To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Amendment #27-633-26 with PerformRx, LLC
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
APPROVE and AUTHORIZE the Health Services Director, or designee, to execute on behalf of the County Contract Amendment Agreement #27-633-26 with PerformRx, LLC, a limited liability corporation, effective May 1, 2024, to amend Contract #27-633-24 to modify contract provisions to conform to Department of Managed Healthcare (DMHC) requirements with no change in the contract payment limit of $50,000,000 or the original term of January 1, 2024 through December 31, 2025.
FISCAL IMPACT:
Approval of this amendment will not result in additional funding and remains funded 100% by Contra Costa Health Plan (CCHP) Enterprise Fund II.
BACKGROUND:
Both the State Department of Health Services and the Federal Centers for Medicare and Medicaid Services (CMS) require a Pharmacy Benefits Manager that can develop, maintain, and manage a large pharmacy network and monitor the correct dispensing of drug benefits, co-pays under multiple group product lines adhering to the required Health Plan Formulary and Health Plan Prior authorization protocol. This contractor has been providing these services and fostering a deep understanding of the CCHP organization’s mission, values, and long-term objectives since May 1, 2006.
This contract is entered into under and subject to the following legal authorities: California Government Code §§ 26227 and 31000; Health and Safety Code § 1451. Health Services Personnel approved this contract to ensure no conflicts with labor relations. This contractor was selected to provide pharmacy program administration services to CCHP’s Pharmacy and Utilization units to help establish and maintain a utilization management program that promotes appropriate utilization for CCHP’s pharmacy benefits program, and continually reviews updated utilization management procedures to control costs for members. The nature of the pharmacy program administration services needed is complex and requires seamless coordination, integration and collaboration with existing programs and systems. There are a total of 3 pharmacy program administration service providers in CCHP’s service area. CCHP is currently contracted with 2 of the agencies. This contract renewal will maintain comprehensive area coverage for the entire CCHP membership and meet the Knox-Keene Act, time and distance mandate required by the State of California Department of Managed Health Care (DMHC) services. This contractor has been approved by the Public Works Department’s Purchasing Division on October 30, 2023.
On January 16, 2024, the Board of Supervisors approved Contract #27-633-24 with PerformRx, LLC, in an amount not to exceed $50,000,000, to provide pharmacy program administration services for CCHP, for the period January 1, 2024 through December 31, 2025.
Approval of Contract Amendment Agreement #27-633-26 will allow the contractor to modify contract provisions to conform with the DMHC requirements with no change in the payment limit or term through December 31, 2025.
CONSEQUENCE OF NEGATIVE ACTION:
If this amendment is not approved, County will not be compliant with DHCS requirements.