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Required Mailings
| Type of Letter |
| Contract Reference |
| Frequency |
| Language |
| Pricing |
| Network Change Notifications |
| 6.3.1 |
| Ad Hoc |
| When a pharmacy is removed from the contractor’s retail pharmacy network, the contractor shall notify beneficiaries who have filled prescriptions at the impacted pharmacies. |
| Included in Admin Price |
| Explanation of Benefits (EOBs) |
| 10.1 |
| Quarterly |
| The contractor shall provide an Explanation of Benefits (EOB) to the beneficiary detailing the beneficiary’s retail, mail order, specialty and MTF prescription activity. The contractor shall provide EOBs primarily by electronic means, but will also offer delivery by mail at the beneficiary’s request. |
| Mailing CLIN (non-electronic EOBs only) |
| Newly-eligible Mailing |
| 10.4 |
| Quarterly |
| On a quarterly basis, the contractor shall mail TPharm educational materials to newly-eligible and newly retired beneficiaries, as identified by the government, on a quarterly basis. |
| Included in Admin Price |
| P&T Mailings |
| 10.4 |
| Quarterly |
| On a quarterly basis, the contractor shall mail notices to beneficiaries who within the past year have received prescriptions for pharmaceutical agents that are (a) newly |
designated as non-formulary; or (b) which have been determined to be Non-FCP compliant by the Director, TRICARE Management Activity.
Mailing CLIN
| Benefit Change Mailingstions (Not contract requirement, currently provided by ESI)ptions for pharmaceutical agents that are bein |
| 10.4 |
| Ad hoc |
| At the direction of the Contracting Officer, the contractor shall mail notices to beneficiaries identified by the Government regarding changes to the prescription drug benefit or other prescription drug information. |
Mailing CLIN
| Clinical Update/Warning Mailings |
| 10.4 |
| Ad hoc |
| The contractor shall monitor clinical issues and send letters to beneficiaries who have filled impacted medications at retail or mail, notifying them of these issues. |
| Included in Admin Price |
| Notification that retail pharmacy is not in network under new contract |
| 17.2 |
| One-Time/ |
Transition
| The contractor will identify beneficiaries who, during the six months prior to the letter mailing date, used pharmacies that are not in the contractor’s pharmacy network. The contractor will inform these beneficiaries by letter that the pharmacy they previously used is not in the retail pharmacy network, and provide information that enables the beneficiary to identify network pharmacies. This letter will be mailed so that beneficiaries will receive it 30 to 40 days prior to the start-up of retail pharmacy services. |
| Implementation Mailing CLIN |
| Start-Up Packet |
| 17.2 |
| One-Time/ Transition |
| The contractor shall assemble and mail an information packet to announce the start-up of the new Mail Order Pharmacy (including specialty pharmacy services) program. The information packet shall be sent to households of eligible covered TRICARE beneficiaries who have filled prescriptions in the TRICARE Mail Order Pharmacy, a TRICARE retail network pharmacy, or a non-network pharmacy within the six month period prior to the date the information packet is mailed. |
| Included in Implementation CLIN |
Defense Health Agency