A.02 PWS HPIS Task 2 DRAFT.docx

Department of Defense Defense Health Agency Performance Work Statement

Health Plan Innovation Services Program – Task 2

Health Care Operations, Pharmacy Operations Division

Solicitation Number:

Version:

Date:

PART 1

1.0 GENERAL INFORMATION

1.1 This is a non-personal services contract to provide Health Plan Innovation Support for the TRICARE Pharmacy Program.

1.2 Description of services/introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform Health Plan Innovation Support for the TRICARE Pharmacy Program as defined in this Performance Work Statement (PWS) except for those items specified as government furnished property and services. The contractor shall perform to the standards in this PWS.

1.3 Background: The TRICARE Program Management Office (PMO) established a T-5 Integrated Project Team (IPT), in accordance with DoDI 5000.74 Acquisition of Services, to understand and articulate to key stakeholders the programmatic needs for the next generation of TRICARE contracts. The TRICARE Pharmacy Program has been undertaking a similar effort for the next generation TRICARE Pharmacy (TPharm) contract.

The TPharm contract delivers high-value, patient-centric services that seamlessly integrate direct care (delivered at military pharmacies) and private sector care operations in support of increasing readiness and improving health outcomes. The contract provides DHA the flexibility to implement adjustments to TRICARE benefits and to adapt care delivery models to support evolving mission requirements and changes in American health care. The TPharm contractor’s pharmacy network complements the capabilities of military pharmacies.

The TRICARE Pharmacy Program provides pharmacy benefits to approximately 9.6 million uniformed service members, retirees, and their family members. DHA administers an integrated TRICARE Pharmacy Benefits Program offering pharmacy services through military pharmacies, network retail pharmacies, non-network retail pharmacies, and TRICARE Mail Order Pharmacy (TMOP). The pharmacy benefits program includes the following features: use of the DoD Uniform Formulary, a tiered cost sharing structure, and a mandatory generic drug policy. The Uniform formulary is developed and maintained by the DoD Pharmacy and Therapeutics (P&T) Committee. The TRICARE Pharmacy Program also provides beneficiaries access to specialty medications at all points of service and through an accredited specialty pharmacy operating under the TRICARE Mail Order Program (TMOP). Specialty pharmacies serve patients with complex and chronic health conditions. In some cases, beneficiaries may be required to fill certain specialty medications, such as those included in the Expanded Use of Military pharmacies and MOP Program, through TMOP.

The TRICARE Pharmacy Program is governed by the following laws, regulations and policies:

· 10 USC Chapter 55 – Medical and Dental Care

· 32 CFR 199 - Civilian Health and Medical Program of the Uniformed Services

· TRICARE Program Manuals 2021 edition (T-5) apply to this effort (https://manuals.health.mil/) (Note: Future versions may be adopted, with notification to the Contractor.)

1.4 Objectives:

OBJECTIVE 1 – Industry Best Practices: Identify health care payer best practices for recommendation and potential implementation into the development of purchased care acquisitions, direct care acquisitions, contractor transitions, beneficiary satisfaction, quality control, and contractor oversight processes.

OBJECTIVE 2 – Incentives: Using qualitative and quantitative analysis, design, implement and measure effective incentives and disincentives in DHA contracts.

OBJECTIVE 3 – Communicate: Support the communication of concepts and program changes of the new integrated health delivery system to key stakeholders (e.g. DHA leadership, DoD leadership, Congress, internal team communication, Industry, DHA Strategic Communication).

OBJECTIVE 4 – Acquisition Phase: Provide cogent technical expertise to Government teams as non-Governmental advisors as needed during evaluation and selection of suppliers. Support technical requirements and risk analysis evaluation during the execution phase of the acquisition processes to provide technical expertise on areas of industry best practices.

OBJECTIVE 5 – Supplier Management – Provide cogent technical and analytic expertise to design systems and data requirements needed for the Government to evaluate and execute transition, initial and ongoing supplier performance.

OBJECTIVE 6 – Alternative Payment Models (APM) and High/Low Value Care support services – Provide analytics and recommendations to DHA for implementation of APMs; support the evaluation of contractor-proposed APMs; identify high value care instances for targeted beneficiary cost share interventions; acquire and utilize MedInsight Health Waste Calculator software (or alternative similar product) to identify and justify low value care services for DHA targeted Reductions.

OBJECTIVE 7 – Pharmacy Cost Estimates – Develop an independent cost estimate for the TPharm5 requirements. Includes pricing individual CLINs, projecting utilization volume CLINs priced per unit, estimating the likely cost of incentives and documentation of all assumptions used.

