S000000161 Cost Workbook.xlsx
XLSX spreadsheet 40 KB Posted
- Attached to
- Pharmacy Benefit Manager
- Solicitation number
- S000000161
- Issued by
- Pulaski County, Arkansas
About this file
This document is an Official Solicitation Price Sheet for a Pharmacy Benefit Manager contract opportunity issued by the state of Arkansas. The solicitation requests pricing for administration services, non-specialty drug pricing, specialty drug pricing, allowances and credits, generic dispensing rate guarantees, cost projections, trend guarantees, and performance guarantees for a 3-year contract term from July 1, 2023 to June 30, 2026. The contract is for an estimated 130,000 members. Prospective contractors must complete all blue-highlighted cells on each tab and provide guaranteed rates for the corresponding contract year.
The pricing includes discounts from Average Wholesale Price (AWP) for brand and generic drugs, dispensing fees, and minimum guaranteed rebates for brand and biosimilar drugs across various pharmacy networks including broad retail, Arkansas independent and associations retail, and the contractor's specialty pharmacy. The solicitation also requires trend guarantees for non-specialty drug spend, specialty drug spend, and generic drug ingredient cost. Performance guarantees are required for the implementation phase and ongoing annual services, with dollars at risk specified for each contract year.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment C - Retail Network Disruption Report~1.xlsx | XLSX spreadsheet | |
| Attachment G Arkansas Independents Network.xlsx | XLSX spreadsheet | |
| Contract and Grant Disclosure~17.pdf | ||
| Attachment B - List of Exclusions~1.xlsx | XLSX spreadsheet | |
| S000000161 Pharmacy Benefits Manager.pdf | ||
| S000000161 Technical Proposal Packet.docx | DOCX document | |
| Attachment A - Non-Disclosure Agreement~1.docx | DOCX document | |
| Attachment E - Financial and Formulary Scoring Examples~1.xlsx | XLSX spreadsheet | |
| Attachment F - Specialty Pharmacy Listing- Revised.xlsx | XLSX spreadsheet | |
| S000000161 - Drug Pricing Product Exclusions.xlsx | XLSX spreadsheet | |
| S000000161 Bidders Conference PPT.pdf | ||
| Attachment D - Formulary Disruption Reporting~1.xlsx | XLSX spreadsheet | |
| S000000161 Q and A.pdf |
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Text version
Instructions
OFFICIAL SOLICITATION PRICE SHEET
S000000107 Medicare Advantage Prescription Drug Services S000000161 Pharmacy Benefits Manager
Prospective Contractor Name:
| ∙ Prospective Contractors shall complete all blue-highlighted cells on each tab. Cells not shaded in blue will calculate. |
| ∙ Submitted rates must be guaranteed for the corresponding contract year (i.e., 7/1/2023, 7/1/2024, 7/1/2025) |
| ∙ The plan design to be used for pricing is outlined in the RFP. |
| ∙ Provide all applicable rates on a per member per month (PMPM) basis where indicated. |
| ∙ The Contractor shall not include commissions and all proposals must be submitted directly from the contracting company, without any intermediary. |
Admin PMPM
OFFICIAL SOLICITATION PRICE SHEET
S000000161 Pharmacy Benefits Manager
| TABLE 1: “ALL-INCLUSIVE” ADMINISTRATION SERVICES FEES (to be used in determining lowest net cost) | |||
| Description | Maximum Fee | X 130,000 Members | |
| (estimated) | Estimated Annual Cost |
(x 12 months)
| 07/01/2023 - 06/30/2024 Administration Year | |||
| Administrative Fee – Per Member Per Month | $ - 0 | 130000 | $ - 0 |
