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Question #RFP Page #RFP Section ReferenceQuestionAnswerAddendum1*RFP Section III-1.D and Appendix NRFP Section III-1.D. (Technical Submittal) seems to require a contractual relationship between the selected offeror andSapphire Health, LLC (“Sapphire”). Appendix N to the RFP provides: “To prevent any disruption to patient care,Offeror must submit a Letter of Intent (LOI) outlining a plan to interface with the Sapphire EHR system. The LOImust be included with the RFP response.” Neither the RFP nor Appendix N is clear as to when, how or by whom theLOI with Sapphire should be negotiated and established. Please (1) confirm that all that is required in the proposal isthe LOI and not a contract with Sapphire and (2) specify when, how and by whom such an LOI is to be negotiated andestablished as part of the procurement process.Appendix N has been modified to eliminate the need for a Letter of Intent with Sapphire Health, LLC. A revised Appendix N is attached to this addendum as Attachment 1 and replaces the one posted on January 13, 2017.Only the selected Offeror will have to contract with Sapphire Health, LLC. Refer to part II-2.A regarding transition/start-up.4/92III-2.F.4Offeror shall describe in detail how they will accomplish the following: Item 4. Distribute medications from a Pennsylvania Licensed Drug Wholesaler.Initial requirements for bidders to be licensed repackagers and licensed wholesalers appear to have been removed in this RPF version, however, this requirement remains.Was it the PADOC’s intent to continue to require licensed wholesaler status for potential bidders?Offerors are not required to be a licensed drug wholesaler. Rather, they must obtain all medications to be dispensed from a licensed drug wholesaler. The language in Part III-2.J has been deleted and replaced with the language contained in Attachment 2 to this Addendum. 43III-2.MThe selected Offeror must establish a file exchange including specified demographic and medication data with the PACE program for purposes of invoicing, reporting, and tracking medications billable to PACE for offenders age 65 and older.What indicators are in the current file exchange that explicitly identify PACE program participants?? How is that information relayed to the pharmacy entity?Does the PACE program utilize a Formulary that is separate or different than the one utilized and administered by the PA DOC?DOC updates the PACE inmate enrollment file, weekly, and sends it to PACE. PACE assigns ID numbers to new enrollees and returns the file to DOC and the vendor. PACE has an open formulary; however, it does not pay for Over-the-Counter or medications not covered by a PACE rebate from the manufacturer. PACE still reimburses pharmacy entity for these medications and then bills those charges back to DOC.44*APPENDIX N - Information Technology Requirements for Integration of Pharmacy Software with Electronic Health RecordShipping information including 2-D barcodes for each medication card. All shipped medications including stock must have a 2D barcode that Sapphire can ingest from the pharmacy system.Can a 2-D Bar Code from a current medication card be supplied as an example ( Patient / Facility Information Redacted)?What is the specific 2D Barcode Matrix that is being utilized?? Aztec Code, Code 1, or Data Matrix technology?Appendix N has been modified to correct the barcode requirement. A revised Appendix N is attached to this addendum and replaces the one posted on January 13, 2017.4/95*Section I-21.Restriction ofContactDoes Sapphire Health, LLC have any relationship through common ownership or otherwise withthe current pharmacy provider or any other potential offerors? In Section I-21 Restriction ofContact, the RFP states “An Offeror who shares information contained in its proposal with otherCommonwealth personnel and/or competing Offeror personnel may be disqualified.” Doescontacting Sapphire Health, LLC violate this RFP clause?Yes. Refer to the answer to Question 1 above and the revised Appendix N. Pursuant to Part I-2, all questions regarding the interface with Sapphire Health, LLC will be coordinated through the Issuing Office. 4/96Appendix NHow many correctional pharmacy software programs currently have interfaces working withSapphire Health EHR to the specifications required by APPENDIX N - Information TechnologyRequirements for Integration of Pharmacy Software with Electronic Health Record? If there areany, what is(are) the name(s) of the software program(s)?Sapphire is currently interfaced with the CIPS Pharmacy Software Program.? CIPS, provided by Kalos, Inc., is the largest provider of pharmacy dispensing software within the correctional pharmacy industry. ?Sapphire has been integrated with CIPS for seven years.? 47N/AAt the Pre-proposal Conference held on December 13, 2016 at SCI-Rockview, David R. Kline, theIssuing Officer, stated that a WebEx tutorial would be presented to all bidders on Sapphire HealthEHR. Can you please provide a date and time for this webinar?Refer to Addendum 3 posted on 1/26/17 regarding a Question and Answer session with Sapphire Health scheduled for 2/2/17 at 9:00 AM EST for all interested Offerors. 48Section III-1. PartE. 340B ProgramWho is the contact to discuss the arrangement with Temple University and the DOC in order tomeet the 340B requirement of III-1.E 340B Program on page 14 of the RFP?The selected Offeror will be provided contact information for Temple University Hospital upon contract award.49*Section III-1, PartD. InformationTechnologyAt the Pre-proposal Conference held on December 13, 2016 at SCI-Rockview, the Chief of ClinicalServices at PA Department of Corrections stated that Sapphire EHR is currently functioning as aneMAR and not yet fully functional as an EHR. Since some time has passed, is the EHR referencedin Part III, Section III-1, Part D now functioning as a full EHR? This question is relevant becausedeveloping an interface for an EHR and an eMAR are two different tasks. Although the wordsEHR and eMAR seem to be used interchangeably, the two programs are different. Not knowingthe system functionality could cause a delay in the “turnkey” requirement on the first day of thecontract start for anyone other than the incumbent.Full implementation of the Sapphire EHR will be completed prior to the implementation of a contract resulting from this RFP. 4/910*Appendix NYour description of the interface requires the use of a shared database to receive and sendinformation.a. Most CIPS versions don’t use this model. Is a shared database required?b. CIPS typical model would be to have Sapphire run a file drop of HL7 messageswhere Sapphire would be given SFTP access to our server and drop orders, as wellas pick-up response files from CIPS as we fill the scripts. Would you allowSapphire to work in that manner?Refer to requirements set forth in Appendix N.6/911Appendix NA recently answered question stated that CIPS Correctional Pharmacy Software was written as theprogram with which you interface. However, Appendix N states, “Barcode must identify theMedispan GPI of the medication on the card for proper administration screening.” CIPS containsdata tied to the fill ID and would not be what Sapphire is expecting. Can you control how youhandle different barcodes?Sapphire can process a variety of barcode, however the end resultant data must be representative of unique item identification which also must be tied to a known GPI and supporting data.? This information is used to validate that proper medication is being administered to the patient.? Alternative barcode options would need to be further explained before a determination could be made if they comply with the requirements to identify the GPI.612*Appendix NReferring to the above statement that CIPS Correctional Pharmacy Software is the program forwhich you have a Sapphire interface. The updated Appendix N states “The preferred interfacemessage format is HL7.” Does your CIPS Correctional Pharmacy Software use HL7 to interface with Sapphire?Refer to requirements set forth in Appendix N.6/913Appendix NIs there a cost associated with using the interface, e.g., per claim, per order, per refill?Refer to Part III-1.D614Appendix NWhat monthly and/or quarterly costs are tied to the interface?There are no financial obligations, routine or otherwise, to Sapphire Health for the Offeror.615Appendix NDo the above costs, in questions 4 and 5, remain the same over the course of the contract?Yes.616Appendix NDoes the processing fee to the state include profiles?Yes617Appendix NWhat is our cost to Sapphire for the programming of the interface?The selected Offeror may incur technical costs associated with making any necessary modifications to their pharmacy system to accommodate the interface with the Sapphire E.H.R. per the requirements. If Sapphire is required to make custom programing changes to the Sapphire system for features not currently supported under the existing interface to accommodate the Offeror’s interface, Sapphire will charge a hourly rate for custom programing.618*Appendix NIn Question and Answers for PADOC Pharmacy and Pharmaceutical