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2nd Amendment 07/19/2023
Kevin Madok, cpA Clerk of the Circuit Court& Comptroller— Monroe County, Florida DATE: Jul), 25, 2023 TO: 11n,an Cook, Director Employee Services ATTN: Natalie Maddox Sr. Employee Benefits Administrator FROM: Panicla G. Hwico 4(-1. SUBJECT: Jul), 19" 110CC Meeting Allaclicd is an, electronic cop),offlic following item for)'our handling: D21 Second Amendment to Pliannac), Benefit Management Services Agreement "111i Capital Rx, Inc., to provide Plianiiac)- Benefits Management scr%lces and an, Eniplo),cr Group Waiver Program ['or ciiiplo)ves, retirees, and dependents, to extend the terns of the Agrcenierit to cover 1/1/2024 - 12/31/2026. 11ils renewal reflects aii increase in ),car I of renewal period (Year I oftlic contract) ol'approxiniatel), $ 0.50 per clalini (7.69%) 1'()r processing, aild all increase iri )vars 5 and 6 of thecontract of$ 0.15 (.021%) per claim. D22 Fourth Amendment to Administrative Services Ageement with f1ori'da Blue, in the amount ol'approxiniatcIN- $1.1 million dollars, extending die term oft-lic Agreement bN1 live (5) )ears (I)cginnirig 1/1/21 dirougli 12/31/28), to continue providing Claims Administration, Case Management and I TIllization Review Senices, Disease Management, Network Management, M'ellness Programs raid ollier Related Services to Moriroe Count),. Sliould ),oil liavc aii),questions please feel free to contact nie at (305) 292-3550. CC: Comity Atlonic), Fillance File KEY WEST MARATHON PLANTATION KEY PK/ROTH BUILDING 500 Whitehead Street 3117 Overseas Highway 88820 Overseas Highway 50 High Point Road Key West,FIcKida 33040 Marathon,Florida 33050 Plantation Key,Florida 33070 Plantation Key,Florida 33070 305-294-4641 305-289-6027 305-852-7145 305-852-7145 SECOND AMENDMENT TO PHARMACY BENEFIT MANAGEMENT SERVICES AGREEMENT This Second Amendment (hereinafter `'Agreement") to the Pharmacy Benefit Management Services Agreement dated January 1,2021 ("Agreement"),is made and entered into this I st day of January,2024,by and between Monroe County Board of County Commissioners ("Sponsor"), and Capital Rx, Inc. ("Capital Rx"). Each of Sponsor and Capital Rx is sometimes individually referred to herein as a"Party" and together as the "Parties". WHEREAS, Capital Rx operates a prescription benefit management program for sponsors requestiong prescription benefit management and related services; and WHEREAS, Sponsor provides for the payment of prescription drugs and related services for persons eligible to receive such benefits; and WHEREAS, Sponsor desires to continue to utilize the services of Capital Rx and certain of its Affiliates, including an entity that holds a Pharmacy Benefit Manager ("PBM"), Third Party Administrator ("TPA"), or similar license, to provide a prescription drug benefit program for its Members; and WHEREAS, the Parties wish to amend the Agreement in order to extend the term of the Agreement and also to amend other terms and conditions; NOW, THEREFORE, in consideration of the covenants and agreements set forth herein, Capital Rx and Sponsor agree as follows: 1. The parties agree to update the Agreement in order to comply with new requirements under applicable Law. a. Section 5.3 of the Agreement shall be deleted in its entirety and replaced with the following: Ownership. Sponsor shall maintain exclusive ownership of Claims data but will provide Capital Rx with a non-exclusive, perpetual license to utilize such data such that Capital Rx may 1) provide the PBM Services under this Agreement, 2) for internal use, and 3) as otherwise allowed by Law. Any clinical and other programs implemented by Capital Rx, including any Formulary,together with any related materials,manuals, lists and descriptions provided hereunder,will remain the exclusive property of Capital Rx. b. Section 6.3 of the Agreement shall be deleted in its entirety and replaced with the following: Exceptions. "Confidential Information" does not include information that (a) prior to disclosure hereunder was known by the Receiving Party, provided that there has not been a violation of any confidentiality obligation to the Disclosing Parry, (b) is or subsequently becomes publicly available without violation of any confidentiality obligation owed to the Disclosing Party, (c) is independently developed by the Receiving Party without violation of this Agreement, (d) is required to be disclosed under the Employee Retirement Income 1 Security Act (ERISA), as amended, or (e) is disclosed with