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2008 Transparency in Pharmaceutical Purchasing Solutions (TIPPSSM)
Standards
Pharmacy benefit managers that are TIPPS certified must agree to the following standards:
Acquisition Cost for Retail Payments
Charge a Coalition member no more than the amount that it pays the pharmacies in
its retail network for brand and generic drugs.
Acquisition-Based Pricing for Mail Service Claims
Charge a Coalition member the acquisition cost of drugs at mail order pharmacies,
plus a dispensing fee, based on actual inventory cost (AAC) or wholesale acquisition
cost (WAC).
Pass Through of Pharmaceutical Revenue
Pass through any and all pharmaceutical manufacturer revenue that the Coalition
member’s utilization enables the PBM to earn.
Specialty Pharmacy
Provide all transparency standards as described above for specialty pharmacy products.
Plan Management and Consumer Engagement
Provide decision support tools, including online formulary tools, price comparison
functionality, and agree to apply all credits including rebates at the point of
sale.
Right to Audit
Grant a Coalition member full rights to audit their claims, the PBM’s pharmacy contracts,
utilization management clinical criteria, and any and all pharmaceutical manufacturer
contracts and mail service purchasing invoices related to the Coalition member’s
contract to ensure compliance.
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