| 07/01/2023 - 06/30/2024 Administration Year Subtotal | $ - 0 | ||
| 07/01/2024 - 06/30/2025 Administration Year | |||
| Administrative Fee – Per Member Per Month | $ - 0 | 130000 | $ - 0 |
| 07/01/2024 - 06/30/2025 Administration Year Subtotal | $ - 0 | ||
| 07/01/2025 - 06/30/2026 Administration Year | |||
| Administrative Fee – Per Member Per Month | $ - 0 | 130000 | $ - 0 |
| 07/01/2025 - 06/30/2026 Administration Year Subtotal | $ - 0 | ||
| Estimated Total Cost of Initial Contract Term | $ - 0 |
Admin PMPM
Non-Specialty Pricing
| OFFICIAL SOLICITATION PRICE SHEET |
| S000000161 Pharmacy Benefit Manager |
| TABLE 2: NON-SPECIALTY PRICING: 07/01/2023 - 06/30/2024 Administration Year (to be used in determining lowest net cost) | ||
| Description | Broad Retail 30 Network | |
| [1 – 31 Days’ Supply] | Arkansas Independent & Associations Retail 30 Network | |
| [1 – 31 Days’ Supply] | Broad Retail 90 Network | |
| [32+ Days’ Supply] | Arkansas Independent & Associations Retail 90 Network | |
| [32+ Days’ Supply] |
[1 – 90+ Days’ Supply]
| Brand Drugs | |||||
| Discount guarantee from AWP for all Brand Drugs | % | % | % | % | % |
| Dispensing Fee Per Rx guarantee | $ | $ | $ | $ | $ |
| Generic Drugs | |||||
| Discount guarantee from AWP for all Generic Drugs (composite discount of MAC and Non-MAC prices, discounted AWP, or usual and customary retail price) | % | % | % | % | % |
| Dispensing Fee Per Rx guarantee | $ | $ | $ | $ | $ |
| Rebates | |||||
| Minimum Guaranteed Rebate Per Brand Drug Claim with 100% Pass Through of any additional rebates beyond the Minimum Rebate Guarantee for All Plans | $ | $ | $ | $ | $ |
| TABLE 3: NON-SPECIALTY PRICING: 07/01/2024 - 06/30/2025 Administration Year (to be used in determining lowest net cost) | ||
| Description | Broad Retail 30 Network | |
| [1 – 31 Days’ Supply] | Arkansas Independent & Associations Retail 30 Network | |
| [1 – 31 Days’ Supply] | Broad Retail 90 Network | |
| [32+ Days’ Supply] | Arkansas Independent & Associations Retail 90 Network | |
| [32+ Days’ Supply] |
[1 – 90+ Days’ Supply]
| Brand Drugs | |||||
| Discount guarantee from AWP for all Brand Drugs | % | % | % | % | % |
| Dispensing Fee Per Rx guarantee | $ | $ | $ | $ | $ |
| Generic Drugs | |||||
| Discount guarantee from AWP for all Generic Drugs (composite discount of MAC and Non-MAC prices, discounted AWP, or usual and customary retail price) | % | % | % | % | % |
| Dispensing Fee Per Rx guarantee | $ | $ | $ | $ | $ |
| Rebates | |||||
| Minimum Guaranteed Rebate Per Brand Drug Claim with 100% Pass Through of any additional rebates beyond the Minimum Rebate Guarantee for All Plans | $ | $ | $ | $ | $ |
| TABLE 4: NON-SPECIALTY PRICING: 07/01/2025 - 06/30/2026 Administration Year (to be used in determining lowest net cost) | ||
| Description | Broad Retail 30 Network | |
| [1 – 31 Days’ Supply] | Arkansas Independent & Associations Retail 30 Network | |
| [1 – 31 Days’ Supply] | Broad Retail 90 Network | |
| [32+ Days’ Supply] | Arkansas Independent & Associations Retail 90 Network | |
| [32+ Days’ Supply] |
[1 – 90+ Days’ Supply]
| Brand Drugs | |||||
| Discount guarantee from AWP for all Brand Drugs | % | % | % | % | % |
| Dispensing Fee Per Rx guarantee | $ | $ | $ | $ | $ |
| Generic Drugs | |||||
| Discount guarantee from AWP for all Generic Drugs (composite discount of MAC and Non-MAC prices, discounted AWP, or usual and customary retail price) | % | % | % | % | % |
| Dispensing Fee Per Rx guarantee | $ | $ | $ | $ | $ |
| Rebates | |||||