the written approval of the Disclosing Party. c. Section 6.8 of the Agreement is hereby renumbered as Section 6.9. d. The following shall be added as Section 6.8 of the Agreement: No Gag Clauses.Nothing in this Agreement or the Schedules hereto shall be construed to be a gag clause that would operate to restrict the Plan from electronically accessing de-identified Claims data for each Plan participant upon request on a per Claim basis or prevent the Plan from sharing such information with a Plan business associate. e. Section 9.1 of the Agreement shall be deleted in its entirety and replaced with the following: Compliance with Law. The Parties represent and warrant that, at all times under this Agreement, they will comply with all Laws governing the performance of their respective businesses and to the performance of their respective obligations hereunder,including without limitation any Laws, including but not limited to ERISA, as amended, relating to the disclosure or notification of compensation,plan benefits,Rebates to Groups and/or Members, or Plan level Prescription Drug information. By signing this Agreement, Sponsor confirms that it has been provided with and has reviewed Capital Rx's compensation disclosures set forth in Schedule G in accordance with ERISA 408(b)(2). The Parties further represent and warrant that each shall maintain all licenses, certifications, and/or qualifications that are required by Law relating to the operation of their respective businesses and/or to comply with their obligations under this Agreement. f. Section 9.2 of the Agreement shall be deleted in its entirety and replaced with the following: Independent Contractors. The relationship between Capital Rx and Sponsor is solely that of independent contractors engaged in the operation of their own respective businesses.Nothing contained in this Agreement shall be construed as creating an employee/employer or agency relationship. Sponsor will not represent that Capital Rx or any of its Affiliates is a Plan Administrator or fiduciary of a Plan or any Group, as applicable, as those terms are used in the Employee Retirement Income Security Act,including applicable regulations. g. Section 9.3 through 9.21 of the Agreement are hereby renumbered as Section 9.4 through 9.22. h. The following shall be added as Section 9.3 of the Agreement: Named Fiduciary. Sponsor is the named fiduciary for the Plan(s) and is responsible for and shall have the sole discretion to decide all matters pertaining to the interpretation and administration of the Plan. Capital Rx provides solely ministerial service functions in connection with the Plan(s)sponsored by Sponsor. Sponsor acknowledges that it has the sole authority to control and administer the Plan(s). Although Sponsor has delegated to Capital Rx the authority to perform administrative and/or clinical initial coverage determinations and appeals Sponsor has complete discretionary,binding,and final authority to construe the terms of the Plan(s),to interpret ambiguous language,to make factual determinations regarding the payment of benefits,to review denied claims and to resolve any complaints by Members. i. The following shall be added to the end of Schedule A, Section 6. of the Agreement: Page 2 of 12 M. Prescription Drug Disclosures. Capital Rx will provide Sponsor with the information required for Sponsor to meet Prescription Drug reporting requirements under the Consolidated Appropriations Act of 2021 (the "CAA"). Aggregated Prescription Drug information will include the reports as outlined by the Centers for Medicare and Medicaid Services (CMS) or the Department of Labor(DOL)that are attainable solely from prescription Claims data. Unless the Parties make a separate agreement, the annual reporting described in this Schedule A, Section 6., M will be provided to the Sponsor reasonably in advance of Sponsor's reporting requirements subject to additional fees as outlined in Schedule B, Section 6. Estimated compensation disclosures made pursuant to ERISA Section 408(b)(2) will be made reasonably in advance of the parties entering into, extending or renewing this Agreement. j. The following shall be added to Schedule B, Section 8. of the Agreement: No Violation of Law. Nothing in this audit provision should be read to prevent Sponsor from electronically accessing de-identified Claims data for each Plan participant upon request on a per claim basis, including access to Claim-related financial information, relevant service codes, and any other data element in Claim or encounter transactions, nor from sharing the information that is accessed with a Plan business associate, pursuant to the execution of a confidentiality agreement. k. Schedule G,as set forth below, shall be added to the Agreement. 