OBJECTIVE 8 – TPharm5 Evaluation Advisory Services – Provide technical and analytical support to the evaluation of proposals.

OBJECTIVE 9 – Pharmacy Benefit Optimization – Provide guidance on future opportunities to optimize the performance of the pharmacy benefit under the TPharm5 contract. May include formulary and benefit design recommendations, channel management, integration of direct and purchased care, coordination between medical and pharmacy benefits, data sharing to drive improved patient outcomes and or value-based initiatives, network optimization, integration of commercial best practices and any other areas that promote the current goals of the TRICARE Pharmacy benefit.

1.5 Scope: The Health Plan Innovation Support for the TRICARE Pharmacy Program will involve providing subject matter expertise to assist the TRICARE Pharmacy program with:

· Developing cost estimates for proposed requirements

· Projecting utilization volume over the course of the TPharm5 contract

· Advisory support in the evaluation of proposals

· Improvement to TRICARE Manuals to support Pharmacy

· Improved coordination between the Pharmacy and Medical benefits

· Optimization of the Pharmacy benefit

1.6 Period of Performance (PoP): The period of performance includes one six-month base period and one six-month option period.

1.6.1 Transition: Transition-in/transition-out period

1.6.1.1 Transition-out period: The Contractor shall facilitate the accomplishment of a seamless transition from the incumbent to an incoming contractor/Government personnel at the expiration of the contract.

1.6.1.1.1 The contractor shall comply with transition-out requirements of the DHA for contractors who have been issued a CAC or who generate “records”, as defined by DoD (records manual), including DoD-directed disposition of records, and others displayed on the In/Out (I/O) Processing Portal.

1.7 Administrative specifications

1.7.1 Place of performance: The work shall be performed remotely or at the Contractor’s location. Government data may not be removed from the jurisdiction of the United States.

1.7.2 Recognized Federal holidays:

Independence Day

1.7.3 Hours of operation: The contractor is responsible for conducting business Monday thru Friday except Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. The contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons.

1.8 Contractor travel: Reserved.

1.9 Other Direct Costs (ODC): Reserved.

1.10 Quality

1.10.1 Quality Management (QM): The contractor shall develop and maintain an effective QM program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure nonrecurrence of defective services. The contractor’s QM program is the means by which the work complies with stated requirements.

1.10.2 Quality assurance (QA): The government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). This plan provides a systematic method for the Government to evaluate performance and to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.11 Contractor personnel

1.11.1 CAC requirements: For all contractors who will work in Government facilities, the Facilities Security Officer (FSO)/Company's Security point of contact (POC) will provide the Government all the required information per the DHA CAC request process current version 2.1, January 2018, or more recent when updated. See process attached at Part 7 Section 7.1.1 of the PWS. A CAC is the standard identification for eligible DoD contractor personnel.

1.11.1.1 The contractor shall return all CACs to the COR upon the departure of the contractor(s).

1.11.2 Contractor onboarding and training. The contractor shall complete all requirements, training, and forms as prescribed in the following requirements:

1.11.2.1 Reserved.

1.11.2.2 The DHA’s contractor training instructions embedded at Part 7 Section 7.1.2.

1.11.2.3 The contractor shall comply with onboarding requirements of the DHA for contractors needing to be issued CAC identification, including DoD- and DHA-directed training and forms submission, prior to network access, as displayed in the In/Out-Processing Portal at: https://info.health.mil/cos/admin/hr/IO/SitePages/home.aspx (note: Public Key Infrastructure (PKI)-restricted, printed versions available).

1.11.3 Physical Security: The contractor shall be responsible for safeguarding all government equipment, information and property provided for contractor use.

1.11.4 Key control: The contractor shall establish and implement methods of making sure all keys/key cards issued to the contractor by the Government are not lost or misplaced and are not used by unauthorized persons. NOTE: All references to keys include key cards. No keys issued to the contractor by the Government shall be duplicated. The contractor shall develop procedures covering key control that shall be included in the QCP. Such procedures shall include turn-in of any issued keys by personnel who no longer require access to locked areas. The contractor shall immediately report any occurrences of lost or duplicate keys/key cards to the CO.

1.11.4.1 In the event keys, other than master keys, are lost or duplicated, the contractor shall, upon direction of the CO, re-key or replace the affected lock or locks; however, the Government, at its option, may replace the affected lock or locks or perform re-keying. When the replacement of locks or re-keying is performed by the Government, the total cost of re-keying or the replacement of the lock or locks shall be deducted from the monthly payment due the contractor. In the event a master key is lost or duplicated, all locks and keys for that system shall be replaced by the Government and the total cost deducted from the monthly payment due the contractor.

