Schedule B-1 - Pharmacy Pricing Exercise.xlsx

XLSX spreadsheet 50 KB Posted Oct 8, 2020

Attached to: RFP - Prisoner Health Care and Pharmacy Services (5 years)
Solicitation number: RFP-171-200000002287-10
Issued by: Kalamazoo County, Michigan

About this file

Written by GovTribe AI · Feb 19, 2025

This is a pharmacy pricing exercise spreadsheet for the Michigan Department of Corrections (MDOC) RFP for Prisoner Health Care and Pharmacy Services. The file contains three separate pricing exercises: Exercise 1 requires bidders to reprice all prescription drugs filled for MDOC in June 2020, Exercise 2 focuses on specialty medication pricing for high-cost and high-volume medications dispensed in 2020, and Exercise 3 requests specific pricing for Hepatitis C and HIV medications. For each exercise, bidders must provide detailed pricing information including total acquisition costs, rebates, manufacturer discounts, and anticipated future cost changes.

The pricing exercises require extensive cost breakdowns across hundreds of medications, including common prescriptions, specialty drugs, and disease-specific treatments. Exercise 1 contains over 200 different medications with their corresponding NDC codes, prescription counts, and metric quantities. Exercise 2 specifically targets 34 specialty medications like Adempas, Aubagio, and Cosentyx. Exercise 3 focuses on pricing for 5 Hepatitis C medications and 31 HIV medications, requiring current and historic unit costs along with any applicable rebates or discounts. The spreadsheet format allows MDOC to compare standardized pricing data across all bidders.

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Exercise 1 Re-Pricing

SCHEDULE B-1 - PHARMACY PRICING EXERCISES

RFP: Prisoner Health Care and Pharmacy Services

BIDDER PHARMACEUTICAL COST EXERCISE #1: RE-PRICING

This file contains all prescription drugs filled for MDOC in June 2020. Multiple orders for the same NDC number filled through the month have been rolled up into a single line.

Column B	If NDC in column A is not available to you, provide an alternative NDC for that line
Column F	Bidders must enter the Total Actual Acquisition Cost for the rx count/metric quantity for each NDC on each fill date
Column G	If bidder receives a manufacture rebate on this medication in June 2020, enter per unit rebate amount. If no rebate, enter NA
Column H	If bidder receives another manufacture discount (not rebate) on this medication in June 2020, enter per unit discount. If no manufacturer discount (MFR), enter NA
Column I	If bidder is aware of any anticipated future cost changes (increase/or decreases) in medications the unit cost for the particular medication should be included in this column

EXAMPLE:
NDC	NDC if Different than Column A	PROUCT DESCRIPTION	RX COUNT	METRIC QUANTITY	TOTAL ACQUISITION COST	Rebates	Other MFR Discounts	Future Costs
16729017301	NA	AMITRIPTYLINE HCL 50 MG TABS	6	185	$140.60	NA	NA	NA
Bidder price on June 1, 2020 was $.76 per pill. Total cost for 185 pills is $140.60. NDC was same as used by MDOC. There were no rebates or MFR discounts