2. The parties agree to incorporate new Value-Added Administrative Services for which Sponsor will not be charged unless Sponsor elects such services. a. Section 6 of Schedule A of the Agreement shall be deleted in its entirety and replaced with the following: 6. VALUE-ADDED ADMINISTRATIVE SERVICES (OPTIONAL) Upon Sponsor election, Capital Rx will provide the following Value-Added Administrative Services. The pricing terms applicable for Value-Added Administrative Services are set forth in Schedule B. A. Specialty Programs. i. RxCap Program.* Capital Rx will provide Sponsor the RxCap program to maximize the value of manufacturer-sponsored copay assistance program(s) for target Specialty Drugs filled through the Specialty Pharmacy. ii. RxContain Program.* Capital Rx will provide Sponsor the RxContain program that coordinates Member enrollment into alternative funding programs for target Specialty Drugs(i.e.,carve-out).Alternative funding programs include,but are not limited to, manufacturer-sponsored and/or charitable organization-sponsored patient assistance programs. B. Custom Network Management. Capital Rx will work with Sponsor to establish a custom network of Participating Pharmacies. Sponsor and Capital Rx agree to work in good faith to support Capital Rx's contracting with such pharmacies.Capital Rx will Page 3 of 12 provide Sponsor ongoing custom network configuration and management services in accordance with the terms of this Agreement. C. Custom Formulary Management. Capital Rx will work with Sponsor to establish a custom Formulary, provided that the drugs included on Sponsor's custom Formulary have been evaluated by a Pharmacy and Therapeutics Committee. Capital Rx will provide Sponsor ongoing custom Formulary configuration and management services in accordance with the terms of this Agreement and will work with Sponsor to affect the adoption, distribution, and implementation of such Formulary. D. Rx Unite.* Capital Rx will deploy Rx Unite reporting in addition to Capital Rx's standard reporting suite for Sponsor's Plan. Sponsor, and any designated third parties, shall work with Capital Rx to load additional benefit information, including but not limited to medical claims. By combining this additional benefit information with the Paid Claims administrated by Capital Rx under this Agreement, Capital Rx will work with Sponsor to provide plan specific insights on chronic conditions to improve overall Plan performance. E. White Labelled Member Communications. Capital Rx will white-label standard Member communications to Sponsor's branding and design requirements. F. Rx Concierge PA.* High-touch program streamlines the prior authorization process through proactive outreach and improves the Member and provider experience. Prescribers receive proactive, outbound telephone call(s) based on reject reports that initiate the prior authorization process in near real time. When a coverage determination is made following review, the provider, pharmacy and Member each receive an outbound telephone call to review the determination outcome and next steps. G. Rx Smart Save.* Currently includes two levels: i. Level 1: Low-cost alternative opportunities are identified at the point of adjudication and Members receive a push notification through Capital Rx's Member tools outlining cost-savings available by utilizing a lower cost alternative. ii. Level 2: Capital Rx pharmacist performs proactive outreach to Members and providers in order to facilitate a switch to a lower-cost alternative. Pharmacist outreach is based on claim reports that initiate outreach in near real time. H. Rx Control (Split Fill).* Rx Control eliminates unnecessary Drug spend for Sponsor by targeting oral Specialty Drugs that are often associated with early discontinuation due to tolerability and/or side effects. Medications targeted in this program are limited to as a fifteen(15)day supply,as opposed to the traditional thirty(30)day fill. A team member from the Specialty Pharmacy contacts a Member before each fill to monitor side effects,assess member response and address any barriers to care. L Rx Ally.* Rx Ally promotes safe use of opioids by implementing opioid restrictions at the point of sale. J. Rx Helix.