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[{"$nulls":3},"Request for PBM Proposal (RFP) for Arlington County Government"]
[{"$nulls":3},"Questionnaire and Minimum Qualifications"]
[]
[{"$nulls":3},"To Vendor:  Use Column G to provide a brief explanation. However if the length of the explanation is greater than 50 characters including spaces, you must use the \"Explanation\" worksheet to provide your detail explanation. Please note, your explanations must be limited to 400 characters or less"]
[]
[null,"","","PBM RFP 2020"]
["","","",""]
["I.","","","GENERAL VENDOR INFORMATION Corporate Headquarters","Format Type","Response","Explanation"]
["","1.",null,"PBM Name","Text"," "]
["",{"$f":"B11+1","v":{"v":2,"d":"2."}},null,"Street Address","Text"]
["",{"$f":"B12+1","v":{"v":3,"d":"3."}},null,"City ","Text"]
["",{"$f":"B13+1","v":{"v":4,"d":"4."}},null,"State","Text"]
["",{"$f":"B14+1","v":{"v":5,"d":"5."}},null,"Zip Code","Text"]
["",{"$f":"B15+1","v":{"v":6,"d":"6."}},null,"Web Address","Text"]
["","","",""]
[null,"","","Contacts","Format Type","Response","Explanation"]
[null,"","","Please indicate the primary and secondary contact who will answer questions related to this RFP."]
[null,{"$f":"B16+1","v":{"v":7,"d":"7."}},null,"Primary Contact"]
[null,null,"a.","Name","Text"]
[null,null,"b.","Title","Text"]
[null,null,"c.","Address","Text"]
[null,null,"d.","City","Text"]
[null,null,"e.","State","Text"]
[null,null,"f.","Zip","Text"]
[null,null,"g.","Phone Number","Text"]
[null,null,"h.","Fax Number","Text"]
[null,null,"i.","E-mail Address","Text"]
[null,{"$f":"B20+1","v":{"v":8,"d":"8."}},null,"Secondary Contact "]
[null,null,"a.","Name","Text"]
[null,null,"b.","Title","Text"]
[null,null,"c.","Address","Text"]
[null,null,"d.","City","Text"]
[null,null,"e.","State","Text"]
[null,null,"f.","Zip","Text"]
[null,null,"g.","Phone Number","Text"]
[null,null,"h.","Fax Number","Text"]
[null,null,"i.","E-mail Address","Text"]
[{"$nulls":3},"Vendor References"]
[null,{"v":9,"d":"9."},null,"Please provide three current client references for the proposed account team, preferably for clients of similar size and complexity as [Client Name] for whom you provide integrated retail and mail services."]
[null,null,"a.","Company","Text"]
[{"$nulls":3},"Contact Person","Text"]
[{"$nulls":3},"Title","Text"]
[{"$nulls":3},"Phone Number","Text"]
[{"$nulls":3},"Email Address","Text"]
[null,null,"b.","Company","Text"]
[{"$nulls":3},"Contact Person","Text"]
[{"$nulls":3},"Title","Text"]
[{"$nulls":3},"Phone Number","Text"]
[{"$nulls":3},"Email Address","Text"]
[null,null,"c.","Company","Text"]
[{"$nulls":3},"Contact Person","Text"]
[{"$nulls":3},"Title","Text"]
[{"$nulls":3},"Phone Number","Text"]
[{"$nulls":3},"Email Address","Text"]
[null,{"v":10,"d":"10."},null,"Please provide two references for plan sponsors who terminated your services within the last two years, preferably plans of similar size and complexity as [Client Name]."]
[null,null,"a.","Company","Text"]
[{"$nulls":3},"Contact Person","Text"]
[{"$nulls":3},"Title","Text"]
[{"$nulls":3},"Phone Number","Text"]
[{"$nulls":3},"Email Address","Text"]
[{"$nulls":3},"Program Termination Date","Text"]
[null,null,"b.","Company","Text"]
[{"$nulls":3},"Contact Person","Text"]
[{"$nulls":3},"Title","Text"]
[{"$nulls":3},"Phone Number","Text"]
[{"$nulls":3},"Email Address","Text"]
[{"$nulls":3},"Program Termination Date","Text"]
[null," ",null,"Vendor Accreditations","Format Type","Response"," Explanation"]
[null,{"$f":"B57+1","v":{"v":11,"d":"11."}},null,"Does your firm currently have URAC accreditation for:"]
[null," ","a.","Pharmacy Benefit Management","Yes / No"]
[null," ","b.","Specialty Pharmacy","Yes / No"]
[null," ","c.","Mail Order Pharmacy","Yes / No"]
[null,null,"d.","Expiration date of accreditation/certification","Date"]
[null,{"$f":"B71+1","v":{"v":12,"d":"12."}},"a.","NCQA Disease Management Program Accreditation","Yes / No"]
[null,null,"b.","Expiration date of accreditation/certification","Date"]
[null,{"$f":"B76+1","v":{"v":13,"d":"13."}},"a.","NCQA Utilization Management Certification","Yes / No"]
[null,null,"b.","Expiration date of accreditation/certification","Date"]
[null,{"$f":"B78+1","v":{"v":14,"d":"14."}}," ","List any other accreditations for which your organization has been certified:","Text"]
[null,{"$f":"B80+1","v":{"v":15,"d":"15."}},null,"CMS Star Rating for 2018 (Scale of 5; 5 being best)","Text"]
["II.",null,null,"Bidding Requirements"]
[{"$nulls":3},"Minimum Qualifications","Format Type","Response","Explanation"]
[null,{"v":1,"d":"1."},null,"A current business license and/or other required certifications necessary to operate in the locations of business operations.","Confirm"]
[null,{"$f":"B84+1","v":{"v":2,"d":"2."}},null,"A  network of pharmacies meeting GeoAccess standards as listed below:"]
[null,null,"a.","Retail 30 Pharmacies – Urban: 1 in 1.5 miles","Confirm"]
[null,null,"b.","Retail 30 Pharmacies – Suburban: 1 in 3 miles","Confirm"]
[null,null,"c.","Retail 30 Pharmacies – Rural: 1 in 10 miles","Confirm"]
[null,null,"d.","Retail 90 Pharmacies – Urban: 1 in 1.5 miles","Confirm"]
[null,null,"e.","Retail 90 Pharmacies – Suburban: 1 in 3 miles","Confirm"]
[null,null,"f.","Retail 90 Pharmacies – Rural: 1 in 10 miles","Confirm"]
[null,{"$f":"B85+1","v":{"v":3,"d":"3."}},null,"Offer a self-insured pharmacy benefits plan. ","Confirm"]
[null,{"$f":"B92+1","v":{"v":4,"d":"4."}},null,"Service at a minimum three large employer groups, i.e., clients of 50,000 subscribers (employees + retirees, excluding dependents) or more.","Confirm"]
[null,{"v":5,"d":"5."},null,"All pharmacists, registered nurses, care managers, physician reviewers, and allied health team members must be appropriately licensed.","Confirm"]
[null,{"v":6,"d":"6."},null,"Current accreditation Utilization Review Accreditation Committee (URAC).","Confirm"]
[null,{"v":7,"d":"7."},null,"Current membership in Proposer’s Book of Business must be a minimum of 3 million participants.","Confirm"]
[null,{"$f":"B96+1","v":{"v":8,"d":"8."}},null,"Coordinate payments for Medicare Part B drugs directly with Medicare for both retail and mail order pharmacy claims.","Confirm"]
[{"$nulls":3},"General","Format Type","Response","Explanation"]
[{"$nulls":3},"Aon requires completion of this section to assess your ability to meet its specific standards and conditions. If your answer is \"Agree\", you acknowledge your willingness to incorporate the standard, exactly as worded here, into a final contract. Additionally, you acknowledge that the final financial proposal is reflective of providing these services as defined by Aon within this RFP.  Any deviation to each standard will be considered a \"No\" answer (even if you select Yes) and will be scored as such.\n\n- If your answer is \"Partial Agree/Disagree\", please explain the specific aspect of the requirement you do not agree with and why. Note that exceptions may be cause for elimination from further consideration."]
[null,{"$f":"B97+1","v":{"v":9,"d":"9."}},null,"You agree to the following statements:  (i) Information provided in accordance with RFP is the only information that may be submitted as part of your offer.  (ii) NO additional documentation may be submitted (or incorporated by reference) unless specifically requested and/or approved by Aon.  (iii) Any additional documentation provided by you will not be reviewed, will not modify or condition your offer, and will not be incorporated into the contract unless specifically requested by Aon .  (iv) Any deviations from the requested terms and conditions in this RFP must be expressly stated within the space provided in this RFP.  (v) Any failure to comply with these requirements constitutes grounds for rejection of your proposal.","Confirm"]
[null,{"$f":"B100+1","v":{"v":10,"d":"10."}},null,"If selected as a finalist or as requested during the bidding process, you will provide a detailed contract draft that reflects all commitments made in the bid, word for word, with a separate index document that specifies each commitment's location within the contract draft. Your organization will provide this document within ten (10) business days following the request. Aon shall have the final determination on the materiality to the final contract of each question in this RFP. Failure to comply with this requirement constitutes grounds for rejection of your proposal.","Confirm"]
[null,{"$f":"B101+1","v":{"v":11,"d":"11."}},null,"You will disclose and certify all sources of revenue on an annual basis.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B102+1","v":{"v":12,"d":"12."}},null,"Your standard policy is to ensure that \"once a generic, always a generic.\" In other words, members will pay a generic copay for single-source and multi-source generics regardless of your drug-type classification policy.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":13,"d":"13."},null,"You use the \"maintenance medication indicator\" provided in a nationally recognized drug information source (e.g., Medispan) to identify/define \"maintenance medications\" for purposes of a mandatory mail program, a program that charges a penalty for refills obtained at retail pharmacies instead of mail, a traditional retail 90 program, or a \"Mail at Retail\" program that allows up to a 90 day supply of maintenance drugs to be dispensed from certain retail pharmacies with mail-like pricing.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B104+1","v":{"v":14,"d":"14."}},null,"In the event there are changes in the marketplace to the pricing benchmark (e.g., AWP), methodology used to determine a drug's ingredient cost, or the pricing source used for [Client Name], even if you use an alternate pricing source for other clients, you will notify [Client Name] at least 120 calendar days in advance of the effective date of any such change and provide an analysis that demonstrates that costs will not increase as a result of the change through the contract term based on up to 12 months worth of data. Your organization must provide full documentation justifying the reason for such change and the adjusted terms must be agreed upon before any changes are made. The terms will be adjusted accordingly to provide an equivalent ingredient cost after the change to [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B105+1","v":{"v":15,"d":"15."}},null,"You agree that amounts owed to [Client Name] during the course of the contract term, including but not limited to Manufacturer Payments, guarantee shortfalls, recoveries identified during claims audits, will be paid by the appropriate due date.  Any amounts unpaid 10 calendar days after the stated due date will bear interest at the greater of LIBOR plus 1% per month or the highest interest rate allowed by law.","Fully Agree / Partial Agree / Disagree"]
[null,{"v":16,"d":"16."},null,"Your organization can administer [Client Name]'s current benefit designs and provisions as defined in attachment \"[Client Name] Benefit Designs\". This includes and is not limited to your ability to administer integrated medical and Rx deductibles and out of pocket maximums on a real time basis for qualified HDHPs and other plan types. If you cannot administer specific provisions for [Client Name], please identify those in a separate attachment and specify.","Fully Agree / Partial Agree / Disagree"," "]
[]
["II.",null,null,"Officer Statement","Format Type","Response","Explanation"]
[null,{"v":1,"d":"1."},null,"You acknowledge that the response provided to this proposal in entirety will become part of the contract with Aon and [Client Name]. If any part of the contract does not agree with the response provided herein, you will amend the contract or defer to the proposal.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B110+1","v":{"v":2,"d":"2."}},null,"Your completed proposal contains the form (included in the \"Officer Statement\" worksheet), signed by a company officer, attesting to compliance with RFP specifications and the accuracy of all responses.","Confirmed"]

