Data Pkg 3 TRICARE Retail Pharmacy Claim Volume.xlsx

XLSX spreadsheet 14 KB Posted

Attached to
DRAFT RFP TRICARE Pharmacy Services, 5th Generation (TPharm5) Federal contract opportunity
Solicitation number
HT940220R0002
Issued by
Defense Health Agency

About this file

Written by GovTribe AI ·

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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Other files for this federal contract opportunity

Other files attached to DRAFT RFP TRICARE Pharmacy Services, 5th Generation (TPharm5), newest first.
File Type Posted
QA CAS Applicability Specific Clauses (May 15 2020).pdf PDF
Responses to Industry on Revised Draft Section C 20200504.pdf PDF
TPharm5 - Overview of Changes to Draft Section C.DOCX DOCX document
DHA Responses to Industry on Draft RFP 20200318.pdf PDF
Data Pkg 7 Specialty Drug Utilization, Retail and Mail.xlsx XLSX spreadsheet
Data Pkg 14 Retail Claims with COB.xlsx XLSX spreadsheet
Attachment J-5 TPharm5 Award Fee Plan 20191122.docx DOCX document
Data Pkg 5 MOP Utilization by Drug.xlsx XLSX spreadsheet
Data Pkg 23 - Paid Claims and Rejects - MHS GENESIS.xlsx XLSX spreadsheet
Data Pkg 22 - Paid Claims and Rejects - Retail.xlsx XLSX spreadsheet
Data Pkg 24 - CHCBP Volume.xlsx XLSX spreadsheet
Attachment L-9.6 Self-Admin Injectables List.xlsx XLSX spreadsheet
Attachment L-9.7 Expanded Use of MTF and TMOP List.xlsx XLSX spreadsheet
Attachment L-18 CDRL Supplemental Bid Schedule.xlsx XLSX spreadsheet
Attachment L-1 Ordering Instructions for Data Files not on SAM.gov.docx DOCX document
TPharm5 Draft Section L 20191202.docx DOCX document
Data Pkg 25 - OHI Development.xlsx XLSX spreadsheet
Attachment L-9.5 Non-Formulary List.xlsx XLSX spreadsheet
Data Pkg 9 Customer_Service_Volume.xlsx XLSX spreadsheet
Data Pkg 16 VA_VA CHDR Volume.xlsx XLSX spreadsheet
Data Pkg 13 - MTF Claims Volumes by Site.xlsx XLSX spreadsheet
Attachment L-3 Specialty Reimbursement for Use in Determining Incentiv....docx DOCX document
Attachment L-9 Benefit Design Document_TPharm5.xlsx XLSX spreadsheet
Attachment L-2 Retail Network Reimbursement Table.docx DOCX document
TPharm5 Draft RFP READ FIRST 20191202.docx DOCX document
Tpharm5 Draft Section G 20191202.docx DOCX document
Attachment L-8 MMC Sample File.xlsx XLSX spreadsheet
Attachment L-9.8 PA_ST_QL List.XLSX XLSX spreadsheet
Attachment L-4 Negotiated Specialty Retail Replenished Dispensing Fees.docx DOCX document
Attachment L-9.9 Fluoride Products List.xlsx XLSX spreadsheet
Attachment L-12 IHS_Pharmacy_Listing_2019.xlsx XLSX spreadsheet
Data Pkg 15 IHS_Pharmacy_Claims_Volume_2017_&_2018.xlsx XLSX spreadsheet
TPharm5 Draft Section E 20191120.docx DOCX document
TPharm5 Draft Section D 20191120.docx DOCX document
Attachment L-1.1 List of Data Packages.docx DOCX document
Attachment L-19 Past Performance Questionnaire Template Tab F 20191120.docx DOCX document
Attachment J-2 Acronym List.docx DOCX document
Attachment J-3 Website Links.docx DOCX document
Attachment L-5 Guaranty_Agreement.pdf PDF
Attachment L-7 Teaming Subcontractor Consent Ltr.docx DOCX document
Attachment L-9.3 Covered OTCs - Purchased Care.xlsx XLSX spreadsheet
Attachment L-19.1 PPI Tool Instructions.docx DOCX document
TPharm5 Draft Section C 20191202.docx DOCX document
Data Pkg 6 - MOP Utilization.xlsx XLSX spreadsheet
Attachment L-13 VA_Pharmacy_Listing_2019.xlsx XLSX spreadsheet
Attachment L-1.2 Non-Disclosure Agreement.docx DOCX document
Data Pkg 21 Enrolled Beneficiary Population.xlsx XLSX spreadsheet
TPharm5 Draft Section H 20191121.docx DOCX document
Data Pkg 10 - Compound Utilizers.xlsx XLSX spreadsheet
TPharm5 Draft Section I 20191120.docx DOCX document
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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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