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.
On January 5, 2021, the Board of Supervisors approved Contract #27-633-18, with PerformRx in the amount of $119,000,000, to provide pharmacy administration services for CCHP members, including drug utilization review and management, prior authorization procedures, account management, member pharmacy call center, analysis and reporting services, and developing partnerships with prescribers and pharmacies, for the period from January 1, 2021 through December 31, 2021. This contract includes mutual indemnification.
Approval of Contract Amendment Agreement #27-663-19 will allow the County and Contractor to remove Pharmacy Benefit Management Services that were anticipated to be effective April 1, 2021, but were rescinded by the DHCS with no replacement date received from the DHCS as of April 1, 2021. There is no change in the payment limit of $119,000,000 and no change in the term of January 1, 2021 through December 31, 2021.
If this amendment is not approved, revisions to the Pharmacy Benefit Management Services will not occur, and both the contractor and County will not be compliant with the DHCS’s current services.