NDC Code	NDC if Different than Column A	PRODUCT DESCRIPTION	RX Count	Metric Quantity	TOTAL ACQUISITION COST	Rebates	Other MFR Discounts	Future Cost
55513000504		DARBEPOETIN ALFA (1ML) 100 MCG/ML INJ	4	93
25682000101		ECULIZMUB (30 ML) 10 MG/ML INJ	2	180
00078059287		NILOTINIB (28/BOX) 150 MG CAPS	1	112
58468004001		AGALSIDASE BETA 35MG VIAL	1	2
00078066815		TRAMETINIB (30/BTL) 2 MG TABS	1	30
00078068166		DABRAFENIB 75 MG CAPS	1	120
68982082006		IMMUNE GLOBULIN-IFAS 10% (300 ML)	1	600
00074379902		ADALIMUMAB SRYG (2/BOX) 40 MG/0.8 ML INJ	17	40
50419048858		SORAFENIB 200 MG TABS	1	60
55513000204		DARBEPOETIN ALFA (1ML) 25 MCG/ML INJ	2	50
00003052811		DASATINIB 50 MG TABS	1	30
55513000304		DARBEPOETIN ALFA (1ML) 40 MCG/ML INJ	5	57
59627022205		INTERFERON B-1A SYRINGE 30 MCG INJ	1	4
64764030020		VEDOLIZUMAB (VIAL) 300 MG INJ	2	2
00078056912		INTERFERON BETA-1B (15/BOX) 0.3 MG KIT	1	15
00078082581		OCTREOTIDE ACET KIT (EACH) 30 MG INJ	2	2
55513074110		ETELCALCETIDE HCL 5MG/ML (1ML) INJ	6	144
68546032512		GLATIRAMER ^40MG/ML INJ (1ML)	1	12
68546017260		DEUTETRABENAZINE 12MG TABS (60/BTL)	1	60
00093360982		FLUTICASONE/SALMETEROL (EACH) 232-14 MCG INHA	83	143
58406002104		ETANERCEPT (4/BOX) 50 MG/ML INJ	3	12
57894003001		INFLIXIMAB VIAL 100 MG INJ	1	4
50242014301		TOCILIZUMAB PEN INJECTOR 162MG/0.9ML INJ	1	3.6
00006430502		INFLIXIMAB-ABDA VIAL 100 MG INJ	26	116
00078081881		OCTREOTIDE ACET KIT (EACH) 20 MG INJ	2	2
00069080901		INFLIXIMAB DYYB VIAL 100 MG INJ	1	7
68982082005		IMMUNE GLOBULIN-IFAS 10% (200 ML)	1	200
58468004101		AGALSIDASE BETA 5MG VIAL	1	4
59572063106		APREMILAST 30 MG TABS	4	240
50242010040		DORNASE ALFA (30 X2.5ML) 1 MG/ML SOLN	2	150
00024591401		DUPILUMAB 300MG/2ML (4ML)	1	4
00005197102		PNEUMOCOCCAL PCV13 INJ(0.5ML)	18	25
50474070062		CERTOLIZUMAB PEG 200MG KIT VIALS	1	1
00032301628		PANCRELIPASE 36-114-180	1	270
65649030302		RIFAXIMIN 550 MG TABS	7	420
69238106201		CHLORPROMAZINE HCL 200 MG TABS	16	1650
50458030811		RISPERIDONE (2ML) 50 MG/2 ML INJ	4	16
00703713301		HALOPERIDOL DEC 100MG/ML (5)	8	340
55513000404		DARBEPOETIN ALFA (1ML) 60 MCG/ML INJ	1	4
00131247935		LACOSAMIDE 150 MG TABS	3	201
50458030711		RISPERIDONE (2ML) 37.5 MG/2ML INJ	2	8
63459091215		TBO-FILGRASTIM SYRG (0.8 ML) 480 MCG/0.8 ML INJ	3	11.2
00781323434		GLATIRAMER ^(30 SYRG/BOX) 20 MG INJ	6	180
00781325089		GLATIRAMER ^40MG/ML INJ (1ML)	8	96
60793070210		PEN-G BENZATHINE (4ML) 2.4 MILLION UNITS INJ	3	28
65757030001		NALTREXONE MICROSPHERE (VL) 380 MG INJ	1	1
00023611501		PANCRELIPASE 5-17-24 CPDR	19	3300
00093578698		ENTECAVIR 0.5 MG TABS	1	30
00006484141		HEPATITIS A VACC VL (1ML) 50 UNITS/ML INJ	10	115
50242004164		ALTEPLASE VIAL (EACH) 2 MG INJ	1	8
00169183711		INSULIN 70/30 VL ^100U/ML 10ML	37	3050
00169183411		INSULIN NPH VL ^100U/ML (10ML)	90	12250
00169183311		INSULIN REG VL ^100U/ML (10ML)	32	2530
00023611401		PANCREALIPASE 40-126-168 CAPS	1	90
00591251030		BUDESONIDE 9MG TB24 (30/BTL)	1	30
69097041102		CINACALCET HCL 60 MG TABS	10	300
54092019112		MESALAMINE 500 MG CPCR	1	180
63402030830		LURASIDONE HCL 80 MG TABS	1	30
42023012901		FLUPHENAZINE DECON VL (5) 25 MG/ML INJ	56	530
55150026705		FLUPHENAZINE DECON VL (5) 25 MG/ML INJ	15	345
00006494300		PNEUMOCOCCAL VACC SDV (0.5ML) INJ	11	22
00378923093		MESALAMINE 1000 MG SUPP	2	90
58160082111		HEPATITIS B VACCINE VIAL (1ML) 20 MCG INJ	17	270
00131248035		LACOSAMIDE 200 MG TABS	5	270
00409272003		HEPARIN 1,000 U/ML INJ (30ML)	1	3750
00338067103		KCL10MEQ-D5W-1/2NS INJ (500ML)	1	45000
54092010001		MESALAMINE 1.2 GM TBEC	21	1410
63459091211		TBO-FILGRASTIM SYRG (0.8 ML) 480 MCG/0.8 ML INJ	1	2.4
00131247835		LACOSAMIDE 100 MG TABS	4	192
50484001030		COLLAGENASE (30) 250 U/GM OINT	14	510
53436016830		PATIROMER CA 16.8 GM PACK (EACH)	1	30
68462053465		TACROLIMUS (60GM) 0.1% OINT	1	240
68382086010		BENZTROPINE MES (2) 1 MG/ML INJ	28	274
69238105801		CHLORPROMAZINE HCL 50 MG TABS	4	480
43598039567		TETRABENAZINE 25 MG TABS	2	120
58160084211		TET-DIPH-PERT (TDAP) (0.5ML) INJ	14	50.5
62935045345		LEUPROLIDE ACETATE (SQ) KIT 45 MG INJ	2	2
69097041202		CINACALCET HCL 90 MG TABS	1	30
63323047105		HALOPERIDOL DEC 100MG/ML (5)	2	30
58914030180		NITROGLYCERIN RECTAL (30GM) 0.4 % OINT	1	30
68180082147		LANTHANUM CARB 1000MG (90/BOX) CHEW	3	270
42023010405		TUBERCULIN PPD VL (5ML) 5 TU/0.1ML INJ	8	80
00088502101		INSULIN GLARGINE VL (10ML) 100 U/ML INJ	22	400
58160082652		HEPATITIS A VACCINE SYRG (1ML) INJ	2	11
69097041002		CINACALCET HCL 30 MG TABS	4	120
49502050002		EPINEPHRINE AUTO-INJ 0.3 MG INJ	1	2
00065924007		DIFLUPREDNATE EMUL (5ML) 0.05% OPTH	5	35
49502010202		EPINEPHRINE AUTO-INJ (2) 0.3 MG INJ	13	38
00169706515		GLUCAGON SYRINGE 1 MG INJ	2	3
00173087310		UMECLIDINIUM BR INH (30) 62.5 MCG INHA	193	5880
00832063111		CLOMIPRAMINE HCL 50 MG CAPS	1	150
00002803101		GLUCAGON SYRINGE 1 MG INJ	1	2
68382071119		MESALAMINE DR 1.2 GM TBEC	3	240
00641139835		CHLORPROMAZINE-(2ML) 50 MG/2 ML INJ	3	102
00078065920		SACUBITRIL/VALSARTAN 24MG/26MG TABS	2	120
00078077720		SACUBITRIL/VALSARTAN 49MG/51MG TABS	1	60
