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Home My WebLink AboutContract 59500-A1R1CSC No. 59500-AlR1 AMENDMENT I AND RENEWAL I TO PARTICIPATION AGREEMENT This AMENDMENT I and RENEWAL I TO PARTICIPATION AGREEMENT, dated and effective as of January 1, 2024 ("Amendment'), is made and entered into by and between City of Fort Worth ("Participating Group" or "City") and OptumRx, Inc. ("Administrator"), with respect to the following facts: RECITALS WHEREAS, Administrator and Participating Group entered into that certain Participation Agreement ("Participation Agreement') on January 1, 2023; WHEREAS, Administrator entered into the Amended and Restated Master Coalition Prescription Drug Benefit Administration Agreement dated January 1, 2024 ("Master Agreement'), with Marsh & McLennan Agency LLC DBA East Region, formerly known as Trion ("Coalition"), pursuant to which Coalition engaged Administrator to provide certain of its services to assist Participating Group in the administration of its Pharmacy Benefit Program; and WHEREAS, Participating Group and Administrator desire to amend the Participation Agreement as more fully described below; and WHEREAS, Participating Group and Administrator agree to renew the Participation Agreement for its first renewal option, effective January 1, 2024 to December 31, 2024. NOW, THEREFORE, for good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, Administrator and Participating Group hereby agree to amend the Participation Agreement as follows: A. Any capitalized terms used in this Amendment, which are not otherwise defined herein, shall have the same meanings ascribed to them in the Participation Agreement or the Master Agreement. All other terms and conditions of the Participation Agreement shall remain in full force and effect. In the event there is any inconsistency or conflict between the provisions in this Amendment and those in the Participation Agreement, the provisions in this Amendment shall supersede and control. B. Section 4.1 (Term) of the Participation Agreement shall be deleted in its entirety and restated as follows: "4.1 Term. This Participation Agreement will become effective on the Participation Agreement Effective Date and continue for an initial term of one (1) year ("Initial Term"). On January 1, 2024, this Participation Agreement shall be renewed for an additional one year, ending on December 31, 2024 ("2024 Renewal Term"). After the 2024 Renewal Term, the Participating Group will renew this Participation Agreement for an additional one (1) year term by providing Administrator with notice of renewal at least 90 days prior to the end of the 2024 Renewal Term. If notice of renewal is not received by Administrator at least 90 days prior to the end of the 2024 Renewal Term, this Participation Agreement will automatically renew at the then -current rates for successive 12-month renewal periods." C. Section B (Pricing) of Exhibit E-1 (Pricing Model) shall be deleted in its entirety and replaced with the information in Attachment I, attached hereto and incorporated by reference. D. The Participation Agreement is hereby renewed for the 2024 Renewal Term, effective January 1, 2024 and expiring December 31, 2024. CONFIDENTIAL CSC 59500 Amendment 1/Renewal 1 Agreement Number: 01316476.0 OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX ACCEPTED AND AGREED: CITY: City of Fort Worth By: cwllt� Name: Jesica McEachern Title: Assistant City Manager Date: Mar 22, 2024 Approval Recommended: By Maver -1 Moyer !fal�v (Mar —T) Name: Holly Moyer Title: Assistant Human Resources Director Attest: 4,ouvvanq� PA�F F,ORr�Ld F P��dd aubbEXAgopA By: Name: JannetteGoodall Title: City Secretary VENDOR: OptumRx, Inc. 11—� By: Kathryn Carey (Mar 19, 2024 10:45 CDT) Name: r.