Request for Information - TRICARE Pharmacy Program 4 (TPharm4)

Request for Information for a Department of Defense (DoD) Acquisition and Management of Services in Support of the TRICARE Pharmacy Program (TPharm) 1.0 SUBJECT The TRICARE Management Activity (TMA) is conducting market research to determine current capabilities of commercial pharmacy benefit management services that provide Home Delivery pharmacy (including specialty pharmacy) services, retail pharmacy networks, claims adjudication, and fiscal intermediary functions. Responses are due to this RFI by 4:00 PM on December 17, 2010. See section 5.0 for further information. 2.0 DISCLAIMER This Request for Information (RFI) is issued solely for information and planning 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 RFP will not be entertained. 3.0 DESCRIPTION TRICARE is the US Department of Defense (DoD) health care plan using military health care as the main delivery system. This system is augmented by a civilian network of providers and facilities serving uniformed service members, their families, retired military, and their families worldwide. TMA is the DoD organization responsible for managing the TRICARE health care benefit. This includes managing the integration of state of the art technologies to enhance patient safety, efficiency, and cost effectiveness. For DoD beneficiaries, the TRICARE Pharmacy Program (TPharm) provides the Home Delivery pharmacy (including specialty pharmacy) services, provides a retail pharmacy network, provides claims adjudication, and serves as a fiscal intermediary on behalf of DoD to pay for all authorized pharmaceuticals and supplies dispensed for beneficiaries at retail pharmacies. TMA is seeking information from industry that will assist in the future TRICARE pharmacy benefit management service contract that will support the MHS. The intent is to maintain and if possible enhance capabilities within the Military Health System (MHS). 4.0 REQUIREMENTS This section enumerates potential functional requirements for the future TPharm pharmacy benefit management service contract. Can industry support the following TPharm contract configurations? a) Configuration 1) Claims processing, historical claims data storage (warehouse), drug utilization reviews, and mail fulfillment as separate contracted functions. 2) Claims processing, historical claims data storage (warehouse), drug utilization reviews, and mail fulfillment as combined contracted functions. The discussion of capability should include the pro's and cons of each. b) Prime Vendor 1) Using the DoD national prime vendor contract for mail fulfillment? 2) Using a contractor's commercial prime vendor contract for mail fulfillment? The discussion of capability should include how the government can ensure procurement costs are equal to or lower than federal ceiling prices or other government contracted prices. c) Specialty Pharmacy 1) The establishment of a national specialty pharmacy network. The discussion of capability should include the optimal number of participating specialty pharmacies needed to provide the maximum coverage at the least cost. 2) The establishment of a mechanism to allow contracted specialty pharmacies to purchase drugs through a central distribution point. The discussion of capability should include the best mechanism to ensure the government receives federal discounts for specialty drugs. 3) The provision of clinical services to assist patients receiving specialty medications is an important aspect of care. What should those services include and how should those services be monitored for effectiveness? What criteria should be used to determine if a pharmacy is acceptable for inclusion in the specialty pharmacy network? d) Network Access Standards 1) The establishment of variable network access standards? The discussion of capability should include whether a smaller network would significantly reduce government costs without adversely impacting beneficiary satisfaction. The discussion of capability should include the optimal number of network pharmacies that balances costs with access based on current commercial practices. e) Data Separation 1) The separation of DoD pharmacy data from other commercial data when designing a retail claims processing and mail fulfillment contract? The discussion of capability should include whether it is practical and cost effective to do so. f) Medication Therapy Management (MTM) 1) Discuss current retail pharmacy applications of MTM services in place today. What services are provided, how are these services reimbursed and measured for effectiveness? g) Data Warehouse 1) DoD pharmacy data is maintained in a data warehouse separate from claims adjudication. Discuss the pros and cons of combining claims processing and data warehouse capabilities on a single platform. The purpose of this RFI is to gather information about those requirements enumerated above. To the extent simplifying assumptions are needed, respondents are encouraged to make and document such assumptions in their responses. This RFI seeks information about approaches that could meet the functional requirements. In doing so, the Government seeks to understand the tradeoffs among risks, costs (initial and ongoing) and alternative technical architectures that incorporate increasing degrees of sharing. The Government welcomes alternative concepts for solutions that meet these 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. 5.0 CONTACT INFORMATION Following is the Point of Contact (POC) for this RFI: William H. Coffenberry Contracting Officer TRICARE Management Activity 16401 E. Centretech Parkway Aurora, CO 80011 (303) 676-3764 William.Coffenberry@tma.osd.mil Please submit responses via e-mail in Microsoft Office 2003 (at a minimum) format by 4:00 PM on December 17, 2010, to Mr. William H. Coffenberry. You may also submit supplemental hardcopy materials such as brochures, etc to the address above.