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{"sheet":"Instructions","index":0,"n_rows":76,"n_cols":5,"rows_kept":76,"cut":false,"hidden":false,"merged":[[1,0,1,16383],[2,1,2,4],[71,1,71,4],[75,1,75,2],[45,1,45,4],[63,1,63,4],[73,1,73,4],[66,1,66,3],[67,1,67,3],[64,1,64,3],[65,1,65,3],[68,1,68,4],[69,1,69,4],[4,1,4,4],[6,2,6,4],[7,3,7,4],[8,3,8,4],[9,3,9,4],[44,1,44,4],[36,1,36,4],[25,1,25,4],[11,1,11,4],[37,1,37,4],[12,1,12,4],[26,1,26,4]]}
[]
[]
[null,"Network Adequacy Report - PBM Network (Part 1)"]
[]
[null,"Network Submission Instructions: To be communicated at least 90 days ahead of initial report due date.\nRespondents must submit data on the 'Network CoveredLives by County', 'PBM Insurer Contract Details', 'PSAO Contracts', and 'PBM Network Data' tabs following guidance on this page. "]
[]
[null,null,"Respondent must complete one template for each Network"]
[null,null,"PBM Name:"]
[null,null,"PBM Network Name:"]
[null,null,"PBM Network ID:"]
[]
[null,"'Network Covered Lives by County' Tab"]
[null,"Respondents must complete the following fields in the 'Network CoveredLives by County' tab for each network offered, starting on row 2:"]
[null,"Required","Data Field Name","Description","Additional Notes"]
[null,"Yes","*County Name","County name","List each county that the PBM provides coverage"]
[null,"Yes","*Status (Active or Expansion)","Status","Options include:\n\"Active\"\n\"Expansion\"\nNo extra spaces before or after characters should be included"]
[null,"Yes","*Anticipated Covered Lives In County In Network (across all plans)","Number of anticipated members (covered lives) expected in the county ","Must be a non-negative integer"]
[null,"Yes","*Total Affiliated In-Network Retail Pharmacies","Number of in-network retail pharmacies that are affiliated with the PBM","Must be a non-negative integer"]
[null,"Yes","*Total Non-Affiliated In-Network Retail Pharmacies","Number of in-network retail pharmacies that are not affiliated with the PBM","Must be a non-negative integer"]
[null,"N/A","Total Retail Pharmacies In-Network","Number of in-network retail pharmacies, affiliated and non-affiliated","Formula driven field based on the sum of total affiliated and non-affiliated in-network retail pharmacies"]
[null,"N/A","Covered Lives to Retail Pharmacy Ratio ","Ratio of covered lives to retail pharmacy locations","Formula driven field based on anticipated covered lives divided by the total retail pharmacies in-network"]
[null,"Yes","*Total Affiliated In-Network Specialty Pharmacies","Number of in-network specialty pharmacies that are affiliated with the PBM","Must be a non-negative integer"]
[null,"Yes","*Total Non-Affiliated In-Network Specialty Pharmacies","Number of in-network specialty pharmacies that are not affiliated with the PBM","Must be a non-negative integer"]
[null,"N/A","Total In-Network Specialty Pharmacies","Number of in-network specialty pharmacies, affiliated and non-affiliated","Formula driven field based on the sum of total affiliated and non-affiliated in-network specialty pharmacies"]
[]
[null,"'PBM Insurer Contract Details' Tab"]
[null,"Respondents must complete the following fields in the 'PBM Insurer Contract Details' tab, for each network offered, starting on row 2:"]
[null,"Required","Data Field Name","Description","Additional Notes"]
[null,"Yes","*PA Commercial Health Insurer Company Name","Name of contracted insurer","Cannot be blank"]
[null,"Yes","*PA Commercial Health Insurer Entity NAIC Code","NAIC code of insurer","Must be 5-characters. No punctuation. If no identifier is available, enter \"99999\". No extra spaces before or after characters should be included"]
[null,"Yes","*Anticipated Covered Lives","Number of covered lives the PBM expects to cover for the insurer","Must be a non-negative integer"]
