City of Stockton
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REQUEST FOR PROPOSALS (RFP)
TO PROVIDE PHARMACY BENEFIT MANAGEMENT SERVICES
FOR THE CITY OF STOCKTON, CALIFORNIA
(PUR 12-005)
NOTICE INVITING PROPOSALS 1
PROPONENT'S CHECKLIST 2
1.0 GENERAL INFORMATION 3
1.1 REQUEST FOR PROPOSAL (RFP) PROCESS 3
1.2 INVITATION TO SUBMIT A PROPOSAL 3
1.3 LOCAL BUSINESS PREFERENCE 3
1.4 LOCAL EMPLOYMENT—PUBLIC WORKS CONTRACTORS 3
1.5 CONSEQUENCE OF SUBMISSION OF PROPOSAL 4
1.6 ACCEPTANCE OR REJECTION OF PROPOSAL 4
1.7 RIGHT TO CHANGE OR AMEND REQUEST 4
1.8 CANCELLATION 5
1.9 EXAMINATION OF PROPOSAL MATERIALS 5
1.10 ADDENDA AND INTERPRETATION 5
1.11 DISQUALIFICATION 6
1.12 INFORMAL PROPOSAL REJECTED 6
1.13 CONDITIONS TO BE ACCEPTED IF WORK IS SUBCONTRACTED 6
1.14 LICENSING REQUIREMENTS 7
1.15 INSURANCE REQUIREMENTS 7
1.16 HOLD HARMLESS DEFENSE CLAUSE 7
1.17 APPLICABLE LAW 7
1.18 METHOD OF PAYMENT 8
1.19 NOTICE TO OUT-OF-STATE VENDOR 8
1.20 TERM 8
1.21 COMPETITIVE PRICING 8
1.22 FUNDING 8
1.23 UNCONDITIONAL TERMINATION FOR CONVENIENCE 8
1.24 AUDITING OF CHARGES AND SERVICES 9
1.25 PROPOSAL SECURITY 9
1.26 CONTRACT BONDS 9
1.27 CHANGES 9
1.28 AWARD 9
1.29 LIQUIDATED DAMAGES 9
1.30 PRODUCT OWNERSHIP 9
1.31 CONFIDENTIALITY 9
1.32 OTHER GOVERNMENTAL AGENCIES 10
2.0 BACKGROUND 11
2.1 SCOPE OF WORK 12
2.2 LICENSED EMPLOYER GROUP WAIVER PLAN SERVICES 13
2.3 ADDITIONAL CONSIDERATIONS 14
3.0 PROPOSAL GUIDELINES, CONTENT AND FORMAT 15
3.1 EVALUATION PROCEDURE AND CRITERIA 17
3.2 PROPOSED DEVELOPMENT COSTS 18
3.3 PROPONENT CONTACT 18
3.4 CITY’S USE OF PROPOSAL MATERIAL 18
3.5 REJECTION OF PROPOSAL 18
PROPONENT’S SUBMITTAL 19
PROPONENT’S AGREEMENT 20
NON-COLLUSION AFFIDAVIT 21
BIDDER’S QUESTIONNAIRE 22
VENDOR INFORMATION SHEET 39
PROPONENT’S SUBMITTAL (UNDER SEPARATE COVER) 40
EXHIBIT 1 (INSURANCE REQUIREMENTS) 60
ATTACHMENT A - MEDICAL/PHARMACY PLAN DESIGNS 62
ATTACHMENT B - PAID PHARMACY CLAIMS DATA 65
ATTACHMENT C – SAMPLE CITY CONTRACT 66
NOTICE INVITING PROPOSALS
NOTICE IS HEREBY GIVEN that Request for Proposals (RFP) are invited by the City of Stockton, California to provide Pharmacy Benefit Management Services (PUR 12-005) in strict accordance with the specifications.
The City is seeking proposals from firms to provide pharmacy benefit management services to employees and retirees who participate in the City of Stockton’s self-insured medical plan. These services include retail, mail order and specialty medications/injectables, and administrative services in support of the City’s Medicare Part D subsidy.
Proposal forms and specifications are available on the City’s web site at and must be delivered to the Office of the City Clerk, City Hall, 425 North El Dorado Street, Stockton, up to but not later than, Thursday, February 23, 2012, at 2:00 p.m.
The City reserves the right to reject any and/or all proposals received.
Information on Technical Data Information on Bid Process/Clarification
Tami Matuska, Human Resources Dept. Dianne Samples, Purchasing Division
(209) 937-8865 (209) 937-7130
E-mail: Tami.Matuska@ e-mail: Dianne.Samples@
DISCLAIMER: The City does not assume any liability or responsibility for errors/omissions in any document transmitted electronically.
Dated: February 7, 2012
//s//BONNIE PAIGE
CITY CLERK OF THE CITY OF STOCKTON
PROPONENT'S CHECKLIST
CITY OF STOCKTON / PURCHASING DIVISION
Did You:
*___ Complete the following proposal documents (FROM THIS PACKET ONLY SUBMIT PAGES 19 to 39 AND PLACE IN THE FRONT OF YOUR PROPOSAL. ADDITIONALLY, SUBMIT PAGES 40 THROUGH 59 UNDER SEPARATE COVER WITH YOUR FEE SCHEDULE).
*___ Sign and notarize by jurat certificate the "Non-Collusion Affidavit" form. An "All-Purpose Acknowledgment" form will not be sufficient.
*___ Complete and sign the "Proponent's Fee Schedule" form, (under separate cover). Include pages 40 through 59 and fee schedule (under separate cover).
*___ Sign the "Proponent’s Agreement" form. Include (with proposal) name and e-mail address for City contact, if different from signatory.
*___ Include your $-0.00 proponent's security, proponents bond, certified or cashier's check.
NOTE: As information, the City will NOT accept company or personal checks for proposal security
*___ Include self-addressed, unstamped envelope (#10, 4- 1/8 x 9- 1/2) with proponent’s security. Please DO NOT seal your security, proponent’s bond, certified or cashier’s check in this envelope. It is for returning the security to the proponent AFTER project award.
*___ Submit one (1) ORIGINAL and SIX (6) COPIES of all proposal documents (unbound, no staples). Additionally, submit one (1) CD with an electronic version of the proposal and all proposal documents.
*___ Review all clarifications/questions/answers on the City’s website at .
*___ Deliver sealed proposal to City Hall, City Clerk's Office (1st floor), 425 North El Dorado Street, Stockton, CA 95202, before February 23, 2012, at 2:00 p.m. Sealed proposal shall be marked "Proposal" and indicate project name, number, and proposal opening date. Please note that some overnight delivery services do not deliver directly to the City Clerk's Office. This could result in the proposal arriving in the City Clerk's Office after the proposal opening deadline and therefore not being accepted.
A) “RFP – TO PROVIDE PHARMACY BENEFIT MANAGEMENT SERVICES”
B) PUR 12-005
C) FEBRUARY 23, 2012
CONTACT INFORMATION:
|Information on Technical Data |Information on Bid Process/Clarification |
|Tami Matuska, Human Resources Department |Dianne Samples, Purchasing Division |
|(209) 937-8865 |(209) 937-7130 |
|e-mail: Tami.Matuska@ |e-mail: Dianne.Samples@ |
*If not completed as required, your proposal may be rejected.
DISCLAIMER: The City does not assume any liability or responsibility for errors/omissions in any document transmitted electronically.
1.0 GENERAL INFORMATION
1.1 REQUEST FOR PROPOSAL (RFP) PROCESS
The purpose of this Request for Proposal (RFP) is to request proponents to present their qualifications and capabilities to provide pharmacy benefit management services (PUR 12-005) for the City of Stockton.
1.2 INVITATION TO SUBMIT A PROPOSAL
Proposals shall be submitted no later than 2:00 p.m., on Thursday, February 23, 2012, in the office of:
CITY CLERK
CITY OF STOCKTON
425 NORTH EL DORADO STREET
STOCKTON, CA 95202-1997
One (1) original and SIX (6) copies of the proposal shall be submitted. Additionally, submit one (1) CD with an electronic version of the proposal. The proposal should be firmly sealed in an envelope which shall be clearly marked on the outside, "RFP to Provide Pharmacy Benefit Management Services for the City of Stockton (PUR 12-005)." Any proposal received after the due date and time indicated may not be accepted and may be rejected and returned, unopened, to the proponent.
1.3 LOCAL BUSINESS PREFERENCE
Stockton Municipal Code Section 3.68.090 reads as follows:
Preference shall be given to the purchase of supplies, materials, equipment and contractual services from local merchants, quality and price being equal. Local merchants who have a physical business location within the boundaries of San Joaquin County, and who have applied for and paid a business license tax and registration fee pursuant to Stockton Municipal Code Chapter 5.08 shall be granted a three (3) percent bid preference. The three (3) percent preference shall be based on the amount of that portion of the bid which is subject to sales tax. This is intended to provide preference in the award of certain City contracts in order to encourage businesses to move into the City. (Prior code § 3-106.1)
1.4 LOCAL EMPLOYMENT—PUBLIC WORKS CONTRACTORS
Proponent must comply with City of Stockton Municipal Code (SMC) Section 3.68.095, Ordinance No. 011-09 adopted September 1, 2009, effective October 1, 2009.
1.5 CONSEQUENCE OF SUBMISSION OF PROPOSAL
A. The City shall not be obligated to respond to any proposal submitted nor be legally bound in any manner by the submission of a proposal.
B. Acceptance by the City of a proposal obligates the proponent to enter into an agreement with the City.
C. An agreement shall not be binding or valid against the City unless or until it is executed by the City and the proponent.
D. Statistical information contained in these documents is for informational purposes only. The City shall not be responsible for the accuracy of said data. City reserves the right to increase or decrease the project scope.
1.6 ACCEPTANCE OR REJECTION OF PROPOSAL
The City reserves the right to select the successful proposal and negotiate an agreement as to the scope of services, the schedule for performance and duration of the services with proponent(s) whose proposal(s) is/are most responsive to the needs of the City. Further, the City reserves the right to reject any and all proposals, or alternate proposals, or waive any informality or irregularity in the proposal as is in the City's best interest.
The City reserves the right to reject any and all proposals, or portions thereof, received in response to the Request or to negotiate separately with any source whatsoever, in any manner necessary, to serve the best interests of the City. Additionally, the City may, for any reason, decide not to award an agreement(s) as a result of this Request.
Non-acceptance of any proposal shall not imply that the proposal was deficient. Rather, non-acceptance of any proposal will mean that another proposal was deemed to be more advantageous to the City or that the City decided not to award an agreement as a result of this Request.
1.7 RIGHT TO CHANGE OR AMEND REQUEST
The City reserves the right to change the terms and conditions of this Request. The City will notify potential proponent(s) of any material changes by posting on the City’s website. No one is authorized to amend any of the Request requirements in any respect, by an oral statement, or to make any representation or interpretation in conflict with its provisions. If necessary, supplementary information and/or clarifications/questions/answers will be posted on the City’s website at . Failure of any proponent to not have received such information and/or clarifications/questions/answers shall not relieve such proponent from any obligation under his/her proposal as submitted.
Any exceptions to this Proposal shall be clearly stated in writing.
1.8 CANCELLATION
The City reserves the right to rescind award of the contract at any time before execution of the contract by both parties if rescission is deemed to be in City’s best interest. In no event shall City have any liability for the rescission of award. The proponent assumes the sole risk and responsibility for all expenses connected with the preparation of its proposal.
1.9 EXAMINATION OF PROPOSAL MATERIALS
The submission of a proposal shall be deemed a representation and warranty by the proponent that it has investigated all aspects of the Request, that it is aware of the applicable facts pertaining to the Request process and its procedures and requirements, and that it has read and understands the Request. No request for modification of the provisions of the proposal shall be considered after its submission on the grounds the proponent was not fully informed as to any fact or condition. Statistical information which may be contained in the Request or any addendum is for informational purposes only. The City disclaims any responsibility for this information which may subsequently be determined to be incomplete or inaccurate.
1.10 ADDENDA AND INTERPRETATION
The City will not be responsible for, nor be bound by, any oral instructions, interpretations, or explanations issued by the City or its representatives. Any request for clarifications/questions/answers of this Request shall be made in writing/e-mail and deliverable to:
CITY OF STOCKTON CITY OF STOCKTON
ATTN: TAMI MATUSKA ATTN: DIANNE SAMPLES
HUMAN RESOURCES DEPARTMENT PURCHASING DIVISION
425 NORTH EL DORADO STREET 425 NORTH EL DORADO STREET
STOCKTON, CA 95202-1997 STOCKTON, CA 95202-1997
Tami.Matuska@ Dianne.Samples@
Such request for clarifications/questions/answers shall be delivered to the City at least ten (10) calendar days prior to the date for receipt of proposals. Any City response to a request for clarifications/questions/answers will be posted on the City’s website at (not later than five (5) calendar days prior to the due date), and will become a part of the Request. The proponent should await responses to inquires prior to submitting a proposal.
1.11 DISQUALIFICATION
Any of the following may be considered cause to disqualify a proponent without further consideration:
A. Evidence of collusion among proponents;
B. Any attempt to improperly influence any member of the evaluation panel;
C. Any attempt to communicate in any manner with a City of Stockton elected official during the RFP/bid process will, and shall be, just cause for disqualification/rejection of proponent’s proposal/proponent’s bid submittal and considered non-responsive.
