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HomeMy WebLinkAboutA-15-318 Agt.pdfAgreement No. 15-318 1 AGREEMENT 2 THIS AGREEMENT is made and entered into this it/-lhday of July, 2015, by and between the 3 COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter referred to as 4 "COUNTY", and US SCRIPT, INC., a Delaware Corporation, whose address is 2425 W. Shaw Avenue, 5 Fresno, CA 93711, hereinafter referred to as "CONTRACTOR". 6 WIT N E S S E T H: 7 WHEREAS, COUNTY, through its Departments of Behavioral Health (DBH) and Social 8 Services (DSS) has a need for prescription drug services for COUNTY's mental health and child 9 welfare clients (from various facilities and programs) which will reduce medication expense; and 10 WHEREAS, COUNTY, through its DBH and DSS is in need of a.pharmaceutical information 11 control system necessary in maintaining services to COUNTY's consumers in a cost effective manner; 12 and 13 WHEREAS, CONTRACTOR is qualified to provide such services pursuant to the terms and 14 conditions of this Agreement; and 15 NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties 16 hereto agree as follows: 1. SERVICES: 17 18 A. CONTRACTOR shall perform all services and fulfill all responsibilities for the 19 provision of prescription drug services, as identified in COUNTY's Request for Proposal (RFP) No. 20 269-5316 dated December 9, 2014, Addendum No. One (1) to COUNTY's RFP No. 269-5316 dated 21 December 29, 2014, hereinafter collectively referred to as COUNTY's Revised RFP set forth in Exhibit 22 G, attached hereto and incorporated herein by this reference and CONTRACTOR's response to said 23 Revised RFP dated January 15, 2015, hereinafter referred to as CONTRACTOR's Response, 24 incorporated herein by reference and made part of this Agreement as Exhibit H. In the event of any 25 inconsistency among these documents, the inconsistency shall be resolved by giving precedence in the 26 following order of priority: 1) to this Agreement, including all Exhibits, and 2) to the Revised RFP, 3) 27 the Response to the Revised RFP. A copy of COUNTY's Revised RFP No. 269-5316 and 28 CONTRACTOR's response to the RFP shall be retained and made available during the term of this -1- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Agreement by COUNTY's Internal Services Department, Purchasing Division. B. Additionally, CONTRACTOR shall perform all services and fulfill all responsibilities identified in the "Scope of W ark" set forth in Exhibit A, attached hereto and incorporated herein by this reference. C. DBH and DSS each require a separate and different service plan. The vendor shall be required to meet the requirements of each individual Department. Facilities and programs for both the Departments are identified in Exhibit C, attached hereto and incorporated herein by this reference. D. CONTRACTOR is a Prescription Benefit Management (PBM) company and shall make available to COUNTY a list of its contracted pharmacies identified in Exhibit F, attached hereto and incorporated herein by this reference. E. In addition to providing prescription drugs for Medi-Cal consumers and private pay insurance consumers treated by COUNTY, CONTRACTOR shall fill patient prescriptions and invoice COUNTY for the patient prescriptions if the patient has a current Medically Indigent Adult/Medical Services Program (MIAIMSP) Certification Form or a Uniform Method to Determine Ability to Pay (UMDAP) Certification Form. F. The parties to this Agreement acknowledge that Consumer Product Information (CPI) sheets are currently available industry-wide in English and Spanish. Both parties further acknowledge that CPI sheets are not available in Hmong, Vietnamese, Laotian or Cambodian, and that these are languages spoken by a significant number of consumers served by COUNTY. It is understood between the parties that should CONTRACTOR become aware of CPI sheets in language needed by COUNTY, CONTRACTOR shall notify COUNTY and bill COUNTY for obtaining said CPI sheets, at CONTRACTOR's cost. When CPI sheets are not available for a COUNTY consumer receiving a prescription or medication under this Agreement, the parties agree that CONTRACTOR shall provide appropriate language assistance for that consumer at the time of dispensing. G. CONTRACTOR shall mail prescriptions, when requested, to consumers located at COUNTY's contracted facilities, to include but not limited to COUNTY clinics located in Fresno County, Institutes of Mental Disease (IMDs), Mental Health Rehabilitation Centers (MHRCs) and Skilled Nursing Facilities (SNFs) which are located in Fresno County or other counties within the State -2- 1 2 3 4 5 6 7 8 9 of California. H. DBH shall have a closed physician network for all Groups and programs in the Department. DBH shall notify the CONTRACTOR of changes made to the list of physicians within thirty (30) business days. I. DSS shall have an open network for the Child Welfare clients. COUNTY shall not pay for medication prescribed by a physician not duly authorized by the COUNTY. J. DBH shall use a medication formulary for all medication prescribed for its consumers unless directed by the DBH Director, or designee for specified programs and cost centers. CONTRACTOR shall administer the formulary for DBH allowing only medication listed to be filled at 1 0 the participating pharmacies. CONTRACTOR shall provide and maintain a process to enable 11 COUNTY staff a pre-authorization to override the formulary, when needed. Unless pre-authorization 12 is granted by the Department for medication not listed in the formulary, CONTRACTOR's pharmacies 13 shall restrict filling prescriptions for only those drugs listed on DBH's formulary, identified in Exhibit 14 B, attached hereto and by this reference incorporated herein. The CONTRACTOR shall provide 15 monthly reports on all the prescription drugs filled that were not on the formulary. CONTRACTOR 16 shall make changes (changes, additions or deletions) to the formulary when requested by the 17 COUNTY. 18 19 K. L. DSS will not use a formulary for any of their programs. The COUNTY mandates a generic substitute for brand name drugs. 20 Generic substitutions for prescriptions is mandatory unless specified otherwise by an authorized 21 COUNTY physician or if the substitute generic drug is not available in the market. If the contracted 22 pharmacy does not have the required generic medication in stock then the pharmacy will refer the 23 client to another pharmacy instead of filling the prescription with a brand name. COUNTY may deny 24 payment for a prescription when CONTRACTOR's pharmacy fails to adhere to this policy. 25 M. COUNTY agrees to provide the following information to the CONTRACTOR: 26 1) COUNTY shall continue to use the point-of sale methodology to 27 provide patient information to build a COUNTY patient database 28 receiving services under this Agreement. The COUNTY shall continue to -3- 1 receiving services under this Agreement. The COUNTY shall continue to 2 explore and will implement if and when ready for a providing an accurate 3 weekly consumer eligibility electronic file at a mutually agreed upon time 4 and date. 5 2). Provide and update COUNTY formularies as necessary 6 3). Identify needed reports for COUNTY Departments 7 4). Indicators on eligibility files (e.g. Medi-Cal or other files defined by 8 COUNTY) when available 9 5). COUNTY shall designate a Project Manager for the duration of the 1 0 contract to whom all contractor communications may be addressed 11 6). Current list of COUNTY'S prescribing physicians 12 N. COUNTY currently has a Twenty Dollar co pay for all prescriptions. 13 CONTRACTOR shall be flexible to change the co pay amount, if and when deemed necessary for 14 service operations by the COUNTY. 15 2. TERM: 16 This Agreement shall become effective on the 1st day of July, 2015 and shall terminate 17 on the 30th day of June, 2018 ("Initial Term"). 18 Following the Initial Term, this Agreement shall automatically be extended effective 19 July 1, 2018 for two (2) additional twelve (12) month periods upon the same terms and conditions herein set 20 forth, unless written notice of non-renewal is given by CONTRACTOR or COUNTY or COUNTY's DBH 21 Director, or designee, not later than ninety (90) days prior to the close of the current Agreement term. 22 23 3. TERMINATION: a. Non-Allocation of Funds -The terms of this Agreement, and the services to be 24 provided thereunder, are contingent on the approval of funds by the appropriating government agency. 25 Should sufficient funds not be allocated, the services provided may be modified, or this Agreement 26 terminated, at any time by giving the CONTRACTOR thirty (30) days advance written notice. 27 b. Breach of Contract -The COUNTY may immediately suspend or terminate this 28 Agreement in whole or in part, where in the determination of the COUNTY there is: -4- 1 2 3 4 1) 2) 3) An illegal or improper use of funds; A failure to comply with any term of this Agreement; A substantially incorrect or incomplete report submitted to the COUNTY; 5 4) Improperly performed service. 6 In no event shall any payment by the COUNTY constitute a waiver by the COUNTY of any 7 breach of this Agreement or any default which may then exist on the part of the CON1RACTOR. Neither 8 shall such payment impair or prejudice any remedy available to the COUNTY with respect to the breach or 9 default. The COUNTY shall have the right to demand of the CON1RACTOR the repayment to the 1 0 COUNTY of any funds disbursed to the CONTRACTOR under this Agreement, which in the judgment of 11 the COUNTY were not expended in accordance with the terms of this Agreement. The CON1RACTOR 12 shall promptly refund any such funds upon demand. 13 c. Without Cause -After the Initial Term, under circumstances other than those set 14 forth above, this Agreement may be terminated by either party upon the giving of thirty (30) days advance 15 written notice of an intention to terminate. 16 In the event of termination of this Agreement, COUNTY shall be relieved of its 17 obligation for further compensation for services provided to COUNTY after the date of termination. 18 19 20 4. COMPENSATION: COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive 21 compensation for services provided to COUNTY's program stated herein, as follows: 22 A. CONTRACTOR shall invoice COUNTY based on price discounts off the current 23 published Average Wholesale Price (A WP) as quoted in the CONTRACTOR's RFP Revised Response 24 as listed in the Pricing Sheet set forth as Exhibit D, attached hereto and incorporated herein by this 25 reference. A WP shall be based on the benchmark figure established by Medi-Span, a nationally 26 recognized and accepted pharmaceutical industry pricing source indexing (i.e.: Medi-Span's Walters 27 Kluwer Price Alert). Any additional costs (consistent with CONTRACTOR'S RFP Revised response) 28 administrative fees, dispensing fees and any other fees mentioned below shall also be included in -5- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 CONTRACTOR'S invoice to COUNTY. B. CONTRACTOR shall mvmce COUNTY only for consumers with Medically Indigent Adult/Medical Services Program (MIAIMSP) Certification and patients with a Uniform Method to Determine Ability to Pay (UMDAP) Certification, in accordance to Paragraph 5 of this Agreement and in accordance with Exhibit A. C. As listed in CONTRACTOR's RFP Revised response, CONTRACTOR shall provide the following discounts off the A WP pricing. For brand name medications, the Base Formula Breakdown shall be A WP less a Sixteen percent ( 16%) discount fee plus One and 251100 Dollars ($1.25) for dispensing fee. For generic class medications the Base Formula Breakdown shall be at A WP less a Seventy-Five percent (75%) discount fee plus One and 25/100 Dollars ($1.25) dispensing fee. It is further agreed that there shall be no minimum cost per prescription for legend prescriptions (medications prescribed by a doctor). COUNTY shall not pay dispensing and administrative fee for any Claims inadvertently added to invoice then reversed by CONTRACTOR's pharmacies but COUNTY shall ~ for dispensing and administrative fee when claim is denied due to a Medi-Cal denial. The parties agree that prices are not based on CONTRACTOR's acquisition costs. D. COUNTY reserves the right to have CONTRACTOR verify A WP pricing and discounts at any time during the term of the Agreement. COUNTY shall randomly check for correct pricing on all invoices. In the event COUNTY objects to the A WP pricing, COUNTY is still obligated to remit payment of the full payment amount to CONTRACTOR within the agreed upon payment terms. Within 30 days of COUNTY'S payment of the invoice, COUNTY shall identify and fully explain the basis for such objections in writing to CONTRACTOR. COUNTY and CONTRACTOR will then work together to determine the validity of the amounts to which COUNTY has objected. CONTRACTOR will reconcile any overpayments or underpayments through a charge or credit in a subsequent invoice to COUNTY. E. CONTRACTOR shall deliver prescriptions to COUNTY's facilities. COUNTY shall pay no fee for each delivery regardless of the number of prescriptions, delivery size and time the delivery is made. CONTRACTOR shall make these deliveries, when requested, Twenty-Four (24) hours a day Seven (7) days a week, including weekends and holidays. CONTRACTOR shall also make rush emergency deliveries at the same rate within one hour from the time called in by designated COUNTY staff. Non rush -6- 1 deliveries may be made at the soonest but within three (3) hours from the time prescription(s) were called in 2 by COUNTY staff. 3 F. Compensation shall be based on a fee for service; the maximum amount of compensation 4 paid to CONTRACTOR shall not exceed Two Hundred Fifty Thousand and 00/100 Dollars ($250,000.00) 5 for the period of July 1, 2015 through June 30, 2016 and each subsequent twelve (12) month period of the 6 Agreement. The maximum total compensation shall not exceed One Million Two Hundred Fifty Thousand 7 and 00/100 Dollars ($1,250,000.00) for the total agreement. 8 It is understood that all expenses incidental to CONTRACTOR's performance of 9 services under this Agreement shall be borne by CONTRACTOR. 10 G. Payments by COUNTY shall be in arrears, for services provided during the 11 preceding month, within forty-five ( 45) days after receipt and verification of CONTRACTOR's invoices by 12 COUNTY's Departments ofBehavioral Health and Social Services. 13 5. INVOICING: 14 CONTRACTOR shall invoice COUNTY accurately once a month on the first (1st) of each 15 month in both a paper hard copy claim and an electronic data download invoice. Contractor shall make 16 available an associate excel file for the electronic invoice and shall enable the downloading of the invoice 17 claims for COUNTY staff access. Separate invoices will be sent to the Department of Behavioral Health 18 and the Department of Social Services. Invoices shall be broken up by Groups which will have Plan IDs 19 listed separately. CONTRACTOR shall Invoice the Department of Behavioral Health in arrears for actual 20 expenses incurred and services rendered in the previous month to: DBH-Invoices@co.fresno.ca.us. 21 CONTRACTOR shall Invoice the Department of Social Services in arrears by the tenth 22 (lOth) of each month for actual expenses incurred and services rendered in the previous month to: 23 j DSSinvoices@co.fresno.ca.us 24 At the discretion of COUNTY's DBH or DSS Director, or their designees, failure by 25 CONTRACTOR to submit invoices as stated above, may result in CONTRACTOR's invoices being 26 disallowed/denied. Any incomplete data or incorrect invoice shall be returned to CONTRACTOR with 27 explanations of the item($) requiring correction(s). COUNTY shall pay the invoice within forty-five (45) 28 days upon receiving and verifying the corrected invoice. fu addition, for invoices received more than -7- 1 days upon receiving and verifying the corrected invoice. In addition, for invoices received more than 2 ninety (90) days after the expiration of each term of this Agreement or termination of this Agreement, at the 3 discretion of COUNTY's DBH Director or designee, COUNTY reserves the right to deny payment of any 4 additional invoices received. 5 CONTRACTOR shall bill COUNTY only for MIA/MSP and UMDAP clients. COUNTY 6 shall not pay for any services to consumers eligible for Medi-Cal or any third-party insurance. Invoice 7 amounts for clients found to be eligible for Med-Cal or any other third-party insurance shall be denied by 8 the COUNTY and CONTRACTOR shall be provided with alternate billing information. Invoiced amounts 9 denied by COUNTY due to clients being eligible for Medi-Cal or any other third-party insurance shall be 1 0 written off by CONTRACTOR on their Aged Receivable Report as soon as COUNTY provides the 11 alternate billing information. 12 6. INDEPENDENT CONTRACTOR: 13 In performance of the work, duties and obligations assumed by CONTRACTOR under this Agreement, it is 14 mutually understood and agreed that CONTRACTOR, including any and all of the CONTRACTOR'S 15 officers, agents, and employees will at all times be acting and performing as an independent contractor, and 16 shall act in an independent capacity and not as an officer, agent, servant, employee, joint venturer, partner, or 17 associate of the COUNTY. Furthermore, COUNTY shall have no right to control or supervise or direct the 18 manner or method by which CONTRACTOR shall perform its work and function. However, COUNTY 19 shall retain the right to administer this Agreement so as to verify that CONTRACTOR is performing its 20 obligations in accordance with the terms and conditions thereof. 21 CONTRACTOR and COUNTY shall comply with all applicable provisions of law and 22 the rules and regulations, if any, of governmental authorities having jurisdiction over matters the subject 23 thereof. 24 Because of its status as an independent contractor, CONTRACTOR shall have 25 absolutely no right to employment rights and benefits available to COUNTY employees. CONTRACTOR 26 shall be solely liable and responsible for providing to, or on behalf of, its employees all legally-required 27 employee benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY harmless 28 from all matters relating to payment of CONTRACTOR'S employees, including compliance with Social -8- 1 2 3 4 5 6 7 8 9 10 11 Security withholding and all other regulations governing such matters. It is acknowledged that during the term of this Agreement, CONTRACTOR may be providing services to others unrelated to the COUNTY or to this Agreement. 7. MODIFICATION: Any matters of this Agreement may be modified from time to time by the written consent of all the parties without; in any way, affecting the remainder. Notwithstanding the above, changes to medication pricing and co pay amounts, addresses to which notices or invoices, are to be sent may be made with the mutual written approval of COUNTY's Department of Behavioral Health Director or designee and Department of Social Services Director or designee. Any such modification shall not increase the maximum compensation payable under this Agreement. 8. NON-ASSIGNMENT: 12 Neither party shall assign, transfer or sub-contract this Agreement nor their rights or duties 13 under this Agreement without the prior written consent of the other party. 14 15 9. HOLD HARMLESS: CONTRACTOR agrees to indemnify, save, and hold harmless, and at COUNTY's 16 request, defend COUNTY, its officers, agents and employees from any and all costs and expenses, 17 including attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to 18 COUNTY in connection with the performance, or failure to perform, by CONTRACTOR, its officers, 19 agents or employees under this Agreement, and from any and all costs and expenses, including attorney 20 fees and court costs, damages, liabilities, claims and losses occurring or resulting to any person, firm or 21 corporation who may be injured or damaged by the performance, or failure to perform, of 22 CONTRACTOR, their officers, agents or employees under this Agreement. 23 CONTRACTOR agrees to indemnify COUNTY for Federal and/or State of California 24 audit exceptions resulting from noncompliance herein on the part of CONTRACTOR. 25 10. INSURANCE: 26 Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR or 27 any third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect, the 28 following insurance policies or a program of self-insurance, including but not limited to, an insurance -9- 1 pooling arrangement or Joint Powers Agreement (JPA) throughout the term of the Agreement: 2 a. Commercial General Liability 3 Commercial General Liability Insurance with limits of not less than One Million 4 Dollars ($1,000,000) per occurrence and an annual aggregate of Two Million Dollars ($2,000,000). This 5 policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including 6 completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal 7 liability or any other liability insurance deemed necessary because of the nature of this contract. 8 b. Automobile Liability This section intentionally blank. c. Professional Liability 11 If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N., L.C.S.W., 12 M.F.T.) in providing services, Professional Liability Insurance with limits of not less than One Million 13 Dollars ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate. This I 14 policy of Professional Liability shall remain in full force and affect for a period of not less than three years 15 after the termination of this Agreement. 16 d. Worker's Compensation 17 A policy of Worker's Compensation insurance as may be required by the California 18 Labor Code. 19 CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance 20 naming the County of Fresno, its officers, agents, and employees, individually and collectively, as additional 21 insured, but only insofar as the operations under this Agreement are concerned. Such coverage for 22 additional insured shall apply as primary insurance and any other insurance, or self-insurance, maintained by 23 COUNTY, its officers, agents and employees shall be excess only and not contributing with insurance 24 provided under CONTRACTOR's policies herein. CONTRACTOR shall provide written notice within 25 thirty (30) days to COUNTY after implementing any material change or cancellation applicable to 26 CONTRACTOR of the insurance coverage agreed upon herein. 27 Within thirty (30) days from the date CONTRACTOR executes this Agreement, 28 CONTRACTOR shall provide certificates of insurance and endorsement as stated above for all of the -10- 1 foregoing policies, as required herein, to the ColUlty of Fresno, Department of Behavioral Health Contract 2 Analyst, 313 3 Millbrook Ave, Fresno, CA 93 703 stating that such insurance coverage has been obtained and 3 is in full force; that the Coilllty of Fresno, its officers, agents and employees will not be responsible for any 4 premiums on the policies; that such Commercial General Liability insurance names the Coilllty of Fresno, its 5 officers, agents and employees, individually and collectively, as additional insured, but only insofar as the 6 operations illlder this Agreement are concerned; and that such coverage for additional insured shall apply as 7 primary insurance and any other insurance, or self-insurance, maintained by COUNTY, its officers, agents 8 and employees, shall be excess only and not contributing with insurance provided illlder CON1RACTOR's 9 policies herein. 10 For the required policies lUlder this agreement that are written on a claims made basis, for 11 three years post contract expiration US Script agrees to either keep such policies in full force, purchase tail 12 coverage, or a combination of both preceding options. 13 In the event CONTRACTOR fails to keep in effect at all times insurance coverage as herein 14 provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate this 15 Agreement upon the occurrence of such event. 16 All policies shall be with admitted insurers licensed to do business in the State of California. 17 Insurance purchased shall be purchased from companies possessing a current A.M. Best, Inc. rating of A 18 FSC VII or better. 19 11. AUDITS AND INSPECTIONS: 20 The CONTRACTOR shall , upon reasonable notice, during business hours, and as often as 21 the COUNTY may deem reasonably necessary, make available to the COUNTY for examination all of its 22 records and data with respect to the matters covered by this Agreement. The CONTRACTOR shall, upon 23 request by the COUNTY, permit the COUNTY to audit and inspect all of such records and data necessary to 24 ensure CON1RACTOR'S compliance with the terms of this Agreement. 25 If this Agreement exceeds ten thousand dollars ($10,000.00), CONTRACTOR shall be 26 subject to the examination and audit of the Auditor General for a period of three (3) years after fmal payment 27 lUlder contract (Government Code Section 8546.7). 28 12. NOTICES: -11- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 The persons and their addresses having authority to give and receive notices under this Agreement include the following: COUNTY Director, Fresno County Department of Behavioral Health 4441 E Kings Canyon Road Fresno, CA 93 702 Director, Fresno County Department of Social Services PO Box 1912 Fresno, CA 93718-1912 CONTRACTOR US Script, Inc 2425 W. Shaw Avenue Fresno, CA 93711 With a copy to: US Script, Inc President & CEO 6923 Lee Vista Blvd., Suite 300 Orlando, FL 32822 Any and all notices between the COUNTY and the CONTRACTOR provided for or permitted under this Agreement or by law shall be in writing and shall be deemed duly served when personally delivered to one of the parties, or in lieu of such personal services, when deposited in the United States Mail, postage prepaid, addressed to such party. 13. LICENSES: CONTRACTOR shall throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary for the provision of services hereunder and required by the laws and regulations of the United States, State of California, the County of Fresno, and any other applicable governmental agency(ies). CONTRACTOR shall notify COUNTY immediately in writing of its inability to obtain or maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions, irrespective of the pendency of any appeal related thereto. Additionally, CONTRACTOR shall comply with all other applicable laws, rules or regulations, as any may now exist or be hereafter changed. 14. COMPLIANCE WITH STATE REQUIREMENTS: CONTRACTOR recognizes that COUNTY operates its mental health programs under an agreement with the State of California Department of Mental Health, and that under said agreement the State of California imposes certain requirements on COUNTY and its subcontractors. CONTRACTOR shall adhere to the State of California requirements identified in Exhibit E, attached hereto and by this -12- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 reference incorporated herein. 15. PROIDBITION ON PUBLICITY: None of the funds, materials, property or services provided directly or indirectly under this Agreement shall be used for CONTRACTOR's advertising, fundraising, or publicity (i.e., purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion. Notwithstanding the above, publicity of the services described in Section One (1) of this Agreement shall be allowed as necessary to raise public awareness about the availability of such specific services when approved in advance by COUNTY's DBH Director or designee and at a cost to be provided for such items as written/printed materials, the use of media (i.e., radio, television, newspapers) and any other related expense(s). \ 16. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT: A. The parties to this Agreement shall be in strict conformance with all applicable Federal and State of California laws and regulations, including but not limited to Sections 5328, 10850, and 14100.2 et seq. of the Welfare and Institutions Code, Sections 2.1 and 431.300 et seq. of Title 42, Code of Federal Regulations (CPR), Section 56 et seq. of the California Civil Code, Sections 11977 and 11812 of Title 22 of the California Code of Regulations, and the Health Insurance Portability and Accountability Act (HIP AA), including but not limited to Section 1320 D et seq. of Title 42, United States Code (USC) and its implementing regulations, including, but not limited to Title 45, CPR, Sections 142, 160, 162, and 164, The Health Information Technology for Economic and Clinical Health Act (HITECH) regarding the confidentiality and security of patient information, and the Genetic Information Nondiscrimination Act (GINA) of2008 regarding the confidentiality of genetic information. Except as otherwise provided in this Agreement, CONTRACTOR, as a Business Associate of COUNTY, may use or disclose Protected Health Information (PHI) to perform functions, activities or services for or on behalf of COUNTY, as specified in this Agreement, provided that such use or disclosure shall not violate the Health Insurance Portability and Accountability Act (HIP AA), USC 1320d et seq. The uses and disclosures of PHI may not be more expansive than those applicable to COUNTY, as the "Covered Entity" under the HIP AA Privacy Rule ( 45 CPR 164.500 et seq.), except as authorized for management, administrative or legal responsibilities of the Business Associate. -13- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 B. CONTRACTOR, including its subcontractors and employees, shall protect, from unauthorized access, use, or disclosure of names and other identifying information, including genetic information, concerning persons receiving services pursuant to this Agreement,, except where permitted in order to carry out data aggregation purposes for health care operations [45 CPR Sections 164.504 (e)(2)(i), 164.504 (3)(2)(ii)(A), and 164.504 (e)(4)(i)] This pertains to any and all persons receiving services pursuant to a COUNTY funded program. This requirement applies to electronic PHI. CONTRACTOR shall not use such identifying information or genetic information for any purpose other than carrying out CONTRACTOR's obligations under this Agreement. C. CONTRACTOR, including its subcontractors and employees, shall not disclose any such identifying information or genetic information to any person or entity, except as otherwise specifically permitted by this Agreement, authorized by Subpart E of 45 CPR Part 164 or other law, required by the Secretary, or authorized by the client/patient in writing. In using or disclosing PHI that is permitted by this Agreement or authorized by law, CONTRACTOR shall make reasonable efforts to limit PHI to the minimum necessary to accomplish intended purpose of use, disclosure or request. D. For purposes of the above sections, identifying information shall include, but not be limited to name, identifying number, symbol, or other identifying particular assigned to the individual, such as finger or voice print, or photograph. E. For purposes of the above sections, genetic information shall include genetic tests of family members of an individual or individual, manifestation of disease or disorder of family members of an individual, or any request for or receipt of, genetic services by individual or family members. Family member means a dependent or any person who is first, second, third, or fourth degree relative. F. CONTRACTOR shall provide access, at the request of COUNTY, and in the time and manner designated by COUNTY, to PHI in a designated record set (as defined in 45 CPR Section 164.501), to an individual or to COUNTY in order to meet the requirements of 45 CPR Section 164.524 regarding access by individuals to their PHI. With respect to individual requests, access shall be provided within thirty (30) days from request. Access may be extended if CONTRACTOR cannot provide access and provides individual with the reasons for the delay and the date when access may be granted. PHI shall be provided in the form and format requested by the individual or COUNTY. -14- 1 CONTRACTOR shall make any amendment(s) to PHI in a designated record set at the 2 request of COUNTY or individual, and in the time and manner designated by COUNTY in accordance 3 with 45 CPR Section 164.526. 