Services, Question #6, theanswer received stated that Sapphire has an interface with the CIPS Pharmacy Software Program.Is Sapphire’s interface with CIPS through an HL7 interface? Can you tell us if Sapphire has beenintegrated with the CIPS Standard version in addition to the incumbent’s own proprietary versionof CIPS for the past 7 years? The answer to this question is most important because the largestprovider of pharmacy dispensing software within the correctional pharmacy industry, CIPS, usesthe standard version for ease of interfacing with any EHR. Stating that there is a CIPS interface forSapphire, when it was built and programmed for a proprietary version of CIPS, is misleadingbecause that interface doesn’t work with the standard CIPS version. Can you please clarifySapphire’s interface experience with CIPS’standard HL7?Refer to requirements set forth in Appendix N.6/919Appendix JCost Proposal Appendix J: There is a discrepancy between the number of prescriptions to base pricing on in the Cost Proposal Appendix J (lists total number of prescriptions as 946,331) and Appendix D amount of medical orders by Institution (lists total number of prescriptions as 1,065,359). Should Appendix J be modified to reflect actual orders placed/received during the utilization period of 9-1-15 to 8-31-16 provided in Appendix D?Appendix D – Medication Orders by Institution is a historical report of ALL prescriptions ordered for the period indicated. Appendix J – Cost Submittal is a subset of medications for pricing evaluation purposes. 620Appendix DAppendix D: Please clarify whether the number of Stock medication orders and OTC medication orders are included in the total prescription orders or if they are in addition to the total prescription orders listed in column 4.Yes. They are included in the total prescription column.621III-1.DWhat is the current published price from SapphireHealth, LLC for a bi-directional interface for a pharmacy information system to Sapphire EHR?See response to question #17. Sapphire charges per hour for custom programing. 622III-1.DWill the pharmacy information system be supplying ADT in addition to script information, or will Sapphire EHR have a separate ADT feed?No. The pharmacy system will not supply ADT to Sapphire. Sapphire EHR receives routine ADT feed from the DOC. ?If the Offeror requires an ADT feed separately, this must be arranged through the DOC.? 623Appendix SPlease provide the number of Pharmacy Medication Events (Errors) with detail the current vendor has made and the amount of the chargeback to vendor (credit to PADOC) over the past two (2) fiscal quarters based on the Contract Performance Standards outlined in Appendix S.None.624III-2.H.6Part III-2.H.6 CQI: #6 of this section refers to acceptance of error rate for filling of medication orders of no more than .05 percent per month at each SCI and aggregate statewide. This conflicts with Appendix S Performance Standards #5 which allows no more than 3 Pharmacy Medication Events (Errors) per quarter. Based on your stated medication orders in Appendix D, Appendix S would only allow for .000817 percent per month error rate for filling of medication orders. Since these two figures conflict one another, please clarify the acceptance of error rate for filling of medication orders is correct as listed in III-2.H.6 as .05 percent is more in line with industry standards and modify the number of allowable medication events in Appendix S to reflect the correct percentage listed in the RFP.Describe and provide a sample of your medication event tracking analysis tool including screenshots or hyperlinks as appropriate.? Offerors shall provide an overview of your medication event monitoring process to include electronic tracking, reporting and trending of Dispensing and Administration Events.? This event report will be sent to the BHCS on a monthly basis.? The PADOC will not accept an error rate for filling medication orders of more than 3 per quarter statewide.? See Appendix S.625III-1.J.2Part III-1.J.2 Qualifications: Please clarify whether the meaning of “aggregate average annual claims volume of at least three million” is referring to PBM claims.This includes all pharmacy claims.626*Addendum 4Official Questions and AnswersQuestion 2Question #2 of Addendum 4 was answered, “Offerors are not required to be a licensed drug wholesaler. Rather, they must obtain all medications to be dispensed from a licensed drug wholesaler. The language in Part III-2.J has been deleted and replaced with the language contained in Attachment 2 to this Addendum.”The Federal Register (64 FR 67720 at 67748) indicates that a pharmacy cannot distribute more than 5% of its gross sales as stock without being registered as a wholesaler or using the services of a wholesaler to distribute wholesale quantities of stock medications. Although some pharmacies have a smaller customer base than others, a fair assumption is that the percentage of stock dispensed by potential Offerors to this RFP would be similar. Therefore, most if not all pharmacies working in the correctional industry provide at least 5% of their overall correctional sales as stock. Such pharmacies need to comply with the federal 5% rule regarding stock distribution as well as the Pennsylvania Wholesaler Act. (1) Will you require bidders to comply with this regulation by amending the RFP to require Offerors to disclose in their written proposal the percentage of overall gross sales their pharmacy dispenses as stock? (2) Will you require the Offeror to provide, at the time of proposal submittal, written documentation or a copy of their wholesaler license to show whether they are licensed as a wholesaler or they use the services of a licensed wholesaler for stock distribution? (3) Will an Offeror’s failure to provide proof of compliance with federal regulations, specifically the aforementioned requirement, deem a pharmacy bidder non-responsive and therefore ineligible for an award? (4) If the answer to part (3) ( immediately preceding) is “no,” what process will DGS follow prior to awarding a contract to ensure compliance with federal and state laws regarding stock distribution so that the DGS does not award a contract to a vendor, only for the DGS to later discover that the vendor is unable to comply, which would place the PADOC and DGS at risk for possible fines and/or disciplinary actions upon inspection?(1) The selected Offeror, in the performance of all of the requirements of any contract resulting from this RFP, must comply with all applicable federal, state, and local laws and regulations as set forth in Part III-1.J(1). By submitting a proposal in response to this RFP, Offerors represent to the Commonwealth that they, and any subcontracts to be used in performance of the Contract, are compliant with the applicable federal, state, and local laws and regulations. See Part I-24.A. If at any point during the contract term, a change in status or scope requires a change in licensure/registration status in order to remain compliant with all applicable federal, state, and local laws and regulations, it is the responsibility of the selected Offeror to ensure that the new requirements are met immediately and must notify the PADOC within 10 calendar days of such a required change.(2) See response to Question 26(1), above.(3) See response to Question 26(1), above.(4) See response to Question 26(1), above.6/927*Addendum 4Official Questions and AnswersQuestion 2Question #2 included, “Initial requirements for bidders to be licensed repackagers and licensed wholesalers appear to have been removed in this RPF [sic] version, however, this requirement remains.” However, Answer #2 does not appear to respond to this comment.As PADOC facilities currently receive legend stock in cost-effective blister cards, a pharmacy or a wholesaler cannot simply put those medications in a blister card and label them as stock and still be in full regulatory compliance with 21 USC 352. A company must be an FDA-registered repackager or use the services of an FDA-registered repackager to legally repackage stock medications into blister cards or into any other packaging that results in a change to the original manufacturer’s packaging. (1) Will you mandate that bidders comply with these regulations and use a FDA-registered repackager if stock is provided in packaging (such as blister cards) that is not the manufacturer’s original packaging? (2) Will you require bidders to provide evidence (such as the repackager’s license and labeler code, or a letter from the repackager on their letterhead) at the time of proposal submittal to show that they use an FDA-registered repackager? (3) Will an Offeror’s failure to provide written documentation at the time of proposal submittal, showing they comply with FDA repackaging regulations regarding the provision of stock, deem that bidder non-compliant and therefore ineligible to receive an award? (4) If the answer to part (3) ( immediately preceding) is “no,” what process will DGS follow prior to awarding a contract to ensure compliance with federal and state laws regarding stock repackaging so that DGS does not award a contract to a vendor, only for the DGS to later discover that the vendor is unable to comply, which would place your facilities at risk for possible fines and/or disciplinary actions upon inspection?