%amrvn uarev Title: U F U Date: 03/19/2024 Contract Compliance Manager: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. By: 2,a.K. /"' . Name: Joanne Hinton Title: Benefits Manager Approved as to Form and Legality: By 9—'- Name: Jessika J. Williams Title: Assistant City Attorney Contract Authorization: M&C: 22-0551 OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX 2 CONFIDENTIAL ATTACHMENT Exhibit E-1 PRICING MODEL B. Pricing. Participating Group will pay Administrator for the services provide herein pursuant to the following table: Term of contract: Term 1: 01/01/2024 to 12/31/2024 Traditional Base Administrative Fees $0.00 per Net Paid Claim Paper Claim Fees $2.50 Per Processed Paper Claim plus the Base Admin. Fee PreCheck MyScript $0.00 per PreCheck MyScript Transaction with ePrescribing Coalition Service Administrator will pay monthly, subject to Participating Group's adherence with payment obligations to Administrator, Fee an amount of $1.00 per Net Paid Claim to Coalition as the designated broker or consultant, as directed by Participating Group. Retail 30 Pharmacy Network Brand Drugs AWP minus 20.50% plus $0.45/$0.45/$0.45 dispensing fee Effective Overall Generic Guarantee AWP minus 86.50% plus $0.45/$0.45/$0.45 dispensing fee (ingredient cost) WAG90 Saver Plus Pharmacy Network Brand Drugs AWP minus 26.80% plus $0.00/$0.00/$0.00 dispensing fee Effective Overall Generic Guarantee AWP minus 88.80% plus $0.00/$0.00/$0.00 dispensing fee (ingredient cost) Mail Service Pharmacy Brand Drugs AWP minus 26.80% plus $0.00/$0.00/$0.00 dispensing fee Effective Overall Generic Guarantee AWP minus 88.80% plus $0.00/$0.00/$0.00 dispensing fee (ingredient cost) Specialty - Exclusive Network Brand Aggregate AWP minus 21.70% plus $0.00 dispensing fee PNPC Specialty Guarantee Generic Aggregate AWP minus 66.40% plus $0.00 dispensing fee PNPC Specialty Guarantee Limited Distribution Drug Aggregate AWP minus 16.40% plus $0.00 dispensing fee PNPC Specialty Guarantee Rebates - Premium Formulary Retail 30 - Minimum $340.00 Per Net Paid Brand Claim WAG90 / Mail Service - Minimum $1,000.00 Per Net Paid Brand Claim Specialty - Fixed $3,250.00 Per Net Paid Brand Claim 3 CONFIDENTIAL 3/21 /24. 9:46 AM M&C Review CITY COUNCIL AGENDA Create New From This M&C DATE: 8/9/2022 REFERENCE NO.. CODE: P TYPE Official site of the City of Fort Worth, Texas FORTWORTII **M&C 22- LOG NAME: 13P 22-0067 PHARMACY 0551 BENEFITS MANAGER CC HR CONSENT PUBLIC NO NO SUBJECT: (ALL) Authorize Execution of an Agreement with OptumRx Inc., for Administration of the City's Pharmacy Benefits for an Initial Term of One Year with Two Optional One -Year Renewal Terms in an Amount Up to $236,000.00 for Each Term RECOMMENDATION: It is recommended that the City Council authorize the execution of an agreement with OptumRx Inc., for administration of the City's Pharmacy Benefits for an initial term of one year with two optional one-year renewal terms in an Amount Up to $236,000.00 for each term. DISCUSSION: The Human Resources Department approached the Purchasing Division to procure an agreement for a pharmacy benefits manager to provide claim administration for pharmacy benefits for active employees, retirees, and surviving spouses of the City of Fort Worth (City). To procure these services, Purchasing issued a Request for Proposal (RFP) No. 22-0067. The RFP was advertised in the Fort Worth Star -Telegram for five consecutive Wednesdays beginning on February 23, 2022, through March 23, 2022. The City received 11 proposals. An evaluation panel consisting of representatives from Human Resources and Municipal Court Departments reviewed and scored the submittals using Best Value criteria. The individual scores were averaged for each of the criteria and the final scores are listed in the table below. Proposals that did not score at least 50\% or more of the total available points