FORM F FORM E ETF, (2) Proposer shall submit two separate quotes for each of the commercial and EGWP programs. The first quote shall be based on current formulary, and the second quote shall be based on ETF’s the proposed formulary. quotes shall be on a 100% Transparent basis as Proposer’s Proposer’s defined in Section 1.5 Definitions and Acronyms for calendar years 2018, 2019, and 2020. The repricing files, Attachment D Repricing File Commercial and Attachment E Repricing – File EGWP, shall be utilized by Proposer to complete the Microsoft Excel file in Attachment F – RFP ETG0013 Cost Proposal (must be returned in the same format using Microsoft Excel). 8.3 Proposers shall provide a disruption analysis for proposed formulary. Using the Proposer’s repricing files, Attachment D Repricing File Commercial and Attachment E Repricing File – EGWP, Proposers must indicate if each current drug (NDC) is included in proposed Proposer’s formulary and on which tier it is located. Proposers shall complete the repricing files by adding two columns: the first column with a or indicator for the drug and the second column with “Y” “N” a or for the tier. Proposers shall submit the completed repricing files to Segal. “1,” “2,” “3,” “4” 8.4 8 The following Attachments are specifically for Section 8 (Attachments A-E will be made available by the Board Actuary, Segal Consulting): Attachment A Member Census – Attachment B Network Disruption File Commercial – – Attachment C Network Disruption File EGWP – – Attachment D Repricing File Commercial – – Attachment E Repricing File EGWP – – Attachment F RFP ETG0013 Cost Proposal – Attachment G Commercial Formulary – Attachment H EGWP Formulary – Attachment I Formulary Companion Guide – Proposer shall return Attachments B, C, D, E and F as well as the GeoAccess Network Accessibility Report and National Network Description as described in Section 8.1. This section is NOT scored. (0 points) The Department will execute a State of Wisconsin Contract with the Contractor. The Pro Forma Contract By Authorized Board is located in Exhibit 1. The Department will execute a Pro Forma
FORM F FORM E ETF, (2) Proposer shall submit two separate quotes for each of the commercial and EGWP programs. The first quote shall be based on ETF’s current formulary, and the second quote shall be based on the Proposer’s proposed formulary. Proposer’s quotes shall be on a 100% Transparent basis as defined in Section 1.5 Definitions and Acronyms for calendar years 2018, 2019, and 2020. The repricing files, Attachment D Repricing File – Commercial and Attachment E Repricing File EGWP, shall be utilized by Proposer to complete the Microsoft Excel file in Attachment F – RFP ETG0013 Cost Proposal (must be returned in the same format using Microsoft Excel). 8.3 Proposers shall provide a disruption analysis for Proposer’s proposed formulary. Using the repricing files, Attachment D Repricing File – Commercial and Attachment E Repricing File EGWP, Proposers must indicate if each current drug (NDC) is included in Proposer’s proposed formulary and on which tier it is located. Proposers shall complete the repricing files by adding two columns: the first column with a “Y” or “N” indicator for the drug and the second column with a “1,” “2,” “3,” or “4” for the tier. Proposers shall submit the completed repricing files to Segal. 8.4 8 The following Attachments are specifically for Section 8 (Attachments A-E will be made available by the Board Actuary, Segal Consulting): Attachment A – Member Census Attachment B – Network Disruption File – Commercial Attachment C – Network Disruption File – EGWP Attachment D – Repricing File – Commercial Attachment E – Repricing File – EGWP Attachment F – RFP ETG0013 Cost Proposal Attachment G – Commercial Formulary Attachment H – EGWP Formulary Attachment I – Formulary Companion Guide Proposer shall return Attachments B, C, D, E and F as well as the GeoAccess Network Accessibility Report and National Network Description as described in Section 8.1. This section is NOT scored. (0 points) The Department will execute a State of Wisconsin Contract with the Contractor. The Pro Forma Contract By Authorized Board is located in Exhibit 1. The Department will execute a Pro Forma