HomeMy WebLinkAboutItem O4 04
BOARD OF COUNTY COMMISSIONERS
COUNTY of MONROE Mayor James K.Scholl,District 3
The Florida Keys Mayor Pro Tern Michelle Lincoln,District 2
Craig Cates,District 1
David Rice,District 4
Holly Merrill Raschein,District 5
Board of County Commissioners Meeting
February 19, 2025
Agenda Item Number: 04
2023-3657
BULK ITEM: No DEPARTMENT: Employee Services
TIME APPROXIMATE: STAFF CONTACT: Natalie Maddox
N/A
AGENDA ITEM WORDING: Discussion and Direction regarding pharmaceutical benefit coverage
of GLP-1 agonist medications for weight management and wellness, and to direct staff to include or
exclude coverage of GLP-1 medications. TIME APPROXIMATE 11:30 A.M.
ITEM BACKGROUND:
At their regular meeting on December 13, 2023, the BOCC approved the Third Amendment to the
Pharmacy 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.
The BOCC could elect to add pharmaceutical benefit coverage of GLP-1 agonist medications for weight
management and wellness.
PREVIOUS RELEVANT BOCC ACTION:
1/22/2020: Board granted approval to advertise a Request for Proposals for Pharmacy Benefit
Management Administrative Services and Medicare Employer Group Administrative Services with
supplemental wrap-around benefits.
7/15/2020: Board granted approval to award bid and to negotiate an Agreement with Capital Rx,
Inc., to provide Pharmacy Benefits Management Services for employees, retirees, and dependents
beginning January 1, 2021.
8/19/2020: Board granted approval and authorized execution of a three-year Agreement with Capital
Rx, Inc., to provide Pharmacy Benefits Management Services and an Employer Group Waiver Program
for employees, retirees, and dependents beginning January 2, 2021; and granted approval and
authorized execution of the Business Associate Agreement.
11/17/2020: Board granted approval and authorized execution of an Amendment to the Contract with
Capital Rx, the County's pharmacy provider, expanding the scope of services and cost to include an
additional configuration necessary to establish electronic data feeds for benefit selection, claims
4159
management, and billing with the Workday ERP Software System currently being implemented by the
office of the Clerk of the Circuit Court and Comptroller, and also changing the frequency for billing
from biweekly to weekly.
7/19/2023: Board granted approval and authorized execution of a Second Amendment to Pharmacy
Benefit Management Services Agreement with Capital Rx, Inc. to provide Pharmacy Benefits
Management Services and an Employer Group Waiver Program for employees, retirees, and
dependents, to extend agreement to cover 1/1/2021 - 12/31/2026. This renewal reflected an increase in
year 1 of the renewal period (Year 1 of the contract) of approximately $ 0.50 per claim (7.69%) for
processing, and an increase in years 5 and 6 of the contract of$0.15 (0.21%)per claim.
12/13/2023: Board granted approval and authorized execution of a 3rd Amendment to the Pharmacy
Benefit Management Services Agreement with Capital Rx, Inc., for Mail Order Pharmacy and Home
Delivery Specialty Pharmacy Pricing, transitioning mail order and specialty medication services to
Optum and making some pricing changes, effective January 1, 2024.
INSURANCE REQUIRED:
No
CONTRACT/AGREEMENT CHANGES:
TBD
STAFF RECOMMENDATION: Staff requests Board's direction on whether include or exclude
benefit coverage of GLP-1 agonist medications for weight management and wellness.
DOCUMENTATION:
FINANCIAL IMPACT:
TBD
Fund 502 - Group Insurance Fund, Cost Center 08002 - Group Insurance Operations
Effective Date: 01/01/2024
Expiration Date: 12/31/2026
Fund 502 - Group Insurance Fund, Cost Center 08003 - Group Insurance Claims
4160
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