MODIFICATION
Q -- RFI TRICARE Pharmacy Program
- Notice Date
- 12/21/2011
- Notice Type
- Modification/Amendment
- NAICS
- 446110
— Pharmacies and Drug Stores
- Contracting Office
- Other Defense Agencies, TRICARE Management Activity, Contract Operations Division - Aurora, 16401 E. CenterTech Pkwy., Aurora, Colorado, 80011, United States
- ZIP Code
- 80011
- Solicitation Number
- TRICAREPharmacyProgram(TPHARM4)
- Point of Contact
- Bruce Mitterer, Phone: 303-676-3812
- E-Mail Address
-
bruce.mitterer@tma.osd.mil
(bruce.mitterer@tma.osd.mil)
- Small Business Set-Aside
- N/A
- Description
- NEW Request for Further Information for the acquisition of pharmacy benefit management services under the Department of Defense (DoD) TRICARE Pharmacy Program (TPharm) December 21, 2011 The TRICARE Management Activity (TMA) is seeking further information and suggestion from the pharmacy industry for acquisition planning and development of a future solicitation to replace the current pharmacy benefit management service contract scheduled to conclude October 2014. Before proposals are solicited, TMA intends to release a draft Request for Proposals for industry comment, and also intends to provide potential offerors with historical data. 1. TMA is soliciting input on which reference pricing benchmark, Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), or other alternative, should be included in the next generation pharmacy contract for reimbursement and/or financial incentive purposes. At a minimum this reference benchmark should be available electronically from a commercial third party source, it should cover the widest number of brand and generic drugs possible, and there should be some assurance it will continue to be published throughout the life of the next contract. 2. TMA is also soliciting input regarding the optimal duration of the next contract. Among other factors for consideration by the Government, the Government is particularly interested in encouraging participation by non-incumbents to maximize competition. Discussion of capital investment and market uncertainty is encouraged. Capability statements, promotional material, or sales pitches are undesired. Responses by consultants or attorneys shall disclose themselves as such and describe or identify their client. CONTACT INFORMATION Following is the Point of Contact (POC) for this RFI: Bruce Mitterer Contracting Officer TRICARE Management Activity 16401 E. Centretech Parkway Aurora, CO 80011 (303) 676-3812 Bruce.Mitterer@tma.osd.mil Please submit responses via e-mail in Microsoft Office 2003 (at a minimum) format by noon January 17, 2012. DISCLAIMER This Request for Information (RFI) is issued solely for informational purposes only and does not constitute a solicitation. Neither unsolicited proposals nor any offers will be considered in response to this RFI. Responses to this notice are not offers and will not be accepted to form a binding contract. Responders are solely responsible for all expenses associated with responding to this RFI. All information received in response to this RFI that is marked Proprietary will be handled accordingly. Responses to the RFI will not be returned. Suggestions from industry will be considered; however the Government reserves the right to solicit for the required services in a manner of its choosing in accordance with applicable procurement regulations. At this time, questions concerning the composition and requirements for a future Request For Proposals will not be entertained. PREVIOUS REQUEST Request for Information (RFI) for a Department of Defense (DoD) Acquisition and Management of Services in Support of the TRICARE Pharmacy Program (TPharm4) INTRODUCTION The TRICARE Management Activity (TMA) is conducting market research to determine current capabilities of commercial pharmacy benefit management (PBM) organizations that provide Home Delivery/Mail Order pharmacy (including specialty pharmacy) services, retail pharmacy network, claims adjudication, and fiscal intermediary functions. TMA is also seeking information from the pharmacy industry regarding how competition may best be achieved and minimize cost by capturing commercial best practices in the Government's objectives and requirements. Suggestions from industry will be considered; however the Government reserves the right to solicit for the required services in a manner of its choosing in accordance with applicable procurement regulations. TMA is currently in the market research and requirements determination stage for the follow-on procurement to the current TRICARE Pharmacy contract which is scheduled to conclude October 2014, if all options are exercised. Before proposals are solicited, and schedule permitting, TMA intends to release a draft Request for Proposals for industry comment and also intends to provide potential offerors with historical data. Interested parties are encouraged to monitor Federal Business Opportunities at fbo.gov. Responses are requested by 4:00 PM on October 31, 2011. Earlier responses are encouraged. DISCLAIMER This Request for Information (RFI) is issued solely for informational purposes only and does not constitute a solicitation. Neither unsolicited proposals nor any other kinds of offers will be considered in response to this RFI. Responses to this notice are not offers and will not be accepted by the Government to form a binding contract. Responders are solely responsible for all expenses associated with responding to this RFI. All information received in response to this RFI that is marked