63304015801		BROMOCRIPTINE MESYLATE 5 MG CAPS	1	120
00703712301		HALOPERIDOL DEC VL 50 MG/ML(5)	1	25
59310057922		ALBUTEROL HFA 90 MCG INHA (8.5GM)	913	8415
00597026010		GLUCAGON (EACH) 1 MG INJ	10	20
00299598035		BRIMONIDINE GEL 0.33% (30 GM)	1	30
65162064978		OXCARBAZEPINE 300MG/5ML SUSP (250ML)	1	750
45802009851		MESALAMINE ENEMA 4 GM/60 ML (7X60ML)	1	3360
59137051504		METHOTREXATE (0.25ML) PF PEN 12.5MG/0.25ML INJ	3	3
59137053004		METHOTREXATE 20MG/0.4ML PF PEN (0.4ML)	4	6.4
59137054004		METHOTREXATE 25MG/0.5ML PF PEN (0.5ML)	5	10
00006011231		SITAGLIPTIN PHOSPHATE 50 MG TABS	1	30
00003089321		APIXABAN 2.5 MG TABS	8	450
00003089421		APIXABAN 5 MG TABS	31	1534
50458058030		RIVAROXABAN 10 MG TABS	4	120
50458057990		RIVAROXABAN 20 MG TABS	8	208
00597036082		DABIGATRAN ETEXILATE 150 MG CAPS (UD)	2	120
62935030330		LEUPROLIDE ACETATE (SQ) KIT 30 MG INJ	4	4
00548560500		ENOXAPARIN SYRG (1ML) 100 MG/1 ML INJ	14	278
00703858023		ENOXAPARIN SYRG (1ML) 100 MG/1 ML INJ	5	156
00456120230		LINACLOTIDE (30/BTL) 290 MCG CAPS	2	60
16729012953		TEMOZOLOMIDE 140 MG CAPS	1	10
00548560400		ENOXAPARIN SYRG (0.8ML) 80 MG/0.8 ML INJ	23	332.8
00378612001		DILTIAZEM-(SR) 120 MG CP12	5	270
00597002402		IPRATROPIUM/ALBUTEROL (4 GM) 20 MCG/100 MCG INHA	1	4
54879002201		CYCLOPHOSPHAMIDE 50 MG CAPS	2	104
00131247760		LACOSAMIDE 50 MG TABS	3	90
00143929810		SOD FERRIC GLUC 62.5 MG/5 ML VL (5)	1	250
00143957010		SOD FERRIC GLUC 62.5 MG/5 ML VL (5)	1	250
00173052100		SALMETEROL XIN. PWD INH (60) 50 MCG INHA	2	120
68382043528		MESALAMINE 800 MG TBDR	1	60
00186077760		TICAGRELOR 90 MG TABS	4	150
70515071201		CICLESONIDE 160 MCG INH (6.1GM)	447	3025.6
00173086910		UMECLIDINIUM/VILANTEROL (60) 62.5-25MCG INHA	37	2220
47335076783		PALIPERIDONE 9 MG TB24	1	30
65597020230		EDOXABAN TOSYLATE 30 MG TABS	2	60
65597020330		EDOXABAN TOSYLATE 60 MG TABS	7	210
16729029212		DALFAMPRIDINE ER 10MG TABS	1	120
64764008060		LUBIPROSTONE 8 MCG CAPS	1	60
00310009530		ROFLUMILAST 500 MCG TABS	2	60
00186037020		BUDESO/FORMOT 160-4.5MCG(10.2)	1	10.2
00168009960		KETOCONAZOLE 2% CREAM (60GM)	13	2760
62935022305		LEUPROLIDE ACETATE (SQ) KIT 22.5 MG INJ	5	5
63323059710		DEFEROXAMINE MESY (VL) 500 MG INJ	3	64
42023016425		VASOPRESSIN (1ML) 20 UNITS/ML INJ	1	2
00065027510		BRINZOLAMIDE O/S (10ML) 1% OPTH	1	10
00527179001		FLUPHENAZINE HCL 5 MG TABS	7	303
59676030201		EPOETIN ALFA 2,000U/ML INJ (1)	1	6
00088222033		INSULIN GLARGINE VL 100 U/ML (10ML)	3	40
47335076683		PALIPERIDONE 6 MG TB24	1	30
00093598627		EPINEPHRINE AUTO-INJ (2) 0.3 MG INJ	4	8
68462050166		CALCIPOTRIENE (120) 0.005% CREA	1	240
69238106001		CHLORPROMAZINE HCL 100 MG TABS	8	300
00527178901		FLUPHENAZINE HCL 2.5 MG TABS	4	147
00023916330		CYCLOSPORINE O/S (30 X 0.4ML) 0.05% OPTH	1	30
00023608210		IRON DEXTRAN COMP (2ML) 50 MG/ML INJ	2	28
47335076583		PALIPERIDONE 3 MG TB24	2	60
63323037110		DAPTOMYCIN 500 MG INJ	10	21
00378204601		TACROLIMUS ANHYDROUS 1 MG CAPS	4	630
64980013401		DIPYRIDAMOLE 50 MG TABS	1	240
72124000202		ACLIDINIUM BROMIDE (EACH) 400MCG INHA	2	4
62332002631		THEOPHYLLINE 450 MG TB12	1	60
63304096201		BROMOCRIPTINE MESY ^2.5 MG TABS	2	240
51672211602		APAP SUPPOSITORY 325 MG SUPP	1	360
00548560700		ENOXAPARIN SYRG (1ML) 150 MG/1 ML INJ	5	106
70954001710		THIOTHIXENE 10 MG CAPS	5	300
00310737020		BUDESONIDE/FORMOTEROL (10.2) 160-4.5 MCG INHA	2	20.4
63323066401		DIPHENHYDRAMINE VIAL (1ML) 50 MG/ML INJ	2	110
59310030480		BECLOMETHASONE INH 80MCG (10.6GM)	1	10.6
66993089749		BETAMETHASONE-(AUG) (50) 0.05% OINT	43	2650
00143301801		COLCHICINE 0.6 MG CAPS	1	60
50458057930		RIVAROXABAN 20 MG TABS	2	26
00121065304		FLUPHENAZINE (120) 5 MG/ML CONC	1	120
00143972905		BENZTROPINE MES (2) 1 MG/ML INJ	1	10
00143992490		CEFAZOLIN SOD 1 GM INJ	1	180
72205003092		ABIRATERONE ACETATE 250 MG TAB	1	120
70069038301		HALOPERIDOL DEC 100MG/ML (1ML)	38	95
00085720601		MOMETASONE-FORMOTEROL (13) 100-5 MCG INHA	1	13
00085461001		MOMETASONE-FORMOTEROL (13) 200-5 MCG INHA	1	13
24208035305		LOTEPREDNOL ETABONAT O/S (5) 0.2% OPTH	8	40
00065064835		TOBRAMY\DEXA OINT (3.5) 0.3%-0.1% OPTH	3	10.5
70515071101		CICLESONIDE (6.1 GM) 80 MCG INHA	585	3653.9
66993040832		CARBAMAZEPINE (12 HR CAP) 200 MG CP12	8	930
00597019261		OLODATEROL (4 GM) 2.5 MCG INHA	5	20
49884046565		CHOLESTYRAMINE W/SUGAR PACKS (EA)	37	1785
50383028608		LEVOFLOXACIN (200 ML) 25 MG/ML SOLN	6	1200
68682030130		PYRIDOSTIGMINE BR 180MG TBCR(30/BTL)	2	60
43598039467		TETRABENAZINE 12.5 MG TABS	1	30
51672138603		FLUOCINONIDE (60GM) 0.05% CREA	5	780
66993058697		FLUTICASONE/SALMETEROL (60) 500/50 INHA	6	360
00023320503		BIMATOPROST O/S (2.5ML) 0.01% OPTH	1	2.5
13533013101		TETANUS-DIPHTHERIA TOX (0.5ML) INJ	3	9
54838052340		FLUOXETINE SOLN 20MG/5ML (120ML)	2	960
55150028209		ERTAPENEM SODIUM VIAL 1GM INJ	4	9
62332002531		THEOPHYLLINE^300 MG TB12	7	270
76329336901		NALOXONE SYRG W/O NEEDLE (2ML 2 MG/2 ML INJ	12	86
42799080601		IVERMECTIN TAB (UD) 3 MG TABS	6	186
63323028110		FLUPHENAZINE HCL VL (10) 2.5 MG/ML INJ	3	60
59310030240		BECLOMETHASONE REDIHALER 40MCG (10.6GM)	1	10.6
