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Pharmaceutical Manufacturers: Contact Us - Billing and Pricing

Billing and Pricing

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Contact the TRICARE Retail Refund Team and FAQs
Q1:

If a product is divested, what should a company do to let TRICARE know?

A:

It is the responsibility of both parties (the previous manufacturer and new manufacturer) to complete an Appendix A Change Request form in its entirety and submit it to UFVARR_Requests@mail.mil. The form must contain the signatures of both parties. Once the TRICARE Retail Refund Team (TRRT) receives, reviews, and approves the form, billing can be updated. Please note that if the form is submitted with transfer dates in a previous quarter, the transfer will be reflected in the upcoming billing quarter.

Q2:

How would a product be eligible for the TRICARE Retail Refund Program if it is not dispensed in the retail network (e.g. if the product is IV or other forms, to be administered by MD, or provided in the hospital)?

A:

If an NDC is reported to the TRRT with a positive minimum refund, it is a covered drug under 38 U.S.C. 8126 of the final rule and eligible for the TRICARE Retail Refund Program. A refund will be owed for covered drugs dispensed through pharmacies identified as part of the TRICARE Retail Network, which includes long term care facilities, specialty pharmacies, and pharmacies inside physician offices or hospitals. In the event that an NDC appears to be incorrectly reported to TRICARE as a covered drug, please contact your POC at the Department of Veterans Affairs. The manufacturer may also submit disputes for these claims (please see the Dispute Submission process in the TRICARE Retail Refund Program Process & Procedures Guide) so that proper credit can be given in the event that the disputes are accepted.

Q3:

If a company has a new NDC for the same pharmaceutical agent that has an ADP Agreement in place, but the NDC is not on this ADP Agreement, how will TRICARE bill the NDC? ii. Will this be handled differently depending on if the drug is on a FCP or WAC ADP Agreement?

A:
  • If an NDC is not included on an ADP Agreement and the pharmaceutical agent is the same for the NDC(s) for which an ADP Agreement is in place, it will be billed under the ADP Program and a discount percentage will be determined based on strength, dosage, and package size of similar NDCs.
  • Typically, WAC ADP Agreements will include drugs that are not Covered Drugs, such as diabetes testing supplies. If the NDC is not included on the WAC ADP Agreement for a non-Covered Drug, it will not be billed under WAC, ADP, or SDP. If the NDC of the pharmaceutical agent on the ADP Agreement is a Covered Drug, then it will be billed ADP (FCP or WAC based on the ADP Agreement in place)
Q4:

How does TRICARE calculate the refund owed for those NDCs not included on a pharmaceutical agent’s ADP Agreement?

A:

If an NDC is not included in a pharmaceutical agent’s ADP Agreement and is eligible to be billed under ADP, the TRRT will calculate the refund owed by assigning the additional percentage from an NDC on the ADP which closely matches this NDC in strength and package size. 

Q5:

If a drug was determined to be non-formulary per the final decision in a P&T Committee Meeting and is currently on an ADP Agreement, will it be terminated? If so, when?

A:

All ADP Agreements for drugs belonging to drug classes reviewed in Pharmaceutical & Therapeutics Committee Meetings will be terminated upon the effective dates determined within the review of each class, regardless of formulary standing. However, if a drug is designated non-formulary per the P&T Committee, a bid that may have been submitted for consideration will not be accepted. ADP Agreements to be terminated will be done so with a termination date determined within each class (not the signing of the minutes unless otherwise indicated). Please refer to the P&T Committee Meeting Minutes for more information.

Q6:

Why is a drug not covered under TRICARE Formulary although the company has a Pricing Agreement in place with the TRICARE Retail Refund Program?

A:

Although Section 703 Compliant, there are many reasons as to why a drug may not be covered under TRICARE formulary. All formulary questions should be directed to the TRICARE Industry Liaison via email or by calling 1-210-536-6121.

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

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