Backup Documents 10/22/2019 Item #16E 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 E 1
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
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.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Risk Risk Management
2. County Attorney Office County Attorney Office
,1)4-4
4. BCC Office Board of County l>J
Commissioners \ 10\z`*\
4. Minutes and Records Clerk of Court's Office —d �-- /014031 ,Valk``
5. Procurement Services Procurement Services
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 Staff Ana Reynoso/PURCHASING Contact Information 239-252-8950
Contact/Department
Agenda Date Item was October 22,2019 V Agenda Item Number 16.E.1
Approved by the BCC
Type of Document AMENDMENT Number of Original 2
Attached Documents Attached
PO number or account N/A 16-0036-Amend Envision
number if document is Envision Pharmaceutical
to be recorded Pharmaceutical Services, LLC
Services, LLC
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 signatur' STAMP OK N/A
2. Does the document need to be sent to another agency for a. 'tional signa s? If yes, N/A
provide the Contact Information(Name;Agency;Address;Phone orr an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be AR
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 AR
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's AR
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
should be provided to the County Attorney Office at the time the item is input into SIRE.
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 10/22/2019 and all changes made during N/A is not
the meeting have been incorporated in the attached document. The County 1 ► an option for
Attorney's Office has reviewed the changes,if applicable. ✓ this line.
9. Initials of attorney verifying that the attached document is the version approved by the '/A is not
BCC, all changes directed by the BCC have been made,and the document is ready for the C ,, option for
Chauruan's signature. ine.
1 6 E 1
MEMORANDUM
Date: October 25, 2019
To: Ana Reynoso,
Procurement Services
From: Teresa Cannon, Sr. Deputy Clerk
Minutes & Records Department
Re: Amendment to Contract #16-0036 "Pharmacy Benefit
Management Services"
Contractor: Envision Pharmaceutical Services, LLC
Attached for your records is an original of the referenced document above,
(Item #16E1) adopted by the Board of County Commissioners on Tuesday,
October 22, 2019.
The Board's Minutes & Records Department has kept an original as part of
the Board's Official Records.
If you have any questions, please feel free to contact me at 252-8411.
Thank you.
Attachment
16E1
AMENDMENT TO AGREEMENT No. 16-0036 FOR
PHARMACY BENEFIT MANAGEMENT SERVICES
THIS AMENDMENT made and entered into on this p1r\flf/ day of
2019, by and between Envision Pharmaceutical Services, LLC f/k/ajEnvision Pharmaceutical
Services, Inc. (the "Contractor") and Collier County, a political subdivision of the State of Florida,
(the "County"):
WHEREAS, on September 24, 2013, (Agenda Item 11.G), the County entered into an
Agreement with Envision Pharmaceutical Services, Inc. to provide Pharmacy Benefit Management
services to the Collier County Group Health Insurance Plan with an effective date of January 1, 2014
and ending December 31, 2016 with a one-year automatic renewal option; and
WHEREAS, on or about October 28, 2013, Envision Pharmaceutical Services, Inc.,
through a Declaration of Conversion filed with the Ohio Secretary of State, converted all the shares of
its capital stock into membership interests in Envision Pharmaceutical Services, LLC (the "LLC"),
that became effective on or about November 4, 2013, and the LLC is now the correct named party to
Agreement No. 16-0036; and
WHEREAS, on September 13, 2016, (Agenda Item 16.E.8), the County approved an
Amendment to the Agreement to: (1) update Exhibit I Drug Pricing and Fees, to become effective
January 1, 2017, and (2) revise Subsection 6.1 Term, providing for an initial term of two years with
an option to renew for two additional one (1) year terms; and
WHEREAS, the parties desire to further amend the Agreement to (1) extend the contract
through December 31, 2020, (2) replace Exhibit 1, and (3) formally acknowledge the Contractor's
name change to the LLC as a result of the corporate conversion.
NOW, THEREFORE, in consideration of the mutual promises and covenants herein
contained, it is agreed by the parties as follows:
1. 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, 2020 and shall
remain in full force and effect through December 31, 2020, unless earlier terminated as
provided herein.
* * *
2. Exhibit 1 Drug Pricing and Fees is hereby replaced in its entirety with Exhibit 1-2020.
3. The Contractor's corporate name shall hereafter be revised, known and reflected in
Agreement No. 16-0036, wherever referenced as Envision Pharmaceutical Services, LLC.
Words Stfuek-Through are deleted; Words Underlined are added
* * *
Page 1 of 2
Amendment to Agreement#16-0036
16E1
IN WITNESS WHEREOF,the Parties have executed this Amendment on the date and year first
written above by an authorized person or agent.
