims Cost | $0.00 | $0.00 | ||||
| QIA Expenses | Member Cost Sharing | ||||||
| Total Medical Claims Cost | $0.00 | $0.00 | Projected 70% Manufacturer Discounts | ||||
| Member Cost Sharing | Direct Capitation (Risk Adjusted) | ||||||
| Direct Capitation (Risk Adjusted) | Federal Reinsurance Payment | ||||||
| Non-Claims Component | $0.00 | $0.00 | Non-Claims Component | $0.00 | $0.00 | ||
| Administration | Administration | ||||||
| Risk Charges | Risk Charges | ||||||
| Profit | Profit | ||||||
| TOTAL | $0.00 | $0.00 | TOTAL | $0.00 | $0.00 |
PMPM Costs
Totals Official Solicitation Price Sheet S0000000107 Medicare Advantage Prescription Drug Services
| TABLE 3: TOTALS (to be used in determining low-cost) | ||
| The ASE and PSE 2023 Guarantee PMPM rate will automatically populate from the 2023 PMPM Rates tab and extend to reflect the initial term total. Enter 2024 and 2025 Cap PMPM rates in the yellow-shaded cells. The Annual PMPM costs will total in the Estimated Annual Contract Term PMPM Cost cells and will automatically populate in the Estimated Total Cost of Initial Contract Term cell. Do not alter this table. | ||
| ASE PMPM Rate | Members | Estimated Annual Contract Term PMPM Cost |
(x 12 months)
| 2023 Guarantee | $ - 0 | 14,000 | $ - 0 |
| 2024 Cap | $ - 0 | $ - 0 | |
| 2025 Cap | $ - 0 | $ - 0 | |
| PSE PMPM Rate | Members | Estimated Initial Contract Term PMPM Cost |
(x 12 months)
| 2023 Guarantee | $ - 0 | 16,000 | $ - 0 |
| 2024 Cap | $ - 0 | $ - 0 | |
| 2025 Cap | $ - 0 | $ - 0 | |
| Estimated Total Cost of Initial Contract Term | $ - 0 |
Totals
File details come from the government source that posted it. Updated .