00254101196		SUCRALFATE (420) 1GM/10 ML SUSP	1	420
66993040932		CARBAMAZEPINE (12 HR CAP) 300 MG CP12	5	420
35573042130		ATOMOXETINE HCL 100 MG CAPS	1	30
64980013501		DIPYRIDAMOLE 75 MG TABS	2	180
00944049302		ALBUMIN HUMAN (100ML) 25% INJ	1	200
45802015065		ALOGLIPTIN 25MG TABS	1	30
00093360882		FLUTICASONE/SALMETEROL (EACH) 113-14 MCG INHA	52	53
00254200801		COLCHICINE 0.6 MG TABS	2	60
24208063562		NEOMY/POLYMX/HC SUSP (10ML) OTIC	6	170
00713050312		HEMORRHOIDAL HC (EACH) 25 MG SUPP	1	60
55513014410		EPOETIN ALFA (1ML) 10,000 U/ML INJ	2	2
67457012410		DIPHENHYDRAMINE 50MG/ML (10ML)	1	180
00548560100		ENOXAPARIN SYRG (0.3ML) 30 MG/0.3 ML INJ	1	18
00832030400		CHLORPROMAZINE HCL 200 MG TABS	2	60
00781598701		CARBAMAZEPINE (12 HR TAB) 200 MG TB12	16	1740
68462050165		CALCIPOTRIENE (60 GM) 0.005% CREA	1	120
52565002060		FLUOCINOLONE (60GM) 0.025% CREA	26	1800
69547035302		NALOXONE (2/BOX) 4MG/0.1ML INHA	16	34
42794008008		ACITRETIN 10 MG CAPS	1	12
00378965132		TRAVOPROST-Z O/S 0.004% 2.5ML	1	2.5
00054350049		LIDOCAINE VISCOUS (100ML) 2% SOLN	3	4400
00131247860		LACOSAMIDE 100 MG TABS	1	10
00548560300		ENOXAPARIN SYRG (0.6ML) 60 MG/0.6 ML INJ	1	18
00002821501		INSULIN REG VL ^100U/ML (10ML)	3	30
00009001201		HYDROCORTISONE 5 MG TABS	2	210
00591352530		LIDOCAINE PATCH (BOX OF 30) 5% PTCH	12	390
67457082399		VANCOMYCIN HCL VIAL 1.25GM INJ	4	22
51672136504		FLUOCINOLONE 0.01% SOLN (60ML)	1	180
00071374066		PHENYTOIN SOD EXT 30 MG CAPS	3	240
46287000601		SOD POLYSTY SULF (473 ML) 15GM/60 ML SUSP	1	473
43598034530		IMATINIB MESYLATE 400 MG TABS	4	120
42543049701		AMANTADINE_HCL 100 MG TABS	1	120
55111078927		SEVELAMER CARBONATE 800 MG TAB	31	10530
00406838062		MORPHINE SULF (UD) ER 60 MG TB12	3	110
60505257507		BALSALAZIDE DISODIUM 750 MG CAPS	20	4890
69452020820		CALCITRIOL 0.5 MCG CAPS	1	480
60793060010		PEN-G_BENZ/PROC (2ML) 1.2 MILLION UNITS INJ	1	2
68382008101		HALOPERIDOL 20 MG TABS	2	150
00781801601		CARBAMAZEPIN (12 HR TAB) 100MG TB12	4	750
00065074114		TETRACAINE HCL O/S (12X4ML) 0.5% OPTH	5	240
61990013002		PIPERACIL\TAZO 4-0.5GM VIAL	3	48
00591401201		VALPROIC ACID 250 MG CAPS	7	1380
42794004610		DOFETILIDE 0.5 MG CAPS	1	60
60687037501		DRONABINOL (UD) 2.5 MG CAPS	4	90
70594004203		VANCOMYCIN HCL 1GM/200ML	3	4400
00168006460		FLUOCINOLONE (60GM) 0.025% OINT	5	420
62756023920		CAPECITABINE 500 MG TABS	2	224
00093747489		CAPECITABINE 500 MG TABS	1	112
00409751716		DEXTROSE 50% INJ SYG (50ML)	2	300
62935075375		LEUPROLIDE ACETATE (SQ) KIT 7.5 MG INJ	4	4
17478021515		ATROPINE SULFATE O/S (15 ML) 1% OPTH	3	45
65862078201		METHENAMINE HIPP 1000 MG TABS	1	60
66794021041		CEFEPIME VIAL 2 GMS INJ	2	14
00591410401		PERPHENAZINE 16 MG TABS	22	1500
51801001130		POTASSIUM CITRATE EFF (30)	3	660
70069038310		HALOPERIDOL DEC (1ML) 100 MG/ML INJ	1	4
00548560200		ENOXAPARIN SYRG (0.4ML) 40 MG/0.4 ML INJ	1	12
00338108904		AMINO ACIDS-DEXTROSE (2000 ML) 4.25%-5% INJ	1	4000
63323047101		HALOPERIDOL DEC 100MG/ML (1ML)	1	2
52565004060		FLUOCINONIDE (60GM) 0.05% OINT	1	120
00338055311		SOD CHLORIDE MINI-BAG+ (50ML) 0.9% INJ	10	7000
00378647099		SCOPOLAMINE PATCH (EACH) 1.5 MG PT72	1	10
42794004410		DOFETILIDE 0.125 MG CAPS	1	60
42794004510		DOFETILIDE 0.25 MG CAPS	1	60
60505463203		CYCLOSPORINE MODIFY 100 MG CAPS	1	60
68382052960		CHOLESTYRAMINE/ASPARTAME 4 GM PACK	1	90
68382052860		CHOLESTYRAMINE (PACKET) 4 GM PACK	1	60
00703868023		ENOXAPARIN SYRG (0.8ML) 80 MG/0.8 ML INJ	3	30.4
00169750111		INSULIN_ASPART (10ML) 100 U/ML INJ	4	40
24208063110		NEOMY/POLYMX/HC SOLN (10ML) OTIC	2	50
60505025801		DESMOPRESSIN ACETATE 0.2 MG TABS	1	120
23155028801		ACETAZOLAMIDE 250 MG TABS	1	120
51672402301		ACETAZOLAMIDE 250 MG TABS	1	120
00703861023		ENOXAPARIN SYRG 120 MG/0.8 ML	1	8
00591410201		PERPHENAZINE 4 MG TABS	1	180
00121058104		HALOPERIDOL ORAL (120) 2 MG/ML CONC	5	2040
00093312501		DICLOXACILLIN 500 MG CAPS	1	120
64980029301		PERPHENAZINE 16 MG TABS	1	120
00527139701		LOXAPINE SUCCINATE 50 MG CAPS	15	1740
00093360782		FLUTICASONE/SALMETEROL (EACH) 55-14 MCG INHA	40	40
24208072002		DEXAMETHASONE SOLN (5ML) 0.1% OPTH	1	10
76329333901		ATROPINE SYRINGE (10ML) 0.1 MG/ML INJ	1	100
00548560600		ENOXAPARIN SYRG (0.8ML) 120 MG/0.8 ML INJ	6	48.8
13925050401		DAPSONE 25MG TABS	1	60
25021012250		CEFEPIME VIAL 2 GMS INJ	4	34
00093026215		FLUOCINONIDE (15GM) 0.05% CREA	1	30
68001030800		BUPROPION HCL^75 MG TABS	26	4740
65162070386		FLUOCINOLONE (120ML) 0.01% OIL	1	240
61748047560		BETAMETHASONE DIP (60ML) 0.05% LOTN	2	420
17478020115		PHENYLEPHRINE O/S (15ML) 2.5% OPTH	2	30
60432012916		CARBAMAZEPINE (450ML) 100 MG/5 ML SUSP	1	900
00168004015		BETAMETHASONE VAL (15GM) 0.1% CREA	7	450
00378204501		TACROLIMUS ANHYDROUS 0.5 MG CAPS	1	180
68382065906		PYRIDOSTIGMINE BROM^60 MG TABS	1	390
71930002890		PYRIDOSTIGMINE BROM^60 MG TABS	3	630
54288010310		EPINEPHRINE AMP (1ML) 1:1000 (1 MG/ML) INJ	1	9
64380072506		MYCOPHENOLATE MOFETIL 500 MG TABS	1	120
65628007010		OMEPRAZOLE ORAL (300ML) 2 MG/ML SUSP	7	2100
00168003346		BETAMETHASONE VAL (45GM) 0.1% OINT	5	765
