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1st Amendment 09/17/2014AMY REAVILIN, CPA CLERK OF CIRCUIT COURT & COMPTROLLER WNROE canmr, RonoA DATE: October 03, 2014 TO: Teresa Aguiar, PHR, CPM Director of Employee Services ATTIC• Christine Diaz FROM: Lindsey Ballard, D. CV101 At the September 17, 2014, Board of County Commissioner's meeting the Board granted approval and execution of Item C25 Amendment No. 1 to the Pharmacy Benefit Management Services Agreement with Envision Pharmaceutical Services, LLC, extending the contract through September 30, 2017. Attached is a duplicate original of the above -mentioned for your handling. Should you have any questions please do not hesitate to contact this office. cc: County Attorney (electronic copy) Finance (electronic copy) File �r1���ii1�Mr�M\I�IIOrri7 W I�IrI�� 500 Whitehead Street Suite 101, PO Box 1980, Key West, FL 33040 Phone: 305-295-3130 Fax: 305-295-3663 3117 Overseas Highway, Marathon, FL 33050 Phone: 305-289-6027 Fax: 305-289-6025 88820 Overseas Highway, Plantation Key, FL 33070 Phone: 852-7145 Fax: 305-852-7146 AMENDMENT NO. 1 TO PHARMACY BENEFIT MANAGEMENT SERVICES AGREEMENT This Amendment No. 1 (this "Amendment"), is entered into by and between Envision Pharmaceutical Services, LLC ("Envision"), and Monroe County Board of County Commissioners ("Plan Sponsor"). BACKGROUND Envision and Plan Sponsor are parties to a Pharmacy Benefit Management Services Agreement dated October 1st, 2011 (the "Agreement"), under which Envision provides PBM Services to Plan Sponsor; and The parties desire to amend the Agreement, and therefore Envision and Plan Sponsor agree as follows: 1. The term of the Agreement shall extend to September 30th, 2017. 2. Section 2.4.5 shall be deleted in its entirety. 3. Exhibit 1 shall be deleted in its entirety and replaced with the following: EXHIBIT 1 DRUG PRICING AND FEES Administrative Fee (Payable to Envision; not including fees payable to Plan Sponsor's TPAs, consultants, or brokers,, if any) For Contract Year 2014: $3.50 Per Employee, Per Month (PEPM) For Contract Year 2015: $3.65 PEPM For Contract Year 2016: $3.65 PEPM Fees for Additional Services and Miscellaneous Expenses 77] 1. Replacement by Envision of lost or stolen ID Cards $1.00 per card plus 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 /Monroe County BOC Am. 1073114 c0 Envision Pharmaceutical Services, LLC Page 1 of 4 6. Clinical Prior Authorizations (Initial Coverage Determinations) $8.00 per authorization Drug Pricing and Dispensing Fees Supply/Source BRAND GENERIC Drug Price W Dispensing Drug Price (A) Dispensing For Contract Year (Annual Average Fee (0 (Annual Average Fee (B) 2014 Effective Bate (Annual Effective Rate (Annual (based on 3 year Guarantee) Average Guarantee) Average Agreement) Guarantee) Guarantee) 30 Days' Supply at a AWP minus 15.35% $1.30 AWP minus 75% $1.30 Retail Pharmacy 84 Days' Supply (or greater) at a Retail AWP minus 20% N/A AWP minus 76% N/A Pharmacy (non -Mail Order) Mail Order Pharmacy Acquisition Cost $9.50 Acquisition Cost $9.50 Specialty Pharmacy (Pass -Through of Contract Rate with Dispensing Pharmacy) Supply/Source BRAND GENERIC Drug Price (A) Dispensing Drug Price (A) Dispensing (Annual Average Fee �B> (Annual Average Fee (B) For Contract Year Effective Rate (Annual Effective Rate (Annual 2015 Guarantee) Average Guarantee) Average Guarantee) Guarantee) 30 Days' Supply at a AWP minus 15.45% $1.30 AWP minus 75.50% $1.30 Retail Pharmacy 84 Days' Supply (or greater) at a Retail AWP minus 20.10% N/A AWP minus 76.50% N/A Pharmacy (non -Mail Order) Mail Order Pharmacy Acquisition Cost $9.50 Acquisition Cost $9.50 