TPharm5 Draft RFP Info Session 20191211.pdf

TRICARE Pharmacy Program (TPharm5) Draft RFP Info Session

“Medically Ready Force…Ready Medical Force”

December 11, 2019 Hosted by Hilary Meckel, Contracting Officer

Agenda

• Introduction

• Disclaimer

• Key Highlights and Areas of Focus

• Current Acquisition Schedule

• Access to Information

• Follow‐Up

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Introduction

∎Defense Health Agency (DHA) provides health benefits for 9.5M beneficiaries – military members, retirees, and their dependents

∎Access to the outpatient pharmacy benefit falls under one contract, which supports delivery of the benefit through the retail network, home delivery, and through military pharmacies

∎ Currently requesting feedback on the Draft RFP for follow‐on TRICARE Pharmacy Services Contract

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Disclaimer

∎DHA is not issuing a solicitation at this time, and this notice shall not be construed as DHA's commitment to issue a solicitation nor does it restrict DHA to a particular acquisition approach.

∎ Interested parties are warned the draft RFP may in no way resemble a final RFP and therefore should take great care in reading through final RFP documents.

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Highlights and Areas of Focus

∎ Use of Statements of Objectives ∎ Specialty Cost Control Approach Replenishment to Specialty Retail Pharmacies Specialty Guarantee Incentive

∎Market Price Pharmaceutical Program ∎ Formulary Management Support ∎ Per Member Per Month Admin Fee ∎ Award Fee ∎ Performance‐based Transition‐In Payments ∎ Use of EZ Source Procurement Tool

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Use of Statements of Objectives (SOOs)

∎ Used in specific areas to allow industry to propose solutions to meet the Government’s needs:

Quality Control Specialty Retail Network Access Compounded Medications Care Coordination Patient Safety Notifications

∎ Looking for feedback on final requirements, especially on innovative approaches, best practices, reporting, and standards to measure performance, etc.

∎ The Government will review draft RFP responses to determine if these elements will remain a SOO or will be restated as performance‐based requirements in the final RFP

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Replenishment to Specialty Retail Pharmacies

∎ Replenishable specialty medications shall be dispensed by an accredited Specialty Retail Network pharmacy Pharmacy will accept replenishment from Government’s NPV in lieu of billing for ingredient cost

Pharmacies will be paid a flat rate dispensing fee (as proposed in Section L, Attachment L‐4)

TPharm5 Contractor will receive a per claim admin fee

(CLIN X003, X004)

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Specialty Guarantee Incentive

∎Will apply to specialty medications dispensed in the retail specialty network that are not replenishable

∎ The Contractor will bid their guaranteed dispensing fees and discounts off of WAC (preferred) or AWP (when no WAC is available)

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Specialty Clinical Services Provided

Procurement Approach

Overall Approach to Specialty Cost Control

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EMM Drug list (Specialty subset)

DLA

Replenishable List

‐PBM: Specialty Admin Fee (CLIN X003/X004)

‐Pharmacy: Flat dispensing fee (L‐4)

TM

O P ‐NPV Replenishment to Contractor‐ designated locations

‐Some commercial sourcing through Market Price Pharmaceutical Program (MPPP)

PBM: Mail Order Admin Fee (CLIN X006/X007), no separate dispensing fee

Re ta il Sp ec ia lty

N et w or k

Excluded from

DLA

Replenishable List

Commercial sources;

Covered by Specialty Guarantee Incentive

‐PBM: Specialty Admin Fee (CLIN X003/X004)

‐Pharmacy: Dispensing Fee and Ingredient Cost

Included Drugs Payment Mechanism

None; Standard TMOP support only

Commercial standard clinical support programs

Market Price Pharmaceutical Program

(MPPP)

∎ Allows Contractor to make purchase offers to the Government in two situations:

To provide inventory for medications that are currently not available through the NPV When a purchase from a commercial vendor can offer significant savings over the NPV price

∎ Applies to brand or generic medications, including specialty ∎ Offer must be accepted by the Government ∎ Contractor will be paid an administrative fee for accepted offers ∎ May also qualify for an incentive payment when cost savings is demonstrated

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Formulary Management Support

∎ Contractor will provide support to DoD Pharmacy & Therapeutics (P&T) through drug class reviews and benefit design analysis

∎ Based on DoD Uniform Formulary drug classes

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Per Member Per Month (PMPM) Admin Fee

∎ Per‐claim admin fees are designed to cover the costs directly related to dispensing/processing a prescription or processing a clinical review

∎ PMPM fees are intended to cover everything else;

general contract administration, security and information assurance, quality control, customer service operations

∎ PMPM also includes support for CHDR and TMDS claims; do not receive a per‐claim admin fee

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Award Fee

∎Offered twice each year (first and second half of the Option Period)

∎Will feature rotating criteria; in advance of each Option Period updated criteria will be provided, highlighting the Government’s key areas of emphasis (Attachment J‐5)

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Performance‐Based Transition‐In Payments

∎ Portions of the transition‐in cost (CLIN 0001) will be allocated to performance‐based payments, based on achieving specific milestones

∎ Performance‐based transition‐in payments may be invoiced by the Contractor after each milestone’s criteria has been met

∎ 80% of transition‐in price will be allocated equally for each milestone

∎ The remaining 20% will be payable upon successful go‐ live and validation that all contract requirements are being met

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EZ Source – Source Selection Tool

∎ The Government will use EZ Source in this procurement EZ Source is an Government owned, contractor supported, web‐based electronic source selection tool that facilitates the creation, organization, and communication of competitive source selection documentation used in the source selection evaluation process.

EZ Source organizes workflow and source selection documentation processes

EZ Source is NOT a decision making tool

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EZ Source – Submission Process

∎ Past Performance Offerors will complete and submit the Past Performance Information (PPI) Tool

Access Database See L.6.8 and Attachment L‐19.1 for more information on the PPI tool Note: PPI tool database was NOT posted due to file limitations; available by request

Past performance questionnaires shall be submitted separately and are NOT submitted within the PPI tool database.

Offerors will send completed and signed PPQs See L.6.6 and Section L Attachment L‐19 for more information

∎ Technical & Cost The Government will import the offerors’ submitted technical & cost proposal information, as needed, into EZ Source Data will be imported from the electronic (CD/DVD) submitted

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Additional Items

∎ TRICARE Manuals – Updates to T2017 manuals in support of TPharm5 are pending; current language may not align to draft requirements

∎ In our commitment to a transparent and competitive process, we have posted a larger number of data files. Is there additional data the Government should consider providing?

Reminder: Deadline for responses to the Draft RFP is 17 January 2020.

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Additional Items

∎ In our commitment to a transparent and competitive process, we have posted a larger number of data files. Is there additional data the Government should consider providing?

∎Non‐Disclosures/DSAs will apply to any final RFP;

therefore we encourage interested vendors to complete the process now.

Reminder: Deadline for responses to the Draft RFP is 17 January 2020.

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Current Acquisition Schedule

∎ Release Final RFP – Mid 2020 ∎Award Contact – Mid 2021 ∎ Begin Transition – July 2021 ∎Go‐Live – January 2023

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Access to Information

Slides presented today will be posted at www.BETA.SAM.gov under solicitation

HT9402‐20‐R‐0002

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Follow‐Up

If you have any further questions, comments, concerns, suggestions, or additional information, please provide by email.

Email:

DHA.Buckley.AFB.Acquis‐Procure.Mailbox.TPharm5@mail.mil

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