1.11.4.2 The contractor shall prohibit the use of Government issued keys/key cards by any persons other than the contractor’s employees. The contractor shall prohibit the opening of locked areas by contractor employees to permit entrance of persons other than contractor employees engaged in the performance of assigned work in those areas, or personnel authorized entrance by the CO.

1.11.5 Lock combinations: The contractor shall establish and implement methods of ensuring that all lock combinations are not revealed to unauthorized persons. The contractor shall ensure that lock combinations are changed when personnel having access to the combinations no longer have a need to know such combinations. These procedures shall be included in the contractor’s QCP.

1.12 Key personnel (Contractor): Reserved.

1.13 Data rights: The Government has unlimited rights to all documents and materials produced under this order, including telephone call recordings and transcripts and web chat transcripts, and all deliverables under the contract. These documents and materials may not be used or sold by the contractor for any purpose without written permission from the Contracting Officer. All materials supplied or developed for the Government shall become the sole property of the Government and may not be used for any other purpose without written permission from the Contracting Officer. This right does not abrogate any other Government rights.

“Materials” means all items in any format and includes, but is not limited to, data, reports, documents, pamphlets, advertisements, surveys, studies, software and computer programs, films, tapes, and/or sound reproductions. Ownership includes the right to copyright, patent, register and the ability to transfer these rights.

1.14 Reporting

1.14.1 Contractor Manpower Reporting (CMR): RESERVED.

1.14.2 Non-Disclosure Agreement (NDA): All contractor personnel who will obtain access to proprietary, classified, or confidential information or any information release of which is protected or governed by law or regulation associated with DHA acquisitions shall be required to complete and sign a DHA contractor NDA (DHA Form 49) prior to beginning work on the subject contract. The contractor shall execute an NDA on behalf of the company and shall ensure that all staff assigned to, including all subcontractors and consultants, or other personnel performing on contract/Task order execute an NDA protecting the procurement sensitive information of the Government and the proprietary information of other contractors. The NDA shall be executed not later than first day of employment and to be renewed upon exercising a contract option period. Assignment of staff who has not executed this statement or failure to adhere to this statement shall constitute default on the part of the contractor. The contractor shall maintain originally signed NDAs of individual employees and provide copy to the COR.

1.14.3 Government’s COR: The COR monitors all technical aspects of the contract and assists in contract administration. The COR is authorized to perform the following functions: assure that the contractor performs the technical requirements of the contract; perform inspections necessary in connection with contract performance; maintain written and oral communications with the contractor concerning technical aspects of the contract; issue written interpretations of technical requirements, including Government drawings, designs, specifications; monitor contractor's performance and notifies both the CO and contractor of any deficiencies; coordinate availability of government furnished property; and provide site entry of contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting contract.

1.14.4 Post award conference/periodic progress meetings: The contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with FAR Subpart 42.5. The CO, COR, and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the CO will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

1.15 Contractor Identification

1.15.1 Contractor personnel performing services in a contractor capacity in a Government facility are required to possess and wear an identification badge that displays his or her name and the name of their company. All contractor personnel shall identify themselves as contractor support personnel in all forms of communication with all entities with whom DHA/Deputy Assistant Director for Acquisition (DAD-A)/Head of the Contracting Activity (HCA) has business dealings. The contractor shall: Answer all telephone calls and have a personalized voice message with an introductory statement that includes the fact that the person is contractor support personnel. Ensure all those with whom the person interacts in any face-to-face dealings while supporting the DAD-A understands that the person is contractor support personnel. Include a title block in all emails that states the fact that the person is contractor support personnel. Ensure all those with whom the person interacts in any face-to-face dealings while supporting DHA/DAD-A/HCA understands that the person is contractor support personnel.

1.15.2 Contractor personnel will be required to attend meetings or otherwise communicate with Government and/or other contract representatives to meet the requirements of this order. Contractor personnel shall make their contractor status known during introductions.

1.15.3 Contractor personnel, while performing in a contractor capacity, are prohibited from using their retired or reserve component military rank or title in any written or verbal communications associated with the contracts in which they provide services.

