A-3 PL-Lung Cancer - METEX14.xlsx

XLSX spreadsheet 45 KB Posted Aug 6, 2026

Attached to: Department of War Pharmacy Uniform Formulary Blanket Purchase Agreement/Uniform Formulary Additional Discount Program
Solicitation number: HT9402-26-Q-9401
Issued by: Defense Health Agency

About this file

Written by GovTribe AI · Aug 6, 2026

This is a pharmaceutical pricing template for a Department of War (DoW) Blanket Purchase Agreement (BPA) and Uniform Formulary Additional Discount Program (ADP) for lung cancer medications in the METEX14 subclass. The template is designed for the DoW Pharmacy and Therapeutics (P&T) Committee meeting scheduled for November 4-5, 2026, with quotes due by October 1, 2026. The document establishes pricing structures for both Military Treatment Facility & Mail Order formulary scenarios and TRICARE retail refund programs, featuring multiple condition sets that allow manufacturers to quote on Uniform Formulary (UF) and Non-Formulary (NF) agents with step therapy options, including Before-Step Therapy, After-Step Therapy, and Tier classifications (Tier 2 and Tier 3). Pricing requirements specify that the price per unit of measure must be uniform across all available package sizes within each dispensing venue.

The template includes provisions for Prior Authorization (PA) applicability, step therapy grandfathering provisions allowing current patients to continue existing therapies while requiring new patients to trial step-preferred agents first, and consideration of specialist bypass recommendations. The pricing appendix contains ten separate class review sections with identical scenario structures, where manufacturers must submit completed Quote Review Checklists and fully executed signature pages along with pricing information. The ADP section calculates total refunds based on non-FAMP (non-Federal Acquisition Method Pricing) pricing, current annual Federal Ceiling Prices, standard refunds, and additional offered refund percentages. All pricing data is subject to confidentiality restrictions noted on the quote cover page.

View the file

Other files

File	Type	Posted
NDC Price List FAQ Class Review.pdf	PDF	Aug 6, 2026
RFQ HT9402-26-Q-9401 CR.pdf	PDF	Aug 6, 2026
A-3 PL - Atopy - Topical Agents.xlsx	XLSX spreadsheet	Aug 6, 2026
Nov 2026 PT Meeting Reporting.xlsx	XLSX spreadsheet	Aug 6, 2026

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BPA

UF BPA NDC Price List for the November 2026 DoW P&T Meeting
DoW Uniform Formulary Class:	LUNG CANCER	P&T Committee Meeting:	November 4-5, 2026
DoW Uniform Formulary Subclass:	METEX14	Quotes due:	October 1, 2026
Formulary Notes
Class Note(s): Prior Authorization (PA) may apply. Agents may be identified as possible candidates for special reimbursement methods, amounts, and procedures to encourage use of high-value products and discourage use of low-value products. The P&T Committee may recommend consideration of preferential status to any non-generic pharmaceutical agent by treating it for purposes of cost sharing as a generic product (Tier 1). Similarly, the P&T Committee may identify candidates to recommend for complete exclusion from the TRICARE pharmacy benefit program.

Step Therapy Addendum: Grandfathering: a prior authorization process that allows current patients to remain on current therapy and requires new patients to complete an adequate trial of the step-preferred (before-step) agent before a non-step-preferred (after-step) agent is provided to the patient at any MTF, Retail, or Mail point of service. The P&T Committee may consider approving specialist bypass for the step-preferred (before-step) agent.

*Note:Step Therapy may be applicable if agents share the same FDA-approved indication(s).

Agents with RFQ not submitted or selected may be designated non-step preferred (after-step).

Notes to Manufacturers: Do not forget to submit the Quote Review Checklist and fully executed signature pages, along with quote information.

The price per unit of measure for a given dosage form and strength (each, gram, mL, etc.) of the pharmaceutical agent will be the same for all available package sizes (e.g., 30s, 100s, 1000s) within a given dispensing venue.