ATTEST:
Crystal K.Kinzel,Cler11 f Courts& BOARD OF COUNTY COMMISSIONERS
Comptroller , `}'/..,«; COLLIER COUNTY, FLORIDA
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` W� tam L. Mc Daniel Jr.,Chat an
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Attest+as Co s.
signature only.
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Page 2 of 2 Deputy Jerk
Amendment to Agreement#16-0036
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EXHIBIT 1-2020
CAS`
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Collier County Board of Commissioners
PHARMACY BENEFIT MANAGEMENT SERVICES AGREEMENT
Update to Exhibit 1
Effective January 1St, 2020
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).
Administrative Fee (Payable to Envision; not including fees payable to Plan Sponsor's TPAs,
consultants, or brokers, if any)
$1.85 per Claim
Fees for Additional Services and Miscellaneous Expenses
1. Manually create or update the Eligibility File $1.00 per Covered Individual data entry
2. Custom Eligibility File layouts (accommodation
or development) $1,000.00 per layout
3. Replacement by Envision of lost or stolen ID $1.00 per card plus cost of postage
Cards (individual)
4. Member Communications Cost of production and postage
5. Custom Website Quoted upon request
6. Standard Online Reporting User Access Standard Online Reporting includes access
for 3 active Plan Sponsor users and 1
consultant user. A licensing fee of
$1,200.00 would apply for each additional
user.
7. Ad Hoc Computer or Report Programming $150 per hour for development of a non-
standard report, with a minimum of$500
8. Incoming Data Transfer Files $250.00 per industry-standard file
(non-industry standard file formats will be
quoted upon request)
9. Submission of Medicare Part D subsidy $1.00 per Member, per month, minimum
$2,000 per year
10. Customized Formulary $0.20 per Member, per month
11. Coverage Determinations (including Clinical Prior $35.00 per request
Authorizations)
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12. Redeterminations (Internal Appeals) $125 per request
13. External Appeals including services of an 100%pass-through of costs incurred
Independent Review Organization (IRO) (ranging between $250 to $350 per appeal,
average cost is approximately $300 per
appeal)
14. Coverage Determinations—Pain Management
(includes Opioid naive patients, immediate release
opioids before extended release opioids, and 200
mg per day cumulative Morphine Equivalent Dose
(MED)) $35.00 per request
15. Value Added Services—Pain Management
(includes Retrospective Review - case
management and enhanced opioid refill
surveillance) $0.10 per Member, per month
16. e-Prescribing $0.30 per transaction, minimum of$250.00
per month for Member and drug eligibility
verification through SureScripts hub
17. Claim Adjustment Checks (charged to Plan
Sponsor for reimbursements made to Covered
Individuals for Claim adjustments requested by
Plan Sponsor.) $8.50 per check
18. Explanation of Benefits (EOB) production and
distribution $1.00 per EOB plus postage
19. Manual Claims Processing (including DMRs)
$3.00 per Claim processed
20. Medicaid Subrogation Claim Adjudication $3.50 per Claim
21. Plan Sponsor Error: Manually reverse and
reprocess Claims due to Plan Sponsor error $1.75 per Claim (paid and reversed)
22. Drug Therapy Care Gap Management $0.55 per Member, per month
23. Medication Adherence and Persistency (up to
three disease states) $0.55 per Member, per month
24. Outgoing Data Transfer Files (Claims History,
Prior Authorization Files, Open Refill Files (Mail
and Specialty), Accumulator Files (deductible,
out-of-pocket, etc.), and/or related participant data $5,000 for any or all of the identified
files (i.e. patient addresses, etc.) reports
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25. ControlTrakRx On-site pharmacy audit $1,500 per onsite audit'
26. Run-Out Claims transmitted post termination $2.24 per Claim
Drug Pricing and Dispensing Fees(A)
Supply/Source BRAND GENERIC
Drug Price(B)(C) Dispensing Drug Price(B)(C) Dispensing
(Annual Average Fee(C) (Annual Average Fee(C)
For Contract Year 1 Effective Rate (Annual Effective Rate (Annual
Guarantee) Average Guarantee) Average
Guarantee) Guarantee)
Retail Pharmacy (30 AWP minus 18.00% $0.85 AWP minus $0.85
Days' Supply) 81.50%
Retail Pharmacy (84
Days' Supply or AWP minus
greater) (non-Mail AWP minus 22.50% N/A N/A
83.50%
Order)(D)
Mail Order Pharmacy
(84 Days' Supply or AWP minus 24.00% N/A AWP minus N/A
greater at 85.50%
EnvisionPharmacies)(F)
Specialty Drugs Priced per Envision Specialty Drug List
Dispensed at Specialty Annual Average Aggregate Guarantee:
Pharmacy (at
EnvisionPharmacies)(E) AWP minus 18.00% with no Dispensing Fee
(A) For purposes of this Agreement the "Average Wholesale Price" or "AWP" means the average wholesale
price of a Covered Drug indicated on the most current pricing file provided to Envision by Medi-Span® (or
other applicable industry standard reference on which pricing hereunder is based)for the actual drug dispensed
using the 11 digit National Drug Code (NDC) number provided by the dispensing pharmacy. Envision uses
a single source for determining AWP and updates the AWP source file at least once weekly.