51672126403		FLUOCINONIDE (60GM) 0.05% OINT	5	660
24208029505		TOBRAMYCIN/DEXA O/S (5) 0.3%-0.1% OPTH	2	10
72485020512		CAPECITABINE 500 MG TABS	2	168
00591036901		LOXAPINE SUCCINATE 5 MG CAPS	1	60
00832156011		HALOPERIDOL 20 MG TABS	6	360
61748005416		TRIHEXYPHENIDYL LIQ (473) 2 MG/5 ML ELIX	2	1892
51672131003		BETAMETHASONE-AUG (50) 0.05% CREA	1	800
13107000130		MIRTAZAPINE 7.5 MG TABS	3	210
49281075221		TUBERCULIN PPD VL (1 ML) 5 TU/0.1ML INJ	2	2
00591299801		URSODIOL 250 MG TABS	1	30
00781922109		CLINDAMYCIN IVPB (50ML) 600 MG/50 ML INJ	2	1250
00338954924		CLINDAMYCIN 0.9% NACL 600MG/50ML INJ (50ML)	1	300
68682092064		TETRACAINE HCL O/S 0.5% OPTH (15ML)	1	15
55150028220		ERTAPENEM SODIUM VIAL 1GM INJ	2	2
52536016801		PERPHENAZINE 8 MG TABS	3	540
69680011225		CYANOCOBALAMIN (1ML) 1000 MCG/ML INJ	1	30
17478071130		LIDOCAINE JELLY (30ML) 2% GEL	4	120
00009004722		METHYLPRED SOD SUCC VL 125 MG INJ	4	35
00065039515		CYCLOPENTOLATE O/S (15ML) 0.5% OPTH	1	15
00168004046		BETAMETHASONE VAL (45GM) 0.1% CREA	1	135
70594004302		VANCOMYCIN HCL 1.5GM/300ML	8	9300
00574985510		BUDESONIDE (MICRO) 3 MG CP24	3	270
60758088005		FLUOROMETHOLONE O/S (5ML) 0.1% OPTH	3	15
43598034490		IMATINIB MESYLATE 100 MG TABS	1	30
00003633717		HYDROXYUREA 400 MG CAPS	1	90
00591410101		PERPHENAZINE 2 MG TABS	2	360
00093574065		CYCLOSPORINE MODIFY 25 MG CAPS	2	240
69238105601		CHLORPROMAZINE HCL 25 MG TABS	1	30
68001037800		URSODIOL 500 MG TABS	1	60
00093716356		TOLTERODINE TARTRATE LA 2 MG CP24	1	30
00869083143		MINERAL OIL (LAX) (480ML) OIL	1	1440
00054855025		METHOTREXATE (UD) 2.5 MG TABS	19	668
51991079406		RIVASTIGMINE TARTRATE 3 MG CAP	1	120
59762007401		HYDROCORTISONE (CORTISOL) 10 MG TABS	2	180
00143952901		FLUPHENAZINE DECON VL (5) 25 MG/ML INJ	4	20
52244010010		THEOPHYLLINE ANHYD 100MG CAPS	1	30
00245021311		MIDODRINE HCL 10 MG TABS	3	270
00378740178		MESALAMINE DR 1.2 GM TBEC	1	30
50580053404		DIPHENHYDRAMINE AF (118 ML) 12.5 MG/5 ML LIQD	1	1770
60432056161		TRIAMCINOLONE 0.1% LOT (60) 0.1% LOTN	4	540
00338055318		SOD CHLORIDE MINI-BAG 0.9% INJ (100ML)	4	4600
70954002020		PRAZOSIN HCL 2 MG CAPS	1	180
00378240201		TRIFLUOPERAZINE HCL 2 MG TABS	1	90
68382052842		CHOLESTYRAMINE REG (378GM) POWD	4	1512
63739095325		HEPARIN SODIUM VL (1ML) 5,000 U/ML INJ	1	50
51672402601		KETOCONAZOLE ^200 MG TABS	1	60
00121085416		SULFAMETH\TRIMETH (473) 200-40 MG/5 ML SUSP	2	946
00338915930		SOD CHLORIDE MINI-BAG 0.9% INJ (100ML)	2	2400
59762500006		SULFASALAZINE ^500 MG TABS	1	360
00781210301		TACROLIMUS ANHYDROUS 1 MG CAPS	1	60
67877041920		LINEZOLID 600 MG TABS	2	66
65862084601		CLOZAPINE 100 MG TABS	1	168
64980029001		PERPHENAZINE 2 MG TABS	2	330
68001031800		NADOLOL 40 MG TABS	1	90
62559015901		FLUVOXAMINE MALEATE 50 MG TABS	3	540
00172524060		ANAGRELIDE HCL 1 MG CAPS	1	60
50742023301		ACETAZOLAMIDE 500 MG CPCR	1	120
68001025404		FLUCONAZOLE 200 MG TABS	1	60
55150012315		NAFCILLIN SOD VIAL (EACH) 2 GM INJ	1	8
49483022110		NITROGLYCERIN 2.5 MG CPCR	1	120
00121087332		LACTULOSE 10GM/15ML (946ML)	1	5676
68084037301		CODEINE/APAP (UD) 60 MG-300 MG TABS	2	200
62332000231		FAMOTIDINE 40 MG TABS	1	120
00121087316		LACTULOSE 10GM/15ML (480ML)	1	4320
68462027601		DESMOPRESSIN ACETATE 0.2 MG TABS	1	90
00338004902		SOD CHLORIDE IV (250 ML) 0.9% INJ	1	1750
45802046564		KETOCONAZOLE (120 ML) 2% SHAM	1	600
00093354656		ATOMOXETINE HCL 60 MG CAPS	1	30
70954001610		THIOTHIXENE 5 MG CAPS	2	60
70954001410		THIOTHIXENE 1 MG CAPS	1	60
60687022901		LOPERAMIDE (UD) 2 MG CAPS	2	200
59528033102		CALCIUM ACETATE 667MG (CAPS/TABS)	1	420
70069040101		BIMATOPROST O/S (2.5ML) 0.03% OPTH	2	5
60687027121		AZITHROMYCIN (UD) 500 MG TABS	1	28
60758011910		PREDNISOLONE ACET O/S (10) 1% OPTH	27	270
00409653102		VANCOMYCIN HCL VIAL 750 MG INJ	1	6
00168002016		HYDROCORTISONE OINT (454GM) 1% OINT	1	454
64380072507		MYCOPHENOLATE MOFETIL 500 MG TABS	5	900
58657052816		DIPHENHYD 12.5MG/5ML ELIX (473	4	7568
00378240501		TRIFLUOPERAZINE HCL^5 MG TABS	3	180
62756045788		CARBIDOPA\LEVO 50-200 MG TBCR	1	90
47781053326		FLUOCINONIDE (60GM) 0.05% GEL	2	120
50742026301		COLCHICIN/PROBEN 0.5-500 MG TABS	1	60
71321080320		CALCIUM ACETATE 667MG (CAPS/TABS)	1	420
00703851023		ENOXAPARIN SYRG (1ML) 150 MG/1 ML INJ	1	6
64253033335		HEPARIN SODIUM PF SYRG (5ML) 100 U/ML INJ	2	1200
65162071310		GUANFACINE 2 MG TABS	13	780
69238105103		PHYTONADIONE (VIT K) 5 MG TABS	1	1
00386000102		ETHYL CHLORIDE SPRAY (103.5ML) AERO	1	207
51672414601		PHENYTOIN (CHEWABLE)^50 MG TABS	1	360
13517011201		PHENOBARBITAL 64.8 MG TABS	1	120
60687043198		POLYETHYLENE GLYCOL 3350 PKTS (14)	1	56
68462013701		OXCARBAZEPINE^150 MG TABS	1	360
68084015701		MORPHINE SULF (U/D) ER 15 MG TB12	3	300
00904617250		CARBAMAZEPINE ^200 MG TABS	1	270
68001010600		DIVALPROEX (24HR TAB) 500 MG TB24	1	120
00591410301		PERPHENAZINE 8 MG TABS	1	90
00009004726		METHYLPRED SOD SUCC VL 125 MG INJ	1	7
63323054031		HEPARIN 1,000 U/ML INJ (30ML)	2	600
00591037201		LOXAPINE SUCCINATE 50 MG CAPS	1	30
00093354556		ATOMOXETINE HCL 40 MG CAPS	1	30
00904791461		IBUPROFEN (UD) 200 MG TABS	1	1200

