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2011 Transparency in Pharmaceutical Purchasing Solutions (TIPPSSM)
Standards
Pharmacy benefit managers that are TIPPS certified must agree to a detailed and comprehensive set of criteria based on the following transparency principles:
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 average actual inventory cost (AAIC) 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,
and agree to allow the carve-out of specialty pharmacy distribution to a third party if requested by the Coalition member.
Plan Management and Consumer Engagement
Provide decision support tools to engage consumers, including online formulary tools and price comparison
functionality, and agree to apply rebates at the point of sale if requested by the Coalition member.
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 to ensure compliance with the Coalition member’s contract.
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