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HomeMy WebLinkAboutAdden 2 CAG-09-184, Adden 2-14 AMENDMENT NO. 1 TO PHARMACY BENEFIT MANAGEMENT SERVICES AGREEMENT This Amendment No. 1 (this "Amendment"), is entered into by and between Envision Pharmaceutical Services, Inc. ("Envision"), and the City of Renton, Washington ("Plan Sponsor"). - BACKGROUND Envision and Plan Sponsor are parties to a Pharmacy Benefit Management Services Agreement dated October 1st 2009 (the "Agreement"), under which Envision provides PBM Services to Plan Sponsor; and The parties desire to amend the Agreement. Envision and Plan Sponsor agree as follows: 1. The term of the Agreement shall extend to 12:59 p.m. Central time, on December 31st,2016. 2. Section 1.2 of the Agreement shall be deleted in its entirety and replaced with the following: 1.2 "Average Wholesale Price" or "AWP" shall mean the average wholesale price of a Covered Drug indicated on the most current pricing file provided to Envision by Medi-Span® (or other applicable industry standard reference on which pricing hereunder is based) for the actual drug dispensed using the 11 digit National Drug Code (NDC)number provided by the dispensing pharmacy. Envision uses a single source for determining AWP and updates the AWP source file at least once weekly. 3. Section 1.20 shall be added as follows: 1.20 "Annual Average Effective Rate" means, for the category of drugs being reviewed, the result calculated by the following formula: (IC/AWP)-1, where IC("Ingredient Cost") is the sum of all amounts paid by Plan Sponsor for the ingredient cost of the Covered Drugs dispensed during the calendar year, and AWP is the sum of the Average Wholesale Price amounts associated with the same Covered Drugs. 4. Section 1.21 shall be added as follows: 1.21 "Contract Year" means the complete twelve month period commencing on the Effective Date and each consecutive complete twelve month period thereafter that this Agreement remains in effect. 5. Exhibit 1 of the Agreement shall be deleted in its entirety and replaced with the following: Amendment 050113 ©Envision Pharmaceutical Services,Inc. Page 1 of 3 Drug Pricing and Dispensing Fee Estimates( Supply/Source BRAND GENERIC. Drug Price.(u): Dispensing Drug Price t� Dispensing •For Contract Year (Annual Average Fee N) (Annual Average' Fee(b) Effective Rate (Annual Effective Rate (Annual 2014,2015&;'2016 ` Estimate) Average , Estimate) Average Estimate) Estimate) 30 Days' Supply at a AWP minus 14.80% $1.40 AWP minus 73.5% $1.50 Retail Pharmacy Mail Order Pharmacy AW minus 19.39% N/A AWP minus P N/A (at Costco Pharmacy) 74.50% Specialty Pharmacy(at Costco Specialty (Pass-Through of Contract Rate with Dispensing Pharmacy) Pharmacy) (A)Calculated price using the applicable negotiated contract rate(i.e.AWP or MAC rate,or U&C Price)for the designated Network. The AWP discounts shown in the table above are Annual Average Effective Rates using current Medi-Span published values. If the calculated price is lower than the allowable amount under any state Medicaid "Favored Nations" rule, Envision shall pass-through, and Plan Sponsor shall pay, the Medicaid allowable amount. ca) Annual Average Effective Rate for Brand Drugs is calculated using the actual price paid by Envision (before deducting earned Manufacturer Derived Revenue) to Participating Pharmacies in the designated Network,plus any Cost Share,(the Ingredient Cost)for all Brand Drug Claims(including Claims paid at the U&C Price) during a Contract Year, excluding (i) Compound Drugs; (ii) drugs dispensed at a Specialty Pharmacy; (iii) Claims from non-Participating Pharmacies, LTC pharmacies, or government owned or operated pharmacies (e.g.Veterans Administration); (iv) Claims paid at government required amounts (e.g. Medicaid); (v) 340B Claims; (vi) non-Prescription Drugs; and (vii) Claims from Plan Sponsor's owned pharmacies,if any. (c) Annual Average Effective Rate for Generic Drugs is calculated using actual price paid by Envision to Participating Pharmacies in the designated Network, plus any Cost Share, (the Ingredient Cost) for all Generic Drug Claims (including Claims paid at the U&C Price) during a Contract Year, excluding (i) Compound Drugs; (ii) drugs dispensed at a Specialty Pharmacy; (iii) Claims from non-Participating Pharmacies,LTC pharmacies,or government owned or operated pharmacies(e.g.Veterans Administration); (iv) Claims paid at government required amounts (e.g. Medicaid); (v) 340B Claims; (vi) non-Prescription Drugs;and(vii)Claims from Plan Sponsor's owned pharmacies,if any. io)Annual Average Dispensing Fee is the average per Claim fee for all Claims by Envision to Participating Pharmacies in the designated Network (including Claims paid at the U&C Price) during a Contract Year, excluding (i) Compound Drugs; (ii) drugs dispensed at a Specialty Pharmacy; (iii) Claims from non- Participating Pharmacies, LTC pharmacies, or government owned or operated pharmacies (e.g. Veterans Administration); (iv) Claims paid at government required amounts (e.g. Medicaid); (v) non-Prescription Drugs;and(vi)Claims from Plan Sponsor's owned pharmacies,if any. Administrative Fee (Payable to Envision; not including fees payable to. Plan Sponsor's TPAs,. consultants, or brokers,if any) Amendment 050113 C Envision Pharmaceutical Services,Inc. Page 2 of 3 For Contract Year 2014: $3.75 Per Eligible Employee,Per Month(PEPM) For Contract Year 2015: $3.90 PEPM For Contract Year 2016: $4.05 PEPM Fees for;Additional Services and Miscellaneous Expenses.. 1. Replacement by Envision of lost or stolen ID Cards $1.00 per card plus cost of postage 2. Manual Claims Processing(including DMRs) $1.50 per Claim processed 3. Claim Adjustment Checks(charged to Plan Sponsor for reimbursements made to Covered Individuals for Claim adjustments requested by Plan Sponsor.) $8.50 per check i 4. Manually create or update the Eligibility File , $1.00 per Covered Individual data entry 5. Ad Hoc Computer or Report Programming $1 50.00 per hour 6. This Amendment shall be effective January 1st, 2014 ("Effective Date"). 7. All other terms or provisions of the Agreement not modified by this Amendment or any other amendments or addenda shall remain unchanged. IN WITNESS WHEREOF,Envision and Plan Sponsor have executed this Amendment as of the Effective Date above. 1 For ENVISION: "For PLAN SPONSOR: By: ' 64/4"\-- 4. %7,e'l By: Barry I. atz,R.Ph.,Pre‘dent Nancy arlson,HRRM Administrator Envision Pharmace�ut cal Services,Inc. Print Name&Title By: \ . -- Thomas J. el Chief Fin ncja1'`Officer Envision Pharmaceutical Services, Inc. Amendment 050113 0 Envision Pharmaceutical Services,Inc. Page 3 of 3