D A proponent's default in any operation of a professional services agreement which resulted in termination of that agreement; and/or
E. Existence of any lawsuit, unresolved contractual claim, or dispute between proponent and the City.
F. No person, firm, or corporation shall be allowed to make or file or be interested in more than one bid for the same supplies, services, or both; provided, however, that subcontract bids to the principal bidders are excluded from the requirements of this section: Section 3.68.120 of the Municipal Code.
1.12 INFORMAL PROPOSAL REJECTED
A proposal shall be prepared and submitted in accordance with the provisions of these Request instructions and specifications. Any alteration, omission, addition, variance, or limitation of, from, or to a proposal may be sufficient grounds for rejection of the proposal. The City has the right to waive any defects in a proposal if the City chooses to do so. The City may not accept a proposal if any document or item necessary for the proper evaluation of the proposal is incomplete, improperly executed, indefinite, ambiguous, or missing.
1.13 CONDITIONS TO BE ACCEPTED IF ANY WORK IS SUBCONTRACTED
A. The proponent assumes full responsibility, including insurance and bonding requirements, for the quality and quantity of all work performed.
B. If proponent's supplier(s) and/or subcontractor's involvement requires the use of a licensed, patented, or proprietary process, the proponent of the process is responsible for assuring that the subcontractor, supplier, and/or operator have been properly authorized to use the process or for providing another process which is comparable to that which is required prior to submission of a proposal.
1.14 LICENSING REQUIREMENTS
Any professional certifications or licenses that may be required will be the sole cost and responsibility of the successful proponent.
A City of Stockton Business license may be required for this project. Please contact the City of Stockton Business License Division at (209) 937-8313.
1.15 INSURANCE REQUIREMENTS
Proponent, at Proponent's sole cost and expense and for the full term of the resultant contract or any extension thereof, shall obtain and maintain at least all of the insurance requirements listed in attached Exhibit 1.
All coverage shall be provided by a carrier authorized to transact business in California and shall be primary. All policies, endorsements, and certificates shall be subject to approval by the Risk Manager of the City to Stockton as to form and content. These requirements are subject to amendment or waiver if so approved in writing by the Risk Manager.
Maintenance of proper insurance coverage is a material element of this contract and that failure to maintain or renew coverage or to provide evidence of renewal may be treated as a material breach of contract.
The Proponent shall satisfy these insurance requirements concurrently with the signing of the contract prior to commencement of work. Please contact City of Stockton Risk Services at (209) 937-5037.
1.16 HOLD HARMLESS DEFENSE CLAUSE
The contractor shall defend, indemnify, and hold harmless City, its officers, officials, employees, and volunteers from and against all claims, damages, losses, and expenses, including attorney fees arising out of the performance of the work described herein, caused in whole or in part by any negligent act or omission of Contractor, any sub-contractor, anyone directly or indirectly employed by any of them, or anyone for whose acts any of them may be liable, except where caused by the active negligence, sole negligence, or willful misconduct of the City.
1.17 APPLICABLE LAW
This agreement shall be governed by the laws of the State of California. Venue shall be proper in the Superior Court of the State of California, County of San Joaquin, Stockton Branch, or, for actions brought in Federal Court, the United States District Court for the Eastern District of California, Sacramento Division.
1.18 METHOD OF PAYMENT
Payment will be made within thirty (30) days after invoices are received and accepted by the City Manager. Invoices are to be rendered monthly.
1.19 NOTICE TO OUT-OF-STATE VENDOR
Sales and use tax on purchases made by the City of Stockton from all companies located outside California and whose products are shipped from out of state will be remitted to the BOE directly by the City under permit number SR KHE 28-051174 DP. Please do not include sales/use tax on the invoice that you submit to the City of Stockton.
Questions regarding the City of Stockton’s payment of sales/use tax can be directed to the City of Stockton’s Purchasing Division at (209) 937-8357.
1.20 TERM
Anticipated contract award is 3 years with the option to renew for 2 additional one-year periods. The projected start date is July 1, 2012.
1.21 COMPETITIVE PRICING
Proponent warrants and agrees that each of the charges, economic or product terms or warranties granted pursuant to this Contract are comparable to or better than the equivalent charge, economic or product term or warranty being offered to any similarly situated commercial or other government customer of proponent. If proponent enters into any arrangements with another customer of proponent to provide product under more favorable charges, economic or product terms or warranties, proponent shall immediately notify CITY of such change and this Contract shall be deemed amended to incorporate the most favorable charges, economic or product terms or warranties.
1.22 FUNDING
Any contract which results from this Request will terminate without penalty at the end of the fiscal year in the event funds are not appropriated for the next fiscal year. If funds are appropriated for a portion of the fiscal year, this contract will terminate without penalty, at the end of the term for which funds are appropriated.
1.23 UNCONDITIONAL TERMINATION FOR CONVENIENCE
The City may terminate the resultant agreement for convenience by providing sixty (60) calendar day advance notice unless otherwise stated in writing.
1.24 AUDITING OF CHARGES AND SERVICES
The City reserves the right to periodically audit all charges and services made by the successful proponent to the City for services provided under the contract. Upon request, the proponent agrees to furnish the City with necessary information and assistance.
1.25 PROPOSAL SECURITY
Not applicable to this project.
1.26 CONTRACT BONDS
Not applicable to this project.
1.27 CHANGES
The City’s representative has the authority to review and recommend or reject change orders and cost proposals submitted by the proponent or as recommended by the proponent’s project manager, pursuant to the adopted City of Stockton Standard Specifications.
1.28 AWARD
Upon conclusion of the Request process, a contract may be awarded to provide pharmacy benefit management services for the City of Stockton.
The City reserves the right to select the successful proponent and to negotiate terms of a contract with the proponent(s) whose proposal(s) is/are most responsive to the needs of the City. Further, the City reserves the right to reject any and all proposals, or alternate proposals, or waive any informality in the proposal as is in the City's best interest.
1.29 LIQUIDATED DAMAGES
Not applicable to this project.
1.30 PRODUCT OWNERSHIP
Any documents, products or systems resulting from the contract will be the property of the City of Stockton.
1.31 CONFIDENTIALITY
If proponent believes that portions of a proposal constitute trade secrets or confidential commercial, financial, geological, or geophysical data, then the proponent must so specify by, at a minimum, stamping in bold red letters the term "CONFIDENTIAL" on that part of the proposal which the proponent believes to be protected from disclosure. The proponent must submit in writing specific detailed reasons, including any relevant legal authority, stating why the proponent believes the material to be confidential or a trade secret. Vague and general claims as to confidentiality will not be accepted. The City will be the sole judge as to whether a claim is general and/or vague in nature. All offers and parts of offers that are not marked as confidential may be automatically considered public information after the contract is awarded. The proponent is hereby put on notice that the City may consider all or parts of the offer public information under applicable law even though marked confidential.
1.32 OTHER GOVERNMENTAL AGENCIES
If mutually agreeable to all parties, the use of any resultant contract/purchase order may be extended to other political subdivisions, municipalities, or tax supported agencies.
Such participating governmental bodies shall make purchases in their own name, make payment directly to successful Proponent and be liable directly to the successful Proponent, holding the City of Stockton harmless.
2.0 BACKGROUND
The City offers one self-insured plan to its active employees and two self-insured plans to its retired employees. The City’s predominant plan is the “Modified” plan, which is offered to both active and retired employees. The City’s “Original” plan is a closed plan for retired employees only. Delta Health Systems is the City’s Third Party Administrator for claims administration.
Medco provides prescription drug services for participants in the self-insured plans only. The City is seeking proposals for pharmacy benefit management services currently provided by Medco on a self-insured basis.
The City currently participates in the Medicare Part D prescription drug subsidy program.
The City also offers a new Kaiser plan for its active employees effective September 1, 2011 which has about 87 active participants.
The City is also considering implementing a Medicare Employer Group Waiver Plan (EGWP) at the same benefit levels as the current plan, where permitted by CMS in lieu of the current Medicare Retiree Drug Subsidy (RDS) option. Proponents shall provide pricing for both the EGWP and RDS option with proponent's fee schedule, (under separate cover).
Enrollment
| |As of September 2011 |
|Modified Plan | |
|Actives |1,143 |
|Non-Medicare Retirees |683 |
|Medicare Retirees |327 |
|Original Plan | |
|Non-Medicare Retirees |1 |
|Medicare Retirees |50 |
|Total |2,204 |
Contributions
Effective July 1, 2011, the City has negotiated a fixed single, two-party, family contribution for active benefits as $481, $875 and $1,165 for health benefits. Contributions by the City vary for retirees based upon year of employment and bargaining agreement.
Plan Design
Modified Plan
| |Retail ( 30 day supply) |Mail ( 90 day supply) |
|Generic |$10 |$20 |
|Formulary Brand |$35 |$70 |
|Non –Formulary Brand |50% |50% |
Please note that the City implemented a mandatory mail order plan effective 1/1/2012; however, we are requesting proposals with and without mandatory mail.
Original Plan
$1 co-pay for generic and brand drugs for retail only for up to a 34-day supply.
Eligibility
Please refer to Attached Appendix A
2.1 SCOPE OF WORK
The City is seeking proposals from firms that can provide services to employees and retirees who participate in the City of Stockton self-insured medical plan. The Prescription Benefit Management (PBM) services include retail, mail order, and specialty medications/injectables, and administrative services in support of the City’s Medicare Part D subsidy. This projected effective contract start date is July 1, 2012.
The scope of work includes, but may not be limited to, the following criteria.
2.1.1 Account Management
Provide a designated Account Manager and Account Management Team.
2.1.2 Customer Service
Provide customer service to answer inquiries on claims, eligibility, provider network, services, coverages, or other inquiries from participants Monday through Friday from 8:00 AM to 5:00 PM (PST)
2.1.3 Enrollment Support
➢ Prepare and provide Benefit Presentations
➢ Attend Open Enrollment Meetings in Stockton, California
➢ Printing & Distribution of customized ID cards (Dual use: Medical & Pharmacy) with personalized letters and copies of the pharmacy directories
2.1.4 Communication/Education Materials
➢ Provide bilingual communication/educational materials
➢ Patient and Provider Education
2.1.5 Claims Administration
➢ Provide claims forms
➢ Receive claims and process payments of benefits in accordance with the plan designs for all claims incurred
➢ Correspond with participants and providers if additional information is necessary to complete the processing of claims
➢ Determine, based on the City’s medical necessity guidelines, benefits payable under the Plan, pursuant to the terms and conditions of the City’s Benefit Plan booklet All Levels of Claim Appeals
2.1.6 Eligibility/Enrollment Administration
Member enrollment and eligibility maintenance coordinated with the City’s third party administrator
2.1.7 Network Management
➢ Network Pharmacy Management
➢ Formulary Management and Rebate Sharing
➢ Cost management services
2.1.8 Medicare Part D Services
➢ Retiree List Submission
➢ Cost Reporting
➢ Reconciliation
➢ Participant communication
3 LICENSED EMPLOYER GROUP WAIVER PLAN SERVICES
2.2.1 Health Management Services
➢ Systematic Prospective, Concurrent and Retroactive Drug Utilization Review medications covered under the “Specialty Self-Injectable Medication” benefit, certain medications covered under the “Retail and Mail Order Pharmacy” benefit (if these medications are available under the benefit plan).
2. Data Reporting
➢ Data reporting as outlined in your proposal response.
4 ADDITIONAL CONSIDERATIONS
2.3.1 The City is considering implementing a Medicare Employer Group Waiver Plan (EGWP) at the same benefit levels as the current plan, where permitted by CMS in lieu of the current Medicare Retiree Drug Subsidy (RDS) option. Proponents shall provide pricing for both the EGWP and RDS option with proponent's fee schedule, (under separate cover). If your proposed pricing will vary depending on whether the EGWP or RDS option is selected please indicate the pricing that applies to each option. Additionally, please provide cost proposals under the following assumptions:
➢ With Mandatory Mail Order, excluding EGWP participants
➢ Without Mandatory Mail order
2. Pricing should be provided on a transparent basis.
3.0 PROPOSAL GUIDELINES, CONTENT AND FORMAT
The City of Stockton uses a qualifications-based selection process in obtaining these services. In order for the City to properly evaluate the Proponents qualification to perform this work, the proposals shall include, as a minimum, the following information:
A. Evidence of the Proponent’s ability to be responsive to this project in regard to timeliness and expertise, including availability of staff proposed to be assigned.
B. The Proponents are encouraged to expand on the Scope of Work to demonstrate their expertise. Evaluation of the proposals will be based on qualifications, the experience of staff proposed to be assigned to the project, references and thoroughness of the proponent’s response to the Scope of Services.
C. Such additional information that the Proponent may feel would be pertinent to assist the City of Stockton in making its final decision.
D. Please submit one (1) original and six (6) copies of your proposal/qualifications. One of the copies should be unbound to allow us to reproduce your proposal, as needed. Additionally, submit one (1) CD with an electronic version of the proposal and all submitted proposal documents.