4 CONTRACTOR shall provide to COUNTY or to an individual, in a time and manner 5 designated by COUNTY, information collected in accordance with 45 CPR Section 164.528, to permit 6 COUNTY to respond to a request by the individual for an accounting of disclosures of PHI in accordance 7 with 45 CPR Section 164.528. 8 G. CONTRACTOR shall report to COUNTY, in writing, any knowledge or reasonable 9 belief that there has been unauthorized access, viewing, use, disclosure, security incident, or breach of 1 0 unsecured PHI not permitted by this Agreement of which it becomes aware, immediately and without 11 reasonable delay and in no case later than fourteen (14) business days of discovery. Immediate notification 12 shall be made to COUNTY's Information Security Officer and Privacy Officer and COUNTY's DPH 13 HIPAA Representative, within fourteen (14) business days of discovery. The notification shall include, to 14 the extent possible, the identification of each individual whose unsecured PHI has been, or is reasonably 15 believed to have been, accessed, acquired, used, disclosed, or breached. CONTRACTOR shall take prompt 16 corrective action to cure any deficiencies and any action pertaining to such unauthorized disclosure required 17 by applicable Federal and State Laws and regulations. CONTRACTOR shall investigate such breach and 18 is responsible for all notifications required by law and regulation or deemed necessary by COUNTY and 19 shall provide a written report of the investigation and reporting required to COUNTY's Information 20 Security Officer and Privacy Officer and COUNTY's DPH HIPAA Representative. This written 21 investigation and description of any reporting necessary shall be postmarked within the thirty (30) working 22 days of the discovery of the breach to the addresses below: 23 24 25 26 27 28 County of Fresno Dept. of Public Health HIP AA Representative (559) 600-6439 P.O. Box 11867 Fresno, CA 93775 County ofFresno Dept. of Public Health Privacy Officer (559) 600-6405 P.O. Box 11867 Fresno, CA 93775 -15- County of Fresno Information Technology Services Information Security Officer (559) 600-5800 2048 N. Fine Street Fresno, CA 93727 1 H. CONTRACTOR shall make its internal practices, books, and records relating to the 2 use and disclosure of PHI received from COUNTY, or created or received by the CONTRACTOR on 3 behalf of COUNTY, in compliance with HIPAA's Privacy Rule, including, but not limited to the 4 requirements set forth in Title 45, CFR, Sections 160 and 164. CONTRACTOR shall make its internal 5 practices, books, and records relating to the use and disclosure of PHI received from COUNTY, or created 6 or received by the CONTRACTOR on behalf of COUNTY, available to the United States Department of 7 Health and Human Services (Secretary) upon demand. 8 CONTRACTOR shall cooperate with the compliance and investigation reviews conducted 9 by the Secretary. PHI access to the Secretary must be provided during the CONTRACTOR's normal 1 0 business hours, however, upon exigent circumstances access at any time must be granted. Upon the 11 Secretary's compliance or investigation review, if PHI is unavailable to CONTRACTOR and in possession 12 of a Subcontractor, it must certify efforts to obtain the information to the Secretary. 13 I. Safeguards 14 CONTRACTOR shall implement administrative, physical, and technical safeguards as 15 required by the HIP AA Security Rule, Subpart C of 45 CFR 164, that reasonably and appropriately protect 16 the confidentiality, integrity, and availability of PHI, including electronic PHI, that it creates, receives, 17 maintains or transmits on behalf of COUNTY and to prevent unauthorized access, viewing, use, disclosure, 18 or breach of PHI other than as provided for by this Agreement. CONTRACTOR shall conduct an accurate 19 and thorough assessment of the potential risks and vulnerabilities to the confidential, integrity and 20 availability of electronic PHI. CONTRACTOR shall develop and maintain a written information privacy 21 and security program that includes administrative, technical and physical safeguards appropriate to the size 22 and complexity of CONTRACTOR's operations and the nature and scope of its activities. Upon 23 COUNTY's request, CONTRACTOR shall provide COUNTY with information concerning such 24 safeguards. 25 CONTRACTOR shall implement strong access controls and other security safeguards and 26 precautions in order to restrict logical and physical access to confidential, personal (e.g., PHI) or sensitive 27 data to authorized users only. Said safeguards and precautions shall include the following administrative -28 -16- 1 and technical password controls for all systems used to process or store confidential, personal, or sensitive 2 data: 3 1. Passwords must not be: 4 a. Shared or written down where they are accessible or recognizable 5 by anyone else; such as taped to computer screens, stored under keyboards, or visible in a work area; 6 b. A dictionary word; or 7 c. Stored in clear text 8 2. Passwords must be: 9 a. Eight (8) characters or more in length; 1 0 b. Changed every ninety (90) days; 11 c. Changed immediately if revealed or compromised; and 12 d. Composed of characters from at least three (3) of the following four 13 ( 4) groups from the standard keyboard: 14 1) Upper case letters (A-Z); 15 2) Lowercase letters (a-z); 16 3) Arabic numerals (0 through 9); and 17 4) Non-alphanumeric characters (punctuation symbols). 18 CONTRACTOR shall implement the following security controls on each 19 workstation or portable computing device (e.g., laptop computer) containing confidential, 20 personal, or sensitive data: 21 1. Network-based firewall and/or personal firewall; 22 2. Continuously updated anti-virus software; and 23 3. Patch management process including installation of all operating 24 system/software vendor security patches. 25 CONTRACTOR shall utilize a commercial encryption solution that has received FIPS 140-2 26 validation to encrypt all confidential, personal, or sensitive data stored on portable electronic media 27 (including, but not limited to, compact disks and thumb drives) and on portable computing devices 28 (including, but not limited to, laptop and notebook computers). -17- 1 CONTRACTOR shall not transmit confidential, personal, or sensitive data via e-mail or 2 other internet transport protocol unless the data is encrypted by a solution that has been validated by the 3 National Institute of Standards and Technology (NIST) as conforming to the Advanced Encryption 4 Standard (AES) Algorithm. CONTRACTOR must apply appropriate sanctions against its employees who 5 fail to comply with these safeguards. CONTRACTOR must adopt procedures for terminating access to 6 PHI when employment of employee ends. 7 J. Mitigation of Harmful Effects 8 CONTRACTOR shall mitigate, to the extent practicable, any harmful effect that is suspected 9 or known to CONTRACTOR of an unauthorized access, viewing, use, disclosure, or breach of PHI by 1 0 CONTRACTOR or its subcontractors in violation of the requirements of these provisions. 11 CONTRACTOR must document suspected or known harmful effects and the outcome. 12 K. CONTRACTOR's Subcontractors 13 CONTRACTOR shall ensure that any of its contractors, including subcontractors, if 14 applicable, to whom CONTRACTOR provides PHI received from or created or received by 15 CONTRACTOR on behalf of COUNTY, agree to the same restrictions, safeguards, and conditions that 16 apply to CONTRACTOR with respect to such PHI and to incorporate, when applicable, the relevant 17 provisions of these provisions into each subcontract or sub-award to such agents or subcontractors .. 18 L. Employee Training and Discipline 19 CONTRACTOR shall train and use reasonable measures to ensure compliance with the 20 requirements of these provisions by employees who assist in the performance of functions or activities on 21 behalf of COUNTY under this Agreement and use or disclose PHI and discipline such employees who 22 intentionally violate any provisions of these provisions, including termination of employment. 23 M. Termination for Cause 24 Upon COUNTY's knowledge of a material breach of these provisions by CONTRACTOR, 25 COUNTY shall either: 26 1. Provide an opportunity for C01-fTRACTOR to cure the breach or end the 27 violation and terminate this Agreement if CONTRACTOR does not cure the breach or end the violation 28 within the time specified by COUNTY; or -18- 1 2. Immediately terminate this Agreement if CONTRACTOR has breached a 2 material term of these provisions and cure is not possible. 3 3. If neither cure nor termination is feasible, the COUNTY's Privacy Officer 4 shall report the violation to the Secretary of the U.S. Department of Health and Human Services. 5 N. Termination due to Change in Law 6 Either party may terminate this Agreement immediately if any change of law or regulation, 7 or interpretation of existing law or regulation would: (i) make this Agreement or a material portion of a 8 party's performance under this Agreement illegal; or (ii) make such party's performance under this 9 Agreement impossible or otherwise materially alter the intent of this Agreement. Notwithstanding the 10 foregoing, if such a change or interpretation requires a material change to any term(s) of this Agreement, or 11 otherwise materially alters the intent of this Agreement, the parties will engage in good faith negotiations in 12 an attempt to reach mutually agreeable terms that comply with the changed law or regulation, or 13 interpretation. If the parties are unable to come to mutually agreeable terms, either party may thereafter 14 terminate the Agreement upon thirty (30) days' prior written notice to the other party. 15 0. Judicial or Administrative Proceedings 16 COUNTY may terminate this Agreement in accordance with the terms and conditions of this 17 Agreement as written hereinabove, if: (1) CONTRACTOR is found guilty in a criminal proceeding for a 18 violation of the HIP AA Privacy or Security Laws or the HITECH Act; or (2) a finding or stipulation that 19 the CONTRACTOR has violated a privacy or security standard or requirement of the HITECH Act, 20 HIP AA or other security or privacy laws in an administrative or civil proceeding in which the 21 CONTRACTOR is a party. 22 P. Effect of Termination 23 Upon termination or expiration of this Agreement for any reason, CONTRACTOR shall 24 return or destroy all PHI received from COUNTY (or created or received by CONTRACTOR on behalf of 25 COUNTY) that CONTRACTOR still maintains in any form, and shall retain no copies of such PHI. If 26 return or destruction of PHI is not feasible, it shall continue to extend the protections of these provisions to 27 such information, and limit further use of such PHI to those purposes that make the return or destruction of 28 such PHI infeasible. This provision shall apply to PHI that is in the possession of subcontractors or agents, -19- 1 if applicable, of CON1RACTOR. If CONTRACTOR destroys the PHI data, a certification of date and 2 time of destruction shall be provided to the COUNTY by CONTRACTOR. 3 Q. Disclaimer 4 COUNTY makes no warranty or representation that compliance by CON1RACTOR with 5 these provisions, the HITECH Act, HIP AA or the HIP AA regulations will be adequate or satisfactory for 6 CONTRACTOR's own purposes or that any information in CON1RACTOR's possession or control, or 7 transmitted or received by CON1RACTOR, is or will be secure from unauthorized access, viewing, use, 8 disclosure, or breach. CONTRACTOR is solely responsible for all decisions made by CONTRACTOR 9 regarding the safeguarding of PHI. 1 0 R. Amendment 11 The parties acknowledge that Federal and State laws relating to electronic data security and 12 privacy are rapidly evolving and that amendment of these provisions may be required to provide for 13 procedures to ensure compliance with such developments. The parties specifically agree to take such 14 action as is necessary to amend this agreement in order to implement the standards and requirements of 15 HIP AA, the HIP AA regulations, the HITECH Act and other applicable laws relating to the security or 16 privacy of PHI. COUNTY may terminate this Agreement upon thirty (30) days written notice in the event 17 that CON1RACTOR does not enter into an amendment providing assurances regarding the safeguarding of 18 PHI that COUNTY in its sole discretion, deems sufficient to satisfy the standards and requirements of 19 HIP AA, the HIP AA regulations and the HITECH Act. 20 S. No Third-Party Beneficiaries 21 Nothing express or implied in the terms and conditions of these provisions is intended to 22 confer, nor shall anything herein confer, upon any person other than COUNTY or CON1RACTOR and 23 their respective successors or assignees, any rights, remedies, obligations or liabilities whatsoever. 24 T. Interpretation 25 The terms and conditions in these provisions shall be interpreted as broadly as necessary to 26 implement and comply with HIP AA, the HIP AA regulations and applicable State laws. The parties agree 27 that any ambiguity in the terms and conditions of these provisions shall be resolved in favor of a meaning 28 that complies and is consistent with HIP AA and the HIP AA regulations. -20- ----~' 1 u. Regulatory References 2 A reference in the terms and conditions of these provisions to a section in the HIP AA 3 regulations means the section as in effect or as amended. 4 v. Survival 5 The respective rights and obligations of CONTRACTOR as stated in this Section shall 6 survive the termination or expiration of this Agreement. 7 w. No Waiver of Obligations 8 No change, waiver or discharge of any liability or obligation hereunder on any one or more 9 occasions shall be deemed a waiver of performance of any continuing or other obligation, or shall prohibit 1 0 enforcement of any obligation on any other occasion. 11 17. INFORMATION SYSTEM DATA: 12 In order to facilitate convenient consumer prescription pick up at pharmacies contracted 13 by the CONTRACTOR, CONTRACTOR and COUNTY shall exchange consumer data on an as needed 14 basis. CONTRACTOR shall ensure that the contracted pharmacies shall provide professional and 15 unimpeded services to COUNTY consumers. CONTRACTOR shall expediently solve any problems 16 which prevent the prescription from being filled and picked up by the consumer. Additionally, new 17 consumer information being provided by COUNTY may be entered into said database by 18 CONTRACTOR's pharmacies. 19 20 21 221 23 24 25 26 27 28 18. GOVERNING LAW: Venue for any action arising out of or related to this Agreement shall only be in Fresno County, California. The rights and obligations of the parties and all interpretation and performance of this Agreement shall be governed in all respects by the laws of the State of California. 19. SEVERABILITY: Should any court or regulatory agency or body determine, in a form and manner which render such determination enforceable against either of the parties, that any provision of this Agreement is void, invalid, unenforceable, or illegal, such determination shall not affect any other provision of this Agreement, and this Agreement shall, if reasonable, be construed and performed as if such void, invalid, unenforceable, or illegal provision had never been contained herein. -21- 1 2 3 4 5 6 7 8 9 10 I 11 12 13 14 15 16 17 18 19 20 21 22 23 20. FORCE MAJEURE: Any delay in the performance of any of the duties or obligations of either party hereto (except the payment of money) shall not be considered a breach of this Agreement and the time required for performance shall be extended for a period equal to the period of such delay, provided that such delay has been caused by or is the result of any acts of God, acts of the public enemy, insurrections, riots, terrorism, embargoes, labor disputes, including strikes, lockouts, job actions, boycotts, fires, explosions, floods, shortages of material or energy, computer viruses or other unforeseeable causes beyond the control and without the fault or negligence of the party so affected. The affected party shall give prompt notice to the other party of such cause, and shall take promptly whatever reasonable steps are necessary to relieve the effect of such cause. 21. DISCLOSURE OF SELF -DEALING TRANSACTIONS: This provision is only applicable if the CONTRACTOR is operating as a corporation (a for-profit or non-profit corporation) or if during the term of the agreement, the CONTRACTOR changes its status to operate as a corporation. Members of the CONTRACTOR's Board of Directors shall disclose any self-dealing transactions that they are a party to while CONTRACTOR is providing goods or performing services under this agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR is a party and in which one or more of its directors has a material financial interest. Members of the Board of Directors shall disclose any self-dealing transactions that they are a party to by. completing and signing a Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit I and incorporated herein by reference, and submitting it to the COUNTY prior to commencing with the self-dealing transaction or immediately thereafter. 22. ENTIRE AGREEMENT: 24 This Agreement constitutes the entire agreement between the CONTRACTOR and 25 COUNTY with respect to the subject matter hereof and supersedes all previous Agreement negotiations, 26 proposals, commitments, writings, advertisements, publications, and understanding of any nature 27 whatsoever unless expressly included in this Agreement. 28 Ill -22- 1 EXECUTED AND EFFECTIVE as of the date first above set forth 2 3 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and year first hereinabove 4 written. 5 ATIEST: 6 CONTRACTORS: 7 8 9 10 11 Donald Howard President & CEO 12 13 Print Name & Title Fresno CA 93711 14 Mailing Address 15 16 17 18 19 20 21 22 23 24 DATE: COUNTY OF FRESNO: "~a. Deborah A. Poochigian, Chairman, Board of Supervisors BERNICE E. SEIDEL, Clerk Board of Supervisors 25 PLEASE SEE ATTACHED PAGES FOR ADDITIONAL INFORMATION 26 27 28 -~~~ ----~-. ---23----· -----~ ~-----~-~-----~-----~-~-~-~---~---------~ -~ ' 1 PLEASE SEE ATTACHED PAGES FOR ADDITIONAL INFORMATION 2 3 APPROVED AS TO LEGAL FORM: 4 DANIEL C. CEDERBORG, COUNTY COUNSEL APPROVED AS TO ACCOUNTING FORM: 10 VICKI CROW, C.P.A., AUDITOR-CONTROLLER! 11 TREASURER-TAX COLLECTOR 12 /)/} 13 By <...&:< {~., 14 15 16 REVIEWED AND RECOMMENDED 17 FOR APPROVAL: 18 19 20 21 22 23 24 25 26 Fund/Subclass: 0001/10000 Organization: 56304512 27 Account/Program: 7295/0 28 FY 2015/16: $250,000 -24- SCOPE OF WORK Exhibit A Page 1 of18 Vendor shall provide prescription drug services and related services to the consumers of the Fresno County Departments of Behavioral Health and Social Services. A. Cost Containment: The Vendor shall provide the lowest possible pricing using whichever source, sources and/or methods necessary to provide appropriate medication for the medically indigent DBH and DSS clients who lack any third- party insurance or Medi-Cal. Vendor shall utilize the lowest cost generic medications approved by the Federal Food and Drug Agency (FDA). Brand names are to be used only when generic medications are not available. Vendor shall develop a drug utilization review and notification program for prescribing DBH physicians to ensure prescribed medication is appropriate in dosage, frequency, and compatibility with other medications, e.g. drug-to-drug interaction audits. This program shall be subject to approval of the DBH. Vendor shall advise County when less expensive medication plans become a more viable form of treatment. Vendor shall maintain criteria, which may be amended from time to time, to establish when and how a Network Pharmacy may be audited to verify compliance with its agreement with Vendor. County acknowledges and agrees that Vendor may contract with a third-party auditor to conduct such periodic on- site and off-site audits. Vendor will retain twenty-five percent (25%) of any overpayments recovered from Network Pharmacies as compensation for audit and administrative costs. Vendor's efforts under this paragraph will be deemed to be made on County's behalf and the balance of any collected overpayments will be paid to County. Vendor will not be required to institute any litigation to collect any overpayments, Vendor's obligations to attempt collection of such overpayments will be Vendor's only obligation with respect to remedying such overpayments, and Vendor will not be obligated to repay such overpayments. B. Information Management/Reporting: Vendor shall provide monthly reports and online access to DBH and DSS and information pertaining to costs, usage, clients, providers, rebates from pharmaceutical companies, and medication dispensed. Vendor shall maintain a centralized consumer medication profile for all clients with a history of all prescriptions filled, prescribing doctors and payment method, pharmacy where meds were picked up, and client demographics. Vendor shall work with the DBH Information Systems staff to decide on the best way to create a file for DBH and client database by utilizing either a point-of- sale system or by monthly uploading of consumer eligibility, and downloading of Exhibit A Page 2 of18 the invoice claims (e-mail, tape, diskette, CD ROM, or other format as mutually agreed upon). The following are examples of desired information to be provided by Vendor on a monthly basis to the DBH: 1. Total prescription costs/credits per program or clinic designated by the County with cost center numbers 2. Usage and prescribing patterns 3. Report of specific medication usage by dosage by client, when requested by DBH 4. Number of unduplicated (unique) individual clients using services 5. All dispensed medications and dosages by physician 6. Number of invalid claims filed and processed 7. Number of complaints filed 8. Cost data per patient 9. Cost per Group and Cost Center 10. Customized management reports as requested by the County 11. Monthly financial utilization reports, applicable to DBH needs 12. Any incidents involving medication which could adversely affect a consumer and the investigative and corrective actions that were taken 13. Vendor shall provide examples of reports in their submitted proposal. Reporting formats should be flexible to provide for new medications released by the FDA, revised guidelines created by the DBH, etc. C. Consumer Access: Vendor shall provide as many pharmacy sites as feasible for medication availability for outpatient clients treated throughout Fresno County. The selected Vendor will not be required to open an in-house pharmacy at any county clinic. D. Legal and Regulatory Requirements: Products and services shall meet the quality and packaging standards, and all other requirements of the State Board of Pharmacy. In addition, vendor shall maintain all licenses and certificates required by any local, State or Federal rules and regulations. E. Vendor shall list cost under Cost Proposal for disposing any outdated or damaged drugs for DBH. IV. County's Responsibilities DBH agrees to provide the following information: A. Update consumer eligibility as mutually agreed upon. B. County formularies. C. Identify needed support reporting for County Departments. Exhibit A Page 3 of18 D. Indicators on eligibility files (e.g. Medi-Cal or other files defined by the County) when available. E. The County will designate a point of contact for the duration of the contract to whom all vendor communications may be addressed. F. Current list of County's prescribing physicians V. Closed Physician Network A. The County's DBH will have a closed physician network for all DBH Groups/Programs. B. The County's DSS will have an open network for the Child Welfare program. C. County will not pay for medication prescribed by a physician not duly authorized by the County. The County will notify the Vendor if/when changes to the list of physicians occur. VI. Department Medication Formulary A. DBH will use a medication formulary for all medication prescribed unless pre- authorization is granted by DBH. B. DSS will not use a formulary for any of its programs. VII. Pharmaceutical Management The selected Vendor shall contract with pharmacies throughout Fresno County to fill pharmaceutical prescriptions at a discounted rate for severely mentally ill adults and severely emotionally disturbed children. The majority of these prescriptions will be for psychotropic pharmaceuticals; however, prescriptions may also be allowed for treatment of those side effects attributed using a psychotropic medications and some health medications with prior authorization. Pharmaceuticals for DBH will be restricted to those drugs listed on County's formulary. A. Retail Pharmacy Network Exhibit A Page 4 oflS 1. Maintain contractual relationships with pharmacies throughout Fresno County for the term of the contract. 2. Contracted pharmacies shall provide consultations for all new prescriptions as required by Federal and State rules and regulations. 3. Have the ability to provide a County payment indicator called Uniform Method for Determining Ability to Pay (UMDAP) to the contracted pharmacy that identifies County as the primary payer for UMDAP eligible mental health clients. 4. Have the ability to provide a Prescription Assistance Program indicator or flag to the contracted pharmacy for clients denied access to prescriptions to be filled through the County's assistance programs. 5. Contracted pharmacies shall accept prescriptions by all allowed methods in accordance to State and Federal rules and regulations. 6. Network Options-The vendor shall offer its most commonly used retail pharmacy network. The vendor shall submit a complete current list of its network of retail pharmacies. 7. Chain Pharmacies-For the network arrangement proposed, vendor shall identify which national or major regional chains are included in the Fresno County area. 8. Network Coverage-For the proposed retail pharmacy network, vendor to provide a GeoAccess analysis using all zip codes that include Fresno County. The following standard shall be used: Two pharmacies within five miles of every zip code. 9. Systems Interface-Describe the systems and processes in place to support eligibility determination, messaging, and communication with participating pharmacies. Be specific in describing the type of information provided to and required from the pharmacy at the time of eligibility verification. 10. Retail Pharmacy Scripts-Describe the editing and messaging process that will be used and how you ensure that only qualifying prescriptions will be filled. 11. Contract-If Vendor is a PBM, attach a copy of your standard pharmacy contract with your contracted pharmacies, including payment terms and conditions. B. Administration 1. Maintain, update, and manage consumer eligibility when information is provided by DBH. 2. Perform eligibility updates to consumer data with input from County. Exhibit A Page 5 of18 3. Update consumer eligibility files within a mutually agreed upon timeline after receiving updates from the County. 4. Maintain history for each consumer available for immediate, direct access by the County during the term of the Agreement. 5. Maintain all data records either on or off-line for a minimum of seven (7) years, in accordance to State and Federal rules and regulations. 6. Provide an override process to allow the County the ability to fill non- formulary drugs when needed. 7. Demonstrate the ability to administer the County's eligibility requirements: (a) client must be County client; and (b) each script must be prescribed from an authorized County provider and (c) each drug must be on the County's formulary for DBH. 8. Support a centralized, consolidated billing process that also provides line item detail for all drug expenditures for each Group as defined by County. Invoicing must be detailed enough to determine each Group's spending by specific drug description, National Drug Code (NDC), consumer information, name, physician, Group ID and Plan ID (as defined by the County), Pharmacy, Rx number, if new or a refill, date filled, metric quantity, day's supply and billed amount. 9. Comply fully with systems, processes, procedures, and policies with current Federal HIPAA Privacy and Security requirements as well as State confidentiality regulations for the collection, maintenance, use and transmission of protected information. Vendor must fully adhere to the most restrictive regulation for the protection of information. C. Account Management and Customer Service 1. Identify an account manager who will be responsible for the overall contract responsibilities and will have administrative authority under this contract. 