# Presentation: 836644

## Department of Defense Uniform Formulary and Pricing Update

## 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

## DoD Uniform Formulary

**NDAA 2000**
**Uniform Formulary Final Rule**
- Published Spring 2004
- Established processes & framework
- Outpatient pharmacy program
- Not a drug list
**A P&T process, not a contracting process**

## 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?**

## 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 P&T process (collective professional judgment) vs. traditional FAR contracting**

## 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

## 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)

## 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**

## 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**

## UF Review Results

- On Uniform Formulary (UF)

- Non-Formulary

- BCF

**CLO NYS**

- MIC  KET  BUT  NAF

**AF-DERMs**

- ECO  SUL CIC OXI  SER

- VAR

**PDE-5s**

- SIL  TAD

- ECF**

- 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 P&T Committee to fill UF non-formulary drugs (ESO, EPR, ECO, SUL, CIC, OXI, SER, SIL, TAD)

- _Must_ have on MTF formulary**

- _May_ have on MTF formulary

- _Cannot_ have on MTF formulary

## Coming soon...

**August 2005**
- CCBs
- ACEs
- BPH Alpha Blockers

**November 2005**
- Antidepressants
- Nasal Corticosteroids
- Alzheimer’s agents
- Macrolide / Ketolides

- Projected Classes to be Reviewed at the P&T Schedule page on the PEC website

## Uniform Formulary Rx Co-Pays

## 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 P&T 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

## Overview of P&T Cycle

**PEC prepares preliminary review (T-180)**
**P&T 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)
**P&T Committee meets (T)**
- Final drug class review
- Makes UF recommendations
**BAP meets (T+45)**
- Reviews recommendations
- Sends comments to TMA
**TMA Executive Director reviews and signs minutes (T+60)**
**Implementation of decisions (no later than T+240)**

## Resources

**HA Policy 04-032**
- _[http://www.ha.osd.mil/policies/2004/04-032.pdf](http://www.ha.osd.mil/policies/2004/04-032.pdf)_
**UF BPA Information**
- _[http://www.tricare.osd.mil/ufbpa/UFBPA_Info.cfm](http://www.tricare.osd.mil/ufbpa/UFBPA_Info.cfm)_
**DoD P&T Committee Minutes**
- _[http://www.tricare.osd.mil/pharmacy/PT_Cmte/default.htm](http://www.tricare.osd.mil/pharmacy/PT_Cmte/default.htm)_
**DoD P&T Committee Schedule**
- _[http://www.pec.ha.osd.mil/PT_Committee.htm](http://www.pec.ha.osd.mil/PT_Committee.htm)_
**Individual drug status**
- _[http://](http://www.tricareformularysearch.org/)__[www.tricareformularysearch.org](http://www.tricareformularysearch.org/)_

## Moving On...

**David Bretzke, PharmD**
- DoD Pharmacoeconomic Center
- (210) 295-1271
- _[David.Bretzke@amedd.army.mil](mailto:David.Bretzke@amedd.army.mil)_
**	****	****	****	****	****	*****Thank You***