3.0.1 Cover Letter
Submit a letter on your company letterhead addressing the proposal and format. The letter should be signed by an officer of the firm authorized to bind the firm to all comments made in the proposal, and shall include the name, address, phone number and e-mail address of the person(s) to contact who will be authorized to represent your firm.
3.0.2 Minimum Experience Qualifications Summary
A statement of professional experience and ability.
3.0.3 Management/Method of Operation
Provide detailed description outlining your firm’s approach to provide the service. Highlight innovative ideas your firm may have to provide to the City and describe in detail your procedures and management techniques.
3.0.4 References
Provide a list of references with current contact person, e-mail address and phone number who may be contacted regarding firm performance.
3.0.5 Financial Statement
The proponent must be able to demonstrate a good record of performance and have sufficient financial resources to ensure that they can satisfactorily provide the services required herein.
Proponent shall submit a full and detailed presentation of the true condition of the proponent’s assets, liabilities and net worth. The report should include a balance sheet and income statement. If the proponent is a new partnership or joint venture, individual financial statements must be submitted for each general partner or joint venture thereof. If firm is a publicly held corporation, the most current annual report should be submitted.
Any proponent who, at the time of submission, is involved in an ongoing bankruptcy as a debtor, or in a reorganization, liquidation, or dissolution proceeding, or if a trustee or receiver has been appointed over all or a substantial portion of the property of the proponent under federal bankruptcy law or any state insolvency, may be declared non-responsive.
3.0.6 Corporate Structure, Organization
Describe how your firm is organized, noting major divisions and any parent/holding companies, as well as brief history of the firm and all personnel potentially to be involved in the project including all sub-consultants. Designate the Principal in Charge and other key personnel. Include résumés. Also provide a description of the experience your firm has had with similar processes.
3.0.7 Proposal Fee (Under Separate Cover)
Complete Provide detailed basic fee structure and break-down of any other charges related to your firm’s proposal. Finalist’s fee structure may be subject to negotiation.
3.0.8 The proposal must be submitted, typewritten on 8½” X 11” white paper and must be bound in a secure manner.
3.0.9 Material and data not specifically requested for consideration, but which the proponent wishes to submit must not appear with the Proposal Form, but may appear only in an “Additional Data” section. This has specific reference to the following types of data:
Generalized narrative of supplementary information; and
Supplementary graphic material
3.0.10 All proposals must be signed with the full name of the proponent, if an individual; by an authorized general partner, if a partnership; or by an authorized officer, if a corporation.
3.0.11 When proposals are signed by an agent other than an officer of a corporation or a member of a general partnership, a power of attorney authorizing the signature must be submitted with the proposal.
3.0.12 If the proposal is submitted by a partnership or joint venture, the Statement of Personal History attached to the Proposal Form must be completed by each general partner or joint venture thereof. If the proposal is submitted by a corporation, the Statement must be completed by each principal officer of said corporation.
3.0.13 The original proposal must have wet ink signatures. Modification to a proposal after the proposal submittal deadline will not be accepted by the City.
3.1 EVALUATION PROCEDURE AND CRITERIA
The City is interested in selecting a qualified firm with the ability to provide pharmacy benefit management services. A key component for the successful firm will be the ability to meet the City‘s performance desires while minimizing the cost.
The Evaluation Panel will consist of City of Stockton staff and any other person(s) designated by the City. Following review of the proposals, the Panel may invite one or more proponents to make an oral presentation. During these presentations, the proponent will be allowed to present such information as may be appropriate in order that the Panel can effectively and objectively analyze all materials and documentation submitted as part of the proposals.
Each firm must be represented by an individual who will be the prime contact person to the City and any other individuals whom the firm may select. The highest-rated proposal(s) will then be further scrutinized through financial analysis and reference checks.
To that end, the Panel will evaluate the proposals based on, but not limited to, the following criteria:
1. Proponent’s ability to provide all services as outlined in the Scope of Services;
2. Related experience with similar projects, company background and personnel qualifications;
3. Proponent’s Fee Schedule: completed and signed (under separate sealed cover);
4. Proponent’s Agreement;
5. Non-Collusion Affidavit;
6. References (Provide on Attachment C)
7. Recently terminated clients (Provide on Attachment C)
8. Performance Guarantees
9. Any other criteria as best suits the City of Stockton.
3.2 PROPOSED DEVELOPMENT COSTS
The cost of preparing and submitting a proposal is the sole responsibility of the proponent and shall not be chargeable in any manner to the City of Stockton.
3.3 PROPONENT CONTACT
Proponent shall provide the name, address, e-mail address and telephone number of an individual in their organization to whom notices and inquiries by the City should be directed as part of this proposal.
3.4 CITY’S USE OF PROPOSAL MATERIAL
All material submitted in or with the proposal shall become the property of the City, unless it is clearly marked as proprietary information. The City reserves the right to use any ideas presented in the proposals, without compensation paid to the Firm. Selection or rejection of the proposal shall not affect this right.
3.5 REJECTION OF PROPOSAL
The City reserves the right to reject any and all proposals submitted and to request additional information from the Proponent. The award will be made to the firm which, in the opinion of the City, is best qualified.
COVER SHEET FOR
PROPONENT’S SUBMITTAL
RFP TO PROVIDE PHARMACY BENEFIT MANAGEMENT SERVICES
PROJECT PUR 12-005
PROJECT DUE DATE 2/23/2012
COMPANY NAME: _________________________________
CONTACT NAME: _________________________________
ADDRESS: _______________________________________
_______________________________________
TELEPHONE NUMBER: ____________________________
EMAIL: __________________________________________
PROPONENT’S AGREEMENT
In submitting this proposal, as herein described, the proponent agrees that:
1. They have carefully examined the Scope of Work and all other provisions of this document and understand the meaning, intent and requirements of same.
2. They will enter into contract negotiations and furnish the services specified.
3. They have signed and notarized the attached Non-Collusion Affidavit form, whether individual, corporate or partnership. Must be ‘A Jurat’ notarization.
4. They have reviewed all clarifications/questions/answers on the City’s website at .
5. Confidentiality: Successful Proponent hereby acknowledges that information provided by the City of Stockton is personal and confidential and shall not be used for any purpose other than the original intent outlined in the Request for Proposal. Breach of confidentiality shall be just cause for immediate termination of contract agreement.
FIRM ADDRESS
SIGNED BY TITLE OR AGENCY
TELEPHONE NO./FAX NO. DATE
E-MAIL ADDRESS
NON-COLLUSION
No. 1 AFFIDAVIT FOR INDIVIDUAL PROPONENT
STATE OF CALIFORNIA, )ss.
County of )
(insert)
being first duly sworn, deposes and says: That on behalf of any person not named herein; that said Bidder has not colluded, conspired, connived or agreed, directly or indirectly with, or induced or solicited any other bid or person, firm or corporation to put in a sham bid, or that such other person, firm or corporation shall or should refrain from bidding; and has not in any manner sought by collusion to secure to themselves any advantage over or against the City, or any person interested in said improvement, or over any other Bidder.
(Signature Individual Bidder)
Subscribed and sworn to (or affirmed) before me on this day of , 20
by , proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.
Seal
Signature
No. 2 AFFIDAVIT FOR CORPORATION PROPONENT
STATE OF CALIFORNIA, )ss.
County of )
(insert)
being first duly sworn, deposes and says: That they are the of a corporation, which corporation is the party making the foregoing bid, that such bid is genuine and not sham or collusive, or made in the interest or behalf of any person not named herein; that said Bidder has not colluded, conspired, connived or agreed, directly or indirectly with, or induced or solicited any other bid or person, firm or corporation to put in a sham bid, or that such other person, firm or corporation shall or should refrain from bidding; and has not in any manner sought by collusion to secure to themselves any advantage over or against the City, or any person interested in said improvement, or over any other Bidder.
(Signature Corporation Bidder)
Subscribed and sworn to (or affirmed) before me on this day of , 20
by , proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.
Seal
Signature
No. 3 AFFIDAVIT FOR FIRM, ASSOCIATION, OR CO-PARTNERSHIP
STATE OF CALIFORNIA, )ss.
County of )
(insert)
,
each being first duly sworn, depose and say: That they are a member of the firm, association or co-partnership,
designated as who is the party making the foregoing bid; that the other partner, or partners, are that such bid is genuine and not sham or collusive, or made in the interest or behalf of any person not named herein; that said Bidder has not colluded, conspired, connived or agreed, directly or indirectly with, or induced or solicited any other bid or person, firm or corporation shall or should refrain from proposing; and has not in any manner sought by collusion to secure to themselves any advantage over or against the City, or any person interested in said improvement, or over any other Bidder.
(Signature)
(Signature)
Subscribed and sworn to (or affirmed) before me on this day of , 20
by , proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.
Seal
Signature
BIDDER’S QUESTIONNAIRE
Questionnaire Instructions to Vendors
***DO NOT ALTER THE QUESTIONS OR QUESTION NUMBERING***.
➢ Provide an answer to each question even if the answer is “not applicable” or “unknown.” Incomplete questionnaires may be cause for disqualification.
➢ Answer the question as directly as possible.
• If the questions asks “How many…” provide a number
• If the question asks, “Do you…” indicate Yes or No first, followed by your additional narrative explanation.
➢ Lengthy responses are less preferred…to avoid this, be concise in your response. Use bullet points as appropriate. Reconsider how to word any response that exceeds 200 words in length so that the response contains the most important points you want displayed. Refer the reader to an appendix/attachment for further information.
➢ Where you desire to provide additional information to assist the reader in more fully understanding a response, refer the reader of your RFP response to your appendix/attachments.
➢ Vendor will be held accountable for accuracy/validity of all answers.
➢ Remember, RFP responses will become part of the contract between the winning Vendor and the City.
NOTE: Please make sure to include an electronic copy of your completed questionnaire on the CD with your response.
|ORGANIZATIONS |YES |NO |NAME AND ADDRESS |
|PROVIDING PBM FUNCTIONS | | |OF THE SERVICE PROVIDER |
|1. Please complete the following indicating the provider of | | | |
|each PBM service. If your company sub-contracts these | | | |
|services, indicate the firm. | | | |
|a. Formulary Management | | | |
|(appeals, utilization management) | | | |
|b. Formulary Pharmacy and Therapeutics Committee | | | |
|c. Drug Manufacturer rebate contracting and invoicing / | | | |
|accounting | | | |
|d. Retail Pharmacy Network contracting | | | |
|e. Customer Service functions | | | |
|f. Member Service functions (800 lines, internet, etc.) | | | |
|g. Mail Order drug purchasing and dispensing | | | |
|h. Ownership of Electronic Claim Payment System | | | |
|i. Client Management reporting tools and standard report | | | |
|production | | | |
|j. Other (Please describe) | | | |
|ADMINISTRATIVE FEES |VENDOR RESPONSE |
|Will you agree to guarantee your quoted fees until the assumed | |
|implementation date? | |
|Will postage be included in ID card generation, duplicate cards, | |
|all mail order prescriptions, and any mailings? | |
|Will multi-language communication phone line support be included | |
|in the base administrative fee? | |
|Describe your banking and billing requirements. | |
|How often will you bill the City or draw from their account? | |
|Is a deposit required to initiate the contract between your firm | |
|and the City? If so, describe. | |
|Claims Appeals | |
|Please confirm your services include all appeal levels | |
|communicating to the City when appropriate. | |
| a. What is your process for coordinating with independent | |
|external appeal organizations? | |
| b. Indicate the name and address of the Independent Review | |
|Organization(s) used by your firm to handle claim appeals? | |
|c. Is there a cost for use of the IRO's? | |
|d. If there is a cost, is it included in your administrative fee | |
|or billed to the City? Describe in detail. | |
|e. Do you agree to have a representative onsite at the annual | |
|Open Enrollment Meetings in Stockton, CA? | |
MINIMUM CONTRACT REQUIREMENTS
➢ Indicate “yes” or “no” as to your organization’s ability to meet the minimum requirements.
➢ Vendor will be held accountable for accuracy/validity of all answers.
