1. Coalition for Government Procurement Committee Meeting 21 July 2015
Focus: Delivering Value – MHS Pharmacy Operations George E. Jones, Jr., Pharm D, MS Chief, Pharmacy Operations Division Health Care Operations Directorate
“Medically Ready Force…Ready Medical Force”

2. The “Why”

3. “Medically Ready Force…Ready Medical Force”
DHA Vision and Mission
Vision
A joint, integrated, premier system of health, supporting those
who serve in the defense of our country.
Key Mission Aspects
A Combat Support Agency supporting the military services
Supports the delivery of integrated, affordable, and high quality health services to beneficiaries of the Military Health System (MHS)
Executes responsibility for shared services, functions, and activities of the MHS
Serves as the program manager for the TRICARE Health Plan and medical resources
Manages the execution of policy as issued by the Assistant Secretary of Defense for Health Affairs
“Medically Ready Force…Ready Medical Force”

4. Defense Health Agency (DHA) Pharmacy Program
Mission
To direct the DoD Pharmacy benefit in support of the MHS’ mission through effective planning, programming, budgeting, and execution of DoD Pharmacy operations.
Goal
To improve patient outcomes while reducing overall healthcare costs through the delivery of optimal pharmaceutical care.
“Medically Ready Force…Ready Medical Force”

5. Supported: MHS Strategy/Quadruple Aim. Supporting: DHA!
Increased Readiness
Ensuring that the total military force is medically ready to deploy and that the medical force is ready to deliver health care anytime, anywhere in support of the full range of military operations, including humanitarian missions.
Better Health
Reducing the generators of ill health by encouraging healthy behaviors and decreasing the likelihood of illness through focused prevention and the development of increased resilience.
Lower Cost
Creating value by focusing on quality, eliminating waste, and reducing unwarranted variation; considering the total cost of care over time, not just the cost of an individual health care activity.
Better Care
Providing a care experience that is patient and family centered, compassionate, convenient, equitable, safe and always of the highest quality.
“Medically Ready Force…Ready Medical Force”

6. An Endeavor of Integration; DHA / Pharmacy Shared Services
Our Time Today:
Federal Refund Pricing Program - Disputes
Regulatory Changes – Changes?
2016 Pilot Program?
2015 Transitions
“Medically Ready Force…Ready Medical Force”

7. TRICARE Retail Refund Program – A Team Success
Manufacturer policy and Procedures Guide
Team Developed – Available Now
Eight Chapters…..count them – 8!
Section on Disputes (Chap 7)
Process
Criteria
“Medically Ready Force…Ready Medical Force”

8. TRICARE Retail Refund Program – A Team Success - Disputes
“Refunds are based solely on utilization of pharmaceutical agents dispensed…”
Standardized /“e”ized the process
Codes / Supporting Docs
Section on 340b Disputes
Goal – Resolution within 60 days – Process refinement
Under development – Process for Unresolved Disputes
Guide Provides Resources / Contact Information
“Medically Ready Force…Ready Medical Force”

9. Regulatory Changes – Changes?
Question – “Apparently DLA authorized a retail pharmacy to make direct purchase off of the Federal Supply schedule through DoD's prime vendor program.”
No Regulatory Changes on This Subject of Which I Am Aware
MHS Pharmacy has pending two proposed regulations
An Interim Final Rule – Implement NDAA 2015 MTF / Mail Program
A Final Rule making administrative changes
Co-Pay alignment/New Drug Coverage/Non-Formulary/OTC coverage
Welcome any inquiries on this issue
“Medically Ready Force…Ready Medical Force”

10. “Medically Ready Force…Ready Medical Force”
2016 Pilot Program
The 2016 Legislative Proposal of Retail Pilot
No Comment on Pending Legislation
TRICARE Retail Refund Program
Solid Track Record of Success
Driving Toward Value
“Medically Ready Force…Ready Medical Force”

11. 2015 Transitions / Opportunities – Unbelievable!
Elections – Who Knows!
Generates interest/uncertainty
Exploration
Bid Processes (eBidding; Condition Sets, etc)
Driving Patient Outcomes (tools, measures)
Value or cost - adherence, clinical integration, outcomes
Receive Your Input to Drive Improvements
Focused Communication During Bid Cycles
Flow through Contracting Officer
“Medically Ready Force…Ready Medical Force”

12. “Medically Ready Force…Ready Medical Force”
Transition - TRICARE For Life Pilot / Mandatory MTF or Mail Refill Program
“5 year” TFL Pilot Born 2013; Deceased Sept 2015
Pilot Terminated by NDAA 2015 as of 30 September 2015
Transitioned to cover All Beneficiaries (except Active Duty)
Requires use of MTFs/ Mail Order for brand name, recurring prescriptions for chronic conditions
Does not include Rxs to treat acute conditions
Includes procedures to assist in the transfer of covered prescriptions to a MTF / the mail order pharmacy program
Transition to begin on/about 1 October 2015
Product list available TRICARE Formulary Website
“Medically Ready Force…Ready Medical Force”

13. Transition – DoD P&T (Once upon a time…)
Success – However, Remains Work in Progress
Wins and Goals
Predictable cycle; Future Planning; Target- 8 week bid cycle
Functionally align staff and information flow
Team focused on Specialty
Developing framework for e-bidding process – Close!
Looking to leverage forward-facing data
Integration - Health Outcome/Burden of Illness
Analysis / trending into formulary process - Drivers
“Medically Ready Force…Ready Medical Force”

14. Future – Vector to Opportunity
“Medically Ready Force…Ready Medical Force”

15. “Medically Ready Force…Ready Medical Force”
Appreciate Your Time!
Questions ?
Thank You
---Still #1 Record in Baseball??---
“Medically Ready Force…Ready Medical Force”