Data Pkg 4 - Clinical Review Volume.xlsx

XLSX spreadsheet 12 KB Posted

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

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This document provides details regarding a draft request for proposals for the TRICARE Pharmacy Services, 5th Generation contract. The Defense Health Agency anticipates issuing a solicitation in mid-2020 for pharmacy services including retail network management, mail order, specialty pharmacy, and care coordination. The estimated period of performance is nine years consisting of an 18-month transition period, seven 1-year option periods for service delivery, and a potential 6-month extension. The agency is seeking industry feedback on requirements and technical approach described in the draft RFP sections provided, with comments requested by January 17, 2020. An information session to discuss the draft RFP was also announced.

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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
DSADHA_SSVTemplate_20170101.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
TPharm5 Draft RFP Info Session 20191211.pdf PDF
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
Data Pkg 3 TRICARE Retail Pharmacy Claim Volume.xlsx XLSX spreadsheet
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
Data Pkg 11 - Retail Utilization Detail, Guarantee Categories.xlsx XLSX spreadsheet
TPharm5 Draft Section F 20191202.docx DOCX document
Data Pkg 19 Historical_TMDS_Volume_2017-2018.xlsx XLSX spreadsheet
Attachment L-9.4 Covered OTC List - MHS GENESIS.xlsx XLSX spreadsheet
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
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PA Breakdown Clinical Review Breakdown

Jan-17Feb-17Mar-17Apr-17May-17Jun-17Jul-17Aug-17Sep-17Oct-17Nov-17Dec-17Jan-18Feb-18Mar-18Apr-18May-18Jun-18Jul-18Aug-18Sep-18Oct-18Nov-18Dec-18
Total Review Request Received59,57650,63757,99250,65056,96257,24355,12561,61057,30556,32651,55452,74255,83250,58455,17253,34856,33451,74753,25359,01552,33461,32856,32153,872
Total Clinical Reviews Received23,62925,21030,60225,00227,76627,09328,32633,47628,48028,98326,71726,05227,16025,56028,16826,30528,00425,54125,68831,08726,40931,76328,97327,251
Number Prior Authorization11,84311,91413,79911,28713,63913,34611,00613,51911,38112,69212,73912,48511,73411,24512,33811,44714,20113,09913,25516,76814,85118,00516,31515,353
Number Brand over Generic1,0429741,1039291,1241,2801,0931,2591,0211,0651,1191,2291,2111,1811,1811,0801,0119391,0881,2731,0871,3561,2021,268
Number Quantity Limit Overrides2,0792,0772,2461,9091,9961,8891,4981,8761,5701,7891,7801,6922,0522,0282,2752,2042,2011,9972,0252,3751,8521,9621,8891,813
Number Age Exceeds Max15199718131012101410106992013148459116
Number of Medical Necessity618606828621729592701868753824764673771685771764734631697803645751675604
Number of Step Therapy8,0329,62012,61710,24910,2609,97314,01815,94213,74512,59910,3059,96311,38610,41211,59410,7909,8448,8618,6159,8647,9699,6808,8818,207
Clinical PA's by Mechanism**26,66332,23426,50429,34328,55029,57434,93530,28030,96528,73728,03830,64328,55230,00428,82730,04727,28527,85533,13628,10733,67631,15528,943
Number of Electronic PA's**6,40011,3979,79511,0759,7999,80111,9089,56410,82910,31710,07311,10210,94311,85211,67712,75010,92810,79813,15911,02213,19912,61113,636
Number of Manual PA's**20,25120,80016,67418,23918,72919,74822,95720,66819,92018,04617,47918,98016,94417,59416,69416,77615,90216,33019,32516,61119,97717,70414,994
Number of MTF Approved PA's**1237352922257048216374486561665558455521455727652474500840313
Total Administrative Received35,32027,21128,73426,35628,61429,61426,19327,58828,24826,74324,21326,16128,00324,52726,49726,31327,50125,62827,06527,25425,26028,83326,62625,905
Number Automated28,55620,71421,80920,37022,50423,51420,64421,24322,62220,56718,60720,72621,07318,41519,64419,93720,78219,42520,84920,29519,12921,84220,55519,984
Number Non-Automated6,7646,4976,9255,9866,1106,1005,5496,3455,6266,1765,6065,4356,9306,1126,8536,3766,7196,2036,2166,9596,1316,9916,0715,921
Admin PA's**27,21128,73426,35628,61429,61426,19327,58828,24826,74324,21326,16128,00324,52726,49726,31327,50125,62827,06527,25425,26028,83326,62625,905
Total Appeals Received627412568584582536606546577600624529669497507729829578500674665732722716
**- Missing data not available before February 2017

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