2. Sufficient vendor staff to resolve day-to-day problems and answer queries will be provided for customer service via a toll free number for participating pharmacies and for County staff. 3. Prescription orders and arrangements for language/cultural assistance, (i.e.: translations/interpretations) will be provided via written, fax, and/or telephone requests from staff, acting as agents of the assigned licensed physician. Vendor shall provide prescriptions in accordance with State Board of Pharmacy Regulations. D. Audits The County reserves the right to perform cost audits on invoices and make any adjustments required to correct errors. Corrections shall be made not more than sixty (60) days after notification to correct is received from County. IX. On-line Queries Vendor shall meet the following requirements: Exhibit A Page 6 of18 A. Provide the County the ability to query online claim data history for creating additional custom reports on an as needed basis. B. Provide the County the ability to query online of specific medication usage by dosage by client. C. Maintain the capability to provide monthly detailed prescription drug claims data to County. D. Ensure the output of any reporting system can be exported to Microsoft compatible software. E. Provide access to technical support staff who can respond to questions concerning the use of any proposed reporting system. X. Medi-Cal Vendor shall meet the following requirements: A. Medi-Cal Eligibility and Billing Clients receiving medication as medically indigent often become eligible for Medi-Cal. Vendor shall be responsible for billing Medi-Cal when the client is Medi-Cal eligible. Medi-Cal eligibility for clients may remain consistent or may fluctuate from month-to-month. On a monthly basis, County will notify the vendor when a client becomes eligible/ineligible for Medi-Cal. Medi-Cal eligibility can be determined retroactively and vendor shall be required to back- bill Medi-Cal and adjust invoices accordingly up to 12 previous months. B. Medi-Cal Report Vendor shall submit a monthly Medi-Cal report containing claim detail on County clients that are being invoiced to the County because of Medi-Cal ineligibility or rejection. The vendor shall provide information that addresses retroactive Medi-Cal eligibility, the dates and amounts of claims that will be credited to the County for expenditures that will be retroactively eligible for Medi-Cal reimbursement. In addition the following shall also be included: 1. Date Claim paid by County 2. Date Claim paid by Medi-Cal 3. Date Claim credited to County 4. Original invoice number and date the original charge is reversed and credited to the Department's program cost center. XI. Rebates Exhibit A Page 7 ofl8 A. Vendor will provide rebate and formulary services directly or through a third- party formulary manager and rebate processor (the "Rebate Processor") contracted by Vendor to collect rebates from pharmaceutical manufacturers for claims submitted by Vendor and provide other formulary management services (the "Rebate Services Agreement"). County authorizes Vendor to: (i) act as, or engage the Rebate Processor as, the exclusive agent for negotiating and arranging for Rebates on the purchase of prescription drugs from pharmaceutical manufacturers and related services; and (ii) authorizes Vendor and/or the Rebate Processor to contract with pharmaceutical companies for Rebates as a group purchasing organization for Vendor's clients, including County. Nothing in this Agreement or otherwise shall be deemed to confer upon either Vendor or the Rebate Processor: (a) the status of fiduciary as defined in ERISA or any applicable state law with respect to County or any Plan; (b) any responsibility for the terms or validity of the Plan; or (c) discretionary authority or responsibility with respect to any Plan or its administration. Vendor and/or the Rebate Processor shall have no liability to County or any Plan or Covered Person because of any plan design issue. B. The formulary identifies those drug products and over-the-counter products that are covered by County for dispensing to Covered Persons as identified in the Benefit Enrollment Form (the "Formulary"). C. Vendor has a standard Formulary that is designed, developed, managed, and maintained by Vendor and/or the Rebate Processor (the "Vendor Formulary"). Vendor shall make this 'Formulary available to County and Plans. From time to time, Vendor may revise the Vendor Formulary and make additions, deletions and modifications and deemed appropriate by Vendor. Such changes may be based upon, among other things: new products, customer safety, clinical appropriateness, efficacy, cost effectiveness, changes in availability of products, new clinical information or other considerations, changes in the pharmaceutical industry, introduction of new generics, and new legislation or regulations. If County has adopted the Vendor Formulary, then Vendor will provide County with thirty (30) days prior written notice of any deletions to the Vendor Formulary, except for written notice for changes due to the following exceptions will be given no later than five (5) business days after the change: (i) when generic substitutions become available due to patent expirations of brand drugs that have been on the Vendor Formulary, and (ii) when drugs on the US script Formulary are subject to FDA action. All other changes to the Vendor Formulary shall be timely communicated by Vendor to County in accordance with Vendor's standard business practices. County acknowledges that County does not have any ownership rights to the Vendor Formulary. Vendor and/or the Rebate Processor may authorize County to put County's or a Plan's logo(s) on the Vendor Formulary, but County shall have no rights to the Vendor Formulary other than as described in this Agreement. County and the Plans may only use the Vendor Formulary for the purposes contemplated by this Agreement. Upon the termination or expiration of this Agreement, County shall cease using the Vendor Formulary as soon as reasonably practicable, but in any event no later than the end of the current Plan year. Exhibit A Page 8 of18 D. THE CLINICAL INFORMATION CONTAINED IN THE US SCRIPT FORMULARY IS INTENDED AS A SUPPLEMENT TO, AND NOT A SUBSTITUTE FOR, THE KNOWLEDGE, EXPERTISE, SKILL, AND JUDGMENT OF PHYSICIANS, PHARMACISTS, OR OTHER HEALTH-CARE PROFESSIONALS IN A COVERED PERSON'S CARE. THE ABSENCE OF A WARNING FOR A GIVEN DRUG OR DRUG COMBINATION SHALL NOT BE CONSTRUED TO INDICATE THAT THE DRUG OR DRUG COMBINATION IS SAFE, APPROPRIATE OR EFFECTIVE FOR ANY COVERED PERSON. If County elects to use a custom Formulary (i.e., any Formulary that differs from the Vendor Formulary), Vendor may make recommendations to County regarding which drugs should be on the Formulary, but the County shall make the final decision; provided, however, that: (i) changes may be made to the Formulary no more often than once per quarter, (ii) changes will only be effective upon the first day of a quarter, (iii) County must provide Vendor with written notice of any changes at least sixty (60) prior to the first day in which such change is to take effect (thus, if County provides Vendor with written notice less than sixty (60) days before the beginning of a quarter, the change shall not be effective until the first day of the subsequent quarter), and (iv) client agrees to provide a published Formulary document via PDF to Vendor each quarter by the 1Oth calendar day of such quarter for purposes of rebate qualification. The foregoing notwithstanding, County may modify the Formulary more frequently than permitted by the preceding sentence solely to the extent a change is mandated by the County's P& T Committee for reasons of Covered Person safety provided: (i) County promptly communicates such modification to Vendor in writing (for which an email shall suffice), which communication shall include a copy of the relevant portions of official minutes from the County's P& T Committee that set forth its findings and determinations in regard to the change (and permission for Vendor to share such minutes with the Rebate Processor), and (ii) all products so deleted from the Formulary shall be excluded from Rebates for such quarter, and to the extent rebate eligibility for other products in the relevant therapeutic class is impacted, such products in the relevant therapeutic class shall also be excluded from Rebates for such quarter. If County is using a custom Formulary, Vendor will not guarantee the rebate structure set forth in Exhibit A. If at any time County modifies its custom Formulary, and such modification materially reduces the Rebates received by Vendor on behalf of County, then Vendor shall have the right to equitably adjust the rebate structure as set forth in Exhibit A to preserve the economic benefit to Vendor under the Agreement. County shall make its current Formulary accessible to Plans, Covered Persons, pharmacies, and physicians, on County's website, and print and distribute copies of the Formulary as may be required by Vendor. Vendor shall provide soft edits for designated Formulary classes at the point-of- sale requiring the pharmacist to read on-line Formulary messaging and description of therapeutic intervention opportunities. Vendor may offer additional formulary compliance programs from time to time, but shall not implement any other formulary compliance programs without County's prior written consent; provided, however, that County acknowledges and agrees that nothing in this section restricts the actions of Participating Pharmacies in Exhibit A Page 9 oflS providing any formulary compliance services or patient communications as part of its professional pharmacy services. County acknowledges and agrees that Vendor and/or the Rebate Processor shall be the exclusive agent for negotiating and arranging for rebates and related services from pharmaceutical manufacturers under this Agreement. During the term of this Agreement, and any renewals hereof, County will not directly or indirectly contract or agree with any pharmaceutical manufacturer or other third party for the purpose of obtaining rebates or other discounts related to the drug utilization of Covered Persons, including the use of over-the-counter drugs. County shall, without claim against Vendor or the Rebate Processor, cancel any existing agreements, arrangements, and/or contracts with any pharmaceutical manufacturer or any other third party related to such rebates or discounts as of the Commencement Date of this Agreement. County acknowledges that any failure to comply with this Section may result in a partial or complete loss of rebates under this Agreement, and that any such loss shall be in addition to any other rights or remedies available to Vendor for such breach. Subject to the terms and conditions of this Agreement, Vendor shall remit rebates to County as set forth in Exhibit A of this Agreement. Vendor's payment of such rebate amounts to County in accordance with the terms of this Agreement will constitute payment in full of Vendor's obligation to County for rebates. County acknowledges and agrees that it shall have no right to interest on, or the time value of, any rebates received by the Rebate Processor or by Vendor or monies payable under this Agreement. Vendor and/or the Rebate Processor and its affiliates may have financial relationships with pharmaceutical companies and may receive and retain fees or other compensation from pharmaceutical companies for services rendered and property provided to pharmaceutical companies, including, without limitation, administrative fees that range between one percent (1 %) and four percent (4%) of the Wholesale Acquisition Cost ("WAC") of the products dispensed across the Rebate Processor's book of business. Likewise, Vendor may contract with the Rebate Processor or with one or more pharmaceutical manufacturers for fees or compensation in exchange for providing property or services to the Rebate Processor and/or such pharmaceutical manufacturer. The Rebate Processor and Vendor also own and operate dispensing pharmacies that may receive concurrent or retrospective discounts from pharmaceutical manufacturers attributable to or based on products purchased by such affiliated dispensing pharmacies. The term rebates as used in this Agreement does not include these fees or discounts, which belong exclusively to the Rebate Processor or to Vendor, as applicable. Nothing in this Agreement shall preclude Vendor and/or the Rebate Processor from pursuing other, independent sources of revenue from pharmaceutical manufacturers, and engaging in other revenue-producing relationships with pharmaceutical manufacturers. In the event that Vendor enters into a new or amended Rebate Services Agreement, or begins to provide similar services directly through its own contracts with pharmaceutical manufacturers, the compensation to be paid to the Rebate Processor for its services, or to Vendor for similar services, may change. Vendor may notify County of any such changes. Exhibit A Page 10 of18 Vendor hereby notifies County that to the extent County contracts with Medicare, Medicaid, or any other Federal healthcare program as defined in Section 1128B(f) of the Social Security Act, 42 U.S.C. § 1320a-7b(f) (or any successor thereto), County maybe obligated to fully and accurately report the rebates and discounts in costs claimed or charges made to such government programs. Vendor shall cooperate with County to determine and provide all information concerning rebates and discounts that is necessary for County to comply with any applicable government program reporting requirements, including, with respect to Medicare Subsidized Plans, 42 C.F.R. 423, Subpart R. If County has been paid rebates with respect to claims that pertain to pharmaceuticals of a particular manufacturer, and if for any reason (including without limitation, manufacturer takebacks, manufacturer shortpays, duplicate claims, audit, reconciliation or otherwise) Vendor is required to repay all or a part of any rebate it has received with respect to such claims, County, upon demand of Vendor, will promptly repay to Vendor (i) the rebate amount County was paid with respect to such claims or (ii) in the case of a partial repayment by Vendor, a pro rata portion of such rebate, as determined by Vendor in its reasonable discretion, based on the portion of the billed rebates that Vendor is required to repay, whichever is applicable. Vendor may offset any amount owed to it under this paragraph against amounts owed to County under this Agreement. County shall: (i) obtain from Covered Persons all consents and/or authorizations required, if any, for Vendor and/or the Rebate Processor to perform its services or activities including the use and disclosure of Protected Health Information; and (ii) disclose to Covered Persons any and all matters relating to the plan design that are required by law to be disclosed, including information relating to the calculations of co-payments, coinsurance amounts, deductibles or any other amounts that are payable by a Covered Person in connection with the plan design, and any other disclosures required by applicable law or reasonably requested by Vendor or the Rebate Processor. County authorizes Vendor to provide the Rebate Processor with all information about Covered Persons as may be reasonably necessary for the Rebate Processor to perform its formulary management and rebate processing services under the Rebate Services Agreement. In compliance with applicable law, including HIPAA, the Rebate Processor may share Covered Person information as appropriate for the treatment, payment, and health care operations of other health care providers (which may or may not be affiliated with the Rebate Processor) or plans. Claims data, as well as eligibility information that is de- identified in accordance with HIPAA and other applicable law, and which is not identifiable on a Plan or Covered Person basis, may be used, disclosed, reproduced, adapted or sold by Vendor and/or the Rebate Processor. Vendor and/or the Rebate Processor may also provide such de-identified data to nationally recognized data integration firms to support appropriate administration of the drug management programs. This benchmarking data enables Vendor and/or the Rebate Processor to compare against other drug population sets and improve programs and services. Exhibit A Page 11 of18 Under the terms of their agreements with the Rebate Processor and/or Vendor, pharmaceutical manufacturers may from time to time modify the definition of what constitutes an "eligible plan" for the purpose of receiving rebates. In the event that County ceases to satisfy a pharmaceutical manufacturer's definition of an "eligible plan" for whatever reason, County will cease to be eligible for rebates from that manufacturer as of the date County ceased to satisfy such definition, and Vendor shall have the right to equitably adjust the pricing terms of this Agreement. Under the Rebate Services Agreement, the following events may trigger a good faith renegotiation of the rebates to be paid under the Rebate Services Agreement: (i) the enactment or amendment of state or federal laws or regulations resulting in an adverse impact on the Rebate benefits, rights or obligations under the Rebate Services Agreement; (ii) a decrease in participation in the Rebate program by pharmaceutical manufacturers; (iii) the unexpected introduction of a generic version of a branded product; (iv) the recall or withdrawal of a branded product from the market prior to patent expiration; (v) the occurrence of any government imposed or industry wide change that impedes the ability to provide its services (including any prohibition or restriction on Vendor and/or the Rebate Processor to collect rebates under its contracts with pharmaceutical companies); (v) a change in plan design parameters that results in a material reduction in rebates; (vi) a decrease in the current level of alignment with the Vendor Formulary; (vii) the average days' supply being something other than 30 days for retail and 90 days for mail order; (viii) a failure to participate in formulary management programs; and (ix) a material change in the performance of County's Plan(s) that results in a material reduction in rebates. County acknowledges and agrees that in the event of such a renegotiation of rebates between Vendor and the Rebate Processor, Vendor may equitably adjust the rebate amounts to be paid to County under this Agreement. County acknowledges and agrees that the termination of the Rebate Services Agreement could eliminate Vendor's ability to provide rebates and formulary management services under this Agreement. In the event of the termination of the Rebate Services Agreement, Vendor will use good faith efforts to enter into a similar agreement with another Rebate Processor; provided, however, that if Vendor is unable to do so, then all obligations of Vendor for rebates and formulary management services under this Agreement will cease or be suspended until Vendor is able to enter into a new agreement for such services. In the case of the expiration or termination of this Agreement, according to its terms, or the expiration or termination of the Rebate Services Agreement, any rebate amounts owed by Vendor to County for the period ending on the date of such expiration or termination will remain due and payable to County and will be paid to County according to the terms of this Agreement to the extent received by Vendor from the Rebate Processor and/or Pharmaceutical Manufacturers. During the quarter prior to the expiration or termination of the Agreement, Vendor may delay the remittance of rebates already received by Vendor to County to allow for final adjustments under this Agreement. Upon termination of the Rebate Services Agreement, the Rebate Processor may delay the Exhibit A Page 12 of18 remittance of: (i) up to twenty percent (20%) of rebates for a period of up to six (6) months to allow for final adjustments; and (ii) additional rebates to the extent such rebates are subject to an ongoing audit or negotiations relating to an audit by a pharmaceutical manufacturer. If the Rebate Services Agreement is terminated or otherwise suspended through action outside the control of Vendor and the Rebate Processor, such as governmental action, all obligations of Vendor for rebate and formulary management services under this Agreement will cease, or be suspended, as of the date of the outside action, and thereafter such obligations will either terminate or continue in accordance with the terms of the Rebate Services Agreement. Any rebate amounts owed by Vendor to County for the period ending on the date of the outside action will remain due and payable to County and will be paid to County according to the terms of this Agreement unless otherwise prohibited by Law. Should County elect to terminate this Agreement without cause during the Initial Term, Vendor will retain all rebates earned and unpaid on the date of termination, excluding rebates already collected and payable to County under the terms of this agreement at the time of such termination. E. Vendor shall submit a report that will clearly detail the rebates issued to the County. The first rebate report is due the month following the first issuance of rebates to the County. Thereafter, a rebate report will be provided based on the agreed upon rebate payment schedule. XII. Training The vendor shall provide the following training to County staff: A. Provide comprehensive training on all aspects of data reporting and system usage including but not be limited to specific software and querying of data for reports. B. Training must be available to County staff at a minimum once a year for each term of the contract. C. Training will be at no cost to the County. D. Vendor shall provide all training materials. The training materials must be made available in either hard copy or online in printable format. The Vendor shall update the training materials on an ongoing basis as technology and needs change throughout each term of the contract. E. Vendor shall be responsible for all costs, including but not limited to travel and material, associated with providing training to County staff. XIII. Invoicing A. Vendor shall work to appropriately bill, including back-bill for prior invoices, all prescriptions that may be eligible under an alternate payer. The County will always be the payer of last resort. Exhibit A Page 13 of18 B. Vendor will provide DBH with invoicing grouped by Group# and Plan ID #(cost center) or as directed and defined by the County for each program as each program has budget responsibility for the cost of drugs prescribed and dispensed to its clients. Each Department (DBH and DSS) are to receive an invoice from vendor that will include charges broken down by group and plan ID (cost center). C. Invoices shall be submitted monthly by Vendor as both a paper claim and as a data download. D. Invoices shall be accurate and timely and contain all information requested by the County. Vendor is to submit accurate monthly invoices that shall be received by County no later than the 1oth day of the preceding month. E. Vendor shall maintain history of all invoices, adjustments, and credits during the term of the agreement. F. Each line item on the invoice shall include the following information: 1. Contract Number 2. Group ID number, as defined by the County 3. Plan ID Number, as defined by the County 4. Client Name and Date of Birth 5. Client DMH # (provided by the County) 6. Prescribing Physician's Name 7. Prescribed Drug, dosage, strength, NDC #,date dispensed 8. The number of units dispensed for each drug/dosage. 9. AWP at the time of sale 10. Discounts 11. Administrative Fee 12. Dispensing Fee G. Vendor will be required to bill all payer sources, including retroactive Medi-Cal, as required, and credit the County to the appropriate original invoice. H. Vendor shall have the ability to provide invoice adjustments or credit memos on a separate invoice from the current monthly invoice that will reference the original invoice. Vendor shall provide a current invoice and a secondary invoice detailing past invoices with line items outstanding due to a client having become Medi-Cal eligible, etc. Vendor shall appoint their Accounts Receivable representative to Exhibit A Page 14 of18 work with County staff to resolve payment issues both on the current and the secondary invoice on an ongoing monthly basis. I. County reviews all invoices for accuracy. Payments to vendor for inaccurate invoices may be delayed or suspended until vendor submits a correct invoice. County shall make payment to vendor upon verification of the accuracy of the invoice. J. County shall not pay dispensing or administrative fees when a claim is denied by the County due to other payer source eligibility. K. Vendor shall provide an example of an invoice in the proposal submitted. L. Invoice Reconciliation -Vendor's Account Manager will work with individual DBH Group representatives to resolve aged receivables balances on a monthly basis. This will include issues related to Medi-Cal or any other billing/payment concerns or aged receivables. XIV. Patient Assistance Program (PAP) Vendor may be requested to provide storage and re-packaging of available medication acquired through drug manufacturer's Patient Assistance Program (PAP) as directed by the County. Vendor PAP dispensing fee, if any, shall be stated in vendor's Cost Proposal. At this time, clients thought to be eligible for a PAP are interviewed by DBH staff for eligibility criteria established by the various Drug Manufacturers. A client's application is sent to the Manufacturer and if/when approved, a client's medications are shipped directly to DBH. DBH nurses in turn dispense the medications to the client in accordance with all State approved guidelines. XV. Technical Requirements Vendor must clearly describe its technical capabilities to administer the County's mental health prescription program. Vendor to provide specific insights into the systems, processes and expertise bidder possesses to ensure the highest level of performance in accordance with the County's requirements. Vendor shall ensure proposed software products are available to DBH twenty-four hours per day, 365 days per year, via a Web browser interface. Vendor's contracted pharmacies shall have software that is "SureScripts" certified. In addition, the vendor's network of contracted pharmacies shall be certified to receive new prescriptions and able to send electronic refill requests (specifically electronic, not by fax) via the Pharmacy Health Information Exchange, operated by SureScripts. XVI. Utilization Management A. Concurrent Drug Utilization Review (OUR)-Vendor must briefly describe its concurrent OUR program including the clinical and administrative edits used and how they are applied. How often are the edits updated? (i.e., less frequently than quarterly, quarterly, or more frequent than quarterly?) Exhibit A Page 15 of18 B. Retrospective Drug Utilization Review (RDUR)-Vendor must describe its online RDUR program and the types of reports available to County's DBH Medical Directors to review prescribing patterns. Vendor shall have ability to provide reports that will allow the County to review its drug usage data (prescriber, patient, drug, dosage, date of dispense). Vendor to specify edits and guidelines it will use for RDUR. C. Generic Substitution -County mandates a generic substitute for brand name drugs whenever possible. Vendor shall be required to administer a mandatory generic substitution for the drugs covered under the Fresno County mental health drug program. D. Prior Authorizations (PA)-Vendor to describe its PA program capabilities including how it functions and the PA's ability to target selected drugs. E. Ad-Hoc Reports-Vendor to describe its ability to provide ad-hoc reports that are not standard pre-formatted. Will this report be available online to County? If not available online, how long will it take to provide any requested information to County? XVII. Formulary Management A. Formulary-Review the list of covered drugs. The Vendor shall administer this list as a Formulary (Exhibit B -Formulary) and if there is a generic available, only the generic will be dispensed. Vendor to describe its override process, what that process is and the time estimated to process an override or seek pre- authorization. Vendor to indicate if it possesses the ability to provide reports on all the drugs prescribed that were not on the formulary. B. Limitations/Constraints-Vendor to describe any limitations or constraints in administering the County's formulary. Vendor to propose solutions to work around these limitations/constraints. C. Formulary Updates/Changes -Vendor to describe its ability to accommodate changes, deletions, and additions to the formulary. Outline the steps necessary to implement formulary changes. D. Vendor to specify the amount of time within which you can incorporate formulary changes after receipt of notification. XVIII. Client Eligibility A. County can provide a monthly recurring eligibility feed that includes all of Fresno County to the vendor selected to administer this program. Can vendor accept data in any format provided by County? If specific, provide detail. B. County updates its eligibility on a continuous basis. Can vendor accept daily/nightly batch downloads of eligibility changes? C. County requires vendor to provide a web-based online access to vendor's claims adjudication systems for such functions as eligibility updates and Exhibit A Page 16 of18 reporting requirements to allow County staff to make real-time immediate online eligibility updates for its clients. D. To track online eligibility, is vendor able to provide online capability to allow County staff to track all claim information for clients, including denied medications? E. Eligibility Reconciliation-vendor to describe process and timing for reconciling eligibility discrepancies between vendor system and the County's. F. Medi-Cal eligibility-vendor to describe the extent to which its system can support messaging of Medi-Cal eligibility information to retail pharmacies. G. County will authorize every new prescription each time a script is given, as each County authorization will only be one prescription and a maximum of two subsequent