2nd Amendment 07/17/2019 O.{GOUgTQ
Kevin Madok, CPA
:o
Clerk of the Circuit Court&Comptroller—Monroe County, Florida
,l,�B cOti^
DATE: August 2, 2019
TO: Natalie Maddox
Employee Benefits ,
FROM: Pamela G. Hanco
SUBJECT: July 17°'BOCC Meeting
Attached is an electronic copy of the following item for your handling:
C2 2nd Amendment to the Pharmacy Benefit Management Services Agreement with
Envision Pharmaceutical Services, LLC, the County's Pharmacy Benefit Manager (PBM), revising
Exhibit 1 to the Agreement(Fees and Financial Guarantees) to reflect changes as a result of the
requirement for 90-day mandated refills but elimination of a requirement to use Wahgreens only
for the refills, both implemented in 2018; also, rescission of the 1st Amendment to the PBM
Services Agreement.
Should you have any questions, please feel free to contact me at(305) 292-3550.
cc: County Attorney
Finance
File
KEY WEST MARATHON PLANTATION KEY PK/ROTH BUILDING
500 Whitehead Street 3117 Overseas Highway 88820 Overseas Highway 50 High Point Road
Key West,Florida 33040 Marathon,Florida 33050 Plantation Key,Florida 33070 Plantation Key,Florida 33070
305-294-4641 305-289-6027 305-852-7145 305-852-7145
DocuSign Envelope ID:D7B7FC6D-ED65-4276-B8A1-7090E583AFE7
AMENDMENT NO. 2
TO
PHARMACY BENEFIT MANAGEMENT SERVICES AGREEMENT
This Amendment No. 2 (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 January 1st,2018(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. Any capitalized term used and not identified in this Amendment shall have the same meaning
as defined in the Agreement.
2. Amendment No. 1 is rescinded in its entirety and considered null and void.
3. "Drug Pricing and Dispensing Fees," "Annual Average Effective Rate and Annual Average
Dispensing Fee Guarantee" sections of Exhibit 1 shall be deleted in their entireties and
replaced with Attachment 1 attached hereto and incorporated into the Agreement by this
reference.
4. This Amendment shall be effective January 1,2018.
5. To the extent there is a conflict between this Amendment and the Agreement,therms of tlx:
Amendment shall control. All other terms or provisions of the Agreement not;mod by tl "1 t
Amendment or any other amendments or addenda shall remain unchanged and areicorporata: i-n
herein by reference. f:i m a
IN WITNESS WHEREOF,Envision and Plan Sponsor have executed this Amendm; iat`3s of theA -.0
Effective Date above. Cli . "
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For ENVISION: For PLAN SP SOR:
Monroe Coun oard o ` • Corn 'ssioners
DocuSigned by: /
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Jane4tUd Yonsa4ao... By. S is J.'
By: r by /
General Manager, Commercial Print Name&Title
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Monroe County Board of Commissioners Ame i WI 'I i y aceutical Services,LLC Page 1 of 4
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DocuSign Envelope ID:D7B7FC6D-ED65-4276-B8A1-7090E583AFE7
ATTACHMENT I
Drug Pricing and Dispensing FeeS(A)
Supply/Source BRAND GENERIC
.............
For Contract Year I Drug Price(B)(1) Dispensing Drug Price(B)(c) Dispensing
(1/l/2018-12/31/2018) (Annual Average Fee(C) (Annual Average Fee(C)
(based on 3 year Effective Rate (Annual Effective Rate (Annual
Agreement) Guarantee) Average Guarantee) Average
Guarantee) Guarantee)]
Retail Pharmacy (30 AWP minus 16.75% $1.00 AWP minus $1.00
Days' Supply) 75.00%
..........
Retail Pharmacy (84
Days' Supply or AWP minus 22.00% N/A AWP minus N/A
greater) (non-Mail 83.00%
Order)
Mail Order Pharmacy AWP minus
(84 Days' Supply or AWP minus 24.00% N/A 85.00% N/A
greater)(1)
Specialty Pharmacy(E) Pass Through of Contracted Rate with Dispensing Pharmacy
Supply/Source BRAND GENERIC
For Contract Year 2 Drug Price(1)(C) Dispensing Drug Price(B)(C) Dispensing
(1/l/19-12/31/19) (Annual Average Fee(C) (Annual Average Fee(C)
(based on 3 Effective Rate (Annual Effective Rate (Annual
year Guarantee) Average Guarantee) Average
Agreement) Guarantee) Guarantee)
Retail Pharmacy ('30 AWP minus 17.00% $1.00 AWP minus $1.00
Days' Supply) 77.50%
Retail Pharmacy (84
Days' Supply or AWP minus 22.25% N/A AWP minus N/A
greater non-Mail 83.25%
Order)(")
Mail Order Pharmacy AWP minus
(84 Days' Supply or AWP minus 24.25% N/A N/A
greater)(F) 85.25%
Specialty Pharmacy("') Pass Through of Contracted Rate with Dispensing Pharmacy
Monroe County Board of Commissioners Amendment No.2 042519C)Envision Pharmaceutical Services,LLC Page 2 of 4
DocuSign Envelope ID:D7B7FC6D-ED65-4276-B8A1-7090E583AFE7
Supply/Source BRAND GENERIC
Drug Price(B)(C) Dispensing Drug Price(B)(c) Dispensing
For Contract Year 3 based-12/31/2 on 3 yearr (Annual Average Fee(C) (Annual Average` Fee(c)
(1/( Effective Rate (Annual Effective Rate (Annual
(based
Agreement) Guarantee) Average Guarantee) Average
Guarantee) Guarantee)
Retail Pharmacy(30 AWP minus 17.00% $1.00 AWP minus $1.00
Days' Supply) 78.00%
Retail Pharmacy (84
Days' Supply or AWP minus 22.50% /A AWP minus N/A
greater) (non-Mail 83.50%
Order)(D)
Mail Order Pharmacy
(84 Days' Supply or AWP minus 24.50% N/A AWP moms N/A
greater)cF>
85.50/®
Specialty Pharmacy(') Pass Through of Contracted Rate with Dispensing Pharmacy
(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-SpanC (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.
(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) drugs dispensed at a Specialty Pharmacy; (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 which is not a Participating Pharmacy;
Monroe County Board of Commissioners Amendment No.2 0425190 Envision Pharmaceutical Services,LLC Page 3 of 4
DocuSign Envelope ID:D7B7FC6D-ED65-4276-B8A1-7090E583AFE7
(xi) manually processed Claims; (xii) coordination of benefits Claims; and (xiii) Medicaid
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.
(')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 For all other purposes, Specialty
Drugs are excluded from all Effective Rate Guarantees.
(')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 I 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. The Annual Average Effective Rates and Annual Average Dispensing
Fees guarantees set forth in Exhibit I 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 and after application of any additional offsets allowed under this
Agreement, than the combined Annual Average Effective Rates and Annual Average Dispensing
Fees stated in Exhibit 1, Envision shall credit Plan Sponsor with the difference as set forth below.
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 change+/- 20% 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.
Monroe County Board of Commissioners Amendment No,2 0425190 Envision Pharmaceutical Services,LLC Page 4 of 4