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[]
[]
[{"$nulls":3},{"$f":"Questionnaire!D3","v":"Request for PBM Proposal (RFP) for Arlington County Government"}]
[{"$nulls":3},"Technical"]
[]
[{"$nulls":3},"To Vendor:  Use Column G to provide a brief explanation. However if the length of the explanation is greater than 50 characters including spaces, you must use the \"Explanation\" worksheet to provide your detail explanation. Please note, your explanations must be limited to 400 characters or less"]
[]
[{"$nulls":3},"Technical Questionnaire","Format Type","Response","Explanation"]
["I.",null,null,"[Client Name] Payment Terms"]
[null,{"v":1,"d":"1."},null,"You will not require an advance deposit and no imprest balance from [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B10+1","v":{"v":2,"d":"2."}},null,"[Client Name] will receive/pay Claim invoices on a biweekly (every two weeks) basis.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B11+1","v":{"v":3,"d":"3."}},null,"You will allow [Client Name] 5 business days to pay claim invoices.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":4,"d":"4."},null,"[Client Name] will pay Administrative Fees on a monthly basis.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":5,"d":"5."},null,"You will allow [Client Name] 15 business days to pay Administrative Fees","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":6,"d":"6."},null,"You will be flexible in accommodating the specific banking requirements of [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":7,"d":"7."},null,"You will provide detailed account structure reporting of claims, invoiced amounts and Manufacturer Payments for corporate and government accounting.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":8,"d":"8."},null,"You shall not require an advance deposit from [Client Name] prior to the effective date or at any time during the contract term.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Rx Formulary ","Format Type","Response","Explanation"]
[null,{"$f":"B17+1","v":{"v":9,"d":"9."}},null,"[Client Name] will have the option of utilizing your standard formulary including all FDA approved drugs or your standard formulary with its formulary exclusions. Your proposal includes two sets of Manufacturer Payment guarantees depending on which option [Client Name] selects.","Fully Agree / Partial Agree / Disagree"]
[null,{"$f":"B19+1","v":{"v":10,"d":"10."}},null,"Your proposal assumes:"]
[null,{"$f":"B20+1","v":{"v":11,"d":"11."}},null,"That [Client Name] has the ability to grandfather incumbent PBM formulary exclusions and/or formulary status (including Clinical Prior Authorizations and Utilization Management programs) for up to ninety (90) days following the contract effective date with NO IMPACT to the Manufacturer Payments quoted on the 'RX-Pricing MFP' tab.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B21+1","v":{"v":12,"d":"12."}},null,"[Client Name] continues to apply the same formulary strategy over the contract term. For instance, if [Client Name] currently utilizes a formulary that excludes certain FDA products, your proposal reflects your organization's exclusion-based formulary and associated Manufacturer Payment guarantees.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B22+1","v":{"v":13,"d":"13."}},null,"If you answer \"Disagree\" to the question above, please describe how your proposal will differ from the current formulary strategy for [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":14,"d":"14."},null,"You, not [Client Name], will be responsible for maintaining this formulary and determining which products are preferred and non-preferred, at no additional cost to [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B24+1","v":{"v":15,"d":"15."}},null,"Formulary Exclusions. "]
[null,{"v":16,"d":"16."},null,"Should [Client Name] elect to adopt a formulary with exclusions, you agree to the following: "]
[null,{"v":17,"d":"17."},null,"Provide written notice to [Client Name] at least 180 calendar days in advance of any formulary changes that narrow the formulary, with the exception of changes due to safety and FDA driven issues.","Fully Agree / Partial Agree / Disagree"]
[null,{"v":18,"d":"18."},null,"Provide written notice to members 120 calendar days in advance of any formulary changes that narrow the formulary, with the exception of changes due to safety and FDA driven issues, for which notification must be provided to the [Client Name] and plan members within five business days.","Fully Agree / Partial Agree / Disagree"]
[null,{"v":19,"d":"19."},null,"Provide written notice to [Client Name] and members within five business days for any formulary changes that narrow the formulary due to safety and FDA driven issues.","Fully Agree / Partial Agree / Disagree"]
[null,{"v":20,"d":"20."},null,"Provide a medical necessity exception process for drugs excluded from your formulary.","Fully Agree / Partial Agree / Disagree"]
[null,{"v":21,"d":"21."},null,"If [Client Name] does not agree to such a formulary change as described directly above, [Client Name] reserves the right to implement a custom formulary or terminate for cause, with 60 calendar days written notice.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":22,"d":"22."},null,"You will provide [Client Name] with a client-specific analysis identifying the financial impact (i.e. ingredient cost before and after Manufacturer Payments) and member impact of the additional exclusions on a drug-by-drug basis and in total at least 120 calendar days in advance of any changes that narrow the formulary. If earned Manufacturer Payments for products remaining on the formulary increase as a result of the additional exclusions, your analysis will identify the financial impact (i.e. ingredient cost before and after Manufacturer Payments) of these improvements on a drug-by-drug basis. There will be no arbitrary or book of business adjustment applied to [Client Name]'s guaranteed Manufacturer Payments. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":23,"d":"23."},null,"How many products are excluded from your proposed exclusions-based formulary? Provide a complete list of the drugs excluded from this formulary.","Number"]
[null,{"v":24,"d":"24."},null,"  How many of these exclusions are Traditional drugs?","Number"]
[null,{"v":25,"d":"25."},null,"  How many of these exclusions are Specialty Drugs?","Number"]
[null,{"v":26,"d":"26."},null,"You  agree that your standard formulary will include at least two drugs in every therapy class and disease state and will provide clinically appropriate access to a sufficient number of pharmaceutical products available in the marketplace.","Text"]
[{"$nulls":3},"Retail Network","Format Type","Response","Explanation"]
[null,{"$f":"B36+1","v":{"v":27,"d":"27."}},null,"Your bid should reflect the broadest retail network available and should not contemplate or underwrite any changes to those networks that diminishes member access.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B38+1","v":{"v":28,"d":"28."}},null,"You agree to base your bid on your broadest retail network available that includes all major retail chains.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B39+1","v":{"v":29,"d":"29."}},null,"If you propose a network change that impacts more than 5% of all pharmacies in the network (add, drop certain chains, etc.) and/or one of the top 5 pharmacy chains by store count before the effective date and or during the contract term, you will provide a detailed analysis describing member disruption and impact to pricing with all underlying assumptions disclosed to [Client Name] at least 90 calendar days prior to the effective date of the proposed network change.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":30,"d":"30."},null,"Furthermore, should the number of retail pharmacies in your network be reduced by more than 3% of all pharmacies in the network (add, drop certain chains, etc.) and/or one of the top 5 pharmacy chains by store count before the effective date and or any point during the contract term, you will provide [Client Name] with an improved pricing offer for the proposed reduced retail network at least 90 calendar days prior to the effective date of such change. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":31,"d":"31."},null,"If the revised pricing that results from a change in the pharmacy network is not acceptable to [Client Name], they reserve the right to renegotiate pricing or terminate for cause with 30 calendar days notice for the remaining term of the contract.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":32,"d":"32."},null,"If you elect to make a change in your pharmacy network, [Client Name]'s pricing cannot be negatively altered (current pricing must be honored or improved). ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":33,"d":"33."},null,"You have a network of pharmacies that will provide significantly greater discounts (i.e. similar or equal to mail pricing) for claims with an 83-90 day supply when mail order copays/coinsurance apply to prescriptions filled at these pharmacies.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":34,"d":"34."},null,"Please input the number of pharmacies nationwide in your proposed Retail-90 and Mail at Retail Networks in the \"RX-Pricing\" Worksheets.","Confirm"]
[{"$nulls":3},"Market Check","Format Type","Response","Explanation"]
[null,{"$f":"B45+1","v":{"v":35,"d":"35."}},null,"You agree to allow fair and flexible market checks to preserve competitiveness of financial terms for [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B47+1","v":{"v":36,"d":"36."}},null,"An annual market check will be included as part of the PBM contract.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B48+1","v":{"v":37,"d":"37."}},null,"You agree that no contractual term or financial component of the contract will be negatively impacted [Client Name] during the market check","Fully Agree / Partial Agree / Disagree"]
[null,{"v":38,"d":"38."},null,"The market check will compare the aggregate value of the discounts, dispensing fees, administration fee pricing terms of [Client Name] with the aggregate value of the discounts, dispensing fees, administration fee pricing terms available in the market place at time of the market check for plans comparable in size and plan design. The results will be shared with you in a Market Check Audit Report Part A.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":39,"d":"39."},null,"In addition, the market check will compare the aggregate value of the Manufacturer Payment pricing terms of [Client Name] with the aggregate value of the Manufacturer Payment pricing terms available in the market place at the time of the market check for plans comparable in size and plan design. The results will be shared with you in a Market Check Audit Report Part B.","Fully Agree / Partial Agree / Disagree"]
[null,{"v":40,"d":"40."},null,"You will provide comments on the Market Check Report within ten (10) business days of receipt.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":41,"d":"41."},null,"If Market Check Audit Report Part A and/or Part B indicates current market conditions can yield a 1% or more savings of net plan costs, the parties will reach mutual agreement on revised pricing terms and other applicable provisions.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":42,"d":"42."},null,"If mutual agreement cannot be reached within 60 calendar days from the receipt date of the Market Check Audit Report, [Client Name] has the right to terminate their agreement without charge or penalty and/or may join a coalition arrangement with your firm effective the plan year immediately following, upon 30 calendar days prior written notice.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":43,"d":"43."},null,"If Market Check Audit Report results in revised pricing terms, you will make those revised pricing terms effective within 30 calendar days following written approval from [Client Name] of the revised pricing terms irrespective of the status of the amendment.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":44,"d":"44."},null,"You will provide an amendment within 10 business days of [Client Name]'s written acceptance of the market check. The amendment must be provided in an unprotected document which can be edited by [Client Name]. Your will turnaround subsequent revisions to the amendment no later than five business days from receipt of the requested revisions from [Client Name]. ","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Term and Termination","Format Type","Response","Explanation"]
[null,{"$f":"B56+1","v":{"v":45,"d":"45."}},null,"Initial [Client Name] contract term will be for 36 months.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B58+1","v":{"v":46,"d":"46."}},null,"You agree to provide a renewal proposal at least 240 calendar days prior to the contract expiration date.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":47,"d":"47."},null,"[Client Name] has the right to terminate the Agreement, with or without cause and without termination charges, with 60 calendar days written notice and [Client Name] shall be the only party to have termination without cause rights.   ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":48,"d":"48."},null,"Should you terminate for cause, [Client Name] will require 180 calendar days written notice.","Fully Agree / Partial Agree / Disagree"]
[null,{"v":49,"d":"49."},null,"Upon termination, you agree to pay [Client Name] all Manufacturer Payments received within 36 months after the end of the agreement, unless termination results from you terming for cause. The payments will follow the contractual cycle.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":50,"d":"50."},null,"You will be responsible for incurred claims up to the contract termination date, regardless of paid date. The replacement vendor will have the responsibility to pay claims incurred after the termination date of the contact. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":51,"d":"51."},null,"Upon termination of [Client Name]'s contract, you will provide all necessary documentation (i.e. plan set-up), claims files, prescription history, and other data needed for the successful transition of the program to the appointed vendor within a mutually agreed upon reasonable timeframe and at no additional cost to [Client Name].  This includes, but is not limited to, all open mail order, specialty at retail (for open specialty network) and specialty pharmacy refills, prior authorization histories, accumulators used in all plan options and at least twelve months of historical claims data. It is appropriate for the PBM to remove confidential pricing information from this documentation.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Client Audit Rights - General","Format Type","Response","Explanation"]
[null,{"$f":"B64+1","v":{"v":52,"d":"52."}},null,"[Client Name] retains the right to audit such information as reasonably required to determine that your firm is complying with the Agreement, which includes but is not limited to: 100% of pharmacy claims data, with all NCPDP fields from the most current version and release; data management; participating pharmacy contracts with PBM (transparent pricing models only); pharmaceutical manufacturer; Mail Order and Specialty Pharmacy contracts to the extent they exist with other vendor(s); approved and denied utilization management reviews; clinical program outcomes; appeals;  and information related to the reporting and measurement of performance guarantees. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B66+1","v":{"v":53,"d":"53."}},null,"Each and every payment by Client to the vendor, whether representing fees, claims or otherwise, would be subject to audit and reconciliation and no such payment made by Client would constitute a waiver of its right to audit or reconcile. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B67+1","v":{"v":54,"d":"54."}},null,"Audits may be performed annually, at any time (including the months of November, December, January and February) by the auditor as determined by [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":55,"d":"55."},null,"Confirm there would be no limit to the number of claims/discrepancies reviewed by [Client Name]’s auditor and vendor.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":56,"d":"56."},null,"[Client Name] retains the right to audit at no additional charge to them, including no direct pass-through of any data retrieval fees, for up to two years of data. If additional data beyond two years is required for any audit and the data has already been stored, your standard data retrieval fees may be charged.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":57,"d":"57."},null,"[Client Name] retains the right to perform additional audits of similar scope at no additional charge during the year if requested as a follow-up to ensure significant/material errors found in any prior audit have been corrected and are not recurring, or if additional information becomes available to warrant further investigation. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":58,"d":"58."},null,"[Client Name] retains the right to audit more than once per year if the audits are different in scope or for different services.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":59,"d":"59."},null,"[Client Name] retains the right to audit up to twenty four (24) months after the termination of this Agreement.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":60,"d":"60."},null,"You agree to provide reasonable cooperation with requests for information, which includes but is not limited to the timing of the audit, deliverables, data/information requests and your response time to auditor questions during and after the process. Your firm will also provide a response to all \"findings\" it receives within 30 calendar days, or at a later date if mutually determined to be more reasonable based on the number and type of findings. To the extent the auditor has follow up questions to your responses, you will acknowledge receipt of the question with 48 hours and provide a formal response with answers to auditors questions within five business days","Fully Agree / Partial Agree / Disagree"]
[null,{"v":61,"d":"61."},null,"If the audit identifies confirmed errors, you will provide service warranty reports to auditor for every confirmed error.","Fully Agree / Partial Agree / Disagree"]
[null,{"v":62,"d":"62."},null,"You will review the service warranty with auditor and [Client Name] for final approval.  The service warranty will not be irreversible and will not introduce new methodology to offset amounts due.","Fully Agree / Partial Agree / Disagree"]
[null,{"v":63,"d":"63."},null,"Issues identified in an external audit will not be used to offset amounts due back to [Client Name] or to members.","Fully Agree / Partial Agree / Disagree"]
[{"$nulls":3},"[Client Name] shall not be liable for underpayments made as result of PBM error and discovered through the audit.  ","Fully Agree / Partial Agree / Disagree"]
[null,{"$f":"B77+1","v":{"v":64,"d":"64."}},null,"100% of any agreed to adjustments, payments and/or reimbursements determined to be necessary as a result of any examination or audit shall be paid by you within 30 calendar days after both parties agree with the amounts to be reconciled, as applicable, and have executed an appropriate release document closing the audit period, which can include electronic acknowledgement.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":65,"d":"65."},null,"You agree to directly fund an audit allowance of $50,000 per year for audits for [Client Name]. ","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Client Audit Rights - Claim Audits","Format Type","Response","Explanation"]
[null,{"$f":"B80+1","v":{"v":66,"d":"66."}},null,"You agree to provide de-identified claims data in a file layout acceptable to [Client Name] to perform a claims audit.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B82+1","v":{"v":67,"d":"67."}},null,"[Client Name], or a mutually acceptable independent third party retained by [Client Name], may conduct a claims audit annually and such audits shall be limited to the prior two contract years of data.  [Client Name] retains the right to audit beyond the prior two contract years if a claims audit indicates a systemic issue.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Client Audit Rights - Manufacturer Payment Audits","Format Type","Response","Explanation"]
[null,{"$f":"B83+1","v":{"v":68,"d":"68."}},null,"[Client Name], through a mutually agreeable independent third party retained by [Client Name], may conduct an annual Manufacturer Payments audit for the prior two contract years. Such audit shall be limited to a review of no less than ten (10) pharmaceutical company contracts directly related to [Client Name]'s Manufacturer Payments as selected by [Client Name].  Such review of pharmaceutical company contracts may include formulary and Manufacturer Payment provisions and shall be limited to information necessary for validating the accuracy of the Manufacturer Payment amounts remitted to [Client Name] by your firm. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B85+1","v":{"v":69,"d":"69."}},null,"The right to audit Manufacturer Payments extends to any and all agreements with pharmaceutical manufacturers based on the definition of Manufacturer Payments. This includes but is not limited to Rebate agreements and other types of agreements that may require [Client Name] to enroll in certain programs in order to be eligible to receive Manufacturer Payments. ","Fully Agree / Partial Agree / Disagree"]
[{"$nulls":3},"Client Audit Rights - Implementation and Platform Migration Audits","Format Type","Response","Explanation"]
[null,{"$f":"B86+1","v":{"v":70,"d":"70."}},null,"[Client Name] reserves the right to conduct 1) a quality review of the plan designs to be loaded in the claims system(s) prior to implementation (or as soon thereafter as reasonably possible) and 2) a [Client Name]-specific readiness assessment prior to the effective date of the implementation. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B88+1","v":{"v":71,"d":"71."}},null,"You will provide all necessary support to enable [Client Name] to review [Client Name]-selected test claims in a test environment that mirrors the plan information present in the \"live\" claims processing system and access your readiness to implement the business without error.","Fully Agree / Partial Agree / Disagree"]
[null,{"$f":"B89+1","v":{"v":72,"d":"72."}},null,"You will perform all of the tasks necessary to complete the implementation audit(s) (including follow up test claims) at least 10 calendar days prior to the effective date. This assumes that [Client Name] has signed off on the benefit set-up by no later than two and a half months prior to the effective date.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":73,"d":"73."},null,"If you require [Client Name] to change claim platforms, you will allow [Client Name] to conduct a pre-migration readiness assessment and claim audit in order to test that the set up and benefits will be processed correctly.  The cost of the migration audit will be paid for by your organization.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Liability/Regulatory ","Format Type","Response","Explanation"]
[null,{"$f":"B91+1","v":{"v":74,"d":"74."}},null,"Your firm maintains a fidelity bond as required by ERISA.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B93+1","v":{"v":75,"d":"75."}},"a.","Your firm maintains liability coverage with limits not less than $5,000,000 per occurrence and in the aggregate per policy year, with excess liability coverage in the amount not less than $5,000,000 per policy year. Evidence thereof will be furnished to [Client Name] upon request.","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","If not, please explain amount of coverage.","Text"]
[null,{"$f":"B94+1","v":{"v":76,"d":"76."}},null,"Liability insurance covers: medical management decisions","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B96+1","v":{"v":77,"d":"77."}},null,"Liability insurance covers: professional malpractice","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B97+1","v":{"v":78,"d":"78."}},null,"Liability insurance covers: provider contracting","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B98+1","v":{"v":79,"d":"79."}},null,"You agree to indemnify and hold [Client Name] harmless for your negligence or for your failure to perform under the Agreement.  [Client Name] shall not provide any indemnity in favor of your firm. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B99+1","v":{"v":80,"d":"80."}},null,"Please describe any judgment or settlement during the past three years or pending litigation that could result in judgments or settlements in excess of $100,000.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Member Appeals","Format Type","Response","Explanation"]
[null,{"$f":"B100+1","v":{"v":81,"d":"81."}},null,"Upon request by [Client Name], you will perform initial claims review, first level appeals, and second level appeals on behalf of [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B102+1","v":{"v":82,"d":"82."}},null,"You will act as plan fiduciary for all claims and appeals and you will facilitate access to external reviews. ","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Compliance - General","Format Type","Response","Explanation"]
[null,{"$f":"B103+1","v":{"v":83,"d":"83."}},null,"You and your subcontracted vendors will comply with all federally mandated statutes, including ERISA, HIPAA and DOL regulations, as applicable, around member services, complaints, appeals, timeliness of responses and confidentiality.  Any fines related to non-compliance will be your sole responsibility.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B105+1","v":{"v":84,"d":"84."}},null,"You maintain a dedicated individual or staff responsible for resolving HIPAA issues.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B106+1","v":{"v":85,"d":"85."}},null,"You will notify [Client Name] of any and all HIPAA violations committed by your organization. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B107+1","v":{"v":86,"d":"86."}},null,"Your processes, systems and reporting will be in full compliance with federal and state requirements, and compliant with HIPAA for acceptance of claim transactions in the applicable industry standard NCPDP format.  Any fines related to non-compliance will be your sole responsibility.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B108+1","v":{"v":87,"d":"87."}},null,"You will provide support for class action settlements and notify [Client Name] of litigation against your organization.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B109+1","v":{"v":88,"d":"88."}},null,"Offshoring of data storage for [Client Name] is not permitted. ","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Compliance – Privacy and Confidentiality","Format Type","Response","Explanation"]
[null,{"$f":"B110+1","v":{"v":89,"d":"89."}},null,"You agree you will not sell pharmacy data of [Client Name] without prior written approval and notice from [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B112+1","v":{"v":90,"d":"90."}},null,"You will adopt and implement written confidentiality policies and procedures in accordance with applicable law to ensure the confidentiality of member information used for any purpose.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B113+1","v":{"v":91,"d":"91."}},null,"You will not use or further disclose protected health information (PHI) other than as permitted or required by the Business Associate Agreement or as required by law.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":92,"d":"92."},null,"You will use appropriate safeguards to prevent the unauthorized use or disclosure of the PHI. You will report to [Client Name] any unauthorized use or disclosure of the PHI.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":93,"d":"93."},null,"You will mitigate, to the extent practicable, any harmful effect that is known to you of a use or disclosure of PHI by your firm in violation of the requirements of the federal privacy rule.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":94,"d":"94."},null,"You will provide access to PHI in a \"designated record set\" in order to meet the requirements under 45 CFR §164.524. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":95,"d":"95."},null,"You will make any amendment(s) to PHI in a \"designated record set\" pursuant to 45 CFR §164.526.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":96,"d":"96."},null,"You will document such disclosures of PHI and information related to such disclosures as would be required to respond to a request by an individual for an accounting of disclosures of PHI in accordance with 45 CFR §164.528.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":97,"d":"97."},null,"You will (i) implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic PHI that your firm creates, receives, maintains, or transmits, (ii) report to [Client Name] any security incident (within the meaning of 45 CFR §164.304) of which you become aware, and (iii) ensure that any employee of your firm or agent, including any subcontractor to whom you provide PHI received from, or created or received by your firm agrees to implement reasonable and appropriate safeguards to protect such PHI.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Claims Pricing/Processing Logic","Format Type","Response","Explanation"]
[null,{"$f":"B120+1","v":{"v":98,"d":"98."}},null,"What is the name of the adjudication platform you will use for [Client Name]?","Text"]
[null,{"$f":"B122+1","v":{"v":99,"d":"99."}},null,"You will not charge [Client Name] a higher AWP price for any repackaged products assigned a new NDC number by a repackager, a manufacturer, or at mail order, than the original manufacturer/labeler AWP price for the same product (drug name, form, and strength).","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B123+1","v":{"v":100,"d":"100."}},null,"Please indicate if your organization is a licensed repackager of prescription drugs.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":101,"d":"101."},null,"The AWP used to price the claim must be from only one nationally recognized source (e.g. Medispan)","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":102,"d":"102."},null,"Confirm that the source above is currently Medispan","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":103,"d":"103."},null,"Your processes, systems and reporting will be in full compliance with federal and state requirements, and compliant with HIPAA for acceptance of claim transactions in the applicable industry standard NCPDP format.  Any fines related to non-compliance will be your sole responsibility.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":104,"d":"104."},null,"You agree to reimburse providers for all claims incurred on or after the effective date of the contract and in accordance with [Client Name]’s provisions for the submission of direct claims for reimbursement.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":105,"d":"105."},null,"You will accept paper claims from [Client Name] or their associates for proper adjudication and invoicing. ","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Specialty Drugs","Format Type","Response","Explanation"]
[null,{"$f":"B129+1","v":{"v":106,"d":"106."}},null,"You will allow [Client Name] the flexibility to determine if plan members can fill specialty drug prescriptions at retail, and will include pricing for a voluntary option (open retail network/no retail refill limit) and a closed network options (retail lockout or retail refill limit). Please include pricing on the \"Specialty Drugs\" Worksheet.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B131+1","v":{"v":107,"d":"107."}},null,"If [Client Name] elects to use your preferred specialty pharmacy on an exclusive basis, you will not charge for the following: "]
[null,{"$f":"B132+1","v":{"v":108,"d":"108."}},null,"Utilization Management (UM) Programs (Prior Authorizations, Quantity Limits, Step Therapy, etc.)","Fully Agree / Partial Agree / Disagree"]
[null,{"v":109,"d":"109."},null,"Medication Adherence Programs","Fully Agree / Partial Agree / Disagree"]
[null,{"v":110,"d":"110."},null,"You must provide [Client Name] with 60 calendar days advance notice of modifications to the list of Specialty Drugs and corresponding pricing terms.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":111,"d":"111."},null,"In making any such modifications, you will provide [Client Name] with a revised and complete list noting the effective date for each modification and the rationale for the change. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":112,"d":"112."},null,"Additions to your Specialty Drug list will be based on the agreed upon criteria for defining Specialty Drugs, unless approved by [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":113,"d":"113."},null,"Specialty Drugs will be removed from the Specialty Drug List when they no longer meet the definition of a Specialty Drug. Upon removal from the Specialty Drug List, they will be subject to the pricing for the channel in which they are dispensed.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"MAC Pricing","Format Type","Response","Explanation"]
[null,{"$f":"B138+1","v":{"v":114,"d":"114."}},null,"You will employ your most aggressive MAC list prices which must include a minimum of 95% of all generic drugs.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B140+1","v":{"v":115,"d":"115."}},null,"Products will be added to the MAC list no later than 21 days after the products becomes available.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B141+1","v":{"v":116,"d":"116."}},null,"You will apply the same MAC list at specialty, mail order and at retail.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B142+1","v":{"v":117,"d":"117."}},null,"In addition, the MAC pricing schedule at mail (including specialty) will include the same or more favorable pricing (i.e. lower per unit prices) than at retail for every drug.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":118,"d":"118."},null,"Your MAC pricing schedule at mail will include a comparable list of 300-400 low cost generics included in retail generic promotion programs at competitive pricing (i.e. pricing will be equal to or less than $10 for a 90 day supply).","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":119,"d":"119."},null,"Effective MAC discounts cannot be lower than non-MAC AWP discounts.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":120,"d":"120."},null,"Upon request, including for audits, you will provide [Client Name] a copy of the actual MAC list and pricing schedule. ","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Mail Service","Format Type","Response","Explanation"]
[null,{"$f":"B146+1","v":{"v":121,"d":"121."}},null,"Provide the total number of mail order facilities wholly owned and operated by your firm nationwide:","Number"]
