To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Amendment #27-633-28 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/Extension #27-633-28 with PerformRx, LLC, a limited liability corporation, effective January 1, 2025, to amend Contract #27-633-24 (as amended by Amendment Agreements #27-633-26 and #27-633-27), to increase the payment limit by $20,000,000, from $50,000,000 to a new payment limit of $70,000,000 and to extend the termination date from December 31, 2025 to December 31, 2026 for additional pharmacy program administration services and to modify additional Contract provisions to conform to Department of Managed Health Care (DMHC) requirements.
FISCAL IMPACT:
Approval of this Amendment will result in additional expenditures of up to $20,000,000 and remains funded 100% by Contra Costa Health Plan (CCHP) Enterprise Fund II revenues. (No rate increase)
BACKGROUND:
Both the State Department of Health Care 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 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 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.
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 Amendment Agreement #27-633-26 with PerformRx, LLC, effective May 1, 2024, to modify contract provisions to conform to Department of Managed Health Care (DMHC) requirements with no change in the contract payment limit of $50,000,000 or term of January 1, 2024 through December 31, 2025.
On November 12, 2024, the Board of Supervisors approved Amendment Agreement #27-633-27 with PerformRx, LLC, effective January 1, 2025, to modify additional contract provisions to conform to Department of Managed Health Care (DMHC) requirements with no change in the contract payment limit of $50,000,000 or term of January 1, 2024 through December 31, 2025.
Approval of Contract Amendment/Extension Agreement #27-633-28 will allow the Contractor to provide additional pharmacy program administration services and modify additional contract provisions to conform with the DMHC requirements through December 31, 2026.
CONSEQUENCE OF NEGATIVE ACTION:
If this Amendment is not approved, County will not be compliant with DMHC requirements and may cause a delay in services provided to the County.