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Pharmaceutical Manufacturers: Billing of 1QCY2008 through 2QCY2009

Billing of 1QCY2008 through 2QCY2009

The 1QCY2008 through 2QCY2009 utilization files were released by the government. Invoice/Demand Letters were issued September 17, 2012 with a payment due date in October 17, 2012.

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Q1:

Why did the Defense Health Agency bill 2008 when we have made waiver/compromise requests that includes that period? (Published January 2013)

A:

The Defense Health Agency (DHA) sent out the utilization data so that Pharmaceutical Manufacturers may calculate refunds due to pursuant to 32 CFR § 199.21 and to enable timely resolution of manufacturer disputes. The DHA resolved pending waiver/compromise requests when sending out letters for 1Q CY2008- 2Q CY2009. At the present time, the DHA is only considering compromise of debt resulting from increased billings of drugs covered by VARRs executed prior to January 28, 2008.

Q2:

Why did the Defense Health Agency send out billings when the appeal is still pending in the case of the Coalition for Common Sense v. United States Department of Defense? (Published January 2013)

A:

The appeal is no longer pending. On January 4, 2013, the U.S. Court of Appeals affirmed the District Court's decision that DoD has the authority to require funds from manufacturers going back to January 29, 2008. View the Court of Appeals for the District of Columbia Circuit Opinion

Q3:

We've seen a number of billing schedules posted. Which is the most current one? (Published January 2013)

A:

The Defense Health Agency (DHA) will strive to meet the scheduled utilization file release date for each quarter; however, billing schedules are subject to change. The DHA will notify the Pharmaceutical Manufacturers when the actual quarter utilization files are released and update the schedule with the actual date. View the Billing Schedule

Q4:

How will the refund amount be calculated? (Published January 2013)

A:

Recalculations for CY2008 and the first two quarters of CY2009 are derived using per package methodology. Beginning with 3QCY2009, any recalculations will be based on the refund calculation method (unit vs. FCP Package Size) selected by the manufacturer on their DoD Retail Refunds Pricing Agreement. If no method is selected, the calculation method will default to FCP Package Size.

Q5:

What about payments manufacturers have already made-how will they be applied? What if we paid more than this calculation-how do we get a refund? (Published January 2013)

A:

Based on prior payments received, if an overpayment exists, the Defense Health Agency (DHA) will not issue a refund of any overage balances. The DHA will be applying additional monies received over and above the original calculations to NDCs that still have outstanding balances. The additional amount of the overpayment will be held until future communication is received from the Pharmaceutical Manufacturer. Please contact your DHA assigned Financial Manager in Aurora to coordinate the applying of these funds to any outstanding balances in subsequent quarters.

Q6:

If some covered drugs were sold to other companies, how will this be handled? (Published January 2013)

A:

The manufacturer that owned the drug at the time of dispensing will be invoiced.

Q7:

What's the process to dispute utilization data for rebilled quarters? (Published January 2013)

A:

Disputes of the accuracy of the TRICARE utilization data should be entered into the TRICARE Retail Refunds Website via the manufacturer's covered drug page.

Q8:

What happened to the waiver/compromise request we submitted for the 1QCY2008 - 2QCY2009 billing periods? (Published January 2013)

A:

The Defense Health Agency (DHA) responded to waiver/compromise requests for 1QCY2008 - 2QCY2009 refund debt in late 2012. At the present time, the DHA is only considering compromise of debt resulting from increased billings of drugs covered by VARRs executed prior to January 8, 2008.

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

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