Data Pkg 3 TRICARE Retail Pharmacy Claim Volume.xlsx

XLSX spreadsheet 14 KB Posted

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DRAFT RFP TRICARE Pharmacy Services, 5th Generation (TPharm5)
Solicitation number
HT940220R0002
Issued by

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This document contains a draft request for proposals for the TRICARE Pharmacy Services, 5th Generation contract along with related utilization data. The draft RFP seeks proposals for pharmacy benefit management services to support the TRICARE pharmacy program for an estimated 9-year period of performance including an 18-month transition period, seven 1-year option periods, and a potential 6-month extension. Services will cover retail pharmacy claims processing, mail order fulfillment, specialty pharmacy, and care coordination. The Defense Health Agency requests industry feedback on sections of the draft RFP pertaining to statements of objectives, specialty pharmacy services, retail network access, compounded medications, care coordination, and quality control by January 17, 2020. A formal RFP may be issued in mid-2020 with awards determined according to Federal Acquisition Regulation part 15. The Defense Health Agency will host an information session on December 11, 2019 to discuss the draft RFP.

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2017 Data

FOR OFFICIAL USE ONLY
Title: Retail Claims Electronic and Paper
Date Range: 1/1/2017 - 12/31/2017
Jan-17Feb-17Mar-17Apr-17May-17Jun-17Jul-17Aug-17Sep-17Oct-17Nov-17Dec-17
Claim TypeOHI Claim Type# RX# RX# RX# RX# RX# RX# RX# RX# RX# RX# RX# RX
Paper Claims
DMR Network ClaimsNon-OHI Claims - Paper*14,59711,2329,5296,7176,6946,4527,6326,5716,7097,3605,7506,809
DMR Network ClaimsOHI Medicare Claims - Paper1,7313,4681,8631,8332,0951,5121,6562,2821,4982,0271,7601,521
DMR Non-Network ClaimsNon-OHI Claims - Paper*12,09610,3199,7967,6387,5457,8817,2338,3766,8387,8217,7207,567
DMR Non-Network ClaimsOHI Medicare Claims - Paper3,0324,4972,8192,4462,7222,3982,1723,6302,0312,7712,8462,429
Total31,45629,51624,00718,63419,05618,24318,69320,85917,07619,97918,07618,326
Electronic Claims
Pharmacy Network Claims - ElectronicNon-OHI Claims - Electronic3,168,3052,962,4283,227,7592,869,9343,054,3902,900,1892,745,2612,981,1052,954,7633,227,7303,059,4433,087,546
Pharmacy Network Claims - ElectronicNon-OHI Medicaid Claims - Electronic1,2375,4945,5452,1782,3244,0741,6562,1201,8681,5741,7142,280
Pharmacy Network Claims - ElectronicOHI Commercial claim - Electronic533,938509,898558,497510,889540,319514,834493,022511,514472,930492,793464,639466,185
Pharmacy Network Claims - ElectronicOHI Medicare Claims - Electronic114,609110,295128,343118,493127,320122,487118,342123,010114,737120,595114,741113,639
Total3,818,0893,588,1153,920,1443,501,4943,724,3533,541,5843,358,2813,617,7493,544,2983,842,6923,640,5373,669,650
Grand Total3,849,5453,617,6313,944,1513,520,1283,743,4093,559,8273,376,9743,638,6083,561,3743,862,6713,658,6133,687,976
* Due to limitations in the data, paper claims with commercial OHI are included under Non-OHI claims.

2018 Data

FOR OFFICIAL USE ONLY
Title: Retail Claims Electronic and Paper
Date Range: 1/1/2018 - 12/31/2018
Jan-18Feb-18Mar-18Apr-18May-18Jun-18Jul-18Aug-18Sep-18Oct-18Nov-18Dec-18
Claim TypeOHI Claim Type# RX# RX# RX# RX# RX# RX# RX# RX# RX# RX# RX# RX
Paper Claims
DMR Network ClaimsNon-OHI Claims - Paper12,9538,1776,0294,5064,5775,1925,6555,0524,1614,9675,1354,831
DMR Network ClaimsOHI Medicare Claims - Paper2,1342,5401,9381,0981,2971,2741,6731,8531,6281,0801,3111,329
DMR Non-Network ClaimsNon-OHI Claims - Paper11,1759,9937,6276,8076,4945,9386,4027,0235,4576,1716,1295,730
DMR Non-Network ClaimsOHI Medicare Claims - Paper2,7833,8743,0372,1612,6372,2222,3723,2972,5442,1232,6032,502
Total29,04524,58418,63114,57215,00514,62616,10217,22513,79014,34115,17814,392
Electronic Claims
Pharmacy Network Claims - ElectronicNon-OHI Claims - Electronic3,374,0472,928,4063,043,6432,905,8173,003,4472,770,4972,836,1373,017,2832,945,0613,484,3913,159,6933,064,487
Pharmacy Network Claims - ElectronicNon-OHI Medicaid Claims - Electronic487327112,1332,4362,1162,1818711,4244,92912,488352
Pharmacy Network Claims - ElectronicOHI Commercial claim - Electronic545,421485,782518,536495,380502,335458,856471,224476,307429,416465,343433,638428,697
Pharmacy Network Claims - ElectronicOHI Medicare Claims - Electronic127,761114,338123,028119,856121,967112,497115,811116,490105,980115,976109,107106,923
Total4,047,7163,528,5583,685,2783,533,1863,630,1853,343,9663,425,3533,610,9513,481,8814,070,6393,714,9263,600,459
Grand Total4,076,7613,553,1423,703,9093,547,7583,645,1903,358,5923,441,4553,628,1763,495,6714,084,9803,730,1043,614,851

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