Pharmacy Benefits Management Services Overview in City of Houston
"Learn about the third-party administrator providing pharmacy benefits management services to City of Houston employees and retirees. Discover the procurement process, evaluation criteria, due diligence considerations, and highlights of the five-year contract. Find out how the vendor will deliver medication therapy management programs, specialty condition support services, and more."
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Presentation Transcript
Third-Party Administrator for Pharmacy Benefits Management Services Briefing by Human Resources Department CITY OF HOUSTON BUDGET AND FISCAL AFFAIRS COMMITTEE JANUARY 8, 2019
OVERVIEW 2 The Third Party Administrator (TPA) for Pharmacy Benefits Management will provide pharmacy services to active full-time and part-time 30 employees, retirees, elected officials and their dependents, not only locally, but nationally as well. The City of Houston (COH) plan is self-insured. The plan will be effective May 1, 2019. 2
PROCUREMENT PROCESS 3 Request for Proposals (RFPs) for the Pharmacy Benefit Management (PBM) services for the City of Houston was released June 1, 2018. Responses were due July 19, 2018. Seven (7) vendors proposed to provide PBM services: Blue Cross Blue Shield of Texas CIGNA Health and Life Insurance Company (Cigna) CVS Health Envision Rx Express Scripts Script Care Ltd. UnitedHealthcare 3
PROCUREMENT PROCESS CONTD 4 Criteria for evaluation of proposals: The ability of the vendor to perform the Scope of Services requested in the RFP Quality and specialized experience of Key Personnel to successfully implement the project as evidenced by experience in a similar role with a previous project Financial competitiveness and guarantees against rate escalation over a multi-year contract Accessibility of network providers with minimum disruption to members The ability of the vendor to provide the best value for the dollars that the city and employees will expend Ability to meet the required 6% proposed M/WBE Participation for the PBM services 4
PROCUREMENT PROCESS CONTD 5 Due Diligence Considerations: 1. Responses to letters of Clarifications 2. Interviews 3. Reporting Systems 4. City s access to reporting systems: Claims and Financial 5. Responses to the City s minimum business and contractual guarantees 6. Health improvements programs and reporting 7. Transfer of data to a City designated data warehouse 8. Stable member outreach and customer service 9. Network structure and discounts 10.Competitive pricing 5
HIGHLIGHTS 6 Five Year contract with two one-year options The PBM services will include but not be limited to: Medication Therapy Management Program Specialty Condition Support Services Narcotics Therapy Management Program Complex Psychiatric Case Management Program Broader Pharmacy Network Vendor has agreed to provide all reports and access to data at no additional costs. 6
RECOMMENDATION 7 Approve: The recommended Third-Party Administrator for Pharmacy Benefits Management Services. 7