* Capital Rx proprietary algorithms identify Members eligible for a pharmacogenomics test("PGx test") and Capital Rx clinical teams engage Members with the opportunity to register for a PGx test. Upon Member registration, a PGx test Page 4 of 12 is conveniently mailed to a Member's home and the results are received within 7-10 days. Following receipt of PGx test results, a pharmacist conducts a Personalized Medication Review(PMR)with the Member and addresses findings directly with their prescriber. K. Rx Enhance.* Rx Enhance is designed to improve adherence and address gaps in care for Members with diabetes, hypertension, high cholesterol, COPD and asthma via multichannel member communication and real-time provider notification. There are two levels of care available: 1. Level 1: Monthly motivational Member text messaging to address barriers to adherence and JUDI-enabled prescriber notifications to close gaps in care. 2. Level 2: In addition to Level 1 interventions, clients who opt into Level 2 also receive high-touch pharmacist outreaches to Members and prescribers to address other key clinical issues. L. Other Value-Added Administrative Services. Sponsor will pay for additional Value-Added Administrative Services provided by Capital Rx as utilized by Sponsor and as set forth in Schedule B. *After election, Sponsor must provide at least one hundred and eighty(180) days prior written notice to discontinue this service. 3. The parties agree to extend the Initial Term of the Agreement through December 31, 2026. a. The table of Minimum Effective Rate Guarantees in Section 1 of Schedule B of the Agreement shall be deleted in its entirety and replaced with the following: 1st 2na 3ra 4tn 5tn 6tn Contract Contract Contract Contract Contract Contract Year Year Year Year Year Year Retail Brand 30 18.00% 18.25% 18.50% 18.65% 18.80% 18.95% Retail Brand 90 21.50% 21.75% 22.00% 22.05% 22.20% 22.35% Retail Generic 30 86.00% 87.00% 88.00% 88.05% 88.25% 88.45% Retail Generic 90 86.00% 87.00% 88.00% 88.05% 88.25% 88.45% b. The table of Maximum Dispensing Fee Guarantees in Section 1 of Schedule B of the Agreement shall be deleted in its entirety and replaced with the following: 1st 2na 3ra 4tn 5tn 6tn Contract Contract Contract Contract Contract Contract Year Year Year Year Year Year Retail Brand 30 $0.75 $0.65 $0.50 $0.50 $0.50 $0.50 Retail Brand 90 $0.50 $0.50 $0.50 $0.50 $0.50 $0.50 Page 5 of 12 Retail Generic 30 $0.75 $0.65 $0.50 $0.50 $0.50 $0.50 Retail Generic 90 $0.50 $0.50 $0.50 $0.50 $0.50 $0.50 c. The table of Minimum Effective Rate Guarantees in Section 2 of Schedule B of the Agreement shall be deleted in its entirety and replaced with the following: 1st 2na 3ra 4tn 5tn 6tn Contract Contract Contract Contract Contract Contract Year Year Year Year Year Year Mail Brand 25.00% 25.25% 25.50% 25.55% 25.60% 25.65% Mail Generic 86.00% 87.00% 88.00% 88.05% 88.25% 88.45% d. The table of Maximum Dispensing Fee Guarantees in Section 2 of Schedule B of the Agreement shall be deleted in its entirety and replaced with the following: 1st 2na 3ra 4tn 5tn 6tn Contract Contract Contract Contract Contract Contract Year Year Year Year Year Year Mail Brand $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Mail Generic $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 e. The table of Minimum Effective Rate Guarantees in Section 3 of Schedule B of the Agreement shall be deleted in its entirety and replaced with the following: 1st 2na 3ra 4tn 5tn 6tn Contract Contract Contract Contract Contract Contract Year Year Year Year Year Year Exclusive Specialty 19.00% 19.25% 19.50% 19.65% 19.80% 19.95% Open Specialty 18.00% 18.25% 18.50% 18.65% 18.80% 18.95% f. The table of Maximum Dispensing Fee Guarantees in Section 3 of Schedule B of the Agreement shall be deleted in its entirety and replaced with the following: 1st 2na 3ra 4tn 5tn 6tn Contract Contract Contract Contract Contract Contract Year Year Year Year Year Year Mail Specialty $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Retail Specialty $0.75 $0.65 $0.50 $0.50 $0.50 $0.50 Page 6 of 12 g. The table of Minimum Guaranteed Rebates in Section 4 of Schedule B of the Agreement shall be deleted in its entirety and replaced with the following: 1st 2nd 3rd 4tn 5tn 6tn Contract Contract Contract Contract Contract Contract Year Year Year Year Year Year Retail Brand 30 $172.00 $186.00 $200.00 $214.00 $232.00 $252.00 Retail Brand 90 $500.00 $556.50 $605.00 $625.00 $650.00 $675.00 Mail Brand $600.00 $670.00 $740.00 $770.00 $780.00 $790.00 Brand Specialty $1,800.00 $1,925.00 $2,075.00 $2,385.00 $2,535.00 $2,705.00 h. The table of fees for Core Administartive Services in Section 6 of Schedule B of the Agreement shall be deleted in its entirety and replaced with the following: 1st 2nd 3rd 4tn 5tn 6tn Contract Contract Contract Contract Contract Contract Year Year Year Year Year Year Per Paid Claim $6.50 $6.50 $6.50 $7.00 $7.15 $7.30 Administrative Fee i. The table of fees for Value-Added Administrative Services in Section 6 of Schedule B of the Agreement shall be deleted in its entirety and replaced with the following: 16 It 16 IB IB 16 Eli2ibility&Accumulation Services Manual Eligibility $2.00 per eligibility record change Electronic Prescribing $0.16 per positive eligibility transaction Retroactive Termination Letters $1.50 per letter Custom Coding (post-implementation only) $5,000 per occurrence ID Cards and Communications Welcome Booklet(with or without ID Cards) $3.00 plus postage ID Card Reissues $1.50 plus postage Targeted Member Mailings $1.50 plus postage Special Mailing Requests Quoted upon request Claims Processin2 and Payment Out-of-Cycle Reversals $0.50 per out-of-cycle reversal Claim Direct Member Reimbursement(DMR) and $2.00 per DMR or RCA Claim,plus Core Retroactive Claim Adjustments (RCA) Administrative Fee Subrogation Claims $4.00 per subrogated Claim,plus Core Administrative Fee Manual Overrides $0.50 per manual override Check Processing Fee $50.00 per check High Dollar Claim Review (HDCR) $0.50 per Claim review Utilization Review Services Page 7 of 12 Clinical Prior Authorization Review $45.00 per pharmacist mediated review Urgent Clinical Prior Authorization Review $60.00 per pharmacist mediated review Standard Is'and 2nd Level Appeals Processing $400 per review Urgent Appeals $550 per review Independent Review Organization (IRO) services—access panel of IROs for external Pass through of fees from IRO entities reviews Value-Added Support Services Custom Drug List Management $1,000 per month per list Specialty Services RxCap Program $100.00 per RxCap Paid Claim Specialty Carve-Out Service Support $0.25 -$0.50 per Paid Claim RxContain Program 20%of program savings Custom Network Management Quoted upon request based on scope Custom Formulary Management Quoted upon request based on scope White-Labelled Member Communications Quoted upon request based on scope Rx Unite $5,000 one-time implementation fee + $0.50 PMPM Rx Concierge (High Touch PA Program) $2.00 PMPM(standard PA fees apply) Rx Smart Save Level 2 $0.50 PMPM Rx Control $0.03 PMPM Rx Ally No program fee; standard PA fees apply for manual clinical reviews and overrides Rx Helix $500 per case Rx Enhance Level 1 $0.10 PMPM <2,OOOlives: $1.50PMPM Rx Enhance Level >2,000 lives: $1.00 PMPM Network Audit/Fraud,Waste and Abuse Sponsor-requested audits of pharmacy On-site audit: $2,500 per audit Desk audit: $1,000 per audit Custom FWA Program Quoted upon request Compliance Services Section I I I Reporting $1,500 per submission CAA Reporting Annual report bundle: $500 each Submission support: $1,500 Additional S12onsor Audits Sponsor Audits (>1 per year) $15,000 per additional audit Retiree Services RDS Support Services $1.00 -$6.50 PMPM, depending on enrollment and services required RDS Re-openings Quoted upon request EGWP Support Services Quoted upon request Post-Termination Services Open Refill Transfer File (ORTF) $4,500 per file Prior Authorization History File $3,500 per file Accumulator History File $2,500 per file Page 8 of 12 4. All other terms or provisions of the Agreement not modified by this Second Amendment, or any other amendments or addenda shall remain unchanged. [SCHEDULE G FOLLOWS] Page 9 of 12 SCHEDULE G COMPENSATION DISCLOSURE Pursuant to the requirements in the Employee Retirement Income Security Act of 1974 (ERISA) Section 408(b)(2)(B) (29 U.S.C. 1108(b)(2)(B)),' Capital Rx has prepared the following disclosure of all compensation it reasonably expects to receive this calendar year in connection with various services Capital Rx will perform on behalf of Sponsor, as set forth in the Agreement. We have prepared this disclosure in good faith,based on reasonable diligence,and in order to support Sponsor,recognizing that Capital Rx may not qualify as a covered service provider under any given client contract or arrangement. Description of Services: Capital Rx will be providing Pharmacy Benefit Management Services("PBM Services")as enumerated in Section 2 and Schedule A of the Agreement. Fiduciary Status: Capital Rx will not provide,nor does it reasonably expect to