TPharm5 - Overview of Changes to Draft Section C.DOCX

Summary of Statement of Work (Section C) Changes from Draft 1 to Draft 2 Note: List may not be comprehensive and focuses on added or materially different requirements. Generally does not include numbering changes, administrative changes, and movement of requirements between sections.

C.1. Program Description

Removed SOO Statement

C.1.4.2 – Updated Approach to Maintaining Manual Versions

C.2, General Claims Processing

C.2.5 – New requirement about contractor-administered OHI

C.2.8.6.4 – Added new requirements for emergency operating procedures

C.3. Retail Prescriptions

Removed Specialty SOO language

C.3.3.2 – Updated approach to calculating retail network access

C.4. Specialty Pharmaceuticals

Created new section for Specialty

New performance-based requirements to replace SOO

C.5. MTF Pharmacy Claims

C.5.3.3, C.5.3.5, C.5.3.7 - Added metric for resolution of MTF Data Integrity Issues

C.5.4.3.1 – New requirement to support COB for MHS GENESIS

C.5.4.10.1 – New requirement for coordination of MHS GENESIS drug file

C.6. Mail Order Pharmacy

C.6.1.8 – Moved OHI at MOP Language from OHI section

C.6.1.18.1 – New requirement for notification of backorder items

C.6.8.10 – New requirement to work collaboratively with NPV

C.6.8.20.1 – Added potential minimum order thresholds for MPPP

C.6.8.20.4 – Added requirement to advise DLA of MPPP offers

C.7. Formulary and Benefit Design

C.7.2.2 - New requirement for monitoring and strategies for new drugs as they come to market

C.7.3.1 – New requirement for implementation of benefit design changes

C.7.7 – Replaced SOO for Compounded Medications with performance-based requirements

C.7.8- Replaced SOOs for Coordination of Care with performance-based requirements for Safety and Enhanced Care Services

Removed SOO for patient safety notifications

C.9. Customer Service

C.9.15 – Revision and reorganization of EOB requirements, with some additions

C.9.1.5.7 – Added clarification of ASA metric to table

C.9.4.4.3. – New language encouraging support for CAC logins

C.9.4.9.5 – New requirement for reporting of FST issues and outages

C.10. Claims Reviews and Audits

C.10.2.1 – new requirement for refinement of claims review parameters

C.11. System Interfaces

C.11.2 – New language encouraging the use of DS Logon and CACs

C.11.3.1 – New requirement to maintain ICDs in a non-proprietary form

C.11.17 – Updated title from “Data Sharing” to “Interfaces with TRICARE Medical Contractors” and added a number of new requirements

C.14. Management

C.14.1 – Replace SOO for Quality Control with performance based requirements for Quality Management

Removed contractor manpower reporting (ECMRA) requirements

C.14.9 – New requirement to maintain SOPs accessible by the Government

C.15. Contract Transition

C.15.1.7 – Added language to clarify that B2B questionnaires must be approved before connecting to any Government system

C.15.1.8- New cross reference for B2B and VPN Device support during transition period

C.15.1.12 – New requirement for formulary management support during transition

C.15.1.13 – New requirement to review proposed OHI process with Government during transition

C.15.1.15 – New requirement to support MHS GENESIS deployment activities during transition

C.15.1.15 – Removed Privacy Impact Assessment from Transition-In Milestone Table