Blanket Purchase Agreement Appendix – Class Review

#1	DoW Uniform Formulary Class:	LUNG CANCER		P&T Committee Meeting:	November 4-5, 2026
	DoW Uniform Formulary Subclass:	METEX14		Quotes due:	October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	Military Treatment Facility & Mail Order

		Formulary Scenarios	Condition Set #	Formulary Category Description	One of (x) Number of Brand Agents	Price per NDC	Package Size	Price per Unit
		Scenario 1: One agent may be UF and before the step.
		Scenario 1	271LC14G1UFBS1	Uniform Formulary
Before-Step Therapy	1			NO QUOTE
			271LC14G1UFAS1M	Uniform Formulary
After-Step Therapy	1 or more			NO QUOTE
			271LC14G1NFAS1M	Non-Formulary
After-Step Therapy	1 or more			NO QUOTE
		Scenario 2: One or more agents may be UF.
		Scenario 2	271LC14G1UF1M	Uniform Formulary	1 or more			NO QUOTE
			271LC14G1NF1M	Non-Formulary	1 or more			NO QUOTE
						If cell highlights red, please confirm intent not to submit a quote

Blanket Purchase Agreement Appendix – Class Review

#2	DoW Uniform Formulary Class:	LUNG CANCER		P&T Committee Meeting:	November 4-5, 2026
	DoW Uniform Formulary Subclass:	METEX14		Quotes due:	October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	Military Treatment Facility & Mail Order

		Formulary Scenarios	Condition Set #	Formulary Category Description	One of (x) Number of Brand Agents	Price per NDC	Package Size	Price per Unit
		Scenario 1: One agent may be UF and before the step.
		Scenario 1	271LC14G1UFBS1	Uniform Formulary
Before-Step Therapy	1			NO QUOTE
			271LC14G1UFAS1M	Uniform Formulary
After-Step Therapy	1 or more			NO QUOTE
			271LC14G1NFAS1M	Non-Formulary
After-Step Therapy	1 or more			NO QUOTE
		Scenario 2: One or more agents may be UF.
		Scenario 2	271LC14G1UF1M	Uniform Formulary	1 or more			NO QUOTE
			271LC14G1NF1M	Non-Formulary	1 or more			NO QUOTE
						If cell highlights red, please confirm intent not to submit a quote

Blanket Purchase Agreement Appendix – Class Review

#3	DoW Uniform Formulary Class:	LUNG CANCER		P&T Committee Meeting:	November 4-5, 2026
	DoW Uniform Formulary Subclass:	METEX14		Quotes due:	October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	Military Treatment Facility & Mail Order

		Formulary Scenarios	Condition Set #	Formulary Category Description	One of (x) Number of Brand Agents	Price per NDC	Package Size	Price per Unit
		Scenario 1: One agent may be UF and before the step.
		Scenario 1	271LC14G1UFBS1	Uniform Formulary
Before-Step Therapy	1			NO QUOTE
			271LC14G1UFAS1M	Uniform Formulary
After-Step Therapy	1 or more			NO QUOTE
			271LC14G1NFAS1M	Non-Formulary
After-Step Therapy	1 or more			NO QUOTE
		Scenario 2: One or more agents may be UF.
		Scenario 2	271LC14G1UF1M	Uniform Formulary	1 or more			NO QUOTE
			271LC14G1NF1M	Non-Formulary	1 or more			NO QUOTE
						If cell highlights red, please confirm intent not to submit a quote

Blanket Purchase Agreement Appendix – Class Review

#4	DoW Uniform Formulary Class:	LUNG CANCER		P&T Committee Meeting:	November 4-5, 2026
	DoW Uniform Formulary Subclass:	METEX14		Quotes due:	October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	Military Treatment Facility & Mail Order

		Formulary Scenarios	Condition Set #	Formulary Category Description	One of (x) Number of Brand Agents	Price per NDC	Package Size	Price per Unit
		Scenario 1: One agent may be UF and before the step.
		Scenario 1	271LC14G1UFBS1	Uniform Formulary
Before-Step Therapy	1			NO QUOTE
			271LC14G1UFAS1M	Uniform Formulary
After-Step Therapy	1 or more			NO QUOTE
			271LC14G1NFAS1M	Non-Formulary
After-Step Therapy	1 or more			NO QUOTE
		Scenario 2: One or more agents may be UF.
		Scenario 2	271LC14G1UF1M	Uniform Formulary	1 or more			NO QUOTE
			271LC14G1NF1M	Non-Formulary	1 or more			NO QUOTE
						If cell highlights red, please confirm intent not to submit a quote