refills. The County and contracted pharmacies shall terminate member eligibility every time a prescription and any accompanying refill(s) have been filled. XIX. Customer Service It is the County's expectation that questions, issues, or problems that may be encountered concerning the provision of services to clients will be managed directly through County's staff; it is not expected that clients will be contacting the Pharmacy Benefits Manager directly. A. Customer Service Facility-vendor to indicate the facility(s) where you propose to support the claims and customer service for this business. Indicate the hours of operation in Pacific Standard Time. B. Customer Service Team -vendor to describe how Customer Service representatives (CSRs) will be assigned to the County account. Describe how staff will be trained to handle the special needs (i.e. nature of the population, limited formulary) of the County's DBH, and identify what back-up resources will be in place. XX. Account Management A. Account Management Performance Approach-Describe how account management service performance is measured, tracked and reported (e.g. timeliness in the return of phone calls, timeliness in resolving problems). B. Account Manager Commitment and Resume-vendor must provide a resume of the designated Account Manager (include education background and work experience). C. Monthly Meetings-vendor must host a monthly meeting. As part of the meeting, the County will measure customer satisfaction by using customers' satisfaction survey during the term of the contract. Identified areas where service levels can be improved will be presented to the Vendor. Exhibit A Page 17 of18 Vendor must agree to work with the County in resolving identified issues resulting from the forums or other sources regarding customer satisfaction. Vendor and the County's contract manager will work together to continually monitor the success levels of this contract and resolve issues at the earliest. These monthly forums will be changed to quarterly forums after any initial operational issues are identified and resolved. D. Implementation -As part of the proposal, vendor shall provide a detailed implementation plan that includes activities, timelines and responsibilities. E. Transition-Describe potential issues that will need to be addressed in making the transition for clients from the current PBM to your program. What information and/or support will you require from the County to successfully complete this transition, including how refills and new prescription related issues will be handled? XXI. Reporting A. Standard reporting-The County prefers electronic reports. Vendor will describe its standard (no additional cost) account reporting tools available to the County, including the frequency of updates and the methods of accessing/receiving these reports (e.g. web portal, electronic, etc.). B. Regional reporting-it is the County's expectation the vendor will support reporting at group and cost center levels as well as consolidated reporting for both county departments. Vendor must describe how they will meet this requirement. C. Ad Hoc Reporting -Vendor must provide ad-hoc reporting capability. Vendor to describe available ad-hoc and other reporting capabilities and tools. Is there an additional cost associated with ad-hoc reports and if yes, what is the cost? D. Technical Support-Will you provide technical support in the use of your reporting tools to the County at no cost? If yes, include the hours of operation (in Pacific Standard Time) and days available for technical support. E. Vendor will support reporting at the Group and Plan ID (cost center) levels as defined by the County as well as consolidated reporting for all of County's clients which will be accessed by County's designee(s). XXII. Medi-Cal Billing A. The vendor shall adjust invoicing every month when a client may become eligible for Medi-Cal retroactively or has Medi-Cal terminated and may become Medi-Cal eligible again. B. Medi-Cal Coordination of Benefits-vendor to describe its process for coordination of payment obligations to ensure Medi-Cal pays for covered drugs dispensed to Medi-Cal eligible clients. Vendor to include a description of the type of emails/messages that the retail pharmacy would receive in this situation. XXIII. DELIVERIES Deliveries of medications may be required XXIV. OTHER REQUIREMENTS Exhibit A Page 18 of18 A. Prescriptions are to be filled for a thirty (30) day supply, unless otherwise indicated. B. Prescriptions for clients shall be prepared in the same manner as that used for the general public using a bubble pack card whenever possible. Some facility sites may need prescriptions prepared in a specific manner as indicated in Specific Requirements Cost Containment. C. Generic substitutions in prescriptions are required unless specified otherwise by a licensed physician or if the substituted generic drug is not available D. The vendor shall utilize the lowest cost generic and brand name meds. E. The County may also use the pharmaceutical services for clients being served by contracted agencies. F. Services being requested in this RFP may be subject to change as County Departments undergo change and reorganization in service delivery. County will disclose any such changes as they occur. DBH Formulary County of Fresno Department of Behavioral Health Drug Formulary 3-18-2014 FRESNO COUNTY BEHAVIORAL HEALTH-FORMULARY DRUG LIST -2014 •.. . .. ., lt~--~-· ~j..,; . -' "' - (3eneric t'Jame Reference Brand Strength Dosage Fqrm Manufacturer Name alprazolam Xanax® 0.25 mg Tablet various alprazolam Xanax® 0.50 mg Tablet various alprazolam Xanax® 1 mg Tablet various alprazolam Xanax® 2mg Tablet various alprazolam Alprazolam lntensol™ 1 mg/ml Oral solution Roxane amantadine Symmetrel® 50 mg/5 ml Syrup various amantadine Symmetrel® 100 mg Capsule various amitriptyline HCL Elavil® 10 mg Tablet various amitriptyline HCL Elavil® 25mg Tablet various amitriptyline HCL Elavil® 50mg Tablet various amitriptyline HCL Elavil® 75mg Tablet various amitriptyline HCL Elavil® 100 mg Tablet various amitriptyline hydrochloride Elavil® 150 mg Tablet various amitriptyline/perphenazine Triavil® 10-2MG Tablet various amitriptyline/perphenazine Tria vii® 25-2MG Tablet various amitriptyline/perphenazine Triavil® 50-4MG Tablet various aripiprazole Ability® 2MG Tablet BMS aripiprazole Ability® 5MG Tablet BMS aripiprazole Ability® 10MG Tablet BMS aripiprazole Ability® 15MG Tablet BMS aripiprazole Ability® 20MG Tablet BMS aripiprazole Ability® 30MG Tablet BMS atomoxetine HCL Strattera® 10MG Tablet Lilly atomoxetine HCL Strattera® 18MG Tablet Lilly atomoxetine HCL Strattera® 25MG Tablet Lilly RFP DBH Formulary ""'~~~~ .. · ~~~~'fj. ' .. ' AHFS · Brand I Pharniacologic-AHFS Phajmacologic-Therapeutic Classification Generic Therapeutic· · Code Generic 28:24.08 Benzodiazepines Generic 28:24.08 Benzodiazepines Generic 28:24.08 Benzodiazepines Generic 28:24.08 Benzodiazepines Brand 28:24.08 Benzodiazepines Central Nervous System Agents, Generic 28:92.00 Miscellaneous Central Nervous System Agents, Generic 28:92.00 Miscellaneous Tricyclics and Other Norepinephrine- Generic 28:16.04.28 reuptake lnhbitors Tricyclics and Other Norepinephrine- Generic 28:16.04.28 reuptake lnhbitors Tricyclics and Other Norepinephrine- Generic 28:16.04.28 reuptake lnhbitors Tricyclics and Other Norepinephrine- Generic 28:16.04.28 reuptake lnhbitors Tricyclics and Other Norepinephrine- Generic 28:16.04.28 reuptake lnhbitors Tricyclics and Other Norepinephrine- Generic 28:16.04.28 reuptake lnhbitors Generic 28:16.08.24 Phenothiazines Generic 28:16.08.24 Phenothiazines Generic 28:16.08.24 Phenothiazines Brand 28:16.08.04 Atypical Antipsychotics Brand 28:16.08.04 Atypical Antipsychotics Brand 28:16.08.04 Atypical Antipsychotics Brand 28:16.08.04 Atypical Antipsychotics Brand 28:16.08.04 Atypical Antipsychotics Brand 28:16.08.04 Atypical Antipsychotics Miscellaneous-Selective Brand 28:92.00 Norepinephrin reuptate inhabitor. Miscellaneous -Selective Brand 28:92.00 Norepinephrine reuptate inhibitor. Miscellaneous -Selective Brand 28:92.00 Norepinephrine reuptate inhibitor. "' ;.:; NOTES Generic only Generic only Generic only Generic only Generic only Generic only Generic cinly Generic only Generic only Generic only Generic only Generic only Generic only Generic only Generic only Generic only Exhibit B Page 2 of 14 Page 1 of 12 DBH Formulary County of Fresno Department of Behavioral Health Drug Formulary 3-18-2014 FRESNO COUNTY BEHAVIORAL HEALTH-FORMULARY DRUG LIST-2014 Generic Name Reference Brand Strength . Dosage Form . Manufacturer Name atomoxetine HCL Strattera® 40MG Tablet Lilly atomoxetine HCL Strattera® 60MG Tablet Lilly atomoxetine HCL Strattera® 80MG Tablet Lilly atomoxetine HCL Strattera® 100MG Tablet Lilly benztropine mesylate Cogentin® 0.5MG Tablet various benztropine mesylate Cogentin® 1MG Tablet various benztropine mesylate Congentin® 2MG Tablet various bupropion HCL Wellbutrin® 75MG Tablet various bupropion HCL Wellbutrin® 100MG Tablet various bupropion HCL Wellbutrin® 150MG Tablet various bupropion HCL Wellbutrin® 200MG Tablet various Tablet Extended bupropion HCL ER Wellbutrin ER® 100MG Release various Tablet Extended bupropion HCL ER Wellbutrin ER® 150MG Release various Tablet Extended bupropion HCL ER Wellbutrin ER® 200MG Release various Tablet Sustained bupropion HCL SR Wellbutrin SR® 100MG Release various Tablet Sustained bupropion HCL SR Wellbutrin SR® 150MG Release various Tablet Sustained bupropion HCL SR Wellbutrin SR® 200MG Release various Tablet Extended bupropion HCL XL Wellbutrin XL® 150MG Release various RFP DBH Formulary AHFS Brand I Phannacologic- Gerjeric Therapeutic Code Brand 28:92.00 Brand 28:92.00 Brand 28:92.00 Brand 28:92.00 Generic 12:08.04 Generic 12:08.04 Generic 12:08.04 Generic 28:16.04.92 Generic 28:16.04.92 Generic 28:16.04.92 Generic 28:16.04.92 Generic 28:16.04.92 Generic 28:16.04.92 Generic 28:16.04.92 Generic 28:16.04.92 Generic 28:16.04.92 Generic 28:16.04.92 Generic 28:16.04.92 ·AHFS Phannacologic-Therapeutic Classification Miscellaneous -Selective Norepinephrine reuptate inhibitor. Miscellaneous -Selective Norepinephrine reuptate inhibitor. Miscellaneous -Selective Norepinephrine reuptate inhibitor. Miscellaneous -Selective Norepinephrine reuptate inhibitor. Anticholinergic-Antiparkinsonian Anticholinergic-Antiparkinsonian Anticholinergic-Antiparkinsonian Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous NOTES Generic only Generic only Generic only. Generic only Generic only Generic only Generic only I Exhibit B Page 3 of 14 Page 2 of 12 DBH Formulary County of Fresno Department of Behavioral Health Drug Formulary 3-18-2014 FRESNO COUNTY BEHAVIORAL HEALTH-FORMULARY DRUG LIST-2014 • .. 1 "" "" -· : .. Generic Name Reference Brand Strength Dosage Forni Manufacturer Name Tablet Extended bupropion HCL XL Wellbutrin XL® 200MG Release various buspirone HCL Bus par® 5MG Tablet various busoirone HCL Buspar® 7.5MG Tablet various buspirone HCL Busoar® 10MG Tablet various buspirone HCL Bus par® 15MG Tablet various buspirone HCL Bus par® 30MG Tablet various carbamazeoine Tegretol® 100MG Tablet various carbamazeoine Tegretol® 200MG Tablet various chlorpromazine HCL Thorazine® 10MG Tablet various chlororomazine HCL Thorazine® 25MG Tablet various chlorpromazine HCL Thorazine® 50MG Tablet various chlorpromazine HCL Thorazine® 100MG Tablet various chlorpromazine HCL Thorazine® 200MG Tablet various citalopram HBR Celexa® 10MG Tablet Forest/Pfizer citalopram HBR Celexa® 20MG Tablet Forest/Pfizer citalopram HBR Celexa® 40MG Tablet Forest/Pfizer clomipramine Anafranil® 25MG Tablet various clomioramine Anafranil® 50MG Tablet various clomioramine Anafranil® 75MG Tablet various clonazepam Klonopin® 0.125MG Tablet various clonazeoam Klonopin® 0.25MG Tablet various clonazepam Klonopin® 0.5MG Tablet various clonazeoam Klonopin® 1MG Tablet various clonazeoam Klonopin® 2MG Tablet various RFP DBH Formulary ·= ii!l 4:1\ -~~ :f'd'. ~ AHFS Brand I Pharmacologic- Generic Therapeuti~ Code Generic 28:16.04.92 Generic 28:24.92 Generic 28:24.92 Generic 28:24.92 Generic 28:24.92 Generic 28:24.92 Generic 28:12.92 Generic 28:12.92 Generic 28:16.08.24 Generic 28:16.08.24 Generic 28:16.08.24 Generic 28:16.08.24 Generic 28:16.08.24 Brand 28:16.04.20 Brand 28:16.04.20 Brand 28:16.04.20 Generic 28:16.04.28 Generic 28:16.04.28 Generic 28:16.04.28 Generic 28:12.08 Generic 28:12.08 Generic 28:12.08 Generic 28:12.08 Generic 28:12.08 ~:"-~ ~"''""~~ AHFS Pharmacologic-Therapeutic Classification Antidepressant, Miscellaneous Anxiolytics, Sedatives, and Hyponotics: Miscellaneous Anxiolytics, Sedatives, and Hyponotics: Miscellaneous Anxiolytics, Sedatives, and Hyponotics: Miscellaneous Anxiolytics, Sedatives, and Hyponotics: Miscellaneous Anxiolytics, Sedatives, and Hyponotics: Miscellaneous Anticonvulsant, Miscellaneous Anticonvulsant, Miscellaneous Phenothiazines Phenothiazines Phenothiazines Phenothiazines Phenothiazines Selective Seratonin Reuptake Inhibitor Selective Seratonin Reuptake Inhibitor Selective Seratonin Reuptake Inhibitor Tricyclics and Other Norepinephrine- reuptake lnhbitors Tricyclics and Other Norepinephrine- reuptake lnhbitors Tricyclics and Other Norepinephrine- reuptake lnhbitors Benzodiazepines Benzodiazepines Benzodiazepines Benzodiazepines Benzodiazepines Exhibit B Page 4 of 14 = .~ ,.,_,.,,, .NOTES Generic onlv Generic only Generic only Generic only Generic only Generic onlv Generic on lye Generic onlv Generic only Generic only Generic only Generic only Generic only. Generic onlv·. Generic only Generic 01ilv. Generic only Generic only Page 3 of 12 DBH Formulary County of Fresno Department of Behavioral Health Drug Formulary 3-18-2014 FRESNO COUNTY BEHAVIORAL HEALTH· FORMULARY DRUG LIST· 2014 ' &~ ~ ~. ., -:Jr· =~~~ ~-'I! . -:Bl Generic Name Reference Brand Strength Dosage Form Manufacturer Name clozapine Clozaril® 12.5MG Tablet various clozapine Clozaril® 25MG Tablet various clozapine Clozaril® SOMG Tablet various clozapine Clozaril® 100MG Tablet various clozapine Clozaril® 200MG Tablet various desipramine HCL Norpramin® 10MG Tablet various desipramine HCL Norpramin® 25MG Tablet various desipramine HCL Norpramin® SOMG Tablet various desipramine HCL Norpramin® 75MG Tablet various desipramine HCL Norpramin® 100MG Tablet various desipramine HCL Norpramin® 150MG Tablet various diazepam Valium® 2MG Tablet various diazepam Valium® SMG Tablet various diazepam Valium® 10MG Tablet various diphenhydramine HCL 25MG Tablet various diphenhydramine HCL SOMG Tablet various divalproex sodium Depakote® 125MG Tablet Abbott divalproex sodium Depakote® 250MG Tablet Abbott divalproex sodium Depakote® SOOMG Tablet Abbott divalproex sodium ER Depakote ER ® 250MG Tablet Abbott divalproex sodium ER Depakote ER ® SOOMG Tablet Abbott doxepin HCL Sinequan® 10MG Capsule various doxepin HCL Sinequan® 25MG Capsule various doxepin HCL Sinequan® SOMG Capsule various doxepin HCL Sinequan® 75MG Capsule various RFP DBH Formulary ... Brand I Generic Generic Generic Generic Generic Generic Generic Generic Generic Generic Generic Generic Generic Generic Generic Generic Generic Generic Generic Generic Brand Brand Generic Generic Generic Generic . _,_, .. ·AHFS Pharmacologic- Therapeutic Code 28:16.08.04 28:16.08.04 28:16.08.04 28:16.08.04 28:16.08.04 28:16.04.28 28:16.04.28 28:16.04.28 28:16.04.28 28:16.04.28 28:16.04.28 28:24.08 28:24.08 28:24.08 04:04.04 04:04.04 28:12.92 28:12.92 28:12.92 28:12.92 28:12.92 28:16.04.28 28:16.04.28 28:16.04.28 28:16.04.28 ·lli'" ···~ ~~ .::>.¥··~ ·'"'·. """ AHFS Pharmacologic-Therapeutic Classification NOTES Atypical Antipsychotics Generic onlY.. Atypical Antipsychotics Generic only Atypical Antipsychotics Generic only Atypical Antipsychotics Generic ohly Atypical Antipsychotics Generic only Tricyclics and Other Norepinephrine- reuptake lnhbitors Generic o~l'f Tricyclics and Other Norepinephrine- reuptake lnhbitors Generic only Tricyclics and Other Norepinephrine- reuptake lnhbitors Generic only Tricyclics and Other Norepinephrine- reuptake lnhbitors Generic only Tricyclics and Other Norepinephrine- reuptake lnhbitors Generic only Tricyclics and Other Norepinephrine- reuptake lnhbitors Generic only Benzodiazepines Generic only Benzodiazepines Generic only Benzodiazepines Generic only First Generation Antihistamines, Ethanolamine Derivatives Generic only First Generation Antihistamines, Ethanolamine Derivatives Generic only Anticonvulsant, Miscellaneous Anticonvulsant, Miscellaneous Anticonvulsant, Miscellaneous Anticonvulsant, Miscellaneous Anticonvulsant, Miscellaneous Tricyclics and Other Norepinephrine-. ' reuptake lnhbitors Generic. only Tricyclics and Other Norepinephrine- reuptake lnhbitors Generic only: Tricyclics and Other Norepinephrine- reuptake lnhbitors Generic .onlY Tricyclics and Other Norepinephrine- reuptake lnhbitors Generic only Exhibit B Page 5 of 14 Page 4 of 12 DBH Formulary County of Fresno Department of Behavioral Health Drug Formulary 3-18-2014 FRESNO COUNTY BEHAVIORAL HEALTH-FORMULARY DRUG LIST-2014 iiiL. -> ' ~ Generic Name doxepin HCL doxepin HCL duloxetine HCL duloxetine HCL duloxetine HCL escitalopram oxalate escitalopram oxalate escitalopram oxalate fluoxetine HCL fluoxetine HCL fluoxetine HCL fluphenazine decanoate fluphenazine HCL fluphenazine HCL fluphenazine HCL fluphenazine HCL fluphenazine HCL fluphenazine HCL fluvoxamine Maleate fluvoxamine Maleate RFP DBH Formulary Reference Brand Name Sinequan® Sinequan® Cymbalta® Cymba Ita® Cymba Ita® Lex a pro® Lexapro® Lex a pro® Prozac® Prozac® Prozac® Prolixin Decanoate® Prolixin® Prolixin® Prolixin® Prolixin® Prolixin® Prolixin® Luvox® Luvox® Strength 100MG 150MG 20MG 30MG 60MG 5MG 10MG 20MG 10MG 20MG 40MG 25MG/ML 1MG 2.5MG 5MG 10MG 2.5MG/5ML 5MG/ML 25MG 50MG :-, Dosage Form Capsule Capsule Capsule Capsule Capsule Tablet Tablet Tablet Pulvules/tablets Pulvules/tablets Pulvules/tablets Injection Tablet Tablet Tablet Tablet Injection Solution Concentrate Tablet Tablet Manufacturer various various Lilly Lilly Lilly Forest Forest Forest various various various Sandoz various various various various American Pharmaceutical Partners various various various Brand I Generic AHFS Pharmacologic- Therapeutic AHFS Pharmacologic-Therapeutic Classification Code Tricyclics and Other Norepinephrine- NOTES Generic 28:16.04.28 reuptake lnhbitors Generic only Tricyclics and Other Norepinephrine- Generic 28:16.04.28 reuptake lnhbitors Generic only Psychotherapeutic Agents, Brand 28:16.04.92 Antidepressant, Miscellaneous Psychotherapeutic Agents, Brand 28:16.04.92 Antidepressant, Miscellaneous Psychotherapeutic Agents, Brand 28:16.04.92 Antidepressant, Miscellaneous Brand 28:16.04.20 Selective Seratonin Reuptake Inhibitor Brand 28:16.04.20 Selective Seratonin Reuptake Inhibitor Brand 28:16.04.20 Selective Seratonin Reuptake Inhibitor Generic 28:16.04.20 Selective Seratonin Reuptake Inhibitor Generic only Generic 28:16.04.20 Selective Seratonin Reuptake Inhibitor Generic only Generic 28:16.04.20 Selective Seratonin Reuptake Inhibitor Generic only Generic 28:16.08.24 Phenothiazines Generic only Generic 28:16.08.24 Phenothiazines Generic only Generic 28:16.08.24 Phenothiazines Generic only Generic 28:16.08.24 Phenothiazines Generic only Generic 28:16.08.24 Phenothiazines Generic only Generic 28:16.08.24 Phenothiazines Generic only Generic 28:16.08.24 Phenothiazines Generic only_ Generic 28:16.04.20 Selective Seratonin Reuptake Inhibitor Generic o~ly Generic 28:16.04.20 Selective Seratonin Reuptake Inhibitor Generic only Exhibit B Page 6 of 14 Page 5 of 12 DBH Formulary County of Fresno Department of Behavioral Health Drug Formulary 3-18-2014 FRESNO COUNTY BEHAVIORAL HEALTH-FORMULARY DRUG LIST-2014 '"''tij .. .-. ' ·Jii!i! -~·> ':.'.;:.,f'~;·'f ,. .··,.,._ GE!neric Name Reference Brand Strength DosaQeForm Manufacturer Name fluvoxamine Maleate Luvox® 100MG Tablet various gabapentin Neurontin® 100MG Capsule Pfizer gabapentin Neurontin® 300MG Capsule Pfizer gabapentin Neurontin® 400MG Capsule Pfizer gabapentin Neurontin® 600MG Capsule Pfizer gabapentin Neurontin® 800MG Capsule Pfizer haloperidol Haldol® 0.5MG Tablet various haloperidol Haldol® 1MG Tablet various haloperidol Hal dol® 2MG Tablet various haloperidol Haldol® 5MG Tablet various haloperidol Hal dol® 10MG Tablet various haloperidol Haldol® 20MG Tablet various haloperidol decanoate Haldol Decanoate® 50MG/ML IM Injection Ortho-McNeil haloperidol decanoate Haldol Decanoate® 100MG/ML IM Injection Ortho-McNeil hydroxyzine HCL Atarax® 10MG/5ML Liquid various hydroxyzine HCL Atarax® 10MG Tablet various hydroxyzine HCL Atarax® 25MG Tablet various hydroxyzine HCL Atarax® 50MG Tablet various hydroxyzine pamoate Vistaril® 25MG Capsule various hydroxyzine pamoate Vistaril® 50MG Capsule various hydroxyzine pamoate Vistaril® 100MG Capsule various imipramine HCL Tofranil® 10MG Tablet various imipramine HCL Tofranil® 25MG Tablet various imipramine HCL Tofranil® 50MG Tablet various RFP DBH Formulary ' , .. ;,.,? AHFS Brand I Pharrilacologic- Generic Therapeutic Code Generic 28:16.04.20 Generic 28:12.92 Generic 28:12.92 Generic 28:12.92 Generic 28:12.92 Generic 28:12.92 Generic 28;16.08.08 Generic 28;16.08.08 Generic 28; 16.08.08 Generic 28;16.08.08 Generic 28;16.08.08 Generic 28; 16.08.08 Generic 28;16.08.08 Generic 28;16.08.08 Generic 28:24.92 Generic 28:24.92 Generic 28:24.92 Generic 28:24.92 Generic 28:24.92 Generic 28:24.92 Generic 28:24.92 Generic 28:16.04.28 Generic 28:16.04.28 Generic 28:16.04.28 ~-!ii>W. < -. 'b ... -·~- AHFS Pharmacologic-Therapeutic Classification Selective Seratonin Reuptake Inhibitor Anticonvulsants, Miscellaneous Anticonvulsants, Miscellaneous Anticonvulsants, Miscellaneous Anticonvulsants, Miscellaneous Anticonvulsants, Miscellaneous Butyrophenones Butyrophenones Butyrophenones Butyrophenones Butyrophenones Butyrophenones Butyrophenones Butyrophenones Axiolytics, Sedatives, and Hypnotics: Miscellaneous Axiolytics, Sedatives, and Hypnotics: Miscellaneous Axiolytics, Sedatives, and Hypnotics: Miscellaneous Axiolytics, Sedatives, and Hypnotics: Miscellaneous Axiolytics, Sedatives, and Hypnotics: Miscellaneous Axiolytics, Sedatives, and Hypnotics: Miscellaneous Axiolytics, Sedatives, and Hypnotics: Miscellaneous Tricyclics and Other Norepinephrine- reuptake lnhbitors Tricyclics and Other Norepinephrine- reuptake lnhbitors Tricyclics and Other Norepinephrine- reuptake lnhbitors NOTES Generic only Generic only Generic only Generic only Generic only Generic ·only Generic only Generic only Generic only Generic only Generic only. Generic only. Generic only. Generic only Generic only Generic only Generic only Generic only Generic only Generic only Generic only Generic only Generic oril'/ Generic only Exhibit B Page 7 of 14 Page 6 of 12 DBH Formulary County of Fresno Department of Behavioral Health Drug Formulary 3-18-2014 FRESNO COUNTY BEHAVIORAL HEALTH-FORMULARY DRUG LIST-2014 ~t1j. " ;."'<! -. ~~ • Generic Name Reference Brand Strength Dosage Form Manufacturer Name Oxford Pharmaceutical isocarboxazid Marplan® 10MG Tablet Services lamotrigine Lamictal® 25MG Tablet GlaxoSmithKiine lamotrigine Lam ictal® 100MG Tablet GlaxoSmithKiine lamotrigine Lamictal® 150MG Tablet GlaxoSmithKiine lamotrigine Lamictal® 200MG Tablet GlaxoSmithKiine Chewable dispersable lamotrigine chew tab Lamictal Chewable® 5MG Tablet GlaxoSmithKiine Chewable dispersable lamotrigine chew tab Lamictal Chewable® 25MG Tablet GlaxoSmithKiine Lamictal Starter Kit® for Patients Taking lamotrigine Valproate 25-mg 25MG Tablet GlaxoSmithKiine Lamictal Starter Kit® for Patients Taking Carbamazepine, Phenytoin, Phenobarbital, Primidone, or Rifampin and Not lamotrigine Taking Valproate 25MG/100MG Tablet GlaxoSmithKiine Lamictal Starter Kit® for Patients Not Taking Carbamazepine, Phenytoin, Phenobarbital, Primidone Rifampin, lamotrigine or Valproate 25MG/100MG Tablet GlaxoSmithKiine lithium carbonate Eskalith® 150MG Capsule/Tablet various RFP DBH Formulary -~-,. .~ , .. ~· ·· .. lfi .. -·· -'"',-:,.,. ·' .><·r.i: • - AHFS Brand I Pharmacologic-AHFS Pharmacologic-Therapeutic Classification Generic Therapeutic Code Brand 28:16.04.12 Monoamine Oxidase Inhibitors Brand 28:12.92 Anticonvulsants, Miscellaneous Brand 28:12.92 Anticonvulsants, Miscellaneous Brand 28:12.92 Anticonvulsants, Miscellaneous Brand 28:12.92 Anticonvulsants, Miscellaneous Brand 28:12.92 Anticonvulsants, Miscellaneous Brand 28:12.92 Anticonvulsants, Miscellaneous Brand 28:12.92 Anticonvulsants, Miscellaneous Brand 28:12.92 Anticonvulsants, Miscellaneous Brand 28:12.92 Anticonvulsants, Miscellaneous Generic 28:28.00 Anti manic Agents • .. ·~ NOTES Generic only Starter kit contains: 35, 25mg tablets Starter Kit Contains: 84, 25 mg tablets and 7,100 mg tablets Starter Kit Contains: 42, 25 mg tablets and 7, 100mg. tablets. Exhibit B Page 8 of 14 Page 7 of 12 DBH Formulary County of Fresno Department of Behavioral Health Drug Formulary 3-18-2014 FRESNO COUNTY BEHAVIORAL HEALTH-FORMULARY DRUG LIST-2014 Generic Name Reference Brand. Strength Dosage Forrri ·Manufacturer ·Name lithium carbonate Eskalith® 300MG Capsule/Tablet various lithium carbonate Eskalith® 600MG Capsule/Tablet various lithium carbonate ER Eskalith CR® 300MG Tablet various lithium carbonate ER Eskalith CR® 450MG Tablet various lithium citrate Lithium Citrate Syrup 8MEQ/5ML Oral Solution various loraz~am Ativan® 0.5MG Tablet various lorazepam Ativan® 1MG Tablet various lorazepam Ativan® 2MG Tablet various loxaQine succinate Loxitane® 5MG Capsule various loxapine succinate Loxitane® 10MG Capsule various loxapine succinate Loxitane® 25MG Capsule various loxapine succinate Loxitane® 50MG Capsule various Oxford Pharmaceutical mesoridazine besylate Serentil® 10mg Tablet Services mirtazapine Remeron® 7.5MG Tablet various mirtazapine Remeron® 15MG Tablet various mirtazapine Remeron® 30MG Tablet various mirtazapine Remeron® 45MG Tablet various modafinil Provigil® 200MG Tablet Chepalon nefazodone Serzone® 50MG Tablet various nefazodone Serzone® 100MG Tablet various nefazodone Serzone® 150MG Tablet various nefazodone Serzone® 200MG Tablet various nefazodone Serzone® 250MG Tablet various nortriptyline HCL Pamelor® 10MG Capsule various nortriptyline HCL Pamelor® 25MG Capsule various nortriptyline HCL Pamelor® 50MG Capsule various nortriptyline HCL Pamelor® 75MG Capsule various olanzapine Zyprexa® 2.5MG Tablet Lilly olanz<~pine Zyprexa® 5MG Tablet Lilly olanzapine Zyprexa® 7.5MG Tablet Lilly RFP DBH Formulary AHFS Brand I ' Pharmacologic- Generic Therapeutic · Code Generic 28:28.00 Generic 28:28.00 Generic 28:28.00 Generic 28:28.00 Generic 28:28.00 Generic 28:24.08 Generic 28:24.08 Generic 28:24.08 Generic 28:16.08.92 Generic 28:16.08.92 Generic 28:16.08.92 Generic 28:16.08.92 Brand 28:16.04.12 Generic 28:16.04.92 Generic 28:16.04.92 Generic 28:16.04.92 Generic 28:16.04.92 Brand 28:20.92 Generic 28:16.04.24 Generic 28:16.04.24 Generic 28:16.04.24 Generic 28:16.04.24 Generic 28:16.04.24 Generic 28:16.04.28 Generic 28:16.04.28 Generic 28:16.04.28 Generic 28:16.04.28 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 AHFS Pharmacologic-Therapeutic Cl~ssification Antimanic Agents Antimanic Agents Antimanic Agents Antimanic Agents Antimanic Agents Benzodiazepines Benzodiazepines Benzodiazepines Antipsychotics, Miscellaneous Antipsychotics, Miscellaneous Antipsychotics, Miscellaneous Antipsychotics, Miscellaneous Monoamine Oxidase Inhibitors Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Risperatory-Cerebral Stimulant, Miscellaneous Serotonin Modulators Serotonin Modulators Serotonin Modulators Serotonin Modulators Serotonin Modulators Tricyclics and Other Norepinephrine- reuptake lnhbitors Tricyclics and Other Norepinephrine- reuptake lnhbitors Tricyclics and Other Norepinephrine- reuptake lnhbitors Tricyclics and Other Norepinephrine- reuptake lnhbitors Atypical Antipsychotics Atypical Antipsychotics Atypical Antigsychotics IIJOTES Gen·eric only Generic only Generic only Generic orily Generic only Generic only Generic only Not available in the us since.2004 Generic ohly Generic only Generic only Generic only Generic only Generic only Generic only Generic only Generic only Generic only Generic only Generic only Genei"ic only Exhibit B Page 9 of 14 Page 8 of 12 DBH Formulary County of Fresno Department of Behavioral Health Drug Formulary 3-18-2014 FRESNO COUNTY BEHAVIORAL HEALTH· FORMULARY DRUG LIST· 2014 Generic Name Reference Brand Strength Dosage Form Manufacturer Name olanzapine Zyprexa® 10MG Tablet Lilly olanz(lpine Zyprexa® 15MG Tablet Lilly olanzapine Zyprexa® 20MG Tablet Lilly olanzapine orally Tablet, orally disintegrating tablets Zyprexa Zydis® 5MG disintegrating Lilly olanzapine orally Tablet, orally disintegrating tablets Zyprexa Zydis® 10MG disintegrating Lilly olanzapine orally Tablet, orally disintegrating tablets Zyprexa Zydis® 15MG disintegrating Lilly olanzapine orally Tablet, orally disintegrating tablets Zyprexa Zydis® 20MG disintegrating Lilly oxcarbazepine Trileptal® 150MG Tablet Norvartis oxcarbazepine Trileptal® 300MG Tablet Norvartis oxcarbazepine Trileptal® 600MG Tablet Norvartis I paroxetine Paxil® 10MG Tablet various paroxetine Paxil® 20MG Tablet various paroxetine Paxil® 30MG Tablet various paroxetine Paxil® 40MG Tablet various perphenazine Trilafon® 2MG Tablet various perphenazine Trilafon® 4MG Tablet various perphenazine Trilafon® 8MG Tablet various perphenazine Trilafon® 16MG Tablet various phenelzine sulfate Nardi!® 15MG Tablet Pfizer I propranolol HCL lnderal® 10MG Tablet various zolpidem tartrate Am bien® 5MG Tablet various zolpidem tartrate Ambien® 10MG Tablet various trihexyphenidyl HCL Artane® 2MG Tablet various trihexyphenidyl HCL Artane® 5MG Tablet · various valproic acid Depakene® 250MG/5ML Oral Solution various valproic acid Depakene® 250MG Caosule various RFP DBH Formulary AHFS Brand I Pharmacologic- Generic Therapeutic Code Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:12.92 Brand 28:12.92 Brand 28:12.92 Generic 28:16.04.20 Generic 28:16.04.20 Generic 28:16.04.20 Generic 28:16.04.20 Generic 28:16.08.24 Generic 28:16.08.24 Generic 28:16.08.24 Generic 28:16.08.24 Brand 28:16.04.12 Generic 24:24.00 Generic 28:24.92 Generic 28:24.92 Generic 12:08.04 Generic 12:08.04 Generic 28:12.92 Generic 28:12.92 AHFS Pharmacologic-Therapeutic Classification Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Anticonvulsants, Miscellaneous Anticonvulsants, Miscellaneous Anticonvulsants, Miscellaneous Selective Seratonin Reuptake Inhibitor Selective Seratonin Reuptake Inhibitor Selective Seratonin Reuptake Inhibitor Selective Seratonin Reuptake Inhibitor Phenothiazines Phenothiazines Phenothiazines Phenothiazines Monoamine Oxidase Inhibitors ~ Adrenergic Blocking Agent Anxiolytics, Sedatives, and Hyponotics: Miscellaneous Anxiolytics, Sedatives, and Hyponotics: Miscellaneous Antiparkinsonian Agent Antiparkinsonian Agent Anticonvulsants, Miscellaneous Anticonvulsants, Miscellaneous NOTES Generic only Generic only Generic only Generic only Generic only Generic only Generic only Generic only Generic only Generic only .