1.16 Contractor Access to Health Affairs (HA)/DHA Network(s)

1.16.1 FSO/Company's Security POC shall notify the DHA Personnel Security Office after being awarded a contract that requires access to a DoD system (If applicable, if not delete 1.16.1 and 1.16.2 and replace to 1.16 Reserved). Contractor personnel requiring access to the HA/DHA networks for performance of their tasks require a background investigation and the security awareness training. The contractor shall be prepared for this process as it could take two (2) or more weeks. The FSO/Security POC shall submit a Standard Form (SF) 85/86 to DHA's Personnel Security Office for a background investigation.

1.16.2 Company's FSO/Security POC must notify the Personnel Security Office when the contractor has submitted the SF-85/86. The FSO/Security POC, or the COR must notify the DHA Personnel Security Office in writing of a contractor's termination from the contract, including the termination date.

1.17 Personnel Security

1.17.1 The contractor shall comply with DoD 8570.01-M, “Information Assurance Workforce Improvement Program, CH4” November 10, 2015 as amended; 8500.01, “Cybersecurity”, dated March 14, 2014; DoD Manual (DoDM) 6025.18, “Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule Compliance in DoD Health Care Programs” dated March 3, 2019, Department of Defense Instruction (DoDI) 6025.18 “HIPAA Privacy Rule Compliance in DoD Health Care Programs”, dated March 13, 2019; and DoDM 5200.02 “Procedures for the DoD Personnel Security Program (PSP),” incorporation change 3, effective September 24, 2020. Contractor responsibilities for ensuring personnel security include, but are not limited to, meeting the following requirements:

1.17.1.1 Follow the DHA Personnel Security Office guidelines for submittal of security clearances. Contact the DHA Personnel Security Office for guidance on the appropriate background investigation required for personnel on the contract. The DHA Personnel Security Office can be reached at (703) 275-6038.

1.17.1.2 Initiate, maintain, and document personnel security investigations appropriate to the individual’s responsibilities and required access to Controlled Unclassified Information (CUI).

1.17.1.3 DHA Personnel Security Office does not deny any access to any automated information system (AIS), network, or Controlled Unclassified Information (CUI). If a contractor receives an unfavorable background investigation, the request for access will be sent back to the FSO for further action. Any unfavorable adjudication will result in DHA Personnel Security Office not signing off on any access request.

PART 2

2.0 DEFINITIONS, ACRONYMS, AND APPLICABLE PUBLICATIONS/INSTRUCTIONS

2.1 Definitions:

2.1.1 Category D: Information Technology (IT) and Telecommunications Services (called D-Services)

2.1.2 Category R: Support (Professional/Administrative/Management) Services (called R-Services)

2.1.3 Contracting Officer (CO): A person with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

2.1.4 Contracting Officer’s Representative (COR): An individual, including a contracting officer’s technical representative (COTR), designated and authorized in writing by the CO to perform specific technical or administrative functions. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.5 Nonpersonal services contract: a contract under which the personnel rendering the services are not subject, either by the contract’s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees.

2.1.6 Quality Assurance Surveillance Plan (QASP): An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance. The Government may either prepare the QASP or require the offerors to submit a proposed quality assurance surveillance plan for the Government’s consideration in development of the Government’s plan.

2.1.7 Reserved.

2.2 Acronyms:

2.3 Applicable Publications, DHA Administrative Instructions (AI), etc. Reserved.

PART 3

3.0 GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

The Requiring Activity Authority has assessed the need for Government Furnished Property, Equipment, and Services and determined:

3.1 Services: The Government:

☒ Will NOT provide Government Furnished Services in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ WILL provide Government Furnished Services required in support of this contract/task orders. These Services are described below: provide

3.2 Facilities: The Government:

☐ Will NOT provide Facilities in support of this contract/task order. As a result, this paragraph is Not Applicable.

☒ WILL provide Facilities in support of this contract/task orders. The Government provided Facilities are described below:

A limited number of DHA laptops for Contractors as required for DHA network access for data analysis and other tasks (no more than five in total). Laptops are authorized for transaction of official Government business only and shall not be used for personal business. Laptops are always subject to communications security monitoring. Contractor and subcontract employees may be issued keys signed for at scheduled and unscheduled key control inspections. Items issued will remain the property of the Government and the Contractor will maintain proper accountability of issued equipment and are to be used, turned in and/or disposed of as directed by the COR or CO.