provide, services under this Agreement that will confer upon Capital Rx the status of a plan fiduciary, as defined in ERISA or under applicable state law. See Section 9 of the Agreement. Direct Compensation: Capital Rx earns administrative fees in connection with the services it performs on behalf of Client. Those administrative fees are referenced in Section 4 of the Agreement and enumerated in Schedule B. Capital Rx may enter into collaborative arrangements with brokers, consultants, and other businesses and individuals called "Channel Partners," which receive direct compensation from Sponsor or Capital Rx; Capital Rx does not receive any direct or indirect compensation from Channel Partners. Any direct compensation Sponsor pays the Channel Partner via Capital Rx if applicable is expressly indicated in the Agreement at Schedule B under the heading "Authorized Third Parties". Capital Rx contracts with a rebate aggregator in connection with the services it performs on behalf of Sponsor. Capital Rx credits Sponsor 100%of the Rebates it receives from the rebate aggregator, as set forth in Schedule B of the Agreement. While the rebate aggregator does not view its services as subject to the disclosure requirements set forth in 29 U.S.C. § 1108(b)(2)(B), Capital Rx hereby discloses that the rebate aggregator earns direct compensation called "program management fees," comprised of a percentage of the rebates, which the rebate aggregator withholds. Indirect Compensation: Capital Rx receives no indirect compensation from any source. Capital Rx has requested and made good faith efforts to obtain, but has not received, information regarding any indirect compensation that its rebate aggregator may receive in connection with services it has been subcontracted to perform, but the rebate aggregator does not view its services as subject to the disclosure requirements set forth in 29 U.S.C. § 1108(b)(2)(B). Capital Rx discloses its own rebate commitments and guarantees in Section 4 and 5 the Agreement, as well as in Schedule B. Compensation Received on a Transactional Basis: Capital Rx sometimes enters into collaborative arrangements with Channel Partners, as described above, and does not receive compensation from Channel Partners for these arrangements. Any compensation received by a Channel Partner should be ' Under ERISA Section 408(b)(2), a covered service provider must provide a description of all direct and indirect compensation that the covered service provider, an affiliate, or a subcontractor reasonably expects to receive in connection with the specified brokerage or consulting services that the covered service provider performs under a contract or arrangement with a covered plan, or upon termination of the contract or arrangement; as well as a description of any compensation paid among the covered service provider,an affiliate,or a subcontractor in connection with such services if the compensation is set on a transaction basis. 29 U.S.C. § 1108(b)(2)(B). Page 10 of 12 disclosed in that Channel Partner's 29 U.S.C. § 1108(b)(2)(B) compensation disclosure to Sponsor. Any direct compensation Sponsor pays the Channel Partner via Capital Rx is expressly indicated in the Agreement at Schedule B under the heading"Authorized Third Parties." Sometimes Capital Rx pays a Channel Partner commissions on a per-claim basis under service agreements that result from the Channel Partner's efforts. Compensation Related to Termination: The Agreement may contain a penalty provision connected to early termination of the contract without cause. See Section 7 of the Agreement for any such termination provision. Schedule B lists post-termination services and the direct compensation that Capital Rx expects to receive in connection with any such services. Capital Rx is not aware of any termination-related compensation due to any subcontractors in connection with the termination of this Agreement. To the best of Capital Rx's knowledge,th is disclosure is accurate as of the Effective Date of the Agreement. Capital Rx reserves the right to issue amendments and modifications to this disclosure in a reasonable format throughout the Term of the Agreement. This disclosure has been prepared in good faith, based on reasonable diligence, and was drafted to comply with applicable requirements under 29 U.S.C. §1108(b)(2)(B). Capital Rx is not responsible for the failure of any other service provider to make its required disclosure of direct and indirect compensation. In the event that Capital Rx made any error