TPharm6 RFI.docx

The Defense Health Agency (DHA) is in the acquisition planning phase for the next generation TRICARE Pharmacy Program (TPharm) contract. This Request For Information (RFI) is the method for initiating market research efforts as the Government begins to build requirements and documentation related to this program.

Disclaimer:

This announcement does not constitute a commitment, implied or otherwise that a solicitation or contract will be issued. Issuance of the RFI is for planning purposes only and does not commit the Government to any contractual agreements or arrangements. The Government is not soliciting proposals with this request.

Please note that the collection of the requested information does not obligate the Government to incorporate solicited comments or procure any services. Responses to this announcement will not be returned. The Government is not liable to pay any costs associated with companies responding to this announcement.

Issuance of the RFI is intended to provide interested parties with information on the anticipated procurement and provide an opportunity for industry feedback into the preliminary programmatic design. All information received resulting from this RFI will be used by the DHA as market research. However, responses may be releasable to the public under the Freedom of Information Act (FOIA) unless appropriately marked.

The DHA, at its discretion, may request respondents to elaborate on information in their written response in writing or through other means. Respondents will not be notified of any results derived from a review of the information provided.

Any responses from the Government are subject to change, as the requirements themselves remain in draft form. Interested parties will have opportunity to seek clarification from the Government for any remaining questions, particularly those pertaining to evaluation criteria, incentives, or contract requirements, at the final RFP stage.

Schedule:

Interested parties should use the draft schedule below for planning purposes.

TRICARE Pharmacy Overview:

The Department of War’s (DoW) Military Health System supports the National Defense Strategy by providing a medically ready force, a ready medical force and a medical benefit in keeping with the service and sacrifice of more than 9.6 million active-duty personnel, retirees, and their dependents, including TRICARE for Life beneficiaries. TRICARE is designed to provide integrated, high quality care offered through military medical treatment facilities (MTFs) and through networks of civilian providers operated by civilian managed care support contractors in the United States and abroad. The TRICARE Pharmacy Benefits Program is a component thereof and is authorized and implemented under 10 U.S.C. § 1074g and 32 C.F.R. § 199.21, respectively.

TRICARE provides a world-class pharmacy benefit to all eligible beneficiaries through the integration of state-of-the-art technologies to enhance patient safety, efficiency, and cost-effectiveness. DoW administers an integrated TRICARE Pharmacy Benefits Program offering pharmacy services through MTFs, retail network pharmacies, retail non-network pharmacies, or delivery through the TRICARE Mail Order Pharmacy (TMOP). TMOP and retail network pharmacy services are currently available in all 50 states and the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. TRICARE augments the direct care system through a civilian network of providers and facilities serving its eligible members.

Features of the TRICARE Pharmacy Benefits Program include the DoW Uniform Formulary (UF), a tiered cost sharing structure, and a preference for generic over branded pharmaceutical agents. The DoW UF is developed by the DoW Pharmacy and Therapeutics Committee, which establishes the basic program benefits. Prescriptions for selected pharmaceutical agents may be subject to prior authorization or utilization review requirements to assure medical necessity, clinical appropriateness, and cost-effectiveness. DoW has statutorily established tiered cost-sharing by which beneficiaries partially defray costs of administering the TRICARE Pharmacy Benefits Program. Cost-sharing amounts differ based on the classification of a pharmaceutical agent as generic, formulary, or non-formulary, in conjunction with the Point of Service from which the pharmaceutical agent is dispensed

Pharmacy benefits administrative functions under this contract include the following: performing claims adjudication, administering a retail pharmacy network, operating TMOP, processing reimbursements for claims filled at retail network and non-network pharmacies, performing clinical reviews, and providing beneficiary and pharmacy support services. The Contractor shall transmit all claim information to the Government’s designated Pharmacy Data Warehouse.

Request for Information instructions:

Step 1: Complete the following capability survey at the link here. The Government is conducting market research to understand industry capabilities.

https://forms.osi.apps.mil/r/9Nbizd9RYg

Step 2: Prepare and submit a written response addressing each of the topics below in addition to the survey. This response must not exceed 10 pages in total length and should not be solely your company’s general capability statement but instead specifically address the Government’s topics listed in this RFI. The Government is conducting market research to gain an understanding of evolving industry trends.