for technical criteria were deemed not acceptable (N/A). Bidders11 Evaluation Factors 11 A. I B. 11 C. I D. I E. 11 Total Score OptumRX I13.50 14.40 12.80 7.40 25.00 73.10 CapitalRx II14.00II12.40II12.80II5.20II24.55II 68.95 Rightway Ill 4.00II11.20II14.40II5.20II22.77II 67.57 CVS-Caremark II8.00II8.0017.20II6.00II X II N/A Elixir II11.50II9.20II10.00II3.80II X II N/A Express Scripts II 9.50 II 8.40 19.20 II5.20II X II N/A Flipt II9.00II9.60II10.80II4.601I X II N/A Independent Health 119.50 Ill 0.00II11.20II5.00II X II N/A Meritan II10.00II8.80I8.80II5.60II X II N/A Script Care II 9.00 II10.00II10.00II5.40II X II N/A WithMe II12.00II9.20II10.80II4.60II X II N/A Best Value Criteria: a. Quality of Proposal/Acceptability of Proposals b. Network, formulary and disruption apps.cfwnet.org/council_packet/mc_review.asp?ID=30104&councildate=8/9/2022 1/3 3/21 /24. 9:46 AM M&C Review c. Prescription drug programs and value added programs d. Firm's background and experience e. Cost After evaluation, the panel concluded that OptumRx Inc., presented the best value to the City. Therefore, the panel recommends that City Council authorize this agreement with OptumRx Inc. No guarantee was made that a specific amount of services would be purchased. Staff certifies that the recommended vendor's proposal met specifications. Funding will be budgeted in the Claims Administration expense of the Group Health Insurance & Retiree Healthcare Trust Funds for Fiscal Year 2023. DVIN-BE: A waiver of the goal for Business Equity subcontracting requirement is approved by the DVIN-BE, in accordance with the Business Equity Ordinance, because the purchase of goods or services is from sources where subcontracting or supplier opportunities are negligible. AGREEMENT TERMS - Upon City Council approval, this agreement shall begin on January 1, 2023 and expire one year from that date. RENEWAL TERMS: The agreement may be renewed for up to two successive one-year terms at the City's option. This action does not require specific City Council approval provided that City Council has appropriated sufficient funds to satisfy the City's obligations during the renewal term. ADMINISTRATIVE CHANGE ORDER: An administrative change order or increase may be made by the City Manager up to the amount allowed by relevant law and the Fort Worth City Code and does not require specific City Council approval as long as sufficient funds have been appropriated. FISCAL INFORMATION/CERTIFICATION: The Director of Finance certifies that upon approval of the above recommendation and adoption of the Fiscal Year 2023 Budget by the City Council, funds will be available in the Fiscal Year 2023 operating budget, as appropriated, in the Group Health Insurance & Retiree Healthcare Trust Funds. Prior to an expenditure being incurred, the Human Resource Department has the responsibility to validate the availability of funds. BQN\\ TO Fund Department Account Project ID ID FROM Fund Department Account Project ID ID Submitted for Citv Manager's Office by: Originating Department Head: Additional Information Contact: ATTACHMENTS Program Activity Budget Reference # Year (Chartfield 2) Program Activity Budget Reference # Year (Chartfield 2) Reginald Zeno (8517) Anthony Rousseau (8338) Dianna Giordano (7783) Cynthia Garcia (8525) Cristina Camarillo (8355) Amount Amount 13P 22-0067 PHARMACY BENEFITS MANAGER CC HR Updated FID table.xlsx (CFW Internal) 22-0067 Waiver Pharmacv Benefits Manaaer 020122 NW.pdf (CFW Internal) apps.cfwnet.org/counci I_packet/mc_review.asp? I D=30104&counci (date=8/9/2022 2/3 3/21/24, 9:46AM M&C Review Copv of FID TABLE BLANK WITH INSTRUCTIONS V2.xlsx (CFW Internal) Form 1295 Certificate 100937403.pdf (CFW Internal) Sams- OptumRX, Inc.pdf (CFW Internal) apps.cfwnet.org/counci I_packet/mc_review.asp? I D=30104&counci ddate=8/9/2022 3/3