(B) For purposes of this Agreement, the "Annual Average Effective Rate" means, for the category of drugs
being reviewed,the result calculated by the following formula:
1. (IC/AWP)-1,where IC(the"Ingredient Cost")is the sum of all amounts paid by Plan Sponsor for the
ingredient costs of the Covered Drugs paid to Participating Pharmacies in the designated Network
during the Contract Year, before deducting applicable Manufacturer Derived Revenue;and
2. AWP is the sum of the Average Wholesale Price amounts associated with the same Covered Drugs
during the Contract Year. 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.
' Retail pharmacy audits and/or investigations are available only to Envision clients enrolled in the ControlTrakRx
Retail Pharmacy Audit program.
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(C)The Annual Average Effective Rate and Annual Average Dispensing Fee is calculated using actual price
paid by Envision to Participating Pharmacies in the designated Network, plus any Cost Share, (the
Ingredient Cost)for all Claims for the applicable category above(including Claims paid at the U&C Price)
during a Contract Year, excluding(i)compound drugs;(ii)Limited Distribution Drugs; (iii) Specialty
Drugs; (iv)Claims from non-Participating Pharmacies,LTC pharmacies, home infusion or government
owned or operated pharmacies(e.g. Veterans Administration); (v)Claims paid at government required
amounts(e.g. Medicaid); (vi)340B Claims; (vii)vaccines; (viii)non-Prescription Drugs (including OTC);
(ix) drugs in limited supply; (x)Claims from any Plan Sponsor owned or affiliated pharmacy; (xi) direct-
member reimbursement(DMR) Claims; and(xii) subrogation Claims.
(D)84 Days' supply or greater at retail pharmacy guarantees apply only if Plan Sponsor's Benefit Plan
includes a 90 days' supply at retail benefit for the entire Contract Year.
(F)In no event will the Retail Pharmacy or Mail Order Pharmacy pricing terms specified in the Agreement,
including, but not limited to, the Annual Average Effective Rate and Annual Average Dispensing Fee
guarantees, apply to Specialty Drugs dispensed at a Specialty Pharmacy. Plan Sponsor is required to utilize
the Envision Exclusive Specialty Pharmacy Program beginning on the Effective Date of this Agreement;and
Members are required to use the Envision Specialty Pharmacy on the first fill of a covered Specialty Drug.
(F)The calculation is inclusive of the postage expense of Mail Order Claims. Should any United States Postal
Service(USPS)or commercial carrier postage rate increase during the contract term, such increase will be
passed through to Plan Sponsor via an equal increase to the Mail Order dispensing fee.
Annual Average Effective Rate and Annual Average Dispensing Fee Guarantee
Plan Sponsor acknowledges that the Annual Average Effective Rates and Annual Average Dispensing Fees
specified in this Exhibit 1 are conditioned upon Plan Sponsor's adherence to certain conditions under this
Agreement and that the actual Annual Average Effective Rates and Annual Average Dispensing Fees will
also depend on Plan Sponsor's drug utilization and mix of Participating Pharmacies. If the amounts paid by
Plan Sponsor during the Contract Year for all Claims in any category in Exhibit 1 with a specified rate (i.e.
30 Day Retail Brand Drug; 30 Day Retail Brand Drug Dispensing Fee; 30 Day Retail Generic Drug; 30 Day
Retail Generic Drug Dispensing Fee; 90 Day Retail Brand Drug; 90 Day Retail Generic Drug; 90 Day Mail
Brand Drug; 90 Day Mail Generic Drug) are less favorable than the Annual Average Effective Rates and
Average Dispensing Fees stated in Exhibit 1, Envision shall credit Plan Sponsor with the difference for that
category. Envision shall not be liable to Plan Sponsor for shortfalls in guaranteed Annual Average Effective
Rates or Annual Average Dispensing Fees if(i) Plan Sponsor makes a change to the Benefit Plan at any time
(regardless of whether or not such change is required by law);(ii)the configuration of System edits is modified
by Plan Sponsor; (iii) Plan Sponsor does not adhere to the Formulary; (iv) the utilization data provided by
Plan Sponsor (or Plan Sponsor's agent) upon which the calculation of guarantees were based is inaccurate,
incomplete; (v)there is a substantial change in drug utilization patterns of Covered Individuals; or(vi) Plan
Sponsor terminates before completion of the applicable, full Contract Year. In addition,Plan Sponsor agrees
that Envision's liability to Plan Sponsor for shortfalls in financial guarantees, in the aggregate, for any
Contract Year shall be limited to amounts paid by Plan Sponsor to Envision for Administrative Fees during
the applicable Contract Year, and Plan Sponsor has no right of offset to withhold any payment due Envision
under this Agreement for any amounts Plan Sponsor believes are owed by Envision for financial guarantees.