Proprietary will be handled accordingly. Responses to the RFI will not be returned. At this time, questions concerning the composition and requirements for a future Request For Proposals will not be entertained. TRICARE OVERVIEW The TRICARE Pharmacy Benefits Program falls under the Department of Defense (DoD) Military Health System (MHS) and TRICARE Program: The medical mission of the DoD is to maintain readiness through health and medical services provided to the armed forces during military operations, and to provide health and medical services/support to the members of the armed forces, their family members and others entitled to the TRICARE benefit. TRICARE is the DoD health care program administered by the TMA by means of the MHS for approximately 9.6 million active duty and retired members of the Uniformed Services (the U.S. Army, the U.S. Navy, the U.S. Air Force, the U.S. Marine Corps, the U. S. Coast Guard, the Commissioned Corps of the Public Health Service and the Commissioned Corps of the National Oceanic and Atmospheric Administration), their spouses and children, including TRICARE for Life beneficiaries entitled to Medicare Part A and Part B based on their age, disability and/or end-stage renal disease. Also eligible are Medal of Honor recipients. Military reservists (and their families) are also TRICARE beneficiaries, for the period in which they are on active duty; or if they choose to enroll to TRICARE Reserve Select; or the TRICARE Retired Reserve program(s). More information about the TRICARE benefit may be found at http://www.tricare.mil/mybenefit/home/overview/Plans. The MHS must be prepared not only to provide a high quality, cost-effective health care benefit to its eligible members during peacetime, but also must be prepared to support the armed forces during exercises, contingencies, operations other than war, and in wartime. The MHS provides quality medical care through: (1) a network of health care providers and pharmacies in the United States and its territories; and (2) direct care Military Treatment Facilities (MTFs) - (hospitals, health and dental clinics) in the Continental United States and overseas. While the number and size of direct care facilities has declined in recent years, it remains important that MTFs are optimized in order to maintain the clinical skills of military clinical staff to support medical readiness. The direct care system cannot fully support the total demand for health care services; therefore, TRICARE uses the direct care system as the main delivery system, and through contracts, augments the direct care system through a civilian network of providers and facilities serving its eligible members. TRICARE PHARMACY BENEFITS PROGRAM: 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. DoD administers an integrated TRICARE Pharmacy Benefits Program offering pharmacy services through direct care pharmacy services at MTFs located at various military bases; retail network pharmacies; authorized retail non-network pharmacies; or delivery through the TRICARE Home Delivery/Mail Order Pharmacy (TMOP). Retail pharmacy services are available in all 50 states and the District of Columbia, Guam, Puerto Rico, and the Virgin Islands. Features of the pharmacy benefits program include the use of the DoD Uniform Formulary; a tiered cost sharing structure; and a preference for generic over branded products. The DoD formulary lists the pharmaceutical agents, by therapeutic classes, that are authorized as 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/or cost effectiveness. DoD has established tiered cost-sharing by which beneficiaries partially defray costs of administering the pharmacy benefits program. Cost-sharing amounts that a beneficiary pays for each prescription will 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 agent is acquired. See 32 CFR 199.21 and Chapter 55 of Title 10 USC Section 1074g for additional information. Additional information is also available at on the TRICARE Management Activity World Wide Web site at www.tricare.osd.mil REQUEST FOR INFORMATION This RFI is a follow-up to an earlier RFI issued and seeks further information on the commercial pharmacy benefit management practices. TMA is seeking information and recommendations from industry that will improve its approach to a future TRICARE pharmacy benefit management service contract that will support the MHS; and to take advantage of the expertise of the industry and incorporate best practices. Please remember there are statutory and regulatory limitations to how / what TRICARE services are provided to beneficiaries; so recommendations conflicting with these may not be able to be implemented. However, any recommendation regarding administrative requirements; as well as any suggestions to promote a more efficient TRICARE Pharmacy Benefits contract would certainly be welcomed by the Government. Information regarding the specific topics identified below is requested: a) Enhanced Services A major function of PBM's today is to assist their commercial clients in influencing beneficiary behavior. This could include making modifications to the benefit plan's design, or developing improved methods of communicating plan information to beneficiaries. We understand these plan enhancements may be purchased as individual programs or as part of an ongoing package of enhancements. The Government is seeking ways to best structure future contracts to ensure the Government has access to all plan upgrades that a PBM would typically provide to its commercial