Specialty Pharmacy (Pass -Through of Contract Rate with Dispensing Pharmacy) Supply/Source BRAND GENERIC Drug Price (A) Dispensing Drug Price (A) Dispensing Far Contract Year (Annual Average Effective Rate Fee (B) (Annual (Annual' Average Effective Rate Fee (B) (Annual 2016 Guarantee) Average Guarantee) Average Guarantee) Guarantee) /Monroe County BOC Am. 1 073114 © Envision Pharmaceutical Services, LLC Page 2 of 4 30 Days' Supply at a AWP minus 15.55% $1.25 AWP minus 76% $1.25 Retail Pharmacy 84 Days' Supply (or greater) at a Retail AWP minus 20.20% N/A AWP minus 77% N/A Pharmacy (non -Mail Order) Mail Order Pharmacy Acquisition Cost $9.50 Acquisition Cost $9.50 Specialty Pharmacy (Pass -Through of Contract Rate with Dispensing Pharmacy) ^l Annual Average Effective Rate 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 (including Claims paid at the U&C Price) during a Contract Year, excluding (i) Compound Drugs; (ii) Limited Distribution Drugs; (iii) drugs dispensed at a Specialty Pharmacy; (iv) Claims from non -Participating Pharmacies, LTC pharmacies, 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; (ix) Claims from any Plan Sponsor owned or affiliated pharmacy which is not a Participating Pharmacy; and (x) Excluded Generics. cBl 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) Limited Distribution Drugs; (iii) drugs dispensed at a Specialty Pharmacy; (iv) Claims from non -Participating Pharmacies, LTC pharmacies, 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; (ix) Claims from any Plan Sponsor owned or affiliated pharmacy which is not a Participating Pharmacy; and (x) Excluded Generics. 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. Within four months after the end of each Contract Year, Envision shall provide Plan Sponsor, upon request, with a report showing the actual Annual Average Effective Rates and Annual Average Dispensing Fees paid by Plan Sponsor for the Contract Year. The Annual Average Effective Rates and Annual Average Dispensing Fees guarantees set forth in Exhibit 1 shall be deemed to have been satisfied if the discounts passed through to Plan Sponsor for all Claims during the Contract Year are equal to or more favorable, in the aggregate, than the drug pricing and dispensing fee guarantees stated for each drug type or category individually. If the amounts paid by Plan Sponsor for all Claims during the Contract Year are less favorable, in the aggregate, than the combined Annual Average Effective Rates and Annual Average Dispensing Fees stated in Exhibit 1, Envision shall credit Plan Sponsor with the difference. 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; or (iv) the utilization data provided by Plan Sponsor (or Plan Sponsor's agent) upon which the calculation of guarantees were based is inaccurate, incomplete, or there is a substantial change in drug utilization patterns of Covered Individuals. 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 /Monroe County BOC Am. 1073114 OO Envision Pharmaceutical Services, LLC Page 3 of 4 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. 4. This Amendment shall be effective October 1s1, 2014 ("Effective Date"). 5. All other terms or provisions of the Agreement not modified by this Amendment or any other amendments or addenda shall remain unchanged. IN WITNESS WHEREOF, Envision and Plan Sponsor have executed this Amendment as of the Effective Date above. For ENVISION: By: 4FrankJ. heehy Executive O icer For PLAN SPONSOR: By. Prmt Name & Title MONROE COUNTY ATTORNEY AC �Y;H AS F RM: L. H LL ASSISTANT COUNTY ATTORNEY Date /Monroe County BOC Am. 1 073114 © Envision Pharmaceutical Services, LLC Page 4 of 4