#16-0036 (Envision) Amendment #3 3
Amendment#Xto"Pharmacy Benefit Management Services Agreement"
This Amendment, dated _q_i 3_.� , 2016 to the referenced Agreement shall be by and between the
parties to the original Agreei1ent, dated January 1,2014, Envision Pharmaceutical Services,Inc.,an Ohio
Corporation, (to be referred to as "Envision") and Collier County Board of Commissioners, a political
subdivision of the State of Florida(to be referred to as"Plan Sponsor").
Statement of Understanding
RE: "Pharmacy Benefit Management Services Agreement"
The parties hereby agree to amend the Agreement as provided below:
Change # 1: Exhibit 1 Drug Pricing and Fees is replaced in its entirety with the attached "Update to
Exhibit 1"effective January 1,2017.
Change#2: Subsection 6.1 Term, is hereby replaced in its entirety with the following:
6.1. Term: The term of this Agreement shall commence on January 1, 2017 and shall remain in full force
and effect for an initial term of two(2)years("Initial Term")unless earlier terminated as provided herein.
Upon the expiration of the Initial Term, this Agreement may be renewed for two additional (1) one year
terms, subject to the mutual approval by the parties, in writing, at least ninety (90) days prior to the
commencement of each renewal term. If either party hereto does not notify the other in writing according
to the renewal notice provision,the Agreement will terminate at the end of the current term.
All other terms and conditions of the agreement shall remain in force.
IN WITNESS WHEREOF, the parties have each, respectively, by an authorized person or agent, have
executed this Amendment on the date(s)indicated below.
Accepted Sc r .\ 13 ,2016
Dwight E. Brock, Clerk
BOA'4 OF COUNT COMMISSIONERS
OF 90
LIER CO 1,1 Y', ORIDA
B
i 1 By:
tteSt as to:. , 1? {�k
lerk Donna Fiala, Chairman
s
ignature only.
First i ess:
/�, Env': on ` .;i� utical Services,Inc.
By: C�L.L `
T lc' a Il By:
S n P.�./ ' r
Print Name ( ZOK2.1"
•t, a- /N t F/�/f
Second Witness: Print Name and Title (3 i
B n,,� : 'proved as to Form and Legality:
Print Name `) sistant County Attorney q•iZ•/(p
[16-PRC-03130/1277286/1] Language deleted has been struck through. New language has been underlined.
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Collier County Board of Commissioners
PHARMACY BENEFIT MANAGEMENT SERVICES AGREEMENT
Update to Exhibit 1
Effective January 1, 2017
The rates and terms set forth below replace the same rates and terms of any prior Exhibit 1 as of the
effective date above (i.e.the changes set forth herein are not retroactive).
Drug Price(B) Dispensing Drug Price(C) Dispensing
For Contract Year (Annual Average Fee(D) (Annual Average Fee(D)
2017 Effective Rate (Annual Effective Rate (Annual
Guarantee) Average Guarantee) Average
Guarantee) Guarantee)
AWP minus 17% AWP minus 80%
(Non-legend Drugs (Non-legend Drugs
30 Days' Supply at a AWP minus AWP minus
Retail Pharmacy 16.75%) $1.15 16.75%) $1.15
(Specialty Drugs: (Specialty Drugs:
AWP minus AWP minus
16.50%) 16.50%)
AWP minus 22% AWP minus 82%
(Non-legend Drugs (Non-legend Drugs
90 Days' Supply at a AWP minus 22%) N/A AWP minus 22%) N/A
Retail Pharmacy (Specialty Drugs: (Specialty Drugs:
AWP minus AWP minus
16.50%) 16.50%)
AWP minus 24% AWP minus 83%
Mail Order Pharmacy (Non-legend Drugs (Non-legend Drugs
(at Orchard AWP minus 24%) N/A AWP minus 24%) N/A
Pharmaceutical (Specialty Drugs: (Specialty Drugs:
Services) AWP minus AWP minus
16.75%) 16.75%)
Specialty Pharmacy (Pass-Through of Contract Rate with Dispensing Pharmacy)
(at Orchard
40,
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EN V •I f i O N R( ,uracI i rec
4rzlam
Pharmaceutical
Services)
Drug Price(B) Dispensing Drug Price(C) Dispensing
For Contract Year (Annual Average Fee(D) (Annual Average Fee(D)
2018 Effective Rate (Annual Effective Rate (Annual
Guarantee) Average Guarantee) Average
Guarantee) Guarantee)
AWP minus
AWP minus 17% 80.25%
(Non legend Drugs (Non-legend Drugs
30 Days' Supply at a AWP minus AWP minus
Retail Pharmacy 16.75/o) $1.15 16.75%) $1.15
(Specialty Drugs:
AWP minus (Specialty Drugs:
16.50%) AWP minus
16.50%)
AWP minus 22% AWP minus 82%
(Non-legend Drugs (Non-legend Drugs
90 Days' Supply at a AWP minus 22%) N/A AWP minus 22%) N/A
Retail Pharmacy (Specialty Drugs: (Specialty Drugs:
AWP minus AWP minus
16.50%) 16.50%)
AWP minus 24% AWP minus 83%
Mail Order Pharmacy (Non-legend Drugs (Non-legend Drugs
(at Orchard AWP minus 24%) N/A AWP minus 24%) N/A
Pharmaceutical (Specialty Drugs: (Specialty Drugs:
Services) AWP minus AWP minus
16.75%) 16.75%)
Specialty Pharmacy
(at Orchard (Pass-Through of Contract Rate with Dispensing Pharmacy)
Pharmaceutical
Services)
(A) Calculated price using the applicable negotiated contract rate (i.e.AWP or MAC rate, or U&C Price)
for the designated Network. The AWP discounts shown in the table above are Annual Average Effective
Rates using current Medi-Span published values. If the calculated price is lower than the allowable
amount under any state Medicaid "Favored Nations" rule, Envision shall pass-through, and Plan
Sponsor shall pay,the Medicaid allowable amount.