••. Exhibit B Page 10 of 14 I Page 9 of 12 DBH Formulary County of Fresno Department of Behavioral Health Drug Formulary 3-18-2014 FRESNO COUNTY BEHAVIORAL HEALTH· FORMULARY DRUG LIST· 2014 Generic Name -Reference Brand Strength _ Dosage F91T)1 Manufacturer . - Name trazodone HCL Desyrel® 50MG Tablet various trazodone HCL Desyrel® 100MG Tablet various Bristol trazodone HCL Dividose Desyrel® 150MG Tablet MversSquibb trazodone HCL Desyrel® 300MG Tablet various Bristol trazodone HCL Dividose Desyrel® 300MG Tablet MversSquibb venlafaxine HCL Effexor® 25MG Tablet various venlafaxine HCL Effexor® 37.5MG Tablet various venlafaxine HCL Effexor® 50MG Tablet various venlafaxine HCL Effexor® 75MG Tablet various venlafaxine HCL Effexor® 100MG Capsule various venlafaxine HCL XR Effexor® XL 37.5MG Capsule various venlafaxine HCL XR Effexor® XL 75MG Capsule various venlafaxine HCL XR Effexor® XL 150MG Capsule various ziprazidone Geodon® 20MG Capsule various ziprazidone Geodon® 40MG Capsule Pfizer ziprazidone Geodon® 60MG Capsule Pfizer ziprazidone Geodon® 80MG Capsule Pfizer triazolam Hal cion® 0.125MG Tablet various triazolam Hal cion® 0.25MG Tablet various propranolol HCL lnderal® 20MG Tablet various propranolol HCL lnderal® 40MG Tablet various propranolol HCL lnderal® 60MG Tablet various thioridazine HCL Mellaril® 10MG Tablet various thioridazine HCL Mellaril® 25MG Tablet various thioridazine HCL Mellaril® 50MG Tablet various thioridazine HCL Mellaril® 100MG Tablet various thiothixene Navane® 20MG Capsule various thiothixene Navane® 1MG Capsule various thiothixene Navane® 2MG Capsule various thiothixene Navane® 5MG Capsule various thiothixene Navane® 10MG Capsule various RFP DBH Formulary AHFS Brand I Pharmacologic- Generic Therapeutic Code Generic 28:16.04.24 Generic 28:16.04.24 Generic 28:16.04.24 Generic 28:16.04.24 Generic 28:16.04.24 Generic 28:16.04.92 Generic 28:16.04.92 Generic 28:16.04.92 Generic 28:16.04.92 Generic 28:16.04.92 Brand 28:16.04.92 Brand 28:16.04.92 Brand 28:16.04.92 Brand 28:16.04.92 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Generic 28:24.08 Generic 28:24.08 Generic 24:24.00 Generic 24:24.00 Generic 24:24.00 Generic 28:16.08.24 Generic 28:16.08.24 Generic 28:16.08.24 Generic 28:16.08.24 Generic 28:16.08.92 Generic 28:16.08.92 Generic 28:16.08.92 Generic 28:16.08.92 Generic 28:16.08.92 AHFS Pharmacologic-Therapeutic Classification ., Tricyclics and Other Norepinephrine- reuptake lnhbitors Tricyclics and Other Norepinephrine- reuptake lnhbitors Tricyclics and Other Norepinephrine- reuptake lnhbitors Tricyclics and Other Norepinephrine- reuptake lnhbitors Tricyclics and Other Norepinephrine- reuptake lnhbitors Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Antidepressant, Miscellaneous Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Benzodiazepines Benzodiazepines ~ Adrenergic Blocking Agent ~ Adrenergic Blocking Agent ~ Adrenergic Blocking Agent Phenothiazines Phenothiazines Phenothiazines Phenothiazines Antipsychotics, Miscellaneous Antipsychotics, Miscellaneous Antipsychotics, Miscellaneous Antipsychotics, Miscellaneous Antipsychotics, Miscellaneous NOTES Generic only Generic onlY Generic·onlv Gerieric only Generic only Generic only Generic only Generic cihlv Generic only Generic ohlv Generic ohly Geheric only Generic only_ Exhibit B Page 11 of 14 Page 10 of 12 DBH Formulary County of Fresno Department of Behavioral Health Drug Formulary 3-18-2014 FRESNO COUNTY BEHAVIORAL HEALTH· FORMULARY DRUG LIST· 2014 Generic Name . Reference Brand .Strength Dosage Form Manufacturer Nanie tranylcypromine sulfate Parnate® 10MG Tablet GlaxoSrnithKiine temazepam Restoril® 7.5MG Capsule various temazepam Restoril® 22.5MG Capsule various temazepam Restoril® 15MG Capsule various temazepam Restoril® 30MG Capsule various risperidone Risperdal® 0.25MG Tablet Janssen risperidone Risperdal® 0.5MG Tablet Janssen risperidone Risperdal® 1MG Tablet Janssen risperidone Risperdal® 2MG Tablet Janssen risperidone Risperdal® 3MG Tablet Janssen risperidone Risperdal® 4MG Tablet Janssen Tablet, orally risperidone ODT Risperdal® M-Tab 0.5MG disintegrating Janssen Tablet, orally risperidone ODT Risperdal® M-Tab 1MG disintegrating Janssen Tablet, orally risperidone ODT Risperdal® M-Tab 2MG disintegrating Janssen lquetiapine fumarate Seroquel® 25MG Tablet AstraZeneca quetiapine fumarate Seroquel® 50MG Tablet AstraZeneca Lquetiapine fumarate Seroquel® 100MG Tablet AstraZeneca quetiapine fumarate Seroquel® 200MG Tablet AstraZeneca lquetiapine fumarate Seroquel® 300MG Tablet AstraZeneca quetiapine fumarate Seroquel® 400MG Tablet AstraZeneca quetiapine fumarate Seroquel® XL 200MG Tablet AstraZeneca lquetiapine fumarate Seroquel® XL 300MG Tablet AstraZeneca quetiapine fumarate Seroquel® XL 400MG Tablet AstraZeneca trifluoperazine HCL Stelazine® 1MG Tablet various trifluoperazine HCL Stelazine® 2MG Tablet various trifluoperazine HCL Stelazine® 5MG Tablet various trifluoperazine HCL Stelazine® 10MG Tablet various topiramate Topamax® 25MG Tablet Ortho-McNeil topiramate Topamax® 50MG Tablet Ortho-McNeil topiramate · Topamax® 100MG Tablet Ortho-McNeil topiramate Topamax® 200MG Tablet Ortho-McNeil sertraline HCL Zoloft® 25MG Tablet various RFP DBH Formulary AHFS Brand f. Ph~rmacologic- Generic Therapeutic Code Brand 28:16.04.12 Generic 28:24.08 Generic 28:24.08 Generic 28:24.08 Generic 28:24.08 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Brand 28:16.08.04 Generic 28:16.08.24 Generic 28:16.08.24 Generic 28:16.08.24 Generic 28:16.08.24 Brand 28:12.92 Brand 28:12.92 Brand 28:12.92 Brand 28:12.92 Generic 28:16.04.20 AHFS Pharmacologic-Therapeutic Classification Monoamine Oxidase Inhibitors Benzodiazepines Benzodiazepines Benzodiazepines Benzodiazepines Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Atypical Antipsychotics Phenothiazines Phenothiazines Phenothiazines Phenothiazines Anticonvulsants, Miscellaneous Anticonvulsants, Miscellaneous Anticonvulsants, Miscellaneous Anticonvulsants, Miscellaneous Selective-serotonin Reuptake Inhibitor NOTES Generic only ·Generic only Generic only Generic only Generic only Exhibit B Page 12 of 14 Page 11 of 12 DBH Formulary County of Fresno Department of Behavioral Health Drug Formulary 3-18-2014 FRESNO COUNTY BEHAVIORAL HEALTH-FORMULARY DRUG LIST-2014 Generic Name· Reference Brand · Strength Dosage Form Manufacturer Nan1e· sertraline HCL Zoloft® 50MG Tablet various sertraline HCL Zoloft® 100MG Tablet various RFP DBH Formulary AHFS Brand 1 Pharmacologic- Generic· Therapeutic ·. Code Generic 28:16.04.20 Generic 28:16.04.20 ·' AHFS Phannacologic-Therapeutic Classification. Selective-serotonin Reuptake Inhibitor Selective-serotonin Reuptake Inhibitor ·~·--" -.. NOTES Generic only Generic only >. Exhibit B Page 13 of 14 Page 12 of 12 Exhibit C FRESNO COUNTY DEPARTMENT OF BEHAVIORAL HEALTH PROGRAM LOCATIONS WHERE MEDICATION DELIVERIES MAY BE REQUIRED OUTPATIENT METRO SERVICES 4441 E. Kings Canyon Road Fresno, CA. 93702 CRESTWOOD PSYCHIATRIC HEALTH FACILITY 4411 E. Kings Canyon Road Fresno, CA. 93702 ExhibitD Page 1 of2 EXHIBIT D-TRADITIONAL PRICING MODEL COVERED PHARMACY SERVICES AT NETWORK PHARMACIES DISCOUNT ... _NETWORK DRUG TYPE OJ?FOFAWP . DISPENSING FEE Ntrr:Es BRAND NAME DRUG 16.0% $1.25 per Paid Claim 1,2,3 RETAIL NETWORK GENERIC DRUG 75.0% 1.25 per Paid Claim 1,2,3 BRAND NAME DRUG NIA N/A N/A MAIL ORDER GENERIC DRUG N/A N/A NIA PASS-THROUGH REBATE RATES . -RE.SATETYPE . REBATE RA'I;E _ ;NO"I:ES • Rebates passed-through to County 75.0% 4,5 • Rebates Retained 25.0% 4,5 -. FE-E' TYPE FEE RATE. ·• _: ~ . -- Administration Fee $0.00 Plastic ID cards-PVC card stock, per ID card 0.00 Manual Claim (UCF), per Manual Claim 0.00 Paper Claim (DMR), per Paper Claim 0.00 Coordination ofBenefits 0.00 Prior authorization-administrative, per PA 0.00 Prior authorization -clinical review, per P A 0.00 Prior authorization -specialty, per P A 0.00 Standard reporting Included Ad hoc reporting $150/hr. ;$500 minimum Custom programming $150/hr.;$500 minimum TRADITIONAL PRICING MODEL 1 Discount rates off A WP are based on post-settlement pricing. 2 Claims adjudicate at the lesser of the Brand A WP discount, MAC or U &C. The stated discount rates in this Exhibit are estimates of aggregated rates and are not guaranteed. 3 County shall pay Vendor the amounts invoiced for Covered Pharmacy Services plus· any applicable Dispensing Fees and other fees in accordance with this Exhibit D. Vendor has negotiated various rates and Dispensing Fees with different Network Pharmacies for providing Covered Pharmacy Services. The amount billed to County may differ from the amounts paid by Vendor to the Network Pharmacies. ExhibitD Page 2 of2 4 Rebate Rates are pass-through to County. Vendor will pay County Rebate amounts due to County and received by Vendor from the Rebate Processor on behalf of County during a quarter within 90 days of the close of such quarter. Vendor's payment of Rebates to County as described in Exhibit A Section X and this Exhibit D will constitute payment in full of Vendor's obligation to County for Rebates under this Agreement. 5 Rebates/Contract Execution. a. County acknowledges and agrees that Rebate payments will not be issued to County unless this Agreement has been executed by the parties. Should contract execution be delayed beyond the Effective Date due to County's actions, as determined by Vendor, County acknowledges that manufacturer Rebates and recoveries, if any, from financial guarantees will be forfeited between the Effective Date and the contract execution date. STATE REQUIREMENTS 1. CONTROL REQUIREMENTS ExhibitE Page 1 of2 COUNTY and its subcontractors shall provide services in accordance with all applicable Federal and State statutes and regulations. 2. PROFESSIONAL LICENSURE All (professional level) persons employed by the COUNTY Mental Health Program (directly or through contract) providing Short-Doyle/Medi-Cal services have met applicable professional licensure requirements pursuant to Business and Professions and Welfare and Institutions Codes. 3. CONFIDENTIALITY A. CONTRACTOR shall comply with applicable laws and regulations, including but not limited to section 5328 et seq. of the California Welfare and Institutions Code regarding the confidentiality of patient information. B. CONTRACTOR shall protect, from unauthorized disclosure, names and other identifying information concerning persons receiving services pursuant to this contract, except for statistical infonnation. This pertains to any and all persons receiving services pursuant to a Department of Mental Health funded program. CONTRACTOR shall not use such identifying infmmation for any purpose other than carrying out the CONTRACTOR's obligations under this contract. C. CONTRACTOR shall not disclose, except as otherwise specifically permitted by this contract or authorized by the client/patient, any such identifying information to anyone other than the County or State without prior written authorization from the County or State in accordance with State and Federal laws. D. For purposes of the above paragraphs, identifying information shall include, but not be limited to, name, identifying number, symbol, or other identifying particular assigned to the individual, such as finger or voice print, or a photograph. 4. NON-DISCRIMINATION A. CONTRACTOR shall not employ any unlawful discriminatory practices in the admission of patients, assignment of accommodations, treatment, evaluation, employment of personnel, or in any other respect on the basis of race, color, gender, religion, marital status, national origin, age, sexual preference, or mental or physical handicap, in accordance with the requirements of applicable Federal or State Law. Exhibit E Page 2 of2 B. During the performance of this contract, CONTRACTOR shall not unlawfully discriminate against any employee or applicant for employment because of race, religion, color, national origin, ancestry, mental or physical handicap, medical condition, marital status, age, or sex. CONTRACTOR shall comply with the provisions of the Americans with Disabilities Act of 1990, the Fair Employment and Housing Act (Government Code, section 12900, et seq.), and the applicable regulations promulgated thereunder (California Code of Regulations, Title 2, section 7285 et seq.). CONTRACTOR shall ensure that the evaluation and treatment of their employees and applicants for employment are free of such discrimination. The applicable regulations of the Fair Employment and Housing Commission implementing Government Code, section 12990, set forth in Chapter 5, Division 4 of Title 2 of the California Code of Regulations are incorporated into this contract by reference and made a part hereof as if set forth in full. CONTRACTOR shall give written notice of its obligations under this clause to labor organizations with which they have a collective bargaining or other agreement. C. CONTRACTOR shall comply with the provisions of section 504 of the Rehabilitation Act of 1973, as amended, pertaining to the prohibition of discrimination against qualified handicapped persons in all federally assisted programs or activities, as detailed in regulations signed by the Secretary of Health and Welfare Agency, effective June 2, 1977, and found in the Federal Register, Volume 42, No. 86, dated May 4, 1977. 5. PATIENTS' RIGHTS CONTRACTOR shall comply with applicable laws and regulations, including but not limited to, laws, regulations, and State policies relating to patients' rights. ----, -------------~- Exhibit F Exhibit F List of.Contracted Pharmacies Page 1 of 10 ... ~ ... ··-· ·-- Name ·Address~ Address 2 . __ C~ty ___ . · -.. Stat'e _ Z.!pC~de Phone . · ~ ...... _ . -. . .. ADVANCED FAMILY PHARMACY 5191 N 6TH ST FRESNO CA 937107502 559-222-8303 ADVANCED PAIN SOLUTIONS 6769 N FRESNO ST STE 206 FRESNO CA 937103715 559-435-1757 ALIXARX-CA HUB 4727 W SHAW AVE FRESNO CA 937226209 559-277-4100 BARR PHARMACY 1825 ACADEMY AVE SANGER CA 936573705 559-875-2517 BAUTISTA MEDICAL GROUP 2505 MERCED ST FRESNO CA 937211811 559-445-0391 BK PHARMACY CORP 3126 E GETTYSBURG AVE FRESNO CA 93726 559-228-1888 BK PHARMACY CORP 540 E HERNDON AVE STE 103 FRESNO CA 93720 559-438-2888 BOWERMANS PHARMACY 3131 S WILLOW AVE STE 103 FRESNO CA 93725 559-256-7988 BROOKS HEALTH CARE 3410 W ASHLAN AVE FRESNO CA 937224440 559-233-4663 BULLARD PHARMACY 2026 W BULLARD FRESNO CA 93711 559-438-0111 CALIFORNIA CANCER ASSOCIATES FOR RESEARC 1791 E FIR AVE FRESNO CA 93720 559-326-1219 CALIFORNIA PAIN CONSULTANTS 7235 N 1ST ST STE 103 FRESNO CA 937202937 559-478-4757 CARE CENTER PHARMACY 1570 E HERNDON FRESNO CA 93720 559-437-7370 CARE RX PHARMACY 302 E BULLARD AVE FRESNO CA 937105299 559-261-9888 CARUTHERS PHARMACY 2436 W TAHOE AVE CARUTHERS CA 93609 559-864-3177 CEDAR PHARMACY AND MEDICAL SUPPLIES INC 6767 N CEDAR AVE FRESNO CA 937104402 559-437-3700 CHESTNUT PHARMACY 7075 N CHESTNUT AVE STE 104 FRESNO CA 937200356 559-317-6720 COMMUNITY FIRST PHARMACY 3636 N FIRST ST SUITE 134A FRESNO CA 93726 559-229-6000 COSTCO PHARMACY 380 WASH LAN BLVD CLOVIS CA 93612 559-291-1084 COSTCO PHARMACY 4500 W SHAW FRESNO CA 93722 559-276-2595 COSTCO PHARMACY 7100 N ABBY NORTH FRESNO CA 93720 559-437-3642 CVS PHARMACY . 1405 HERNDON AVE CLOVIS CA 936110504 559-322-0150 CVS PHARMACY 634 SHAW AVE CLOVIS CA 93612 559-299-9511 CVS PHARMACY 2133 SHAW AVE CLOVIS CA 93611 559-297-6730 CVS PHARMACY 1794 ASH LAN AVE CLOVIS CA 93611 559-294-6603 CVS PHARMACY 111 E MERCED ST FOWLER CA 93625 559-834-1606 CVS PHARMACY 7096 N WAVE FRESNO CA 93711 559-436-0471 CVS PHARMACY 6750 N CEDAR AVE FRESNO CA 93710 559-299-3115 CVS PHARMACY 3011 E SHIELDS AVE FRESNO CA 93726 559-224-2965 CVS PHARMACY 1325 W SHIELDS AVE FRESNO CA 93705 559-224-6963 CVS PHARMACY 1302 FULTON MALL FRESNO CA 93721 559-233-7311 CVS PHARMACY 4077 W CLINTON AVE FRESNO CA 93722 559-271-3177 CVS PHARMACY 929 SIERRA ST KINGSBURG CA 93631 559-897-0290 Exhibit F Exhibit F List of Contracted Pharmacies Page2 ofiO •Fax ~~~'!tv f e,~~~!~l< ! 9. .2.4::HPHr -NCPDP: ID !\!PI. •' ': .:c:;/ ~' •• • •c• ~ ... 559~222-1082 FRESNO 461737643 N 5646712 1,831439967 FRESNO 270163308 564927S 1710256235 FRESNO 364717407 N 5649871 1033530977 559o875~37:18 FRESNO 272761955 N 546943 1.467544478 FRESNO 770314948 5954252 > 1487634317 559"228~0211 FRESNO 271552041 N 5.13425 1215921515 559-438-071~ FRESNO 271552041 N 56.28524 1710176045 866-514-2911 FRESNO 222862167 N 523402 1144325556 559-638-9652 FRESNO 770471114 N 561870 1760417232 559-438~0350 FRESNO 942720782 N 563379 1619978921. 559-326-1229 FRESNO 770324589 N 5622522 1750394342 559-326-3533 FRESNO 260689621 N 5654694 1316286982 559-437-7322 FRESNO 770175659 N 569042 1497813901 559-261-9487 FRESNO 455092809 N 5645203 1457600215 559"864-3497 FRESNO 941628870 N 570057 1063593192 559-437-3777 FRESNO 271783644 N 5638056 1811217177 559-353-2042 FRESNO 461170865 N 5648160 1427300664 888-727-9111 FRESNO 454038284 N 5696008 1285676585 559-348-2273 FRESNO 911223280 N 513805 1467562066 559-276-1738 FRESNO 911223280 N 598790 16S9481265 559-437~3663 FRESNO 911223280 N 586238 1942310552 559-322"0156 FRESNO 941059121 N 544850 1235173683 559-299~2610 FRESNO 941059121 N 525254 1568406395 559-297-6735 FRESNO 941059121 N 582999 1477595288 559-294"6.607 FRESNO 941059121 N 5628651 1821277344 559-834-5841 FRESNO 941059121 N 5626392 1154442093 559-436-:4231 FRESNO 941059121 N 578952 1518900851 559-298"1649 FRESNO 941059121 N 569460 1447292263 559-229"6165 FRESNO 941059121 N 504919 1255373080 559-225-3830 FRESNO 941059121 N 504933· 1962445221 559-233-0640 FRESNO 941059.121 N 504907 1962445759 559-271-3182 FRESNO 941059121 N 508727 122507i582 559-897-0378 FRESNO 941059121 N 507179 1316980675 Exhibit F Exhipit F List of Contracted Pharmacies Page:3of10 CVS PHARMACY 29.412 AUBERRY RD PRATHER CA '93651 559'-855-4220 CVS PHARMACY i065.\N MANNING' ·REEDLEY cA 93654 559-638-0467 cV:s'PHARMACY.# 1107 N WfLLOINAVE CLOVIS CA 93611 559-322-0340 CVS PHARMACY # 1113 E,CHAIVIPLAIN AVE FRESNO CA 9372.0 559"434.-2158 CVS PHARMACY# 728 WSHAW AVE FRE~NO CA 93704 559-226-1485 CVS Pl:lARMACY # 6800'·N MILBURN AVE FRESNO CA 93722 559-451-3486 CVS PHARMACY# 5995 E KINGS CANYON RD FRESNO CA 93727 < 559~252-1124 CVS PH,li;RI\(lACY # 333 ACADE.MY AVE SANGER CA 93657 559-875-2044 CVS PHARMACY # 05422 5180 E KINGS CANYON RD FRESNO CA 937273971 559~255-9009 CVS PHARMACY #04446 14967WWHITESBRJDGE AVE KERMAN CA 93630 559"842-0030 CVS. PHARMACY #.06772 4987N FRESNO ST FRESNO CA 93726 559-227-7137 DISCOUNT PHARMACY AND MEDICAL SUPPLY 703 N FULTON ST STE 201 FRESNO CA 937283405 559-268-0712 DMR 2425 WEST SHAW AVE FRESNO CA 93711 FOX DRUG STORE 1939 HIGH ST SELMA CA 93662 559-896-1645 FOX DRUG STORE INC. 3020 SAN ANTONIO DR FOWLER CA 936259507 559-344-6945 FOX DRUG STORE PARLIER 13699 E.MANNING AVE STE 105 PARLIER CA 93648 559-646-8888 FRESNO PHARMACY 4917 E KINGS CANYON RD SUITE 102 FRESNO CA 937273812 559-255-8085 FRESNO VAMC PHARMACY 2615 E CLINTON AVE FRESNO CA 93703 559-228-5339 FRIANT PHARMACY 17122 N FRIANT RD FRIANT CA 936260388 559-822~6401 JEFFREY K SHINODA PHARM D INC 6121 N THESTA STE 204 FRESNO CA 93710 559-435-2425 KAISER PERMANENTE PHARMACY #291 2071 HERNDON AVE CLOVIS CA 93611 559-324-5011 KMART PHARMACY #4721 25W POLK COALINGA CA 93210 559-935-1690 KMART PHARMACY4705 333 SIERRA KINGSBURG CA 93631 559-897-1913 MANOR DRUG 5795 N FIRST ST FRESNO CA 937106294 559-431-4142 MEDICINE SHOPPE 195 W SHAW AVE 101 CLOVIS CA 936123680 559c297-0251 MEDICINE SHOPPE 219 E OLIVE AVE FRESNO CA 937283129 559-268-8258 MEDICINE SHOPPE 4845 E BUTLER AVE F~ESNO CA 937275015 559-255-3301 MEDICINE SHOPPE PHARMACY 4009 N MARKS AVE FRESNO CA 93722 559~226"1201 MEDICINE SHOPPE PHARMACY 2484 E GETTYSBURG AVE FRESNO CA 93726 559-222-6276 MENDOTA DRUG 497 OLLERST MENDOTA CA 936402312 559-655-4254 MOQELDRUG 1506 DRAPER ST KINGSBURG CA 93631 559-897-5111 MODERN DRUG COMP 3044 TULARE ST FRESNO CA-93721 5~9~266~0701 NORTH FRESNO PRIMARY CARE 1805 E FIR AVE STE 101 FRESNO CA 937203859 559~298~9600 NOR,THWEST MEDICAL PHARMACY 4770 W HERNDON AVE STE101 FRESNO CA 93722 559-271-6370 Exhibit F Exhibit F list of Contracted 'Pharmacies Page'4of 10 559-855-4211 FRESNO 941059121 N 546626 1679516405 .559-638-0457 FRESNO 941059121 N 5616187 1447278098 559-322~0535 FRESNO 94i059121 N 512740 1477597813 559·-434,2167 FRESNO 941059121 N '523197 192.2042753 559"226"4255 FRESNO 941QS9121 N 519047 17:7052~030 559-261-9975 FRESNO 941059121 N 562S613 1477732014 FRESNO 352243093 5643336 15788,39791 559"875-2268 FRESNO 941059121 N 5631747 1831354397 FRESNO 352243093 5633436 1245478494 FRESNO 352243093 5637713 1245556281 FRESNO 352243093 5635593 1659504678 559-268-0722 FRESNO 770461511 N 547995 1487653994 FRESNO 9900021 559-896-3266 FRESNO 271551800 N 500074 1427041185 559-344-6947 FRESNO 271551800 N 5644655 1558617001 559-646"8889 FRESNO 271551800 N 56269,62 1487869376 559-255-2342 FRESNO 261676460 N 551160 1780714089 559~228~5339 FRESNO 770356492 N 550207 1366400244 559-822-6404 FRESNO 202937165 N 5617076 1962485219 559-438-4372 FRESNO 201564162 N 5615123 1497807945 559-324-5013 FRESNO 941340523 N 5600487 1255488581 559-935-Hi96 FRESNO 380729500 5649667 1841621695 559-897-1430 FRESNO 380729500 N 530712 1891726915 559"431-4357 FRESNO 941457365 N 524377 1407889819 559-297-4251 FRESNO 753258022 N 5629324 1609058064 559-268-1807 FRESNO 770411458 N 576453 1427160340 559-255~2912 FRESNO 770075757 N 585325 1962514885 559-226•2623 FRESNO 770085380 N 585717 1104910512 559-222•4388 FRESNO 204990478 N 589905 1326071572 559-GSS-4280 FRESNO 941628870 N 537754 1881780757 559-897-5729 FRESNO 920178738 N 526523 1790792356 559-266~2438 FRESNO 208450145 N 532728 1760455711 FRESNO 452356329 N 5653995 1245527357 559-271-6371 FRESNO 941628870 N 514390 1801982798 E-?Chibit F Exhibit F List of Contracted Pharmades Page5 of 10 PHARMERICA 4910£ASHLAN AVE SUITE 111 FRESNO CA 93726 800~499-907·9 PILL ·so)(Pi-iARMACY 2608 .E ASH LAN AVE FRESNO CA 937263207 S59,492<li62. PRIMARY CARE PHARMACY 5551 E'KINGS CANYON RD STE iOl FRESNO CA 93727 559-452-0420 RAY FISHER PHARMACY, INC. 6629 N BLACKSTONE AVE FRESNO CA 93710 559A37-3800 R~EDLEY PRO-SCRIPT PHARMACY :J-045 GST REEDLEY CA 936542935 559-637-7000 RITE AID PHARMACY 04072 2020 E COPPER AVE FRESNO CA 93730 559-433-1290 RITE AID PHARMACY OS793 159W POLKST COAliNGA CA 93?102302 559~935-3597 RITE AID PHARMACY 05849 1155 SHAW AVE CLOVIS CA 936123928 559~297-4198 RITE AID PHARMACY 05.853 456SMAPERAAVE KERMAN CA 936301019 559c846-7115 RITE AID PHARMACY 05858 975 t MANNING AVE REEDLEY CA 936542:348 559-638-6349 RITE AID PHARMACY 05860 2640 FLORAL AVE SELMA CA 936622602 559-896-7105 RITE AID PHARMACY 05861 4224 E SHIELDS FRESNO CA 937267120 559-229-6024 RITE AID PHARMACY 05862 1210 N BLACKSTONE AVE FRESNO CA 937033606 559-445-Q694 RITE AID PHARMACY 05863 6074 N 1ST AVE FRESNO CA 937105405 559-431-5231 RITE AID PHARMACY 05865 2011 W SHAW AVE FRESNO CA 937113404 559-224-0920 RITE AID PHARMACYOS869 3795 W SHIELDS AVE FRESNO CA 937225247 559-271-5030 RITE AID PHARMACY 05872 5574 E KINGS CANYON FRESNO CA 937274526 559-458-0534 RITE AID PHARMACY.06289 4593 N CEDARAVE FRESNO CA 937262540 559-222-2472 RITE AID PHARMACY 06295 1101 FRESNO ST FRESNO CA 937063235 559-441-0998 RITE AID PHARMACY 06378 8027 N CEDAR AVE FRESNO CA 937204827 559~431-1002 RITE AID PHARMACY 06476 2990 E NEES AVE FRESNO CA 937206008 559"297-4306 RIVERDALE DRUG 3462 W MT WHITNEY AVE RIVERDALE CA 936569401 559-867-3013 RX CARE PHARMACY 155 S 5TH ST STE A COALINGA CA 93210 559-935-8833 SAMS PHARMACY 10A704 7663 NO BLACKSTONE AVE FRESNO CA 93720 559-446-0196 SAVE MART PHARMACY 1835 HERNDON AVE CLOVIS CA 93612 559-32:2"0123 SAVE MART PHARMACY 2179SHAW AVE CLOVIS CA 93612 559-298-1707 SAVE MART PHARMACY 1157 N WILLOW CLOVIS CA 93612 559~297•0174 SAVE MART PHARMACY 659 E NEES AVE FRESNO CA 93720 559-446-0715 SAVE MART PHARMACY 7075 N MARKS FRESNO CA 93711 559-439~1211 SAVE MART PHARMACY 1107 E CHAMPLAIN AVE FRESNO CA 93720 559"433-0283 SAVE MART PHARMACY 6797 N MILBURN FRESNO CA 93722 5.59~261-4126 SAVE MART PHARMACY 5750 N FIRSTST FRESNO CA 93710 559-435-7903 sAVE MART PHARMACY 242.5 N BLACKSTONE AVE FRESNO CA 93.703 559;229-3119 SCRIPTLIFE PHARMACY 255 W HERNDON AVE STE 101 CLOVIS CA 936120204 559~324"1808 Exhibit F Exhibit F List of Contracted Pharmacies Page6Jfiq 559-294-3.879 FRE?NO 953849613 N. 591277 12058691372 559~283-844'1 FRESNO 26404~116 N 5.641243 1881989564 FRESNO 371565832 N 5631482 1093961211 559-437-3838 FRESNO 941674864 N 53:2754 1700878030 559-637-9819 FRESNO 463448340 N 56534~8 1164820197 FRESNO 954391·249 5(i34755 130607~762 559~935-5879 FRESNO 954:391249 N 564080 1861501256 !?59-297~7388 FRESNO 954391249 N 50.7319 153827~981 559-846-9756 FRESNO 954391249 N 569155 1497864805 559-637-1523 FRESNO 954391249 N ~88028 1043329493 559~896-3673 FRESNO 954391249 N 583294 16098!:)8279 559-229-8093 FRESNO 954391249 N 519819 1003925538 559-445-1480 FRESNO 954391249 N 567377 1437269297 559-431-0224 FRESNO 954391249 N 525937 11746~2616 559-225-0114 FRESNO 954391249 N 520127 1467561993 559-271-5041 FRESNO 954391249 N 595491 1942319,306 559~458-0976 FRESNO 954391249 N 509969 1881703239 559~222-2495 FRESNO 954391249 N 501521 1942319371 559-441-1088 FRESNO 954391249 N 522551 1457460990 559-431-1099 FRESNO 954391249 N 522626 1366551806 FRESNO 954391249 N 5624499 1245306182 559-867-2015 FRESNO 941695675 N 526585 1023117975 559-935-8838 FRESNO 611492633 N 5618458· 1578512471 FRESNO 710794414 N 56365,8 1831116177 559~322~9531 FRESNO 941245496 N 539900 1780663997 559~298~280 FRESNO 941245496 N 561945 1669451993 559-297~0212 FRESNO 941245496 N 576643 1740269943 559•446-0278 FRESNO 941245496 N 547820 1649259987 559-439~3520 FRESNO 941245496 N 597027' 1376522607 559-433~0321 FRESNO 941245496 N 510796 1629057963 559-261-4129 FRESNO 941245496 N 5615933 1134109176 559-435-8279 FRESNO 941245496 N 5625869. 1861536948 559-229-3182 FRESNO 941245496 N 5625871 177062.7853 559-324~1876 FRESNO 270475441 N 5635896 1265665517 Exhibit F EX.hibit F List of Contracted Pharmacies Page? of 10 SCRIPTCARE RX AND MEDICALSUPPLIES :J,S9WSIJAW AVE CLOVIS CA s36123726. 559"298-0600 SiERRA. PACIFIC ORTHOPAEDIC & SPINE'tENTE 1630 E HERNDON AVE #304 FRESNO CA 93720 559~25.6•5200 SUNNYSIDE PHARMACY 56l:W E KINGS CANYON RD STE 104 FRESNO CA 93Ti.7 559"251-8601 TARGET .PHARMACY 900.SHAW AVE CLOVIS CA 93612 559-297-5697 TARGET PHARMACY 695 W HERNDcJNAVE CLOViS t:A 93612 559.-321-0010 TARGET PHARJVIACY 3173 ESHIELDS AVE FR~SNO CA 93726 559,-222-6287 TARG~T PHARMACY 5740 N BLACKSTONE FRESNO CA 93710 559-431-8650 TARGET PHARMACY 3150 W SHAW AVE FRESNO CA; •93711 559~276-8926 TARGET PHARMACY 7600 N BLACKSTONE AVE FRESNO CA 93720 559-490-0031 TARGET PHARMACY 6655 N RIVERSIDE DRIVE FRESNO CA 93722 559-490-5568 TOUS PHARMACY 3250 E OLIVE AVE STE B FRESNO CA 937021033 559-268-2547 UNITED HEALTH CENTERS 445l1TH ST ORANGE COVE CA 936462298 559-626-4031 UNITED HEALTH CENTERS 650 S ZEDIKER AVE PARLIER CA 936482639 559-646-3561 UNITED HEALTH CENTERS OF THE SJV 121 BARBOZA ST MENDOTA CA 93640 559-655-5000 UNITED HEALTH CNTRS OF THE SJV INC 517 S MADERA AVE KERMAN CA 93630 559-846-6330 UNITED HEALTH CTR SAN JOAQUIN 16928 11TH ST HURON CA 93234 559-945-2541 UNIVERSITY MEDICAL CENTER 290 N WAYTE LANE FRESNO CA 93701 559-459-4592 VINA PHARMACY 2308 N FRESNO.ST FRESNO CA 937032239 559-224-5210 VISTA PHARMACY 4233 E TULARE ST FRESNO CA 937023098 559-255-3071 VONS PHARMACY #1754 5638 E KINGS CANYON FRESNO CA 93727 559-458-0240 VONS PHARMACY #1756 1650 HERNDON AVE CLOVIS CA 93611 559-297-6440 VONS PHARMACY #2181 7733 N FIRST ST FRESNO CA 93720 559~439-1016 VONS PHARMACY #2188 8949 N CEDAR AVE FRESNO CA 93720 559-438-1356 VONS PHARMACY #2189 4343 N BLACKSTONE FRESNO CA 93726 559-243-0163 VONS PHARMACY #2701 3100 FOWLER AVE CLOVIS CA 93611 55~-294-6730 WALGREEN$ 1219 N CEDAR AVE FRESNO CA 93703 559-498-8283 WALGREEN$ #10243 2420 N BLACKSTONE AVE FRESNO CA 93703 559-244-0974 WALGREENS#10334 1790SHAWAVE CLOVIS CA 93611 559-299-2724 WALGREENS #10335 2424 N BRAWLEY AVE FRESNO CA 937225109 559-277-5912 WALGREEN$ #10481 265 FOREST ST COALINGA CA 93210 559•934-0461 WALGREEN$ #11877 4771 W ASHLAN AVE FRESNO CA 937L24307 559-274•0559 WALGREENS #12281 2950 N FOWLER WAY FRESNO CA 937219148 559-291-7589 WALGREENS #12282 2589JENSEN AVE SANGER CA 936572251 559-8.75-4061 WALGREEN$ #12298 852 E MANNING AVE REEDLEY CA 93654223.2 559-643-0367 Exhib-it F Exhibit F listof Con~racted Pharmacil~s Page 8 of 10 559.-325-22215 FRESNO 454122205 N .564'l441 :1.2556874'89 S59~i56-~376 FRESNO 770548187 N 5636533' 1285669655 559,::251-8727 FRESNO 271551800 N 532829 1952438525 559-321-0484 'FRESNO 4l0215i70 N '5600134 1730101338 559-326-1351 FRESNO 410215170 N 5616444 1659394971 559-490-420.1 FRESNO 410215170 N 562531 19927276!39 559-431-8650 FRESNO 410215170 N 568672 1346262037 559-276-8926 FRESNO 410215170 N 5600122 1821010422 559-490-4316 FRESNO 410215170 N 5615666 1487676011 FRESNO 410215170 N 5650127 1871915736 FRESNO 208450145 N 547793 1134128655 559-626-5070 FRESNO 941732538 N 562581 1194825265 559-646-6916 FRESNO 941732538 N 540496 1013024132 559-655-6818 FRESNO 941732538 N 590186 1871695130 559-842-2370 FRESNO 941732538 N 5616795 1962504225 559-945-5094 FRESNO 941732538 N 521698 1710087887 559-459-6110 FRESNO 946005120 N 507472 1518988575 559-225-5902 FRESNO 770203569 N 541878 1164421988 559-255-5058 FRESNO 941622131 N 532867 1154490878 559-458-0248 FRESNO 381623900 N 574663 1528004306 559-297-6444 FRESNO 381623900 N 557249 17'70512709 559-439-0581 FRESNO 381623900 N 578130 1164453973 559-438-6594 FRESNO 381623900 N 510277 1134165764 559"243-0723 FRESNO 381623900 N 503931 1407885478 559~294"6735 FRESNO 381623900 N 587418 1376574186 559-498~0252 FRESNO 361924025 N 574233 1295740587 FRESNO 361924025 N 5630377 1336316884 559-299-4926 FRESNO 361924025 N 544343 1871508150 ·FRESNO 361924025 N 5626544 1811103443 FRESNO 361924025 5631684 1891941944 FRESNO 361924025 N 5635822 1811220411 FRESNO 361924025 N 5635125 1336379031 FRESNO 361924025 N 5635480 1447481619 FRESNO 361924025 N 5635024 1114156668 Exhib.it F Exhibit F Lis.t of Contract~<;~ Pha.rrna~ies Page 9of 10 WALGREENS #12337 2795 FLORALAVE SELMA CA 936622675 559-891-9823 WALGREEN$ #12707 4i72 N1STST FRESNO cA 93726 559-243-0121 WALGREENS #13871 1016 W SHAW AVE FRESNO CA 93711:3701 559~219-2361 WALGREEN$ #2702 1344W CLINTON AVE FRESNO GA 93705 559-264-86.93 WALGREEN$ #4907 .2840 ASH !,AN AVE FRESNO fA 93705 559-225-8700 WALGREEN$ #5847 6+0 E NEESAVE FRE.SNO CA 93720 559.