(1) The selected Offeror, in the performance of all of the requirements of any contract resulting from this RFP, must comply with all applicable federal, state, and local laws and regulations as set forth in Part III-1.J(1). By submitting a proposal in response to this RFP, Offerors represent to the Commonwealth that they, and any subcontracts to be used in performance of the Contract, are compliant with the applicable federal, state, and local laws and regulations. See Part I-24.A. If at any point during the contract term, a change in status or scope requires a change in licensure/registration status in order to remain compliant with all applicable federal, state, and local laws and regulations, it is the responsibility of the selected Offeror to ensure that the new requirements are met immediately and must notify the PADOC within 10 calendar days of such a required change.(2) See response to Question 27(1) above(3) No.6/928General QuestionThe FDA-registered repackager requirement appears to have been removed from the RFP. However, all of the following remain true:? All legend stock medications are required to be sent by a licensed wholesaler, according to the Wholesale Prescription Drug Distributors License Act (Act No. 1992-145, H.B. No. 2602).? A transaction history document (formerly called a “pedigree”) is required for wholesale transactions, according to the federal Drug Quality and Security Act (DQSA).? A transaction history document (formerly called a “pedigree”) cannot be broken down further than the original manufacturer’s package size.(1) As the above are true for a vendor to comply with federal and state laws, is the PADOC’s intent to obtain all stock medication in original manufacturers’ bottles since obtaining cards without a repackager will not be an option? (2) If the PADOC’s intent is not to receive all stock in bulk manufacturer packaging, please confirm that the RFP will be amended to require wholesaler licensure and the use of an FDA-registered repackager to provide stock in cost- effective and easily manageable blister cards.(1) The selected Offeror, in the performance of all of the requirements of any contract resulting from this RFP, must comply with all applicable federal, state, and local laws and regulations as set forth in Part III-1.J(1). By submitting a proposal in response to this RFP, Offerors represent to the Commonwealth that they, and any subcontracts to be used in performance of the Contract, are compliant with the applicable federal, state, and local laws and regulations. See Part I-24.A. If at any point during the contract term, a change in status or scope requires a change in licensure/registration status in order to remain compliant with all applicable federal, state, and local laws and regulations, it is the responsibility of the selected Offeror to ensure that the new requirements are met immediately and must notify the PADOC within 10 calendar days of such a required change.(2) The RFP language remains as stated.629General QuestionWhen will the intent to award a contract be published?Refer to section I-25630General QuestionOnce the contract is awarded, what is the proposed contract start date?Refer to section I-23631General QuestionWhat are the current contracted pharmacy rates (dispensing fees) for patient specific orders, stock orders, and IV Infusion orders? This information should not be proprietary as this information is now historic in relationship to the expiring contract. It would seem reasonable that information available in relationship to cost and the expenditure of public monies to a private contractor should be considered open and public. Failure to disclose the known information would be a substantial disadvantage to any bidders wishing to compete in a fair and competitive bid process.The rates are available to view on eMarketplace. Below is a link to view the current contract on eMarketplace: 632General QuestionAre medical supplies (needles, syringes, diabetic test strips, etc.) for your location ordered from the current contracted pharmacy? If not, is this a service PADOC would like to consider? If so, please revise RFP specifications to include ability for vendors to describe this service offered.The medical supplies are purchased of off contract 4400010454. Below is a link to view the current contract on eMarketplace: PADOC consider PDF files to be a Microsoft Office compatible format? Since most proposal responses are created in graphic design programs to allow for special formatting as specified in the RFP (ex: section from RFP differentiated from Offeror’s response in another color or test box, insertion of graphs, illustrative pictures, etc.) These files can then be exported as a PDF file which can be opened universally on any computer. Additionally, PADOC had acknowledged on the previously released RFP that they would accept PDF files for the Appendix listed in previous Addendum #2. Submission as a PDF file protects the content of the Offeror’s proposal as PDF files are not able to be edited by the viewer.Yes. Refer to section I-13.634I-13.AWill the State accept an electronic copy of the proposal response by email prior to the due date/time or is a physical CD/DVD or Flash Drive required?No. Refer to section I-13.635II-4.APlease describe in detail how the Technical Portion of the Evaluation of Proposals will be scored and weighted, including a breakdown of the number of technical points allocated to each category for evaluation listed in RFP in order to make up the 40% of the total points for the technical portion of evaluation: Offeror/Personnel Qualifications, Soundness of Approach, Specialty Programs (340B and PACE), and Data Management/Fiscal Reporting and Automation.Refer to section II-4.A No additional detail on point allocation will be provided.636III-2.LIn order to provide specific cost containment/avoidance strategies as requested in Part III-2.L Cost Savings Strategies, actual utilization data would be required for potential bidders to study medication mix and prescriber ordering trends in order to prepare a responsible and competitive bid rate along with suggestions for cost containment/avoidance strategies. Can you please provide the past 3 months detailed pharmacy invoices for review to include drug names, strengths, and quantities with patient information redacted??Please differentiate clearly between stock medications and patient specific medications.Offerors should propose cost containment/avoidance strategies based upon data already provided in the RFP.637III-1.DIs there still an intent to provide a WebEx Tutorial on Sapphire Health EHR? More specific questions regarding the EHR Information Technology Requirement of the RFP may arise after seeing a demonstration of the EHR that all offerors are required to interface with. If so, please inform of the date of demonstration prior to the final deadline for all questions on 2-9-17.Refer to Addenda 3 and 5.638Appendix SPerformance Standards Appendix: File name is Appendix S but still says Appendix R at the top when you open the file. Should this be modified so as not to create confusion among the bidders?Appendix S has been corrected and is now made part of this RFP639VI.3Part VI Contract Terms and Conditions: VI.3 Renewal of Contract Term; Adjusted Prices – Fixed Percentage: This section refers to renewing existing bonds or providing new bonds for the contract renewal. Can this section be modified to remove the reference to bonds as the Performance Bond requirement has been removed from the RFP?Part VI.3 has been replaced in its entirety with the provision set forth on Addendum 6.640III-1.J.1Part III-1.J.1 Qualifications: This paragraph refers to required licenses but then references Acts and Regulations. Please clarify which specific licenses are required.Refer to III-1.J.1641III-2-G-1.cWith expected closing of SCI Pittsburgh by June 30, 2017 should we still submit an answer to III-2-G-1.c regarding oncology?Yes.? While the oncology program will no longer be at SCI Pittsburgh following its closure, the DOC will be continuing the program at a different facility to be named at a later date.? The selected Offeror will be required to support that program at the new facility.642III-2.G.1.aWhat is your current cutoff time for next-day delivery orders to be submitted to the pharmacy? Do you intend to keep this the same?Refer to III-2.G.1.a843NAWhat is the average pharmacy dollar amount spent monthly over the past 12 months?Refer to I-4. The current annual spend on the pharmacy and pharmaceutical services covered by this RFP is approximately $39 million.844NAWhat is the percentage of stock medications vs. patient specific medications? What percentage of stock medications are received in 30 count blister cards vs. manufacturer’s bulk bottles?This varies by date and by site. Please see note in Appendix J – Cost Submittal REV 022117 instructions block.The percentage of stock medications are received in 30 count blister cards is indeterminable. Virtually all stock medication come in some form of blister pack to insure appropriate tracking of medication.845III-2.EMay we have a copy of your current formulary?The current formulary will be shared with the selected offeror at time of award.846III-2.G.2.cWho is the current after-hours back-up pharmacy for each facility? Agreements with backup pharmacies are in place through our current pharmaceutical provider. PADOC is not directly involved with those agreements. 