NDC Price List - TIBS - IL-1 IL-6 CTLA-4.xlsx

BPA

Step Therapy Addendum: Grandfathering: a prior authorization process that allows current patients to remain on current therapy and requires new patients to complete an adequate trial of the step-preferred (before-step) agent(s) before a non-step-preferred (after-step) agent is provided to the patient at any MTF, Retail, or Mail point of service. The P&T Committee may consider approving specialist(s) bypass and/or an automated drug look-back (up to 720 days) for the step-preferred (before-step) agent.

Biosimilar Step Therapy Addendum: No Grandfathering may apply. Biosimilars are therapeutically equivalent to the reference product.

All Scenarios:

• For drugs in this subclass, the P&T Committee will maintain the TIBS class step preference (i.e., adalimumab) for the indications which it has FDA’s approval.

• Agents with RFQ not submitted or selected may be designated non-step preferred (after-step).

Notes to Manufacturers: Do not forget to submit fully executed signature pages along with quote information.

The price per unit of measure for a given dosage form and strength (each, gram, mL, etc.) of the pharmaceutical agent will be the same for all available package sizes (e.g., 30s, 100s, 1000s) within a given dispensing venue.

Blanket Purchase Agreement Appendix – Class Review

Blanket Purchase Agreement Appendix – Class Review

Blanket Purchase Agreement Appendix – Class Review

Blanket Purchase Agreement Appendix – Class Review

Blanket Purchase Agreement Appendix – Class Review

Blanket Purchase Agreement Appendix – Class Review

Blanket Purchase Agreement Appendix – Class Review

Blanket Purchase Agreement Appendix – Class Review

Blanket Purchase Agreement Appendix – Class Review

Blanket Purchase Agreement Appendix – Class Review

ADP (non-FAMP Discount)

Step Therapy Addendum: Grandfathering: a prior authorization process that allows current patients to remain on current therapy and requires new patients to complete an adequate trial of the step-preferred (before-step) agent(s) before a non-step-preferred (after-step) agent is provided to the patient at any MTF, Retail, or Mail point of service. The P&T Committee may consider approving specialist(s) bypass and/or an automated drug look-back (up to 720 days) for the step-preferred (before-step) agent.

Biosimilar Step Therapy Addendum: No Grandfathering may apply. Biosimilars are therapeutically equivalent to the reference product.

All Scenarios:

• For drugs in this subclass, the P&T Committee will maintain the TIBS class step preference (i.e., adalimumab) for the indications which it has FDA’s approval.

• Agents with RFQ not submitted or selected may be designated non-step preferred (after-step).

Notes to Manufacturers: Do not forget to submit fully executed signature pages along with quote information.

* Total Calculated Refund Per FCP is calculated as: ((non-FAMP-FCP)+(non-FAMP*Y%)) = Total Calculated Refund **Based on the most recent annual non-FAMP (reported to the Department of Veterans Affairs) from which the current annual Federal Ceiling Price (FCP) calculated ceiling is derived. The current annual FCP and the annual non-FAMP from which it is derived will be applicable to all prescriptions filled during a calendar year. The quoted additional refund percentage will remain static during the life of the agreement but the most recent annual non-FAMP, and thus the calculated refund, may change each calendar year.

Additional Discount Program Appendix – Class Review

Additional Discount Program Appendix – Class Review

Additional Discount Program Appendix – Class Review

Additional Discount Program Appendix – Class Review

Additional Discount Program Appendix – Class Review

Additional Discount Program Appendix – Class Review

Additional Discount Program Appendix – Class Review

Additional Discount Program Appendix – Class Review

Additional Discount Program Appendix – Class Review

Additional Discount Program Appendix – Class Review