-431-1102 WALGREEN$ #6082 .p26 S CLOVIS AVE FRESNO CA 93727 559•251-0106 WALGREENS #6386 4810E KINGS CANYON ROAD FRESNO CA 93727 559c458'-0129 WALGREENS #6387 1815 HERNDON AVE CLOVIS CA 93611 559-325'-1084 WALGREENS #6942 60.10 N FIG GARDEN DR FRESNO CA 93722 559-271-4923 WALGREENS #7204 7015 N WAVE FRESNO CA 93711 559-440-1401 WALGREENS #7266 8'975 N CHESTNUT AVE FRESNO CA 93720 559-325-6417 WALGREENS #7830 205 SHAW AVE CLOVIS CA 93612 559-325-3474 WALGREENS #9655 6885 N WILLOW AVE FRESNO CA 93720 559~322-0698 WALGREENS #9702 5785 N 1STST FRENSNO CA 937106203 559-440-0152 WALGREEN$ #9815 988 SIERRA ST KINGSBURG CA 93631 559-897-9733 WAL-MART PHARMACY 1185 HERNDON AVE CLOVIS CA 936120409 559-321-0284 WAL-MART PHARMACY 3680WSHAW FRESNO CA 93711 559-277-8274 WAL-MART PHARMACY 1804 E ASH LAN AVE FRESNO .cA 93726 559-470-6967 WAL-MART PHARMACY 10.-1882 3400 FLORAL AVE SELMA CA 93662 559-891-1960 WAL-MART PHARMACY 10-2001 5125 E KINGS CANYON FRESNO CA 93727 559-252-9518 WAL-MART PHARMACY 10-2277 323WSHAWAVE CLOVIS CA 93612 559-297-4391 WAL-MART PHARMACY 10~2689 3131 N CEDARAVE FRESNO CA 937031532 479-258-2115 WAL-MART PHARMACY 10-2985 7065 N INGRAM AVE FRESNO CA 93650 559-431-0747 WAL.MART PHARMACY 10:4238 2761 JENSEN AVE SANGER CA 93657 559-875-1813 WAL-MART PHARMACY 10-5633 1830 SHAW AVE CLOVIS CA 936114000 559-862-2837 WAL-MART PHARMACY 10.5634 6855 N WILLOW AVE FRESNO CA 937105949 559~862-2065 WAL-MART PHARMACY 10-5701 14061W WHITESBRIDGE AVE KERMAN CA 93f:j309297 479-273~4885 WESTSIDE DRUG 11010 ST FIREBAUG.H CA 936222297 559.:,659--2159 WINTONS PHARMACY 1377 EHERNDON STE 102 FRESNO CA 93720 559"435-1950 -- - --~----------------------------·------ Exhibit F Exhibit F List of Contracted Pharmacies Page 10 of 10 FRESNO 361924025 N 5634440 1063647238 559-243-0313 FRESNO 361924025 N 505682 1306851670 559-261-0748 FRESNO 361924025 y 574106 1578578860 559-264-2157 FRESNO 361924025 N 566793 1023024692 559-225-2430 FRESNO 361924025 N 512271 1831104108 559-431-1607 FRESNO 361924025 N 562872 1447265731 559-251-0243 FRESNO 361924025 y 559560 1457366734 559-458-0193 FRESNO 361924025 N 560967 1396751962 559-325-1909 FRESNO 361924025 N 561541 1235145616 559-271-4930 FRESNO 361924025 N 585301 1245245570 559-440-1407 FRESNO 361924025 N 5614688 1609881614 559-325-6455 FRESNO 361924025 N 5602037 1427065481 559-325-3479 FRESNO 361924025 y 5601706 1205841392 FRESNO 361924025 N 5624261 1043389018 FRESNO 361924025 N 5626455 1538374392 FRESNO 361924025 N 5625136 1467571471 FRESNO 710415188 N 5646546 1386982015 559-277-8196 FRESNO 710415188 N 529959 1770500191 559-470-6970 FRESNO 710415188 5651674 1609287127 FRESNO 710415188 N 529810 1861419285 559-252-3501 FRESNO 710415188 N 540826 1033136353 559-297-4391 FRESNO 710415188 N 524048 1780601104 559-538-1377 FRESNO 710415188 N 5653212 1477958478 FRESNO 710415188 N 565602 1588681837 FRESNO 710415188 N 5626936 1619185535 559-862-2834 FRESNO 710415188 5648184 1093156754 559-298-7371 FRESNO 710415188 N 5647005 1518209162 FRESNO 710415188 5647865 1962849646 559-659-2985 FRESNO 941509567 N 532285 1780795377 559-435-7241 FRESNO 941622131 N 565599 1326117052 COUNTY OF FRESNO REQUEST FOR PROPOSAL NUMBER: 269-5316 PHARMACEUTICAL SERVICES Issue Date: December 9, 2014 Closing Date: JANUARY 15,2015 Exhibit G Page 1 of71 Proposal will be considered LATE when the official Purchasing time clock reads 2:00P.M. Questions regarding this RFP should be directed to: Carolyn Flores, phone (559) 600-7112, e-mail countvpurchasing@co.fresno.ca.us, or fax (559) 600-7126. Check County of Fresno Purchasing's Open Solicitations website at https ://www2.co.fresno.ca.us/0440/Bids/BidsHome.aspx for RFP documents and changes. Please submit all Proposals to: County of Fresno -Purchasing 4525 E. Hamilton Avenue, 2"d Floor Fresno, CA 93702-4599 BIDDER TO COMPLETE UNDERSIGNED AGREES TO FURNISH THE COMMODITY OR SERVICE STIPULATED IN THE ATTACHED PROPOSAL SCHEDULE AT THE PRICES AND TERMS STATED, SUBJECT TO THE "COUNTY OF FRESNO PURCHASING STANDARD INSTRUCTIONS AND CONDITIONS FOR REQUEST FOR PROPOSALS (RFP'S)" ATTACHED. COMPANY ADDRESS CITY STATE ZIP CODE TELEPHONE NUMBER FACSIMILE NUMBER E-MAIL ADDRESS SIGNED BY PRINT NAME TITLE PD-040 (9/14) Proposal No. 269-5316 Exhibit G Page 2 of71 COUNTY OF FRESNO PURCHASING STANDARD INSTRUCTIONS AND CONDITIONS FOR REQUESTS FOR PROPOSALS (RFP'S) AND REQUESTS FOR QUOTATIONS (RFQ'S) Note: the reference to "bids" in the following paragraphs applies to RFP's and RFQ's GENERAL CONDITIONS By submitting a bid the bidder agrees to the following conditions. These conditions will apply to all subsequent purchases based on this bid. 1. BID PREPARATION: A) All prices and notations must be typed or written in ink. No erasures permitted. Errors may be crossed out, initialed and corrections printed in ink by person signing bid. B) Brand Names: Brand names and numbers when given are for reference. Equal items will be considered, provided the offer clearly describes the article and how it differs from that specified. In the absence of such information it shall be understood the offering is exactly as specified. C) State brand or make of each item. If bidding on other than specified, state make, model and brand being bid and attach supporting literature/specifications to the bid. D) Bid on each item separately. Prices should be stated in units specified herein. All applicable charges must be quoted; charges on invoice not quoted herein will be disallowed. E) Time of delivery is a part of the consideration and must be stated in definite terms and must be adhered to. F.O.B. Point shall be destination or freight charges must be stated. F) All bids must be dated and signed with the firm's name and by an authorized officer or employee. G) Unless otherwise noted, prices shall be firm for one hundred eighty ( 180) days after closing date of bid. 2. SUBMITIING BIDS: A) Each bid must be submitted on forms provided in a sealed envelope/package with bid number and closing date and time on the outside of the envelope/package. B) Interpretation: Should any discrepancies or omissions be found in the bid specifications or doubt as to their meaning, the bidder shall notify the Buyer in writing at once. The County shall not be held responsible for verbal interpretations. Questions regarding the bid must be received by Purchasing stated within this document. All addenda issued shall be in writing, duly issued by Purchasing and incorporated into the contract. C) ISSUING AGENT/AUTHORIZED CONTACT: This RFP/RFQ has been issued by County of Fresno, Purchasing. Purchasing shall be the vendor's sole point of contact with regard to the RFP/RFQ, its content, and all issues concerning it. All communication regarding this RFP/RFQ shall be directed to an authorized representative of County Purchasing. The specific buyer managing this RFP/RFQ is identified on the cover page, along with his or her telephone number, and he or she should be the primary point of contact for discussions or information pertaining to the RFP/RFQ. Contact with any other County representative, including elected officials, for the purpose of discussing this RFP/RFQ, its content, or any other issue concerning it, is prohibited unless authorized by Purchasing. Violation of this clause, by the vendor having unauthorized contact (verbally or in writing) with such other County representatives, may constitute grounds for rejection by Purchasing of the vendor's quotation. The above stated restriction on vendor contact with County representatives shall apply until the County has awarded a purchase order or contract to a vendor or vendors, except as follows. First, in the event that a vendor initiates a formal protest against the RFP/RFQ, such vendor may contact the appropriate individual, or individuals who are managing that protest as outlined in the County's established protest procedures. All such contact must be in accordance with the sequence set forth under the protest procedures. Second, in the event a public hearing is scheduled before the Board of Supervisors to hear testimony prior to its approval of a purchase order or contract, any vendor may address the Board. D) Bids received after the closing time will NOT be considered. E) Bidders are to bid what is specified or requested first. If unable to or unwilling to, bidder may bid alternative or option, indicating all advantages, disadvantages and their associated cost. 3. FAILURE TO BID: A) If not bidding, return bid sheet and state reason for no bid or your name may be removed from mailing list. 4. TAXES, CHARGES AND EXTRAS: A) County of Fresno is subject to California sales and/or use tax (8.225%). Please indicate as a separate line item if applicable. B) DO NOT include Federal Excise Tax. County is exempt under Registration No. 94-73-03401-K. C) County is exempt from Federal Transportation Tax. Exemption certificate is not required where shipping papers show consignee as County of Fresno. D) Charges for transportation, containers, packing, etc. will not be paid unless specified in bid. 5. W-9 -REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION & CALIFORNIA FORM 590 WITHHOLDING EXEMPTION CERTIFICATE: Upon award of bid, the vendor shall submit to County Purchasing, a completed IRS Form W-9-RequestforTaxpayer Identification Number and Certification 1A Proposal No. 269-5316 and a California Form 590 Withholding Exemption Certificate if not currently a County of Fresno approved vendor. 6. AWARDS: A) Award(s) will be made to the most responsive responsible bidder; however, the Fresno County Local Vendor Preference and/or the Disabled Veteran Business Enterprise Preference shall take precedence when applicable. Said Preferences apply only to Request for Quotations for materials, equipment and/or supplies only (no services); the preference do not apply to Request for Proposals. RFQ evaluations will include sucti things as life-cycle cost, availability, delivery costs and whose product and/or service is deemed to be in the best interest of the County. The County shall be the sole judge in making such determination. B) Unless bidder gives notice of ali-or-none award in bid, County may accept any item, group of items or on the basis of total bid. C) The County reserves the right to reject any and all bids and to waive informalities or irregularities in bids. D) Award Notices are tentative: Acceptance of an offer made in response to this RFP/RFQ shall occur only upon execution of an agreement by both parties or issuance of a valid written Purchase Order by Fresno County Purchasing. E) After award, all bids shall be open to public inspection. The County assumes no responsibility for the confidentiality of information offered in a bid. 7. TIEBIDS: All other factors being equal, the contract shall be awarded to the Fresno County vendor or, if neither or both are Fresno County vendors, it may be awarded by the flip of a coin in the presence of witnesses or the entire bid may be rejected and re-bid. If the General Requirements of the RFQ state that they are applicable, the provisions of the Fresno County Local Vendor Preference shall take priority over this paragraph. 8. PATENT INDEMNITY: The vendor shall hold the County, its officers, agents and employees, harmless from liability of any nature or kind, including costs and expenses, for infringement or use of any copyrighted or un-copyrighted composition, secret process, patented or unpatented invention, article or appliance furnished or used in connection with this bid. 9. SAMPLES: Samples, when required, must be furnished and delivered free and, if not destroyed by tests, will upon written request (within thirty (30) days of bid closing date) be returned at the bidder's expense. In the absence of such notification, County shall have the right to dispose of the samples in whatever manner it deems appropriate. 10. RIGHTS AND REMEDIES OF COUNTY FOR DEFAULT: A) In case of default by vendor, the County may procure the articles or service from another source and may recover the cost difference and related expenses occasioned thereby from any unpaid balance due the vendor or by proceeding against performance bond of the vendor, if any, or by suit against the vendor. The prices paid by the County shall be considered the prevailing market price at the time such purchase is made. B) Articles or services, which upon delivery inspection do not meet specifications, will be rejected and the vendor will be considered in Exhibit G Page 3 of71 default. Vendor shall reimburse County for expenses related to delivery of non-specified goods or services. C) Regardless of F.O.B. point, vendor agrees to bear all risks of loss, injury or destruction to goods and materials ordered herein which occur prior to delivery and such loss, injury or destruction shall not release vendor from any obligation hereunder. 11. DISCOUNTS: Terms of less than fifteen (15) days for cash payment will be considered as net in evaluating this bid. A discount for payment within fifteen (15) days or more will be considered in determining the award of bid. Discount period will commence either the later of delivery or receipt of invoice by the County. Standard terms are Net forty-five (45) days. 12. SPECIAL CONDITIONS IN BID SCHEDULE SUPERSEDE GENERAL CONDITIONS: The "General Conditions" provisions of this RFP/RFQ shall be superseded if in conflict with any other section of this bid, to the· extent of any such conflict. 13. SPECIAL REQUIREMENT: With the invoice or within twenty-five (25) days of delivery, the seller must provide to the County a Material Safety Data Sheet for each product, which contains any substance on "The List of 800 Hazardous Substances", published by the State Director of Industrial Relations. (See Hazardous Substances Information and Training Act, California State Labor Code Sections 6360 through 6399.7.) 14. RECYCLED PRODUCTS/MATERIALS: Vendors are encouraged to provide and quote (with documentation) recycled or recyclable products/materials which meet stated specifications. 15. YEAR COMPLIANCE WARRANTY: Vendor warrants that any product furnished pursuant to this Agreement/order shall support a four-digit year format and be able to accurately process date and time data from, into and between the twentieth and twenty-first centuries, as well as leap year calculations. 'Product" shall include, without limitation, any piece or component of equipment, hardware, firmware, middleware, custom or commercial software, or internal components or subroutines therein. This warranty shall survive termination or expiration of this Agreement. In the event of any decrease in product functionality or accuracy related to time and/or date data related codes and/or internal subroutines that impede the product from operating correctly using dates beyond December 31, 1999, vendor shall restore or repair the product to the same level of functionality as warranted herein, so as to minimize interruption to County's ongoing business process, time being of the essence. In the event that such warranty compliance requires the acquisition of additional programs, the expense for any such associated or additional acquisitions, which may be required, including, without limitation, data conversion tools, shall be borne exclusively by vendor. Nothing in this warranty shall be construed to limit any rights or remedies the County may otherwise have under this Agreement with respect to defects other than year performance. 16. PARTICIPATION: Bidder may agree to extend the terms of the resulting contract to other political subdivision, municipalities and tax-supported agencies. Such participating Governmental bodies shall make purchases in their own name, make payment directly to bidder, and be liable directly to the bidder, holding the County of Fresno harmless. 18 Proposal No. 269-5316 17. CONFIDENTIALITY: All services performed by vendor shall be in strict conformance with all applicable Federal, State of California and/or local laws and regulations relating to confidentiality, including but not limited to, California Civil Code, California Welfare and Institutions Code, Health and Safety Code, California Code of Regulations, Code of Federal Regulations. Vendor shall submit to County's monitoring of said compliance. Vendor may be a business associate of County, as that term is defined in the "Privacy Rule" enacted by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). As a HIPAA Business Associate, vendor may use or disclose protected health information ("PHI") to perform functions, activities or services for or on behalf of County as specified by the County, provided that such use or disclosure shall not violate HIPAA and its implementing regulations. The uses and disclosures if PHI may not be more expansive than those applicable to County, as the "Covered Entity" under HIPAA's Privacy Rule, except as authorized for management, administrative or legal responsibilities of the Business Associate. Vendor shall not use or further disclose PHI other than as permitted or required by the County, or as required by law without written notice to the County. Vendor shall ensure that any agent, including any subcontractor, to which vendor provides PHI received from, or created or received by the vendor on behalf of County, shall comply with the same restrictions and conditions with respect to such information. 18. APPEALS: Appeals must be submitted in writing within seven (7) working days after notification of proposed recommendations for award. A "Notice of Award" is not an indication of County's acceptance of an offer made in response to this RFP/RFQ. Appeals should be submitted to County of Fresno Purchasing, 4525 E. Hamilton Avenue, Fresno, California 93702-4599. Appeals should address only areas regarding RFP contradictions, procurement errors, quotation rating discrepancies, legality of procurement context, conflict of interest, and inappropriate or unfair competitive procurement grievance regarding the RFP/RFQ process. Purchasing will provide a written response to the complainant within seven (7) working days unless the complainant is notified more time is required. If the protesting bidder is not satisfied with the decision of Purchasing, he/she shall have the right to appeal to the Purchasing Agent/GAO within seven (7) working days after Purchasing's notification; except if, notified to ·appeal directly to the Board of Supervisors at the scheduled date and time. If the protesting bidder is not satisfied with Purchasing Agent/GAO's decision, the final appeal is with the Board of Supervisors. 19. OBLIGATIONS OF CONTRACTOR: A) CONTRACTOR shall perform as required by the ensuing contract. CONTRACTOR also warrants on behalf of itself and all subcontractors engaged for the performance of the ensuing contract that only persons authorized to work in the United States pursuant to the Immigration Reform and Control Act of 1986 and other applicable laws shall be employed in the performance of the work hereunder. B) CONTRACTOR shall obey all Federal, State, local and special district laws, ordinances and regulations. 20. AUDITS & RETENTION: Exhibit G Page 4 of71 The Contractor shall maintain in good and legible condition all books, documents, papers, data files and other records related to its performance under this contract. Such records shall be complete and available to Fresno County, the State of California, the federal government or their duly authorized representatives for the purpose of audit, examination, or copying during the term of the contract and for a period of at least three (3) years following the County's final payment under the contract or until conclusion of any pending matter (e.g., litigation or audit), whichever is later. Such records must be retained in the manner described above until all pending matters are closed. 21. DISCLOSURE-CRIMINAL HISTORY & CIVIL ACTIONS: Applies to Request for Proposal (RFP); does not apply to Request for Quotation (RFQ) unless specifically stated elsewhere in the RFQ document. In their proposal, the bidder is required to disclose if any of the following conditions apply to them, their owners, officers, corporate managers and partners (hereinafter collectively referred to as "Bidder"): • Within the three-year period preceding the proposal, they have been convicted of, or had a civil judgment rendered against them for: o fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; o violation of a federal or state antitrust statute; o embezzlement, theft, forgery, bribery, falsification, or destruction of records; or o false statements or receipt of stolen property Within a three-year period preceding their proposal, they have had a public transaction (federal, state, or local) terminated for cause or default. 22. DATA SECURITY: Individuals and/or agencies that enter into a contractual relationship with the COUNTY for the purpose of providing services must employ adequate controls and data security measures, both internally and externally to ensure and protect the confidential information and/or data provided to contractor by the COUNTY, preventing the potential loss, misappropriation or inadvertent access, viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse of COUNTY resources; and/or disruption to COUNTY operations. Individuals and/or agencies may not connect to or use COUNTY networks/systems via personally owned mobile, wireless or handheld devices unless authorized by COUNTY for telecommuting purposes and provide a secure connection; up to date virus protection and mobile devices must have the remote wipe feature enabled. Computers or computer peripherals including mobile storage devices may not be used (COUNTY or Contractor device) or brought in for use into the COUNTY's system(s) without prior authorization from COUNTY's Chief Information Officer and/or designee(s). No storage of COUNTY's private, confidential or sensitive data on any hard- disk drive, portable storage device or remote storage installation unless encrypted according to advance encryption standards (AES of 128 bit or higher). The COUNTY will immediately be notified of any violations, breaches or potential breaches of security related to COUNTY's confidential information, data and/or data processing equipment which stores or processes COUNTY data, internally or externally. 1C Proposal No. 269-5316 COUNTY shall provide oversight to Contractor's response to all incidents arising from a possible breach of security related to COUNTY's confidential client information. Contractor will be responsible to issue any notification to affected individuals as required by law or as deemed necessary by COUNTY in its sole discretion. Contractor will be responsible for all costs incurred as a result of providing the required notification. 23. PURCHASING LOCATION & HOURS: Fresno County Purchasing is located at 4525 E. Hamilton Avenue (second floor), Fresno, CA 93702. Non-holiday hours of operation are Monday through Friday, 8:00A.M. to 12:00 Noon and 1:00 P.M. to 5:00 P.M. PST; Purchasing is closed daily from 12:00 Noon to 1:00 P.M. The following holiday office closure schedule is observed: January 1* Third Monday in January Third Monday in February March 31* Last Monday in May July 4* First Monday in September November 11 * Fourth Thursday in November Friday following Thanksgiving December 25* New Year's Day Martin Luther King, Jr.'s Birthday Washington -Uncoln Day Cesar Chavez' Birthday Memorial Day Independence Day Labor Day Veteran's Day Thanksgiving Day Christmas * When this date falls on a Saturday, the holiday is observed the preceding Friday. If the date falls on a Sunday, the holiday is observed the following Monday. 24. FRESNO COUNTY BOARD OF SUPERVISORS ADMINISTRATIVE POLICIES: The link below references the Fresno County Board of Supervisors Administrative policies that will apply to this Request for Proposal. Click here to view 10 Exhibit G Page 5 of71 Proposal No. 269-5316 TABLE OF CONTENTS Exhibit G Page 6 of71 Page2 PAGE OVERVIEW ..................................................................................................................... 3 KEY DATES .................................................................................................................... 5 TRADE SECRET ACKNOWLEDGEMENT ..................................................................... 6 DISCLOSURE-CRIMINAL HISTORY & CIVIL ACTIONS ............................................. 8 REFERENCE LIST ........................................................................................................ 11 PARTICIPATION ........................................................................................................... 12 GENERAL REQUIREMENTS ....................................................................................... 13 SPECIFIC BIDDING INSTRUCTIONS AND REQUIREMENTS .................................... 20 SCOPE OF WORK ........................................................................................................ 23 COST PROPOSAL ........................................................................................................ 37 PRICING INSTRUCTION SHEET ................................................................................. 38 PROPOSAL CONTENT REQUIREMENTS .................................................................. 39 AWARD CRITERIA ....................................................................................................... 42 CHECK LIST ................................................................................................................. 43 EXHIBIT A PROGRAM LOCATIONS ............................................................................ 44 EXHIBIT B COUNTY'S FORMULARY .......................................................................... 45 EXHIBIT C TOP NATIONAL DRUG CODE ................................................................... 46 EXHIBIT D PRICING WORKSHEETS .......................................................................... 47 G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 OVERVIEW Exhibit G Page 7 of71 Page3 The County of Fresno is requesting proposals from qualified vendors to obtain pharmaceutical services from a pharmacy, pharmacy chain or Pharmaceutical Benefits Manager (PBM) that have pharmacies or relationships with pharmacies throughout the County of Fresno, hereinafter referred to as County, for the purpose of filing prescriptions of adults and children who receive mental health services from the County's Department of Behavioral Health (DBH) and Department of Social Services (DSS). The selected Vendor shall work with the County to fill prescriptions for outpatient County mental health clients and provide better pricing advantages to the County. This Pharmaceutical Services Request for Proposal (RFP) is designed to obtain the lowest cost and best service to the County. Vendors with experience providing prescription drug services and having worked with local governments are encouraged to respond to this RFP. Program Background: DEPARTMENT OF BEHAVIORAL HEALTH (DBH) DBH provides outpatient mental health treatment to severely mentally ill adults and severely emotionally disturbed children in Fresno County through its System of Care Outpatient Clinics. Outpatient mental health clinics are located throughout metropolitan and rural areas of Fresno County. A list of DBH's current clinics is shown in Exhibit A (this list may be modified from time to time). DBH provides a continuum of mental health treatment and services to the County's target populations (Adult/Children), with the ultimate goal of wellness and recovery through the stabilization of the client's mental health status to the lowest possible or least restrictive level of care for successful transition back into the community, or discharge from treatment. During Fiscal Year (FY) 2012-13, DBH treated 21,587 unique clients (adult and children) with outpatient mental health services. DBH anticipates purchasing approximately $160,000 of prescription medications during FY 2014-15. This amount is not a guarantee of contract expenditures, but only an estimate based upon historical data. DEPARTMENT OF SOCIAL SERVICES (DSS) DSS provides medication assistance to children involved in Child Welfare Services. Child Welfare Services are in place to support children and families who face challenges that put the safety and well-being of children at risk. Services can be provided to children when living in the family home or when necessary for safety, in the home of a Substitute Care Provider such as a relative or foster parent. The need for medication services at DSS usually occurs after hours (after 5:00p.m. M-F, and all day on Weekends) when a child is in need of medications but is not Medi-Cal eligible and has no other funding source. DSS reviews the medications needed by the child and contacts a local pharmacy to fill the prescription. DSS pays for medications at pharmacies throughout Fresno County using a Payment Authorization Form to be provided by the selected vendor through this Pharmaceutical Services RFP. A variety of medications are purchased to treat both physical and mental illness. DSS seeks to contract with a vendor that has established business relationships with pharmacies throughout Fresno County. Prescriptions must be filled in a timely and efficient manner. