Web viewpotential 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

Questions and AnswersPADOC Pharmacy and Pharmaceutical Services

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RFP Section Reference

Question Answer Addendum

1 RFP Section III-1.D and Appendix N

RFP 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 and

established 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.

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2 III-2.F.4 Offeror 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.

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3 III-2.M The selected Offeror must establish a file exchange including specified demographic and medication data

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

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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?

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.

4 APPENDIX N - Information Technology

Requirements for Integration of Pharmacy

Software with Electronic

Health Record

Shipping 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.

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5 Section I-21.Restriction of

Contact

Does 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.

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6 Appendix N How 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.

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7

N/A

At 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.

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8 Section III-1. Part

E. 340B Program

Who 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.

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9 Section III-1, PartD. Information

Technology

At 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 execution of a contract resulting from this RFP.

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10 Appendix N Your description of the interface requires the use of a shared database to receive and send

Refer to requirements set forth in Appendix N. 6

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information.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?

11 Appendix N A 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.

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12 Appendix N Referring 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?


13 Appendix N Is there a cost associated with using the interface, e.g., per claim, per order, per refill?

Refer to Part III-1.D 6

14 Appendix N What monthly and/or quarterly costs are tied to the interface?

There are no financial obligations, routine or otherwise, to Sapphire Health for the Offeror.

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15 Appendix N Do the above costs, in questions 4 and 5, remain the Yes. 6

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same over the course of the contract?16 Appendix N Does the processing fee to the state include profiles? Yes 617 Appendix N What 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.

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18 Appendix N In 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?


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19 Appendix J Cost 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.

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20 Appendix D Appendix 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. 6

21 III-1.D What 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.

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22 III-1.D Will 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.

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23 Appendix S Please 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. 6

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24 III-2.H.6 Part 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 you 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.

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25 III-1.J.2 Part 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 al pharmacy claims. 6

26 Addendum 4Official Questions and AnswersQuestion 2

Question #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.

(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.

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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

(2) See response to Question 1(1), above.



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fines and/or disciplinary actions upon inspection?27 Addendum 4

Official Questions and AnswersQuestion 2

Question #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


(2) See response to Question 2(1) above

(3) No.

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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?

28 General Question

The 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


(2) The RFP language remains as stated.

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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.

29 General Question

When will the intent to award a contract be published? Refer to section I-25 6

30 General Question

Once the contract is awarded, what is the proposed contract start date?

Refer to section I-23 6

31 General Question

What 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:

http://www.emarketplace.state.pa.us/BidContractDetails.aspx?ContractNo=4400007074

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32 General Question

Are 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:


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33 I-13.A Does PADOC consider PDF files to be a Microsoft Yes. Refer to section I-13. 6

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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.

34 I-13.A Will 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. 6

35 II-4.A Please 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. 6

36 III-2.L In 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

Offerors should propose cost containment/avoidance strategies based upon data already provided in the RFP.

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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.

37 III-1.D Is 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 addendum 3 and 5. 6

38 Appendix S Performance 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 RFP 6

39 VI.3 Part 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.

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40 III-1.J.1 Part III-1.J.1 Qualifications: This paragraph refers to required licenses but then references Acts and Regulations. Please clarify which specific licenses are

Refer to III-1.J.1 6

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required.

41 III-2-G-1.c With 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.

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42 III-2.G.1.a What 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.a 8

43 NA What 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.

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44 NA What 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.

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45 III-2.E May we have a copy of your current formulary? The current formulary will be shared with the selected offeror at time of award. 8

46 III-2.G.2.c Who 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.

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47 III-2.I.1 How 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.

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48 III-2.F.1 a. What is the current process for notifying pharmacy of inmate release dates?

b. Will it be required to ship inmate

a. The PADOC does not notify the pharmacy of an impending inmate release date, as this would be a security violation.

b. Release medications are ordered for delivery in safety cap vials to the

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discharge/transfer medications to private residences or are they shipped to each correctional facility only for discharge/transfer patients?

SCI prior to the release date.

49 III-2.H.4 Is/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. 8

50 III-2.H.4 Please provide all current Accreditation for all facilities. This information is publicly available via the ACA website at www.aca.org/. 8

51 NA What 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. 8

52 NA Are 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.

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53 III-2.E.3 How 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.

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54 III-1.N.1.n Please 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).

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55 NA Do 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.

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56 NA Please provide the following pharmacy information by year for the last three years: number of patients on HIV medication, number of patients on psychotropic

Refer to Appendix J – Cost Submittal Revised 021717 for the medications ordered by the PADOC’s contracted providers for treatment of their patients.

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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.

Note: Hemophilia medications are not in the scope of this RFP. Refer to Part III 2. F 6

57 NA Of 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. 8

58 NA Please 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. 8

59 NA Do 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

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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 tab

60 NA Please 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.

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61 NA How 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.

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62 III-8 Can 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.

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a) What training will be required for Offeror’s employees who will be visiting PADOC facilities to fulfill contract requirements?

b) Is the required training offered on an ongoing basis or is it offered only on certain scheduled dates/times?

c) Who is required to complete this training?

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.

64 III-1.H.1 Will 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.

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65 III-2.F.1 Please 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 Standards

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66 III-2.H.3 Please 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.

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67 III-2.H.5 How 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. 8

68 III-2.K Patient 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. 8

69 Appendix J Line 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

Appendix J has been revised to reflect this discontinued item 8

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1.25 mg strengths are still available), or will the State modify Appendix J to remove this line item?

70 III-2.E.4 Please 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.

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71 III-3.C Please 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.

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72 III-1.D Will 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. 8

73 III-1.D Please 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.

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74 III-1.F How 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 proposal

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75 III-1.F How many prescriptions for the past three (3) months have been processed through the PACE program?

Refer to answer to question #75 8

76 Appendix J-Cost Submittal

Please clarify lowest unit of measure pricing definition for ‘Per Aerosol’. Does it mean per gram? Per puff? Per inhaler? Per Microgram?

Per inhaler. 8


Please 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. 8

78 Appendix J- Please clarify pricing for Humulin and Lantus insulin. 10ML 8

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Cost Submittal Does per injection mean to price per 1ML or price per (1) 10ML vial? If neither, please provide the measurement of calculation.


Please 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) 8


Please 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 ML 8


Please clarify how to price Gammagard LIQ 10% 30gm/300ML 10%. Should we price Per Gram? Per ML? Other measure?

Per ML 8

82 Appendix J – Cost Submittal

Cost 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.

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83 Appendix A In 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: http://www.cor.pa.gov/About%20Us/Statistics/Documents/current%20monthly%20profile.pdf

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84 III-G-2-1Can you provide the average daily number of scripts received by 12:00 noon that are delivered the same day?

Unknown. This varies by day.8

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85 III-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.

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86 III-G-2-1 Are 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. 8

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