[null,{"$f":"B148+1","v":{"v":122,"d":"122."}},null,"Service Statistics for all Mail Order Facilities:"]
[null,null,"a.","Quarterly Dispensing Capacity","Number"]
[null,null,"b.","Number of Prescriptions Dispensed in the Most Recent Quarter","Number"]
[null,null,"c.","Ratio of Pharmacists to Pharmacy Technicians","Text"]
[null,null,"d.","Average Number of Prescriptions Dispensed per Pharmacist per Hour","Number"]
[null,{"$f":"B149+1","v":{"v":123,"d":"123."}},null,"Average turnaround time in the most recent quarter for prescriptions that:"]
[null,null,"a.","Required intervention (in days)","Number"]
[null,null,"b.","Did not require intervention (in days)","Number"]
[null,{"$f":"B154+1","v":{"v":124,"d":"124."}},null,"You will communicate any delays beyond 3 calendar days in the delivery of prescriptions to the member.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B157+1","v":{"v":125,"d":"125."}},null,"In the event of a natural disaster or national emergency, you will continue to fill all prescription requests, proactively obtaining any necessary overrides to facilitate this process, and provide members with expedited delivery to convenient locations.","Yes/No/Explain"]
[null,{"$f":"B158+1","v":{"v":126,"d":"126."}},null,"You will arrange and pay for a short-term retail supply of a delayed or incorrectly processed mail order prescription caused by your organization.  In addition, you agree not to charge members for expedited delivery of the mail order prescription if the prescription delay is caused by your organization.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B159+1","v":{"v":127,"d":"127."}},null,"You will assure that 100% of mail order prescriptions will be imaged and entered when received at mail order (including Specialty prescriptions). You will assure that you will be able to electronically track 100% of all mail order prescriptions (Including Specialty) throughout the filling process, on a timely basis, from the point of prescription is received until it is shipped to the member.","Yes/No/Explain"]
[null,{"v":128,"d":"128."},null,"You assure that, within 24 hours, you will contact prescribers and/or members via a telephone call or email for 100% of incomplete mail order prescriptions (including Specialty) that require additional information.","Yes/No/Explain"]
[null,{"v":129,"d":"129."},null,"You will provide both email and telephone voicemail capabilities to communicate to members their mail order has been received and the date the order has been shipped to members.","Yes/No/Explain"]
[null,{"v":130,"d":"130."},null,"You will have the capability to accept early refill orders and suspend or “queue” these orders in your system until the earliest refill date for processing.","Yes/No/Explain"]
[null,{"v":131,"d":"131."},null,"You will have the capability to accept major credit cards and store credit card number(s) by member account for future mail order prescriptions. You will advise members 30 days in advance of the date their credit card number is going to expire.","Yes/No/Explain"]
[null,{"v":132,"d":"132."},null,"If requested, you will provide members with checks for monies owed to them instead of maintaining credits at your mail facility.","Yes/No/Explain"]
[null,{"v":133,"d":"133."},null,"Can you can support a floor limit of $300 for accepting prescription orders from members without the correct payment? ","Yes/No/Explain"]
[null,{"v":134,"d":"134."},null,"You agree not to bill members for copayments greater than $500 without first contacting them to advise them of their copayment.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":135,"d":"135."},null,"[Client Name] will not be required to pay outstanding balances owed by membership.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":136,"d":"136."},null,"[Client Name] shall have the right to advise you in writing to change the floor limit for all members or just those with unpaid balances after 120 calendar days of dispensing.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":137,"d":"137."},null,"You will not require [Client Name] to mandate use of the mail pharmacies.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":138,"d":"138."},null,"If requested, you will provide a toll-free number to members currently using the incumbent's mail facility for the sole purpose of furnishing the information necessary to transition prescriptions to your firm.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":139,"d":"139."},null,"If a mail package is lost, stolen or not delivered, you will not charge [Client Name] or the plan participant for the Mail Drug.","Fully Agree / Partial Agree / Disagree"]
[null,{"v":140,"d":"140."},null,"If requested, you are willing and able to prorate copays at mail order for claims that are processed for less than or equal to a 60 day supply.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B173+1","v":{"v":141,"d":"141."}},null,"You will not require [Client Name] to pay outstanding balances owed by membership.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Specialty Pharmacy Services","Format Type","Response","Explanation"]
[null,{"$f":"B174+1","v":{"v":142,"d":"142."}},null,"If a Specialty drug package is lost, stolen or not delivered, you will not charge [Client Name] or plan participants for the Specialty Drug.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B176+1","v":{"v":143,"d":"143."}},null,"You will allow [Client Name] the flexibility to determine if participants can fill specialty drug prescriptions at retail, and will include pricing for a voluntary option (open retail network/no retail refill limit) and a closed network option (retail lockout or retail refill limit).","Yes/No/Explain"]
[null,{"$f":"B177+1","v":{"v":144,"d":"144."}},null,"You will not require [Client Name] to pay outstanding balances owed by membership.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Channel Management - Internal Audits","Format Type","Response","Explanation"]
[null,{"$f":"B178+1","v":{"v":145,"d":"145."}},null,"You agree to share 100% of all audit recoveries (retail, mail, and specialty) with [Client Name] on a quarterly basis within 30 calendar days from the close of the contract quarter.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Website/Mobile Application-Capabilities","Format Type","Response","Explanation"]
[null,{"$f":"B180+1","v":{"v":146,"d":"146."}},null,"Vendor will provide a customized page on its website specifically for [Client Name]'s Pharmacy Benefits plan(s).","Yes/No/Explain"]
[null,{"$f":"B182+1","v":{"v":147,"d":"147."}},null,"Vendor will delete content on such page and exclude access to certain features on its website upon Authority request","Yes/No/Explain"]
[null,{"$f":"B183+1","v":{"v":148,"d":"148."}},null,"Participants will have access to a web-based application, which allows them to:"]
[null,null,"a.","Review claim history","Yes/No/Explain"]
[null,null,"b.","Look up claim status in real time","Yes/No/Explain"]
[null,null,"c.","Access pharmacy directories and formulary drug placement","Yes/No/Explain"]
[null,null,"d.","Review prescription drug cost and compare retail drug cost versus mail order drug cost","Yes/No/Explain"]
[null,null,"e.","View benefit plan summaries and plan coverage details","Yes/No/Explain"]
[null,null,"f.","View copies of member's Explanation of Benefits","Yes/No/Explain"]
[null,null,"g.","Check benefit status (deductibles met, amount of benefit remaining, etc.)","Yes/No/Explain"]
[null,null,"h.","Order replacement identification cards","Yes/No/Explain"]
[null,null,"i.","Download printable versions of claim forms","Yes/No/Explain"]
[null,null,"j.","Submit appeals","Yes/No/Explain"]
[null,null,"k.","Submit inquiries to customer service via email","Yes/No/Explain"]
[null,null,"l.","Access educational information","Yes/No/Explain"]
[null,{"$f":"B184+1","v":{"v":149,"d":"149."}},null,"[Client Name] will have access to a web-based application, which allows them to:"]
[null,null,"a.","Add, delete, and update eligible employees, retirees, and dependents in real time","Yes/No/Explain"]
[null,null,"b.","Receive standard reports, including claims experience, utilization data, eligibility, billing history, premium rates","Yes/No/Explain"]
[null,null,"c.","Create customized reports","Yes/No/Explain"]
[null,null,"d.","Correspond with account management and customer service for problem resolution purposed","Yes/No/Explain"]
[null,null,"e.","Review claim history of plan members","Yes/No/Explain"]
[null,null,"f.","Access plan details","Yes/No/Explain"]
[null,null,"g.","Access health topics and medical information","Yes/No/Explain"]
[null,null,"e.","Print and produce ID Cards on behalf of members","Yes/No/Explain"]
[{"$nulls":3},"Systems - General","Format Type","Response","Explanation"]
[null,{"$f":"B197+1","v":{"v":150,"d":"150."}},null,"Claims data are stored online for a minimum of 24 months post adjudication.","Yes/No/Explain"]
[null,{"$f":"B207+1","v":{"v":151,"d":"151."}},null,"You will accept from the incumbent a claims file that you can use to transfer current prior authorization approvals.","Yes/No/Explain"]
[null,{"v":152,"d":"152."},null,"You will accept from the incumbent a refill file that you can use to transfer prescriptions to your mail and specialty pharmacy.","Yes/No/Explain"]
[null,{"v":153,"d":"153."},null,"Will you accept files, electronic or other format, from selected third party vendors (e.g. medical carrier)?","Yes/No/Explain"]
[null,{"v":154,"d":"154."},null,"Please describe your organization's ability to administer ACA-required out of pocket maximums in conjunction with [Client Name]'s medical vendor(s).","Text"]
[null,{"v":155,"d":"155."},null,"How often do you backup claim system data?","Text"]
[null,{"v":156,"d":"156."},null,"Where is your claim system data backed up? For example, offshore, offsite, etc.","Text"]
[{"$nulls":3},"Eligibility","Format Type","Response","Explanation"]
[null,{"$f":"B213+1","v":{"v":157,"d":"157."}},null,"You will accept electronic reporting of enrollment from at least 3 sources for [Client Name].  You must accept various file formats, media and schedules, including daily or even real-time updates at no additional cost.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B215+1","v":{"v":158,"d":"158."}},null,"You will also be capable of supporting manual updates and off-cycle files, which may arise from new acquisitions or strike situations.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":159,"d":"159."},null,"You will provide immediate online real-time manual eligibility updates for urgent requests by [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":160,"d":"160."},null,"You must capture both the 9-digit SSN and the alphanumeric [Client Name] ID in your eligibility system.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":161,"d":"161."},null,"Based on the eligibility files you receive, you will add coverage for members who have joined the plan within 48 hours of receipt of eligibility data.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":162,"d":"162."},null,"Based on the eligibility files you receive, you will update member information (e.g. address changes) within 48 hours of receipt of eligibility data.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":163,"d":"163."},null,"Based on the eligibility files you receive, you will notify appropriate party of eligibility issues within 24 hours of receipt of eligibility data.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"ID Cards","Format Type","Response","Explanation"]
[null,{"$f":"B221+1","v":{"v":164,"d":"164."}},null,"Upon request by [Client Name], you will produce and send prescription drug ID cards for receipt by plan members on or before December 15 prior to the start of each plan year at no additional cost.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B223+1","v":{"v":165,"d":"165."}},null,"You will produce and send prescription drug ID cards for distribution to members within 5 business days or less of receipt of clean eligibility and enrollment files at no additional cost. One ID Card must be sent per individual member and two (2) ID Cards per family.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B224+1","v":{"v":166,"d":"166."}},null,"If related to PBM errors or PBM-initiated changes, you will be responsible for the cost to reproduce ID cards (including priority shipping).","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Data Feeds and Overrides","Format Type","Response","Explanation"]
[null,{"$f":"B225+1","v":{"v":167,"d":"167."}},null,"You will provide periodic electronic data feeds at no additional cost for a minimum of 8 unique data feeds. Each data feed could be unique in nature and range from real time to quarterly transmission intervals.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B227+1","v":{"v":168,"d":"168."}},null,"You have the ability to override retail and mail order prescriptions and provide up to a year's supply for overseas travel/vacation based on [Client Name]'s specific plan provisions.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Reporting","Format Type","Response","Explanation"]
[null,{"$f":"B228+1","v":{"v":169,"d":"169."}},null,"Reporting must be provided to [Client Name] for each individual business group and in aggregate, as defined by [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B230+1","v":{"v":170,"d":"170."}},null,"You will provide quarterly electronic summary reports of claims activity and an annual report analyzing [Client Name]'s prescription drug trend within 15 business days from the end of the reporting period.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":171,"d":"171."},null,"You will provide online access to standard reports so that authorized users and third party representatives can view current reports within a day of user access.  There will be no limit on the number of authorized users allowed at no additional cost.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":172,"d":"172."},null,"You will provide [Client Name] with sophisticated online reporting and modeling (plan design, clinical and financial) tools at no additional cost.  The online reporting tool will include a custom, ad hoc reporting function with access to all data elements captured.  You will provide training and ongoing user support to manage the prescription drug program.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":173,"d":"173."},null,"You will provide reporting for the purposes of monitoring and reconciling financial and performance guarantees.  Sampling techniques and report formats will be defined and mutually agreed upon.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":174,"d":"174."},null,"You will provide prescription drug claim-level detail, all reports, billings, Manufacturer Payment records, performance measures, service concerns and issues, or any other communication, to each business group in a manner mutually agreed upon by both parties and at no additional charge.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":175,"d":"175."},null,"You will track and report the number of prescriptions dispensed and the dollar amount value paid for all copay coupons and patient assistance by product, therapy class, and source of assistance for [Client Name]. ","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Formulary Disruption","Format Type","Response","Explanation"]
[null,{"$f":"B236+1","v":{"v":176,"d":"176."}},null,"Confirm that you have completed the Formulary Disruption Excel file with a tab for [Client Name] (provided as separate attachment). The completed file should be submitted as an attachment with your RFP response. ","Confirmed"]
[]
["II.",null," ","Performance Guarantees","Format Type","Response","Explanation"]
[null,null," ","[Client Name] is seeking performance guarantees to encourage the selected bidder to provide superior service. Your failure to meet the performance guarantee(s) would result in a financial penalty.  Please indicate your concurrence below."]
[null,{"v":1,"d":"1."}," ","Confirm your willingness to offer performance guarantees. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B242+1","v":{"v":2,"d":"2."}}," ","You agree to provide quarterly reports (or other frequency as mutually defined) to [Client Name] to validate compliance with the service and performance guarantees.  Reports will be provided automatically without a written request requirement.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":3,"d":"3."}," ","You agree that [Client Name] can allocate up to 30% of the annual aggregate dollars at risk to individual performance guarantees with no minimum percent applied to any individual guarantee and as long as the total percentage at risk across all ongoing performance guarantees does not exceed 100%. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":4,"d":"4."}," ","[Client Name] will have the flexibility to allocate in writing the total amount at risk among the various performance categories at least 30 calendar days prior to the start of each contract year.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":5,"d":"5."}," ","You agree that the guarantees will be measured and reconciled quarterly within 30 calendar days from the close of the measurement period. Performance guarantees will be audited by [Client Name] on a scheduled basis.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":6,"d":"6."}," ","You agree that penalties will automatically be paid within 75 calendar days of the close of the measurement period without any written request requirement.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":7,"d":"7."}," ","All performance guarantees must be measured and reported on [Client Name]-specific data, not book of business data.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":8,"d":"8."},null,"Should you require [Client Name] to migrate adjudication platforms or service facilities, you will guarantee that [Client Name] will be satisfied with the migration. Satisfaction will be measured as \"satisfied\" or \"not satisfied\". This will be a separate, stand-alone performance guarantee. The amount at risk will be equal to 30% of the combined total amount at risk for all other ongoing performance guarantees.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":9,"d":"9."},null,"You agree to place at least $25 per household at risk annually for ongoing service performance for both [Client Name] Commercial Plan and [Client Name] EGWP Plan separately.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":10,"d":"10."},null,"You will agree to pay any performance guarantees regardless of the status of an executed contract or subsequent amendments.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":11,"d":"11."},null,"You will measure, report and pay implementation guarantees within 120 calendar days after implementation.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":12,"d":"12."},null,"Implementation guarantees:"]
[null,null,"a.","All services are implemented as proposed within specified timeframe and to [Client Name]’s satisfaction - Measured by vendor’s ability to complete all key functions in an accurate and timely manner according to the detailed work plan.  Specifically, [Client Name] may assess a penalty if, three (3) months after the effective date, [Client Name] do not rate vendor’s  performance in implementing the program in an accurate and timely manner an average of 4 or better on a scale of 1 to 5 (5 being the best).","Fully Agree / Partial Agree / Disagree"," "]
[null," ","b.","Benefit Set Up - Guarantee that upon receipt of final sign-off from [Client Name] of plan parameters, you will load, fully test, and release the plan benefit coding information for production within 6 weeks of [Client Name] final sign off. Plan parameters shall include but not be limited to member cost share (e.g. integrated deductible, copayments, maximums, etc.) plan limitations (e.g. days supply, refills allowed, refill-too-soon, etc.), and compensable medications (e.g. covered drugs, exclusions, etc.). ","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"c.","ID Card Production & Mailing - Vendor must produce and distribute Identification (ID) Cards, at no additional cost to [Client Name], within five (5) business days of the receipt and processing of an initial eligibility record and no later than December 15th, 2019.","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"d.","Open Enrollment Support - You will guarantee to provide support for open enrollment meetings.","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"e.","Pre-Implementation Audit - You will guarantee that the pre-implementation audit will be completed, including follow up test claims, at least 15 days prior to the effective date. The penalty amount at risk for this stand-alone performance guarantee is $30,000 per implementation audit.","Fully Agree / Partial Agree / Disagree"," "]
[null,null," ","Year 1: Implementation Service Guarantees - Per Member Total Dollar Amount at Risk","dollar, 0"]
[null,{"$f":"B253+1","v":{"v":13,"d":"13."}}," ","Ongoing Service: The following lists ongoing service performance guarantees"]
[null,{"$f":"B260+1","v":{"v":14,"d":"14."}},"a.","Network access - At least 97% of participants shall reside within 1.5 miles of a network pharmacy for Urban areas, within 3 miles for Suburban areas and within 10 miles for Rural areas.","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Annually","Yes / No Explain"]
[null,{"$f":"B261+1","v":{"v":15,"d":"15."}},"a.","Network stability - You guarantee that there will not be greater than 5% total net loss of pharmacies in your broadest network for the duration of the contract provided that pharmacies remain in business, are not involved in fraudulent activities, or perform any actions that warrant removal from the network. Total net loss will be calculated as the total network pharmacies at the beginning of the contract term plus all new network pharmacies added during the life of the contract, less any network pharmacies terminated during the life of the contract (except for the termination conditions noted) divided by the total network pharmacies at the start of the contract term. This guarantee does not apply to [Client Name] requested pharmacy network changes for removal of pharmacies from the network. ","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Annually","Yes / No Explain"]
[null,{"$f":"B263+1","v":{"v":16,"d":"16."}},"a.","Overall Account Satisfaction - At least a 4.0 on a scale of 1 to 5 (with 5 being the best).\n\nDesignated members of [Client Name]'s staff will complete an annual report card to evaluate vendor account team, or the overall service performance. Guarantee will be measured using a mutually agreed upon survey and tool. Scorings can be pass/fail or based on a rating such as: \n\n5 = Outstanding\n4 = Commendable\n3 = Satisfactory\n2 = Needs improvement\n1 = Unacceptable\n\nThe account team is typically scored on:  \nTechnical knowledge\nAccessibility and Responsiveness\nInterpersonal Skills\nCommunication Skills\nOverall Performance\n\nVendor’s overall service may be scored on such dimensions as:\n- Proactiveness in communication of issues and recommendations\n- Timeliness and accuracy of reports\n- Responsiveness to day to day needs\n- Adequacy of staffing and training\n- Ability to meet performance standards\n\nPBM shall be responsible for survey design, data collection, analysis and all costs associated with conducting the surveys. ","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Annually","Yes / No Explain"]
[null,null,"c. ","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B265+1","v":{"v":17,"d":"17."}},"a.","Account Management Open Issue Log - The account team will maintain an open issues log and share it with [Client Name] on at least a monthly basis. The account team will be available to meet with [Client Name] on a weekly basis to discuss the status report. ","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c. ","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B268+1","v":{"v":18,"d":"18."}},"a.","Account Management Responsiveness - Account team will respond to Client requests within 2 Business Days and when applicable provide any requested modeling turnaround time within the 2 Business Days.  Any issues requiring service warranty escalation and review will be submitted for analysis in the service warranty process within 5 Business Days.","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c. ","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B271+1","v":{"v":19,"d":"19."}},"a.","Account management team continuity - The account team (including the strategic account executive, account manager, and clinical account manager) will not change over the duration of the contract term except for promotion or termination of employment, unless mutually agreed to by [Client Name] and you. ","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B274+1","v":{"v":20,"d":"20."}},"a.","Annual benefit plan review - Vendor will maintain a documented quality control and pre-implementation document and provide it to [Client Name] for review and approval at least 15 days prior to implementation of any benefit or program change.\n\nVendor will conduct an annual benefit plan review by November 15 to coincide with [Client Name]’s plan implementation of benefit plan modifications. If such reviews identify any systems set in error by Vendor, then Vendor will reconcile such errors on a dollar for dollar basis, and shall pay the [Client Name]’s penalty amount at risk.","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Annually","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B277+1","v":{"v":21,"d":"21."}},"a.","Timeliness of Standard Performance Reports - Vendor will make available online their Standard Financial Performance Package Report within fifteen (15) business days of the end of the billing cycled that includes the last calendar day of the reporting month, for monthly reports, and thirty (30) business days of the end of the billing cycle that includes the last calendar day of the reporting quarter for quarterly reports.","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B280+1","v":{"v":22,"d":"22."}},"a.","Timeliness of Billing Reports - Vendor will mail Billing Reports, providing [Client Name] with detailed claim activity, within five (5) business days of the end of each claim cycle report period.","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B283+1","v":{"v":23,"d":"23."}},"a.","Management Report Timeliness - Standard quarterly management reports shall be available within 45 calendar days after the end of each contract quarter.","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B286+1","v":{"v":24,"d":"24."}},"a.","Fraud, Waste, and Abuse Reporting - Vendor will provide quarterly reports to [Client Name] addressing potential fraud, waste, and abuse within 30 days of the end of the quarter and your staff will conduct quarterly meetings to review these reports. Quarterly reports will be at a mutually acceptable time. ","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B289+1","v":{"v":25,"d":"25."}},"a.","Claims Compliance Format - Vendor will guarantee that 99% of the prescription drug claims submitted on behalf of eligible participant will be submitted in a HIPAA-compliant format.","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B292+1","v":{"v":26,"d":"26."}},"a.","Claims Processing Accuracy (Retail, Mail, and Specialty) -  >99.9% Retail >99.99% Mail >99.99% Specialty \nBased on vendor’s internal quality review. Calculated as all claims audited and found to be without adjudication error of any kind (i.e. any claim processing inaccuracy that results in an incorrect charge to the client or its plan members), divided by all claims audited.","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c. ","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B295+1","v":{"v":27,"d":"27."}},"a.","Eligibility Processing Accuracy - PBM guarantees that 100% of usable, error-free eligibility files received by your organization will be loaded without error. This will be measured as the number of eligibility files audited and found to be processed and loaded without error divided by the total number of eligibility files received","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B298+1","v":{"v":28,"d":"28."}},"a.","Eligibility Updates - Vendor will process any processable maintenance eligibility transactions received in a mutually agreed upon format within two (2) business days of receipt (if received before 12:00 p.m. E.T. on any business day).","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B301+1","v":{"v":29,"d":"29."}},"a.","Retail direct reimbursement claims timeliness of processing and response - At least 100% of retail direct reimbursement claims processed for payment or rejected and responded to within five (5) business days (not an average).","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B304+1","v":{"v":30,"d":"30."}},"a.","Mail Order Turnaround Time for Prescription Drugs Requiring No Intervention (Non-Protocol or Clean Rxs) - 100% shipped within 2 business days (not an average). This guarantee is measured in business days from the date the prescription drug claim is received by the vendor (either via paper, phone, fax or Internet) to the date it is shipped. ","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B307+1","v":{"v":31,"d":"31."}},"a.","Mail Order Turnaround Time for Prescription Drugs Requiring Administrative/Clinical Intervention (Protocol Rxs) - 100% of prescriptions requiring administrative/clinical intervention will be shipped within 4 business days (not an average). This guarantee is measured in business days from the date the prescription drug claim is received by the vendor (either via paper, phone, fax or Internet) to the date it is shipped. ","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B310+1","v":{"v":32,"d":"32."}},"a.","Mail Order Dispensing Accuracy - At least 99.996% or greater.\nDispensing Accuracy Rate means (i) the number of all mail order prescriptions dispensed in a contract quarter less the number of those prescriptions dispensed in such contract quarter which are reported and verified as having been dispensed with the incorrect drug, strength, dosage form, patient name, directions, packing non-conformance, or address causing medication to be delivered incorrectly divided by (ii) the number of all mail order prescriptions dispensed in such contract quarter.","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Annually","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B313+1","v":{"v":33,"d":"33."}},"a.","Phone Average Speed of Answer - 100% of calls will be answered by a live voice within an average of 25 seconds or less. The amount of time that elapses between the time a call is received into a member service queue to the time the phone is answered by a Customer Service Representative (CSR). Measurement excludes calls routed to IVR. Inbound calls to the PBM’s toll-free customer service lines shall be answered within an average time of thirty (30) seconds or less.  Measurement excludes calls routed to an IVR.  ","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B316+1","v":{"v":34,"d":"34."}},"a.","Phone Abandonment Rate - 2% or less of calls will be abandoned (i.e. caller hangs up) before call is answered by CSR. Calculated as the number of calls that are not answered divided by the number of calls received. Measurement excludes calls routed to IVR and includes calls abandoned within the first 20 seconds.","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B319+1","v":{"v":35,"d":"35."}},"a.","First Call Resolution - At least 98% of all calls will be resolved at first point of contact. Calculated as the total calls to vendor minus total number of unresolved calls divided by the total number of calls received. Measurement excludes calls routed to IVR.","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B322+1","v":{"v":36,"d":"36."}},"a.","Prior Approvals - You will promptly review and respond to requests for prior approval for specific drugs following receipt of all required information, but in any case will respond in no more than 2 business days (no average) once all clinical information is received.","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B325+1","v":{"v":37,"d":"37."}},"a.","Plan Administration Turnaround Time - PBM guarantees that Client’s standard Plan design changes will be implemented within 10 calendar days.  Plan design changes during November, December and January, as well as complex Plan design changes, will be implemented by a mutually agreed upon date.  ","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B328+1","v":{"v":38,"d":"38."}},"a.","Member Satisfaction with Retail, Mail order, and Specialty Program - At least 95% satisfaction. Measured as the number of satisfied to highly satisfied survey ratings divided by the total number of survey responses. Survey tool and survey methodology will be mutually agreed upon by vendor and Client","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B331+1","v":{"v":39,"d":"39."}},"a.","ID Card Mailing - You will issue at least 99% of all new member ID cards within four business days and 100% within seven business days following your receipt and update of a processable eligibility tape or transmission identifying the applicable Eligible Participant(s).","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B334+1","v":{"v":40,"d":"40."}},"a.","Written Inquiry (paper or electronic mail) response time - 98% within five business days (not an average) and 100% within seven business days (not an average). Response time for all written inquiries will be based on the number of calendar days subtracting the date received by vendor from the date the response was sent.","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B337+1","v":{"v":41,"d":"41."}},"a.","Performance Guarantee Reporting - PBM guarantees it will provide reporting to the [Client Name] demonstrating compliance to these performance guarantees within 45 calendar days of the end of the measurement period and any penalties due will be credited within 75 calendar days of the end of the measurement period. ","Fully Agree / Partial Agree / Disagree"," "]
[null,null,"b.","Will Measure and Report Quarterly","Yes / No Explain"]
[null,null,"c.","Measurement will be based on client-specific data","Yes / No Explain"]
[null,{"$f":"B340+1","v":{"v":42,"d":"42."}},null,"Year 1: Total Amount at Risk Per Member (Ongoing Service Guarantees not including Platform Migration Guarantee)","dollar, 0"]
[null,{"$f":"B343+1","v":{"v":43,"d":"43."}},null,"Year 1: Aggregate Amount at Risk Per Member (Sum of Year 1 Implementation and Ongoing Service Guarantees not including Platform Migration Guarantee)","dollar, 0"]
[null,{"$f":"B344+1","v":{"v":44,"d":"44."}},null,"Year 2: Aggregate Amount at Risk Per Member (Ongoing Service Guarantees not including Platform Migration Guarantee)","dollar, 0"]
[null,{"$f":"B345+1","v":{"v":45,"d":"45."}},null,"Year 3: Aggregate Amount at Risk Per Member (Ongoing Guarantees not including Platform Migration Guarantee)","dollar, 0"]