[null,"Yes","*Negotiate on Behalf of Health Insurer","Does the PBM negotiate on behalf of the insurer?","Must be either \"Y\" or \"N\""]
[null,"Yes","*Affiliate of PBM","Is the insurer an affiliate of the PBM?","Must be either \"Y\" or \"N\""]
[null,"Yes","*Health Insurer Date Of Original Contract","Original contract date","Format:\nMM/DD/YYYY"]
[null,"Yes","*Health Insurer Contract Expiration Date","Contract expiration date","Format:\nMM/DD/YYYY"]
[]
[null,"'PSAO Contracts' Tab"]
[null,"Respondents must complete the following fields in the 'PSAO Contracts' tab, for each network offered, starting on row 2:"]
[null,"Required","Data Field Name","Description","Additional Notes"]
[null,"Yes","*Name of Contracted PSAO","Name of each contracted PSAO","Cannot be blank"]
[null,"Yes","*Original Date of PSAO Contract","Original PSAO contract date","Format:\nMM/DD/YYYY"]
[null,"Yes","*PSAO Contract Expiration Date","PSAO contract expiration date","Format:\nMM/DD/YYYY"]
[null,"Yes","*Number of Pharmacies Associated with PSAO Contract","Number of pharmacies associated with the PSAO","Must be a non-negative integer"]
[]
[null,"'PBM Network Data' Tab"]
[null,"Respondents must complete the following fields in the 'PBM Network Data' tab, for each network offered, starting on row 3:"]
[null,"Required ","Data Field Name","Description","Additional Notes"]
[null,"Yes","*PharmacyName","Name of pharmacy","Cannot be blank"]
[null,"Yes","*PharmacyNPI","Unique pharmacy identifier","Must be 10-characters. No punctuation. If no identifier is available, enter \"9999999999\". No extra spaces before or after characters should be included"]
[null,"Yes","*PharmacyTIN","Unique taxpayer identification number","Must be 9-characters. No punctuation. If no identifier is available, enter \"999999999\". No extra spaces before or after characters should be included"]
[null,"Yes","*PharmacyTier","Pharmacy insurance tier","Options include:\n\"1\"\n\"2\"\n\"3\"\n\"4\"\n\"5\"\n\"N/A\"\nNo extra spaces before or after characters should be included. Validations are case-sensitive so values should match those shown above"]
[null,"Yes","*PharmacyAddr1","Pharmacy address","Cannot be blank. Must be a street address, not a P.O. box"]
[null,"No","PharmacyAddr2","Pharmacy address 2","Required if applicable (suite, floor, department)"]
[null,"Yes","*PharmacyCity","Pharmacy address city","Cannot be blank"]
[null,"Yes","*PharmacyState","Pharmacy address state","Must be 2-characters. No punctuation. No extra spaces before or after characters should be included. "]
[null,"Yes","*PharmacyZip","Pharmacy address zip code","Must be a service location ZIP code or ZIP + 4. Must be greater than 3-characters or fewer than 10-characters. No punctuation. No extra spaces before or after characters should be included"]
[null,"Yes","*PharmacyCounty","Pharmacy address county in Pennsylvania","Cannot be blank"]
[null,"Yes","*PharmacyType","Type of pharmacy","Options include:\n\"Retail\"\n\"Specialty\"\n\"MailOrder\" \nNo extra spaces before or after characters should be included. Validations are case-sensitive so values should match those shown above. A pharmacy should be listed multiple times by the number of pharmacy types associated with the pharmacy"]
[null,"Yes","*AffiliateToPBM","Is the pharmacy an affiliate to the PBM? ","Must be either \"Y\" or \"N\". No extra spaces before or after characters should be included. Validations are case-sensitive so values should match those shown"]
[null,"No","ContractedPSAOName","PSAO Name"]
[null,"Yes","*PharmacyDateOfOriginalContract","Original contract date","Format:\nMM/DD/YYYY"]
[null,"Yes","*PharmacyContractExpirationDate","Contract expiration date","Format:\nMM/DD/YYYY"]
[]