➢ The following are base requirements. Please respond to each requirement and indicate your organizations willingness to comply by having an authorized representative of your organization provide his/her initials next to each requirement. Please note that your responses to these requirements are mandatory in order to have your organization considered as a bidder. Incomplete questionnaires may be cause for disqualification.
|MINIMUM CONTRACTUAL REQUIREMENTS |YES |NO |
|General Requirements – Agreement with Terms | | |
|Definitions | | |
|“Pass Through” and “Transparent” - PBM agrees to pass-through 100% of contracted discounts with | | |
|network pharmacies at the point-of-service and to provide auditing protocol, enabling tracking of | | |
|individual claims back to original pharmacy network contract documents. The PBM agrees to disclose | | |
|details of all programs and services generating financial remuneration from outside entities. | | |
|AWP is based on date sensitive, 11-digit NDC as supplied by a nationally recognized pricing source | | |
|(i.e., First DataBank or MediSpan) for retail and mail order adjudicated claims. (Subject to | | |
|outstanding litigation). | | |
|Formulary – The listing of current City preferred, non-preferred, and generic medications. | | |
|Rebates - Compensation or remuneration of any kind received or recovered from a pharmaceutical | | |
|manufacturer attributable to the purchase or utilization of covered drugs by eligible persons, | | |
|including, but not limited to, incentive rebates categorized as mail order purchase discounts; | | |
|credits; rebates, regardless of how categorized; market share incentives; promotional allowances; | | |
|commissions; educational grants; market share of utilization; drug pull-through programs; | | |
|implementation allowances; clinical detailing; rebate submission fees; and administrative or | | |
|management fees. Rebates also include any fees that PBM receives from a pharmaceutical manufacturer | | |
|for administrative costs, formulary placement, and/or access. | | |
|The City claim data - All claims records are the sole property of the City. Selling of the City data| | |
|to outside entities must be approved in advance, reported on a monthly basis and all income derived | | |
|must be disclosed and shared per agreement with the City. Even if PBM has not "sold" the claim data,| | |
|they are NOT free to use the data for analyses that they publish or provide at a fee to outside | | |
|industries. | | |
|Paid Claims – Defined as all transactions made on eligible members that result in a payment to | | |
|pharmacies or members from the City or the City member copays. (Does not include reversals and | | |
|adjustments.) Each unique prescription that results in payment shall be calculated separately as a | | |
|paid claim. | | |
|Member – All eligible employees and their eligible dependents enrolled under the City prescription | | |
|benefit program. This includes all participants previously mentioned in the Background section. | | |
|The PBM will provide a signature ready contract incorporating all agreed upon provisions within this | | |
|RFP. Contract document will be submitted along with proposal response. | | |
|The PBM agrees to market checks after the first year. Should the City receive a proposal that would | | |
|result in a 2% or greater savings, your organization shall have 21 days to offer a comparable or | | |
|better financial arrangement. Otherwise, the City may terminate the agreement with at least 90 days | | |
|notice. | | |
|The PBM agrees it would not modify its contract terms in the event that covered members varies by 10%| | |
|or less from the number provided during negotiations or the City changes its medical benefit carrier.| | |
|The PBM Will NOT implement or administer or allow any program that results in the conversion from | | |
|lower discounted ingredient cost drug products to higher ingredient cost drug products without the | | |
|prior written consent of the City or its designee. | | |
|The PBM mail order service must notify individual participating enrollees and the City or its | | |
|designee prior to substituting products that will result in increased member out of pocket expense. | | |
|All pricing will be effective and guaranteed for the term of the agreement (excluding the | | |
|renegotiated specialty pricing) and will not include adjustments for claims volume shifts amongst the| | |
|various provider channels (i.e., mail utilization rates decline or 90-day retail utilization | | |
|increases). | | |
|The City or its designee will review and approve all member communication materials before | | |
|distribution to members. | | |
|The PBM will not automatically enroll the City in any programs that involve any type of | | |
|communications with enrollees or alterations of enrollees’ medications, without express written | | |
|consent from the City. | | |
|The PBM agrees to load all current Prior Authorizations, open mail order refills, and accumulator | | |
|files that exist for current members from existing PBM at NO charge to the City no later than the | | |
|date of implementation of management by the selected PBM. All future edits required as a result of | | |
|plan design changes implemented by the City or its designee, and uploads therefore, shall be | | |
|completed, after testing, by the PBM within 30 days of request/advisory by the City or its designee. | | |
|The PBM agrees to notify the City or its designee, Segal, in advance when a formulary drug is | | |
|targeted to be removed from the formulary. The PBM must provide a detailed disruption and financial | | |
|impact analysis at the same time. | | |
|All fees will be based on approved paid claims as defined in 1.f definitions. | | |
|PBM agrees to provide separate monthly data transmissions to chosen vendors as requested at no charge| | |
|and two full, annual electronic claims files, in NCPDP format, at no charge to the City. | | |
|The City will be notified of any switch in the AWP source at least 180 days prior to the change. In | | |
|the event that the AWP source change is not determined by a third party to be price neutral for the | | |
|City. The City will have the right to terminate the contract with no penalty. | | |
|The PBM agrees to a review and negotiate the pricing applied to newly introduced generics drugs | | |
|annually. | | |
|The PBM agrees to provide Retail/Mail Order unit cost equalization to the City, meaning that Mail | | |
|Order unit costs prior to member cost sharing, dispensing fees, and sales taxes charged to the City | | |
|will be no greater than those at Retail. The PBM agrees to produce a date sensitive comparison report| | |
|showing unit costs charged to the City at a GCN level, and reimburse the City on a dollar-for-dollar | | |
|basis for all instances where mail order unit costs exceed retail unit’s costs. Report and | | |
|reconciliation will be provided on an annual basis. | | |
|The PBM shall indemnify, defend and hold harmless the City, its officers, directors, employees and | | |
|agents from and against any and all claims, actions, demands, costs and expenses, including | | |
|reasonable attorney fees and disbursements, as a result of a breach by the PBM of any of its | | |
|obligations under this Agreement or arising out of the negligent act or omission or willful | | |
|misconduct of the PBM or its employees or agents. | | |
|The PBM acknowledges that it is compliant with the electronic Data Interchange (“EDI”), Privacy and | | |
|Security Rules of the Health Insurance Portability and Accountability Act (“HIPAA”), and will execute| | |
|the appropriate Business Associate Agreement (“BAA”) as provided by the City. PBM also agrees that in| | |
|the event of a privacy violation or data breach, that the PBM will notify the City and the impacted | | |
|members to a breach and provide any required remedies. | | |
|The PBM must agree that in the event of a dispute between the parties, about the payment or | | |
|entitlement to receive payment, or any administrative fees hereunder, the PBM and the City shall | | |
|endeavor to meet and negotiate a reasonable outcome of said dispute. In NO event shall PBM undertake| | |
|unilateral offset against any monies due and owing the City, whether from manufacturer rebates, | | |
|credit adjustment or otherwise. | | |
|The PBM agrees to routinely transmit and receive data from the Medical Claims and Administrative | | |
|Services provider at no additional cost to the City. | | |
|Member Copay – Members will pay the lowest of the following: Plan copay, Plan discounted price plus | | |
|dispensing fee, U&C, or retail cash price. | | |
|All pricing will exclude any contingency on participation in any proposed PBM clinical management | | |
|programs, group medical or behavioral health programs proposed by you or any other vendor, or any | | |
|other programs. | | |
|The City or its designee will have the ability to annually “carve-out” specialty drug pricing and | | |
|service terms if they determine it is in their best interest to do so, with no impact on the pricing | | |
|of your other programs. | | |
|The PBM agrees to grandfather formulary (preferred) co-pays if requested as per the City requirements| | |
|up to 1-year. | | |
|The PBM agrees to conduct a Member Satisfaction Survey for each contract year and that the | | |
|Satisfaction rate will be 90% or greater. A penalty of $30,000 per Contract Year may be assessed | | |
|against the PBM for failure to meet this standard. “Member Satisfaction Rate” means (i) the number of| | |
|Eligible Persons responding to PBM annual standard Patient Satisfaction Survey as being satisfied | | |
|with the overall performance under the Integrated Program divided by (ii) the number of Eligible | | |
|Persons responding to such annual Patient Satisfaction Survey; The City must provide timely approvals| | |
|and responses, and a minimum of 20% of surveys must be returned for the Performance standard to be | | |
|applicable. | | |
|The City may assess a penalty in the amount of $30,000 per Contract year if, after the first Contract| | |
|Year and each successive Contract Year, the City employees who are members of the City benefits staff| | |
|do not rate the PBM account team’s performance for such Contract Year an average of 3 or better on a | | |
|scale of 1 to 5 (5 being the best based on a range of performance criteria agreed to between the City| | |
|and the PBM at the beginning of such Contract Year). Additional City staff members may be included in| | |
|the survey at the request of the PBM. | | |
|Agree to provide annual renewal offers to the City or their designated Consultant by January 1 of the| | |
|prior plan year for a July 1 effective date. | | |
|Agree that your proposal is being submitted net of commissions. | | |
|Agree to handle all levels of claim appeals. | | |
|With the exception of FDA directed market removals, the PBM agrees that it will not remove a covered | | |
|drug from the Formulary/Drug List, exclude coverage of a drug, or change the utilization management | | |
|status (i.e., add an prior authorization, step therapy, or quantity limit) of any drug without | | |
|written approval from the City. | | |
|The PBM agrees that, with the exception of a FDA directed market removal, if a drug is removed from | | |
|the Formulary/Drug List or moves from one coverage to tier to another and the City opts out of said | | |
|change, deletion, or exclusion, the City’s current financial arrangement will not be modified. | | |
|Termination | | |
|The City will have the right to terminate the PBM contract at the end of each contract year with or | | |
|without cause. The City will provide selected PBM 60-days written notice in the event of termination.| | |
|The PBM agrees to July 1, 2012 to June 30, 2015 contract term and the City reserves the right to | | |
|extend the period of any resultant contract for up to two additional one-year terms. | | |
|Service | | |
|The City reserves the right to access all call recordings or call notes from customer service calls | | |
|with its enrollees. PBM agrees to allow The City the right to request call recordings and notes at | | |
|any time. | | |
|The PBM agrees to allow the City access to its enrollee website behind login prior to the go-live | | |
|date. | | |
|The PBM will provide the City with a virtual tour of its CSR system and any custom messaging system. | | |
|The PBM agrees to, at minimum, quarterly calls to review customer service issues. The PBM agrees to | | |
|allow the City to review customer service quality issues to the resolution endpoint. | | |
|The PBM agrees to a minimum of one annual meeting with call center executives to discuss services | | |
|regarding Open Enrollment and enrollee issues. | | |
|The PBM agrees to document all customer service calls through call recordings and/or call notes. | | |
|Guarantees | | |
|All rebate revenue earned by the City will be paid to the City regardless of their termination status| | |
|as a client. | | |
|Each distinct minimum discount and pricing guarantee category is guaranteed on a dollar for dollar | | |
|basis with 100% of any shortfall recouped by the City. No offsetting surpluses in one category will | | |
|be used against shortfalls in other category. | | |
|Guaranteed rebate per prescription will be based on all prescriptions dispensed, not on brand or | | |
|formulary prescriptions dispensed. | | |
|Rebates are guaranteed for the life of the contract as well as any extension of the underlying | | |
|agreement. | | |
|Rebates are guaranteed as minimum amounts (i.e., not fixed). | | |
|Please confirm that over-performance of minimum rebate guarantees will not be used to offset | | |
|shortfalls in other areas. | | |
|Audit Requirements | | |
|The City or its designee will have the right to audit, with an auditor of its choice, with full | | |
|cooperation of the selected PBM, the services and pricing (including rebates) provided in order to | | |
|verify compliance with all program requirements and contractual guarantees. This provision shall | | |
|survive the termination of the agreement between the parties for a period of 3 years. | | |
|The PBM agrees to a 60-day turnaround time to provide its response to claims audit findings. | | |
|The City will not be held responsible for time or miscellaneous costs incurred by the PBM in | | |
|association with any audit process including, all costs associated with provision of data, audit | | |
|finding response reports, or systems access, provided to the City or its designee by the PBM during | | |
|the life of the contract. Please note: This includes any data required to transfer the business to | | |
|another vendor and money collected from lawsuits and internal audits. | | |
|The City requires PBM to produce an auditable quarterly report demonstrating transparent or | | |
