3rd Amendment 12/13/2023 `JR COURrd0.
o"p Kevin Madok, CPA
b. .......0 Clerk of the Circuit Court&Comptroller—Monroe County, Florida
DATE: December 15, 2023
TO: Bryan Cook, Director
Employee Services
ATTN: Natalie Maddox
Sr. Employee Benefits Administrator
FROM: Pamela G. Hanco ka.C.
SUBJECT: December 13'BOCC Meeting
Attached is an electronic copy of die following item for your handling:
C12 3rd Amendment to Pharmacy Benefit Management Services Agreement with
Capital Rx, Inc., transitioning mail order and specialty medication services to Optum and making
some pricing changes effective January 1, 2024.
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 83050 Plantation Key,Florida 88070 Plantation Key,Florida 33070
305-294-4641 305-289-6027 305-852-7145 305-852-7145
MAIL ORDER PHARMACY& HOME DELIVERY SPECIALTY PHARMACY PRICING
AMENDMENT
THIS THIRD AMENDMENT (hereinafter "Amendment") to the Pharmacy Benefit Management
Services Agreement (hereinafter "Agreement") by and between Monroe County Board of County
Commissioners ("Sponsor"), and Capital Rx, Inc. ("Capital Rx") is effective on January 1, 2024. Each of
Sponsor and Capital Rx is sometimes individually referred to herein as a "Party" and together as the
"Parties". Any capitalized term used and not identified in this Amendment shall have the same meaning as
defined in the Agreement.
WHEREAS, Capital Rx and Sponsor wish to amend the Agreement to revise certain terms of the
Agreement.
NOW,THEREFORE, in consideration of the covenants and agreements set forth herein, Capital Rx and
Sponsor agree as toIIows:
1. Within Schedule B (Pricing and Reconciliation Terms), Section 2 ("Mail Order Pharmacy") the
heading and the"Lesser of Logic"section are deleted in their entirety and replaced with the fol lowing:
EXCLUSIVE MAIL ORDER PHARMACY
Lowest of Logic. Sponsor will pay Capital Rx for Covered Pharmaceuticals (except Specialty
Drugs and OTC Drugs) dispensed to Members through Capital Rx's exclusive Mail Order
Pharmacy an amount equal to the lowest of:
Pharmacy's U&C Price, or
National Average Drug Acquisition Cost(NADAC)+$0.00, or
AWP—26%+ $0.00 for Brand Drugs
• AWP—86%+ $0.00 for Generic Drugs
less the Cost Share.
2. Within Schedule B, Section 3 ("Specialty Pharmacy")the heading and the"Lesser of Logic" section
are deleted in their entirety and replaced with the following:
EXCLUSIVE HOME DELIVERY SPECIALTY PHARMACY
Sponsor will pay Capital Rx for Specialty Drugs(except for Limited Distribution Drugs)dispensed
to Members by Capital Rx's exclusive home delivery Specialty Pharmacy an amount equal to:
The reimbursement outlined in the applicable list of Exclusive Specialty Drug pricing (the
"Exclusive Specialty Network Price List"),then the lowest of:
• Pharmacy's U&C Price or
• AWP—20%+ $0.00, or
• NADAC+ $10.00
The contents of this document are confidential and proprietary to Capital Rx and may not be reproduced,transmitted,published,or disclosed to
others without prior written authorization from Capital Rx.
Mail&Specialty Pricing Amendment 2023
less the Cost Share.
Any Specialty Drug product that is not available in the marketplace at the time of execution of this
Agreement will be considered a new-to-market Market Specialty Drug and will default to the above
processing logic, unless otherwise updated by Capital Rx. The Capital Rx Exclusive Specialty
Network Price List, as defined above, is subject to change from time to time and it shall be at the
sole discretion of Capital Rx to review, add, remove, or migrate drugs on and off that Exclusive
Specialty Network Price List.
3. All other terms or provisions of the Agreement not modified by this Amendment, or any other
amendments or addenda shall remain unchanged.
[SIGNATURE PAGE FOLLOWS]
2
The contents of this document are confidential and proprietary to Capital Rx and may not be reproduced,transmitted,published,or disclosed to
others without prior written authorization from Capital Rx.
Mail&Specialty Pricing Amendment 2023
MAIL ORDER PHARMACY&HOME DELIVERY SPECIALTY PHARMACY PRICING
AMENDMENT
SIGNATURE PAGE
IN WITNESS WHEREOF,Capital Rx and Sponsor have executed this Amendment as of the Effective Date
above.
Capital Rx,Inc. Monroe County Board of County
Commissioners
lCHrtin 54 ti
By:Kristin Begley(Nov 16,26231 . OEST) By:
Print Name:Kristin Begley Print Name: Holly Merrill Raschein
Title:CCO Title: Mayor
Date: Nov 16,2023 Date: l��3�2oy?j
KEVIN MADOK,CLERK
' m
' Deputy Clerk
o t
aryl ,r
�"^.00r couw*r
MONROE COUNTY ATTORNEY'S OFFICE
Approved for form and legal sufficiency
t•1W
Cynt is Hall, Sr. Assistant County Attorney
C�n Ci
3
The contents of this document are confidential and proprietary to Capital Rx and may not be reproduced,transmitted,published,or disclosed to
others without prior written authorization from Capital Rx.
Mail&Specialty Pricing Amendment 2023
Final Audit Report 2023-11-16
Created: 2023-11-16
By: Lenore Keefer(Ikeefer@catrrx.com)
Status: Signed
Transaction ID: CBJCHBCAABAAI5tVotgvcOXsUr 7VKgXLDmk1Y3V-gee
"Third Amendment to PBMSA with Monroe County BOCC and C
apital Rx" History
".� Document created by Lenore Keefer(Ikeefer@cap-rx.com)
2023-11-16-3:46:56 PM GMT
" . Document emailed to kristinbegley@cap-rx.com for signature
2023-11-16-3:48:05 PM GMT
�.....q Email viewed by kristinbegley@cap-rx.com
2023-11-16-3:49:50 PM GNAT
Signer kristinbegley@cap-rx.com entered name at signing as Kristin Begley
2023-11-16-3:50:11 PM GMT
`2 Document e-signed by Kristin Begley (kristinbegley@cap-rx.com)
Signature Date:2023-11-16-3:50:13 PM GMT-Time Source:server
), Agreement completed.
2023-11-16-3:50:13 PM GMT
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