{"sheet":"Customer Service Questionnaire","index":2,"n_rows":53,"n_cols":7,"rows_kept":53,"hidden":true,"merged":[[2,3,2,4],[5,3,5,6]]}
[]
[]
[{"$nulls":3},{"$f":"Questionnaire!D3","v":"Request for PBM Proposal (RFP) for Arlington County Government"}]
[{"$nulls":3},"Customer Service"]
[]
[{"$nulls":3},"To Vendor:  Use Column G to provide a brief explanation. However if the length of the explanation is greater than 50 characters including spaces, you must use the \"Explanation\" worksheet to provide your detail explanation. Please note, your explanations must be limited to 400 characters or less"]
[]
[{"$nulls":3},"Customer Service and Account Management Questionnaire","Format Type","Response","Explanation"]
["I.",null,null,"Customer Service"]
[null,{"v":1,"d":"1."},null,"You will provide [Client Name] with a dedicated toll-free telephone line with live caller support through a designated member service team (including member service representatives and supervisors) available 24 hours a day, seven days a week, 365 days a year. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B10+1","v":{"v":2,"d":"2."}},null,"You shall also provide telephonic emergency pharmacist services twenty-four (24) hours a day, seven (7) days a week, 365 days a year. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":3,"d":"3."},null,"You will support [Client Name] with US-based call center support only. No off-shoring of call center support is allowed.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":4,"d":"4."},null,"[Client Name] reserve the right to review the on-line scripting for call center representatives prior to the implementation/effective date.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":5,"d":"5."},null,"The member service teams will be knowledgeable of the specific pharmacy benefit programs of [Client Name] to respond to member questions. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":6,"d":"6."},null,"You (or your designee at your expense) will perform a client-specific (versus book of business) member satisfaction survey at least once annually. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":7,"d":"7."},null,"Member/provider service representatives will have access to a pharmacist in the event the call requires the attention of a clinician.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":8,"d":"8."},null,"You will make available a geo-access and customized pharmacy provider locator service via customer service.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":9,"d":"9."},null,"You will allow [Client Name] to customize the phone tree accessed by their members.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":10,"d":"10."},null,"You will notify [Client Name] of any customer service disruptions lasting more than an hour. Customer service disruptions include but are not limited to unexpected technical issues, scheduled maintenance, or known unknown risks (e.g., weather-related)","Fully Agree / Partial Agree / Disagree"]
[null,{"v":11,"d":"11."},null,"Your customer service representatives will offer the name and phone number of the \"manager/supervisor\" for escalated issues if requested.","Fully Agree / Partial Agree / Disagree"]
[null,{"v":12,"d":"12."},null,"How many and which languages does your call center support? ","Text"]
[null,{"v":13,"d":"13."},null,"Your customer service representatives have access to an application that allows them to run \"test claims\" (to obtain prices) for members requesting this information.","Fully Agree / Partial Agree / Disagree"]
[null,{"v":14,"d":"14."},null,"Do you currently provide versions of your member site in multiple languages that offer the same functionality as the English version?","Fully Agree / Partial Agree / Disagree"]
[null,{"v":15,"d":"15."},null,"Your online web-based member service capabilities must be able to support the following customer service functions: mail service refill/order tracking capabilities, pharmacy locator, formulary support, drug pricing tool, requests for explanation of benefits (EOB), appeal forms, and direct member reimbursement forms.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":16,"d":"16."},null,"You will hold call calibration meetings, where [Client Name] listen to selected member calls and provide feedback.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":17,"d":"17."},null,"You will provide a telephone tracking system for [Client Name]'s specific member/provider telephone inquiries and will provide monthly reports of call volume, first call resolution rates, average wait times and abandonment rates.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":18,"d":"18."},null,"You will record 100% of all member calls.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":19,"d":"19."},null,"You shall open telephone lines as early as 1 month prior to open enrollment and in following contract years will add additional staff during [Client Name]'s open enrollment to answer calls from prospective members.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":20,"d":"20."},null,"You will provide all member services and provider service staff with training on [Client Name]'s program at least 10 calendar days prior to opening telephone lines and 30 calendar days before launch date, respectively.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":21,"d":"21."},null,"This training will recur as needed for newly assigned staff and/or in the event of benefit modification.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":22,"d":"22."},null,"You will provide training materials to [Client Name] for review and approval prior to execution of training","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":23,"d":"23."},null,"Confirm that you have provided a separate attachment with sample website screenshots in an electronic file. Please name the file [Your Organization Name]_Sample Website Screenshots.","Confirmed"]
[null,{"v":24,"d":"24."},null,"Confirm that you have provided a separate attachment with smartphone screenshots in an electronic file. Please name the file [Your Organization Name]_Sample Smart Phone Screenshots.","Confirmed"]
[{"$nulls":3},"Implementation Support ","Format Type","Response","Explanation"]
[null,{"$f":"B33+1","v":{"v":25,"d":"25."}},null,"You will provide a designated implementation team for [Client Name] that will include an implementation manager and the account manager or account executive. Implementation team members will provide assistance during the transition/implementation process and participate in regularly scheduled status meetings (at least weekly) with [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B35+1","v":{"v":26,"d":"26."}},null,"You will maintain an implementation project plan and issue log documenting all implementation issues, actions, due dates and responsible parties.  Implementations must be supported year round as required by [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B36+1","v":{"v":27,"d":"27."}},null,"You agree to accept and load all open mail order and specialty pharmacy refills, prior authorization histories and at least six months of historical claims data at no additional cost to [Client Name] during the implementation process.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B37+1","v":{"v":28,"d":"28."}},null,"You will offer alternative approaches to minimize the need for members to request new prescriptions during transition.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Account Management","Format Type","Response","Explanation"]
[null,{"$f":"B38+1","v":{"v":29,"d":"29."}},null,"You will provide a designated, experienced account management team to [Client Name] including a daily, operational account manager and named backup.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B40+1","v":{"v":30,"d":"30."}},null,"You will provide a designated, experienced account management team to [Client Name] including an account director/executive and named backup.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":31,"d":"31."},null,"You will provide a designated, experienced account management team to [Client Name] including an eligibility specialist, as required.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":32,"d":"32."},null,"You will provide a designated, experienced account management team to [Client Name] including a financial analyst dedicated to conducting quarterly business reviews of network adequacy, service levels, plan performance and strategic trend analysis.  At [Client Name]'s request, this person will provide ad hoc financial reports. The financial analyst shall also focus on methods to manage costs, interpret trends in the plans and marketplace. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":33,"d":"33."},null,"You will provide a designated, experienced account management team to [Client Name] including a clinical manager/licensed pharmacist to support pharmacy program policy, plan design and clinical management programs.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":34,"d":"34."},null,"You will provide a designated, experienced account management team to [Client Name] including a communications specialist to customize standard member communications and developing custom member communications that reflect [Client Name]’s preferred style.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":35,"d":"35."},null,"Please confirm you have completed the tab \"Account Team\" which details the team you are proposing for [Client Name], including a management level resource with oversight and accountability for the [Client Name] and an executive sponsor for the [Client Name]. For each account team member, include years of experience servicing similar types of organizations.","Confirmed"]
[null,{"v":36,"d":"36."},null,"Will the team be dedicated or designated to the [Client Name]? Explain how you determined the proposed staffing levels.","Text"]
[null,{"v":37,"d":"37."},null,"You will coordinate with [Client Name] for management of the SPD, SMM and SBC.  This includes, but is not limited to, reviewing changes to the SPD, SMM and SBC, making sure that you administer the plan as reflected in the SPD and communicating any plan/clinical program changes to [Client Name] for inclusion in the SPD, SMM and SBC.","Confirmed"]
[null,{"v":38,"d":"38."},null,"You will measure [Client Name]'s satisfaction with the account management team (account executive, clinical account manager, account manager, financial analyst) at least annually.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":39,"d":"39."},null,"You will allow [Client Name] to interview and approve any proposed replacements to the account team.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":40,"d":"40."},null,"The account executive or account manager will participate on [Client Name]'s implementation team.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":41,"d":"41."},null,"You shall support annual employee meetings and benefit fairs as required by [Client Name]. This may include sending PBM staff and/or materials to meetings and benefit fairs, as determined by [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":42,"d":"42."},null,"Describe any initiatives within your firm that you believe would be of interest and value to [Client Name]. For each initiative, include:                                                                 \n- A summary description of the initiative;                                                                                      \n- Whether any portion has been implemented (i.e. a current pilot program);                             \n- Planned timing of roll out;                                                                                                                    \n- Any limitations (e.g. group size, geography);                                                               \n- Projected fee levels and savings","Text"]