Blanket Purchase Agreement Appendix – Class Review

		#5	DoW Uniform Formulary Class:	LUNG CANCER		P&T Committee Meeting:	November 4-5, 2026
			DoW Uniform Formulary Subclass:	METEX14		Quotes due:	October 1, 2026
			NDC Number	Drug Name	Strength	Dosage Form	Package Size	Military Treatment Facility & Mail Order
							1.00
		Formulary Scenarios	Condition Set #	Formulary Category Description	One of (x) Number of Brand Agents	Price per NDC	Package Size	Price per Unit
		Scenario 1: One agent may be UF and before the step.
		Scenario 1	271LC14G1UFBS1	Uniform Formulary
Before-Step Therapy	1		1.00	NO QUOTE
			271LC14G1UFAS1M	Uniform Formulary
After-Step Therapy	1 or more		1.00	NO QUOTE
			271LC14G1NFAS1M	Non-Formulary
After-Step Therapy	1 or more		1.00	NO QUOTE
		Scenario 2: One or more agents may be UF.
		Scenario 2	271LC14G1UF1M	Uniform Formulary	1 or more		1.00	NO QUOTE
			271LC14G1NF1M	Non-Formulary	1 or more		1.00	NO QUOTE
						If cell highlights red, please confirm intent not to submit a quote

Blanket Purchase Agreement Appendix – Class Review

#6	DoW Uniform Formulary Class:	LUNG CANCER		P&T Committee Meeting:	November 4-5, 2026
	DoW Uniform Formulary Subclass:	METEX14		Quotes due:	October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	Military Treatment Facility & Mail Order

		Formulary Scenarios	Condition Set #	Formulary Category Description	One of (x) Number of Brand Agents	Price per NDC	Package Size	Price per Unit
		Scenario 1: One agent may be UF and before the step.
		Scenario 1	271LC14G1UFBS1	Uniform Formulary
Before-Step Therapy	1			NO QUOTE
			271LC14G1UFAS1M	Uniform Formulary
After-Step Therapy	1 or more			NO QUOTE
			271LC14G1NFAS1M	Non-Formulary
After-Step Therapy	1 or more			NO QUOTE
		Scenario 2: One or more agents may be UF.
		Scenario 2	271LC14G1UF1M	Uniform Formulary	1 or more			NO QUOTE
			271LC14G1NF1M	Non-Formulary	1 or more			NO QUOTE
						If cell highlights red, please confirm intent not to submit a quote

Blanket Purchase Agreement Appendix – Class Review

#7	DoW Uniform Formulary Class:	LUNG CANCER		P&T Committee Meeting:	November 4-5, 2026
	DoW Uniform Formulary Subclass:	METEX14		Quotes due:	October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	Military Treatment Facility & Mail Order

		Formulary Scenarios	Condition Set #	Formulary Category Description	One of (x) Number of Brand Agents	Price per NDC	Package Size	Price per Unit
		Scenario 1: One agent may be UF and before the step.
		Scenario 1	271LC14G1UFBS1	Uniform Formulary
Before-Step Therapy	1			NO QUOTE
			271LC14G1UFAS1M	Uniform Formulary
After-Step Therapy	1 or more			NO QUOTE
			271LC14G1NFAS1M	Non-Formulary
After-Step Therapy	1 or more			NO QUOTE
		Scenario 2: One or more agents may be UF.
		Scenario 2	271LC14G1UF1M	Uniform Formulary	1 or more			NO QUOTE
			271LC14G1NF1M	Non-Formulary	1 or more			NO QUOTE
						If cell highlights red, please confirm intent not to submit a quote

Blanket Purchase Agreement Appendix – Class Review

#8	DoW Uniform Formulary Class:	LUNG CANCER		P&T Committee Meeting:	November 4-5, 2026
	DoW Uniform Formulary Subclass:	METEX14		Quotes due:	October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	Military Treatment Facility & Mail Order