847III-2.I.1How are the prescription returns from your facility currently handled? Do you currently receive credit for returned medications? Are there any restocking fees or minimum costs to qualify as a return?Unused medications, eligible for return and credit are sent to the pharmacy. Monetary credit is received for the returned medication. There are no restocking fees.848III-2.F.1What is the current process for notifying pharmacy of inmate release dates?Will it be required to ship inmate discharge/transfer medications to private residences or are they shipped to each correctional facility only for discharge/transfer patients?The PADOC does not notify the pharmacy of an impending inmate release date, as this would be a security violation. Release medications are ordered for delivery in safety cap vials to the SCI prior to the release date.849III-2.H.4Is/are your correctional facility(ies) accredited by the National Commission on Correctional Health Care (NCCHC) or American Correctional Association (ACA)? If not, do you expect to seek accreditation during the term of the contract?All PADOC facilities are ACA accredited. 850III-2.H.4Please provide all current Accreditation for all facilities.This information is publicly available via the ACA website at .851NAWhat percentage of your inmates, if any,?are?Federal? Specifically, what percentages are under jurisdiction of each the US Marshals Service (USMS) and US Immigrations and Customs Enforcement (ICE)? This information is confidential and cannot be published for security purposes.852NAAre OTC medications for commissary provided by the Contracted Pharmacy? If not, where do they come from?OTC medications for commissary are purchased through the commissary products ITQ.853III-2.E.3How are non-formulary requests approved? Please describe your Non-Formulary Review process in detail.Medication orders are entered in the E.H.R. Items deemed Non-formulary are presented to either the Regional Medical Director or the Regional Mental Health Director for review and approval. If not approved, ordering clinician is electronically notified. If approved, order is sent to pharmacy to be filled.854III-1.N.1.nPlease describe the current destruction policy for all outdated/expired drugs. PADOC nurses dispose of most outdated/expired medications. Schedule II narcotics are destroyed during quarterly audits that are required/performed by the pharmacy vendor’s designated pharmacist(s). 855NADo any of your facilities have a DEA License? If so, whose name(s) is (are) under licensure?Yes, all facilities have a DEA licenses. These licenses are issued in the name of the institution. 856NAPlease provide the following pharmacy information by year for the last three years: number of patients on HIV medication, number of patients on psychotropic medications, number of patients on Hepatitis C medications, number of patients receiving medications associated with?hemophilia, HIV medication dollars, psychotropic medication dollars, hepatitis C medication dollars, and?hemophilia?related medications dollars.?Refer to Appendix J – Cost Submittal Revised 021717 for the medications ordered by the PADOC’s contracted providers for treatment of their patients. Note: Hemophilia medications are not in the scope of this RFP. Refer to Part III 2. F 6 857NAOf inmates receiving Hepatitis C treatment, what is the nature of the treatment? Please list medications used to treat over the past three years.Refer to Appendix J medications prescribed by PADOC contracted clinicians.858NAPlease outline the medical personnel shifts that will require start up in-service training?In-service training is not required for our institutional level medical personnel. 859NADo your institutions maintain an Emergency Drug Box? If so, please provide a list of medications to be contained in the Emergency Drug Boxes. Yes. Our facilities maintain a crash cart and a mobile bag, the required contents of each are provided below:Actidose/Sorbitol????????????????????????? Bottle?????????????????????????????????????????????????? 1 (Activated Charcoal)Albuterol Rescue Inhaler???????????? Multi-dose Inhaler????????????????????????????? 1 Inhaler????????? Albuterol Nebulizer Soln 0.083%????? Pre-mixed Solns????????????????????????? 1 BoxASA 81 mg???? Chewable?????? 1 Blisterpack of ???? 30Benadryl (Diphenhydramine) ????? Carpuject???????????? 2 CarpujectsIM or IV 50mg/ml InjCogentin (Benztropine Mesylate)?????? Single Dose Vial SDV???????????? 2 SDVIM or IV 1mg/ml InjDextrose 5% Water D5W-500ml??????? Bag????1 BagDextrose 50% (pre-filled syringe)?????? Syringe?????? 2 Syringes50ml-Inj- IV useEpinephrine 1:1000?????????????? Ampule????????????? 2 Ampules(SQ or IM) 1mg/ml InjGlucaGen Hypo-Kit - Low Blood ?????? Kit????????????? 1 Hypo-kitSugar 1mg/unit (Prefilled syringe)????????????????????????????????????????????????????????????????? Injection KitInsta-Glucose Gel (Oral)??????????????????? 45 grams tube???????????????????????? 2 TubesLow Blood SugarHaldol (Haloperidol) IM only?????????? SDV????????????????????????? 2 SDV 5mg/ml ?????????????????????????????????????????????? Lasix (Furosemide) IM or IV?????????????? 4ml Prefilled Syringe????????????? 2 Syringes10mg/ml Inj --40mg Total Syringe????????????????????????????? Narcan (Naloxone) Nasal Spray Apparatus2mg/2ml Narcotic Antagonist ?????? 2ml Luerlock plus Atomizer?? 2 Prefilled Syringes (may utilize Carpuject until medication meets expiration date.Nitroglycerin Sublingual tabs????????????? SL-tabs??????????????????????????????????????????????? 1 Bottle (#25)1/150 grain =0.4mg tabSodium Chloride??? 0.9% NSS Soln?? 1 Bag1000ml bagSodium Chloride???????? 0.9% Inj 10ml Vial?????? 2 VialsSolu-Medrol IM or IV, ?????????????????????? 125mg Act-O-Vial???2 Vials125mg/2ml????????????????????????????????????????????????????????????????????????????? Valium (Diazepam) IM or IV Carpuject??? 2 Carpujects10mg/2ml InjThe Mobile Bags would require the following:ASA – 81mg?? Chewable? 1 Blisterpack of 30Dextrose 50% (prefilled syringe) 50 ml-Inj-IV use??? 1Epinephrine Inj 0.3mg Auto-Injector??? 1 Auto-InjectorGlucaGen Hypo-Kit- Low Blood Sugar1mg/unit (Prefilled syringe) Injection ????? 1 Hypo-KitInsta-Glucose Gel (Oral) Low Blood Sugar?????? 3 TubesNarcan (Naloxone) Nasal Spray Apparatus 2mg/2ml Narcotic Antagonist ??2ml Luerlock plus Atomizer??? 2 Prefilled(may utilize Carpuject until medication meets expiration date)??Syringes Nitroglycerin Sublingual tabs 1 Bottle (#25) 1/150 grain =0.4mg tab860NAPlease provide a list of your current stock medications at each facility.Because medications are dispensed daily in accordance with clinical needs, an accurate listing of stock medication is not available.861NAHow many med carts are currently in use by your correctional facility? Are these med carts the property of the current contractor or will they remain with the County? Please outline the quantity of medications carts needed for each facility (if required)?This varies by site. They are the property of the PADOC. Additional carts are not needed at this time.862III-8Can PADOC provide examples of current monthly reports provided by current pharmaceutical services vendor?No. These are confidential documents. Offerors are to provide examples of their reports. Please refer to Part III-8 Reports and Project Control. 863III-1.B.2Security:What training will be required for Offeror’s employees who will be visiting PADOC facilities to fulfill contract requirements? Is the required training offered on an ongoing basis or is it offered only on certain scheduled dates/times?Who is required to complete this training? All employees of Offeror who will be entering PADOC facilities must participate in a security briefing. This briefing includes an overview of Prison Rape Elimination Act (PREA) policies and completion of a verification form as a requirement of that training. This does not pertain to delivery drivers, as they should not enter PADOC facilities.864III-1.H.1Will Offeror be required to provide phone lines for fax machines at each facility or can the fax machine be hooked up to an existing DOC phone line?Phone lines currently exist however, the cost of the service to them is the responsibility of the selected Offeror.865III-2.F.1Please describe in detail the pre-approval process if a partial fill of a medication is necessary.The PADOC will not routinely accept partial fills. If the need arises due to extenuating circumstances, communication (a phone call initially, followed by an email) must be initiated by the pharmacy to the ordering clinician, SCI, and BHCS seeking approval to send a partial fill, indicating the reason for their inability to provide a full fill, the quantity available at the time, and plan for providing balance of order. Refer to Appendix – S Performance Standards866III-2.H.3Please clarify whether each individual institution has its own Pharmacy & Therapeutics Committee or is there one Pharmacy & Therapeutics Committee for the entire PADOC to promote consistency among all PADOC institutions.There is a site level P&T Committee at each SCI and a Statewide P&T Committee which is an element of the PADOC Continuous Quality Improvement Program. 