| Minimum Guaranteed Rebate Per Brand Drug Claim with 100% Pass Through of any additional rebates beyond the Minimum Rebate Guarantee for All Plans | $ | $ | $ | $ | $ |
Non-Specialty Pricing &P of &N
Specialty Pricing
| OFFICIAL SOLICITATION PRICE SHEET |
| S000000161 Pharmacy Benefit Manager |
| TABLE 5: Specialty Drugs Dispensed at Participating Retail Pharmacies (to be used in determining lowest net cost) | ||||
| Item | Description | 07/01/2023 - 06/30/2024 | 07/01/2024 - 06/30/2025 | 07/01/2025 - 06/30/2026 |
| a | Overall Effective Discount (OED) Guarantee for Specialty Brand Drugs (including Limited Distribution Specialty Drugs that the PBM has access but excluding Biosimilars) | % | % | % |
| b | Overall Effective Discount (OED) Guarantee for Specialty Generic Drugs (including Limited Distribution Specialty Drugs that the PBM has access but excluding Biosimilars) | % | % | % |
| c | Overall Effective Discount (OED) Guarantee for Biosimilars (including Limited Distribution Specialty Drugs that the PBM has access and including New to Market Biosimilars) | % | % | % |
| d | If Limited Distribution Specialty Drugs that the PBM does not have access to are not included in the above OED guarantees, then please indicate the Limited Distribution and Exclusive Distribution Drug Brand Guarantee for those products that the PBM does not have access and are dispensed at a Participating Retail Pharmacy | % | % | % |
| e | If Limited Distribution Specialty Drugs that the PBM does not have access to are not included in the above OED guarantees, then please indicate the Limited Distribution and Exclusive Distribution Drug Generic Guarantee for those products that the PBM does not have access to and are dispensed at a Participating Retail Pharmacy | % | % | % |
| f | Indicate the New to Market Specialty Drug Discount Guarantee | % | % | % |
| g | Indicate the New to Market Limited Distribution Drug Discount Guarantee | % | % | % |
| h | Indicate the New to Market Biosimilars Discount Guarantee | % | % | % |
| i | Dispensing Fee Guarantee - Per Prescription (including Limited Distribution Drugs with Access and without Access, Biosimilars and New to Market products) | $ | $ | $ |
| k | Minimum Rebate Guarantee – Per Brand Prescription (Passed Through at 100%) | $ | $ | $ |
| l | Minimum Rebate Guarantee – Per Biosimilar Prescription (Passed Through at 100%) | $ | $ | $ |
| TABLE 6: Specialty Drugs Dispensed at Arkansas Independents & Associations Retail Pharmacies (to be used in determining lowest net cost) | ||||
| a | Overall Effective Discount (OED) Guarantee for Specialty Brand Drugs (including Limited Distribution Specialty Drugs that the PBM has access but excluding Biosimilars) | % | % | % |
| b | Overall Effective Discount (OED) Guarantee for Specialty Generic Drugs (including Limited Distribution Specialty Drugs that the PBM has access but excluding Biosimilars) | % | % | % |
| c | Overall Effective Discount (OED) Guarantee for Biosimilars (including Limited Distribution Specialty Drugs that the PBM has access and including New to Market Biosimilars) | % | % | % |
| d | If Limited Distribution Specialty Drugs that the PBM does not have access to are not included in the above OED guarantees, then please indicate the Limited Distribution and Exclusive Distribution Drug Brand Guarantee for those products that the PBM does not have access and are dispensed at a Participating Retail Pharmacy | % | % | % |
