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Backup Documents 09/13/2016 Item #16E 8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO RL1 E THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATU Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Routed by Procurement Services to the Office Initials Date Following Addressee(s) (In routing order) 1. Risk Risk Management (,\ILL )VU 1© 2. County Attorney Office County Attorney OfficeCrn E\ I 'iI 'I 3. BCC Office Board of County Commissioners "per [ zAk 4. Minutes and Records Clerk of Court's Office �pq Q 1 1/i 3: s; 1 5. Return to Procurement Services Division Procurement Services —r Contact: Viviana Giarimoustas PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. / Name of Primary Camille Shim-Marinos for Sandra Herrer , Phone Number 239-252-4270✓ Procurement Staff 10/19/2016 Contact and Date VVV Agenda Date Item was 9/13/2016 Agenda Item Number 16.E.8 Approved by the BCC Type of Document Contract Number of Original 2 V/ Attached Documents Attached PO number or account N/A Solicitation/Contract 16-0036 /Pharmacy number if document is Number/Company Benefit Manageme to be recorded Name Services agreement INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature? -t-'I1 , h1C .€' M I A 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be TSM signed by the Chairman,with the exception of most letters,must be reviewed and signed �. by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the N/A document or the fmal negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's CJSM signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip C'15 , should be provided to the County Attorney Office at the time the item is input into SIRE. jj Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on the date above and all changes made CJSM f`` during the meeting have been incorporated in the attached document. The County p, + Attorney's Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the 4 • BCC,all changes directed by the BCC have been made,and the document is ready for the 1i Chairman's signature. I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WINS Original 9.03.04,Revised 1.26.05,Revised 224.05;Revised 11/30/12 1 t: a,`� MEMORANDUM Date: October 21, 2016 To: Camille Shim-Marinos Procurement Services From: Teresa Cannon, Deputy Clerk Minutes & Records Department Re: Amendment #3 to Contract #16-0036 "Pharmacy Benefit Management Services Agreement" Contractor: Envision Pharmaceutical Services, Inc. Attached is an original of the document referenced above, (Item #16E8) approved by the Board of County Commissioners on Tuesday, September 13, 2016. The second original has been held by the Minutes and Records Department as part of the Board's Official Record. If you have any questions, please contact me at 252-8411. Thank you. Attachment uux 1bj Amendment#A to"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 Agreexfient, 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 l" 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 5 ,2016 Dwight E. Brock, Clerk BOA'II OF COUNT COMMISSIONERS _ OF ' LIER CO �l Y', ORIDA By: tteSt aS`f19:. {� lerk Donna Fiala, Chairman siunature only. First witness: Env.:'an T utical Services,Inc. By: By: A Print Name W-DNQT t, ar \ r e• Second Witness: Print Name and Title B : aproved as to Form and Legality: Y' Print Name "• sistant County Attorney q•13./�p [16-PRC-03130/1277286/1] Language deleted has been straek-through. New language has been underlined. 0 EN VifIONR 16E8 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 4009 Clearly, Beneficial. 2 L I 6 8 ENVifiONR iuraci {Uf_C m m 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 17% AWP minus (Non-legend Drugs 80.25% AWP minus (Non-legend Drugs 30 Days' Supply at ao AWP minus Retail Pharmacy 16.75% $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. Clearly. Beneficial. 3 16 E8 /� i urat) 'urac�; E N !/ I . I O N i 'UraC (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. wr Clearly. Beneficial. 4 16E E N 1/ I J I N R ucae� uraei (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 C3eariy. Beneficial. 5