867III-2.H.5How frequently is on-site presence needed for additional audits such as Forensic Treatment Center audits and Mental Health Unit’s audits?These audits are conducted annually. 868III-2.KPatient Education: Will inmates have access to watch live or pre-recorded WebEx videos for patient education? What other types of multimedia will inmates have access to in order to receive patient education?No. None at this time.869Appendix JLine 342: Menest 2.5 mg has been discontinued by the manufacturer. Would PADOC prefer pricing on an alternate strength of this medication (.3 mg, .625 mg, or 1.25 mg strengths are still available), or will the State modify Appendix J to remove this line item?Appendix J has been revised to reflect this discontinued item.870III-2.E.4Please define what are “high cost medications” or the parameters used to identify such. Medications will be included in the restricted formulary list at the discretion of the PADOC Chief of Clinical Services and the Director of the Bureau of Health Care Services.871III-3.CPlease describe in detail the process currently used to determine an inmate’s eligibility for Medicaid upon release. Medicaid eligibility is determined by the Pennsylvania Department of Human Services upon receipt of a completed Commonwealth Application for Social Services, submitted by a representative of the PADOC on behalf of the re-entrant prior to his/her release.872III-1.DWill there be any additional ongoing monthly fees associated with the Sapphire EHR beyond the initial bi-directional interface fee?Refer to answer to question #14.873*III-1.DPlease provide the original RFP and bid number that was released for the EHR for which Sapphire now has the contract so that we may better understand the specs of the EHR offerors are expected to interface with. Additionally, please provide the current state contract with Sapphire for the contracted EHR. The Sapphire E.H.R. was obtained through the Commonwealth Dell Contract, Purchase Order #4300460084.Please refer to Appendices N and O, as well as previously submitted questions and answers regarding the specifications of interfacing with the Sapphire E.H.R. 8/974III-1.FHow many inmates currently qualify for the PACE program?Refer to Appendix Q for overview of PACE agreement requirements. This information is not necessary to submit a proposal875III-1.FHow many prescriptions for the past three (3) months have been processed through the PACE program?Refer to answer to question #75876Appendix J-Cost SubmittalPlease clarify lowest unit of measure pricing definition for ‘Per Aerosol’.? Does it mean per gram? Per puff? Per inhaler? Per Microgram?Per inhaler.877Appendix J-Cost SubmittalPlease clarify lowest unit of measure pricing for Humira (2 injections per kit) 40MG/0.8 INJ.? Should we price one kit with two injections or pull one injection out of kit and price as a single unit?Single unit.878Appendix J-Cost SubmittalPlease clarify pricing for Humulin and Lantus insulin.? Does per injection mean to price per 1ML or price per (1) 10ML vial?? If neither, please provide the measurement of calculation.?10ML879Appendix J-Cost SubmittalPlease define the lowest unit of measure for creams.? For example should creams, lotions (Vitamin E Lotion Lot), and other topicals be priced per gram? Per ounce? Per tube?Per tube (based on weight of tube)880Appendix J-Cost SubmittalPlease clarify how to price Atovaquone 750/5ML SUS.? The lowest unit of measure stated is ‘Per Vial’, but Atovaquone is an oral suspension.? How should we calculate this price?? Per ML or other measure?Per ML881Appendix J-Cost SubmittalPlease clarify how to price Gammagard LIQ 10% 30gm/300ML 10%.? Should we price Per Gram?? Per ML? Other measure?Per ML882Appendix J – Cost SubmittalCost Submittal (Drug Cost Details tab) states that PA DOC’s annual drug spend is $39.2M.? What drugs does this cost include and exclude?? Does that annual spend estimate include Hep C and HIV medications?The $39.2M spend referenced in the RFP document and appendix J refers to the total spend on medications purchased through the current pharmacy contract. The list of medications provided on Appendix J “Cost Submittal” is a subset of all medications purchased for PADOC patients either via the pharmacy contract or through the 340B program. Appendix J will be updated to remove all 340B (HIV) Medications.883Appendix AIn an effort to better understand the population being served, can you provide inmate acuity statistics?? Can you provide inmate demographic reports by age, sex, and race?Please refer to: you provide the average daily number of scripts received by 12:00 noon that are delivered the same day?Unknown. This varies by day.885III-G-2-1Will deliveries to the community correction centers be next day and not same day?The PADOC expects the same delivery service for Community Corrections Centers as is proposed for the State Correctional Institutions.886III-G-2-1Are there any SCI facilities that will not receive same day delivery and will expect next day delivery via FedEx or UPS?Offerors are to submit their recommended delivery schedule in their proposal. 887I-4Mission Statement and BackgroundIII-2.ATransition/Start UpI-4 states, “…pharmacy and pharmaceutical services through an Emergency Purchase Order which will cease upon implementation of the contract resulting from this RFP.” III-2.A states, “The selected Offeror should ensure that all services outlined in this RFP are fully implemented within ninety (90 days) of the execution date of the contract.” Please confirm that (1) a potential Offeror must be ready to provide all contract requirements including 340B program management, PACE program management, and oncology program management; (2) the potential Offer must have a fully functional interface with Sapphire within 90 days of an executed contract; and (3) the date the contract is signed establishes the execution date of the contract, as of which an awardee will have 90 days to complete a transition of services.Refer to Part I-4.Refer to Part III.2.A.988I-4Mission Statement and BackgroundThe current emergency pharmacy procurement extends until June 2017, after which time an awarded vendor will be expected to initiate all services, specifications, and interfaces. Please confirm this is accurate.Refer to Part I-4.989General QuestionAppendix SAppendix S lists numerous performance standards, yet no performance standard is noted for a vendor that is not fully prepared to provide the required RFP services within 90 days of an executed contract. An Offeror’s inability to provide services promised in a proposal within 90 days of an executed contract would be very costly to the PADOC in terms of continuity of patient care as well as numerous litigations and grievances. For service-level specifications not met by the vendor, as determined by the PADOC, what daily performance credits (in dollars) will be expected by DGS per violation per day from that vendor? Refer to Appendix S – Performance Standards990I-13.BProposal FormatThe RFP states, “The Issuing Office reserves the right to request additional information which, in the Issuing Office’s opinion, is necessary to assure that the Offeror’s competence, number of qualified employees, business organization, and financial resources are adequate to perform according to the RFP.” (1) Please provide the criteria that DGS will apply to determine if a potential Offeror has the financial resources, number of qualified employees, and capacity to be deemed qualified and eligible for an award? (2) Will DGS make visits to inspect the facilities of all potential Offerors in making these determinations? (3) If not, how will they be quantified by DGS in making an award decision? (1) Refer to RFP(2) Refer to Part I-13.B.(3) Refer to Part I-13.B.991I-17Prime Contractor ResponsibilitiesI-17 states, “The selected Offeror must perform at least 51% of the total contract value.” Could you please clarify if this is 51% of the actual work performed, or 51% of the total contract dollars?51% pertains to the total value of the services performed.992I-19.B.3The RFP states, “Those Offerors whose score for their technical submittal of the proposal is less than 75% of the total amount of technical points allotted to the technical criterion” will not be invited by the Issuing Office to submit and Best and Final Offer. Thus, Offers scoring below 75% of the total technical points will not be eligible for an award. In most circles, a 75% performance standard for technical qualifications would be considered average to below average. However, DGS is permitting an average-to-below-average potential Offeror to possibly provide a professional services contract for inmate pharmacy services. (1) To ensure that only the highest level of service will be accepted from any Offeror, would DGS consider increasing this threshold to an 85% to 90% level to determine the technical qualifications of a potential Offeror? (2) If not, is DGS prepared to stand behind that vendor regardless of negative outcomes in patient healthcare and patient safety? (3) If not, then why would such a low threshold be considered acceptable in determining technical qualifications? (1) No.