{"sheet":"Financial Questionnaire","index":3,"n_rows":177,"n_cols":7,"rows_kept":177,"merged":[[2,3,2,4],[3,3,3,4],[6,3,6,6]]}
[]
[]
[{"$nulls":3},{"$f":"Questionnaire!D3","v":"Request for PBM Proposal (RFP) for Arlington County Government"}]
[{"$nulls":3},"RFP No. 21-HRD-RFP-141 - Pharmacy Plan"]
[{"$nulls":3},"Financial"]
[]
[{"$nulls":3},"To Vendor:  Use Column G to provide a brief explanation. However if the length of the explanation is greater than 50 characters including spaces, you must use the \"Explanation\" worksheet to provide your detail explanation. Please note, your explanations must be limited to 400 characters or less"]
[]
["I.",null," ","Financial Questionnaire","Format Type","Response","Explanation"]
[{"$nulls":3},"Definitions"]
[null,{"v":1,"d":"1."},null,"\"340B Claim(s)\" means a Claim that receives 340B program pricing and is dispensed from a 340B program covered entity.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B11+1","v":{"v":2,"d":"2."}},null,"\"Administrative Fee(s)\" means the fee paid to PBM for agreed upon PBM services.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B12+1","v":{"v":3,"d":"3."}},null,"“Average Wholesale Price” or “AWP” means the average wholesale unit price for a product on the date the product is dispensed as set forth from the most current pricing information provided to PBM by Medi-Span Prescription Guide including supplements multiplied by the Fill Quantity. For determining the AWP, the actual 11-digit NDC package size dispensed on the date the product is dispensed will be used.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":4,"d":"4."},null,"\"Authorized Generics\" means an approved Brand Drug that is marketed without the brand name on its label. Other than the fact that it does not have the brand name on its label, it is the exact same drug product as the branded product. An Authorized Generic may be marketed by the brand name drug company, or another company with the brand company’s permission. Authorized Generics will be identified using MediSpan Multisource Code of “M” (co-branded product) with a Brand Drug Code of “B” (Branded Generic Name) or “G” (generic). ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":5,"d":"5."},null,"\"Biosimilar Drug\" means a type of biological product that is licensed (approved) by the FDA that is highly similar to a biological product already approved by the FDA not withstanding minor differences in clinically inactive components; and that there are no clinically meaningful differences between the biologic product and the reference product in terms of the safety, purity, and potency of the product.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":6,"d":"6."},null,"\"Brand Drug\" or \"Brand Product\" means an FDA approved drug, or a drug that is designated by FDA a DESI (Drug Efficacy Study Implementation) drug, or product, which is manufactured and distributed by an innovator drug company, or its licensee , set forth in Medi-Span’s National Drug Data File (MS) as a brand drug identified by all of the products meeting at least one of the following criteria:\n\n1. Brand Name code of “T” (trademarked) and Multisource Code “M” \n2. Brand Name code of “B” or “T” and Multisource Code of “N”\n3. Brand Name code of “B” or “T” and Multisource Code “O” and a DAW code of 0, 1, 2, 7, 8, or 9 \n\nFor avoidance of doubt, Brand Drugs may include, but are not limited to: vaccines, supplies, medical devices, kits, diabetic supplies, OTCs  and test strips. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":7,"d":"7."},null,"\"Claim(s)\" means a claim processed through PBM’s on-line claims adjudication system or otherwise transmitted or processed in accordance with the terms of this Agreement in connection with Arlington County Government’s plan, including claims in which the Member pays the full cost and Arlington County Government has no cost liability, but does not include claims that rejected due to system edits designed to enforce Arlington County Government’s pharmacy benefit programs nor reversed from the claim payment system.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":8,"d":"8."},null,"\"Client-Owned Pharmacy\" means a Retail Pharmacy that is owned, licensed, operated or identified by Arlington County Government, where the pharmacy is operating on Arlington County Government’s campus for use by its Members. Client-Owned Pharmacy can be identified by NCPDP XXXXXX.  ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":9,"d":"9."},null,"“Compound Drug” shall mean a mixture of two (2) or more ingredients when at least one of the ingredients in the preparation is an FDA approved federal legend drug, and the mixture of which is not otherwise generally available in an equivalent commercial form or strength in response to a physician’s prescription to create a medication tailored to the specialized medically required need for an individual patient. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":10,"d":"10."},null,"\"Coordination of Benefits or COB Claim(s)\" means a Claim where more than one health insurance program, policy, or other form of coverage, including governmental or non-governmental coverage, has payment and a primary and secondary carrier liability is determined. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":11,"d":"11."},null,"\"Data Fees\" means fees received by PBM for the sale of aggregate blinded data to a limited group of third parties including nationally recognized data integration firms.  ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":12,"d":"12."},null,"\"Days of Supply\" means the number of days supplied for a Claim as submitted to PBM by the dispensing Pharmacy.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":13,"d":"13."},null,"\"Dispensing Fee(s)\" means the fee paid to the dispensing pharmacy for the professional service of filling a claim and is equal to the Total Claim Cost less the Ingredient Cost and less the applicable sales tax. U&C Claims will always have a zero dollar Dispensing Fee.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":14,"d":"14."},null,"\"Fill Quantity\" means the number of units dispensed for a Claim as submitted to PBM by the dispensing Pharmacy.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":15,"d":"15."},null,"\"Formulary Rebate(s)\" or \"Access Rebate(s)\" means a rebate collected by PBM from pharmaceutical companies for products where the implemented formulary encourages Member use over other products and is attributable to Client’s specific utilization.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":16,"d":"16."},null,"\"Generic Drug\" or \"Generic Product\" means an FDA approved drug, or a drug that is designated by FDA a DESI (Drug Efficacy Study Implementation) drug, or product, that is therapeutically equivalent to other pharmaceutically equivalent products, as set forth in Medi-Span’s National Drug Data File (MS) as a generic drug identified by all products meeting at least one of the following criteria:\n\n1. Brand Name code of “G” (generic) for all Multisource Codes (M, N, O, and Y)\n2. Multisource Code of “Y” (generic)\n3. “O” (originator brand) with a DAW code of 3, 4, 5, or 6.  \n\n For avoidance of doubt, Generic Drugs may include, but are not limited to: vaccines, supplies, medical devices, kits, diabetic supplies, OTCs  and test strips. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":17,"d":"17."},null,"\"Home Infusion Pharmacy or HIF\" means a Retail Pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients with acute or chronic conditions generally pertaining to parenteral administration of drugs, biologics and nutritional formulae administered through catheters and/or needles in home and alternate sites. These Pharmacies are identified by a National Council for Prescription Drug Program’s (NCPDP’s) dispenser type code of 6.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":18,"d":"18."},null,"\"House Generics\" means a Brand Drug submitted with a Dispense As Written (DAW) 5 code in place of the generic equivalent and where the pharmacy is reimbursed at a Generic Drug rate, including MAC, as applicable. For reconciliation of the Generic Drug discount guarantees, the AWP of House Generic drugs shall be the per unit AWP of the generic equivalent and not the AWP of the Brand Drug. House Generics will be identified using MediSpan Multisource Code M, N, O, or Y and a Dispense as Written (DAW) code of 5.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":19,"d":"19."},null,"\"Incentive Rebate(s)\" means a rebate collected by PBM from pharmaceutical companies for products where restrictions on competitor products have been put in place and is attributable to Client’s specific utilization.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":20,"d":"20."},null,"\"Indian Health Services, Tribal or Urban Indian Health or I/T/U\" means a Retail Pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization as defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. These Pharmacies are identified by a National Council for Prescription Drug Program’s (NCPDP’s) dispenser type code of 8.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":21,"d":"21."},null,"“Inflation Protection Payments” means  payments received by your firm (if any; and whether separately made or in the form of increased Rebates) from a pharmaceutical manufacturer for the purpose of adjusting for year over year price inflation of the manufacturer’s price to your firm for prescriptions on which Rebates are paid; in accordance with and pursuant to applicable pharmaceutical manufacturer agreements.  ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":22,"d":"22."},null,"\"Ingredient Cost\" means the discounted AWP cost of a claim and is equal to the Total Claim Cost less the applicable Dispensing Fee and less the applicable sales tax.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":23,"d":"23."},null,"\"Limited Distribution Specialty Drugs\" are those Specialty Drugs only available through select pharmacy providers as determined by the drug manufacturer.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":24,"d":"24."},null,"\"Long Term Care Pharmacy or LTC\" means a Retail Pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally disabled, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. These Pharmacies are identified by a National Council for Prescription Drug Program’s (NCPDP’s) dispenser type code of 4.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":25,"d":"25."},null,"\"Mail Order Pharmacy\" means a Pharmacy that is owned, licensed, operated or identified by PBM, where Claims are filled and delivered through the mail to Members.  ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":26,"d":"26."},null,"\"Manufacturer Administrative Fee(s)\" or \"Rebate Administrative Fee(s)\" means fees for services rendered to pharmaceutical manufacturers in relation to administrative duties in connection with aggregation, allocating, collecting, and invoicing for rebates.  ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":27,"d":"27."},null,"\"Manufacturer Payments\" includes Rebates, Manufacturer Administrative Fees, Inflation Protection Payments, and Data Fees, but excludes Other Pharma Revenue. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B37+1","v":{"v":28,"d":"28."}},null,"\"Market Share Rebate(s)\" or \"Performance Rebate(s)\" means a rebate collected by PBM from pharmaceutical companies that is based on the utilization of a rebated product compared to the utilization of competitor products and is attributable to Client’s specific utilization.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":29,"d":"29."},null,"\"Maximum Allowable Cost or MAC\" means the price that has been established by PBM for a Brand Drug or Generic Drug included on its MAC drug list, which may be amended from time to time by PBM. A copy of such MAC drug list shall be provided to Arlington County Government, prior to execution and upon Arlington County Government’s reasonable request, and shall be updated by PBM in its sole discretion. The same MAC list will be used for a Retail Pharmacy, a Mail Order Pharmacy, and a Specialty Pharmacy (i.e. same number of drugs, same drugs). The Mail Order Pharmacy and Specialty Pharmacy MAC list price points for individual drugs/generic class numbers shall be equal to or less (i.e., more deeply discounted) than the Retail Pharmacy MAC price points for the same drugs/generic class numbers.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":30,"d":"30."},null,"\"Member(s)\" means each individual who Arlington County Government identifies in the eligibility file to be eligible for prescription drug benefits under its plan.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":31,"d":"31."},null,"\"Member Cost Share\" means the amount which a Member is required to pay for a Claim in accordance with Arlington County Government’s benefit design, which may be a deductible, a percentage of the Claim price, a fixed amount and/or other charge or penalty.  ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":32,"d":"32."},null,"\"Member-Submitted Claim(s) or Paper Claim(s)\" means a Claim submitted to PBM for reimbursement by a Member for which the Member paid cash. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":33,"d":"33."},null,"\"Military Pharmacy\" means a Retail Pharmacy whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to uniformed services beneficiaries. These pharmacies may be associated with Department of Defense or U.S. Coast Guard clinic, Department of Defense hospital or freestanding. Usually associated with outpatient services. Associated with taxonomy code “332000000X”. These Pharmacies are identified by a National Council for Prescription Drug Program’s (NCPDP’s) dispenser type code of 17.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":34,"d":"34."},null,"\"Onsite Pharmacy\" means a Retail Pharmacy that is owned, licensed, operated or identified by PBM, where the Pharmacy is operating on Arlington County Government’s campus for use by its Members. Onsite Pharmacy can be identified by NCPDP XXXXXX .","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":35,"d":"35."},null,"”Open Formulary” will be defined as a listing of all FDA-approved prescription drugs. No FDA-approved prescription drugs will be excluded from an open formulary without the express written consent of Arlington County Government.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":36,"d":"36."},null,"\"Other Pharma Revenue\" means Pharmacy Purchase Discounts (i.e.. Mail Order Volume Discounts), Transmission Fees, and Specialty Service Fees.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":37,"d":"37."},null,"\"Over-the-Counter\" or \"OTC\" Claim(s) means a Claim for items that do not require a prescription for a Member to purchase that Arlington County Government has chosen to or has been required to include as covered products under the prescription drug benefit. OTC Claims are defined as having an ‘O’ or 'P\" indication in Medi-Span’s Rx-OTC Indicator Code.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":38,"d":"38."},null,"\"Pass Through Pricing” means a pricing structure comprised of fixed guaranteed discounts at PBM's Mail Order Pharmacy and Specialty Pharmacy and a full pass through of PBM's contracted rates with Participating Pharmacies and pharmaceutical manufacturers. In this arrangement, PBM retains the difference between mail service and specialty acquisition costs and the amounts guaranteed to Arlington County Government. PBM passes through (1) its contracted rates with Participating Pharmacies and (2) all Manufacturer Payments it receives from pharmaceutical manufacturers in excess of the Arlington County Government’s guaranteed Manufacturer Payments. The amount billed to Arlington County Government at Retail Pharmacies will be equal to the amount paid by PBM to the Retail Pharmacies. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":39,"d":"39."},null,"\"Pharmacy\" means a pharmacy that participates in the PBM network pursuant to an agreement between the pharmacy and PBM. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":40,"d":"40."},null,"\"Pharmacy Purchase Discount(s)\" or \"Mail Order Volume Discount(s)\" means discounts, paid at time of purchase, or retrospectively, received by PBM or its affiliates from pharmaceutical manufacturers, which are attributable to or based on products purchased by PBM affiliated dispensing pharmacies.  ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":41,"d":"41."},null,"\"Rebates\" means the return of partial payments from a pharmaceutical manufacturer, pursuant to the terms of a rebate contract, negotiated by a PBM on behalf of all plan sponsors, and directly attributable to the utilization of certain prescriptions by plan sponsor's members. Rebates shall include Formulary Rebates (i.e. Access Rebates), Market Share Rebates (i.e. Performance Rebates), Incentive Rebates and Value-Based Rebates.  ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":42,"d":"42."},null,"\"Retail Pharmacy\" means a Pharmacy that is not a Mail Order Pharmacy nor a Specialty Pharmacy. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":43,"d":"43."},null,"\"Sales Tax\" means a tax imposed by local, state, or federal government at the point of sale on a Claim that is collected by the dispensing Pharmacy","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":44,"d":"44."},null,"\"Single Source Generic(s) or SSG(s)\" are Generic Drugs that are manufactured by one generic drug manufacturing company. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":45,"d":"45."},null,"“Specialty Drugs” are defined as certain pharmaceuticals, biotech or biological drugs, that are used in the management of complex or genetic disease that meet at least one of the first two criteria (a and b) and all of the last three criteria (c-e) in order to be placed on your specialty drug list:                                                \na)      Produced through DNA technology or biological processes\nb)      Targets a complex disease caused by a combination of genetic, environmental and lifestyle factors                                                                                           \nc)      Unique handling, distribution, and/or administration requirements such that the drug cannot be safely dispensed from a mail service pharmacy                                                                   \nd)      Requires a customized medication management program that includes medication use review, patient training, coordination of care and adherence management for successful use such that more frequent monitoring and training is required                                                                                                                                  \ne)     Are not a device, supply, medical food, or durable medical equipment.                                                                                                                                      \n\nLastly, only newly FDA-approved and launched drugs, and drugs not on the market as of January 1, 2020 may be considered for addition to the specialty pharmacy drug price list after this date, unless the Specialty Pharmacy gains access to a previously unavailable Limited Distribution Specialty Drug.  ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":46,"d":"46."},null,"\"Specialty Pharmacy\" means a pharmacy that is owned, licensed, operated or identified by PBM, where Specialty Drugs are filled and delivered to Members via the mail order service.  ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":47,"d":"47."},null,"\"Specialty Service Fees\" means fees collected by a PBM from pharmaceutical companies for certain costs or services associated with stocking, handling and dispensing certain Specialty Drugs, such as distribution data reporting, inventory tracking and management, FDA Risk Evaluation and Mitigation Strategy (REMS) support and enhanced adverse even reporting and coordination.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":48,"d":"48."},null,"\"Territory Pharmacy or TER\" means a Retail Pharmacy located in one of the United States territories, i.e. American Samoa, Guam, Northern Mariana Islands, Puerto Rico, United States Virgin Islands. These Pharmacies are identified by an ISO 3166 code (state code) of AS, GU, MP, PR, and VI.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":49,"d":"49."},null,"\"Total Claim Cost\" is equal to the Ingredient Cost plus the applicable Dispensing Fee plus the applicable sales tax. For each claim, the Total Claim Cost is determined by the Claim adjudication logic stated in the Pricing Guarantees Section below.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":50,"d":"50."},null,"“Traditional Pricing” means a financial structure comprised of fixed guaranteed discounts and fees. In this arrangement, PBM retains the difference between (1) Mail Order Pharmacy and Specialty Pharmacy acquisition costs and the amounts guaranteed to Arlington County Government and (2) contracted rates with Retail Pharmacies and the amounts guaranteed to Arlington County Government. PBM passes through all Manufacturer Payments it receives in excess of Arlington County Government’s guaranteed Manufacturer Payments. Retail Pharmacy rates may vary and the amount paid by PBM to the Retail Pharmacy may not be equal to the amount billed to Arlington County Government and PBM shall retain any difference.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":51,"d":"51."},null,"\"Transmission Fees\" means fees from participating pharmacy providers that are used to offset costs incurred to support network services.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":52,"d":"52."},null,"“Usual and Customary” or “U&C” means a pharmacy’s usual selling price that a cash paying customer pays a pharmacy for prescription drugs. These shall include all applicable customer discounts including but not limited to: generic promotions, special customer, senior citizen, frequent shopper, discount club, discount card program, etc. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":53,"d":"53."},null,"\"Vaccine Claim(s)\" means a Claim in which the dispensed product is a vaccine and the purchase price includes both the Ingredient Cost and the cost to administer the vaccine.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":54,"d":"54."},null,"\"Veteran Affairs Pharmacy or VA\" means a Retail Pharmacy under veteran affairs jurisdiction where drugs are dispensed and pharmaceutical care is provided to enrolled veterans, by licensed pharmacists. These Pharmacies are identified by a National Council for Prescription Drug Program’s (NCPDP’s) dispenser type code of 9.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":55,"d":"55."},null,"\"Value-based Rebates\" mean payments collected by PBM from pharmaceutical companies when pharmaceutical companies' drug therapies underperform by not meeting certain effectiveness criteria. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":56,"d":"56."},null,"“Zero Balance Due” or “ZBD” claim means any claim where the member pays the total amount of the claim, including any applicable sales tax, and the plan pays zero","Fully Agree / Partial Agree / Disagree"," "]
[]
["II.",null,null,"Financial Questionnaire - Pricing Guarantees","Format Type","Response","Explanation"]
[{"$nulls":3},"General"]
[{"$nulls":3},"In the \"RX-Pricing\" worksheets included in this Excel workbook, you will quote on a post-AWP rollback basis, with guaranteed minimum discounts and maximum dispensing fees at Retail 30, Retail 90, Mail at Retail, Mail Service, and Specialty and a full pass through of Manufacturer Payments. The \"Mail at Retail\" option listed below refers to mail pricing at certain retail pharmacies for an 83-90 day supply with the same copay/coinsurance as mail.  Pricing worksheets requesting your organization's pricing are provided in this workbook. \n\nOnly the responses in the designated response areas will be incorporated into the final agreement.\n                                                                    \n                                        "]
[null,{"v":1,"d":"1."},null,"The \"RX-Pricing Exclusions\" Worksheet has been completed:","Yes / No Explain"]
[null,{"$f":"B71+1","v":{"v":2,"d":"2."}},null,"The \"RX-Pricing Acquisition Cost\" Worksheet has been completed:","Yes / No Explain"]
[null,{"$f":"B72+1","v":{"v":3,"d":"3."}},null,"The \"RX-Pricing Other Costs\" Worksheet has been completed:","Yes / No Explain"]
[null,{"v":4,"d":"4."},null,"The \"RX-Pricing MFP\" Worksheet has been completed:","Yes / No Explain"]
[null,{"v":5,"d":"5."},null,"The \"RX-Pricing Specialty Drugs\" Worksheet has been completed:","Yes / No Explain"]
[null,{"$f":"B75+1","v":{"v":6,"d":"6."}},null,"The \"RX-Pricing Projections\" Worksheet has been completed:","Yes / No Explain"]
[null,{"$f":"B76+1","v":{"v":7,"d":"7."}},null,"You will provide a current and complete list of Specialty Drugs with  pricing as of January 1, 2020 .  Your list will identify if each drug is a Brand/Generic, New to Market, Biosimilar, and Limited Distribution Drugs, even if your firm does not have access to them. Please provide list in the \"RX-Pricing Specialty Drugs\" Worksheet ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B77+1","v":{"v":8,"d":"8."}},null,"In the \"RX-Pricing\" tabs, the percentage discounts you enter represent the guaranteed minimum annual (\"Effective\") AWP Discounts.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":9,"d":"9."},null,"In the \"RX-Pricing\" tabs, the Dispensing Fees you enter at a Retail Pharmacy represent the guaranteed maximum average annual Dispensing Fees. The Dispensing Fees you enter at Mail Order Pharmacy and Specialty Pharmacy represent the guaranteed Dispensing Fee for each paid claim.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":10,"d":"10."},null,"In the \"RX-Pricing\" tabs, the Manufacturer Payments you enter represent the guaranteed minimum Manufacturer Payments per dispensing channel.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":11,"d":"11."},null,"Confirm, your organization's financial proposal is for a period of 4 years beginning July 1, 2021 and ending June 30, 2025 with (six) one year annual extensions. Arlington County Government at its own discretion will have the option to extend the terms of this RFP. All terms and conditions of the existing contract at the time of extension, including price, will be applicable.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Pricing Changes","Format Type","Response","Explanation"]
[{"$nulls":3},"In the event one or more of the following occurs, you will have the right, upon notice, to request an equitable adjustment to the rates and guarantees in the respective \"RX-Pricing\" worksheets, solely as necessary to return the deal to its contracted economic position as of the effective date of such event:"]
[null,{"$f":"B81+1","v":{"v":12,"d":"12."}},null,"A greater than a twenty five percent (25%) change in Arlington County Government’s average plan membership (measured on a rolling twelve month basis); and/or","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B84+1","v":{"v":13,"d":"13."}},null,"Arlington County Government changes its benefit designs (e.g., implements OTC plans, clinical or trend programs) in a manner for which pricing has not been negotiated in this Agreement or otherwise takes an action that has the effect of lowering the amount of Manufacturer Payments earned for Arlington County Government by more than 15%; and/or ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B85+1","v":{"v":14,"d":"14."}},null,"Arlington County Government implements a full replacement CDH/HDHP.","Text"]
[null,null,"a.","Please specify the maximum percentage of claims that constitutes your CDH/HDH plan threshold at which point your pricing guarantees stated in this bid will not change.","percentage, 0"]
[null,{"$f":"B86+1","v":{"v":15,"d":"15."}},null,"More than 25% of Arlington County Government’s claims are incurred in Massachusetts, Hawaii, Alaska, or Puerto Rico; and/or","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":16,"d":"16."},null,"Revenue from Manufacturer Payments is materially decreased because Brand Drugs unexpectedly move off-patent to generic status.  Unexpectedly means the movement of a top 100 Brand Drug (measured as top 100 GPI-10 associated with single source Brand Drugs in your book of business by AWP) to off-patent more than six (6) months prior to its established patent expiration date or where Generic Drugs or over-the-counter substitutes for a top 100 Brand Drug become available more than six (6) months prior to the Brand Drug’s patent expiration date.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":17,"d":"17."},null,"Should any of the above occur, you will provide the request to Arlington County Government along with the reason for the change, a Arlington County Government-specific analysis of the financial impact and any Member impact. Arlington County Government will have forty-five (45) days to review and determine if the change is reasonably acceptable. If Arlington County Government, in good faith, determines that the change is not reasonably acceptable, except as required by law, it will not occur during the term of the contract.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":18,"d":"18."},null,"Except as explicitly set forth herein, pricing and financial guarantees will only change on an annual basis with the explicit written approval of Arlington County Government.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Pricing Requirements","Format Type","Response","Explanation"]
[null,{"$f":"B91+1","v":{"v":19,"d":"19."}},null,"All applicable financial terms (including but not limited to adjudication formulas, AWP discounts, dispensing fees, administrative and clinical program fees, Manufacturer Payments, specialty discounts, and specialty dispensing fees) submitted by you will be guaranteed as specified for the full contract period and incorporated into the contract.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B93+1","v":{"v":20,"d":"20."}},null,"The financial terms you propose are Arlington County Government-specific, and not book of business averages.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"+B94+1","v":{"v":21,"d":"21."}},null,"The financial guarantees you propose do NOT require Arlington County Government to make any plan design changes or implement any programs that are different from the current plan design(s).","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"+B95+1","v":{"v":22,"d":"22."}}," ","You will provide reporting to validate compliance with each and every financial guarantee, and such reporting must tie to your standard management reports. (This includes separate Manufacturer Payment reports where prescription counts by dispensing channel and drug type must tie out to management reports).","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B96+1","v":{"v":23,"d":"23."}},null,"You will utilize the brand/generic indicator available from only one nationally recognized source (e.g., Medispan) unless a change in the indicator will lower the price for Arlington County Government or Arlington County Government agrees that the change is acceptable. In your response, please indicate which source will be used.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":24,"d":"24."},null,"Your proposed pricing guarantees (i.e. discounts, dispensing fees, admin fees, Manufacturer Payments) will not be based on minimum days supply at retail, mail order, or specialty (not including Retail 90 or \"Mail at Retail\" programs).","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":25,"d":"25."},null,"Your quoted dispensing fees per claim are based on paid claims only, NOT claims that are reversed or rejected.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":26,"d":"26."},null,"U&C priced claims at retail will NOT be assessed a dispensing fee.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":27,"d":"27."},null,"Retail claims priced using the U&C price (or submitted price, etc.) will be NOT be included in the guaranteed maximum dispensing fee per claim.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":28,"d":"28."},null,"The dispensing fee per claim listed for mail, if any, is not an average but the guaranteed maximum amount that will apply per paid claim. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":29,"d":"29."},null,"Adjudication for Retail Pharmacy Claims:  For each claim processed and dispensed to a member through a retail pharmacy, Arlington County Government shall pay PBM the Total Claim Cost less the member cost share plus any applicable administrative fees. The Total Claim Cost is defined to be the lowest of:\ni. The AWP minus the Brand Drug discount + Dispensing Fee + sales tax (Brand Drugs);\nii. The AWP minus the non-MAC discount + Dispensing Fee + sales tax (Generic Drugs);\niii. MAC + Dispensing Fee + sales tax; or,\niv. The dispensing pharmacy’s U&C + sales tax.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":30,"d":"30."},null,"Adjudication for Mail Order Pharmacy Claims:  For each Claim processed and dispensed to a member through a mail order pharmacy, Arlington County Government shall pay PBM the Total Claim Cost less the member cost share plus any applicable administrative fees. The Total Claim Cost is defined to be the lowest of:\ni. The AWP minus the Brand Drug discount + Dispensing Fee + sales tax (Brand Drugs); \nii. The AWP minus the non-MAC discount + Dispensing Fee + sales tax (Generic Drugs); or,\niii. MAC + Dispensing Fee + sales tax.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":31,"d":"31."},null,"Member Cost Share:  At the point of sale, members will pay the lowest of:\ni. The Total Claim Cost as defined by dispensing channel above; or,\nii. The applicable copayment/coinsurance as defined by the benefit plan.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":32,"d":"32."},null,"Confirm you will adjudicate multi-ingredient Compound Drug claims using the NCPDP D.0 standard.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":33,"d":"33."},null,"For any Compound Drug claims submitted for reimbursement under the pharmacy benefit plan, you will request a copy of the written recipe to verify that the claim has been submitted in accordance with contractual and NCPDP standards.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":34,"d":"34."},null,"You will collect the following elements for each Compound Drug claim from every pharmacy submitting a claim for a Compound Drug:\n 1. Compound Indicator\n 2. NDC, Quantity, Submitted ingredient cost for each individual component in the recipe\n 3. Total Quantity and the total Usual & Customary price\n 4. Level of Effort value","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":35,"d":"35."},null,"Adjudication logic for each NDC in the Compound Drug claim recipe will be processed at the lowest of:\ni. The AWP minus the Brand Drug discount;\nii. The AWP minus the non-MAC discount;\niii. MAC (if applicable); or,\niv. The dispensing pharmacy’s submitted price.\n\nThe lowest adjudicated price for each ingredient in the Compound Drug claim recipe will be combined to create a Total Compound Drug Claim Cost","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":36,"d":"36."},null,"Arlington County Government will reimburse you for each Compound Drug claim at the lowest of:\ni. The Total Compound Drug Claim Cost;\nii. The pharmacy submitted Total Usual & Customary price;","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":37,"d":"37."},null,"As a standard practice, you will review each and every Compound Drug claim greater than $200 and complete an audit of the recipe when claims appear aberrant.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":38,"d":"38."},null,"You will review all pharmacies that submitted a Compound Drug claim quarterly to be measured against peer groups to control for fraud, waste and abuse. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":39,"d":"39."},null,"Pricing for Specialty Drugs (excluding New to Market Limited Distribution Specialty Drugs) added to the list on or after 1/1/20 shall be equal to or greater than the respective brand or generic specialty Overall Effective Discount (OED) guarantee. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B113+1","v":{"v":40,"d":"40."}},null,"New to Market Limited Distribution Specialty Drugs may be defaulted to an initial rate for the first 60 calendar days. After 60 calendar days of acquiring access to a Limited Distribution Specialty Drug, you will renegotiate the price on the specialty drug list with Arlington County Government to a market competitive rate. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":41,"d":"41."},null,"Split fills for specialty products will not be assessed two dispensing fees.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Reconciliation of Discount and Dispensing Fee Guarantees","Format Type","Response","Explanation"]
[null,{"$f":"B115+1","v":{"v":42,"d":"42."}},null,"All pricing discounts and dispensing fees guarantees will be reconciled on an individual component basis in each delivery channel (Retail, Retail 90/Mail at Retail, Mail Order, Specialty) comparing actual discounts and dispensing fees achieved with guaranteed discounts and dispensing fees. The reconciliation will be guaranteed dollar for dollar, meaning that a surplus in one pricing component will not be allowed to make up for a shortfall in another component within or across delivery channels.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B117+1","v":{"v":43,"d":"43."}},null,"You will calculate the achieved discounts with the following formula: [1-(total discounted AWP ingredient cost --excluding dispensing fees and penalties due to DAW claims and prior to application of copayments --of applicable prescription drug claims for the measurement period divided by total undiscounted AWP ingredient cost (both amounts will be calculated as of the date of adjudication) for the measurement/guarantee period)]. Discounted ingredient cost will always be the lowest of the AWP discount, MAC or U&C adjudication methodology.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B118+1","v":{"v":44,"d":"44."}},null,"You will measure and report quarterly the discount and dispensing fee performance for each delivery channel against the guaranteed discount and dispensing fee guarantees.  ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":45,"d":"45."},null,"You will pay/credit Arlington County Government 100% of any shortfall for the brand, generic, specialty discount guarantees within ninety (90) calendar days from the close of each annual reconciliation period (with Arlington County Government retaining 100% of any additional savings achieved above each minimum guarantee and below each maximum guarantee).","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":46,"d":"46."},null,"If the reconciliation of any guaranteed discounts or dispensing fees result in a shortfall owed to Arlington County Government, you will not use Zero Balance Due claims, savings associated with any drug utilization review and/or step therapy programs (including brands to generics),  DAW penalty amounts if the penalty applies to the member or make any other additional adjustments to offset the shortfall amount.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":47,"d":"47."},null,"Brand Discount Guarantees.  You will include all Brand Drugs in the brand drug discount guarantees. Brand drugs shall include single-source and multi-source brand drugs. You will not include any Generic Drugs (including but not limited to Single-Source Generics, House Generics, new to market generics, patent litigation generics, Authorized Generics and limited supply generics) in the brand discount guarantee nor reclassify any generics to adjudicate at the brand discount. If you do not fully agree to this requirement, your brand discounts will be reduced in the financial analysis of your offer.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":48,"d":"48."},null,"Generic Discount Guarantees.  You will include all generics (including but not limited to generic drugs with an approved ANDA, Authorized Generics,  House Generics, multi-source generics, generics subject to MAC pricing, new to market generics, Single-Source Generics, generics involved in patent litigation, and limited supply generics) in the overall generic discount and will not reclassify any Generics to adjudicate at the Brand Drug discount.  You will not include any multi-source brand claims where a DAW penalty is assessed in the generic discount calculation. If you do not fully agree to this requirement, your generic discounts will be reduced in the financial analysis of your offer.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":49,"d":"49."},null,"Specialty Brand Discount Guarantees. You will include all Specialty Brand Drugs dispensed through your preferred Specialty Pharmacy (including but not limited to Biosimilars, new to market Specialty Drugs, Exclusive/Limited Distribution Specialty Drugs) in the Overall Effective Discount (OED). You will not include any specialty generic drugs in the OED calculation.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B124+1","v":{"v":50,"d":"50."}},null,"In addition, your proposed specialty pricing will include varying ingredient cost discounts by Specialty Drug. The ingredient cost discount proposed for each specialty drug shall be guaranteed and you will adjudicate specialty claims filled in your preferred specialty pharmacy using the lesser of MAC or the \"locked-in\" drug discount.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":51,"d":"51."},null,"You will include all specialty generic drugs dispensed through your preferred Specialty Pharmacy in the non-specialty Retail Pharmacy Generic Drug discount and dispensing fee guarantees. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":52,"d":"52."},null,"You agree to include all Specialty Drugs dispensed at a Retail Pharmacy will be included in the reconciliation of the non-specialty retail 30 minimum Brand and Generic discount and dispensing fee guarantees in the \"Rx-Pricing\" Worksheet.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":53,"d":"53."},null,"All Zero Balance Due claims (regardless of the delivery channel) will be reconciled at the adjudicated ingredient cost discount and will not be counted as AWP – 100%.  Arlington County Government shall not be billed for any Zero Balance Due claims.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":54,"d":"54."},null,"Calculation of the discount and dispensing fee guarantees shall only exclude the following types of claims:\na. Compounds, bulk chemicals, powders;\nb. Secondary COB claims;\nc. Subrogation claims\nd. Prescriptions filled at VA Hospitals\ne. Claims processed at 340b pricing\nf.  In-house pharmacy claims if in-house pharmacy is not part of retail network\ng. Out of Network Paper claims","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":55,"d":"55."},null,"You will provide a separate Generic Dispensing Rate guarantee at Retail and Mail channels, backed by a dollar for dollar guarantee for each component. You will reimburse Arlington County Government 100% of any shortfall.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":56,"d":"56."},null,"Your will not pass on future increases in postage/mailing fees for your Mail Order Pharmacy and your preferred Specialty Pharmacy  to Arlington County Government during the contract term.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":57,"d":"57."},null,"You will adjudicate non-MAC generics with a discount that is higher than the minimum guaranteed discount for Brand Drugs in the same channel. Please specify your Non-MAC discount and dispensing fee guarantees in the \"Rx-Pricing\" worksheet.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B132+1","v":{"v":58,"d":"58."}},null,"Regardless as to whether an Agreement has been executed by Arlington County Government, Vendor will measure, report, reconcile and pay any discount, dispensing fee shortfall as well as minimum guaranteed manufacturer payments in accordance with the terms specified below.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Reconciliation and Payment of Manufacturer Payment Guarantees","Format Type","Response","Explanation"]
[null,{"$f":"B133+1","v":{"v":59,"d":"59."}},null,"Your offer will include guaranteed minimum Manufacturer Payments per Brand paid prescription at Retail 30, Retail 90, \"Mail at Retail\"/Mail Order and Specialty. You may provide different minimum Manufacturer Payment guarantees in each year of the contract. Your guaranteed Manufacturer Payments should represent at least 98% of the expected 100% pass through of Manufacturer Payments at the time of underwriting. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":60,"d":"60."},null,"You will disclose all sources of Manufacturer Payments and Other Pharma Revenue.","Fully Agree / Partial Agree / Disagree"]
[null,{"$f":"+B136+1","v":{"v":61,"d":"61."}},null,"Your proposed guaranteed minimum Manufacturer Payments are guaranteed minimums for the term of the agreement. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B137+1","v":{"v":62,"d":"62."}},null,"Your firm represents and warrants that it will not enter into any agreement with a pharmaceutical manufacturer for Manufacturer Payments with the impact to reduce or otherwise circumvent monies received from pharmaceutical manufacturers as being considered Manufacturer Payments. Furthermore, you will not require Arlington County Government to enroll in programs to receive Manufacturer Payments.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":63,"d":"63."},null,"Your offer of Manufacturer Payments will be the greater of the minimum guaranteed amounts or 100% pass through of Manufacturer Payments.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":64,"d":"64."},null,"Your offer assumes the Manufacturer Payment guarantees are NOT based on an average days' supply or pro-rated in any fashion. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":65,"d":"65."},null,"Calculation of the Manufacturer Payment guarantees shall only exclude the following types of claims:\na. Member submitted claims older than 180 days;\nb. 100% Member Cost Share Program Claims\nc. Subrogation claims\nd. Claims processed at 340b pricing","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":66,"d":"66."},null,"Please confirm the following:"]
[null,{"$f":"B142+1","v":{"v":67,"d":"67."}},null,"You agree to pass-through 100% of Inflation Payments","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":68,"d":"68."},null,"You agree to pass-through 100% of Manufacturer Administrative Fees","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":69,"d":"69."},null,"You agree to pass-through 100% of Rebates","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":70,"d":"70."},null,"You agree to pass-through 100% of Data Fees","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":71,"d":"71."},null,"You agree to pass-through 100% of Other Pharma Revenue","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":72,"d":"72."},null,"You will provide an annual reconciliation of the 100% pass-through of Manufacturer Payments and pharma revenue and minimum guaranteed Manufacturer Payments.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":73,"d":"73."},null,"You will report and pay guaranteed Manufacturer Payments amounts to Arlington County Government on a quarterly basis within 60 calendar days after the end of the quarter, regardless of when the Manufacturer Payments are invoiced or collected.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":74,"d":"74."},null,"At year end, you will reconcile the Manufacturer Payment pass-through percent against the guaranteed Manufacturer Payments and provide documentation of your calculation and the result to Arlington County Government within 120 calendar days from the end of each contract year.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":75,"d":"75."},null,"You will pay any resulting credit to Arlington County Government automatically within 150 calendar days after the end of each contract year without written request.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":76,"d":"76."},null,"Any Manufacturer Payments received from manufacturers after the reconciliation will be applied to the next annual reconciliation and will be clearly noted in the next annual reconciliation.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Allowances/Pharmacy Management Fund","Format Type","Response","Explanation"]
[null,{"$f":"B152+1","v":{"v":77,"d":"77."}},null,"You agree to pay the cost of a pre-implementation audit and readiness assessment, up to $30,000 (for 3 plan designs) or up to $45,000 (for 5+ plan designs).  If this review cannot be supported remotely and requires an on-site meeting, you will be responsible for travel costs up to $3,000 per incident.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B154+1","v":{"v":78,"d":"78."}},null,"In addition to the allowances requested in the Medical portion of the RFP, you agree to provide a separate Pharmacy Management Fund allowance to cover any additional costs incurred by Arlington County Government either directly through you or external costs related to the administration of the prescription drug program.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B155+1","v":{"v":79,"d":"79."}},null,"For sake of clarity, however not limited to, please confirm the willingness of the PMF to pay for the following:"]
[null,{"v":80,"d":"80."},null,"Market Check","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":81,"d":"81."},null,"Audits (Benefit, Financial, Manufacturer Payment, Clinical, FWA etc.)","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":82,"d":"82."},null,"Clinical Programs and Utilization Management Fees (PAs, QL, Step Therapy)","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":83,"d":"83."},null,"Carve-out Fees (ex. third party file feeds/data exchanges) if applicable.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":84,"d":"84."},null,"Health Initiatives (ex. Wellness credits)","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":85,"d":"85."},null,"Costs associated with a third party Health Benefits Administration Team.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B162+1","v":{"v":86,"d":"86."}},null,"You agree that any unused portion of the Pharmacy Management Fund in one period will carry over to the subsequent plan year.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B163+1","v":{"v":87,"d":"87."}},null,"Confirm your input the appropriate allowances for the RFP Marketing, Implementation, Pre-Implementation Audit, and Pharmacy Management Fund (PMF) allowance in the \"RX-Pricing\" Worksheets.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":88,"d":"88."},null,"Clinical Programs - Savings & Reporting","Format Type","Response","Explanation"]
[{"$nulls":3},"You agree that clinical programs included in your financial proposal will have no shared savings and the fee will not be based on Arlington County Government's average membership.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B165+1","v":{"v":89,"d":"89."}},null,"All proposed clinical programs will be guaranteed dollar-for-dollar, and Arlington County Government will receive 100% of any/all savings achieved in excess of any minimum guaranteed savings within 90 calendar days from the end of each contract year.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B167+1","v":{"v":90,"d":"90."}},null,"All proposed utilization management programs will have a positive ROI for the entire time period they are in place.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B168+1","v":{"v":91,"d":"91."}},null,"You will provide the methodology for calculating ROI prior to the start of the program and will not change methodology during the life of the program without prior Arlington County Government consent.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":92,"d":"92."},null,"Any savings achieved in excess from one clinical program will not be used to subsidize shortfalls in savings resulting from any other clinical program in any contract year.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":93,"d":"93."},null,"You will exclude savings from Concurrent DUR and administrative edits, including but not limited to “refill too soon”, from any clinical savings guarantee.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":94,"d":"94."},null,"You will provide quarterly performance reporting (activity and savings/outcomes) for Arlington County Government for all clinical programs, including fraud, waste, and abuse, within 30 calendar days from the close of each quarter. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":95,"d":"95."},null,"The reporting must clearly outline the performance of each individual clinical edit separately in addition to summary level reporting.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":96,"d":"96."},null,"Savings assumptions must be based on Arlington County Government-specific utilization and not on book of business measures.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":97,"d":"97."},null,"Savings reported will be direct savings associated with the pharmacy benefit and will not include any inferred medical savings.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":98,"d":"98."},null,"You will provide a fixed fee per letter, if any, to provide and mail communications pieces to participants to help them lower costs (e.g., switching to generics, mail, etc.).","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":99,"d":"99."},null,"There are no other programs for which the Plan will be charged that is not disclosed as \"Other Program Fee(s)/Cost(s)\" in the \"RX-Pricing\" Worksheets.","Fully Agree / Partial Agree / Disagree"," "]