		Formulary Scenarios	Condition Set #	Formulary Category Description	One of (x) Number of Brand Agents	Price per NDC	Package Size	Price per Unit
		Scenario 1: One agent may be UF and before the step.
		Scenario 1	271LC14G1UFBS1	Uniform Formulary
Before-Step Therapy	1			NO QUOTE
			271LC14G1UFAS1M	Uniform Formulary
After-Step Therapy	1 or more			NO QUOTE
			271LC14G1NFAS1M	Non-Formulary
After-Step Therapy	1 or more			NO QUOTE
		Scenario 2: One or more agents may be UF.
		Scenario 2	271LC14G1UF1M	Uniform Formulary	1 or more			NO QUOTE
			271LC14G1NF1M	Non-Formulary	1 or more			NO QUOTE
						If cell highlights red, please confirm intent not to submit a quote

Blanket Purchase Agreement Appendix – Class Review

#9	DoW Uniform Formulary Class:	LUNG CANCER		P&T Committee Meeting:	November 4-5, 2026
	DoW Uniform Formulary Subclass:	METEX14		Quotes due:	October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	Military Treatment Facility & Mail Order

		Formulary Scenarios	Condition Set #	Formulary Category Description	One of (x) Number of Brand Agents	Price per NDC	Package Size	Price per Unit
		Scenario 1: One agent may be UF and before the step.
		Scenario 1	271LC14G1UFBS1	Uniform Formulary
Before-Step Therapy	1			NO QUOTE
			271LC14G1UFAS1M	Uniform Formulary
After-Step Therapy	1 or more			NO QUOTE
			271LC14G1NFAS1M	Non-Formulary
After-Step Therapy	1 or more			NO QUOTE
		Scenario 2: One or more agents may be UF.
		Scenario 2	271LC14G1UF1M	Uniform Formulary	1 or more			NO QUOTE
			271LC14G1NF1M	Non-Formulary	1 or more			NO QUOTE
						If cell highlights red, please confirm intent not to submit a quote

Blanket Purchase Agreement Appendix – Class Review

#10	DoW Uniform Formulary Class:	LUNG CANCER		P&T Committee Meeting:	November 4-5, 2026
	DoW Uniform Formulary Subclass:	METEX14		Quotes due:	October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	Military Treatment Facility & Mail Order

		Formulary Scenarios	Condition Set #	Formulary Category Description	One of (x) Number of Brand Agents	Price per NDC	Package Size	Price per Unit
		Scenario 1: One agent may be UF and before the step.
		Scenario 1	271LC14G1UFBS1	Uniform Formulary
Before-Step Therapy	1			NO QUOTE
			271LC14G1UFAS1M	Uniform Formulary
After-Step Therapy	1 or more			NO QUOTE
			271LC14G1NFAS1M	Non-Formulary
After-Step Therapy	1 or more			NO QUOTE
		Scenario 2: One or more agents may be UF.
		Scenario 2	271LC14G1UF1M	Uniform Formulary	1 or more			NO QUOTE
			271LC14G1NF1M	Non-Formulary	1 or more			NO QUOTE
						If cell highlights red, please confirm intent not to submit a quote

&"-,Italic"Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this quote.

ADP (non-FAMP Discount)

UF ADP Appendix for the November 2026 DoW P&T Meeting
DoW Uniform Formulary Class:	LUNG CANCER	P&T Committee Meeting:	November 4-5, 2026
DoW Uniform Formulary Subclass:	METEX14	Quotes due:	October 1, 2026
Formulary Notes
Class Note(s): Prior Authorization (PA) may apply. Agents may be identified as possible candidates for special reimbursement methods, amounts, and procedures to encourage use of high-value products and discourage use of low-value products. The DoW P&T Committee may recommend consideration of preferential status to any non-generic pharmaceutical agent by treating it for purposes of cost sharing as a generic product (Tier 1). Similarly, the DoW P&T Committee may identify candidates to recommend for complete exclusion from the TRICARE pharmacy benefit program.

*Note: Step Therapy may be applicable if agents share the same FDA-approved indication(s).

Agents with RFQ not submitted or selected may be designated non-step preferred (after-step).

Notes to Manufacturers: Do not forget to submit the Quote Review Checklist and fully executed signature pages, along with quote information.