| e | If Limited Distribution Specialty Drugs that the PBM does not have access to are not included in the above OED guarantees, then please indicate the Limited Distribution and Exclusive Distribution Drug Generic Guarantee for those products that the PBM does not have access to and are dispensed at a Participating Retail Pharmacy | % | % | % |
| f | Indicate the New to Market Specialty Drug Discount Guarantee | % | % | % |
| g | Indicate the New to Market Limited Distribution Drug Discount Guarantee | % | % | % |
| h | Indicate the New to Market Biosimilars Discount Guarantee | % | % | % |
| i | Dispensing Fee Guarantee - Per Prescription (including Limited Distribution Drugs with Access and without Access, Biosimilars and New to Market products) | $ | $ | $ |
| k | Minimum Rebate Guarantee – Per Brand Prescription (Passed Through at 100%) | $ | $ | $ |
| l | Minimum Rebate Guarantee – Per Biosimilar Prescription (Passed Through at 100%) | $ | $ | $ |
| TABLE 7: Specialty Drugs Dispensed at Contractor's Specialty Pharmacy (to be used in determining lowest net cost) | ||||
| Item | Description | 07/01/2023 - 06/30/2024 | 07/01/2024 - 06/30/2025 | 07/01/2025 - 06/30/2026 |
| a | Overall Effective Discount (OED) Guarantee for Specialty Brand Drugs (including Limited Distribution Specialty Drugs that the PBM has access and does not have access to but excluding Biosimilars) | % | % | % |
| b | Overall Effective Discount (OED) Guarantee for Specialty Generic Drugs (including Limited Distribution Specialty Drugs that the PBM has access to and does not have access to but excluding Biosimilars) | % | % | % |
| c | Overall Effective Discount (OED) Guarantee for Biosimilars (including New to Market Biosimilars) | % | % | % |
| d | Indicate the New to Market Specialty Drug Discount Guarantee | % | % | % |
| e | Indicate the New to Market Limited Distribution Drug Discount Guarantee | % | % | % |
| f | Indicate the New to Market Biosimilars Discount Guarantee | % | % | % |
| g | Dispensing Fee Guarantee - Per Prescription (including Limited Distribution Drugs with Access and without Access, Biosimilars and New to Market products) | $ | $ | $ |
| i | Minimum Rebate Guarantee – Per Brand Prescription (Passed Through at 100%) | $ | $ | $ |
| j | Minimum Rebate Guarantee – Per Biosimilar Prescription (Passed Through at 100%) | $ | $ | $ |
Specialty Pricing &P of &N
Allowances Credits
| OFFICIAL SOLICITATION PRICE SHEET |
| S000000161 Pharmacy Benefit Manager |
| TABLE 8: ALLOWANCES AND CREDITS | ||||
| Item | Description | 07/01/2023 - 06/30/2024 | 07/01/2024 - 06/30/2025 | 07/01/2025 - 06/30/2026 |
| a | Implementation Allowance - Indicate the $ (dollar) Per Member Per Year amount you are offering the Plan. | $ - 0 | $ - 0 | $ - 0 |
| b | Pre/ Post Implementation Audit Allowance - Indicate the flat dollar ($) amount you are offering the Plan to be used to conduct a pre or post implementation audit | $ - 0 | $ - 0 | $ - 0 |
| c | Annual Allowance - Indicate the flat dollar ($) amount you are offering the Plan to be used annually to verify the Plan is receiving discounted costs and major services as contracted as well as 100% of rebates. | $ - 0 | $ - 0 | $ - 0 |
| d | General Pharmacy Program Management Allowance - Indicate the $ (dollar) Per Member Per Year amount you are offering the Plan for general expenses related to the management of the pharmacy benefits program such as pharmacy claim and rebate audits, communication expenses, clinical programs, consulting fees or be used as a credit against claim invoices. | $ - 0 | $ - 0 | $ - 0 |