|pass-through pricing. PBM will attach a sample of the report they intend to use as part of their | | |
|response. Rebate reports listing detailed rebate calculations should be included. | | |
|Financial Assumptions | | |
|All pricing will not be contingent on selecting your organization to provide Medical Claims and | | |
|Administrative Services to the City. | | |
|All pricing must be provided on a transparent basis. | | |
|Please confirm that retail and mail order brand discounts are on a post September 26, 2009 AWP | | |
|rollback basis. | | |
|Please confirm that your proposed retail and mail order generic effective rate guarantees include | | |
|both single source and multi-source generic products regardless of the exclusivity period and/or | | |
|number of manufacturers. | | |
|There are NO additional fees (beyond those outlined in the financial section) required to administer | | |
|the services outlined in this Proposal. Any mandatory fees, including clinical and formulary | | |
|programs fees, must be clearly outlined in the Cost Proposal. | | |
|Confirm that your fees include the cost of claims incurred/filled during the effective dates of this | | |
|contract regardless of when they are actually processed and paid (run-out). | | |
|Minimum Brand and Minimum Generic Discount Guarantees for both mail and retail shall be defined as | | |
|follows: (Aggregate Ingredient Cost/Aggregate AWP ) | | |
|AWP discount guarantees will be measured and reconciled on a component (brand, generic, retail, mail | | |
|order, and specialty pharmacy program) basis only. Surpluses in one component may not be utilized to| | |
|offset deficits in another component. | | |
|The guarantee measurement must exclude the savings impact from DUR programs, formulary programs, | | |
|utilization management programs, and/or other therapeutic interventions. | | |
|Any shortfall between the actual result and the minimum guarantee will be paid, dollar-for-dollar, to| | |
|the City within 60 days of the end of the measurement period. | | |
|Measurement will be performed annually via independent audit utilizing date sensitive AWP derived | | |
|from a single, nationally recognized price source for all claims. | | |
|Minimum Discount Rate Guarantees for both mail and retail shall be defined as follows: (Aggregate | | |
|Discounted Ingredient Cost/Aggregate Undiscounted AWP ) | | |
|Aggregate Discounted Ingredient Cost prior to application of plan specific co-payments will be the | | |
|basis of the calculation. | | |
|Aggregated Undiscounted AWP will be from a single, nationally recognized price source for all claims.| | |
|Dispensing Fees are not included in the Aggregate Discounted Ingredient Cost. | | |
|Discount guarantees MUST be measured and reconciled on a channel (retail, mail order, and specialty) | | |
|basis only. Surpluses in one channel may not be utilized to offset deficits in another channel. | | |
|Zero balance or zero amount claims paid by the City, will NOT be included in the guaranteed | | |
|measurement for AWP, Ingredient cost or dispensing fees. | | |
|Both the Aggregate Discounted Ingredient Cost and Aggregate Undiscounted AWP from the actual date of | | |
|claim adjudication will be used. | | |
|Aggregated Undiscounted AWP will be the date sensitive, 11-digit NDC of the actual product dispensed.| | |
|Compounds, defined Specialty claims, OTC claims, and claims with ancillary charges will be excluded | | |
|from the calculation. | | |
|Discounts must exclude the savings impact from DUR programs, formulary programs, utilization | | |
|management programs and/or other therapeutic interventions. | | |
|Any shortfall between the actual result and the minimum guarantee will be paid, dollar-for-dollar, to| | |
|the City within 60 days of the end of the measurement period. | | |
|Measurement will be performed annually via independent audit utilizing date sensitive AWP derived | | |
|from a single, nationally recognized price source for all claims. | | |
|Please confirm that retail and mail order brand guarantees exclude compounds, single-source generic | | |
|claims, paper/direct claims, co-payment differential claims, specialty claims, OTC claims, claims | | |
|with ancillary charges, and claims from non-traditional pharmacies. | | |
|ORGANIZATIONAL STABILITY & EXPERIENCE |VENDOR RESPONSE |
|1. Complete the following table: | |
|a. Parent Company | |
|b. Year PBM Established | |
|c. Number of PBM Employees involved in direct client support activities | |
|(account management) | |
|Current | |
|1 year prior | |
|2 years prior | |
|d. Membership count (total covered lives) | |
|Current | |
|1 year prior | |
|2 years prior | |
|% from top 10 clients | |
|% from MCO/HMO plans | |
|e. Number of Group Plans In Force | |
|Total | |
|Under 10,000 lives | |
|Over 100,000 lives | |
|Number of Collectively Bargained Plans | |
|f. AWP dollars processed (most recent 12 months) | |
|Retail | |
|Mail Order | |
|g. Number of Group Plans Added: | |
|Past 12 months | |
|Past 24 months | |
|h. Number of Group Plans Terminated: | |
|Past 12 months | |
|24 months | |
|2. a. Indicate the number of any outstanding legal actions pending | |
|against your organization. | |
|Please explain the nature and current status of the action(s). | |
| c. Can you assure the City these actions will not disrupt business | |
|operations? | |
|3. What general and professional liability coverage do you currently have| |
|in place for the entity that is bidding to protect the client from losses | |
|or negligence? | |
|Describe the type and amount of the fidelity bond insuring your employees,| |
|which would protect this plan in the event of a loss. | |
|4. Please provide the total number of years of direct PBM experience for | |
|the lead Account Manager, Financial Services, and Clinical staff assigned | |
|to this account. Please provide a resume for each. | |
|ADMINISTRATIVE, MEMBER & CLAIM PAYING SERVICES |VENDOR RESPONSE |
|1. Which sales office would handle the general servicing of this | |
|account? | |
|a. Would this office handle both the retail and mail order programs? | |
|b. What are the standard office hours for the sales and service | |
|office? | |
|2. Will you agree to meetings with the City to discuss plan | |
|performance, present financial results etc.? | |
|How frequently would these meetings occur and what information would | |
|be shared? | |
|3. Will you provide dedicated clinical, account management, and | |
|customer service staffing to the City? | |
|4. Do you have the ability to administer a zero copay for diabetic | |
|syringes distributed within 30 days of insulin purchase? | |
|5. Do you have the ability to administer a zero copay for syringes? | |
|NETWORK MANAGEMENT & QUALITY ASSESSMENT |VENDOR RESPONSE |
|1. Do you monitor individual physician prescribing patterns? If so, | |
|what action is taken with physicians who have a high degree of | |
|non-compliance to improve their compliance? | |
|2. What safeguards exist for preventing breaches in patient | |
|confidentiality with regard to medical claims information? | |
|3. Will you guarantee that the City will be charged the generic price| |
|and member is charged the generic co-pay, if generic is out of stock?| |
|4. Does your organization comply with all HIPAA regulations? Please | |
|provide supporting documentation outlining your organizations HIPAA | |
|policies and procedures as they relate to management of the | |
|prescription benefit plan for the City. | |
|5. Will the City or its designee receive a 90-day notice, when | |
|possible, of any event or negotiation that may cause a disruption in | |
|the retail pharmacy network access? | |
|6. Provide a listing of contracted pharmacy providers in Stockton | |
|City. Also provide this information in Excel formal on the disc with | |
|your proposal response. | |
|RETIREE DRUG SUBSIDY |VENDOR RESPONSE |
|Regarding Medicare Part D Subsidy program: | |
|Do you currently have an RDS dedicated staff? | |
|Please confirm that your organization understands that the City is | |
|applying for the Medicare Part D subsidy. | |
|Will you provide hands-on support for the City to file for the CMS | |
|subsidy? | |
|Do you agree to fully disclose your methodology for reporting rebates | |
|to the client? | |
|Are there any associated costs with providing EGWP If so, how much? | |
|Do you agree that your firm will reimburse the client for any drug cost| |
|data reporting that is incorrect? | |
|Do you agree that the financial parameters (discounts, dispensing fees,| |
|rebates) will be as guaranteed in your response to Section 3 of this | |
|RFP? | |
|Do you agree to provide the following services under the EGWP Plan? | |
|Collect and validate Medicare HICN | |
|Research and resolve enrollment errors | |
|Medication Therapy Management (MTM) Program | |
|Monitor and track all changes made by CMS | |
|Enrollment modifications resulting in Low-Income assistance as granted | |
|or removed by CMS | |
|Benefit Consultation and Actuarial Equivalence validation | |
|Fraud, Waste and Abuse Program | |
|Grievance, Appeals, and coverage determination – investigate and | |
|resolve complaints from the CMS Complaint Tracking Module | |
|Full enrollment reports (accepted, rejected, or CMS changes) | |
|Evidence of Coverage (EOC)/ID Card/Abridged Formulary/Pharmacy | |
|Directory | |
|Annual Notices of Changes/EOC | |
|Low-Income Subsidy (LIS) Rider | |
|LIS premium refunds directly to low-income retirees | |
|Transition Letters | |
|Explanation of Benefits | |
|Receive and reconcile CMS Direct Subsidy (paid – 45 days after | |
|receipts), LIS, LICS, (Paid at time of reconciliation) and Catastrophic| |
|Payments (paid at time of reconciliation) | |
|Reconcile LIS eligibility with CMS on a monthly basis | |
|Manage TrOOP | |
|Describe how you comply with CMS's requirement that PBM contracts | |
|ensure adequate reporting to the plan sponsor of the manufacturer | |
|rebates retained by the PBM in lieu of administrative fees. | |
|If an individual has prescription drug coverage under this client’s Rx | |
|plan and enrolls in another Medicare Part D prescription drug plan, how| |
|do you identify such a situation at the point of sale? | |
|What will your computer system indicate what the pharmacist is to do | |
|with a person who presents with dual Medicare Rx coverage? | |
|Can you coordinate with other Medicare Part D prescription drug plans? | |
|Do you perform the coordination of benefits at the point of sale or do | |
|paper claims have to be submitted? | |
|At the point of sale | |
|Paper claims have to be submitted | |
|Describe any extra fees you charge for COB services? | |
|Is there an additional charge for post-contract termination data | |
|reporting? | |
|Outline your Compliance Plan to prevent Fraud, Waste, and Abuse with | |
|respect to the RDS. | |
|Explain in detail your medication therapy management process. | |
|Do you agree to provide a discount prescription drug program that is | |
|statutorily required for non-members? | |
|CLIENT AUDIT RIGHTS |VENDOR RESPONSE |
|1. Describe in detail the network pharmacy claims auditing | |
|procedures established by your company (frequency, extent, etc.). | |
|2. Will you supply a copy of all audit reports to the City or its | |
|designee? | |
|3. Is the right to audit included in your standard provider | |
|contracts? | |
|4. Explain in detail the auditing process you propose to validate | |
|transparency at retail and mail order. | |
|5. Outline your company's proposed plan for third party audits of | |
|pass through pricing at retail and mail order. | |
|6. Will the right to audit survive the contract term by three (3) | |
|years after termination? | |
|7. The City reserves the right to select independent auditors at any| |
|time with 90-day advanced notice. | |
|8. The City reserves the right to select the month to conduct an | |
|audit provided that The City gives 90-day advance notice. | |
VENDOR INFORMATION SHEET
|Organization Name: | |
|Date Founded | |
|Contact Person’s Name | |
|Title | |
|Address | |
|City/State | |
|Phone Number | |
|E-mail Address | |
|Fax Number | |
|Website | |
|CURRENT CLIENT REFERENCES |
|Name |Contact Name |Phone Number and Client |Number of Employees |Contract Start Date |
| | |Location | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
|RECENTLY TERMINATED CLIENTS |
|Name |Contact Name |Phone Number |Termination Reason |Termination Date |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
Authorized Signature
COVER SHEET FOR
PROPONENT’S SUBMITTAL
(With Fee Schedule – Under Separate Cover)
RFP TO PROVIDE PHARMACY BENEFIT MANAGEMENT SERVICES
PROJECT PUR 12-005
PROJECT DUE DATE 2/23/2012
SUBMIT THIS SECTION (PAGES 40-59) WITH YOUR FEE
SCHEDULE (UNDER SEPARATE COVER)
COMPANY NAME: _________________________________
CONTACT NAME: _________________________________
ADDRESS: _______________________________________
_______________________________________
TELEPHONE NUMBER: ____________________________
EMAIL: __________________________________________
FINANCIAL EXHIBITS
Bidders are required to complete all financial exhibits as instructed. Administrative and dispensing fees are requested on a per-prescription paid basis. If alternative pricing is proposed, explain in detail. Note that fees must be based on prescription dispensed (not adjustments, errors, or redo's) and include, but not be limited to, the following services:
➢ Providing ID cards (initial, duplicate, additional and replacement cards), online provider directories, and formulary lists. Printed versions of the directories and formulary lists should be provided as requested by the members.
➢ Integration of PBM services with Medical/Third Party Administrator
➢ Claims adjudication
➢ Standard Systems Edits (must include “too early refill” edit)
➢ Basic Formulary Management
➢ Eligibility Verification and Maintenance
➢ MAC pricing program administration
➢ Data Reporting
➢ Medicare Part D Services
➢ Customer Service including toll free telephone and internet access
➢ Provider Management and Education
➢ Patient Education
➢ Data Requests
➢ Online Systems for the City members and the City and its designees
➢ Ad-Hoc Reporting
➢ Handling of Appeals
All services covered under the fee should be listed. However, some services may be offered as optional or ancillary and be covered by separate add-on fees. For example, separate fees for providing EOBs, COB, or for providing duplicate ID cards can be offered and excluded from the base fees. These fees should be listed separately as an option.
All fees must be binding until the assumed implementation date specified in this proposal and must be guaranteed for a minimum of the initial July 1, 2012 to June 30, 2013 contract period. Thereafter, all fees must be guaranteed for a minimum of each 12-month contract period.
