Department of Defense Uniform Formulary and Pricing Update

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Department of Defense Uniform Formulary and
Pricing Update
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Speakers

• David Bretzke, PharmD
• Uniform Formulary (UF) introduction
• Charles Brown, Contracting Officer
• UF Blanket Purchase Agreements
• Capt Peter Trang, PharmD, BSC, USAF
• Post UF decision pricing

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DoD Uniform Formulary

• NDAA 2000
• Uniform Formulary Final Rule
• Published Spring 2004
• Established processes framework
• Outpatient pharmacy program
• Not a drug list
• A PT process, not a contracting process

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Determining 3rd tier candidates

• Clinical effectiveness (clinical utility)
• Defined in rule
• How a drug compares in its class
• Cost effectiveness
• Defined in rule
• Across all three dispensing venues
• Which in most important?

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GAO Protest to UF

• Protest of Merck Co. B-295888 May 13, 2005
• Confirmed statutory requirement to evaluate cost
  effectiveness determination across all three
  points of service
• Validated BPA structure and quote process
• Confirms the PT process (collective professional
  judgment) vs. traditional FAR contracting

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Implementing the UF

• Implemented one class at a time
• Health Affairs Policy 04-032
• Established a more centralized management system
• BCF remains, Extended Core Formulary (ECF) added
• Established Beneficiary Advisory Panel

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MTF Formulary Management

• MTF Formularies must contain
• BCF drugs
• ECF drugs in each ECF drug class that is included
  on the MTF formulary
• MTF Formularies may also contain
• Other UF drugs generic (1st tier) or formulary
  (2nd tier)
• Drug used solely for inpatient services
• Medications not covered by TRICARE pharmacy
  benefit that are allowed to be covered by MTFs
• OTCs, weight loss meds, smoking cessation, etc.
• MTF Formularies cannot contain
• Drugs classified as non-formulary on UF (3rd
  tier)

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DoD Core Formularies

• All drug classes will fall under either
• Basic Core Formulary (generally primary care)
• Extended Core Formulary (all other classes,
  generally specialized care)
• Drugs are selected for the BCF or ECF because
  they provide greater value than other drugs on
  the Uniform Formulary
• Where clinically appropriate, MTFs should
  maximize the use of BCF and ECF drugs over other
  UF drugs

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Beneficiary Advisory Panel (BAP)

• Operates under Federal Advisory Committee Act
  (FACA) and provides new level of accountability
  and oversight for the UF process
• Purpose is to provide beneficiaries a voice and
  representation in the UF process
• Members consist of nominees from major
  beneficiary representative organizations such as
  MOAA, contractors, professionals

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UF Review Results
Non-Formulary
On Uniform Formulary (UF)
BCF
CLO NYS
MIC KET BUT NAF
AF-DERMs
ECO SUL CIC OXI SER
ECF
VAR
SIL TAD
PDE-5s
Must have on MTF formulary
May have on MTF formulary
Cannot have on MTF formulary
Where clinically appropriate, MTFs should
maximize the use of BCF (or ECF) drugs over other
UF drugs
MTFs must use Medical Necessity criteria
developed by the DoD PT Committee to fill UF
non-formulary drugs (ESO, EPR, ECO, SUL, CIC,
OXI, SER, SIL, TAD)
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Coming soon

• August 2005
• CCBs
• ACEs
• BPH Alpha Blockers

• November 2005
• Antidepressants
• Nasal Corticosteroids
• Alzheimers agents
• Macrolide / Ketolides

Projected Classes to be Reviewed at the PT
Schedule page on the PEC website
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Uniform Formulary Rx Co-Pays
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Non-formulary Agents

• 22 cost share per prescription at Mail Order and
  Retail - no questions asked
• 9 cost share if medical necessity is validated
• Excluded from all MTF formularies
• Available only upon approval from non-formulary
  special order process that validates Medical
  Necessity criteria established by the DoD PT
  Committee
• MTF non-formulary special order process can only
  be used by
• MTF providers
• Prescriptions written by a civilian provider to
  whom the patient was referred by the MTF

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Overview of PT Cycle

• PEC prepares preliminary review (T-180)
• PT Committee meets (T-90)
• Defines drug class and constituents
• Designates classes as BCF or ECF
• Defines number of agents on BCF/ECF
• Public release (T-75)
• Change websites
• Provide datasets
• Set UF-BPA price quotes due date (T-20)
• PT Committee meets (T)
• Final drug class review
• Makes UF recommendations
• BAP meets (T45)
• Reviews recommendations
• Sends comments to TMA
• TMA Executive Director reviews and signs minutes
  (T60)
• Implementation of decisions (no later than T240)

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Resources

• HA Policy 04-032
• http//www.ha.osd.mil/policies/2004/04-032.pdf
• UF BPA Information
• http//www.tricare.osd.mil/ufbpa/UFBPA_Info.cfm
• DoD PT Committee Minutes
• http//www.tricare.osd.mil/pharmacy/PT_Cmte/defaul
  t.htm
• DoD PT Committee Schedule
• http//www.pec.ha.osd.mil/PT_Committee.htm
• Individual drug status
• http//www.tricareformularysearch.org

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Moving On

• David Bretzke, PharmD
• DoD Pharmacoeconomic Center
• [phone]
• David.Bretzke_at_amedd.army.mil
• Thank You