To: Board of Directors
From: Dr. Grant Colfax, Health Services Director
Report Title: Contract Amendment #27-633-30 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 #27-633-30 with PerformRx, LLC, a limited liability company, effective January 1, 2026, to amend Contract #27-633-24 (as amended by Contract Amendments #27-633-26, #27-633-27, and #27-633-28), to provide additional pharmacy program administration services and include additional contract provisions to comply with Federal Centers for Medicare and Medicaid Services (CMS) requirements, with no change in the payment limit of $70,000,000 or term ending December 31, 2026.
FISCAL IMPACT:
Approval of this Contract Amendment will not result in additional expenditures and remains funded 100% by Contra Costa Health Plan (CCHP) Enterprise Fund III revenues. (No rate increase)
BACKGROUND:
Both the State Department of Health Services and the Federal CMS require a Pharmacy Benefits Manager that can develop, maintain, and manage a large pharmacy network and monitor the correct dispensing of drug benefits and co-pays under multiple group product lines while 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 organizations 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. Contractor was selected to provide pharmacy program administration services to CCHP’s Pharmacy and Utilization Units and help establish and maintain a Utilization Management (UM) program that promotes appropriate utilization for CCHP’s pharmacy benefits program. The UM program 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. This Contractor was 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.
On June 25, 2024, the Board of Supervisors approved Contract Amendment #27-633-26 with PerformRx, LLC, effective May 1, 2024, to include contract provisions to conform to Department of Managed Healthcare (DMHC) requirements with no change in the contract payment limit of $50,000,000 or term ending December 31, 2025.
On November 12, 2024, the Board of Supervisors approved Contract Amendment #27-633-27 with PerformRx, LLC, effective January 1, 2025, to include additional contract provisions to conform to DMHC requirements with no change in the contract payment limit of $50,000,000 or term ending December 31, 2025.
On January 21, 2025, the Board of Supervisors approved Contract Amendment/Extension #27-633-28 with PerformRx, LLC, effective January 1, 2025, to increase the payment limit by $20,000,000 to a new payment limit of $70,000,000 and to extend the termination date from December 1, 2025 to December 1, 2026 for additional pharmacy program administrative services and to include additional contract provisions to conform to CMS requirements.
Approval of Contract Amendment #27-633-30 will allow the Contractor to provide additional pharmacy program administration services and include additional contract provisions to comply with CMS requirements through December 31, 2026.
CONSEQUENCE OF NEGATIVE ACTION:
If this Contract Amendment is not approved, County will not be compliant with CMS requirements and may cause a delay in services provided to the County.