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 Exhibit G Page 8 of71 Page4 DSS anticipates purchasing approximately $10,000 of medication annually to serve 25-50 children. This amount is not a guarantee of contract expenditures, but only an estimate based upon historical data. AFFORDABLE CARE ACT It should be noted with implementation of the Affordable Care Act, there may be additional clients in need of medications. For this reason, additional medication may be required. To allow for this, DBH and DSS anticipate an annual expenditure of up to approximately $250,000 towards prescriptive medication services provided by the selected Vendor. Pharmaceutical Management: The selected Vendor shall contract with pharmacies throughout the County to fill pharmaceutical prescriptions at a discounted rate for adults and children receiving mental health services from DBH and DSS. The majority of these prescriptions will be for psychotropic pharmaceuticals; however, prescriptions may also allow for treatment of side effects related to using psychotropic medications as well as physical health related medications. Pharmaceuticals will be restricted to those drugs listed on the County's Formulary, attached as Exhibit B. The selected Vendor will be required to provide a formulary override process. County desires to obtain these services from a single pharmaceutical firm or Pharmaceutical Benefits Manager (PBM) that have pharmacies or relationships with pharmacies throughout Fresno County and throughout the State for the purpose of filling prescriptions for the targeted populations. The term of the Agreement with the selected Vendor will be for three years with the option of two (2) additional one-year (1) extensions. Vendor's discount level and dispensing fee of pharmaceuticals shall be fixed during the contract period, and applied to any new drug added to the formulary or a prior authorized drug. The objectives of this Request for Proposal (RFP) are: 1) To obtain the lowest total cost for prescription medications and best service for Fresno County. 2) To provide clients access to pharmacies throughout Fresno County. 3) To provide an efficient and effective method for the County to manage the prescription process. 4) To implement and maintain a pharmaceutical reporting process provided by the selected Vendor for the administration of the County's Adult and Children's Mental Health and Social Services systems. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 KEY DATES RFP Issue Date: Vendor Conference: Vendors are to contact Carolyn Flores at (559) 600-7110 if planning to attend vendor conference. Deadline for Written Requests for Interpretations or Corrections of RFP: December 9, 2014 December 22, 2014 at 10:00 A.M. County of Fresno Purchasing 4525 E. Hamilton Avenue, 2nd Floor Fresno, CA 93702 December 23, 2014 at 4:00P.M. Fax No. (559) 600-7126 Exhibit G Page 9 of71 PageS E-Mail: CountyPurchasing@co. fresno.ca. us RFP Closing Date: January 15, 2015 at 2:00P.M. County of Fresno Purchasing 4525 E. Hamilton Avenue, 2nd Floor Fresno, CA 93702 G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 TRADE SECRET ACKNOWLEDGEMENT Exhibit G Page 10 of71 PageS All proposals received by the County shall be considered "Public Record" as defined by Section 6252 of the California Government Code. This definition reads as follows: " ... Public records" includes any writing containing information relating to the conduct of the public's business prepared, owned, used or retained by any state or local agency regardless of physical form or characteristics "Public records" in the custody of, or maintained by, the Governor's office means any writing prepared on or after January 6, 1975." Each proposal submitted is Public record and is therefore subject to inspection by the public per Section 6253 of the California Government Code. This section states that "every person has a right to inspect any public record". The County will not exclude any proposal or portion of a proposal from treatment as a public record except in the instance that it is submitted as a trade secret as defined by the California Government Code. Information submitted as proprietary, confidential or under any other such terms that might suggest restricted public access will not be excluded from treatment as public record. "Trade secrets" as defined by Section 6254.7 of the California Government Code are deemed not to be public record. This section defines trade secrets as: " ... Trade secrets," as used in this section, may include, but are not limited to, any formula, plan, pattern, process, tool, mechanism, compound, procedure, production data or compilation of information that is not patented, which is known only to certain individuals within a commercial concern who are using it to fabricate, produce, or compound an article of trade or a service having commercial value and which gives its user an opportunity to obtain a business advantage over competitors who do not know or use it." Information identified by bidder as "trade secret" will be reviewed by County of Fresno's legal counsel to determine conformance or non-conformance to this definition. Such material should be submitted in a separate binder marked "Trade Secret". Examples of material not considered to be trade secrets are pricing, cover letter, promotional materials, etc. INFORMATION THAT IS PROPERLY IDENTIFIED AS TRADE SECRET AND CONFORMS TO THE ABOVE DEFINITION WILL NOT BECOME PUBLIC RECORD. COUNTY WILL SAFEGUARD THIS INFORMATION IN AN APPROPRIATE MANNER. Information identified by bidder as trade secret and determined not to be in conformance with the California Government Code definition shall be excluded from the proposal. Such information will be returned to the bidder at bidder's expense upon written request. Trade secrets must be submitted in a separate binder that is plainly marked "Trade Secrets." The County shall not in any way be liable or responsible for the disclosure of any proposals or portions thereof, if they are not (1) submitted in a separate binder that is plainly marked "Trade Secret" on the outside; and (2) if disclosure is required or allowed under the provision of law or by order of Court. Vendors are advised that the County does not wish to receive trade secrets and that vendors are not to supply trade secrets unless they are absolutely necessary. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 Exhibit G Page 11 of71 Page7 TRADE SECRET ACKNOWLEDGEMENT I have read and understand the above "Trade Secret Acknowledgement." I understand that the County of Fresno has no responsibility for protecting information submitted as a trade secret if it is not delivered in a separate binder plainly marked "Trade Secret." I also understand that all information my company submits, except for that information submitted in a separate binder plainly marked "Trade Secret," are public records subject to inspection by the public. This is true no matter whether my company identified the information as proprietary, confidential or under any other such terms that might suggest restricted public access. Enter company name on appropriate line: Has submitted information identified as Trade -(-=-=c:-o-m-pa_n_y_N:-a-m-e),------------Secrets in a separate marked binder.** Has not submitted information identified as Trade -(.,...,C_o_m_pa_n_y_N_a_m-e) ___________ Secrets. Information submitted as proprietary confidential or under any other such terms that might suggest restricted public access will not be excluded from treatment as public record. ACKNOWLEDGED BY: Signature Telephone Print Name and TiUe Date Address City State Zip **Bidders brief statement that clearly sets out the reasons for confidentiality in conforming with the California Government Code definition. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services. doc Proposal No. 269-5316 DISCLOSURE -CRIMINAL HISTORY & CIVIL ACTIONS Exhibit G Page 12 of 71 PageS In their proposal, the bidder is required to disclose if any of the following conditions apply to them, their owners, officers, corporate managers and partners (hereinafter collectively referred to as "Bidder''): • Within the three-year period preceding the proposal, they have been convicted of, or had a civil judgment rendered against them for: o fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; o violation of a federal or state antitrust statute; o embezzlement, theft, forgery, bribery, falsification, or destruction of records; or o false statements or receipt of stolen property • Within a three-year period preceding their proposal, they have had a public transaction (federal, state, or local) terminated for cause or default. Disclosure of the above information will not automatically eliminate a Bidder from consideration. The information will be considered as part of the determination of whether to award the contract and any additional information or explanation that a Bidder elects to submit with the disclosed information will be considered. If it is later determined that the Bidder failed to disclose required information, any contract awarded to such Bidder may be immediately voided and terminated for ·material failure to comply with the terms and conditions of the award. Any Bidder who is awarded a contract must sign an appropriate Certification Regarding Debarment, Suspension, and Other Responsibility Matters. Additionally, the Bidder awarded the contract must immediately advise the County in writing if, during the term of the agreement: (1) Bidder becomes suspended, debarred, excluded or ineligible for participation in federal or state funded programs or from receiving federal funds as listed in the excluded parties list system (http://www.epls.gov); or (2) any of the above listed conditions become applicable to Bidder. The Bidder will indemnify, defend and hold the County harmless for any loss or damage resulting from a conviction, debarment, exclusion, ineligibility or other matter listed in the signed Certification Regarding Debarment, Suspension, and Other Responsibility Matters. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 Exhibit G Page 13 of 71 Page9 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS INSTRUCTIONS FOR CERTIFICATION 1. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below. 2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction. 3. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. 4. The prospective primary participant shall provide immediate written notice to the department or agency to which this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 5. The terms covered transaction, debarred, suspended, ineligible, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations. 6. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 CERTIFICATION Exhibit G Page 14 of 71 Page 10 (1) The prospective primary participant certifies to the best of its knowledge and belief, that it, its owners, officers, corporate managers and partners: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency; (b) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default. (2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Signature: Date: (Printed Name & Title) (Name of Agency or Company) G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 VENDOR MUST COMPLETE AND RETURN WITH REQUEST FOR PROPOSAL Firm: Exhibit G Page 15 of71 Page 11 --------------------------------------- REFERENCE LIST Provide a list of at least five (5) customers for whom you have recently provided similar services. Be sure to include all requested information. Reference Name: ----------------------Contact: Address: City: ------------------State: ---Zip: Phone No.: (_) _________________ Date: Service Provided: Reference Name: ----------------------Contact: Address: City: --------------------State: ---Zip: Phone No.: (_) _________________ Date: Service Provided: Reference Name: ______________________ Contact: Address: City: -------------------State: ---Zip: Phone No.: (_) _________________ Date: Service Provided: Reference Name: ______________________ Contact: Address: City: State: ------------------------------------Zip: --- Phone No.: (_) Date: ----------------- Service Provided: Reference Name: ______________________ Contact: Address: City: State: ------------------------------------Zip: --- Phone No.: (_) Date: ----------------- Service Provided: Failure to provide a list of at least five (5) customers may be cause for rejection of this RFP. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 PARTICIPATION Exhibit G Page 16 of 71 Page 12 The County of Fresno is a member of the Central Valley Purchasing Group. This group consists of Fresno, Kern, Kings, and Tulare Counties and all governmental, tax supported agencies within these counties. Whenever possible, these and other tax supported agencies co-op (piggyback) on contracts put in place by one of the other agencies. Any agency choosing to avail itself of this opportunity, will make purchases in their own name, make payment directly to the contractor, be liable to the contractor and vice versa, per the terms of the original contract, all the while holding the County of Fresno harmless. If awarded this contract, please indicate whether you would extend the same terms and conditions to all tax supported agencies within this group as you are proposing to extend to Fresno County. Yes, we will extend contract terms and conditions to all qualified agencies within the Central Valley Purchasing Group and other tax supported agencies. No, we will not extend contract terms to any agency other than the County of Fresno. (Authorized Signature) Title * Note: This form/information is not rated or ranked in evaluating proposal. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 GENERAL REQUIREMENTS Exhibit G Page 17 of 71 Page 13 DEFINITIONS: The terms Bidder, Proposer, Contractor and Vendor are all used interchangeably and refer to that person, partnership, corporation, organization, agency, etc. which is offering the proposal and is identified on the Proposal Identification Sheet. RFP CLARIFICATION AND REVISIONS: Any revisions to the RFP will be issued and distributed as written addenda. FIRM PROPOSAL: All proposals shall remain firm for at least one hundred eighty (180) days. PROPOSAL PREPARATION: Proposals should be submitted in the formats shown under "PROPOSAL CONTENT REQUIREMENTS" section of this RFP. County of Fresno will not be held liable or any cost incurred by bidders responding to RFP. Bidders are to bid what is specified or requested first. If unable to or unwilling to, bidder may bid alternative or option, indicating all advantages, disadvantages and their associated cost. SUPPORTIVE MATERIAL: Additional material may be submitted with the proposal as appendices. Any additional descriptive material that is used in support of any information in your proposal must be referenced by the appropriate paragraph(s) and page number(s). Bidders are asked to submit their proposals in a binder (one that allows for easy removal of pages) with index tabs separating the sections identified in the Table of Contents. Pages must be numbered on the bottom of each page. Any proposal attachments, documents, letters and materials submitted by the vendor shall be binding and included as a part of the final contract should your bid be selected. TAXES: The quoted amount must include all applicable taxes. If taxes are not specifically identified in the proposal it will be assumed that they are included in the total quoted. SALES TAX: Fresno County pays California State Sales Tax in the amount of 8.225% regardless of vendor's place of doing business. RETENTION: County of Fresno reserves the right to retain all proposals, excluding proprietary documentation submitted per the instructions of this RFP, regardless of which response is selected. ORAL PRESENTATIONS: Each finalist may be required to make an oral presentation in Fresno County and answer questions from County personnel. AWARD/REJECTION: The award will be made to the vendor offering the overall proposal deemed to be to the best advantage of the County. The County shall be the sole judge in making such determination. The County reserves the right to reject any and all proposals. The lowest bidders are not arbitrarily the vendors whose proposals will be selected. Award Notices are tentative: Acceptance of an offer made in response to this RFP shall occur only upon execution of an agreement by both parties or issuance of a valid written Purchase Order by Fresno County Purchasing. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 County Purchasing will chair or co-chair all award, evaluation and contract negotiation committees. Award may require approval by the County of Fresno Board of Supervisors. Exhibit G Page 18 of71 Page 14 WAIVERS: The County reserves the right to waive any informalities or irregularities and any technical or clerical errors in any quote as the interest of the County may require. TERMINATION: The County reserves the right to terminate any resulting contract upon written notice. MINOR DEVIATIONS: The County reserves the right to negotiate minor deviations from the prescribed terms, conditions and requirements with the selected vendor. PROPOSAL REJECTION: Failure to respond to all questions or not to supply the requested information could result in rejection of your proposal. ASSIGNMENTS: The ensuing proposed contract will provide that the vendor may not assign any payment or portions of payments without prior written consent of the County of Fresno. BIDDERS LIABILITIES: County of Fresno will not be held liable for any cost incurred by vendors in responding to the RFP. CONFIDENTIALITY: Bidders shall not disclose information about the County's business or business practices and safeguard confidential data which vendor staff may have access to in the course of system implementation. DISPUTE RESOLUTION: The ensuing contract shall be governed by the laws of the State of 'california. Any claim which cannot be amicably settled without court action will be litigated in the U. S. District Court for the Eastern District of California in Fresno, CA or in a state court for Fresno County. NEWS RELEASE: Vendors shall not issue any news releases or otherwise release information to any third party about this RFP or the vendor's quotation without prior written approval from the County of Fresno. BACKGROUND REVIEW: The County reserves the right to conduct a background inquiry of each proposer/bidder which may include collection of appropriate criminal history information, contractual and business associations and practices, employment histories and reputation in the business community. By submitting a proposal/bid to the County, the vendor consents to such an inquiry and agrees to make available to the County such books and records the County deems necessary to conduct the inquiry. PERFORMANCE BOND: The successful bidders may be required to furnish a faithful performance bond. Bidders are to quote a separate price for a performance bond. ACQUISITIONS: The County reserves the right to obtain the whole system/services/goods as proposed or only a portion of the system/services/goods, or to make no acquisition at all. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 Exhibit G Page 19 of71 Page 15 OWNERSHIP: The successful vendor will be required to provide to the County of Fresno documented proof of ownership by the vendor, or its designated subcontractor, upon request of the proposed programs/services/goods. EXCEPTIONS: Identify with explanation, any terms, conditions, or stipulations of the RFP with which you CAN NOT or WILL NOT comply with by proposal group. ADDENDA: In the event that it becomes necessary to revise any part of this RFP, addenda will be provided to all agencies and organizations that receive the basic RFP. SUBCONTRACTORS: If a subcontractor is proposed, complete identification of the subcontractor and his tasks should be provided. The primary contractor is not relieved of any responsibility by virtue of using a subcontractor. CONFLICT OF INTEREST: The County shall not contract with, and shall reject any bid or proposal submitted by the persons or entities specified below, unless the Board of Supervisors finds that special circumstances exist which justify the approval of such contract: 1. Employees of the County or public agencies for which the Board of Supervisors is the governing body. 2. Profit-making firms or businesses in which employees described in Subsection (1) serve as officers, principals, partners or major shareholders. 3. Persons who, within the immediately preceding twelve (12) months, came within the provisions of Subsection (1}, and who were employees in positions of substantial responsibility in the area of service to be performed by the contract, or participated in any way in developing the contract or its service specifications. 4. Profit-making firms or businesses in which the former employees described in Subsection (3) serve as officers, principals, partners or major shareholders. 5. No County employee, whose position in the County enables him to influence the selection of a contractor for this RFP, or any competing RFP, and no spouse or economic dependent of such employee, shall be employees in any capacity by a bidder, or have any other direct or indirect financial interest in the selection of a contractor. 6. In addition, no County employee will be employed by the selected vendor to fulfill the vendor's contractual obligations to the County. ORDINANCE 3.08.130-POST-SEPARATION EMPLOYMENT PROHIBITED No officer or employee of the County who separates from County service shall for a period of one year after separation enter into any employment, contract, or other compensation arrangement with any County consultant, vendor, or other County provider of goods, materials, or services, where the officer or employee participated in any part of the decision making process that led to the County relationship with the consultant, vendor or other County provider of goods, materials or services. Pursuant to Government Code section 25132(a), a violation of the ordinance may be enjoined by an injunction in a civil lawsuit, or prosecuted as a criminal misdemeanor. EVALUATION CRITERIA: Respondents will be evaluated on the basis of their responses to all questions and requirements in this RFP and product cost. The County shall be the sole judge in the ranking process and reserves the right to reject any or all bids. False, incomplete or G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc ' ,_ Proposal No. 269-5316 Exhibit G Page 20 of71 Page 16 unresponsive statements in connection with this proposal may be sufficient cause for its rejection. SELECTION PROCESS: All proposals will be evaluated by a team consisting of representatives from appropriate County Department(s), and Purchasing. It will be their responsibility to make the final recommendations. Purchasing will chair or co-chair the evaluation or evaluation process. Organizations that submit a proposal may be required to make an oral presentation to the Selection Committee. These presentations provide an opportunity for the individual, agency, or organization to clarify its proposal to ensure thorough, mutual understanding. INDEPENDENT CONTRACTOR: In performance of the work, duties, and obligations assumed by Contractor under any ensuing Agreement, it is mutually understood and agreed that Contractor, including any and all of Contractor's officers, agents, and employees will at all times be acting and performing as an independent contractor, and shall act in an independent capacity and not as an officer, agent, servant, employee, joint venture, partner, or associate of the County. Furthermore, County shall have no right to control, supervise, or direct the manner or method by which Contractor shall perform its work and function. However, County shall retain the right to administer this Agreement so as to verify that Contractor is performing its obligations in accordance with the terms and conditions thereof. Contractor and County shall comply with all applicable provisions of law and the rules and regulations, if any, of governmental authorities having jurisdiction over matters the subject thereof. Because of its status as an independent contractor, Contractor shall have absolutely no right to employment rights and benefits available to County employees. Contractor shall be solely liable and responsible for providing to, or on behalf of, its employees all legally required employee benefits. In addition, Contractor shall be solely responsible and save County harmless from all matters relating to payment of Contractor's employees, including compliance with Social Security, withholding, and all other regulations governing such matters. It is acknowledged that during the term of the Agreement, Contractor may be providing services to others unrelated to the COUNTY or to the Agreement. HOLD HARMLESS CLAUSE: Contractor agrees to indemnify, save, hold harmless and at County's request, defend the County, its officers, agents and employees, from any and all costs and expenses, damages, liabilities, claims and losses occurring or resulting to County in connection with the performance, or failure to perform, by Contractor, its officers, agents or employees under this Agreement and from any and all costs and expenses, damages, liabilities, claims and losses occurring or resulting to any person, firm or corporation who may be injured or damaged by the performance, or failure to perform, of Contractor, its officers, agents or employees under this Agreement. SELF-DEALING TRANSACTION DISCLOSURE: Contractor agrees that when operating as a corporation (a for-profit or non-profit corporation), or if during the term of the agreement the Contractor changes its status to operate as a corporation, members of the Contractor's Board of Directors shall disclose any self-dealing transactions that they are a party to while Contractor is providing goods or performing services under the agreement with the County. A self-dealing transaction shall mean a transaction to which the Contractor is a party and in which one or more of its directors has a material financial interest. Members of the Board of Directors shall disclose any self-dealing transactions that they are a party to by completing and signing a Fresno County Self-Dealing Transaction Disclosure Form and submitting it to the County prior to commencing with the self-dealing transaction or immediately thereafter. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 Exhibit G Page 21 of71 Page 17 PRICE RESPONSIBILITY: The selected vendor will be required to assume full responsibility for all services and activities offered in the proposal, whether or not they are provided directly. Further, the County of Fresno will consider the selected vendor to be the sole point of contact with regard to contractual matters, including payment of any and all charges resulting from the contract. The contractor may not subcontract or transfer the contract, or any right or obligation arising out of the contract, without first having obtained the express written consent of the County. ADDRESSES AND TELEPHONE NUMBERS: The vendor will provide the business address and mailing address, if different, as well as the telephone number of the individual signing the contract. ASSURANCES: Any contract awarded under this RFP must be carried out in full compliance with The Civil Rights Act of 1964, The Americans With Disabilities Act of 1990, their subsequent amendments, and any and all other laws protecting the rights of individuals and agencies. The County of Fre~no has a zero tolerance for discrimination, implied or expressed, and wants to ensure that policy continues under this RFP. The contractor must also guarantee that services, or workmanship, provided will be performed in compliance with all applicable local, state, or federal laws and regulations pertinent to the types of services, or project, of the nature required under this RFP. In addition, the contractor may be required to provide evidence substantiating that their employees have the necessary skills and training to perform the required services or work. INSURANCE: Without limiting the COUNTY's right to obtain indemnification from CONTRACTOR or any third parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect, the following insurance policies or a program of self-insurance, including but not limited to, an insurance pooling arrangement or Joint Powers Agreement (JPA) throughout the term of the Agreement: A. Commercial General Liability Commercial General Liability Insurance with limits of not less than One Million Dollars ($1 ,000,000) per occurrence and an annual aggregate of Two Million Dollars ($2,000,000). This policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including completed operations, products liability, contractual liability, Explosion- Collapse-Underground, fire legal liability or any other liability insurance deemed necessary because of the nature of this contract. B. Automobile Liability Comprehensive Automobile Liability Insurance with limits for bodily injury of not less than Two Hundred Fifty Thousand Dollars ($250,000.00) per person, Five Hundred Thousand Dollars ($500,000.00) per accident and for property damages of not less than Fifty Thousand Dollars ($50,000.00), or such coverage with a combined single limit of Five Hundred Thousand Dollars ($500,000.00). Coverage should include owned and non-owned vehicles used in connection with this Agreement. C. Professional Liability If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N., L.C.S.W., M.F.C.C.) in providing services, Professional Liability Insurance with limits of not less than One Million Dollars ($1 ,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc L Proposal No. 269-5316 Exhibit G Page 22 of71 Page 18 This coverage shall be issued on a per claim basis. Contractor agrees that it shall maintain, at its sole expense, in full force and effect for a period of three (3) years following the termination of this Agreement, one or more policies of professional liability insurance with limits of coverage as specified herein. D. Worker's Compensation A policy of Worker's Compensation insurance as may be required by the California Labor Code. Contractor shall obtain endorsements to the Commercial General Liability insurance naming the County of Fresno, its officers, agents, and employees, individually and collectively, as additional insured, but only insofar as the operations under this Agreement are concerned. Such coverage for additional insured shall apply as primary insurance and any other insurance, or self-insurance, maintained by County, its officers, agents and employees shall be excess only and not contributing with insurance provided under Contractor's policies herein. This insurance shall not be cancelled or changed without a minimum of thirty (30) days advance written notice given to County. Within thirty (30) days from the date Contractor executes this Agreement, Contractor shall provide certificates of insurance and endorsement as stated above for all of the foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health, 4441 E. Kings Canyon Road, Fresno, CA 93702, stating that such insurance