Price List Atopy - Atopy-IL-13 IL-31.xlsx

BPA

Class Note(s): Prior Authorization (PA) may apply. Agents may be identified as possible candidates for special reimbursement methods, amounts, and procedures to encourage use of high-value products and discourage use of low-value products. The DoD P&T Committee may recommend consideration of preferential status to any non-generic pharmaceutical agent by treating it for purposes of cost sharing as a generic product (Tier 1). Similarly, the DoD P&T Committee may identify candidates to recommend for complete exclusion from the TRICARE pharmacy benefit program.

Step Therapy Addendum: Grandfathering: a PA process requires new patients to complete an adequate trial of the step-preferred agent(s) before a non-step-preferred agent is provided to the patient at any MTF, Retail, or Mail point of service. There will be no grandfathering between biosimilar products.

All Scenarios:

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

• Specialist bypass and/or drug auto-lookback may be considered for the step-preferred agent.

• The P&T Committee may consider a step preference for the Atopic Dermatitis indication, and all other indications would not have a 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)

Class Note(s): Prior Authorization (PA) may apply. Agents may be identified as possible candidates for special reimbursement methods, amounts, and procedures to encourage use of high-value products and discourage use of low-value products. The DoD P&T Committee may recommend consideration of preferential status to any non-generic pharmaceutical agent by treating it for purposes of cost sharing as a generic product (Tier 1). Similarly, the DoD P&T Committee may identify candidates to recommend for complete exclusion from the TRICARE pharmacy benefit program.

Step Therapy Addendum: Grandfathering: a PA process requires new patients to complete an adequate trial of the step-preferred agent(s) before a non-step-preferred agent is provided to the patient at any MTF, Retail, or Mail point of service. There will be no grandfathering between biosimilar products.

All Scenarios:

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

• Specialist bypass and/or drug auto-lookback may be considered for the step-preferred agent.

• The P&T Committee may consider a step preference for the Atopic Dermatitis indication, and all other indications would not have a 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