Complete the following Administrative Fee Table:
|ADMINISTRATIVE FEES |VENDOR RESPONSE |
|1. Complete the following Administrative Fee Table |CONTRACT |CONTRACT |CONTRACT |
| |YEAR 1 |YEAR 2 |YEAR 3 |
|Basic Retail Fee | | | |
|Transparent Pricing – Per Rx Paid | | | |
|Transparent Pricing – Per Employee per Month | | | |
|Basic 90-day Retail Fee | | | |
|Transparent Pricing – Per Rx Paid | | | |
|Transparent Pricing – Per Employee per Month | | | |
|Basic Mail Order Fee - Mandatory | | | |
|Transparent Pricing – Per Rx Paid | | | |
|Transparent Pricing – Per Employee per Month | | | |
|Basic Mail Order Fee –Without | | | |
|Mandatory Mail | | | |
|Transparent Pricing – Per Rx Paid | | | |
|Transparent Pricing – Per Employee per Month | | | |
|Services to be included in fees above: (For services that are not | | | |
|included in the fees above, indicate the fee for each service.) | | | |
|Toll Free Phone Lines | | | |
|Prospective /Concurrent/Retro DUR | | | |
|Standard Reports | | | |
|Ad Hoc Reports | | | |
|COB Program | | | |
|Custom Dosing Programming (Quantity Limitations) | | | |
|Custom System Overrides | | | |
|Out of Pocket and Annual Maximums | | | |
|Annual EOB Statements | | | |
|Retro Termination Letters | | | |
| |CONTRACT |CONTRACT |CONTRACT |
| |YEAR 1 |YEAR 2 |YEAR 3 |
|Group Coding | | | |
|Direct submission of paper claims for PBM processing by the City | | | |
|or its designee | | | |
|Drug Notification Letters | | | |
|Formulary Administration/Management | | | |
|ID Cards | | | |
|Standard 1st level appeals processing | | | |
|Overrides | | | |
|Audit Recovery Fees | | | |
|Other Services (show fees separately) | | | |
|- Monthly data feeds to fund/designee(s) | | | |
|- Prior authorization program | | | |
|- Mandatory mail program | | | |
|- Dose optimization program (if implemented) | | | |
|- Step therapy program (if implemented) | | | |
|- Pharmacy Directories | | | |
|- Medicare Part D services | | | |
|Note: For services that are not included in the fees above, | | | |
|indicate the fee for each service. | | | |
|Detail all services and supplies to be provided under your basic | | | |
|fees, which are not included in administrative fee grid 1. | | | |
|2. Will there be any additional charges if the plan of benefits | | | |
|is restructured or new classes of eligible members are added? If | | | |
|so, how are these charges determined and state amount of charges. | | | |
|Will you agree to guarantee your quoted fees until the assumed | |
|implementation date? | |
|Will postage be included in ID card generation, duplicate cards, | |
|all mail order prescriptions, and any mailings? | |
|Will multi-language communication phone line support be included | |
|in the base administrative fee? | |
|Describe your banking and billing requirements. | |
|7. How often will you bill the City or draw from their | |
|account? | |
|8. Is a deposit required to initiate the contract between your| |
|firm and the City? If so, describe. | |
|9. Claim Appeals | |
|Please confirm your services include all appeal levels | |
|communicating to the City when appropriate. | |
|What is your process for coordinating with independent external | |
|appeal organizations? | |
|Indicate the name and address of the Independent Review | |
|Organization(s) used by your firm to handle claim appeals? | |
|Is there a cost for use of the IRO's? | |
|If there is a cost, is it included in your administrative fee or | |
|billed to the City? Describe in detail. | |
|Do you agree to have a representative onsite at the annual Open | |
|Enrollment Meetings in Stockton, CA? | |
Prescription Drug Pricing Using Post 9/26/09
AWP Rollback Discount and Dispensing Fee Logic
Transparent Financial Arrangement - AWP
AWP Reimbursement Basis—Complete the following tables using the drug reimbursement that your organization is willing to guarantee on a dollar-for-dollar basis for each year of the contract. Columns marked "Standard AWP Discount" are to be completed using a standard AWP discount and dispensing fee logic. All Retail discount guarantees must be based on the actual AWP dispensed at the point of sale.
1. Contract Year 1 –WITH MANDATORY MAIL*
|Broad Retail Network (List any Major Retail Chains Excluded) |AWP Discount |AWP Discount |AWP Discount |
| |Retail Supply |Retail Supply 35-90 |Mail Order |
| |Up to 34 | | |
|Brand Drugs | | | |
|Single source discount from 100% AWP | | | |
|Multi-source discount from 100% AWP | | | |
|Composite Brand discount from 100% AWP | | | |
|Dispensing Fee/Rx | | | |
|Guaranteed Rebate Per Rx | | | |
|Generic Drugs | | | |
|Composite discount from AWP of all generics (composite of MAC prices,| | | |
|discounted AWP, or usual and customary retail price) Pricing must | | | |
|reflect the effective discount rate in aggregate, and not specific to| | | |
|the MAC list | | | |
|Dispensing Fee/Rx | | | |
* If your pricing will change based on acceptance of EGWP or RDS option for Medicare Retirees please provide the applicable pricing by copying these tables and labeling them appropriately
2. Contract Year 2–WITH MANDATORY MAIL*
|Broad Retail Network (List any Major Retail Chains Excluded) |AWP Discount |AWP Discount |AWP Discount |
| |Retail Supply |Retail Supply 35-90 |Mail Order |
| |Up to 34 | | |
|Brand Drugs | | | |
|Single source discount from 100% AWP | | | |
|Multi-source discount from 100% AWP | | | |
|Composite Brand discount from 100% AWP | | | |
|Dispensing Fee/Rx | | | |
|Guaranteed Rebate Per Rx | | | |
|Generic Drugs | | | |
|Composite discount from AWP of all generics (composite of MAC prices,| | | |
|discounted AWP, or usual and customary retail price) Pricing must | | | |
|reflect the effective discount rate in aggregate, and not specific to| | | |
|the MAC list | | | |
|Dispensing Fee/Rx | | | |
* If your pricing will change based on acceptance of EGWP or RDS option for Medicare Retirees please provide the applicable pricing by copying these tables and labeling them appropriately
3. Contract Year 3–WITH MANDATORY MAIL*
|Broad Retail Network (List any Major Retail Chains Excluded) |AWP Discount |AWP Discount |AWP Discount |
| |Retail Supply |Retail Supply 35-90 |Mail Order |
| |Up to 34 | | |
|Brand Drugs | | | |
|Single source discount from 100% AWP | | | |
|Multi-source discount from 100% AWP | | | |
|Composite Brand discount from 100% AWP | | | |
|Dispensing Fee/Rx | | | |
|Guaranteed Rebate Per Rx | | | |
|Generic Drugs | | | |
|Composite discount from AWP of all generics (composite of MAC prices,| | | |
|discounted AWP, or usual and customary retail price) Pricing must | | | |
|reflect the effective discount rate in aggregate, and not specific to| | | |
|the MAC list | | | |
|Dispensing Fee/Rx | | | |
* If your pricing will change based on acceptance of EGWP or RDS option for Medicare Retirees please provide the applicable pricing by copying these tables and labeling them appropriately
Prescription Drug Pricing Using Post 9/26/09
AWP Rollback Discount and Dispensing Fee Logic
Transparent Financial Arrangement - AWP
AWP Reimbursement Basis—Complete the following tables using the drug reimbursement that your organization is willing to guarantee on a dollar-for-dollar basis for each year of the contract. Columns marked "Standard AWP Discount" are to be completed using a standard AWP discount and dispensing fee logic. All Retail discount guarantees must be based on the actual AWP dispensed at the point of sale.
1. Contract Year 1–WITHOUT MANDATORY MAIL*
|Broad Retail Network (List any Major Retail Chains Excluded) |AWP Discount |AWP Discount |AWP Discount |
| |Retail Supply |Retail Supply 35-90 |Mail Order |
| |Up to 34 | | |
|Brand Drugs | | | |
|Single source discount from 100% AWP | | | |
|Multi-source discount from 100% AWP | | | |
|Composite Brand discount from 100% AWP | | | |
|Dispensing Fee/Rx | | | |
|Guaranteed Rebate Per Rx | | | |
|Generic Drugs | | | |
|Composite discount from AWP of all generics (composite of MAC prices,| | | |
|discounted AWP, or usual and customary retail price) Pricing must | | | |
|reflect the effective discount rate in aggregate, and not specific to| | | |
|the MAC list | | | |
|Dispensing Fee/Rx | | | |
* If your pricing will change based on acceptance of EGWP or RDS option for Medicare Retirees please provide the applicable pricing by copying these tables and labeling them appropriately
2. Contract Year 2–WITHOUT MANDATORY MAIL*
|Broad Retail Network (List any Major Retail Chains Excluded) |AWP Discount |AWP Discount |AWP Discount |
| |Retail Supply |Retail Supply 35-90 |Mail Order |
| |Up to 34 | | |
|Brand Drugs | | | |
|Single source discount from 100% AWP | | | |
|Multi-source discount from 100% AWP | | | |
|Composite Brand discount from 100% AWP | | | |
|Dispensing Fee/Rx | | | |
|Guaranteed Rebate Per Rx | | | |
|Generic Drugs | | | |
|Composite discount from AWP of all generics (composite of MAC prices,| | | |
|discounted AWP, or usual and customary retail price) Pricing must | | | |
|reflect the effective discount rate in aggregate, and not specific to| | | |
|the MAC list | | | |
|Dispensing Fee/Rx | | | |
* If your pricing will change based on acceptance of EGWP or RDS option for Medicare Retirees please provide the applicable pricing by copying these tables and labeling them appropriately
3. Contract Year 3–WITHOUT MANDATORY MAIL*
|Broad Retail Network (List any Major Retail Chains Excluded) |AWP Discount |AWP Discount |AWP Discount |
| |Retail Supply |Retail Supply 35-90 |Mail Order |
| |Up to 34 | | |
|Brand Drugs | | | |
|Single source discount from 100% AWP | | | |
|Multi-source discount from 100% AWP | | | |
|Composite Brand discount from 100% AWP | | | |
|Dispensing Fee/Rx | | | |
|Guaranteed Rebate Per Rx | | | |
|Generic Drugs | | | |
|Composite discount from AWP of all generics (composite of MAC prices,| | | |
|discounted AWP, or usual and customary retail price) Pricing must | | | |
|reflect the effective discount rate in aggregate, and not specific to| | | |
|the MAC list | | | |
|Dispensing Fee/Rx | | | |
* If your pricing will change based on acceptance of EGWP or RDS option for Medicare Retirees please provide the applicable pricing by copying these tables and labeling them appropriately.
Specialty Drug Pricing Using Post 9/26/09
AWP Rollback Discount and Dispensing Fee Logic
1. Specialty Drug Pricing Using either WAC or AWP and Rebates (include rebate guarantees).
Transparent Financial Arrangement
Please provide a pricing list (in EXCEL format) of all specialty pharmaceuticals that your company dispenses and distributes to providers and patients. Your pricing must include adequate supplies of ancillaries such as needles, swabs, syringes, and containers. The following items must be included in your list:
a. Product Name
b. Therapeutic Group/Therapeutic Category
c. Guaranteed discount off of AWP
d. Guaranteed WAC mark-up
EGWP Program Pricing
A. Fees, Discounts, and Rebates: Provide your fees, discounts, and rebates for each of the following:
| |Contract Year 1 |Contract Year 2 |Contract Year 3 |
| |Up to 34 day Supply @ Retail |35-90 day Supply @ Retail |Up to 90 day Supply @ Mail |
| |90 day Supply @Home |90 day Supply @Long Term |90 day Supply @ITU |
| |Infusion |Care | |
|Contract Year 1 | | | |
|Contract Year 2 | | | |
|Contract Year 3 | | | |
2. What dollar amount are you prepared to put at risk for failure to meet your GDR guarantee?
3. Please complete the following table indicating the amount that would be collected from the participant for each prescription claim scenario (copays are illustrative).
|Rx Cost |Scenario 1 |Scenario 2 |Scenario 3 |Scenario 4 |Scenario 5 |
| |(Retail) |(Retail) |(Mail Order) |(Mail Order) |($4 Generic) |
|Ingredient. Cost plus Dispensing Fee plus Sales Tax |$9.00 |$9.00 |$22.00 |$22.00 |$3.00 |
|Copay/Coinsurance |$10.00 |$5.00 |$35.00 |$5.00 |$5.00 |
|U&C |$25.00 |$25.00 |$55.00 |$55.00 |$4.00 |
|Amount Collected from Participant | | | | | |
|Amount Charged to Plan | | | | | |
GENERIC MEDICATION CHART
The table below contains commonly prescribed generic medications for the City’s participants. Please complete the AWP/Rx column using the drug reimbursement that your organization is willing to guarantee for the City. All pricing must be based on the AWP unit cost dispensed at the RETAIL point of sale, post September 26, 2009 AWP rollback.
|GPI-14 (GPI Name) | |Metric Quantity|Days Supply | |Ingredient Cost/Rx Based |
| | | | | |on Your Quote |
| | | | | | |
| |GPI-14 | | |AWP/Rx | |
|FLUTICASONE SPR 50MCG |42200032301810 |16 |30 | | |
|SIMVASTATIN TAB 40MG |39400075000340 |30 |30 | | |
|ZOLPIDEM TAB 10MG |60204080100315 |30 |30 | | |
|LISINOPRIL TAB 10MG |36100030000310 |30 |30 | | |
|AMOX/K CLAV TAB 875MG |01990002200340 |20 |10 | | |
|LISINOPRIL TAB 20MG |36100030000315 |30 |30 | | |
|SIMVASTATIN TAB 20MG |39400075000330 |30 |30 | | |
|SIMVASTATIN TAB 40MG |39400075000340 |90 |90 | | |
|TRINESSA TAB |25992002300320 |28 |28 | | |
|SIMVASTATIN TAB 20MG |39400075000330 |90 |90 | | |
|LISINOPRIL TAB 10MG |36100030000310 |90 |90 | | |
|AMLODIPINE TAB 10MG |34000003100340 |30 |30 | | |
|LISINOPRIL TAB 40MG |36100030000330 |30 |30 | | |
|METFORMIN TAB 1000MG |27250050000350 |60 |30 | | |
|CITALOPRAM TAB 20MG |58160020100320 |30 |30 | | |
|METHYLPRED PAK 4MG |22100030006405 |21 |6 | | |
|METFORMIN TAB 500MG |27250050000320 |60 |30 | | |
|LOVASTATIN TAB 40MG |39400050000320 |30 |30 | | |
|SERTRALINE TAB 50MG |58160070100310 |30 |30 | | |
|HYDROCHLOROT TAB 25MG |37600040000305 |30 |30 | | |
|LISINOPRIL TAB 5MG |36100030000305 |30 |30 | | |
|HYDROCHLOROT TAB 25MG |37600040000305 |90 |90 | | |
|LEVOTHYROXIN TAB 100MCG |28100010100320 |90 |90 | | |
|OMEPRAZOLE CAP 20MG |49270060006520 |30 |30 | | |
Performance Guarantees
1. The City is looking for a flat dollar ($$$) performance guarantee amount that can be allocated by the City across the various guarantees as they choose. Please indicate the amount you are willing to place at risk.
