Delivering Value – MHS Pharmacy Operations

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

2. The “Why”

3. 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 Goal To improve patient outcomes while reducing overall healthcare costs through the delivery of optimal pharmaceutical care. To direct the DoD Pharmacy benefit in support of the MHS’ mission through effective planning, programming, budgeting, and execution of DoD Pharmacy operations. “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 • WWW.HEALTH.MIL • Eight Chapters…..count them – 8! • Section on Disputes (Chap 7) • Process • Criteria http://www.health.mil/About-MHS/Defense-Health-Agency/Healthcare-Operations/Pharmacy-Division/Information-for-Pharmaceutical-Manufacturers/Operational-Documents “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. 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. 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. Appreciate Your Time! Questions ? Thank You ---Still #1 Record in Baseball??--- “Medically Ready Force…Ready Medical Force”