(2) A response is not necessary to prepare a response to this RFP.(3) A response is not necessary to prepare a response to this RFP.993I-24Offeror’s Representations and AuthorizationsThe RFP states, “The Commonwealth shall treat any misstatement, omission or misrepresentation as fraudulent concealment of the true facts relating to the Proposal submission, punishable pursuant to 18 Pa. C.S. § 4904.” Please confirm that any statements made by potential Offerors regarding medication returns and credits, repackaging laws for stock distribution, and wholesaler requirements for stock distribution, along with any misrepresentations of SDB certifications will be punishable pursuant to 18 Pa. C.S. § 4904.Language of the RFP remains as stated.994I-30Regulatory RequirementsThe RFP states, “The selected Offeror agrees to render its services as herein provided in accordance with the rules and regulations of the Pennsylvania Board of Pharmacy including but not limited to the Pharmacy Act and all applicable Federal, State and local laws and regulations.” Please confirm at this time that DGS does accept and acknowledge that any potential Offeror will need to be licensed in Pennsylvania or use the services of a wholesaler licensed in Pennsylvania to provide legend stock medications to DOC facilities (if over the federal 5% rule). Refer to answer of question 27.995I-30Regulatory RequirementsThe RFP states, “The selected Offeror agrees to render its services as herein provided in accordance with the rules and regulations of the Pennsylvania Board of Pharmacy including but not limited to the Pharmacy Act and all applicable Federal, State and local laws and regulations.” Please confirm at this time that DGS does accept and acknowledge that any potential Offeror will need to be a registered repackager or use the services of a registered repackager if an Offeror is to provide stock in cost-effective blister cards or packaging other than that of the manufacturer’s original packaging. Refer to answer of question 27.996II-4.ATechnicalThe RFP states, “The Issuing Office has established the weight for the Technical criterion for this RFP 40% of the total points. Evaluation will be based upon the following: Offeror/Personnel Qualifications, Soundness of Approach, Specialty Programs (340B and PACE), and Data Management/Fiscal Reporting and Automation.” To eliminate subjectivity during the evaluation process but while not changing the overall possible score of 400 in this category, will DGS assign an objective, firm-and-fixed numeric evaluation parameter to these DGS subcategories (for example, qualifications and current compliance with all laws, regulations, and licensing up to 150 points; soundness of approach up to 100 points; 340B established program in another DOC system up to 50 points; automation up to 50 points; reporting and data management capabilities up to 50 points) instead of assigning 400 total possible points for the entire category that may be scored subjectively overall? No.997II-4.BCostThe RFP states, “The Issuing Office has established the weight for the Cost criterion for this RFP as 40% of the total points. The cost criterion is rated by giving the proposal with the lowest total cost the maximum number of Cost points available.” Appendix J is understood to help DGS identify medication acquisition costs and dispensing fees. However, it does not consider a calculation for credits, the ability to prevent costly fines, specialty medication pricing, compounding costs, maintenance of the 340B program, or maintenance of the PACE program. How will these factors be evaluated in assessing lowest cost? Refer to Part II-4 Evaluation Criteria and Appendix J – Cost Submittal998II-4.CSmall Diverse Business and Small Business ParticipationThe RFP states, “BDISBO has established the minimum evaluation weight for the Small Diverse Business and Small Business Participation criterion for this RFP as 20% of the total points.” We understand this percentage will not likely change, but it is very disproportionate to the 40% technical and 40% cost metrics. Any prime contractor that is an SDB (Small Diverse Business) will gain an extremely decisive advantage in scoring with the current 40/40/20 criteria. Thus, SDB points truly will be the determining factor for this procurement. Prime contractors who are SDBs will receive a full complement of 200 points in this category (20% of overall scoring), whereas non-SDB prime contractors can only receive a score of 100 (at most) in this category. There is simply no breadth in other categories to make up the difference. Further, the value of this contract exceeds the maximum annual revenue for a business to qualify as an SDB. Please clarify whether or not the possibility even exists for an SDB to qualify as a prime contractor for this procurement. The following is an incorrect statement “non SDB prime contractors can only receive a score of 100 points (at most).” The Offeror with the highest raw score will receive the maximum 200 points allotted. All others will be pro-rated against the highest’ offeror’s raw score by applying the formula found in Section II-4C of this RFP.Per the RFP, Section V-1, Small Diverse Businesses and Small Businesses are encouraged to participate as prime contractors. 999III-1.DInformation TechnologyThe RFP states, “…The two systems’ touch points are upon doctor submission of order, pharmacy receiving the order, the processing, packaging, and shipping of the order, and nurse scanning the order into inventory at the facility upon receipt.” To properly track all dispensed and distributed medications, a vendor’s barcode must contain a unique identifier for each blister card or piece dispensed or distributed to a DOC facility. Without this unique identifier, the PADOC and DGS cannot properly account financially for all medications shipped and received. The same also would hold true for medication returns. If a potential Offeror, at the time of proposal submittal, cannot guarantee that they will provide a barcode label with a unique identifier for each blister card/piece, will that Offeror then be considered non-responsive and therefor ineligible for an award? All proposals shall be evaluated as described in Part II-4.9100III-1.E.2340B ProgramThe RFP states, “the selected Offeror must…have experience as a 340B contracted pharmacy.” The prior RFP stated that the Offeror must be an established 340B pharmacy. The term “have experience” can be very loosely interpreted, which will affect the responsiveness of a bidder in terms of eligibility for an award. Some potential Offerors may be in a 340B model where a 340B program is in place, yet they may have no involvement as a contracted 340B pharmacy, do not dispense or have a relationship with the OPA, or have true 340B contracting experience within a covered-entity relationship. In other words, their 340B model simply does not use them as a resource or include them as part of the prescription fulfillment triangle. Therefore, such a vendor actually would not “have experience.”(1) Considering the high importance of maintaining the existing 340B program and the significant cost savings associated with the existing program, why did DGS remove the prior mandate of being an established 340B pharmacy? (2) Will DGS modify the current requirement and once again mandate that all potential Offerors be an established 340B contract pharmacy to at least one DOC system at the time of proposal submittal? (3) If not, please provide the definition of “have experience” that DGS will use to determine if a potential Offeror is considered to “have experience.”(1, 2, and 3) Language of the RFP remains as stated.9101III-1.FPACE ProgramThe RFP states, “The selected Offeror must execute and maintain an agreement with the Pennsylvania Department of Aging’s Pharmaceutical Assistance Contract for the Elderly (PACE) to support the PADOC’s PACE program Appendix Q, PACE Program Requirements.” The prior RFP stated that this agreement must be in place 30 days prior to implementation, or as established earlier, 60 days after contract is signed as executed. Please clarify if this was intentionally omitted or omitted in error, and explain what is the requirement. The language of the RFP remains as stated.9102III-1.HDisaster Recovery PlanThe RFP states, “The Offeror must provide a disaster recovery plan regarding computer failure (loss of data) and destruction to the facility with their Technical response.” (1) Does “destruction to the facility” refer to the pharmacy’s facility and implementation of a disaster recovery plan at that level? (2) Or, does this item ask bidders how they would handle destruction at an SCI facility? (3) Will DGS require potential Offerors to have an off-site disaster recovery center that houses a redundant server to ensure continuity of service to DOC facilities in the case of a disaster? (4) If so, would DGS add bonus scoring for an Offeror with this capacity at the time of proposal submittal? (1) Offerors shall provide a disaster recovery plan for their facilities in their technical response.