3.3 Utilities: The Government:

☒ Will NOT provide Utilities in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ WILL provide Utilities in support of this contract/task orders. The Government provided Utilities are described below:

3.4 Equipment: The Government:

☒ Will NOT provide Equipment in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ WILL provide Equipment in support of this contract/task orders. The Government provided Equipment is described below:

3.4.1 Procurement Integrated Enterprise (PIEE), GFP Module Application The contractor shall be responsible for obtaining and maintaining access, training and successful operation of the PIEE/GFP Module application for the entirety of the contract/task order PoP. The PIEE GFP Module application is located at the following website: https://wawf.eb.mil/piee-landing/. Access to PIEE/GFP Module application training materials and in-depth information applicable to the contractor’s responsibilities regarding GFP can be found at the following website: https://dodprocurementtoolbox.com/.

Contracting Office Responsibilities:

The Contracting Office shall ensure close coordination and validation of the GFP items with the COR and DHA Accountable Property Officer prior to uploading the GFP Attachment into the PIEE/GFP Module. At the time GFP is anticipated and identified, the Government will upload the GFP Attachment into the PIEE/GFP Module. It is the Contracting Office’s responsibility to prepare, upload and maintain the GFP Attachment in the PIEE/GFP Module in accordance with the GFP Attachment instructions provided at the DoD Procurement Toolbox. The CO and COR shall manage and keep an inventory of any GFP associated with contract/task orders awarded through DHA, in accordance with applicable FAR Part 45, DoD FAR Supplement (DFARS) 245 with respective clauses, DHA AI 095 and PD 45-01 following the change in disposition of items listed on that PIEE/GFP Module Attachment.

The contracting office will also review, acknowledge, reject and/or approve shipment orders provided by the contractor as appropriate. Functional roles can be determined within the Contracting Office, and requested within the PIEE/GFP Module system.

Contractor Responsibilities:

A key contractor responsibility is to work with the CO and COR to ensure the PIEE/GFP Module data, to include the PIEE/GFP Attachment, provides a timely, complete and accurate accounting of the GFP applicable to the contract/task order. Contractors are required to report the receipt of any GFP shipped to them, regardless of whether it is listed on the GFP Attachment for their contract. Similarly, contractors are required to utilize the GFP Module application in conjunction with the shipment of GFP to the Government, or in reporting Property Loss of GFP issued (such as destruction or loss). Discrepancies or disputes regarding property shipped to or shipped from the contractor must be reported via the GFP Module application, with the CO having authority over final designation of status.

The contractor shall report semi-annually 100% inventories, reconciliations, and final disposition of GFP provided by the government. Final invoices will not be paid pending GFP reconciliation. Contractors shall be aware of and ensure compliance with applicable FAR Part 45, DFARS 245 and 252.245, Defense Pricing and Contracting Policies, Procurement Integrated Enterprise Environment Standards, DHA Administrative Instruction 094 and DHA Guidance. (If this option is used, a semi-annual GFP inventory CDRL will need to be added to the PWS Technical Exhibit 1.)

3.5 Materials: The Government:

☒ Will NOT provide Materials in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ IS providing Materials in support of this contract/task orders. The Government-provided Materials are described below:

PART 4

4.0 CONTRACTOR FURNISHED ITEMS AND SERVICES

4.1 Services: The Contractor:

☒ Will NOT provide Contractor Furnished Services in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ WILL provide Contractor Furnished Services required in support of this contract/task orders. These Services are described below:

4.2 General: The contractor shall furnish all supplies, equipment, facilities and services required to perform work listed under Section 5 of this PWS.

4.3 Secret Facility Clearance: N/A

4.4 Materials: N/A

4.5 Equipment: N/A

4.6 Facilities: N/A

PART 5

5.0 SPECIFIC TASKS

5.1 Industry Best Practices

The Contractor shall provide experts and technological solutions to help DHA navigate the procurement process, and identify areas and practices to optimize the pharmacy benefit. The Contractor shall provide industry best practices and a leading suite of Pharmacy Benefit Manager (PBM) analytic, reporting and procurement monitoring tools. The Contractor shall bring experience consulting in the joint Federal pharmacy ecosystem, a comprehensive understanding of what makes leading PBMs highly reliable, and advance consulting experts in transforming the Military Health System (MHS) across all levels of governance. The Contractor shall provide an integrated team with existing commercial and public sector expertise with experience in the MHS.

5.2 Independent Cost Estimates

The Contractor shall develop independent cost estimates for pharmacy requirements, including all proposed Contract Line Items Numbers (CLINs). The Contractor shall analyze leading practices across public and private health sectors and develop cost models relevant to the TRICARE Pharmacy Benefit objectives. The Contractor’s independent cost estimates shall include pricing individual CLINs, projecting utilization volume CLINs priced per unit, estimating the likely cost of incentives and documentation of all assumptions used. To perform develop independent cost estimates, the Contractor shall develop pharmacy cost estimate models, estimate the likely cost of incentives, compare pricing using comparative delivery models, develop projections for utilization volume, and provide routine status updates on completed activities. The Contractor shall develop the CLIN pricing estimate model by using the most recent historical pharmacy claims data combined with market pipeline intelligence to perform predictive analytics for future pharmacy requirements. The Contractor shall document and validate any assumptions prior to conducting analysis to ensure it meets with the Government’s intent.