Annual Average Manufacturer Derived Revenue Guarantee(cmo,(0,0)
For Contract Year 1:
• For 30 days' supply of Brand Drugs at a Retail Pharmacy - $147.56 per paid Brand Drug Claim
• For 84 days' supply of Brand Drugs at a Retail Pharmacy - $346.34 per paid Brand Drug Claim
• For 84 days' supply of Brand Drugs at the Mail Order Pharmacy - $600.40 per paid Brand Drug
Claim
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• For Specialty Brand Drugs - $1,278.93 per paid Specialty Brand Drug Claim
(G)Manufacturer Derived Revenue guarantees are stated as annual average amounts per Contract Year.
(H) 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. Guarantees are
contingent upon Plan Sponsor employing a Plan Sponsor-funded Benefit Plan design in which, in general,
Plan Sponsor funds a minimum of fifty percent(50%)of the cost of the Covered Drug.
(I) Claims dispensed by Pharmacies participating in 340B program, Claims not eligible for Manufacturer
Derived Revenue (e.g. Vaccines, Compounds, Direct Member Reimbursement Claims, etc.), OTC drug
Claims(with the exception of diabetic testing supplies and insulin), subrogation claims, Limited Distribution
Drugs, biosimilars, Claims pursuant to 100% Member Copayment plan, and Claims from any Plan Sponsor
owned or affiliated pharmacy, shall be excluded from the calculation of the guarantees above.
0)Guarantees require Plan Sponsor to utilize current Envision Select Formulary.
Plan Sponsor acknowledges that the annual average Manufacturer Derived Revenue guaranteed amounts
specified in this Exhibit 1 are conditioned upon Plan Sponsor's adherence to certain conditions under this
Agreement.
(a) If the Manufacturer Derived Revenue advanced to Plan Sponsor for the Contract Year is, overall,
lower than the overall Manufacturer Derived Revenue earned by Plan Sponsor for the Contract Year,Envision
shall pay the difference to Plan Sponsor, after application of any additional offset allowed under this
Agreement.
(b) If the Manufacturer Derived Revenue earned by Plan Sponsor for the Contract Year is,overall,lower
than the annual average Manufacturer Derived Revenue guaranteed amounts specified above,in the aggregate,
Envision shall pay the difference to Plan Sponsor,after application of any additional offset allowed under this
Agreement.
Notwithstanding anything herein to the contrary,Envision shall not be liable to Plan Sponsor for any shortfall
in guaranteed Manufacturer Derived Revenue if: (i) Plan Sponsor makes a change to the Benefit Plan at any
time (regardless of whether or not such change is required by law); (ii) the configuration of System edits is
modified by Plan Sponsor; (iii) Plan Sponsor does not adhere to the Formulary; (iv) the utilization data
provided by Plan Sponsor(or Plan Sponsor's agent) upon which the calculation of guarantees were based is
inaccurate, incomplete; (v) there is a substantial change in drug utilization patterns of Covered Individuals;
(vi) there is a loss of rebates due to pharmaceutical manufacturer drug patent expirations, manufacturer
bankruptcy, or removal of a drug from the market; (vii) there are changes in pharmaceutical manufacturer
rebate contracting terms or policies;(viii)Plan Sponsor's Benefit Plan does not meet the conditions for rebates
of pharmaceutical manufacturer contracts including market share rebates; (ix) if Plan Sponsor has been
excluded by a manufacturer; (x) there is any governmental regulation, ruling, or guidance that impacts
Envision's ability to maintain current Manufacturer Derived Revenue yields;or(xi)Plan Sponsor terminates
before completion of the applicable, Contract Year. Plan Sponsor agrees that Envision's liability to Plan
Sponsor for shortfalls in financial guarantees, in the aggregate, for any Contract Year shall be limited to
amounts paid by Plan Sponsor to Envision for Administrative Fees during the applicable Contract Year, and
Plan Sponsor has no right of offset to withhold any payment due Envision under this Agreement for any
amounts Plan Sponsor believes are owed by Envision for financial guarantees.
*Financial guarantees and fees are contingent upon Plan Sponsor maintaining at least 4,674 Members each
month for each Contract Year. If the annual average of enrollment falls 20% or more from 4,674, Plan
Sponsor acknowledges and agrees that Envision may modify the financial guarantees or fees.
Ac