clients. Please discuss various ways commercial contracts are structured to receive at no change in contract price, or to pay for these enhancements (i.e., Per Member Per Month, Tiered Pricing Structure, etc.). Recognize that there are Government-directed changes to contract requirements. The mandates may include increased benefits for its members and changes to statutes/regulations/policies/procedures. These Government-directed upgrades are incorporated through unilateral change orders to the contract or by mutual agreement of the parties. b) Formulary Management A major function of PBM's is to assist plan sponsors in benefit design. This includes all areas of formulary management. The Government is interested in ways that that a PBM could support DoD's Pharmacy and Therapeutics Committee in developing and maintaining the TRICARE formulary. The Government is also interested in best business practices for implementing and managing formulary decisions and what functions a PBM typically performs. For example, ideally, how often should formulary changes be made, once a year or more frequently? c) Maximum Receipt Time To Receive a Mail Order Prescription What is the industry standard for mail order turnaround times? Would industry expect turnaround times be calculated from receipt of the prescription until it's shipped or until it's delivered? Would a requirement to verify successful delivery be a cost driver, or is verification a direction that industry is headed in already? What is the optimal method for evaluating contract compliance, (i.e. sampling or some other method)? d) Medication Therapy Management (MTM) Discuss current retail pharmacy applications of MTM services such as case reviews and therapeutic substitutions by pharmacists. How are these services reimbursed and measured for effectiveness? e) Call Center Metrics The Government would like its call center requirements to align with industry best practices. The Government would also like to understand the implications and costs for call center metrics, i.e., tighter requirements increasing costs. Should there be variation to account for peak times? Does industry actively attempt to educate consumers about peak times and moderate call volumes? f) Claim Transaction Turn-around time For the purposes of this question, transaction time is defined as the time in seconds from the point when a claim is submitted by a retail pharmacy until the pharmacy receives a confirmation or rejection of the claim. Turnaround time includes determination of eligibility, formulary compliance, DUR and all cost calculations. Based on this definition, what is the industry standard for prescription claim processing turnaround time? What is the maximum acceptable turnaround time? g) Incentives What positive and negative incentives are used in the industry, if any, and how do they impact your operations and proposals. What incentives could be created that would effectively reduce cost and achieve desirable outcomes? h) PBM Owned Pharmacies We understand some PBMs own pharmacies. What are the significant benefits (pro and con) of excluding/including PBM-owned pharmacies in a network used to support TRICARE beneficiaries? Please substantiate any cost benefits. What mitigation plans (if any) are in place to prevent conflicts of interest regarding this relationship? Please note any PBM contractor will be required to be a fiscal intermediary on behalf of the Government and engage in program integrity functions (see TRICARE Operations Manual chapter 13) and other pharmacy oversight matters. i) Competition What solicitation requirements and other actions can the Government do to promote competition at any stage of the acquisition process? j) Other TMA is contemplating developing a solicitation similar to the current contract. A public copy of the current contract is available in the attachment of this FBO announcement. The TRICARE Operations Manual, TRICARE Policy Manual, TRICARE Systems Manual, and TRICARE Reimbursement Manual will be incorporated into the solicitation by reference. These are available for review at www.tricare.mil and may provide insight to interested parties and potential sources. Please provide any other comments not otherwise solicited above. CONCLUSION This RFI seeks information about approaches that could meet functional requirements. In doing so, the Government seeks to understand the tradeoffs among risks, costs (initial and ongoing) and alternatives that incorporate increasing degrees of sharing. The Government welcomes alternative concepts for solutions that meet requirements including an overview of new technologies or approaches to providing the requested or similar functionality. The Government encourages creativity and outside-the-box thinking in responses to this RFI. To the extent simplifying assumptions are needed, respondents are encouraged to make and document such assumptions in their responses. Capability statements, promotional material, or sales presentations are undesired and will not be read. Request consultants or attorneys describe or identify their client. CONTACT INFORMATION Following is the Point of Contact (POC) for this RFI: Bruce Mitterer Contracting Officer TRICARE Management Activity 16401 E. Centretech Parkway Aurora, CO 80011 (303) 676-3812 Bruce.Mitterer@tma.osd.mil Please submit responses via e-mail in Microsoft Office 2003 (at a minimum) format or hard copy by 4:00 PM on October 31, 2011 to the POC. Earlier responses are encouraged.
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