| e | Invoice Credit - Place the flat dollar ($) amount you are offering the Plan that can be used as a general credit against claim invoices. | $ - 0 | $ - 0 | $ - 0 |
Trend Guarantees
GDR Guarantees
| OFFICIAL SOLICITATION PRICE SHEET |
| S000000161 Pharmacy Benefit Manager |
| TABLE 9: GENERIC DISPENSING RATE GUARANTEES | |||||
| Complete the tables below for contract Years 1, 2, and 3. Note that generic dispensing rate includes only true instances of generic dispensing (i.e., exclude multi-source brand drugs dispensed under member-pay-difference plan designs). | |||||
| Administration Year | Broad Retail 30 Network | Arkansas Independent & Associations Retail 30 Network | Broad Retail 90 Network | Arkansas Independent & Associations Retail 90 Network | Mail Order |
| [1 – 31 Days’ Supply] | [1 – 31 Days’ Supply] | [32+ Days’ Supply] | [32+ Days’ Supply] | [All Days’ Supply] | |
| 07/01/2023 - 06/30/2024 | |||||
| 07/01/2024 - 06/30/2025 | |||||
| 07/01/2025 - 06/30/2026 |
GDR Guarantees
Trend Guarantees
| OFFICIAL SOLICITATION PRICE SHEET |
| S000000161 Pharmacy Benefit Manager |
| TABLE 10: PROJECTED COSTS Projected PMPM cost based on the proposed formulary and pricing for each contract year. Projections should include the projected ingredient cost, dispensing fees, administrative fees, rebates and before member cost share. | ||||
| Item | Description | 07/01/2023 - 06/30/2024 | 07/01/2024 - 06/30/2025 | 07/01/2025 - 06/30/2026 |
| a | Annual PMPM Projected Cost | $ - 0 | $ - 0 | $ - 0 |
| TABLE 11: TREND GUARANTEES | ||||
| Item | Description | 07/01/2023 - 06/30/2024 | 07/01/2024 - 06/30/2025 | 07/01/2025 - 06/30/2026 |
| a | Indicate the proposed annual Non-Specialty Gross Drug Spend per Member per Year Trend Guarantee (Indicate as a maximum percentage increase compared to the prior contract year) | |||
| b | Indicate the Specialty Gross Drug Spend Per Member per Year Trend Guarantee | |||
| c | Indicate the proposed annual Generic Drug Ingredient Cost per Member per Year Trend Guarantee (Indicate as a maximum percentage increase compared to the prior contract year) |
| TABLE 12: DRUG CLASS TREND GUARANTEES Enter Post-Rebates Per Member Per Year Gross Cost (i.e., Plan Cost after dispensing fees, rebates and before member cost share) Guarantee for Each Drug Class | ||||
| Item | Therapeutic Drug Class | 07/01/2023 - 06/30/2024 | 07/01/2024 - 06/30/2025 | 07/01/2025 - 06/30/2026 |
| a | Inflammatory Conditions (Specialty Only) | $ - 0 | $ - 0 | $ - 0 |
| b | Multiple Sclerosis | $ - 0 | $ - 0 | $ - 0 |
| c | Diabetes | $ - 0 | $ - 0 | $ - 0 |
| d | Cancer | $ - 0 | $ - 0 | $ - 0 |
| e | Dermatologicals (Acne, Psoriasis, Skin Conditions) | $ - 0 | $ - 0 | $ - 0 |
| f | Hematological Products | $ - 0 | $ - 0 | $ - 0 |
| g | Asthma and COPD | $ - 0 | $ - 0 | $ - 0 |
Trend Guarantees
Performance Guarantees
| OFFICIAL SOLICITATION PRICE SHEET |
| S000000161 Pharmacy Benefit Manager |
| TABLE 13: Performance Guarantees Dollars at Risk | ||||
| Item | Description | 07/01/2023 - 06/30/2024 | 07/01/2024 - 06/30/2025 | 07/01/2025 - 06/30/2026 |
| a | Implementation Performance Guarantees - Indicate the indicate the Total Amount at Risk (per Member dollar amount) you are proposing to the Plan for Implementation Performance Guarantees. | $ - 0 | $ - 0 | $ - 0 |
| b | Ongoing Annual Service Performance Guarantees - indicate the Total Annual Amount at Risk (per Member dollar amount) per contract year you are proposing to the Plan for Ongoing Annual Service Performance Guarantees | $ - 0 | $ - 0 | $ - 0 |
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