2. The City will require specific performance guarantees. In addition, you may provide other guarantees designed to differentiate your program. All guarantees shall be set and measured annually. Measurement of performance guarantees may be based on internal self-reporting, subject to independent audit.
| |Standard |Penalty $$ at Risk |Timing of Payments |
|Financial accuracy |Provide Vendor Standard | | |
|Telephone response time |Provide Vendor Standard | | |
|Phone Abandonment Rate |Provide Vendor Standard | | |
|Clean Implementation |No systems errors, ID card delays, client online | | |
| |access to all tools prior to effective date | | |
|Delivery of Standard Reports |Within 30 days of end of reporting quarter | | |
|Mail Service Prescription Accuracy |Provide Vendor Standard | | |
|Specialty Pharmacy Prescription Accuracy |Ninety-nine and ninety nine one hundredths of a | | |
| |percent (99.99%) or greater of all claims from | | |
| |Vendors designated specialty pharmacy will be | | |
| |dispensed accurately, in accordance with the | | |
| |written prescription (correct mediation and | | |
| |strength) and the City’s Plan Design Profile | | |
|On-Site Pharmacy Audits |Vendor will audit at least twenty percent (20%) | | |
| |of Participating Pharmacies that dispense more | | |
| |than four thousand (4,000) prescriptions to the | | |
| |City Participants each Agreement year. | | |
|Eligibility Processing Accuracy |Ninety-nine percent (99%) or greater of Usable | | |
| |Eligibility Files will be accurately loaded, | | |
| |without error | | |
|Claims Eligibility Data |Eligibility loads not to exceed 24-hours after | | |
| |receipt | | |
|ID Card Production |Ninety five percent (95%) or greater of | | |
| |identification cards and Participant introduction| | |
| |materials will be Produced and Released for | | |
| |distribution to new Participants within five (5) | | |
| |business days or less of Vendors receipt of | | |
| |Useable Eligibility File | | |
|First Call Resolution |Ninety percent (90%) or greater of Participant | | |
| |calls to Vendors toll-free telephone line will be| | |
| |Resolved within twenty-four (24) hours of a | | |
| |Customer Service Representative’s (CSR) receipt | | |
| |of the call | | |
|Member Satisfaction Survey |The PBM agrees to conduct a Member Satisfaction | | |
| |Survey for each contract year and that the | | |
| |Satisfaction Rate will be 90% or greater. A | | |
| |penalty of $30,000 per Contract Year may be | | |
| |assessed against the PBM for failure to meet this| | |
| |standard. “Member Satisfaction Rate” means (i) | | |
| |the number of Eligible Persons responding to PBM | | |
| |annual standard Patient Satisfaction Survey as | | |
| |being satisfied with the overall performance | | |
| |under the Integrated Program divided by (ii) the | | |
| |number of Eligible Persons responding to such | | |
| |annual Patient Satisfaction Survey; the City must| | |
| |provide timely approvals and responses, and a | | |
| |minimum of 20% of surveys must be returned for | | |
| |the Performance standard to be applicable. | | |
|PBM Account Teams Performance |The City may assess a penalty in the amount of | | |
| |$30,000 per Contract year if, after the first | | |
| |Contract Year and each successive Contract Year, | | |
| |those City employees who are members of the | | |
| |City’s benefits staff do not rate the PBM account| | |
| |team’s performance for such Contract Year an | | |
| |average of 3 or better on a scale of 1 to 5 (5 | | |
| |being the best based on a range of performance | | |
| |criteria agreed to between City and the PBM at | | |
| |the beginning of such Contract Year). Additional | | |
| |City staff members may be included in the survey | | |
| |at the request of the PBM. | | |
|Implementation Allowance |Place the $ (dollar) per employee amount or the | | |
| |flat dollar amount you are offering the City. | | |
|Audit Allowance |Place the $ (dollar) per employee amount or the | | |
| |flat dollar ($) amount you are offering the City | | |
| |to be used annually to verify that the City is | | |
| |receiving discounted costs and major services as | | |
| |contracted. | | |
EXHIBIT 1
INSURANCE REQUIREMENTS
PRESCRIPTION DRUG PROGRAM MANAGER
VENDOR shall procure and maintain for the duration of the Agreement, insurance against all claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by the VENDOR, its agents, representatives, volunteers, or employees.
1. INSURANCE Throughout the life of this Contract, the Vendor shall pay for and maintain in
full force and effect with an insurance company admitted by the California Insurance Commissioner to do business in the State of California and rated not less than “A: VII” in Best Insurance Key Rating Guide, the following policies of insurance:
A. COMMERCIAL (BUSINESS) AUTOMOBILE LIABILITY insurance, endorsed for “any auto” with combined single limits of liability of not less than $1,000,000 each occurrence.
B. WORKERS’ COMPENSATION insurance as required under the California Labor Code and Employers Liability Insurance with limits not less than $1,000,000 per accident/injury/disease.
C. COMMERCIAL OR COMPREHENSIVE GENERAL LIABILITY AND MISCELLANEOUS SUPPLEMENTARY INSURANCE;
FOR ADDITIONAL REQUIREMENT(S):
i) COMMERCIAL OR COMPREHENSIVE GENERAL LIABILITY insurance which shall include Contractual Liability, Products and Completed Operations coverage’s, Bodily Injury and Property Damage Liability insurance with combined single limits of not less than $3,000,000 per occurrence, and if written on an Aggregate basis, $6,000,000 Aggregate limit.
ii) PROFESSIONAL ERRORS AND OMISSIONS, Not less than $3,000,000 per Claim (5 yr discovery and reporting tail period coverage). Certificate of Insurance only required.
Deductibles and Self-Insured Retentions must be declared and are subject to approval by the CITY.
The Policy(s) shall also provide the following:
1. The Commercial General Liability insurance shall be written on ISO approved occurrence form with additional insured endorsement naming: City of Stockton, its Mayor, Council, officers, representatives, agents, employees and volunteers are additional insureds.
2. All insurance required by this Agreement shall be with a company acceptable to the CITY and issued and executed by an admitted insurer authorized to transact insurance business in the State of California. Unless otherwise specified by this Agreement, all such insurance shall be written on an occurrence basis, or, if the policy is not written on an occurrence basis, such policy with the coverage required herein shall continue in effect for a period of three years following the date VENDOR completes its performance of services under this Agreement.
2. For any claims related to products provided under this contract, the Vendor’s insurance coverage shall be primary insurance as respects the City of Stockton its officers, agents, and employees. Any coverage maintained by the CITY shall be excess of the Vendor’s insurance and shall not contribute with it. Policy shall waive right of recovery (waiver of subrogation) against the CITY.
3. Each insurance policy required by this clause shall have a provision that coverage shall not be cancelled by either party, except after thirty (30) days’ prior to written notice by certified mail, return receipt requested, has been given to the CITY. Further, the thirty (30) day notice shall be unrestricted, except for workers’ compensation, or non-payment of premium, which shall permit ten (10) days advance notice. The insurer and/or the contractor and/or the contractor's insurance agent shall provide the CITY with notification of any cancellation, major change, modification or reduction in coverage.
4. Regardless of these contract minimum insurance requirements, the Vendor and its insurer shall agree to commit the Vendor’s full policy limits and these minimum requirements shall not restrict the Vendor’s liability or coverage limit obligations.
5. Coverage shall not extend to any indemnity coverage for the active negligence of the additional insured in any case where an agreement to indemnify the additional insured would be invalid under Subdivision (b) of Section 2782 of the California Civil Code.
6. The Company shall furnish the City of Stockton with the Certificates and Endorsement for all required insurance, prior to the CITY’s execution of the Agreement and start of work.
7. Proper address for mailing certificates, endorsements and notices shall be:
City of Stockton
Attention: Risk Services
425 N. El Dorado Street
Stockton, CA 95202
8. Upon notification of receipt by the CITY of a Notice of Cancellation, major change, modification, or reduction in coverage, the Vendor shall immediately file with the CITY a certified copy of the required new or renewal policy and certificates for such policy.
Any variation from the above contract requirements shall only be considered by and be subject to approval by the CITY’s Risk Manager (209) 937-8682. Our fax is (209) 937-8833.
If at any time during the life of the Contract or any extension, the Vendor fails to maintain the required insurance in full force and effect, all work under the Contract shall be discontinued immediately. Any failure to maintain the required insurance shall be sufficient cause for the CITY to terminate this Contract.
If the Vendor should subcontract all or any portion of the work to be performed in this contract, the Vendor shall cover the sub-contractor, and/or require each sub-contractor to adhere to all subparagraphs of these Insurance Requirements section. Similarly, any cancellation, lapse, reduction or change of sub-contractor’s insurance shall have the same impact as described above.
ATTACHMENT A - MEDICAL/PHARMACY PLAN DESIGNS
ARTICLE 2. ELIGIBILITY FOR BENEFITS
Section 2.01 Eligibility Rules for Employees and their Family Members
A. Eligible Employees
The following persons are eligible for enrollment as Employees in the Plan:
1. Active Employees
Full-time employees and eligible regular part-time employees of the City, some elected officials, or individuals who occupy a position which, according to the Memorandum of Understanding, management compensation plan, or other employment/contract, is entitled to benefits.
2. Retired Employees
Retired employees of the City who are entitled to benefits for a period of time, according to the provisions of the Memorandum of Understanding in effect at the time of their retirement. Retired employees eligible for Medicare are required to enroll in Medicare Parts A and B.
B. Eligible Family Members
The following persons may be enrolled as eligible Family Members of the Employee:
1. The Employee’s Spouse, or
2. The Employee’s Registered Domestic Partner.
3. Child of the Employee or the Spouse or Registered Domestic Partner of the Employee.
A child is “Placed for Adoption” with you on the date you first become legally obligated to provide full or partial support of the child whom you plan to adopt.
Disabled Child(ren). A covered unmarried dependent Child who is incapable of self-sustaining employment by reason of mental or physical disability and who is chiefly dependent upon the Employee for support, can remain covered beyond age 26 provided that written proof by a Physician of such incapacity and dependency is provided to the City of Stockton Human Resources Department within 31 days of the date the Child reached age 26. Proof of continuing dependency and disability may be required periodically as requested by the Administrator.
4. Legal Guardianship. The Plan will cover a minor child as a dependent on the Plan, who does not meet the definition of Child, until he/she reaches age 18, provided the following conditions are met:
a. A Legal Guardian Statement form is completed and submitted certifying the minor child is under the legal guardianship of the Employee.
b. A copy of the Letter of Guardianship is provided to the Plan.
c. The minor child must reside with the Employee full-time.
d. The minor child must be claimed as a dependent on the Employee’s Income Taxes. (A copy of the first page of the tax return reflecting the minor child as a dependent shall be required annually.)
e. The minor child must be enrolled in the Medi-Cal program. A copy of the
minor child’s Medi-Cal identification card must be provided to the Plan.
5. Qualified Medical Child Support Orders (QMCSOs).
This Plan will provide benefits to a child named as an “alternate recipient” under a Qualified Medical Child Support Order (QMCSO). In this document the term QMCSO is used and includes compliance with a National Medical Support Notice. According to federal law, a Qualified Medical Child Support Order is a judgment, decree or order (issued by a court or resulting from a state’s administrative proceeding) that creates or recognizes the rights of a child, also called the “alternate recipient,” to receive benefits under a group health plan, typically the non-custodial parent’s plan. The QMCSO typically requires that the plan recognize the child as a dependent even though the child may not meet the plan’s definition of dependent. A QMCSO usually results from a divorce or legal separation and typically:
a. Designates one parent to pay for a child’s health plan coverage;
b. Indicates the name and last known address of the parent required to pay for the coverage and the name and mailing address of each child covered by the QMCSO;
c. Contains a reasonable description of the type of coverage to be provided under the designated parent’s health care Plan or the manner in which such type of coverage is to be determined;
d. States the period for which the QMCSO applies; and
e. Identifies each health care plan to which the QMCSO applies.
An order is not a QMCSO if it requires the Plan to provide any type or form of benefit or any option that the Plan does not otherwise provide, or if it requires an employee who is not covered by the Plan to provide coverage for a dependent child, except as required by a state’s Medicaid-related child support laws. For a state administrative agency order to be a QMCSO, state statutory law must provide that such an order will have the force and effect of law, and the order must be issued through an administrative process established by state law.