* Total Calculated Refund Per FCP is calculated as: ((non-FAMP-FCP)+(non-FAMP*Y%)) = Total Calculated Refund **Based on the most recent annual non-FAMP (reported to the Department of Veterans Affairs) from which the current annual Federal Ceiling Price (FCP) calculated ceiling is derived. The current annual FCP and the annual non-FAMP from which it is derived will be applicable to all prescriptions filled during a calendar year. The quoted additional refund percentage will remain static during the life of the agreement but the most recent annual non-FAMP, and thus the calculated refund, may change each calendar year.

Additional Discount Program Appendix – Class Review

#1	DoW Uniform Formulary Class:		LUNG CANCER		P&T Committee Meeting:		November 4-5, 2026
	DoW Uniform Formulary Subclass:		METEX14		Quotes due:		October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	TRICARE RETAIL REFUND

		Formulary Scenarios	Condition Set #	Formulary Category	One of (x) Number of Brand Agents	Non-FAMP Price of Drug Per FCP Package**	Additional Offered Refund Per FCP Package**	Current Annual Federal Ceiling Price Per FCP Package**	Standard Refund Per FCP	Total Calculated Retail Refund Per FCP Package*
		Scenario 1: One agent may be T2 and before the step.
		Scenario 1	271LC14G1T2BS1	Tier 2
Before-Step Therapy	1
			271LC14G1T2AS1M	Tier 2
After-Step Therapy	1 or more
			271LC14G1T3AS1M	Tier 3
After-Step Therapy	1 or more
		Scenario 2: One or more agents may be T2.
		Scenario 2	271LC14G1T21M	Tier 2	1 or more
			271LC14G1T31M	Tier 3	1 or more
							If cell highlights red, please confirm intent not to submit a quote

Additional Discount Program Appendix – Class Review

#2	DoW Uniform Formulary Class:		LUNG CANCER		P&T Committee Meeting:		November 4-5, 2026
	DoW Uniform Formulary Subclass:		METEX14		Quotes due:		October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	TRICARE RETAIL REFUND

		Formulary Scenarios	Condition Set #	Formulary Category	One of (x) Number of Brand Agents	Non-FAMP Price of Drug Per FCP Package**	Additional Offered Refund Per FCP Package**	Current Annual Federal Ceiling Price Per FCP Package**	Standard Refund Per FCP	Total Calculated Retail Refund Per FCP Package*
		Scenario 1: One agent may be T2 and before the step.
		Scenario 1	271LC14G1T2BS1	Tier 2
Before-Step Therapy	1
			271LC14G1T2AS1M	Tier 2
After-Step Therapy	1 or more
			271LC14G1T3AS1M	Tier 3
After-Step Therapy	1 or more
		Scenario 2: One or more agents may be T2.
		Scenario 2	271LC14G1T21M	Tier 2	1 or more
			271LC14G1T31M	Tier 3	1 or more
							If cell highlights red, please confirm intent not to submit a quote

Additional Discount Program Appendix – Class Review

#3	DoW Uniform Formulary Class:		LUNG CANCER		P&T Committee Meeting:		November 4-5, 2026
	DoW Uniform Formulary Subclass:		METEX14		Quotes due:		October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	TRICARE RETAIL REFUND

		Formulary Scenarios	Condition Set #	Formulary Category	One of (x) Number of Brand Agents	Non-FAMP Price of Drug Per FCP Package**	Additional Offered Refund Per FCP Package**	Current Annual Federal Ceiling Price Per FCP Package**	Standard Refund Per FCP	Total Calculated Retail Refund Per FCP Package*
		Scenario 1: One agent may be T2 and before the step.
		Scenario 1	271LC14G1T2BS1	Tier 2
Before-Step Therapy	1
			271LC14G1T2AS1M	Tier 2
After-Step Therapy	1 or more
			271LC14G1T3AS1M	Tier 3
After-Step Therapy	1 or more
		Scenario 2: One or more agents may be T2.
		Scenario 2	271LC14G1T21M	Tier 2	1 or more
			271LC14G1T31M	Tier 3	1 or more
							If cell highlights red, please confirm intent not to submit a quote

