TRICARE Pharmacy Program RFI (Draft Section C & H)

Background
The Defense Health Agency (DHA) is in the acquisition planning phase for the next generation TRICARE Pharmacy Program (TPharm6) contract. This program is designed to provide pharmacy benefits to approximately 9.5 million active duty and retired members of the Uniformed Services, along with their families.

The DHA aims to enhance DoD readiness and national security by ensuring high-quality healthcare support through an integrated pharmacy benefits program that includes both military treatment facilities and civilian networks.

Work Details
The contractor will be responsible for various tasks under the TRICARE Pharmacy Benefits Program, including:
1. Efficient processing of claims and clinical reviews across all service points, ensuring compliance with TRICARE benefit design, policy, regulation, and law.
2. Providing convenient access to all agents covered by the TRICARE pharmacy benefits program.
3. Ensuring superior levels of care, safety, and beneficiary satisfaction.
4. Managing costs effectively while optimizing resource use.
5. Delivering services through secure systems that streamline operations for prescribers and beneficiaries.
6. Performing claims adjudication, administering a retail pharmacy network, operating the TRICARE Mail Order Pharmacy (TMOP), processing reimbursements for claims filled at pharmacies, conducting clinical reviews, and providing beneficiary support services.
7. Maintaining a complete patient profile for all claims processed under this contract.
8. Supporting coordination of benefits with Other Health Insurance (OHI) and Medicare Part D claims as necessary.

Place of Performance
The contract will be performed across various locations including all 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands.