TRICARE Medicare Eligible Program (TMEP2) Industry Forum

Questions & Answers / Clarifications

This document provides the government's responses to questions raised by industry during the TMEP2 (TRICARE Medicare Eligible Pharmaceutical program) Industry One-on-One follow-up session. It clarifies various aspects of the upcoming procurement.

• Accumulator Establishment: For TRICARE Medicare-eligible beneficiaries, accumulators (deductible, cost-share, catastrophic cap) will be established based on data from the Defense Enrollment Eligibility Reporting system (DEERS). The current and prior four years of data are stored.
• Cutover Model: The transition will follow a "date of receipt" cutover model, not a "date of service" model. The contractor is responsible for claims received starting Option Period 1, regardless of their service dates.
• Historical Data: Historical claims data will be provided by the outgoing contractor. Historical accumulator and cost-share balance data will also be provided for reference and reconciliation. This historical data is expected to be migrated for operational use.
• Performance Guarantees: Performance guarantees and incentives will be enforced from the start of Option Period 1. Beneficiary satisfaction metrics will begin in the third quarter of the first option period.
• Provider Validation: Provider validation will be conducted using the DHA centralized TRICARE Encounter Provider Records (TEPRV). If a provider is not listed, the contractor must obtain and maintain documentary evidence of their eligibility.
• Teaming Arrangements: Contractor Teaming Arrangements (CTAs) are permitted. The government will require identification of key subcontractors or CTA members at the time of proposal submission. Workshare limitations between CTA members and subcontractors are not anticipated.

This document provides significant clarifications that bidders must consider when preparing their proposals. Key areas impacted include transition procedures, data handling, performance expectations, and teaming strategies. The final solicitation will include further details on these and other transition requirements.

Other / Unclassified

This document is a list of attendees for the TRICARE Medicare Eligible Program Second Generation (TMEP2) Industry Day. It includes the organization name, contact name, and contact email for each attendee.

This document is relevant to potential bidders as it identifies companies and individuals who attended the TMEP2 Industry Day. This information can be useful for understanding the competitive landscape, identifying potential partners or subcontractors, and gauging industry interest in the TMEP2 program.

Other / Unclassified

This document is a presentation from an industry forum held on January 27, 2026, for the TRICARE Medicare Eligible Program 2nd Generation (TMEP-2). The forum was conducted by the Defense Health Agency (DHA) for ongoing market research purposes to help the government define requirements and engage with industry regarding capabilities. It outlines the purpose of the forum, disclaimers regarding pre-decisional information, the scope of TMEP, high-level requirements, the anticipated solicitation process, small business goals, and the award timeline.

This presentation provides insight into the government's objectives and requirements for the TMEP-2 program. Key areas covered include:

• TMEP Scope: Claims processing and customer support for Military Health System (MHS) beneficiaries.
• High-Level Requirements: Claims processing, customer service, management functions (quality, fraud/abuse prevention), and transition activities.
• Solicitation Process: The final solicitation is anticipated in Q2 CY26, with a pre-solicitation notice to be posted at least 15 days prior.
• Small Business Goals: DHA is committed to promoting small business opportunities, with specific subcontracting goals outlined.
• Award Timeline: Key milestones such as RFP issuance, proposal due dates, and contract award are provided.
• Key Contract Objectives: Accurate and cost-effective claims processing, high-quality customer service, effective management, and smooth transition planning.
• Updates: A revised TRICARE Operations Manual (TOM) 2021 edition, Chapter 20, will be included with the final solicitation.