{"sheet":"ACQ Cost Plus Questionnaire","index":4,"n_rows":56,"n_cols":7,"rows_kept":56,"hidden":true,"merged":[[2,3,2,4],[5,3,5,6]]}
[]
[]
[{"$nulls":3},{"$f":"Questionnaire!D3","v":"Request for PBM Proposal (RFP) for Arlington County Government"}]
[{"$nulls":3},"Acquisition Cost Plus Pricing Questionnaire"]
[]
[{"$nulls":3},"To Vendor:  Use Column G to provide a brief explanation. However if the length of the explanation is greater than 50 characters including spaces, you must use the \"Explanation\" worksheet to provide your detail explanation. Please note, your explanations must be limited to 400 characters or less"]
[]
["I.",null," ","Financial Questionnaire","Format Type","Response","Explanation"]
[{"$nulls":3},"Definitions"]
[null,{"v":1,"d":"1."},null,"\"Acquisition Cost Plus Pricing\" means a pricing structure comprised of a full 100% pass-through of PBM's contracted rates with Retail Pharmacies, Mail Order Pharmacies, Specialty Pharmacies, Manufacturer Payments and Other Pharma Revenue. In this arrangement, PBM shall not retain any margin in the difference between Retail, Mail Order and Specialty Pharmacy acquisition costs and the amounts guaranteed to [Client Name]. PBM passes through (1) its contracted rates with Retail Pharmacies and (2) all Manufacturer Payments and Other Pharma Revenue received from pharmaceutical manufacturers in excess of the [Client Name]’s guaranteed Manufacturer Payments.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":2,"d":"2."},null,"\"Total Remuneration\" is defined as Manufacturer Payments, Other Pharma Revenue, and includes other discounts or monies attributed to member utilization.","Fully Agree / Partial Agree / Disagree"," "]
[]
["II.",null,null,"Financial Questionnaire - Pricing Guarantees","Format Type","Response","Explanation"]
[{"$nulls":3},"Pricing Requirements"]
[{"$nulls":3},"All of the following requirements are in ADDITION to the requirements on the Financial Questionnaire. These will be incorporated into the final PBM agreement. "]
[null,{"v":1,"d":"1."},null,"You agree to provide Acquisition Cost Plus pricing with minimum AWP discount guarantees and maximum dispensing fee guarantees developed to approximate the value of your acquisition cost for each component (Brand Drugs, Generic Drugs, Specialty Drugs) and by dispensing channel (Retail Pharmacy, Mail Order Pharmacy, and Specialty Pharmacy).","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B16+1","v":{"v":2,"d":"2."}},null,"Your proposed Specialty Drug ingredient cost discount guarantees by drug will approximate actual acquisition cost for each drug listed on Rx-Pricing, Specialty Drugs. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B17+1","v":{"v":3,"d":"3."}},null,"Your maximum guaranteed dispensing fee is reflective of the variable cost incurred to dispense medications at your Mail Pharmacy and Specialty Pharmacy.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":4,"d":"4."},null,"Your Per Member Per Month (PMPM) administrative fee is reflective of the overhead cost incurred to administer PBM services on behalf of [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":5,"d":"5."},null,"Your Per Claim administrative fee is reflective of all profit to administer PBM services on behalf of [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":6,"d":"6."},null,"You agree to pass on the full value of any improvements made in your pricing throughout the contract term with your contracted supply chain including Retail Pharmacies, Mail Order Pharmacies, Specialty Pharmacies, distributors, wholesalers and pharmaceutical manufacturers.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":7,"d":"7."},null,"[Client Name] will have the option to utilize a Retail Pass-through pricing methodology as stated below OR the Retail NADAC Methodology as stated below.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Retail Pass-through Methodology"]
[null,{"$f":"B22+1","v":{"v":8,"d":"8."}},null,"For this retail pass-through, please confirm that the amount charged to [Client Name] will be equal to the reimbursement amount paid to the Retail Pharmacy for every retail claim, without exception or exclusion.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B24+1","v":{"v":9,"d":"9."}},null,"You agree to use the most current pricing, reimbursement contract that you have agreed to with each Retail Pharmacy and/or pharmacy chain throughout the contract term.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Retail NADAC Methodology"]
[null,{"$f":"B25+1","v":{"v":10,"d":"10."}},null,"You agree to use National Average Drug Acquisition Cost (NADAC) as published by CMS as the basis of reimbursement for all retail claims processed for [Client Name].  ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B27+1","v":{"v":11,"d":"11."}},null,"The retail pharmacy reimbursement for each claim will be based on the most recently published NADAC price specific to the NDC-11 of the dispensed drug, as of the date the claim is initially processed.  Reimbursement will be calculated as “NADAC + Dispensing Fee”, except under the circumstances indicated below.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B28+1","v":{"v":12,"d":"12."}},null,"Confirm your adjudication logic for any claims with NDCs that do not have a published NADAC price.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":13,"d":"13."},null,"Confirm your adjudication logic for any claims where the pharmacy’s Usual and Customary (U&C) price is lower than the published NADAC price.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":14,"d":"14."},null,"The Dispensing Fee will be negotiated with each Retail Pharmacy, and will be fully disclosed and passed-through to [Client Name] without markup or modification. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":15,"d":"15."},null,"Upon request of [Client Name], the PBM will provide to [Client Name] or its designee a listing of Retail Pharmacies and their respective Dispensing Fees.  This information will be delivered to [Client Name] within 10 business days of such request.  The PBM agrees that this request does not constitute an audit.   ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":16,"d":"16."},null,"Under no circumstances will any retail claim be processed or reimbursed using a Maximum Allowable Cost (MAC) list or other similar price list controlled by the PBM.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":17,"d":"17."},null,"The PBM will not charge a retail pharmacy any fees or charges for the receipt and/or processing of electronic claims or for the pharmacy’s participation in a retail network.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Mail Order Pharmacy and Specialty Pharmacy"]
[null,{"$f":"B34+1","v":{"v":18,"d":"18."}}," ","On the first and 16th of every month, you will load acquisition cost pricing by unit cost (excluding dispensing fees) for each NDC level product dispensed through your Mail Order and Specialty Pharmacy. For claims with a service date from the first of the month through the 15th of the month,  the pricing loaded on the first will serve as the acquisition cost for reconciliation for every product dispensed at your Mail Order and Specialty Pharmacy.  For claims with a service date from the 16th of the month through the 31st of the month (or end of month),  the unit cost (excluding dispensing fees) loaded on the 16th will serve as the acquisition cost for reconciliation for every product dispensed at your Mail Order and Specialty Pharmacy.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B36+1","v":{"v":19,"d":"19."}},null,"If you are unable to accommodate the tracking of acquisition cost pricing by unit cost as written above, please describe how your firm intends to capture acquisistion cost pricing by unit for reconciliation.","Text"]
[{"$nulls":3},"Reconciliation of Discount and Dispensing Fee Guarantees to Actual Acquisition Cost","Format Type","Response","Explanation"]
[null,{"$f":"B37+1","v":{"v":20,"d":"20."}},null,"On an annual basis, within thirty (30) calendar days following the end of each calendar year, you will calculate the acquisition cost for each claim dispensed by your Mail Order and Specialty Pharmacy by multiplying the quantity for each NDC dispensed in a given semi-monthly period by the acquisition cost price loaded for the period in which the claim was dispensed. You will then aggregate the claim-level acquisition costs by component (Brand Drug, Generic Drug, Specialty Drug) and dispensing channel (Mail Order and Specialty Pharmacy) to determine component-level acquisition cost by dispensing channel. ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B39+1","v":{"v":21,"d":"21."}},null,"On an annual basis, within ninety (90) calendar days following the end of each calendar year, you agree to provide a reconciliation report between the pricing guarantees and the acquisition cost pricing by component (Brand Drugs, Generic Drugs, Specialty Drugs) and by dispensing channel (Retail Pharmacy, Mail Order Pharmacy, and Specialty Pharmacy). If the cost plus pricing is lower than the pricing guarantees, you will pay the difference within thirty (30) calendar days. If the cost plus pricing is greater than the pricing guarantees, [Client Name] will NOT reimburse you. ","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Reconciliation and Payment of Other Pharma Revenue Guarantees"]
[{"$nulls":3},"Please confirm the following:"]
[null,{"$f":"B40+1","v":{"v":22,"d":"22."}},null,"You agree to pass-through 100% of Transmission Fees","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B43+1","v":{"v":23,"d":"23."}},null,"You agree to pass-through 100% of Specialty Service Fees","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B44+1","v":{"v":24,"d":"24."}},null,"You agree to pass-through 100% of \"Pharmacy Purchase Discount(s)\"","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B45+1","v":{"v":25,"d":"25."}},null,"You agree to pass-through 100% of any other Discounts/Fees associated with administering the pharmacy benefit on behalf of [Client Name].","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B46+1","v":{"v":26,"d":"26."}},null,"On the annual reconciliation of the 100% pass-through of Manufacturer Payments and Other Pharma Revenue with the minimum guaranteed Manufacturer Payments you will clearly note the value of Transmission Fees, Specialty Service Fees and Pharmacy Purchase Discounts separately and distinct from Manufacturer Payments.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B47+1","v":{"v":27,"d":"27."}},null,"Any Other Pharma Revenue received from manufacturers, wholesalers after the reconciliation will be applied to and clearly identified on the next claims invoice immediately following reconciliation.","Fully Agree / Partial Agree / Disagree"," "]
[]
["III.",null,null,"Expanded Audit Rights for Acquisition Cost Plus Pricing"]
[null,{"v":1,"d":"1."},null,"[Client Name] retains the right to audit such information as reasonably required to determine that your firm is complying with the Acquisition Cost Plus pricing model, which includes but is not limited to: 100% of pharmacy claims data, with all NCPDP fields from the most current version and release; data management; Retail Pharmacy contracts with PBM; pharmaceutical manufacturer and wholesaler agreements; Mail Order and Specialty Pharmacy acquisition contracts; Specialty Service Fee agreements; approved and denied utilization management reviews; clinical program outcomes; appeals;  and information related to verifying compliance with the Acquisition Cost Plus pricing model.  ","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B51+1","v":{"v":2,"d":"2."}},null,"Upon request of [Client Name], the PBM shall provide to [Client Name] or its designee a copy of any and all Electronic Remittance Advice (ERA) 835 files, also referred to as HIPAA X12N 835 files, which contain any processed and/or reversed claims relevant to [Client Name]’s plan.  Such files must be provided in their original form, without redaction or modification, except that such files may be redacted to exclude Personally Identifiable Information (PII) for any payers other than [Client Name].  The files will be delivered to [Client Name] within 10 business days of such request.  The PBM agrees that this request does not constitute an audit.","Fully Agree / Partial Agree / Disagree"," "]
[]
["IV.",null,null,"Clinical Program Bundled Fee"]
[null,{"v":1,"d":"1."},null,"You agree to provide all services listed on the \"RX-Pricing Other Costs\" in column B, for a bundled clinical program fee and any additional clinical programs developed throughout the life of agreement shall be included. You will not charge [Client Name] any fees for clinical programs or services other than the single clinical program fee.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B55+1","v":{"v":2,"d":"2."}},null,"Confirm you input the Clinical Program Bundled Fee in Cell D12, on the \"Rx-Pricing, Other Costs\" tabs","Yes/No/Explain"]

