Responses to Industry on Revised Draft Section C 20200504.pdf
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- Attached to
- DRAFT RFP TRICARE Pharmacy Services, 5th Generation (TPharm5) Federal contract opportunity
- Solicitation number
- HT940220R0002
- Issued by
- Defense Health Agency
About this file
This document provides responses to industry questions on a revised draft Section C for the TRICARE Pharmacy Program, 5th Generation Request for Proposal. The Defense Health Agency plans to release the Specialty Drug List and draft list of replenishable specialty drugs within the next month. Replenishment from the National Prime Vendor is permitted only for drugs on the Specialty Drug List dispensed through the TRICARE Mail Order Pharmacy or specialty retail pharmacies. The guaranteed average dispensing fee for non-replenishable drugs will include supplies and services, while replenished drugs will be covered under a separate CLIN. Non-specialty drugs dispensed at specialty pharmacies will follow the cost guarantees of the appropriate network. Network adequacy will be evaluated based on drive time standards using commercially available tools.
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Text version
TRICARE Pharmacy Program, 5th Generation Draft Request for Proposal (RFP)
HT9402-20-R-0002
Responses to Industry on Revised Draft Section C 4 May 2020
Availability of Information to Offerors
1) When will the following items be available?
DoD Specialty Drug List: DHA plans to release the Specialty Drug list within the next month.
The list will indicate which medications are expected to be replenishable by the National Prime Vendor. This list will be posted to beta.SAM.gov.
Draft list of Specialty drugs that are expected to be replenishable: See above.
Updated Sections of B, G, H, L and M: DHA does not plan to release additional drafts of these documents before the full RFP is released. Offerors will have the opportunity to request additional clarification through the Q&A process.
CDRLs: With the final RFP
Specialty Pharmacy
2) Can you confirm that replenishment from the NPV is only permitted 1) at specialty retail pharmacies for replenishable drugs on the DoD specialty drug list; and 2) for those drugs dispensed from TMOP?
Answer: Yes, this is correct.
3) Is there a maximum number of specialty locations the Government will be willing to replenish?
Answer: This is still being determined but we anticipate there will be a limit included in the final
RFP.
4) How will the Government ensure an equitable distribution of specialty prescriptions that cannot be replenished through NPV among the in-network specialty pharmacies that have access to the specialty drug? What will prevent the contractor from self-referring for non-replenishable specialty drugs?
Answer: The Government's primary concern is ensuring that all beneficiaries have access to specialty medications, including limited distribution, within the specialty network. Within the specialty network, the choice of pharmacy will be left to the beneficiary.
5) How can a manufacturer-supported medication assistance program be used for a Government paid prescription?
Answer: The Government's intent is to address non-financial assistance programs. Absent any restrictions on the part of the manufacturer or TRICARE Program, beneficiaries may utilize manufacturer driven medication care support programs (e.g. Teva Copaxone injection training).
6) Are supplies (for specialty medications) included as part of the dispensing fee or billed separately?
Does CLIN X014 cover these items?
Answer: For non-replenishable drugs, the offeror will bid a Guaranteed Average Dispensing Fee (Sec H Cost Control Incentive), which shall include the cost of supplies and specialty services. For replenished drugs, the offeror shall consider specialty supplies and services under CLIN X014 (Pharmacy Services, Admin Support).
7) Would the Government install an NPV terminal at other non-TMOP sites or PBM owned specialty pharmacies such as other in network Specialty pharmacies?
Answer: It is not the Government's intent to limit specialty replenishment to TMOP or a single specialty pharmacy. Replenishing pharmacies will follow the ordering requirements in Section C.
8) Would the Government require the PBM to put any willing provider with NPV access into the network?
Answer: The requirements allow the offeror to establish a specialty network that can maximize replenishment and provide access to all specialty drugs.
9) If a specialty provider was willing to do the NPV with the right price, would the Government require the PBM to place them in network?
Answer: The requirements allow the offeror to establish a specialty network that can maximize replenishment and provide access to all specialty drugs.
10) What will be the Government's process for validation of the drugs requested for replenishment under the NPV or off the FSS?
Answer: The Government will utilize reporting described in the Contract and CDRLs, which may be expanded in a future version of the RFP.
11) What will be the Government audit process for the NPV and replenishment of drugs on the FSS?
Answer: The Government will perform audits at its discretion.
12) What reimbursement rate will non-specialty drugs dispensed from a specialty pharmacy be billed to the Government? Retail or specialty reimbursement rate?
Answer: Non-Replenished Specialty drugs will be held to the cost control guarantees for Specialty Network. Non-specialty drugs dispensed in the retail network (to include the specialty network) will be held to the cost control guarantees for the Retail Network.
13) Please clarify NDC reconciliation. Does it NDC-11 only apply to MPPP or also to the NPV?
Answer: It applies to both. NDC-11 level data is required where specified in the CDRLs (to be posted with the final RFP).
TMOP
14) Will contractor be required to log the pharmacy where patients fill prescriptions for products unavailable at TMOP?
Answer: There is no specific requirement to log this information, as the Government has access pharmacy claims adjudication data that identifies where a prescription is filled.
15) When TMOP can’t fill a prescription and it must be transferred, how will DHA ensure the contractor uses a fair and equitable process to help beneficiaries select a pharmacy?
Answer: The Government's primary concern is ensuring that all beneficiaries have access to medications within the network. Within the network, the choice of pharmacy will be left to the beneficiary.
Retail Network Access
16) How will DHA evaluate network adequacy based on a time standard?
Answer: The contractor will be responsible for demonstrating the meeting of the time metric via C.3.3.4. The contractor shall use commercially available software or web tools to calculate this metric and the methodology shall be made available to the Government for audit upon request. The Contractor should evaluate drive time based on when a reasonably prudent person would make the trip. The Government will provide beneficiary address or geocode data to allow offerors to evaluate possible networks.
Other
17) If the Government releases the final RFP while organizations are still following widespread social distancing practices related to the COVID-19 response, will the Government consider allowing electronic submission, including the use of electronic signatures, in lieu of paper copies?
Answer: DHA will monitor the situation and adjust submission requirements as appropriate.
Any additional questions may be directed to our team at:
dha.buckley.acquisprocure.mbx.tpharm5@mail.mil
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