Additional Discount Program Appendix – Class Review

#4	DoW Uniform Formulary Class:		LUNG CANCER		P&T Committee Meeting:		November 4-5, 2026
	DoW Uniform Formulary Subclass:		METEX14		Quotes due:		October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	TRICARE RETAIL REFUND

		Formulary Scenarios	Condition Set #	Formulary Category	One of (x) Number of Brand Agents	Non-FAMP Price of Drug Per FCP Package**	Additional Offered Refund Per FCP Package**	Current Annual Federal Ceiling Price Per FCP Package**	Standard Refund Per FCP	Total Calculated Retail Refund Per FCP Package*
		Scenario 1: One agent may be T2 and before the step.
		Scenario 1	271LC14G1T2BS1	Tier 2
Before-Step Therapy	1
			271LC14G1T2AS1M	Tier 2
After-Step Therapy	1 or more
			271LC14G1T3AS1M	Tier 3
After-Step Therapy	1 or more
		Scenario 2: One or more agents may be T2.
		Scenario 2	271LC14G1T21M	Tier 2	1 or more
			271LC14G1T31M	Tier 3	1 or more
							If cell highlights red, please confirm intent not to submit a quote

Additional Discount Program Appendix – Class Review

#5	DoW Uniform Formulary Class:		LUNG CANCER		P&T Committee Meeting:		November 4-5, 2026
	DoW Uniform Formulary Subclass:		METEX14		Quotes due:		October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	TRICARE RETAIL REFUND

		Formulary Scenarios	Condition Set #	Formulary Category	One of (x) Number of Brand Agents	Non-FAMP Price of Drug Per FCP Package**	Additional Offered Refund Per FCP Package**	Current Annual Federal Ceiling Price Per FCP Package**	Standard Refund Per FCP	Total Calculated Retail Refund Per FCP Package*
		Scenario 1: One agent may be T2 and before the step.
		Scenario 1	271LC14G1T2BS1	Tier 2
Before-Step Therapy	1
			271LC14G1T2AS1M	Tier 2
After-Step Therapy	1 or more
			271LC14G1T3AS1M	Tier 3
After-Step Therapy	1 or more
		Scenario 2: One or more agents may be T2.
		Scenario 2	271LC14G1T21M	Tier 2	1 or more
			271LC14G1T31M	Tier 3	1 or more
							If cell highlights red, please confirm intent not to submit a quote

Additional Discount Program Appendix – Class Review

#6	DoW Uniform Formulary Class:		LUNG CANCER		P&T Committee Meeting:		November 4-5, 2026
	DoW Uniform Formulary Subclass:		METEX14		Quotes due:		October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	TRICARE RETAIL REFUND

		Formulary Scenarios	Condition Set #	Formulary Category	One of (x) Number of Brand Agents	Non-FAMP Price of Drug Per FCP Package**	Additional Offered Refund Per FCP Package**	Current Annual Federal Ceiling Price Per FCP Package**	Standard Refund Per FCP	Total Calculated Retail Refund Per FCP Package*
		Scenario 1: One agent may be T2 and before the step.
		Scenario 1	271LC14G1T2BS1	Tier 2
Before-Step Therapy	1
			271LC14G1T2AS1M	Tier 2
After-Step Therapy	1 or more
			271LC14G1T3AS1M	Tier 3
After-Step Therapy	1 or more
		Scenario 2: One or more agents may be T2.
		Scenario 2	271LC14G1T21M	Tier 2	1 or more
			271LC14G1T31M	Tier 3	1 or more
							If cell highlights red, please confirm intent not to submit a quote

Additional Discount Program Appendix – Class Review

#7	DoW Uniform Formulary Class:		LUNG CANCER		P&T Committee Meeting:		November 4-5, 2026
	DoW Uniform Formulary Subclass:		METEX14		Quotes due:		October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	TRICARE RETAIL REFUND

		Formulary Scenarios	Condition Set #	Formulary Category	One of (x) Number of Brand Agents	Non-FAMP Price of Drug Per FCP Package**	Additional Offered Refund Per FCP Package**	Current Annual Federal Ceiling Price Per FCP Package**	Standard Refund Per FCP	Total Calculated Retail Refund Per FCP Package*
		Scenario 1: One agent may be T2 and before the step.
		Scenario 1	271LC14G1T2BS1	Tier 2
Before-Step Therapy	1
			271LC14G1T2AS1M	Tier 2
After-Step Therapy	1 or more
			271LC14G1T3AS1M	Tier 3
After-Step Therapy	1 or more
		Scenario 2: One or more agents may be T2.
		Scenario 2	271LC14G1T21M	Tier 2	1 or more
			271LC14G1T31M	Tier 3	1 or more
							If cell highlights red, please confirm intent not to submit a quote