{"sheet":"DropDown","index":5,"n_rows":5,"n_cols":9,"rows_kept":5,"hidden":true}
["Included Retail Only","Yes","Fully Agree","Yes","Complete ","Wholly Owned","Confirmed ","At least quarterly","Monthly"]
["Included Mail Only","No","Partial Agree","No, Explain","Not Complete","Outsourced","Not Confirmed","At least semi-annually","Quarterly"]
["Included Channel Agnostic",null,"Disagree",{"$nulls":4},"At least annually","Semi-Annually"]
["Excluded Channel Agnostic",{"$nulls":6},"Other, specify","Annually"]
[{"$nulls":8},"Other, Explain"]

{"sheet":"Retiree Questionnaire","index":6,"n_rows":64,"n_cols":7,"rows_kept":64,"hidden":true,"merged":[[2,3,2,4],[5,3,5,6]]}
[]
[]
[{"$nulls":3},{"$f":"Questionnaire!D3","v":"Request for PBM Proposal (RFP) for Arlington County Government"}]
[{"$nulls":3},"Retiree Questionnaire"]
[]
[{"$nulls":3},"To Vendor:  Use Column G to provide a brief explanation. However if the length of the explanation is greater than 50 characters including spaces, you must use the \"Explanation\" worksheet to provide your detail explanation. Please note, your explanations must be limited to 400 characters or less"]
[]
["I.",null,null,"Medicare Part D: RDS","Format Type","Response","Explanation"]
[{"$nulls":3},"You are able to provide the following assistance and reporting to the client related to its Medicare Part D Retire Drug Subsidy:"]
[null,{"v":1,"d":"1."},null,"You will provide all standard reporting to the [Client Name] at no charge.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B10+1","v":{"v":2,"d":"2."}},null,"If requested, you will provide all standard reporting to CMS on behalf of the [Client Name] at no charge.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B11+1","v":{"v":3,"d":"3."}},null,"Upon request of the [Client Name], you will provide notice of creditable coverage to members at no charge.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":4,"d":"4."},null,"You will assist the [Client Name] in the course of any CMS audit.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":5,"d":"5."},null,"You will provide the [Client Name] with reports separating out the Part D population for reporting purposes.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":6,"d":"6."}," ","You will comply with CMS guidance and include language in your contract in compliance with CMS guidance.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":7,"d":"7."},null,"In a separate attachment, please suggest performance guarantees in regards to the above Medicare Part D questions. Please name the attachment [Your Organization Name]_Medicare Part D Performance Guarantees. Confirm this is attached to your response.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":8,"d":"8."},null,"Confirm your capability to administer RDS Services.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":9,"d":"9."},null,"Confirm that you provided your proposed RDS fee (if applicable) on a per member, per month (PMPM) basis in the \"RX-Pricing\" worksheet.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B18+1","v":{"v":10,"d":"10."}},null,"You will provide required RDS reconciliation support to the [Client Name] for up to two years after termination at no additional cost.","Fully Agree / Partial Agree / Disagree"," "]
[]
["II.",null,null,"EGWP Requirements","Format Type","Response","Explanation"]
[null,{"v":1,"d":"1."},null,"You are required to support an enhanced Prescription Drug Plan (PDP) (Employee Group Waiver Program (EGWP) 800 Series) (EGWP+Wrap), both as fully self-funded.  An enhanced PDP is defined as a contract with a PDP sponsor for coverage equal to or greater than the standard Medicare benefit. Please confirm your capability to offer an EGWP + Wrap Product.","Confirmed"]
[null,{"v":2,"d":"2."},null,"For purposes of determining the federal subsidy, the proposed regulations provide that no administrative costs may be included in dispensing fees and that administrative costs may not be offset by any manufacturer or pharmacy discounts, chargebacks, rebates or similar price concessions. Any charges for Medicare Part D services must be included in your financial proposal.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":3,"d":"3."},null,"Will your organization notify the [Client Name] of any Part D participant who qualifies for the Low-Income Subsidy (LIS) and automatically provide the [Client Name] with LIS proceeds (once the participant's premium is reduced to zero)?","Yes/No/Explain"]
[null,{"v":4,"d":"4."},null,"Your organization agrees it will meet all requirements regarding coordination with CMS for billing, reconciliation, and reporting for Employer Group Waiver Plans (EGWP). This includes reconciliation of capitation payments, administration of Low-Income Subsidies, reporting requirements related to rebates, TrOOP, and “Prescription Drug Event” requirements.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":5,"d":"5."},null,"Your organization agrees it will maintain and administer CMS requirements for benefit design, networks, formulary, rebate management, clinical program management, and Medication Therapy Management for EGWP plans.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"v":6,"d":"6."},null,"Your organization agrees it will maintain and administer CMS requirements for member customer service, member enrollment, and member materials for EGWP plans.","Fully Agree / Partial Agree / Disagree"," "]
[{"$nulls":3},"Enrollment and Disenrollment Requirements"]
[null,{"v":7,"d":"7."},null,"Is your organization able or willing to accept enrollment/disenrollment from the [Client Name] without obtaining an election form from each participant?","Yes/No/Explain"]
[null,{"v":8,"d":"8."},null,"What assistance with this process will your organization require from the [Client Name] with the enrollment process?","Text"]
[null,{"v":9,"d":"9."},null,"If your organization will not accept enrollment/disenrollment from the [Client Name], what type of enrollment administration does your organization use (e.g., Internet, Telephone, or Paper)?","Text"]
[null,{"v":10,"d":"10."},null,"If enrollment/disenrollment does not occur through the [Client Name], how will your PDP plan communicate with the [Client Name] and the  [Client Name]'s participants regarding enrollment? (Answer N/A if you are willing to accept enrollment/disenrollment information from the [Client Name].)","Text"]
[null,{"v":11,"d":"11."},null,"Will you plan disenroll a participant who enrolls in another Medicare Part D PDP or an MA-PD plan?","Yes/No/Explain"]
[null,{"v":12,"d":"12."},null,"If yes, how will you notify the participant? Will you notify the participant and give them an opportunity to disenroll from the PDP or MA-PD?","Text"]
[null,{"v":13,"d":"13."},null,"Does your plan utilize the Part D Special Enrollment Period (SEP)?","Yes/No/Explain"]
[null,{"v":14,"d":"14."},null,"Will you be able to administer split family/dependent coverages if also covering Pre-65 Retirees?","Yes/No/Explain"]
[null,{"v":15,"d":"15."},null,"If yes, what are the administrative implications of split dependents with the PDP product(s) you are offering the [Client Name]?","Text"]
[null,{"v":16,"d":"16."},null,"How will you manage eligibility rejections from CMS that are not related to enrollment in another Medicare Part D PDP or an MA-PD plan?","Text"]
[null,{"v":17,"d":"17."},null,"Will you allow a participant to change PDP plans after initial enrollment?","Yes/No/Explain"]
[null,{"v":18,"d":"18."},null,"If yes, what are the conditions under which a change is permitted? How will this impact billing to the individual and balance billing to the [Client Name]?","Text"]
[{"$nulls":3},"Waivers"]
[null,{"v":19,"d":"19."},null,"Has your organization applied for all of the standard employer Part D waivers? If not, what waiver(s) did you not apply for and why?","Text"]
[null,{"v":20,"d":"20."},null,"Ability to restrict enrollment to retirees only?","Text"]
[null,{"v":21,"d":"21."},null,"Marketing/beneficiary communication requirements?","Text"]
[null,{"v":22,"d":"22."},null,"Service area requirements? What service area applies to your PDP? Any specific restrictions?","Text"]
[null,{"v":23,"d":"23."},null,"Did your organization request any individual employer waivers? If yes, what were they?","Text"]
[null,{"v":24,"d":"24."},null,"Did you request a waiver of appeals and coverage determinations? In other words, did you request a waiver to allow employers to use ERISA's claims and appeals procedures?","Text"]
[{"$nulls":3},"Communication Materials"]
[null,{"v":25,"d":"25."},null,"What communication materials, if any, will you provide to the [Client Name]'s participants?","Text"]
[null,{"v":26,"d":"26."},null,"Will you provide customized and targeted mailings?","Yes/No/Explain"]
[null,{"v":27,"d":"27."},null,"If yes, what is the additional cost?","Text"]
[null,{"v":28,"d":"28."},null,"Are you flexible in how these materials are branded?","Yes/No/Explain"]
[]
["III.",null,null,"Medicare Part B COB","Format Type","Response","Explanation"]
[null,{"v":1,"d":"1."},null,"Do you currently offer a real-time Medicare Part B COB solution at mail order?","Yes/No/Explain"]
[null,{"v":2,"d":"2."},null,"As separate attachment, you agree to provide a process flow for the program and explain which entity provides these services. This should be submitted as an attachment with your cost proposal response. ","Yes/No/Explain"]
[null,{"v":3,"d":"3."},null,"Are all of your mail order pharmacies, including specialty pharmacies, enrolled as Medicare Part B Suppliers? If no, are some of your mail order pharmacies, including specialty pharmacies, enrolled as Medicare Part B Suppliers? If yes, how many?","Yes/No/Explain"]
[null,{"v":4,"d":"4."},null,"If some or all of your pharmacies are Medicare Part B Suppliers, which classes of drugs and supplies are currently dispensed to Medicare Part B members?","Text"]
[null,{"v":5,"d":"5."},null,"Do you have edits in place at retail to identify Medicare Part B eligible members and reject their claims with messaging to pharmacies that the claims should be submitted to Medicare Part B?","Yes/No/Explain"]
[null,{"v":6,"d":"6."},null,"Is there an additional fee for this? If so, provide the additional fee in the \"RX-Pricing Other Costs\" Worksheet.","Yes/No/Explain"]
[]
["IV.",null,null,"Clinical Program Bundled Fee"]
[null,{"v":1,"d":"1."},null,"You agree to provide all services listed on the \"RX-Pricing Other Costs\" in column B, for a bundled clinical program fee and any additional clinical programs developed throughout the life of agreement shall be included. You will not charge [Client Name] any fees for clinical programs or services other than the single clinical program fee.","Fully Agree / Partial Agree / Disagree"," "]
[null,{"$f":"B63+1","v":{"v":2,"d":"2."}},null,"Confirm you input the Clinical Program Bundled Fee in Cell D12, on the \"RX-Pricing Other Costs\" tabs","Yes/No/Explain"]

{"sheet":"RX-Pricing Exclusions","index":7,"n_rows":59,"n_cols":10,"rows_kept":59,"merged":[[2,3,2,4],[3,3,3,4],[6,3,6,9]]}
[]
[]
[{"$nulls":3},{"$f":"Questionnaire!D3","v":"Request for PBM Proposal (RFP) for Arlington County Government"}]
[{"$nulls":3},"RFP No. 21-HRD-RFP-141 - Pharmacy Plan"]
[{"$nulls":3},"RX-Pricing, Exclusions"]
[]
[{"$nulls":3},"To Vendor:  Use Columns F-I to provide a response as to whether the claim type listed in Column D is \"INCLUDED\" in the respective discount, dispensing fee, Manufacturer Payment guarantee. However if the length of the explanation is greater than 50 characters including spaces, you must use the \"Explanation\" worksheet to provide your detail explanation. Please note, your explanations must be limited to 400 characters or less"]
[]
[{"$nulls":3},"Claim Inclusion/Exclusion of Specific Claim Types\n(THIS EXHIBIT WILL BE INCLUDED IN THE FINAL CONTRACT)",null,"Non-Specialty Discount and Dispensing Fee Guarantees","Specialty Discount and Dispensing Fee Guarantees\n(Including your Overall Effective Discount)","Non-Specialty Manufacturer Payment Guarantees","Specialty Manufacturer Payment Guarantees"]
["I.",{"$nulls":3},"Format Type","Response","Response","Response","Response","Explanation"]
[null,{"v":1,"d":"1."},null,"100% Member Cost Share Program Claims","Included / Excluded, Explain"]
[null,{"v":2,"d":"2."},null,"340B Claims","Included / Excluded, Explain"]
[null,{"v":3,"d":"3."},null,"Anti-Nausea Drugs","Included / Excluded, Explain"]
[null,{"v":4,"d":"4."},null,"Biosimilar Drugs","Included / Excluded, Explain"]
[null,{"v":5,"d":"5."},null,"Bulk Chemicals","Included / Excluded, Explain"]
[null,{"v":6,"d":"6."},null,"Claims approved by formulary exception","Included / Excluded, Explain"]
[null,{"v":7,"d":"7."},null,"Claims from Entities Eligible for Federal Supply Schedule Prices","Included / Excluded, Explain"]
[null,{"v":8,"d":"8."},null,"Claims older than 180 days","Included / Excluded, Explain"]
[null,{"v":9,"d":"9."},null,"Compound Drug Claims","Included / Excluded, Explain"]
[null,{"v":10,"d":"10."},null,"Coordination of Benefit (COB) / Secondary Payer","Included / Excluded, Explain"]
[null,{"$f":"B20+1","v":{"v":11,"d":"11."}},null,"Copay Offset Program dollars","Included / Excluded, Explain"]
[null,{"$f":"B21+1","v":{"v":12,"d":"12."}},null,"Discount Card Claims","Included / Excluded, Explain"]
[null,{"v":13,"d":"13."},null,"Dispense as Written (DAW) Claims","Included / Excluded, Explain"]
[null,{"v":14,"d":"14."},null,"Diabetic Supplies (Meters, Strips, Syringes etc.)","Included / Excluded, Explain"]
[null,{"v":15,"d":"15."},null,"Exclusive/Limited Distribution Specialty Drugs for which you do not have access","Included / Excluded, Explain"]
[null,{"v":16,"d":"16."},null,"Exclusive/Limited Distribution Specialty Drugs that your specialty pharmacy has access","Included / Excluded, Explain"]
[null,{"v":17,"d":"17."},null,"Exclusive/Limited Distribution Specialty Drugs that only your specialty pharmacy has access","Included / Excluded, Explain"]
[null,{"v":18,"d":"18."},null,"Exclusive/Limited Distribution Specialty Drugs that are New to Market (NTM)","Included / Excluded, Explain"]
[null,{"v":19,"d":"19."},null,"Generic Specialty Drugs","Included / Excluded, Explain"]
[null,{"v":20,"d":"20."},null,"Hepatitis B Drugs","Included / Excluded, Explain"]
[null,{"v":21,"d":"21."},null,"Hepatitis C Drugs","Included / Excluded, Explain"]
[null,{"v":22,"d":"22."},null,"HIV Drugs","Included / Excluded, Explain"]
[null,{"v":23,"d":"23."},null,"Home Infusion Pharmacy or HIF","Included / Excluded, Explain"]
[null,{"v":24,"d":"24."},null,"Indian Health Services, Tribal or Urban Indian Health or I/T/U","Included / Excluded, Explain"]
[null,{"v":25,"d":"25."},null,"Long Term Care Pharmacy or LTC","Included / Excluded, Explain"]
[null,{"v":26,"d":"26."},null,"Low List Price Brand Drugs","Included / Excluded, Explain"]
[null,{"v":27,"d":"27."},null,"Medicaid Managed Claims","Included / Excluded, Explain"]
[null,{"v":28,"d":"28."},null,"Military Pharmacy","Included / Excluded, Explain"]
[null,{"v":29,"d":"29."},null,"Missing / Invalid MediSpan data","Included / Excluded, Explain"]
[null,{"v":30,"d":"30."},null,"Most Favored Nation States","Included / Excluded, Explain"]
[null,{"v":31,"d":"31."},null,"Multi-Source Brand (MSB) Claims","Included / Excluded, Explain"]
[null,{"v":32,"d":"32."},null,"New to Market (NTM) Specialty Drugs","Included / Excluded, Explain"]
[null,{"v":33,"d":"33."},null,"No Bill, No Remit","Included / Excluded, Explain"]
[null,{"v":34,"d":"34."},null,"Non-Preferred Brand Drug Claims","Included / Excluded, Explain"]
[null,{"v":35,"d":"35."},null,"Onsite Pharmacy Utilization","Included / Excluded, Explain"]
[null,{"v":36,"d":"36."},null,"Out of Network Claims","Included / Excluded, Explain"]
[null,{"v":37,"d":"37."},null,"Over-the-Counter (Claims)","Included / Excluded, Explain"]
[null,{"v":38,"d":"38."},null,"Paper or Member Submitted Claims","Included / Excluded, Explain"]
[null,{"v":39,"d":"39."},null,"Patient/Copay Assistance dollars","Included / Excluded, Explain"]
[null,{"v":40,"d":"40."},null,"PCSK-9 Inhibitor Claims","Included / Excluded, Explain"]
[null,{"v":41,"d":"41."},null,"Pharmacies subject to Region-specific Pricing","Included / Excluded, Explain"]
[null,{"v":42,"d":"42."},null,"Pharmacies that Do Not Meet your Discount or Credential standards","Included / Excluded, Explain"]
[null,{"v":43,"d":"43."},null,"Repackaged National Drug Code (NDC) Claims","Included / Excluded, Explain"]
[null,{"v":44,"d":"44."},null,"Rural Pharmacies","Included / Excluded, Explain"]
[null,{"v":45,"d":"45."},null,"Subrogation Claims","Included / Excluded, Explain"]
[null,{"v":46,"d":"46."},null,"Transplant Drugs","Included / Excluded, Explain"]
[null,{"v":47,"d":"47."},null,"Usual and Customary (U&C)","Included / Excluded, Explain"]
[null,{"v":48,"d":"48."},null,"Vaccine and Vaccine Administration Claims","Included / Excluded, Explain"]
[null,{"v":49,"d":"49."},null,"Veteran Affairs Pharmacy or VA","Included / Excluded, Explain"]

{"sheet":"RX-Pricing Traditional","index":8,"n_rows":104,"n_cols":8,"rows_kept":104,"merged":[[2,1,2,5],[3,1,3,2],[6,1,6,5],[8,1,8,5],[9,2,9,5],[11,1,11,7],[12,2,12,7],[13,2,13,5],[13,6,13,7],[14,2,14,5],[14,6,14,7],[15,2,15,5],[15,6,15,7],[16,2,16,5],[16,6,16,7],[29,1,29,7],[30,2,30,7],[31,2,31,5],[31,6,31,7],[32,2,32,5],[45,1,45,7],[46,2,46,7],[47,6,47,7],[48,2,48,5],[48,6,48,7],[49,2,49,5],[49,6,49,7],[62,1,62,7],[63,6,63,7],[76,1,76,7],[77,6,77,7],[91,1,91,7],[92,6,92,7],[99,1,99,7],[100,6,100,7]]}
[]
[]
[null,{"$f":"Questionnaire!D3","v":"Request for PBM Proposal (RFP) for Arlington County Government"}]
[null,"RFP No. 21-HRD-RFP-141 - Pharmacy Plan"]
[null,"RX-Pricing, Traditional, Broadest Network, Commercial Plans"]
[]
[null,"Instructions: Please complete every cell on this worksheet. For retail, please propose pricing for your broadest retail network. Your financial offer MUST COMPLY with all Bidding Requirements and requirements in the Financial Questionnaire. Your pricing offer must be on a post-AWP rollback basis.  All proposed terms are guaranteed including adjudication formulas."]
[]
[null,"Aon Identification Data"]
[null,"Vendor Name"]
[]
[null,"RETAIL 30 (INCLUDING SPECIALTY FROM NON-PREFERRED SPECIALTY VENDORS)"]
[null,"Type of Network:","Broadest Network\n"]
[null,null,"Base Contract Term",{"$nulls":3},"Optional Contract Term ((2) one year extensions))"]
[null,"Number of Pharmacies Nationwide"]
[null,"Please confirm Specialty Drugs filled at Retail Pharmacy are included in the guarantees below. If not, please indicate how they are priced and provide. "]
[null,"Please confirm Specialty Generic Drugs filled at your preferred Specialty Pharmacy are included in the Generic Drug discount guarantees below. If not, please indicate how they are priced and provide. "]
[null,null,"Year 1 ","Year 2","Year 3","Year 4","Year 5","Year 6"]
[null,"Minimum AWP Discount Guarantees"," "," ",null," "," "," "]
[null,"Brand Drug Discount Guarantee","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount "]
[null,"Generic Effective Rate (MAC+Non-MAC) Discount Guarantee","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount "]
[null,"Generic Drug Non-Mac Discount Guarantee","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount "]
[null,"Average Dispensing Fee per Paid Claim"]
[null,"All Brands","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[null,"All Generics","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[null,"Administration Fees"]
[null,"  Per Paid Claim","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[null,"  Per Member Per Month","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[]
[null,"RETAIL 90 (INCLUDING SPECIALTY FROM NON-PREFERRED SPECIALTY VENDORS)"]
[null,"Type of Network:","Retail 90 Network\n"]
[null,null,"Base Contract Term",{"$nulls":3},"Optional Contract Term"]
[null,"Number of Pharmacies Nationwide"]
[null,null,"Year 1 ","Year 2","Year 3","Year 4","Year 5","Year 6"]
[null,"Minimum AWP Discount Guarantees"," "," ",null," "," "," "]
[null,"Brand Drug Discount Guarantee","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount "]
[null,"Generic Effective Rate (MAC+Non-MAC) Discount Guarantee","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount "]
[null,"Generic Drug Non-Mac Discount Guarantee","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount "]
[null,"Maximum Dispensing Fee per Paid Claim"]
[null,"All Brands","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[null,"All Generics","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[null,"Administration Fees"]
[null,"  Per Paid Claim","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[null,"  Per Member Per Month","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[]
[null,"MAIL AT RETAIL (EXCLUDING SPECIALTY) "]
[null,null,"Mail at Retail Network"]
[null,null,"Base Contract Term",{"$nulls":3},"Optional Contract Term"]
[null,"Anchor Chains in Mail at Retail Network"]
[null,"Number of Pharmacies Nationwide"]
[null,null,"Year 1","Year 2","Year 3","Year 4","Year 5","Year 6"]
[null,"Minimum AWP Discount Guarantees "]
[null,"Brand Drug Discount Guarantee","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount "]
[null,"Generic Effective Rate (MAC+Non-MAC) Discount Guarantee","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount "]
[null,"Generic Drug Non-Mac Discount Guarantee","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount "]
[null,"Maximum Dispensing Fee per Paid Claim"]
[null,"All Brands","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[null,"All Generics","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[null,"Administration Fees"]
[null,"  Per Paid Claim","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[null,"  Per Member Per Month","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[]
[null,"MAIL ORDER (EXCLUDING SPECIALTY) "]
[null,null,"Base Contract Term",{"$nulls":3},"Optional Contract Term"]
[null,null,"Year 1","Year 2","Year 3","Year 4","Year 5","Year 6"]
[null,"Minimum AWP Discount Guarantees "]
[null,"Brand Drug Discount Guarantee","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount "]
[null,"Generic Effective Rate (MAC+Non-MAC) Discount Guarantee","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount "]
[null,"Generic Drug Non-Mac Discount Guarantee","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount ","Insert AWP discount "]
[null,"Maximum Dispensing Fee per Paid Claim"]
[null,"All Brands","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[null,"All Generics","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[null,"Administration Fees"]
[null,"  Per Paid Claim","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[null,"  Per Member Per Month","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[]
[null,"SPECIALTY (THROUGH YOUR PREFERRED SPECIALTY VENDOR)"]
[null,null,"Base Contract Term",{"$nulls":3},"Optional Contract Term"]
[null,null,"Year 1","Year 2","Year 3","Year 4","Year 5","Year 5"]
[null,"Open Network:"]
[null,"Minimum AWP Discount Guarantee: All Brands ","Insert Guaranteed Discount for all brands at Specialty ","Insert Guaranteed Discount for all brands at Specialty ","Insert Guaranteed Discount for all brands at Specialty ","Insert Guaranteed Discount for all brands at Specialty ","Insert Guaranteed Discount for all brands at Specialty ","Insert Guaranteed Discount for all brands at Specialty "]
[null,"Minimum AWP Discount Guarantee: All Generics","Insert Guaranteed Discount for all generics at Specialty ","Insert Guaranteed Discount for all generics at Specialty ","Insert Guaranteed Discount for all generics at Specialty ","Insert Guaranteed Discount for all generics at Specialty ","Insert Guaranteed Discount for all generics at Specialty ","Insert Guaranteed Discount for all generics at Specialty "]
[null,"Exclusive Network  - Exclusive of Manufacturer Payments"]
[null,"Minimum AWP Discount Guarantee: All Brands ","Insert Guaranteed Discount for all brands at Specialty ","Insert Guaranteed Discount for all brands at Specialty ","Insert Guaranteed Discount for all brands at Specialty ","Insert Guaranteed Discount for all brands at Specialty ","Insert Guaranteed Discount for all brands at Specialty ","Insert Guaranteed Discount for all brands at Specialty "]
[null,"Minimum AWP Discount Guarantee: All Generics","Insert Guaranteed Discount for all generics at Specialty ","Insert Guaranteed Discount for all generics at Specialty ","Insert Guaranteed Discount for all generics at Specialty ","Insert Guaranteed Discount for all generics at Specialty ","Insert Guaranteed Discount for all generics at Specialty ","Insert Guaranteed Discount for all generics at Specialty "]
[null,"Maximum Dispensing Fee per Paid Claim (Open and Exclusive)"]
[null,"All Brands and Generics","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[null,"Administration Fees"]
[null,"  Per Paid Claim","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[null,"  Per Member Per Month","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[]
[null,"Compound Drug Claims"]
[null,null,"Base Contract Term",{"$nulls":3},"Optional Contract Term"]
[null,"Level of Effort values (Non-Sterile Only)","Year 1","Year 2","Year 3","Year 4","Year 5","Year 6"]
[null,"11 - Single ingredient batched capsule; any combination of commercially available","Insert LOE Amt","Insert LOE Amt","Insert LOE Amt","Insert LOE Amt","Insert LOE Amt","Insert LOE Amt"]
[null,"12 - Two or Three ingredient batched capsule; transdermal gel","Insert LOE Amt","Insert LOE Amt","Insert LOE Amt","Insert LOE Amt","Insert LOE Amt","Insert LOE Amt"]
[null,"13 - Four or  more ingredient batched capsule; three or less ingredient cream/ointment/gel: suppository; two or less ingredient capsule: noncomplex suspension; tablet triturate","Insert LOE Amt","Insert LOE Amt","Insert LOE Amt","Insert LOE Amt","Insert LOE Amt","Insert LOE Amt"]
[null,"14 - Topical containing controlled ingredient; three or more ingredient troche; four or more ingredient capsule; complex suspensions (i.e. pediatric); custom capsule (includes rapid dissolution preparations); chemotherapy cream/ointment/gel; hormone therapy (capsules, troches, and suppositories).","Insert LOE Amt","Insert LOE Amt","Insert LOE Amt","Insert LOE Amt","Insert LOE Amt","Insert LOE Amt"]
[]
[null,"Generic Dispensing Rate (GDR) Guarantee"]
[null,null,"Base Contract Term",{"$nulls":3},"Optional Contract Term"]
[null,null,"Year 1","Year 2","Year 3","Year 4","Year 5","Year 6"]
[null,"Retail GDR Guarantee","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]
[null,"Mail GDR Guarantee","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt","Insert Guaranteed Amt"]