5.3 Pharmacy Benefit Optimization

The Contractor shall identify opportunities to optimize the performance of the pharmacy benefit. Such recommendations shall include formulary and benefit design recommendations, channel management, integration of the TRICARE benefit (such as pharmacy benefit delivery across both direct and purchased care and between medical and pharmacy benefits), data sharing to drive improved patient outcomes and/or value-based initiatives, data integration and analysis to support monitoring the pharmacy program, retail network optimization, and any other areas that promote the current goals of the TRICARE Pharmacy benefit. The Contractor shall conduct pharmacoeconomic analysis to support optimization of the TRICARE formulary and benefit delivery. The Contractor shall analyze cost and budgetary impacts of alternative benefit delivery options. The Contractor shall evaluate proposed changes to statutory and regulatory requirements. The Contractor shall provide recommended courses of action for Pharmacy Operations Division (POD) deliberation and decisions through DHA governance process.

5.4 Special Qualifications: Reserved.

PART 6

6.0 INFORMATION TECHNOLOGY & SECURITY

6.1 All work under this contract is unclassified.

6.2 The TIER 1 or TIER 2 levels and position sensitivity designation for positions under this contract is:

6.2.1 TIER I: Critical sensitive position

6.3 Personally Identifiable Information (PII)/Protected Health Information (PHI), Procurement, and Federal information requirements:

6.3.1. Data Sharing Agreements (DSAs): Contractors requiring access to PII, which includes PHI, or access to de-identified data, are subject to the DHA Privacy and Civil Liberties Office (DPCLO) (Privacy Office) Data Sharing Program. This program requires DHA to enter into DSAs with parties outside the MHS who use or create MHS data. A DHA contract may use the term Data Use Agreement (DUA) rather than DSA. DSAs assure that outside parties protect MHS data in accordance with the Privacy Act and the HIPAA Rules. To apply for a DSA, the contractor submits a Data Sharing Agreement Application (DSAA) to the DHA DPCLO. The contractor submits the DSAA even if a subcontractor will be the party accessing MHS data. After review and approval of the DSAA, the Privacy Office provides a DSA to the contractor for execution.

6.3.2. Processing Procurement Sensitive Information: All individuals shall seek guidance from the CO regarding the coordination of documents, dissemination, and transmission of procurement sensitive information. Procurement sensitive information shall not be transmitted electronically unless encryption is utilized. Depending on a particular procurement, other restrictions may apply.

6.4 Training

6.4.1 Contractor employees performing cybersecurity/cyberspace functions shall comply with the following requirements: Not applicable.

6.4.2 User requirements: All contractor employees that require access to DHA IT must comply with the requirements of DHA-Procedural Instruction 8140.01, Acceptable Use of DHA IT, to include those contract employees with privileged access.

6.5 Cybersecurity Requirements for Non-DoD IT or Covered Contractor IS:

6.5.1 The contractor shall, at time of award, have implemented the security requirements prescribed in the National Institute of Standards and Technology (NIST) Special Publication (SP) 800-171, “Protecting Controlled Unclassified Information in Nonfederal Information Systems and Organizations” (available via the internet at http://dx.doi.org/10.6028/NIST.SP.800-171), in accordance with DFARS clause 252.204-7012.

6.5.2 NIST SP 800-171 DoD Assessment Methodology. The DFARS provision 252.204-7019 introduces the “NIST SP 800-171 DoD Assessment Methodology” requirement. This requirement enables a strategic assessment of a contractor’s implementation of the NIST SP 800-171 requirements as required in DFARS clause 252.204-7012. The DoD Assessment Methodology requirement flows down to subcontractors.

6.5.2.1 Basic Assessment: The contractor shall obtain and maintain access to the Supplier Performance Risk System (SPRS) via the PIEE, (available via the internet at https://www.sprs.csd.disa.mil/)

6.5.2.1.1 The contractor shall perform a Basic Assessment, using the NIST SP 800-171 DoD Assessment Scoring Template, and enter the results electronically in SPRS for each covered contractor information system that is relevant to an offer, contract, task order, or delivery order. See Attachment 2, Deliverable Schedule Table.