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ENVIfIONF lug) ' `'
(B)Annual Average Effective Rate for Brand Drugs is calculated using the actual price paid by Envision
(before deducting earned Manufacturer Derived Revenue) to Participating Pharmacies in the
designated Network, plus any Cost Share, (the Ingredient Cost) for all Brand Drug Claims (including
Claims paid at the U&C Price) during a Contract Year, excluding (i) Compound Drugs; (ii) drugs
dispensed at a Specialty Pharmacy; (iii)Claims from non-Participating Pharmacies,LTC pharmacies,or
government owned or operated pharmacies (e.g. Veterans Administration); (iv) Claims paid at
government required amounts (e.g. Medicaid); (v) 340B Claims; (vi) non-Prescription Drugs; and (vii)
Claims from Plan Sponsor's owned pharmacies,if any.
(C)Annual Average Effective Rate for Generic Drugs is calculated using actual price paid by Envision to
Participating Pharmacies in the designated Network, plus any Cost Share, (the Ingredient Cost) for all
Generic Drug Claims (including Claims paid at the U&C Price) during a Contract Year, excluding (i)
Compound Drugs; (ii) drugs dispensed at a Specialty Pharmacy; (iii) Claims from non-Participating
Pharmacies, LTC pharmacies, or government owned or operated pharmacies (e.g. Veterans
Administration); (iv) Claims paid at government required amounts (e.g. Medicaid); (v) 340B Claims;
(vi) non-Prescription Drugs; and (vii) Claims from Plan Sponsor's owned pharmacies,if any.
(D)Annual Average Dispensing Fee is the average per Claim fee for all Claims by Envision to
Participating Pharmacies in the designated Network(including Claims paid at the U&C Price) during a
Contract Year,excluding(i) Compound Drugs; (ii) drugs dispensed at a Specialty Pharmacy; (iii)
Claims from non-Participating Pharmacies, LTC pharmacies,or government owned or operated
pharmacies (e.g.Veterans Administration); (iv) Claims paid at government required amounts (e.g.
Medicaid); (v) non-Prescription Drugs;and (vi) Claims from Plan Sponsor's owned pharmacies,if any.
Annual Average Earned Manufacturer Derived Revenue Guarantee(E),(F).(G),(H)
For Contract Year 2017:
• For 30 Day Supply of Brand Drugs at a Retail Pharmacy- $66.63 per paid Brand Drug Claim
• For 90 Day Supply of Brand Drugs at a Retail Pharmacy-$141.15 per paid Brand Drug Claim
• For 90 Day Supply Brand Drugs at the Mail Order Pharmacy- $202.59 per paid Brand Paid
Claim
• For a Specialty Drug at a Retail Pharmacy: $846.08 per paid Brand Drug Claim
• For a Specialty Drug at the Specialty Pharmacy: $662.25per paid Brand Drug Claim
For Contract Year 2018:
• For 30 Day Supply of Brand Drugs at a Retail Pharmacy- $71.74 per paid Brand Drug Claim
• For 90 Day Supply of Brand Drugs at a Retail Pharmacy-$154.37 per paid Brand Drug Claim
• For 90 Day Supply Brand Drugs at the Mail Order Pharmacy- $219.53 per paid Brand Paid
Claim
• For a Specialty Drug at a Retail Pharmacy: $973.66 per paid Brand Drug Claim
• For a Specialty Drug at the Specialty Pharmacy: $745.03 paid Brand Drug Claim
(E) Earned Manufacturer Derived Revenue guarantees are stated as annual average amounts per
Contract Year.
Ire
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•
EN VIPON ' `) ` c;
(F)Guarantees require Plan Sponsor to maintain a Benefit Plan that has a tier structure with a minimum
$20 differential in Cost Share between preferred Brand Drugs and non-preferred Brand Drugs.
(G)340B Claims,Claims paid entirely by Covered Individuals,and Claims processed from Plan Sponsor's
owned pharmacies,if any,shall be excluded from the calculation of the guarantees above.
(H)Guarantees require Plan Sponsor to utilize current Envision Select Formulary
Administrative Fee (Payable to Envision; not including fees payable to Plan Sponsor's TPAs,
consultants, or brokers, if any)
For Contract Year 2017 &2018: $1.85 per Claim
Fees for Additional Services and Miscellaneous Expenses
1. Replacement by Envision of lost or stolen ID $1.00 per card plus $0.15 per packet and
Cards cost of postage
2. Manual Claims Processing (including DMRs) $1.50 per Claim processed
3. Claim Adjustment Checks (charged to Plan
Sponsor for reimbursements made to Covered
Individuals for Claim adjustments requested
by Plan Sponsor.) $8.50 per check
4. Manually create or update the Eligibility File $1.00 per Covered Individual data entry
5. Ad Hoc Computer or Report Programming $150.00 per hour
6. Clinical Prior Authorizations (Initial Coverage
Determinations) $35.00 per authorization
7. Drug Therapy Care Gap Management $0.55 per Member,per month
8. Medication Adherence and Persistency(up to
three disease states) $0.55 per Member,per month
9. Additional User to Access RxBirt (beyond 1
user) $1,200.00 per user
10.Custom Formulary Management The greater of$0.20 per Member per
month (PMPM) or$2,000.00 per month
040
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