(2) Offerors shall provide a disaster recovery plan for their facilities in their technical response.(3) Offerors shall provide a disaster recovery plan for their facilities in their technical response.(4) No.9103III-1.JQualificationsThe RFP states, “The selected Offeror must have the following minimum corporate qualifications and provide detailed documentation in their Technical response to the following in order to provide the services and supplies outlined in this RFP” and “2. Have an aggregate average annual claims volume of at least three (3) million.” As this procurement has a value of $40 million, understanding how a potential Offeror with only $3 million in claims would be able to provide services to 26 PADOC facilities with a typically high-acuity inmate patient population without greatly compromising continuity of care and especially patient safety is difficult.Before a potential Offeror is considered qualified regarding the provision of services required by the RFP, will DGS consider modifying this requirement to a claims volume of at least $80 million to $100 million per year for the past 3 years where the Offeror’s clients actually purchase that amount from the pharmacy that will be servicing the PADOC from their wholesaler account using their own company funds? See response to question 25.9104III-2.F.1Prescription FulfillmentThe RFP states, “Partial fills are not acceptable unless approved in advance by PADOC.” On occasion, all pharmacies experience a run on medications in which a full quantity for dispensing is not available and therefore a partial supply is provided until inventory can be replaced, which is typically the next day or the same business day. (1) Please confirm that the preference of DGS is to have an inmate be without a medication instead of a pharmacy sending a partial supply to maintain continuity of care. The same requirement is also repeated in the performance standards of Appendix S. Refer to Part III.2.F.1.9105III-2.GDeliveryThe RFP indicates that DGS is fine with next-day delivery despite the current standard of same-day medication delivery. (1) If a potential Offeror wishes to provide same-day delivery, how will that be scored by the evaluation team, as lumping such a value-added service that is not considered under the scoring metric into one’s technical evaluation hardly seems appropriate? (2) Would DGS consider bonus scoring if same day delivery is offered? (3) If not, please clarify that your intent is to have medications delivered Monday through Saturday within 24 hours of an Offeror’s proposed order cutoff time the prior business day. In other words, if an Offeror proposes a 12:00 p.m. (noon) cutoff time Monday through Friday, are you requiring the delivery to arrive by 12:00 p.m. (noon) the following day? (1) Value-added services are not part of the technical evaluations(2) See response to question 105 (1) (3) Refer to Part III.2.G.1.a.9106III-2.HContinuous Quality ImprovementThe RFP requires inspections and P&T meetings at all 26 PADOC facilities per quarter. Earlier the RFP requires Pennsylvania-licensed pharmacists to provide work related to this RFP. (1) For a potential Offeror to be considered responsive and eligible for an award, how many Pennsylvania-licensed pharmacists will DGS require an Offeror to have on staff at the time of proposal submittal? (2) Will you require copies of licenses to be submitted at the time of proposal submittal for verification? (3) Will DGS require the Pennsylvania-licensed pharmacists to be full-time employees of the Offeror at the time of proposal submittal so they can meet the needs of the PADOC compared with a bidder having pharmacists provided by an agency to simply meet your RFP requirements? (1) Offerors must propose staffing levels to meet the requirements of the RFP.(2) No.(3) The Offeror’s staffing plan is part of the technical evaluation. See III-1.N and III-1.O.9107III-2.H.6Continuous Quality ImprovementAccording to the performance standards, if 3 errors per quarter is the performance standard, the allowable error rate would be 0.00149% and a substantial and unprecedented fine of $1,000.00 per occurrence would be levied should the vendor’s error rate exceed that standard. However, item III-2.H.6 states, “The PADOC will not accept an error rate for filling medication orders of more than 0.05 percent for each month at each SCI and aggregate statewide.” This percentage corresponds to 100 errors per quarter, not 3 errors per quarter.(1) What source is the DGS using as a reference in their establishment of a 0.00149% error rate? (2) Please clarify which standard will be enforced, as they seem to conflict. (1 and 2) Refer to Part III.2.H.6 as amended through Addendum 9 and Appendix S – Performance Standards.9108III-7Value Added ServicesThe RFP states, “The Offeror may provide any optional value added services that are within the scope of the project.” (1) Would DGS consider adding any additional bonus scoring criteria to potential Offerors that can provide additional value-added services beyond the requirements of the RFP? (2) If not, how will value-added services be objectively scored? Value-Added Services are not part of the technical evaluation.109V-1Small Diverse Business and Small Business General InformationThe RFP states, “The business may not be dominant in its field of operation” in the consideration of a business’s status as an SDB. (1) What definition will DGS use to exactly define the term “dominant,” as this term can be interpreted very loosely and, based on your interpretation, may impact one’s status as an SDB, especially if a bidder also wishes to have themselves considered as a prime contractor and an SDB? (2) Would you consider a potential Offeror servicing over 25,000 correctional beds as dominant in the field and thus not be able to claim SDB status? (3) If not, what objective definition will be used so that all potential Offerors understand your interpretation? (1) Dominant –A business dominant in its field of operation is one that exercises control or major influence in its industry.(2) It depends on the market structure for the particular industry, and the Offeror’s market share in the industry(3) See definition of dominant stated above in response 109(1)9110V-1Small Diverse Business and Small Business General InformationThe RFP states, “A Small Diverse Business is a DGS-verified minority-owned small business, woman-owned small business, veteran-owned small business, service-disabled veteran-owned small business, LGBT-owned small business, Disability-owned small business, or other small businesses as approved by DGS…” Can you provide the process DGS follows to verify and approve a business as an SDB beyond the business’s requirement to simply provide its own self-certification? DGS completes a verification process to confirm that the SDB certificate is issued by a DGS accepted third-party certification entity. DGS then confirms with the third-party certifying entity that the certificate is valid and up to date. Upon verification with the third-party certifying agency, the entity is then “validated” and added to the DGS list of SDB/SB vendors.9111VI.2Contract Terms and ConditionsThe RFP states, “The Effective Date shall be: a) the Effective Date printed on the Contract after the Contract has been fully executed by the Contractor and the Commonwealth (signed and approved as required by Commonwealth contracting procedures) or b) the ‘Valid from’ date printed on the Contract, whichever is later.” Please confirm that a potential Offeror must be able to meet all RFP requirements set forth in the RFP including but not limited to an established interface with Sapphire, the ability to track and trace each individual blister card or stock piece by unique identifier, and continuation of the existing 340B, PACE, and oncology programs within 60 days of contract execution (signing). Refer to Part III-2.A and also Part VI.2.9112VI.21.bContract Terms and ConditionsThe RFP states, “The Commonwealth shall have the option of using the Commonwealth purchasing card to make purchases under the Contract or Purchase Order. The Commonwealth's purchasing card is similar to a credit card in that there will be a small fee which the Contractor will be required to pay and the Contractor will receive payment directly from the card issuer rather than the Commonwealth. Any and all fees related to this type of payment are the responsibility of the Contractor. In no case will the Commonwealth allow increases in prices to offset credit card fees paid by the Contractor or any other charges incurred by the Contractor, unless specifically stated in the terms of the Contract or Purchase Order.”Most credit card companies charge up to a 3% merchant fee to vendors. On a $40 