6.5.2.1.2 The contractor shall ensure that applicable subcontractors also have their results of a current assessment posted in SPRS prior to awarding a subcontract or other contractual instrument in accordance with DFARS clause 252.204-7020.

6.5.3 The contractor shall provide the government with access to its facilities, systems, and personnel when necessary to conduct or renew a higher-level (i.e., Medium or High) assessment in accordance with DFARS clause 252.204-7020.

6.5.4 Cybersecurity Maturity Model Certification (CMMC) (When applicable): The CMMC (DFARS clause 252.204-7021) builds upon the NIST SP 800-171 DoD Assessment Methodology by adding a comprehensive and scalable certification element to verify the implementation of processes and practices associated with the achievement of a cybersecurity maturity level. The CMMC is designed to increase assurance to the DoD that federal contract information (FCI) and DoD Controlled Unclassified Information (CUI) is protected at a level commensurate with the risk. The CMMC requirement flows down to subcontractors.

6.5.4.1 The contractor shall have a current (i.e., not more than three years old) CMMC certificate in SPRS issued by an accredited CMMC Third Party Assessment Organization (3PAO) at the required CMMC level. The description of CMMC levels is available at https://www.cmmcab.org/.

6.5.5 The contractor shall submit requests to vary from NIST SP 800-171 in writing to the CO or COR, for consideration by the DoD Chief Information Officer (CIO). The contractor need not implement any security requirement adjudicated by an authorized representative of the DoD CIO to be non-applicable or to have an alternative, but equally effective, security measure that may be implemented in its place.

6.5.6 If the DoD CIO has previously adjudicated the contractor’s requests indicating that a requirement is not applicable or that an alternative security measure is equally effective, a copy of that approval shall be provided to the CO or COR when requesting its recognition under this contract.

6.5.7 Cloud Computing: If the contractor intends to use an external cloud service provider, on their behalf, to store, process, or transmit any DoD CUI in performance of this contract, the contractor shall require the cloud service provider meets security requirements equivalent to those established by the Government for the Federal Risk and Authorization Management Program (FedRAMP) Moderate baseline (https://www.fedramp.gov/) and that the cloud service provider complies with requirements in paragraphs 6.5.8 through 6.5.14 for cyber incident reporting, malicious software, media preservation and protection, access to additional information and equipment necessary for forensic analysis, and cyber incident damage assessment.

6.5.7.1 If the information is DoD CUI-specific (e.g., PII/PHI), then the contractor shall ensure the external cloud service provider meet the security requirements equivalent to FedRAMP High baseline.

6.5.8 Cyber Incident Reporting Requirement

6.5.8.1 When the contractor discovers a cyber incident that affects a covered contractor information system or the covered defense information residing therein, or that affects the contractor’s ability to perform the requirements of the contract that are designated as operationally critical support and identified in the contract, the contractor shall:

6.5.8.1.1 Conduct a review for evidence of compromise of covered defense information, including, but not limited to, identifying compromised computers, servers, specific data, and user accounts. This review shall also include analyzing covered contractor information system(s) that were part of the cyber incident, as well as other IS on the contractor’s network(s), that may have been accessed as a result of the incident in order to identify compromised covered defense information, or that affect the contractor’s ability to provide operationally critical support; and

6.5.8.1.2 In accordance with DFARS clause 252.204-7012, rapidly report (within 72 hours) cyber incidents involving DoD CUI to DoD Cyber Crime Center (DC3) via https://dibnet.dod.mil/portal/intranet/. In the event of a cybersecurity incident involving a CUI-Specific breach (i.e., PII/PHI), the contractor, in addition to reporting to the DC3, shall follow the incident reporting guidance prescribed in the TRICARE Operations Manual, Chapter 1, Section 5, “Compliance with Federal Statutes” at https://manuals.health.mil/

6.5.8.2 Cyber incident report: The cyber incident report shall be treated as information created by or for DoD and shall include, at a minimum, the required elements as prescribed at the https://dibnet.dod.mil/portal/intranet/.

6.5.8.3 Medium assurance certificate requirement: In order to report cyber incidents in accordance with this clause, the contractor or subcontractor shall have or acquire a DoD-approved medium assurance certificate to report cyber incidents. For information on obtaining a DoD-approved medium assurance certificate, see https://public.cyber.mil/

6.5.9 Malicious software: When the contractor or subcontractors discover and isolate malicious software in connection with a reported cyber incident, submit the malicious software to DC3 in accordance with instructions provided by DC3 or the Contracting Officer. Do not send the malicious software to the Contracting Officer.