or omission in disclosing this information and later learns of such an error or omission,the correct information will be disclosed as soon as practicable,and within thirty(30)days from discovery of the error or omission. Capital Rx reserves the right to issue amendments and modifications to this disclosure and such modification may be done formally, through issuance of another disclosure form, or within the body of emails throughout the plan year. Individual modifications or updates to compensation disclosures do not invalidate or replace the entirety of this disclosure,but rather only modify the provisions that are indicated. [SIGNATURE PAGE FOLLOWS] Page 11 of 12 SECOND AMENDMENT SIGNATURE PAGE WHEREOF, each party caused this Amendment to be executed by its duly a r sentative. Execution by the Contractor must be by a person with authority to bind e it BOARD OF COUNTY COMMISSIONERS s zf adok, Clerk OF MONROE COUNTY, FLORIDA Bv: By: As Deputy Clerk ayor Pro Tem Date aZ-A> MONROE COUNTY ATTORNEY'S OFFICE CAPITAL RX, INC. Approved for form and legal sufficiency knstl� Signature:Kiistin Beglev Jut EMI) Print Name: Kristin Begley Cynthia all, Sr. Assistant County Attorney Title: CGO Date:Jun 30,2023 F= rrt CD ace N) cil CD C* 4 Page 12 of 12 Final Audit Report 2023-06-30 Created: 2023-06-30 By: Lenore Keefer(Ikeefer@cap-rx.com) Status: Signed Transaction ID: CBJCHBCAABAAeBzlKucnwK_ecdpflFnVOfa87oQYzrhl "Capital Rx and Monroe County—Second Amendment to PBMSA " History t"111 Document created by Lenore Keefer(Ikeefer@cap-rx.com) 2023-06-30-12:41:19 PM GMT Document emailed to kristinbegley@cap-rx.com for signature 2023-06-30-12:43:24 PM GMT Email viewed by kristinbegley@cap-rx.com 2023-06-30-1:40:01 PM GMT Signer kristinbegley@cap-rx.com entered name at signing as Kristin Begley 2023-06-30-1:40:20 PM GMT Document e-signed by Kristin Begley (kristinbegley@cap-rx.com) Signature Date:2023-06-30-1:40:22 PM GMT-Time Source:server Agreement completed. 2023-06-30-1:40:22 PM GMT Adobe Acrobat Sign Client#: 1865577 CAPITRX DATE(MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1 5/18/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Gerard Dimino USI Insurance Services, LLC PHONE 800 227-0185 FAX A/C,No,Ext: (A/C,No): 180 Park Avenue E-MAIL ADDRESS: gerard.dimino@usi.com Suites 103 INSURER(S)AFFORDING COVERAGE NAIC# Florham Park, NJ 07932 INSURER A:Continental Casualty Company 20443 INSURED INSURER B:Ohio Casualty Insurance Company 24074 Capital RX, Inc Allied World Assurance Company,Ltd. NONAIC INSURER C: Y. 1 World Trade Center, Suite 49D Westchester Fire Insurance Company 10030 INSURER D: p Y New York, NY 10003 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY B7013643550 02/10/2023 02/10/2024 EACH OCCURRENCE $2,000,000 CLAIMS-MADE [*OCCUR PREMISESOEa occur°nce $1,000,000 APPROVED BY RISK MANAGEMENT MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: DATE �]/�/Zn2� GENERAL AGGREGATE $4,000,000 X POLICY JECT LOC WAIVER N/A YES PRODUCTS-COMP/OP AGG s4,000,000 OTHER: $ A AUTOMOBILE LIABILITY B7013643550 02/10/2023 02/10/202 COMBINED Ea accident SINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ A X UMBRELLA LIAB N OCCUR B7013643564 02/10/2023 02/10/2024 EACH OCCURRENCE $1 O 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1 O 000 000 DED I X RETENTION$1 O 000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Excess Liability ECO2464660220 02/10/2023 02/10/2024 10,000,000 C Cyber/E&O 03133841 05/12/2023 05/12/2024 5,000,000 D Excess C ber/E&O G72579215002 05/12/2023 05/12/2024 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additional Coverages: Managed Care E&O policy#HC7CACIYQP002 Effective 05/12/2023-05/12/2024 Limit$5,000,000 EL policy#MML-25435-22 Effective 07/23/2022-07/23/2023 Limit$1,000,000 D&O/EPL policy#ML42628652 Effective: 07/23/2022-07/23/2023 Limit: $5,000,000 Crime policy#P00100099131701 Effective: 09/16/2022-09/16/2023 Limit: $5,000,000 Retention: $50,000 (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Monroe Count Board of Count SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street, Suite: 2-268 AUTHORIZED REPRESENTATIVE Key West, FL 33040 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S40104785/M40102931 LBSZP DESCRIPTIONS (Continued from Page 1) Monroe County Board of County Commissioners is an Additional Insured as respects to General Liability And Auto Liability policies, pursuant to and subject to the policy's terms, definitions,conditions and exclusions. SAGITTA 25.3(2016/03) 2 of 2 #S40104785/M40102931