Additional Discount Program Appendix – Class Review

#8	DoW Uniform Formulary Class:		LUNG CANCER		P&T Committee Meeting:		November 4-5, 2026
	DoW Uniform Formulary Subclass:		METEX14		Quotes due:		October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	TRICARE RETAIL REFUND

		Formulary Scenarios	Condition Set #	Formulary Category	One of (x) Number of Brand Agents	Non-FAMP Price of Drug Per FCP Package**	Additional Offered Refund Per FCP Package**	Current Annual Federal Ceiling Price Per FCP Package**	Standard Refund Per FCP	Total Calculated Retail Refund Per FCP Package*
		Scenario 1: One agent may be T2 and before the step.
		Scenario 1	271LC14G1T2BS1	Tier 2
Before-Step Therapy	1
			271LC14G1T2AS1M	Tier 2
After-Step Therapy	1 or more
			271LC14G1T3AS1M	Tier 3
After-Step Therapy	1 or more
		Scenario 2: One or more agents may be T2.
		Scenario 2	271LC14G1T21M	Tier 2	1 or more
			271LC14G1T31M	Tier 3	1 or more
							If cell highlights red, please confirm intent not to submit a quote

Additional Discount Program Appendix – Class Review

#9	DoW Uniform Formulary Class:		LUNG CANCER		P&T Committee Meeting:		November 4-5, 2026
	DoW Uniform Formulary Subclass:		METEX14		Quotes due:		October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	TRICARE RETAIL REFUND

		Formulary Scenarios	Condition Set #	Formulary Category	One of (x) Number of Brand Agents	Non-FAMP Price of Drug Per FCP Package**	Additional Offered Refund Per FCP Package**	Current Annual Federal Ceiling Price Per FCP Package**	Standard Refund Per FCP	Total Calculated Retail Refund Per FCP Package*
		Scenario 1: One agent may be T2 and before the step.
		Scenario 1	271LC14G1T2BS1	Tier 2
Before-Step Therapy	1
			271LC14G1T2AS1M	Tier 2
After-Step Therapy	1 or more
			271LC14G1T3AS1M	Tier 3
After-Step Therapy	1 or more
		Scenario 2: One or more agents may be T2.
		Scenario 2	271LC14G1T21M	Tier 2	1 or more
			271LC14G1T31M	Tier 3	1 or more
							If cell highlights red, please confirm intent not to submit a quote

Additional Discount Program Appendix – Class Review

#10	DoW Uniform Formulary Class:		LUNG CANCER		P&T Committee Meeting:		November 4-5, 2026
	DoW Uniform Formulary Subclass:		METEX14		Quotes due:		October 1, 2026
	NDC Number	Drug Name	Strength	Dosage Form	Package Size	TRICARE RETAIL REFUND

		Formulary Scenarios	Condition Set #	Formulary Category	One of (x) Number of Branded Agents	Non-FAMP Price of Drug Per FCP Package**	Additional Offered Refund Per FCP Package**	Current Annual Federal Ceiling Price Per FCP Package**	Standard Refund Per FCP	Total Calculated Retail Refund Per FCP Package*
		Scenario 1: One agent may be T2 and before the step.
		Scenario 1	271LC14G1T2BS1	Tier 2
Before-Step Therapy	1
			271LC14G1T2AS1M	Tier 2
After-Step Therapy	1 or more
			271LC14G1T3AS1M	Tier 3
After-Step Therapy	1 or more
		Scenario 2: One or more agents may be T2.
		Scenario 2	271LC14G1T21M	Tier 2	1 or more
			271LC14G1T31M	Tier 3	1 or more
							If cell highlights red, please confirm intent not to submit a quote

&"-,Italic"Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this quote.

File details come from the government source that posted it. Updated Aug 6, 2026.