Exercise #2 Speciality Meds BIDDER PHARMACEUTICAL COST EXERCISE #2: HISTORIC AND CURRENT PRICING OF SPECIALITY MEDICATIONS

The following drugs and quantities are the high cost and high volume medications dispensed to MDOC inmates in 2020, including the NDC for multi-source and generic drugs. (Note: Two Pages)
Bidders must complete columns F - M for each medication listed, per the following instructions
Column F	Minimum unit cost for the medication in 2020
Column G	NDC for multi-source and generic drugs if different than the one MDOC purchased
Column H	Maximum unit cost for the medication in 2020
Column I	NDC for multi-source and generic drugs if different than the one MDOC purchased
Column J	Current unit cost for the medication as of September, 2020
Column K	NDC for multi-source and generic drugs if different than the one MDOC purchased
Column L	If bidder receives a manufacture rebate on this medication in Septmeber 2020, enter per unit rebate amount. If no rebate, enter NA
Column M	If bidder receives another manufacture discount (not rebate) on this medication in September 2020, enter per unit discount. If no manufacturer discount (MFR), enter NA
Column N	If bidder receives a manufacture discount in September 2020, is it included in the reported unit cost? Enter Yes or No, or NA if there is no manufacturer discount
Column O	If bidder receives discount(s) from wholesaler, GPO, or other source on this medication in September 2020, enter total per unit discount. If no other discount, enter NA
Column P	If bidder discounts from wholesalers, GPO, or other sources, are they included in the reported unit cost? Enter Yes or No, or NA if there is no other discount discount
Column Q	If bidder is aware of any anticipated future cost changes (increase/or decreases) in medications the unit cost for the particular medication should be included in this column