If a court or state administrative agency has issued an order with respect to health care coverage for any dependent child of the Employee, the Plan Administrator or its designee will determine if that order is a QMCSO as defined by federal law. That determination will be binding on the Employee, the other parent, the child, and any other party acting on behalf of the child. The Plan Administrator or its designee will notify the parents and each child if an order is determined to be a QMCSO and, if the Employee is covered by the Plan, advise them of the procedures to be followed to provide coverage of the dependent child(ren).
If the Employee is a Plan participant, the QMCSO may require the Plan to provide coverage for the Employee’s dependent child(ren) and to accept contributions for that coverage from a parent who is not a Plan participant. The Plan will accept special enrollment of the dependent child(ren) specified by the QMCSO from either the Employee or the custodial parent. Coverage of the dependent child(ren) will become effective as of the date the enrollment is received by the Plan and will be subject to all terms and provisions of the Plan.
No coverage will be provided for any dependent child under a QMCSO unless the applicable Employee contributions for that dependent child’s coverage, if any, are paid and all of the Plan’s requirements for coverage of that dependent child have been satisfied.
Coverage of a dependent child under a QMCSO will terminate when coverage of the Employee-parent terminates for any reason, including failure to pay any required contributions, subject to the dependent child’s right to elect COBRA continuation coverage, if that right applies.
Note regarding Imputed Income
Please note that if you add a child for coverage, and the child does not qualify as a tax dependent under IRC § 152 or where a state law definition of a dependent does not match with the federal law definition of a dependent, the City must include in your gross income the fair market value of the coverage provided to the adult child. This is known as “imputed income.” This will likely increase both the employee’s taxable income and tax liability.
C. Application for Enrollment
Employees must file a written application with the City Human Resources Department – Benefits Section, within 31 days of becoming eligible for coverage hereunder and as to Family Members, within 31 days of marriage or the acquiring or birth of a Child.
Refer to Article 9 for Special Enrollment rights that may apply if you do not enroll within 31 days of becoming eligible.
D. Effective Date of Coverage
After the Employee has met the provisions of sub-section 2.01 C. of this Article 2, and if payment of any required premiums to the City have been made, coverage shall commence as follows:
1. For a Member enrolled on the Effective Date of this Plan, coverage shall commence as of the Effective Date of this Plan.
2. For an Active Employee enrolled subsequent to the Effective Date, coverage shall commence on the first day of the month following 30 days active employment. The 30 day waiting period is waived for Active Employees who reinstate within 6 months from the date of termination.
3. For a Retired Employee, the first day of the month following the date of retirement.
4. For a Family Member, other than a newborn Child, who becomes eligible after the Employee has been enrolled, coverage shall commence on the first day of the following month, provided written application for the addition of such Family Member is filed with the City’s Human Resources Department – Benefits Section, and any required premiums are paid within 31 days of marriage or the acquiring of the Child.
5. For a Child born while the Employee is covered hereunder, coverage shall commence from the date of birth, provided written application for the addition of such Child is filed with the City’s Human Resources Department – Benefits Section, and any required premiums are paid within 31 days of the date of birth.
ATTACHMENT B - PAID PHARMACY CLAIMS DATA
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ATTACHMENT C – SAMPLE CITY CONTRACT
PROFESSIONAL SERVICES CONTRACT FOR
CONSULTING SERVICES
THIS CONTRACT is entered into on ________________________ 20XX, by and between the CITY OF STOCKTON, hereinafter referred to as "CITY," and NAME, hereinafter referred to as “CONSULTANT.”
Section 1
SCOPE OF SERVICES
Subject to the terms and conditions set forth in this Agreement, CONSULTANT shall provide CITY the services described in Exhibit A, entitled Scope of Services, attached hereto and by reference made a part thereof. CONSULTANT shall not be compensated for services outside the scope of services as set forth in Exhibit A unless, prior to the commencement of such services: (a) CONSULTANT notifies CITY and CITY agrees that such services are outside of the scope of services to be performed; (b) CONSULTANT estimates the additional compensation required for the additional services; and, (c) CITY, after notice, approves the additional services and amount of compensation therefore.
Section 2
COMPENSATION
CITY shall pay CONSULTANT for services rendered pursuant to this Agreement at the times and in the manner as set forth in Exhibit A, attached hereto and by reference made a part hereof, in a total amount of $AMOUNT. Payments specified in Exhibit A shall be the only payments to be made to CONSULTANT for services rendered pursuant to this Agreement unless, pursuant to Section I above, CITY approved additional compensation for additional services.
CONSULTANT will submit monthly invoices to CITY for services completed and reasonable expenses incurred to the date of the invoice. All invoices will be itemized to reflect the categories of employees performing the requested tasks, the billing rate for each employee and the hours for services.
All invoices sent by CONSULTANT to CITY shall be paid within thirty (30) days of receipt provided supporting narrative and hours billed against the specific task allocations in the contract’s scope of work are included and acceptable to the CITY. Invoices are to be rendered monthly.
Section 3
TERMS AND CONDITIONS OF AGREEMENT
1. Time for Commencement and Completion of Services: CONSULTANT shall commence services on DATE, CITY and shall prosecute the services to completion, unless the agreement is terminated as provided for herein or modified by CITY and agreed to by CONSULTANT.
2. Facilities and Property: CITY shall not be required to make its facilities accessible to CONSULTANT as required for CONSULTANT’s performance of its services.
3. License, Permits, and Compliance with Law: Prior to performing any services for CITY, CONSULTANT, if not already in possession of a valid City of Stockton business license, shall obtain at its own expense and maintain for the duration of this Agreement a City of Stockton Business License. In addition, CONSULTANT represents that prior to commencing any services under this Agreement, it shall obtain and maintain at its own expense during the life of this Agreement any other licenses, permits, qualifications, and approval required to practice its profession and perform the contract services and shall comply with any and all applicable local, state and federal laws in performing the contract services.
4. Relationship of Parties, No Third-Party Beneficiaries: CONSULTANT is an independent contractor under this Agreement. This Agreement gives no rights or benefits to anyone not named as a party to this Agreement, and there are no third party beneficiaries to this Agreement. In the exercise of rights and obligations under this Agreement, CONSULTANT acts as an independent contractor and not as an agent or employee of CITY. CITY shall not control where and how services are performed. CITY shall not reimburse CONSULTANT for business expenses or supplies and shall not provide CONSULTANT with vacation, pension, insurance, or sick leave. CONSULTANT shall provide CONSULTANT’S own office, tools and supplies and shall be free to engage in contracts with other persons or agencies, either public or private. CONSULTANT shall not be entitled to any rights and benefits accorded or accruing to the City Council members, officers or employees of CITY, and CONSULTANT expressly waives any and all claims to such right and benefits.
5. Subcontracts: CONSULTANT may use the services of independent contractors to perform a portion of its obligations under this Agreement with prior approval by CITY. Independent contractors and subcontractors shall be provided with a copy of this Agreement and shall agree to be bound by its terms. CONSULTANT shall be the responsible party with respect to all actions of its independent contractors and subcontractors, and shall obtain such insurance and indemnify provisions from contractors and subcontractors as CONSULTANT shall determine to be necessary.
6. No Discrimination: In performing the services under this Agreement, CONSULTANT shall not discriminate in the employment of its employees and the engagement of any subcontractors on the basis of race, color, national origin, ancestry, sex or any other criteria prohibited by law.
7. Insurance Requirements: CONSULTANT shall comply with the insurance requirements set forth in Exhibit B, which is attached to this Agreement and incorporated by reference. In addition, CONSULTANT, in accordance with the provisions of Section 3700 of the California Labor Code, secure at its own expense and maintain during the life of this Agreement, Workers’ Compensation coverage for its employees as necessary to protect CONSULTANT and its employees under the Workers’ Compensation Insurance and Safety Act. Such insurance shall be in a standard form and shall relieve CITY of all responsibility for such claims and or liability. CONSULTANT shall, prior to undertaking the work contemplated herein, supply CITY with a certificate of insurance evidencing that said coverages are in full effect.
8. Indemnity and Hold Harmless: The parties shall each indemnify, save harmless, and defend the other, and their representatives, from liability, claims, demands, costs or attorney’s fees for any injury or damages to persons or property resulting from their negligent acts in connection with the performance of professional services identified in this agreement.
9. Standard of Performance: CONSULTANT shall perform all services required pursuant to this Agreement in the manner and according to the standards observed by a competent practitioner of the profession. All services and/or products of whatsoever nature which CONSULTANT delivers to CITY pursuant to this Agreement shall be prepared in a professional manner and conform to the standards of quality normally observed by a person practicing the profession of CONSULTANT and its agents, employees and subcontractors assigned to perform the services contemplated by this Agreement.
10. Ownership and Use of Documents and Electronic Media Deliverables: All completed reports and other data or documents provided or prepared by CONSULTANT in accordance with this Agreement are the property of CITY, and may be used by CITY at its own risk.
11. Resolutions of Disputes, Forum, Attorneys’ Fees: The laws of the State of California shall govern the interpretation of and the resolution of disputes under this Agreement. Any dispute arising from this Agreement shall be adjudicated in the courts of San Joaquin County in the State of California. If any claim, at law or otherwise is made by either party to this Agreement, the prevailing party shall be entitled to its costs and reasonable attorneys’ fees.
12. Termination: This Agreement shall continue until terminated as provided for herein. CITY may terminate this Agreement at any time by providing written notice to CONSULTANT. CONSULTANT may terminate this Agreement by providing thirty (30) days written notice to CITY. In the event CITY shall give such notice of termination, CONSULTANT shall immediately cease rendering services pursuant to this Agreement.
In the event CITY shall terminate this Agreement: (a) CITY shall have full ownership and control of all writings which have been delivered by CONSULTANT pursuant to this Agreement and all drafts of reports and writings which form the basis for any writing or report which would have been otherwise delivered to CITY pursuant to this Agreement; (b) CITY shall pay CONSULTANT the reasonable value of services rendered by CONSULTANT pursuant to this Agreement provided, however, CITY shall not in any manner be liable for lost profits which might have been made by CONSULTANT had CONSULTANT completed the services required by this Agreement. In this regard, CONSULTANT shall furnish the CITY such financial information as in the judgment of the CITY representative is necessary to determine the reasonable value of the services rendered by CONSULTANT.
13. Notices: All notices, requests, demands and other communications hereunder shall be deemed given only if in writing signed by an authorized representative of the sender (may be other than the representative referred to in Paragraph 13 above), and delivered by facsimile with a hard copy mailed first class, postage prepaid, or when sent by a courier or express services guaranteeing overnight delivery to the receiving party, and addressed to the respective party as follows:
To CITY: City of Stockton
City Hall
425 N. El Dorado Street
Stockton, CA 95202
Attn: City Manager
To CONSULTANT: NAME AND ADDRESS
15. Entire Agreement: This document, including all exhibits, contains the entire agreement between the parties and supersedes whatever oral or written understanding they may have had prior to the execution of this Agreement.
16. Severability: If any portion of this Agreement or the application thereof to any person or circumstance shall be invalid or unenforceable to any extent, the remainder of this Agreement shall not be affected thereby and shall be enforced to the greatest extent permitted by law.
17. Headings, Assignment and Waiver: The headings in this Agreement are inserted for convenience only and shall not constitute a part hereof. Neither party to this Agreement shall assign its duties and obligations hereunder without the prior written consent of the other party. A waiver of any party or any provision or a breach of this Agreement must be provided in writing and shall not be construed as a waiver of any other provision or any succeeding breach of the same or any other provisions herein.
18. Auditing: CITY reserves the right to periodically audit all charges made by CONSULTANT to CITY for services under this Agreement. Upon request, CONSULTANT agrees to furnish CITY, or a designated representative, with necessary information and assistance.
CONSULTANT agrees that CITY or its delegate will have the right to review, obtain and copy all records pertaining to the performance of this Agreement. CONSULTANT agrees to provide CITY or its delegate with any relevant information requested and shall permit CITY or its delegate access to its premises, upon reasonable notice, during normal business hours for the purpose of interviewing employees and inspection and copying such books, records, accounts, and other material that may be relevant to a matter under investigation for the purpose of determining compliance with this requirement. CONSULTANT further agrees to maintain such records for a period of three (3) years after final payment under this Agreement.
19. Integration and Modification: This Agreement represents the entire integrated agreement between CONSULTANT and CITY; supersedes all prior negotiations, representations, or agreements, either written or oral, between the parties; and may be amended only by written instrument signed by CONSULTANT and CITY.
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20. Authority: The undersigned hereby represent and warrant that they are authorized by the parties to execute this Agreement.
IN WITNESS WHEREOF, CITY and CONSULTANT have executed this Agreement as of the date first above written.
| |NAME AND TYPE OF ENTITY, |
| | |
| | |
| |By |
| |NAME |
| |TITLE |
|ATTEST: |CITY OF STOCKTON, a municipal corporation, |
| | |
| | |
| |By |
| |J. GORDON PALMER, JR. |
|KATHERINE GONG MEISSNER |City Manager |
|City Clerk of the City of Stockton | |
|APPROVED AS TO FORM AND CONTENT: | |
|RICHARD E. NOSKY, JR. | |
|CITY ATTORNEY | |
| | |
| | |
|By | |
|JOHN M. LUEBBERKE | |
|Assistant City Attorney | |
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