SOLICITATION NOTICE
Q -- TRICARE Pharmacy Program, Fourth Generation (TPharm4) - Pre-Solicitation Data - Pre-Solicitation - Instructions to Order Confidential and Protected Information
- Notice Date
- 5/22/2013
- Notice Type
- Presolicitation
- NAICS
- 524292
— Third Party Administration of Insurance and Pension Funds
- 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
- HT9402-13-R-0001
- Point of Contact
- Matthew L. Anderson, Phone: 303-676-3754, Bruce Mitterer, Phone: 303-676-3812
- E-Mail Address
-
Matthew.Anderson@tma.osd.mil, bruce.mitterer@tma.osd.mil
(Matthew.Anderson@tma.osd.mil, bruce.mitterer@tma.osd.mil)
- Small Business Set-Aside
- N/A
- Description
- Instructions to Order - Confidential and Protected Information Draft Data Pkg 17_Historical Theater Medical Data Store (TMDS) Volume (May 15, 2013) Draft Data Pkg 16_Historical Federal Ceiling Price (FCP) Dispute Volume (May 22, 2013) Draft Data Pkg 15_Misc Summary Volumes (May 15, 2013) Draft Data Pkg 14_TRICARE Beneficiaries by Zip Code (June, 2012) Draft Data Pkg 13_IHS & VA Historical Claims Volume (May 15, 2013) Draft Data Pkg 12_Dept. of Veteran's Affairs (DVA) Pharmacy Listing (March, 2013) Draft Data Pkg 11_Indian Health Service (IHS) Pharmacy Listing (March, 2013) Draft Data Pkg 10_Historical MTF Call Volume (May 15, 2013) Draft Data Pkg 9_Historical MTF Claim Volume (May 15, 2013) Draft Data Pkg 8_Unreplenished Agents for OP1, OP2, and OP3 (Oct, 2012) Draft Data Pkg 7_Historical Deployed Prescription Volume (May 15, 2013) Draft Data Pkg 6_Pre-Deployment Out-Processing Centers (May 15, 2013) Draft Data Pkg 5_Utilization of Retail Maintenance Meds by Benes Over 65 (May 15, 2013) Draft Data Pkg 4_Retail Utilization Detail CY2012 (May 15, 2013) Draft Data Pkg 3_Retail Utilization Detail CY2011 (May 15, 2013) Draft Data Pkg 2_Utilization Data for Jan - Dec 2012 (May 17, 2013) Draft Data Pkg 1_Utilization Data for Jan - Dec 2011 (May 15, 2013) Draft MTF to TMOP Implementation Guide (Feb, 2013) Draft Managed Care Pricing File - MTF Sample Part 3 of 3 (April 25, 2013) Draft Managed Care Pricing File - MTF Sample Part 2 of 3 (April 25, 2013) Draft Managed Care Pricing File - MTF Sample Part 1 of 3 (April 25, 2013) Draft Managed Care Pricing File - TMOP Sample (May 15, 2013) Draft Managed Care Pricing File Info May 15, 2013) Draft TFL Mandatory Mail Drug List (May 15, 2013) Draft DoD Formulary Restrictions and Limitations (April 4, 2013) Draft DoD Benefit Design (March 29, 2013) Summary of Pre-Solicitation Data Files PRE-SOLICITATION NOTICE This is the PRE-SOLICITATION NOTICE for the acquisition of the TRICARE Pharmacy Program, Fourth Generation (TPharm4) requirement, in support of the Department of Defense (DoD), Military Health System's (MHS) pharmacy benefits program. The TRICARE Management Activity (TMA) anticipates posting the Request for Proposal (RFP) no earlier than 30 days from this notice with an approximate release in late June 2013. When this solicitation is released, the requirements will be for a Full and Open competition. In addition to this posting on Federal Business Opportunities, the solicitation will also be posted and accessible at an external TMA web site http://www.tricare.mil/tma/AMS/ams_solicitations.aspx. Pharmacy Benefits Management (PBM) services under this RFP provide Mail Order Pharmacy (MOP) and retail pharmacy services to all eligible beneficiaries. See below for an overview of the TRICARE and Pharmacy programs. TMA is providing data files (attached to this pre-solicitation notice) to potential offerors in advance of the solicitation release. These data files will be added to and updated with the issuance of the solicitation and are for informational purposes only. The data files included with this notice are listed in the attachment titled "Summary of Pre-Solicitation Data Files". In addition to the attached data files, potential offerors may also request information that is designated as "Confidential and Protected Information". This information is not included as attached files to this notice but may be requested by following the instructions in the listed attachment titled "Instructions to Order - Confidential and Protected Information". This attachment also lists the confidential and protected information available to potential offerors. TRICARE OVERVIEW The TRICARE Pharmacy Benefits Program falls under the Department of Defense (DoD) Military Health System (MHS) and TRICARE Program: TRICARE is the DoD health care program administered by the TMA by means of the MHS for approximately 9.7 million MHS eligible beneficiaries, including Medicare eligible beneficiaries meeting statutory requirements as authorized under 10 U.S.C. § 1086. More information about the TRICARE benefit may be found at http://tricare.mil/Welcome/Plans.aspx/. 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. 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 (MOP). 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 http://www.tricare.mil/tma/. Extensive information on TRICARE Operations, Policy, Reimbursement, and Systems may be found in the system of manuals located at http://manuals.tricare.osd.mil/.
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