				HISTORIC COST				CURRENT COST							Future Cost
				Minimum Unit Cost 2020		Maximum Unit Cost 2020									Any anticipated cost adjustments
NDC	BRAND	RX COUNT	METRIC QUANTITY	Unit Cost	NDC if different than Column A	Unit Cost	NDC if different than Column A	Unit Cost on September 1, 2020	NDC if different than Column A	Rebate	Other MFR Discount	In Unit Cost?	Other Discount	In Unit Cost?	Future Unit Cost
50419025201	ADEMPAS 1.5MG	1	90
50419025301	ADEMPAS 2 MG	11	990
58468021002	AUBAGIO 14MG	4	56
58468021004	AUBAGIO 14MG	9	266
49401008835	BENLYSTA 200MG/ML	2	8
00078063968	COSENTYX 150MG/ML	2	2
00078063997		15	16
50242012206	ESBRIET 267MG	5	873
00597013830	GILOTRIF 40 MG	1	30
57962014012	IMBRUVICA 140MG	2	0
57962028028	IMBRUVICA 280MG	13	364
50881002060	JAKAFI 20MG	1	60
50881001060	JAKAFI 10MG	2	120
50881002060	JAKAFI 20MG	11	660
50881000560	JAKAFI 5MG	2	0
62856070830	LENVIMA 8mg	3	180
62856070830	LENVIMA 8mg	1	60
47335023783	LETAIRIS 10MG	1	30
47335023783	LETAIRIS 10MG	4	120
61958080201	LETAIRIS 10MG	3	90
63020008002	NINLARO 4MG	1	3
63020007902	NINLARO 3MG	5	13
63020008002	NINLARO 4MG	10	22
50242015001	OCREVUS 300/10ML	10	150
59572050300	POMALYST 3MG	2	28
59572050300	POMALYST 3MG	19	287
59572042500	REVLIMID 25MG	1	21
59572041000	REVLIMID 10MG	2	0
59572042500	REVLIMID 25MG	17	308
50419017103	STIVARGA 40MG	4	252
64406000501	TECFIDERA 120MG	1	14
64406000602	TECFIDERA 240MG	57	3,060
00074057622	VENCLEXTA 100MG	1	120
00469012599	XTANDI 40MG	15	1,826