{"sheet":"RX-Pricing Other Costs","index":9,"n_rows":89,"n_cols":5,"rows_kept":89,"merged":[[2,1,2,4],[3,1,3,2],[6,1,6,4],[7,1,7,4],[8,1,8,2],[8,3,8,4],[11,1,11,4],[12,2,12,4],[34,2,34,4],[63,2,63,4],[75,2,75,4],[83,1,83,4],[84,2,84,3]]}
[]
[]
[null,{"$f":"Questionnaire!D3","v":"Request for PBM Proposal (RFP) for Arlington County Government"}]
[null,"RFP No. 21-HRD-RFP-141 - Pharmacy Plan"]
[null,"RX-Pricing, Other Costs"]
[]
[null,"Instructions: Please complete every cell on this worksheet.  Your financial offer MUST COMPLY with all Bidding Requirements and requirements in the Financial Questionnaire. All proposed terms are guaranteed. Please indicate the charges/fees associated with the following types of utilization management programs (Include charges for basic and optional programs). If charges vary depending on drug class, put a range in the corresponding cell, (ex.: $0.05-$0.08 PM)"]
[null,"Aon Identification Data"]
[null,"Vendor Name"]
[]
[]
[null,"Other Costs"]
[null,"Clinical Program Fee (Inclusive of all services listed below and any additional clinical programs developed throughout the life of the agreement)","[Insert PMPM fee here]"]
[null,"Services","Included in Pricing?","Basic","Optional"]
[null,"Customized Messages"]
[null,"Checks/Remittance/Processing Charge (unless indicated otherwise)"]
[null,"Charges for on-line adjudication (paid, reversed and denied claims)"]
[null,"Mail order claims integration"]
[null,"Specialty pharmacy claims integration"]
[null,"Toll-Free Numbers for Participants, Pharmacies and Providers"]
[null,"Member welcome packages including ID card production with medical vendor information for each member and delivery to household"]
[null,"Replacement ID cards (production and delivery to household)"]
[null,"Eligibility maintenance and support, including manual eligibility updates as needed"]
[null,"Hard copy of retail network listing when requested"]
[null,"Account management team and support "]
[null,"Designated implementation team and support"]
[null,"Support for open enrollment benefit fairs"]
[null,"Plan design set-up and maintenance"]
[null,"Point of Sale (POS) Manufacturer Payment Administration"]
[null,"Medical Pharmacy accumulator fees for OOPM"]
[null,"CDH support services (including bidirectional connectivity for exchanging accumulators)"]
[null,"SMS Mandated Annual Communications"]
[null,"E-prescribing Fees"]
[null,"Real time Medicare Part B COB"]
[null,"Clinical Programs:"]
[null,"Concurrent Drug Utilization Reviews (CDUR) - Base/Core"]
[null,"Concurrent Drug Utilization Reviews (CDUR) - Optional"]
[null,"Drug utilization review, Retrospective (RDUR) - Base/Core"]
[null,"Drug utilization review, Retrospective (RDUR) - Optional"]
[null,"Controlled substance excessive use (i.e. fraud and abuse) programs - Base/Core"]
[null,"Controlled substance excessive use (i.e. fraud and abuse) programs - Optional"]
[null,"Formulary management"]
[null,"Exception process for formulary exclusions (i.e., PA)"]
[null,"Medication adherence programs (e.g., refill reminders) - Base/Core"]
[null,"Medication adherence programs (e.g., refill reminders) - Optional"]
[null,"Medication Therapy Management programs "]
[null,"Communications to participants about lower cost alternatives (generics, mail, etc.) when available"]
[null,"Member access to web-based drug information"]
[null,"Member access to web-based patient claims history records"]
[null,"Member access to smart phone based drug information"]
[null,"Member access to smart phone based patient claims history records"]
[null,"Appeals (first level, second level and urgent)"]
[null,"Independent medical reviews"]
[null,"ACA external reviews"]
[null,"Electronic Prior Authorization - Base/Core (Does not apply to exclusive specialty)"]
[null,"Prior authorization - Base/Core (Does not apply to exclusive specialty)"]
[null,"Prior authorization - Optional (Does not apply to exclusive specialty)"]
[null,"Quantity duration/level limits (Does not apply to exclusive specialty)"]
[null,"Step therapy protocols. (Does not apply to exclusive specialty)"]
[null,"Disease Management programs - Base/Core (Does not apply to exclusive specialty)"]
[null,"Disease Management programs - Optional (Does not apply to exclusive specialty)"]
[null,"Smoking Cessation program (including counseling)"]
[null,"Please provide a list of clinical programs and associated fees not listed above"]
[null,"Data Reporting:"]
[null,"Access Charge"]
[null,"Access to web-based reporting"]
[null,"Hardware/Software access fees"]
[null,"Member profiling"]
[null,"Pharmacy profiling - Base/Core"]
[null,"Pharmacy profiling - Optional"]
[null,"Physician profiling - Base/Core"]
[null,"Physician profiling - Optional"]
[null,"Standard Reporting Package"]
[null,"Consultant Data Requests"]
[null,"Adhoc reports"]
[null,"Member-Directed Materials:"]
[null,"Claim Forms (e.g., direct member reimbursement, home delivery pharmacy, etc.)"]
[null,"Explanation of Benefits"]
[null,"Hard Copy of Formulary (or preferred drug list)"]
[null,"Communication and Marketing Materials"]
[null,"Toll-Free Numbers for Participants, Pharmacies and Providers"]
[]
[]
[null,"Credits / Allowances"]
[null,"Line of Business","Commercial"]
[null,"ALLOWANCE TYPE","Amount","Basis \n(Drop Down)"]
[null,"Pre-implementation Audit Credit"]
[null,"Pharmacy Management Fund (PMF) Allowance "]
[null,"Other Credit"]

{"sheet":"RX-Pricing MFP","index":10,"n_rows":37,"n_cols":8,"rows_kept":37,"merged":[[1,2,1,7],[2,1,2,7],[3,1,3,2],[6,1,6,7],[7,1,7,7],[8,2,8,7],[11,1,12,1],[11,2,12,7],[13,2,13,5],[13,6,13,7],[15,2,15,7],[16,2,16,7],[17,2,17,7],[25,1,26,1],[25,2,26,7],[27,2,27,7],[29,2,29,7],[30,2,30,7]]}
[]
[]
[null,{"$f":"Questionnaire!D3","v":"Request for PBM Proposal (RFP) for Arlington County Government"}]
[null,"RFP No. 21-HRD-RFP-141 - Pharmacy Plan"]
[null,"RX-Pricing, Manufacturer Payment Bid"]
[]
[null,"Instructions: Please complete every cell on this worksheet. For retail, please propose pricing for your broadest retail network. Your financial offer MUST COMPLY with all Bidding Requirements and requirements in the Financial Questionnaire. All proposed terms are guaranteed."]
[null,"Aon Identification Data"]
[null,"Vendor Name"]
[]
[]
[null,"BASED ON ALL PLAN DESIGNS WITHIN EXCLUSION FORMULARY","Guaranteed Manufacturer Payment Amount Per Brand Rx"]
[]
[null,null,"Base Contract Term",{"$nulls":3},"Optional Contract Term ((2) one year extensions))"]
[null,"Manufacturer Payment Percentage shared with the Plan",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
[null,"Guaranteed Minimum Manufacturer Payment per Paid Claim"]
[null,"Name of Formulary Proposed","Please insert the Name of the Formulary Proposed"]
[null,"Number of Excluded Products on Formulary as of today","Please specify the number of excluded products on Formulary"]
[null,null,"Year 1","Year 2","Year 3","Year 4","Year 5","Year 6"]
[null,"    Per Retail Brand Claim ","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim"]
[null,"    Per Retail 90 Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim"]
[null,"    Per Mail and \"Mail at Retail\" Brand Claim (excluding Specialty)","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim"]
[null,"    Per Retail Specialty Brand Claim (Non-preferred specialty vendor)","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim"]
[null,"    Per Specialty Brand Claim (Preferred Specialty Pharmacy)","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim"]
[]
[null,"BASED ON ALL PLAN DESIGNS WITHIN OPEN FORMULARY","Guaranteed Manufacturer Payment Amount Per Brand Rx"]
[]
[null,null,"Base Contract Term"]
[null,"Manufacturer Payment Percentage shared with the Plan",{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"},{"v":1,"d":"100%"}]
[null,"Guaranteed Minimum Manufacturer Payment per Paid Claim"]
[null,"Name of Formulary Proposed","Please insert the Name of the Formulary Proposed"]
[null,null,"Year 1","Year 2","Year 3","Year 4","Year 5","Year 6"]
[null,"    Per Retail Brand Claim ","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim"]
[null,"    Per Retail 90 Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim"]
[null,"    Per Mail and \"Mail at Retail\" Brand Claim (excluding Specialty)","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim"]
[null,"    Per Retail Specialty Brand Claim (Non-preferred specialty vendor)","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim"]
[null,"    Per Specialty Brand Claim (Preferred Specialty Pharmacy)","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim","Guaranteed Manufacturer Payment per Paid Brand Claim"]

{"sheet":"RX-Pricing Specialty Drugs","index":11,"n_rows":12,"n_cols":20,"rows_kept":12,"merged":[[2,1,2,4],[3,1,3,4],[6,1,6,4],[7,2,7,4],[9,1,9,6],[10,1,10,6],[10,14,10,15],[10,16,10,17],[10,18,10,19]]}
[]
[]
[null,{"$f":"Questionnaire!D3","v":"Request for PBM Proposal (RFP) for Arlington County Government"}]
[null,"RFP No. 21-HRD-RFP-141 - Pharmacy Plan"]
[null,"RX-Pricing, Specialty Drug List (Preferred Specialty Pharmacy/Mail)"]
[]
[null,"Aon Identification Data"]
[null,"Vendor Name"]
[]
[null,"Instructions: Please provide your list in alphabetic order by therapeutic class description; within in each therapeutic class description, please list the drug names in alphabetical order. All columns must be completed for each product listed."]
[null,"Discount is % off AWP on a post-rollback basis \nPlease use the GPI-4 Indicator for Therapeutic Class ID",{"$nulls":8},"Biosimilar","New to Market Specialty Drug","Limited Distribution","Is Your Preferred Specialty Pharmacy a Limited Distribution Vendor?","Specialty Retail (If not included in Non-Specialty Retail)",null,"Open Network Guaranteed Terms",null,"Exclusive Network Guaranteed Terms"]
[null,"Therapeutic Class ID GPI-4","Therapeutic Class Description (GPI-4)","Generic Drug Identifier (e.g. GCN or full GPI)","Drug Name","Strength","NDC","Dosage Form","Launch Date","Brand/ Generic","Yes / No","Yes / No","Yes / No","Yes / No","Discount","Disp Fee","Discount","Disp Fee","Discount","Disp Fee"]

{"sheet":"RX-Pricing Projections","index":12,"n_rows":21,"n_cols":11,"rows_kept":21,"merged":[[2,1,2,8],[3,1,3,4],[6,1,6,8],[13,3,13,6],[13,7,13,8]]}
[]
[]
[null,{"$f":"Questionnaire!D3","v":"Request for PBM Proposal (RFP) for Arlington County Government"}]
[null,"RFP No. 21-HRD-RFP-141 - Pharmacy Plan"]
[null,"RX-Pricing, Projections"]
[]
[null,"Instructions: Please complete every cell on this worksheet. Your offer MUST COMPLY with all Bidding Requirements and requirements in the Financial Questionnaire and reflect the pricing inputs in the Rx, Pricing Sections of this workbook."]
[null,"Aon Identification Data"]
[null,"Vendor Name"]
[]
[]
[]
[null,"Calculation","Spend Component","Year 1","Year 2","Year 3","Year 4","Year 5","Year 6"]
[{"$nulls":3},"Base Contract Term",{"$nulls":3},"Optional Contract Term ((2) one year extensions))",null,null," "]
[null,1,"Ingredient Costs","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]"]
[null,2,"Dispensing Fees","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]"]
[null,"3 (1+2)","Projected Costs","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]"]
[null,4,"Administrative Fees","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]"]
[null,5,"Clinical Program Fees","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]"]
[null,6,"Total Manufacturer Payments (guarantees)","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]"]
[null,"3+4+5-6","Total Net Drug Spend","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]","[Insert Response]"]

{"sheet":"Account Team","index":13,"n_rows":35,"n_cols":3,"rows_kept":35,"hidden":true,"merged":[[2,1,2,2],[5,1,5,2]]}
[]
[]
[null,{"$f":"Questionnaire!D3","v":"Request for PBM Proposal (RFP) for Arlington County Government"}]
[null,"Account Management"]
[]
[null,"Instructions: Please complete every cell on this worksheet. Your offer MUST COMPLY with all Bidding Requirements and requirements in the Financial Questionnaire. All proposed terms are guaranteed."]
[null,"Aon Identification Data"]
[null,"Vendor Name"]
[]
[]
[]
[null,"Account Team Role","Proposed Account Team for [Client Name]"]
[null,"Executive Sponsor"]
[null,"Name","[Insert Response]"]
[null,"Title","[Insert Response]"]
[null,"Length of Service","[Insert Response]"]
[null,"Account Executive"]
[null,"Name","[Insert Response]"]
[null,"Total Number of Clients under Management","[Insert Response]"]
[null,"Total Number of Lives under Management","[Insert Response]"]
[null,"Length of Service","[Insert Response]"]
[null,"Account Manager"]
[null,"Name","[Insert Response]"]
[null,"Total Number of Clients under Management","[Insert Response]"]
[null,"Total Number of Lives under Management","[Insert Response]"]
[null,"Length of Service","[Insert Response]"]
[null,"Clinical Account Manager"]
[null,"Name","[Insert Response]"]
[null,"Credentials","[Insert Response]"]
[null,"Total Number of Clients under Management","[Insert Response]"]
[null,"Total Number of Lives under Management","[Insert Response]"]
[null,"Length of Service","[Insert Response]"]
[null,"Financial Analyst"]
[null,"Name","[Insert Response]"]
[null,"Length of Service","[Insert Response]"]

{"sheet":"Geo Access Request","index":14,"n_rows":58,"n_cols":7,"rows_kept":58,"hidden":true,"merged":[[1,3,1,6],[2,1,2,6],[5,1,5,6],[6,1,6,6],[7,1,7,2],[7,3,7,6],[11,1,12,2],[11,3,11,6],[36,1,37,2],[36,3,36,6]]}
[]
[]
[null,{"$f":"Questionnaire!D3","v":"Request for PBM Proposal (RFP) for Arlington County Government"}]
[null,"Geo-Access"]
[]
[null,"Instructions: Please complete every cell on this worksheet, based on the access standards specified below. "]
[null,"Aon Identification Data"]
[null,"Vendor Name"]
[]
[]
[]
[1,"Network #1: Broadest Retail Network:",null,"Mileage Standard Measured in Driving Distance"]
[{"$nulls":3},"Urban (1.5 M)","Suburban (3 M)","Rural (10 M)","Total"]
[null,"A.","Total number of network pharmacies within access standard"]
[null,"B.","Number of members on census file"]
[null,"C.","Number of members included in geo-analysis"]
[null,"D.","Number of members not included in geo-analysis"]
[null,"E.","Number of members with access to at least one network pharmacy within standard"]
[null,"F.","Number of members without access to at least one network pharmacy within standard (Line C-E)"]
[null,"G.","Number of members without access because no pharmacy exists within access standard"]
[null,"H.","Number of members without access because a pharmacy exists but is not in the proposed network (Line F-G)"]
[]
[]
[null,null,"Questions"]
[null,2,"Explain why the members in D. were not included in the geo-analysis for the proposed network."]
[null,3,"Please attach a listing of those pharmacies identified in Line H above, including:"]
[null,null,"NCPDP number"]
[null,null,"Name of Pharmacy"]
[null,null,"Address (Street, city, state, zip)"]
[null,4,"Please attach a summary of the zip codes where access standards are not met."]
[null,5,"Briefly describe your methodology for geo-analysis, including:"]
[null,null,"software used and when last updated"]
[null,null,"definition of distance if not driving distance"]
[null,null,"other assumptions and approach"]
[]
[]
[6,"Network #2: Retail 90 Network:",null,"Mileage Standard Measured in Driving Distance"]
[{"$nulls":3},"Urban (1.5 M)","Suburban (3 M)","Rural (10 M)","Total"]
[null,"A.","Total number of network pharmacies within access standard"]
[null,"B.","Number of members on census file"]
[null,"C.","Number of members included in geo-analysis"]
[null,"D.","Number of members not included in geo-analysis"]
[null,"E.","Number of members with access to at least one network pharmacy within standard"]
[null,"F.","Number of members without access to at least one network pharmacy within standard (Line C-E)"]
[null,"G.","Number of members without access because no pharmacy exists within access standard"]
[null,"H.","Number of members without access because a pharmacy exists but is not in the proposed network (Line F-G)"]
[]
[null,null,"Questions"]
[null,7,"Explain why the members in D. were not included in the geo-analysis for the proposed network."]
[null,8,"Please attach a listing of those pharmacies identified in Line H above, including:"]
[null,null,"NCPDP number"]
[null,null,"Name of Pharmacy"]
[null,null,"Address (Street, city, state, zip)"]
[null,9,"Please attach a summary of the zip codes where access standards are not met."]
[null,10,"Briefly describe your methodology for geo-analysis, including:"]
[null,null,"software used and when last updated"]
[null,null,"definition of distance if not driving distance"]
[null,null,"other assumptions and approach"]

{"sheet":"Hold Harmless","index":15,"n_rows":9,"n_cols":2,"rows_kept":9,"hidden":true}
[]
[]
[null,{"$f":"Questionnaire!D3","v":"Request for PBM Proposal (RFP) for Arlington County Government"}]
[null,"Hold Harmless Language"]
[]
[null,"You agree to the following Hold Harmless language:"]
[]
[null,"Hold Harmless"]
[null,"By submitting a response to this RFP, you agree to indemnify and hold harmless Aon, its directors, officers, employees and agents against any and all liability, loss, damage or expense (including reasonable attorney’s fees and costs) which may arise or result from your fraudulent or willful misconduct or from your responses to and participation in this RFP solicitation."]

{"sheet":"Officer Statement","index":16,"n_rows":32,"n_cols":2,"rows_kept":32,"hidden":true,"merged":[[2,1,2,2],[8,1,8,2],[24,1,24,2]]}
[]
[]
[null,{"$f":"Questionnaire!D3","v":"Request for PBM Proposal (RFP) for Arlington County Government"}]
[null,"Officer Certification"]
[]
[null,"Please have an Officer review and sign this worksheet to confirm the information is valid."]
[null,"Please include the completed form with your proposal."]
[]
[null,"OFFICER'S STATEMENT"]
[null,"PBM Vendor Legal Name"]
[null,"PBM Vendor Marketing Name"]
[null,"Street Address"]
[null,"City"]
[null,"State"]
[null,"Zip"]
[null,"Phone Number"]
[null,"Fax Number"]
[null,"Web Address"]
[null,"Name of Officer completing statement"]
[null,"Title of Officer completing statement"]
[null,"Phone Number of Officer completing statement"]
[null,"Email Address of Officer completing statement"]
[]
[]
[null,"I certify that our response to Aon's Request for Proposal is complete and accurate to the best of my knowledge and contains no material omissions or misstatements. I acknowledge that Aon's clients will rely upon the information included in our response to make decisions concerning the pharmacy benefit management services that are offered to their employees."]
[]
[]
[]
[null,"Officer's Signature"]
[]
[]
[null,"Date Signed"]

{"sheet":"Explanation","index":17,"n_rows":12,"n_cols":3,"rows_kept":12,"merged":[[2,1,2,2],[3,1,3,4]]}
[]
[]
[null,{"$f":"Questionnaire!D3","v":"Request for PBM Proposal (RFP) for Arlington County Government"}]
[null,"RFP No. 21-HRD-RFP-141 - Pharmacy Plan"]
[null,"Explanation"]
[]
[null,"This worksheet should be used to provide additional explanations for any questions for which a \"See Explanation\" response "]
[null,"was given.  Explanations must be numbered to correspond to the question to which they pertain and they must be brief."]
[]
[null,"State the number of questions you addressed with further explanation:"]
[]
[null,"Section/ Question #","Explanation"]