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HomeMy WebLinkAboutMINUTES - 05092006 - SD.2 y TO: BOARD OF SUPERVISORS Contra FROM: William Walker, M.D., Health Services Director :; Costa SD r By: Jacqueline Pigg, Contracts Administrator " ' • Z DATE: AP.r'il 26, 2006 c � " " County SUBJECT: Approval of Contract #27-633 with AmeriHealth Mercy Health Plan (dba AmeriHealth Mercy Contractor) SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND JUSTIFICATION RECOMMENDATION(S): _ Approve and authorize the Health Services Director, or his designee (Richard Harrison) to execute on behalf of the County, Contract #27-633 with AmeriHealth Mercy Health Plan (dba AmeriHealth Mercy Contractor), a partnership, in an amount not to exceed $76,000,000, to provide pharmacy administration services for the Contra Costa Health Plan (CCHP), for the period from May 1, 2006 through April 30, 2009. In accordance with the terms of the agreement, County and Contractor agree to a mutual indemnification clause to hold each other harmless for any claims arising out of the performance of this contract. FISCAL IMPACT: This Contract is funded 100% by Contra Costa Health Plan Member Premiums. Actual costs will depend upon usage. BACKGROUND/REASON(S)FOR RECOMMENDATION(S): The Contra Costa Health Plan (CCHP) is changing its contracted Pharmacy Benefits Manager (PBM) to meet the required terms of the Health Plan Individual and Group Health Plan membership contracts. Both the State Department of Health Services and the Federal Centers for Medicare and Medicaid Services (CMS) require a Pharmacy Benefits Manger who can develop, maintain, and manage a large pharmacy network and monitor the correct dispensing of drug benefits, co-pays under multiple group product lines adhering to the required Health Plan Formulary and Health Plan Prior authorization protocol. Since CCHP has filed with CMS to become a Special Needs Plan for dual eligible Medi-Cal and Medicare beneficiaries and may offer Medicare Part D drugs, the skills and expertise of a Pharmacy Benefits Manager (PBM) who can oversee all of the CCHP business lines is much more complex. Due to the complexity of this Contract, CCHP reviewed three bids last Fall from three separate PBM organizations including NMHC, Med-Impact and Perform Rx (a subsidiary of AmeriHealth Mercy Health Plan). The Contra Costa Health selected Perform Rx in January 2006 based upon the following factors: 1. Perform Rx offers an expanded contracted network of pharmacies with nearly all pharmacies CONTINUED ON ATTACHMENT: YES SIGNATURE: of ✓RECOMMENDATION OF COUNTY ADMINISTRATOR RE M NDATION OF BOA D C MITTEE ,---APPROVE OTHER SIGNATURE (S): ACTION OF BOARD O �, d(st�plC/ AP/PjROXED AS ECOM ENDED OTHER VOTE OF SUPER ISORS �Lc ;LL I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN UNANIMOUS (ABSENT AND ENTERED ON THE MINUTES OF THE BOARD AYES: NOES: �(/� � OF SUPERVISORS ON THE DATE SHOWN. ABSENT: ABSTAIN: ATTESTED Contact Person: Richard Harrison 313-6008 JOHN CU N, CLERK OF THE BOARD OF ) SUPERVI ORS AND COUNTY ADMINISTRATOR CC: Health Services Department (Contracts) Auditor Controller Risk Management BY © ` DEPUTY Contractor 1' Board Order Page 2 in Contra Costa County, including all national chains and the new addition of Walgreen's county- wide. These national chains are also under contract nationally which will assists all CCHP members who travel and require emergency drug coverage. 2. Perform Rx is owned by a HMO AmeriHealth Mercy Health Plan who also provides health plan coverage to both Medi-Cal and Medicare members including a Medicare approved Skilled Needs Plan with Part D coverage. Both the parent company and their PBM, Perform Rx are knowledgeable about the Medicare requirements for filing and complying with Skilled Needs Plans and Part D provider status. Their consultation to the health plan has been and remains an integral part of this contract as a value-added service. 3. Perform Rx offers better local account management to CCHP and expanded hours of a member and provider call center(9a.m. to 9p.m. Monday through Friday and 9a.m. to 1p.m. on Saturday). 4. Perform Rx has an enhanced computer program which will simplify eligibility and benefit plan daily information transmittal between the Health Plan and the many pharmacies in their expanded pharmacy network throughout the county. Perform Rx has more sophisticated chain payment processes and standardized report packages which are included in this contract than the current vendor at no extra costs to CCHP. 5. The costs to CCHP under this contract with Perform Rx will decrease substantially due to decreased prior authorization costs and enhanced rebates. 6. The contract also includes aggressive performance guarantees with financial penalties for accurate and timely service, reports, claims payments and member and provider satisfaction. In accordance with the terms of the agreement, County and Contractor agree to a mutual indemnification clause to hold each other harmless for any claims arising out of the performance of this contract. Approval of Contract #27-633, will allow the Contractor to act as the Contra Costa Health Plan's Pharmacy Benefits Manager including, but not limited to, providing pharmacy administration services for CCHP members, providing drug utilization review, prior authorization procedures, account management, member pharmacy call center, analysis and reporting services and developing partnerships with prescribers and pharmacies,through April 30, 2009. ADDENDUM TO SD.2 MAY 99 2006 On this day the Board of Supervisors considered approving and authorizing the Health Services Director, or designee, to execute a contract with AmeriHealth Mercy Health Plan (dba AmeriHealth Mercy Contractor) in an amount not to exceed $76,000,000 to provide pharmaceutical and pharmacy administration services for the Contra Costa Health Plan for the period May 1, 2006 through April 30, 2009, including a mutual indemnification and hold harmless agreement for any claims arising out of the performance of this contract. Ralph Hoffinan, Danville resident, asked if the contract with AmeriHealth Mercy Health Plan was the lowest responsive and responsible bidder and if so, asked how many bidders there were. Chief Executive Officer, Health Services Department Richard Harrison said over the life of the existing contract they have gone to the market several times with general Request for Proposals. He explained they did this two years ago and received 13 responses, some of which had no operations on the West Coast or had other problems that made them unacceptable to the Health Services Department. Mr. Harrison said contractors whose responses were acceptable were asked to revise and update their proposals, and out of three that met all the criteria they chose Perform RX. Supervisor Uilkema noted that she and Supervisor Glover are on the Committee overseeing the Contra Costa Health plan and agreed this is a cost-conscious health plan and addresses issues of cost without sacrificing the quality of service to members. By a unanimous vote with none absent, the Board of Supervisors took the following action: APPROVED and AUTHORIZED the Health Services Director, or designee, to execute a contract with AmeriHealth Mercy Health Plan in an amount not to exceed $76,000,000 to provide pharmaceutical and pharmacy administration services for the.Contra Costa Health Plan for the period May 1, 2006 through April 30, 2009.