million spend per year after credits, that fee would amount to approximately $1.2 million, which would amount to a full loss if most of the amount billed is the Actual Acquisition Cost of the medications. Therefore, a potential Offeror would have to factor this into the front end of any dispensing fees to offset that loss, which would ultimately cost the Commonwealth much more than any potential credit card rebate. Would DGS consider removing this option since this is an acquisition-cost bid or permitting bidders to mark up the Actual Acquisition Cost of the medications as well as consider accepting payment by check of EFT, so potential Offerors can in fact provide the most aggressive bid to DGS at this time? The purchasing card will not be used for this contract.9113VI.40Contract Terms and ConditionsThe RFP states, “In the event there is a conflict among the documents comprising this Contract, the Commonwealth and the Contractor agree on the following order of precedence: the Contract; the RFP, the Best and Final Offer, if any; the Contractor's Proposal in Response to the RFP.” Since DGS is making an award based on technical merit of an Offeror’s proposal, would you consider an order of precedence of: Contract, BAFO, Contractor’s Response to RFP, then RFP? No.9114Appendix J Cost SubmittalThis appendix states that potential Offerors are not to provide 340B pricing for any of the drugs listed below. (1) Would DGS amend Appendix J to remove those medications currently procured under the 340B program in place so that bidders will not artificially underprice these medications to lower their overall price worksheet, knowing those medications will always be provided under the 340B contract and not from the vendor’s inventory? (2) Additionally, since pricing for these medications are going to be covered by the 340B program and those values are known to DGS through the current contracts, what benefit is having the prices of these medications? (3) How will DGS verify the accuracy of the pricing submitted by potential Offerors for the medications listed in Appendix J? (1) Refer to Addendum 8, Appendix J- Cost Submittal was replaced with Appendix J-Cost Submittal REV 022117 (2) Refer to Addendum 8, Appendix J- Cost Submittal was replaced with Appendix J-Cost Submittal REV 022117(3) Refer to Part VI.26 9115Appendix J Cost SubmittalThis tab to the Appendix does not provide a line item for bidders to submit a dispensing fee that considers the time and labor need to provide compounded items, oncology products, or specialty pharmaceuticals. It also does not provide a mechanism regarding how DGS will compute a potential Offeror’s credit policy regarding actually lowering overall cost. Will DGS add these line items to Appendix J, as DGS considers cost as equally important to an Offeror’s qualifications in this procurement? Appendix J remains as amended through Addendum 8.9116Appendix P 340B Program RequirementsRegarding 340B medications, Appendix P states, “The parties expressly agree that the inventory system is not a replenishment inventory system.” For HIV medications to be dispensed in a timely manner when the pharmacy is presented with a patient-specific order, that medication typically is dispensed from the pharmacy’s inventory and then replenished. Otherwise, the medication must be ordered in from the Covered Entity’s wholesaler and then dispensed, which potentially may cause a delay of up to 3-4 days (depending on weekends and holidays) before a patient would receive their HIV medications. (1) Please elaborate on any reservations DGS has regarding a replenishment ordering system. The model DGS requires, in effect, delays patient treatment until the product is ordered in by the pharmacy—which, if over a weekend, may see a patient decompensate. (2) To best serve the needs of PADOC patients, would the DGS permit bidders to provide a replenishment model? (3) If not, will bidders be relieved of the next day delivery requirement? (1,2, &3) Refer to Appendix P – 340B Requirements REV 022417 as stated.9117Appendix P 340B Program RequirementsAppendix P states, “Pharmacy shall accept prescription orders sent from Covered Entity’s [340B] electronic medical record system.” (1) Currently, do the 340B prescribers utilize the Sapphire EHR/CPOE system for data entry? (2) If so, why would the RFP requirements allow them to go away from that model—which seems to have intrinsic CQI value for the PADOC healthcare team such as direct medication pass implications, drug-drug interaction checks, medication duplication checks, allergy checks, and (more importantly) the entire patient profile at their fingertips—and move to a model with that information loaded into the system of the covered entity? The covered entity’s EMR seems to have some major downfalls for the PADOC and the current PADOC online medication pass program. Models that utilize only the covered entity’s EMR are greatly compromised by not having the patient’s entire or split profile, which greatly compromises these concerns along with patient safety.(3) If DGS still requires use of the covered entity’s EMR, please provide the name of the system currently used by the covered entity. (4) Will there be a need to interface with their system? (5) What is the mechanism used to convey these prescriptions to the pharmacy? (6) Will the covered entity be expected to pick up those fees, or will they fall to the pharmacy to absorb, thus increasing the costs to the BID process? (7) If so, what are those fees so potential Offerors can account for those costs in their bid price? (1) Yes(2) PADOC does not intend to move away from this model.(3) PADOC does not require the selected Offeror to use the Covered Entity’s electronic medical record system. See revised Appendix P 340B Prorgram Requirements REV 022417(4) No(5) Sapphire E.H.R.(6) There is no fees.(7) See response above 117(1)9118Appendix S Performance StandardsRegarding the availability of medications upon hospital discharge:(1) Will this standard exclude penalties for medications considered specialty pharmaceuticals that can only be dispensed through a very limited distribution network of specialty pharmacies? Certain medications simply cannot be legally dispensed if there are Risk Evaluation and Mitigation Strategy (REMS) requirements prior to the dispensing of those medications, which often requires provider and/or patient registration. In these instances, a pharmacy vendor to the PADOC would simply be prevented from dispensing these items and therefore should not be subject to a $1,000.00 per day performance fine. (2) Will these exceptions be noted and permitted by the DGS? (1) Yes.(2) PADOC will be responsible for administering this contract an all exceptions will require PADOC prior approval per Appendix S.9119Appendix S Performance StandardsRegarding the partial dispensing of medications:To expect any pharmacy—whether in the correctional industry, at the retail level, or at the hospital level—to dispense every medication order in the full amount without occasionally needing to owe a portion of that dispensing due to a short supply in the pharmacy’s current inventory would be quite difficult. As written, the standard requires no partial dispensing ever. Would DGS consider some flexibility in this requirement and adjusting the standard to reflect a 97% compliance standard regarding partial dispensing of medications, as providing a small supply to a patient is better than not providing a supply at all? Refer to Appendix S – Performance 9120General QuestionSeveral states provide a scoring bonus to businesses incorporated in or domiciled in that state, similar to the 3% domestic workforce bonus available in this solicitation. To encourage a “Buy Pennsylvania First” procurement that will keep and/or develop jobs in the Commonwealth of Pennsylvania, does DGS provide a local business preference (such as a 5% scoring bonus for solicitations) to bidders incorporated in Pennsylvania?No.9121Appendix G Intent to RespondOur understanding of RFP 6100041263 is that proposals in response to this RFP will only be accepted from potential Offerors that have submitted a completed Appendix G – Intent to Respond form to DGS by no later than 5:00 p.m. EST on February 7, 2017. Please confirm this is accurate. Refer to Part II-1 and II-2. Appendix G – Intent to Respond is not a mandatory requirement.9122Appendix G Intent to RespondWill DGS please issue an addendum that contains copies of the Appendix G forms (required to be submitted by the February 7, 2017, deadline) submitted by all potential Offerors intending to reply as well as by potential Offerors not intending to reply? No.9123GeneralIn accordance with the Governor’s “Jobs that Pay” tour in 2016, what other initiatives can DGS incorporate into this procurement to support the Governor’s intent to prevent jobs and tax revenues from leaving the Commonwealth? Refer to Part I-4 and 5.9124GeneralIn the event that responses to questions are unclear, will potential Offerors be permitted to submit further questions for clarification purposes only?Refer to Part I-10.9 ................
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