[null,"Please Note: Respondent must complete the 'PBM Network Data' tab for all the retail, specialty, and mail order pharmacies, keeping in mind the following guidance:"]
[null,"- 1 row per pharmacy / address / pharmacy type"]
[null,"- PBM network should be representative of the current contracted network"]
[null,"- Pharmacy Tier - Indicate the pharmacy tier where 1 is the lowest cost to consumer, 2 is higher cost, 3, is higher than 2, etc. "]
[null,"- Do not delete or add any columns to the 'PBM Network Data' tab"]
[null,"- If there are any validation failures for required fields in the 'PBM Network Data' tab, the failed value and corresponding column header will be colored red. All of the required field errors can be found in the 'Errors' tab, where the reason for the failure will be shown, as well as the location of the failure. The first 10,000 errors will be shown on the 'Error' tab to support template performance"]
[null,"- Any not required fields that fail validations will have their values colored red, but the error will not be found in the 'Errors' tab. These will not impact color of the respective column header"]
[]
[null,"Upon completion of populating the template, in cell A1 on the 'PBM Network Data' tab, respondents should see a validation button. Respondents must select the button and confirm all cells pass the validation. If necessary, respondents must correct any red highlighted cells and rerun the validation until all column headers are green."]
[]
[null,"Act 77 2024 Definitions"]
[]
[null,"Version: 2025-05-07"]

{"sheet":"Network Covered Lives By County","index":1,"n_rows":68,"n_cols":10,"rows_kept":68,"cut":false,"hidden":false,"merged":[]}
["*County Name","*Status (Active or Expansion)","*Anticipated Covered Lives (across all plans)","*Total In-Network Affiliated Retail Pharmacies","*Total In-Network Non-Affiliated Retail Pharmacies","Total Retail Pharmacies In-Network","Covered Lives to Retail Pharmacy Ratio ","*Total Affiliated In-Network Specialty Pharmacies","*Total Non-Affiliated In-Network Specialty Pharmacies","Total In-Network Specialty Pharmacies"]
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[null,null,null,null,null,0,{"$error":"#DIV/0!"},null,null,0]
[null,null,null,null,null,{"$f":"SUM(D34:E34)","v":0},{"$f":"C34/F34","v":{"$error":"#DIV/0!"}},null,null,{"$f":"SUM(H34:I34)","v":0}]
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{"sheet":"PBM Insurer Contract Details","index":2,"n_rows":1,"n_cols":7,"rows_kept":1,"cut":false,"hidden":false,"merged":[]}
["*PA Commercial Health Insurer Company Name","*PA Commercial Health Insurer Entity NAIC Code","*Anticipated Covered Lives","*Negotiate on Behalf of Health Insurer","*Affiliate of PBM","*Health Insurer Date Of Original Contract","*Health Insurer Contract Expiration Date"]

{"sheet":"PSAO Contracts","index":3,"n_rows":1,"n_cols":4,"rows_kept":1,"cut":false,"hidden":false,"merged":[]}
["*Name of Contracted PSAO","*Original Date of PSAO Contract","*PSAO Contract Expiration Date","*Number of Pharmacies Associated with PSAO Contract"]

{"sheet":"PBM Network Data","index":4,"n_rows":2,"n_cols":15,"rows_kept":2,"cut":false,"hidden":false,"merged":[[0,4,0,14]]}
[null,null,null,null,"Please correct any red highlighted cells and rerun validation. All column headers with an * are required and need to be green before submitting data."]
["*PharmacyName","*PharmacyNPI","*PharmacyTIN","*PharmacyTier","*PharmacyAddr1","PharmacyAddr2","*PharmacyCity","*PharmacyState","*PharmacyZip","*PharmacyCounty","*PharmacyType","*AffiliateToPBM","ContractedPSAOName","*PharmacyDateOfOriginalContract","*PharmacyContractExpirationDate"]

{"sheet":"Error","index":5,"n_rows":1,"n_cols":3,"rows_kept":1,"cut":false,"hidden":false,"merged":[]}
["Data Column","Cell","Error Message"]