Exercise 3 Disease Specific

BIDDER PHARMACY SPECIALTY MEDICATION PRICING EXERCISE #3: DISEASE-SPECIFIC PHARMACEUTICALS

This exercise is for bidder's to provide separate pricing for their Hepatitis C and HIV medications. Bidders should use the same NDC or indicate a different one if necessary when completing the pricing exercise. Cost information should be included for each of the medications MDOC currently provides along with any additional medications the Bidder could provide for these conditions. If bidder is aware of any anticipated future cost changes (increase/or decreases) in medications the unit cost for the particular medication should be included in the appropriate column.

				HISTORIC COST		CURRENT COST						Future Cost
				Minimum Unit Cost 2020	Maximum Unit Cost 2020	Unit Cost on August 1, 2020	Rebate	Other MFR Discount	In Unit Cost?	Other Discount	In Unit Cost?	Any anticipated cost adjustments
NDC	Group	MEDICINE NAME	RX Count
00074262528	Hepatitis C	GLECAPREVIR-PIBRENTASVIR (84) 100 MG-40 MG TABS	26,544
00006307402	Hepatitis C	ELBASVIR-GRAZOPREVIR (28) 50 MG-100 MG TABS	16,660
61958240101	Hepatitis C	SOFOSB/VELPAT/VOXILA 400-100-100 MG (28/BTL)	308
61958180101	Hepatitis C	LEDIPASVIR-SOFOSBUVIR (28/BTL) 90 MG-400 MG TABS	56
72626270101	Hepatitis C	SOFOSBUVIR/VELPATASVIR 400-100MG (28)	1,008
68382026012	Hepatitis C	RIBAVIRIN 200 MG CAPS	2,197
65862090030	HIV	ABACAVIR/LAMIVUDINE 600-300 MG	240
49702022813	HIV	DOLUTEGRAVIR SOD 50 MG TABS	19,830
64380071104	HIV	LAMIVUDINE (3TC) 300 MG TABS	5,940
65862042130	HIV	TENOFOVIR DISOPROXIL 300 MG TA	2,730
69097030102	HIV	EFAVIRENZ 600 MG TABS	3,810
61958190101	HIV	ELVIT-COBIC-EMTR-TEN ALAF 150-	5,970
69097036202	HIV	ABACAVIR/LAMIVUDINE	5,092
68180028806	HIV	ABACAVIR/LAMIVUDINE 600-300 MG	6,900
61958120101	HIV	ELVIT-COBIC-EMTR-TEN DISO 150-	240
59676057530	HIV	DARUNAVIR/COBICISTAT 800 MG-15	6,510
31722053530	HIV	TENOFOVIR DISOPROXIL 300 MG TA	8,130
59676027801	HIV	RILPIVIRINE HCL 25 MG TABS	2,130
00003364111	HIV	ATAZANAVIR-COBICISTAT 300 MG-1	570
31722055760	HIV	ABACAVIR 300 MG TABS	1,800
61958230101	HIV	TENOFOVIR ALAFENAMIDE 25 MG TA	180
61958070101	HIV	EMTRICITABINE/TENOFOVIR 200-30	489
00006022761	HIV	RALTEGRAVIR 400 MG TABS	1,165
68180060306	HIV	LAMIVUDINE (3TC)	2,073
61958250101	HIV	BICTEGRAVIR-EMTRICITABINE-TENO	990
59676057101	HIV	ETRAVIRINE (60/BTL) 200 MG TAB	1,020
31722050430	HIV	EFAVIRENZ 600 MG TABS	2,280
59676056201	HIV	DARUNAVIR ETHANOLATE 600 MG TA	1,440
49702022318	HIV	MARAVIROC 150 MG TABS	300
00054040713	HIV	RITONAVIR 100MG TABS	570
61958200201	HIV	EMTRICITABINE/TENOFOVIR 200-25	180
00093538256	HIV	ABACAVIR/LAMIVUDINE 600-300 MG	6,030
00378410591	HIV	ABACAVIR	426
69097053302	HIV	TENOFOVIR DISOPROXIL 300 MG TA	1,470
59676080030	HIV	DARUNAVIR/COB/EMTRI/TENOF ALAF	90
31722050660	HIV	LAMIVUDINE - AZT 150/300 MG TA	360
65862002630	HIV	LAMIVUDINE (3TC) 300 MG TABS	390
49702023113	HIV	ABACAV/DOLUTEGRA/LAMIVUDINE 60	60
65862033530	HIV	ABACAVIR/LAMIVUDINE 600-300 MG	3,450
65862068730	HIV	RITONAVIR 100 MG TABS	840
64380071404	HIV	TENOFOVIR DISOPROXIL 300 MG TABS	900
15584010101	HIV	EFAVIRENZ/EMTRICIT/TENOFOVIR 600-200-300 MG TABS	60

File details come from the government source that posted it. Updated Feb 19, 2025.