1. Pharmacy Benefit Administration Services. Please provide details regarding your ability to provide each of the following:

· Commercial standard contract types

· Customer service metrics

· Claims processing and adjudication metrics

· Optimizations to cost and beneficiary access

· Use of telehealth in the delivery of pharmacy benefits

· Reducing complaints and promoting beneficiary satisfaction

· Formulary and benefit design

· Clinical reviews

· Use of social media and Artificial Intelligence (AI) to enhance beneficiary communication

2. Mail Order Pharmacy Fulfillment Services. Please provide details regarding your ability to provide each of the following:

· Scalable processes for approximately 1.9 million prescriptions a month

· Provide timely and accurate delivery of prescriptions to beneficiaries

· Address replenishment challenges, including tracking and reconciliation

· Capabilities and metrics related to dispensing low-cost pharmaceuticals and realizing cost-savings

3. Enhanced Care (Specialty) Program. Please provide details regarding your ability to provide each of the following through mail order and retail Points of Service (POS):

· Specialty pharmacy services offered (please highlight novel services and the impact on patient health outcomes which make you unique from other specialty pharmacies).

· Innovative management of utilization of specialty pharmaceuticals to meet evolving patient needs while enhancing cost-effectiveness.

· Performance metrics around receipt, processing, and distribution of orders.

· Successes in education, and compliance to maximize beneficiary outcomes and satisfaction, minimize waste, etc.

· Care coordination successes to mitigate adverse drug events, appropriate use and compliance, minimizing plan costs, etc.

· TRICARE has defined its own Specialty Drug List. How do you overcome challenges with obtaining access to limited distribution medications or medications that are on the TRICARE Specialty Drug list where the manufacturer does not initially want to provide access to your pharmacy?

4. Management Control. What management controls and oversight have you implemented to enable quality control and quality assurance that ensures integrity of the pharmacy benefit programs?

5. Procurement Method. Based on your experience and what you understand about the TRICARE Pharmacy Benefit Program, what contract structure might you recommend or prefer and why? The Government presents a few options below. Please discuss potential advantages and disadvantages from your perspective, and propose other options not listed here that would enable your participation or that might incentivize your company to respond to a proposal request from the Government:

Procurement Model & Description

Multi-Award (Region-Based): Award contract to multiple vendors, each responsible for a specific TRICARE network region (e.g. TRICARE East, TRICARE West) or another type of regional split.

Multi-Award (Task-Based): Award contract to multiple vendors, highly skilled for each task area (e.g. claims review, specialty medication management, etc.).

Issue a Statement of Objectives (SOO) Multi or Single Award: Determine specific tasks or activities that could be explored more openly through a SOO. Implement a hybrid solicitation model with some task areas through a SOO and others through a more stringent PWS.

6. Operational Barriers. What regulatory or operational barriers (i.e. U.S. Trade Agreements Act of 1979 (TAA) compliance, Defense Logistics Agency (DLA) replenishment, federal reporting requirements) prevent and/or discourage vendors from participating in federal pharmacy contracts, and how can the Government reduce/mitigate these barriers to encourage industry response? Be specific. Will this structure preclude you from participating in the competition? Please provide the breadth of impact and what this might mean for your company and the team members working on the contract.

This completes the RFI. The Government anticipates publishing future RFIs and draft documents during acquisition design and acquisition development phases. The Government appreciates the time and expense related to tracking this program.

Important Note. Please review the background statement below to best understand DHA’s relationship with other Government Agencies as well as the replenishment model – responses not compatible will be received by the Government but may not be actionable regarding future program design.

The Department of Defense Directives designate the Director, DLA as the DoW Executive Agent (DoW EA) for medical materiel and establishes the relationship of the DoW EA for Medical Materiel to the other DoW Components.

As the DoW EA, DLA establishes National Prime Vendor (NPV) contracts to procure pharmaceutical agents to be dispensed at the MTFs and TMOP. DLA currently provides pharmaceutical agents through its National Prime Vendor (NPV), Cencora.

TPharm is a replenishable contract, whereas the contractor establishes a base layer of pharmaceutical agents to be dispensed at TMOP and as the dispensing occurs, the DHA replenishes the pharmaceutical agents dispensed with pharmaceutical agents from the NPV purchased via the DLA (a pill for a pill, brand for brand, generic for generic). The TPharm contractor orders replenishment off DLA’s Medical Master Catalog a menu of pharmaceutical agents available from Federal Supply Schedules, Distribution and Pricing Agreements, Joint DoW/U.S. Department of Veterans Affairs national contracts, DoW contracts, and Blanket Purchase Agreements. The TPharm contractor orders replenishment from the NPV - selecting the most economical (choice) from amongst the sources.

Replenishment inventory must be TAA compliant. In addition, brand name pharmaceutical agents procured directly by the Government are bought at the “Big 4” rates.

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