6.5.10 Media preservation and protection: When a contractor discovers a cyber incident has occurred, the contractor shall preserve and protect images of all known affected IS and all relevant monitoring/packet capture data for at least 90 days from the submission of the cyber incident report to allow DoD to request the media or decline interest.

6.5.11 Access to additional information or equipment necessary for forensic analysis: Upon request by DoD, the contractor shall provide DoD with access to additional information or equipment that is necessary to conduct a forensic analysis.

6.5.12 Cyber incident damage assessment activities: If DoD elects to conduct a damage assessment, the CO will request that the contractor provide all of the damage assessment information gathered in accordance with paragraph (e) of DFARS clause 252.204-7012.

6.5.13 Apply other IS security measures when the contractor reasonably determines that IS security measures may be required to provide adequate security in a dynamic environment or to accommodate special circumstances (e.g., HIPAA) and any individual, isolated, or temporary deficiencies based on an assessed risk or vulnerability. These measures may be addressed in a system security plan.

6.5.14 The contractor shall maintain within the US or US territories all Government data that is not physically located on DoD premises, unless the contractor receives written notification from the CO to use another location, in accordance with DFARS 239.7602-2(a).

6.5.15. The contractor shall mitigate supply chain risk to the government by complying with DFARS 252.239-7018 and only utilizing unified capability equipment identified on the DODIN Unified Capabilities Approved Products List (https://aplits.disa.mil/processAPList), unless granted a waiver in accordance with DODI 8100.04, DOD Unified Capabilities (UC).

6.6 Risk Management Framework (RMF) for DoD IT: All IS, Platform Information Technology (PIT) and IT Services or Products under this requirement, that receive, transmit, store, or process nonpublic government data must be accredited in accordance with DoDI 8510.01, Risk Management Framework (RMF) for DoD IT and comply with annual Federal Information Security Modernization Act (FISMA) security control testing. IS and PIT systems must be categorized in accordance with Committee on National Security Systems Instruction (CNSSI) 1253, implement a corresponding set of security controls from the NIST SP 800-53, and use assessment procedures from NIST SP 800-53A with additional DoD-specific assignment values, overlays, implementation guidance, and assessment procedures as required.

6.6.1 All systems subject to RMF must present evidence of authorization in the System Security Plan, Security Assessment Report) a Plan of Action and Milestones (POA&M) and authorization decision document or show that the system has a DoD RMF or equivalent DoD Component PIT system accreditation decision that is current within 3 years within 5 business days of CO request. Evidence of FISMA compliance must be presented in the form of a POA&M. Systems must have and maintain an Authority to Operate (ATO) or Authority to Operate with Conditions (ATO-C) by contract award.

6.6.2 The contractor shall implement security controls in accordance with NIST implementation and validation requirements specified in the NIST SP 800-37 Risk Management Framework (RMF) and DoDI 8510.01, Risk Management Framework (RMF).

6.6.3 The contractor shall configure the information system in accordance with Defense Information Agency (DISA) Security Requirements Guides (SRGs) and security technical implementation guides (STIGs).

6.6.4 The contractor shall ensure that the information system conforms to the requirements of DoDI 8551.01 “Ports, Protocols, and Services Management (PPSM)”.

6.6.5 The contractor shall ensure that the information system shall authenticate all entities as specified in DoDI 8520.03 “Identity Authentication for Information Systems” prior to granting access.

6.6.6 The contractor shall Public Key (PK) enable the information system, implementing digital signature and encryption requirements specified in DoDI 8520.02, “Public Key Infrastructure (PKI) and Public Key (PK) Enabling”.

6.6.7 The contractor will be responsible for compliance with the Joint Force Head Quarters – Department of Defense Information Network issuances and IA Vulnerability Management (IAVM) issuances by ensuring that the issuances are assessed, implemented and maintained throughout development and sustainment in accordance with specified timelines.

6.6.8 The contractor shall support reciprocity, by providing all directed information in NIST security documents to the government.

6.6.9 The contractor shall implement system level protection and detection capabilities that are consistent with their contract for NIST Security requirements that meet DoD and DHA Cybersecurity Architectures.

6.6.10 Cyber Incident Reporting Requirement: The contractor shall comply with the incident management requirements of Chairman of the Joint Chiefs of Staff Manual (CJCSM) 6510.01B, “Cyber Incident Handling Program”.

6.6.11 Information security continuous monitoring (ISCM): ISCM is defined as maintaining ongoing awareness of information security, vulnerabilities, and threats to support organizational risk…