coverage have been obtained and are in full force; that the County of Fresno, its officers, agents and employees will not be responsible for any premiums on the policies; that such Commercial General Liability insurance names the County of Fresno, its officers, agents and employees, individually and collectively, as additional insured, but only insofar as the operations under this Agreement are concerned; that such coverage for additional insured shall apply as primary insurance and any other insurance, or self-insurance, maintained by County, its officers, agents and employees, shall be excess only and not contributing with insurance provided under Contractor's policies herein; and that this insurance shall not be cancelled or changed without a minimum of thirty (30) days advance, written notice given to County. In the event Contractor fails to keep in effect at all times insurance coverage as herein provided, the County may, in addition to other remedies it may have, suspend or terminate this Agreement upon the occurrence of such event. All policies shall be with admitted insurers licensed to do business in the State of California. Insurance purchased shall be purchased from companies possessing a current A.M. Best, Inc. rating of A FSC VII or better. AUDIT AND RETENTION: The Contractor shall maintain in good and legible condition all books, documents, papers, data files and other records related to its performance under this contract. Such records shall be complete and available to Fresno County, the State of California, the federal government or their duly authorized representatives for the purpose of audit, examination, or copying during the term of the contract and for a period of at least three years following the County's final payment under the contract or until conclusion of any pending matter (e.g., litigation or audit), whichever is later. Such records must be retained in the manner described above until all pending matters are closed. DEFAULT: In case of default by the selected bidder, the County may procure materials and services from another source and may recover the loss occasioned thereby from any unpaid balance due the selected bidder, or by any other legal means available to the County. I G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 Exhibit G Page 23 of71 Page 19 BREACH OF CONTRACT: In the event of breach of contract by either party, the other party shall be relieved of its obligations under this agreement and may pursue any legal remedies. CONFIDENTIALITY All services performed by vendor shall be in strict conformance with all applicable Federal, State of California and/or local laws and regulations relating to confidentiality, including but not limited to, California Civil Code, California Welfare and Institutions Code, Health and Safety Code, California Code of Regulations, Code of Federal Regulations. Vendor shall submit to County's monitoring of said compliance. Vendor may be a Business associate of County, as that term is defined in the "Privacy Rule" enacted by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). As a HIPAA Business Associate, vendor may use or disclose protected health information ("PHI") to perform functions, activities or services for or on behalf of County, as specified by the County, provided that such use or disclosure shall not violate HIPAA and its implementing regulations. The uses and disclosures of PHI may not be more expansive than those applicable to County, as the "Covered Entity" under HIPAA's Privacy Rule, except as authorized for management, administrative or legal responsibilities of the Business Associate. Vendor shall not use or further disclose PHI other than as permitted or required by the County, or as required by law without written notice to the County. Vendor shall ensure that any agent, including any subcontractor, to which vendor provides PHI received from, or created or received by the vendor on behalf of County, shall comply with the same restrictions and conditions with respect to such information. APPEALS Appeals must be submitted in writing within *seven (7) working days after notification of proposed recommendations for award. A "Notice of Award" is not an indication of County's acceptance of an offer made in response to this RFP. Appeals shall be submitted to County of Fresno Purchasing, 4525 E. Hamilton Avenue 2"d Floor, Fresno, California 93702-4599. Appeals should address only areas regarding RFP contradictions, procurement errors, quotation rating discrepancies, legality of procurement context, conflict of interest, and inappropriate or unfair competitive procurement grievance regarding the RFP process. Purchasing will provide a written response to the complainant within *seven (7) working days unless the complainant is notified more time is required. If the protesting bidder is not satisfied with the decision of Purchasing, he/she shall have the right to appeal to the Purchasing Agent/GAO within seven (7) working days after Purchasing's notification; except, if notified to appeal directly to the Board of Supervisors at the scheduled date and time. If the protesting bidder is not satisfied with Purchasing Agent/GAO's decision, the final appeal is with the Board of Supervisors. *The seven (7) working day period shall commence and be computed by excluding the first day and including the last day upon the date that the notification is issued by the County. RIGHTS OF OWNERSHIP The County shall maintain all rights of ownership and use to all materials designed, created or constructed associated with this service/project/program. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 SPECIFIC BIDDING INSTRUCTIONS AND REQUIREMENTS Exhibit G Page 24 of71 Page 20 ISSUING AGENT: This RFP has been issued by County of Fresno, Purchasing. Purchasing shall be the vendor's sole point of contact with regard to the RFP, its content, and all issues concerning it. AUTHORIZED CONTACT: All communication regarding this RFP shall be directed to an authorized representative of County Purchasing. The specific buyer managing this RFP is identified on the cover page, along with his or her telephone number, and he or she should be the primary point of contact for discussions or information pertaining to the RFP. Contact with any other County representative, including elected officials, for the purpose of discussing this RFP, it content, or any other issue concerning it, is prohibited unless authorized by Purchasing. Violation of this clause, by the vendor having unauthorized contact (verbally or in writing) with· such other County representatives, may constitute grounds for rejection by Purchasing of the vendor's quotation. The above stated restriction on vendor contact with County representatives shall apply until the County has awarded a purchase order or contract to a vendor or vendors, except as follows. First, in the event that a vendor initiates a formal protest against the RFP, such vendor may contact the appropriate individual, or individuals who are managing that protest as outlined in the County's established protest procedures. All such contact must be in accordance with the sequence set forth under the protest procedures. Second, in the event a public hearing is scheduled before the Board of Supervisors to hear testimony prior to its approval of a purchase order or contract, any vendor may address the Board. VENDOR CONFERENCE: On December 22,2014 at 10:00 A.M., a vendor's conference will be held in which the scope of the project and proposal requirements will be explained. The meeting will be held at the office of County of Fresno Purchasing, 4525 E. Hamilton (between Cedar and Maple), 2"d Floor, Fresno, California. Addendum will be prepared and distributed to all bidders only if necessary to clarify substantive items raised during the bidders' conference. Bidders are to contact Carolyn Flores at County of Fresno Purchasing, (559) 600-7112, if they are planning to attend the conference. NUMBER OF COPIES: Submit one (1) original, with two (2) *reproducible compact disc enclosed and eight (8) copies of your proposal no later than the proposal acceptance date and time as stated on the front of this document to County of Fresno Purchasing. The cover page of each document is to be appropriately marked "Original" or "Copy". *Bidder shall submit two (2) reproducible compact disc (i.e.: PDF file) containing the complete proposal excluding trade secrets. Compact disc should accompany the original binder and should be either attached to the inside cover of the binder or inserted in an1 attached sleeve or envelope in the front of the binder to insure the disc is not misplaced. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 Exhibit G Page 25 of71 Page 21 INTERPRETATION OF RFP: Vendors must make careful examination of the requirements, specifications and conditions expressed in the RFP and fully inform themselves as to the quality and character of services required. If any person planning to submit a proposal finds discrepancies in or omissions from the RFP or has any doubt as to the true meaning or interpretation, correction thereof may be requested at the scheduled Vendor Conference (see above). Any change in the RFP will be made only by written addendum, duly issued by the County. The County will not be responsible for any other explanations or interpretations. Questions may be submitted subsequent to the Vendor Conference, subject to the following conditions: a. Such questions are submitted in writing to the County Purchasing not later than December 23, 2014 at 4:00p.m. Questions must be directed to the attention of Carolyn Flores, Senior Buyer. b. Such questions are submitted with the understanding that County can respond only to questions it considers material in nature. c. Questions shall be e-mailed to CountvPurchasinq@co.fresno.ca.us. NOTE: The bidder is encouraged to submit all questions at the Vendor Conference. Time limitations can prevent a response to questions submitted after the conference. SELECTION COMMITTEE: All proposals will be evaluated by a team co-chaired by Purchasing. All proposals will be evaluated by a review committee that may consist of County of Fresno Purchasing, department staff, community representatives from advisory boards and other members as appropriate. The proposals will be evaluated in a multi-stage selection process. Some bids may be eliminated or set aside after an initial review. If a proposal does not respond adequately to the RFP or the bidder is deemed unsuitable or incapable of delivering services, the proposal may be eliminated from consideration. It will be the selection committee's responsibility to make the final recommendation to the Department Head. CONTRACT TERM: It is County's intent to contract with the successful bidder for a term of three (3) years with the option to renew for up to two (2) additional one (1) year periods based on mutual written consent. County will retain the right to terminate the Agreement upon giving thirty (30) days advance written notification to the Contractor. PAYMENT: The County of Fresno, if appropriate, may use Procurement Card to place and make payment for orders under the ensuing contract. AUDITED FINANCIAL STATEMENTS: Copies of the audited Financial Statements for the last three (3) years for the business, agency or program that will be providing the service(s) proposed. If audited statements are not available, complied or reviewed statements will be accepted with copies of three years of corresponding federal tax returns. This information is to be provided after the RFP closes, if requested. Do not provide with your proposal. CONTRACT NEGOTIATION: The County will prepare and negotiate its own contract with the selected vendor, giving due consideration to standard contracts and associated legal documents submitted as a part of bidder's response to the RFP. The tentative award of the contract is based on successful negotiation pending formal recommendation of award. Bidder is to include in response the names and titles of officials authorized to conduct such negotiations. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 Exhibit G Page 26 of71 Page 22 NOTICES: All notices, payments, invoices, insurance and endorsement certificates, etc. need to be submitted as follows: referencing contract/purchase order number, department, position, title and address of administering official. EPAYMENT OPTION: The County of Fresno provides an Epay Program which involves payment of invoices by a secure Visa account number assigned to the supplier after award of contract. Notification of payments and required invoice information are issued to the supplier's designated Accounts Receivable contact by e-mail remittance advice at time of payment. To learn more about the benefits of an Epay Program, how it works, and obtain answers to frequently asked questions, click or copy and paste the following URL into your browser: \Nww.bankofamerica.com/epayablesvendors or call Fresno County Accounts Payable, 559-600- 3609. LOCAL VENDOR PREFERENCE: The Local Vendor Preference does not apply to this Request for Proposal. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 SCOPE OF WORK I. Introduction Exhibit G Page 27 of71 Page 23 The County of Fresno, through its Department of Behavioral Health (DBH), provides mental health services to severely mentally ill (SMI) adults and severely emotionally disturbed (SED) children within Fresno County. The Department of Social Services (DSS) provides medication assistance to children involved in Child Welfare Services within Fresno County. This Request for Proposal (RFP) is designed to obtain the lowest cost pharmaceutical prescription drug services for Fresno County clients at the lowest cost. Vendor may be a pharmacy, pharmacy chain or .a Pharmaceutical Benefits Manager (PBM). Vendors with experience providing prescription drug services to local governments are encouraged to submit their proposal. The Department of Behavioral Health has clinics throughout Fresno County. The following are the geographic service regions: 1. East County-Sanger, Selma, Reedley, Parlier and surrounding communities 2. Central County -Fresno, Pinedale, Clovis and surrounding communities 3. West County-Kerman, Coalinga, Huron, Five Points, Firebaugh, Mendota, San Joaquin and surrounding communities 4. North County-Friant, Auberry, Prather, Shaver Lake, and surrounding communities II. Program Background: DBH psychiatrists write an average of 1 ,600 medication prescriptions annually, including refills. The average annual cost of medication for both departments is approximately $170,000. However, this amount only provides an estimate. The County has included Exhibit C-Top National Drug Code (NDC) by Volume for reference. The County does not guarantee any minimum amount of medications that may be purchased from the selected Vendor. This amount may change in the future as the County reorganizes service delivery to increase efficiency. Department of Behavioral Health (DBH) DBH provides outpatient mental health treatment to severely mentally ill adults in Fresno County through its Adult System of Care outpatient clinics and to severely emotionally disturbed children through its Children's System of Care. The outpatient mental health clinics are located throughout metropolitan and rural areas of Fresno County. DBH provides a continuum of mental health treatment and services to the County's adult target population, with the ultimate goal of wellness and recovery through the stabilization of the client's mental health status to the lowest possible or least restrictive level of care for successful transition back into the community, or discharge from treatment. DBH treated 21,587 unique clients (adults and children), providing both inpatient and outpatient mental health services in Fiscal Year (FY) 2012-13. DBH anticipates spending approximately $160,000 annually for the purchase of medication related to the resulting Agreement produced from this RFP. This amount is not a guarantee but only an estimate based upon historical data. DBH also operates the Crisis Assessment Intervention & Resolution Center (CCAIR) which operates 24 hours per day, 7 days per week. Prescriptions for children are generated by the CCAIR and the Intensive Outpatient Program. Both of these G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 Exhibit G Page 28 of71 Page 24 children's mental health programs are currently located at the Heritage Center facility: 3133 N. Millbrook, Fresno CA, although these locations may change during the contract period associated with this RFP. The CCAIR also orders stock medications on a month to month basis, but may require access to prescriptions services at any time of day or night. Prescriptions must be filled in a timely and efficient manner. Department of Social Services (DSS) DSS provides medication assistance to children involved in Child Welfare Services. Child Welfare Services are in place to support children and families who face challenges that put the safety and well-being of children at risk. Services can be provided with the children as they live in the family home or when necessary for safety, in the home of a Substitute Care Provider such as a relative or foster parent. DSS also refers children to the CCAIR program. The need for medication services at DSS usually occurs after hours (after 5:00p.m. M-F, and all day on Weekends) when a child is in need of medications but is not Medi-Cal eligible and has no other funding source. DSS reviews the medications needed by the child and contacts a local pharmacy to fill the prescription. DSS pays for medications at pharmacies throughout Fresno County using a payment authorization form provided by the vendor selected through this Pharmaceutical Services RFP. DSS anticipates purchasing approximately $10,000 worth of medications per year to serve 25-50 children. This amount is not a guarantee of contract expenditures, but only an estimate based upon historical data. A variety of medications are purchased to treat both physical and mental illness. DSS seeks to contract with a Vendor that has established business relationships with pharmacies throughout Fresno County. Prescriptions must be filled in a timely and efficient manner. AFFORDABLE CARE ACT It should be noted with implementation of the Affordable Care Act, there may be additional clients in need of medications through County. For this reason, additional medication may be required. To allow for this, DBH and DSS anticipate an annual expenditure of up to approximately $250,000 towards prescriptive medication services provided by the selected Vendor. Ill. RFP Desired Outcomes A. Cost Containment: The Vendor shall provide the lowest possible pricing using whichever source, sources and/or methods necessary to provide appropriate medication for the medically indigent DBH and DSS clients who lack any third-party insurance or Medi-Cal. Vendor shall utilize the lowest cost generic medications approved by the Federal Food and Drug Agency (FDA). Brand names are to be used only when generic medications are not available. Vendor shall develop a drug utilization review and notification program for prescribing DBH physicians to ensure prescribed medication is appropriate in dosage, frequency, and compatibility with other medications, e.g. drug-to-drug interaction audits. This program shall be subject to approval of the DBH. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 Exhibit G Page 29 of71 Page 25 Vendor shall advise County when less expensive medication plans become a more viable form of treatment. B. Information Management/Reporting: Vendor shall provide monthly reports and online access to DBH and DSS and information pertaining to costs, usage, clients, providers, rebates from pharmaceutical companies, and medication dispensed. Vendor shall maintain a centralized consumer medication profile for all clients with a history of all prescriptions filled, prescribing doctors and payment method, pharmacy where meds were picked up, and client demographics. Vendor shall work with the DBH Information Systems staff to decide on the best way to create a file for DBH and client database by utilizing either a point-of-sale system or by monthly uploading of consumer eligibility, and downloading of the invoice claims (e- mail, tape, diskette, CDROM, or other format as mutually agreed upon). The following are examples of desired information to be provided by Vendor on a monthly basis to the DBH: 1. Total prescription costs/credits per program or clinic designated by the County with cost center numbers 2. Usage and prescribing patterns 3. Report of specific medication usage by dosage by client, when requested by DBH 4. Number of unduplicated (unique) individual clients using services 5. All dispensed medications and dosages by physician 6. Number of invalid claims filed and processed 7. Number of complaints filed 8. Cost data per patient 9. Cost per Group and Cost Center 10. Customized management reports as requested by the County 11. Monthly financial utilization reports, applicable to DBH needs 12. Any incidents involving medication which could adversely affect a consumer and the investigative and corrective actions that were taken 13. Vendor shall provide examples of reports in their submitted proposal. Reporting formats should be flexible to provide for new medications released by the FDA, revised guidelines created by the DBH, etc. C. Consumer Access: Vendor shall provide as many pharmacy sites as feasible for medication availability for outpatient clients treated throughout Fresno County. The selected Vendor will not be required to open an in-house pharmacy at any county clinic. D. Legal and Regulatory Requirements: Products and services shall meet the quality and packaging standards, and all other requirements of the State Board of Pharmacy. In addition, vendor shall maintain all licenses and certificates required by any local, State or Federal rules and regulations. E. Vendor shall list cost under Cost Proposal for disposing any outdated or damaged drugs for DBH. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 IV. County's Responsibilities DBH agrees to provide the following information: A. Update consumer eligibility as mutually agreed upon. B. County formularies. C. Identify needed support reporting for County Departments. Exhibit G Page 30 of71 Page 26 D. Indicators on eligibility files (e.g. Medi-Cal or other files defined by the County) when available. E. The County will designate a point of contact for the duration of the contract to whom all vendor communications may be addressed. F. Current list of County's prescribing physicians V. Closed Physician Network A. The County's DBH will have a closed physician network for all DBH Groups/Programs. B. The County's DSS will have an open network for the Child Welfare program. C. County will not pay for medication prescribed by a physician not duly authorized by the County. The County will notify the Vendor if/when changes to the list of physicians occur. VI. Department Medication Formulary A. DBH will use a medication formulary for all medication prescribed unless pre- authorization is granted by DBH. B. DSS will not use a formulary for any of its programs. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 THE SELECTED VENDOR MUST MEET THE FOLLOWING REQUIREMENTS AND PROVIDE A DETAILED RESPONSE THAT DESCRIBES VENDORS PLAN TO ADDRESS ALL OF THE FOLLOWING SECTIONS (VII THROUGH XVII) VII. Pharmaceutical Management Exhibit G Page 31 of 71 Page 27 The selected Vendor shall contract with pharmacies throughout Fresno County to fill pharmaceutical prescriptions at a discounted rate for severely mentally ill adults and severely emotionally disturbed children. The majority of these prescriptions will be for psychotropic pharmaceuticals; however, prescriptions may also be allowed for treatment of those side effects attributed using a psychotropic medications and some health medications with prior authorization. Pharmaceuticals for DBH will be restricted to those drugs listed on County's formulary. A. Retail Pharmacy Network 1. Maintain contractual relationships with pharmacies throughout Fresno County for the term of the contract. 2. Contracted pharmacies shall provide consultations for all new prescriptions as required by Federal and State rules and regulations. 3. Have the ability to provide a County payment indicator called Uniform Method for Determining Ability to Pay (UMDAP) to the contracted pharmacy that identifies County as the primary payer for UMDAP eligible mental health clients. 4. Have the ability to provide a Prescription Assistance Program indicator or flag to the contracted pharmacy for clients denied access to prescriptions to be filled through the County's assistance programs. 5. Contracted pharmacies shall accept prescriptions by all allowed methods in accordance to State and Federal rules and regulations. 6. Network Options -The vendor shall offer its most commonly used retail pharmacy network. The vendor shall submit a complete current list of its network of retail pharmacies. 7. Chain Pharmacies-For the network arrangement proposed, vendor shall identify which national or major regional chains are included in the Fresno County area. 8. Network Coverage -For the proposed retail pharmacy network, vendor to provide a GeoAccess analysis using all zip codes that include Fresno County. The following standard shall be used: Two pharmacies within five miles of every zip code. 9. Systems Interface-Describe the systems and processes in place to support eligibility determination, messaging, and communication with participating pharmacies. Be specific in describing the type of information provided to and required from the pharmacy at the time of eligibility verification. 1 0. Retail Pharmacy Scripts -Describe the editing and messaging process that will be used and how you ensure that only qualifying prescriptions will be filled. 11. Contract-If Vendor is a PBM, attach a copy of your standard pharmacy contract with your contracted pharmacies, including payment terms and conditions. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 B. Administration Exhibit G Page 32 of71 Page 28 1. Maintain, update, and manage consumer eligibility when information is provided by DBH. 2. Perform eligibility updates to consumer data with input from County. 3. Update consumer eligibility files within a mutually agreed upon timeline after receiving updates from the County. 4. Maintain history for each consumer available for immediate, direct access by the County during the term of the Agreement. 5. Maintain all data records either on or off-line for a minimum of seven (7) years, in accordance to State and Federal rules and regulations. 6. Provide an override process to allow the County the ability to fill non-formulary drugs when needed. 7. Demonstrate the ability to administer the County's eligibility requirements: (a) client must be County client; and (b) each script must be prescribed from an authorized County provider and (c) each drug must be on the County's formulary for DBH. 8. Support a centralized, consolidated billing process that also provides line item detail for all drug expenditures for each Group as defined by County. Invoicing must be detailed enough to determine each Group's spending by specific drug description, National Drug Code (NDC), consumer information, name, physician, Group ID and Plan ID (as defined by the County), Pharmacy, Rx number, if new or a refill, date filled, metric quantity, day's supply and billed amount. 9. Comply fully with systems, processes, procedures, and policies with current Federal HIPAA Privacy and Security requirements as well as State confidentiality regulations for the collection, maintenance, use and transmission of protected information. Vendor must fully adhere to the most restrictive regulation for the protection of information. C. Account Management and Customer Service 1. Identify an account manager who will be responsible for the overall contract responsibilities and will have administrative authority under this contract. 2. Sufficient vendor staff to resolve day-to-day problems and answer queries will be provided for customer service via a toll free number for participating pharmacies and for County staff. 3. Prescription orders and arrangements for language/cultural assistance, (i.e.: translations/interpretations) will be provided via written, fax, and/or telephone requests from staff, acting as agents of the assigned licensed physician. Vendor shall provide prescriptions in accordance with State Board of Pharmacy Regulations. D. Audits The County reserves the right to perform cost audits on invoices and make any adjustments required to correct errors. Corrections shall be made not more than sixty (60) days after notification to correct is received from County. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 VIII. On-line Queries Vendor shall meet the following requirements: Exhibit G Page 33 of71 Page 29 A. Provide the County the ability to query online claim data history for creating additional custom reports on an as needed basis. B. Provide the County the ability to query online of specific medication usage by dosage by client. C. Maintain the capability to provide monthly detailed prescription drug claims data to County. D. Ensure the output of any reporting system can be exported to Microsoft compatible software. E. Provide access to technical support staff who can respond to questions concerning the use of any proposed reporting system. IX. Medi-Cal Vendor shall meet the following requirements: A. Medi-Cal Eligibility and Billing Clients receiving medication as medically indigent often become eligible for Medi-Cal. Vendor shall be responsible for billing Medi-Cal when the client is Medi-Cal eligible. Medi-Cal eligibility for clients may remain consistent or may fluctuate from month-to- month. On a monthly basis, County will notify the vendor when a client becomes eligible/ineligible for Medi-Cal. Medi-Cal eligibility can be determined retroactively and vendor shall be required to back-bill Medi-Cal and adjust invoices accordingly up to 12 previous months. B. Treatment Authorization Request (TAR) For DBH and DSS clients who are Medi-Cal eligible, the vendor shall assume responsibility for Treatment Authorization Request (TAR) submission of Medi-Cal covered drugs, non-covered medications, and situations involving over six (6) prescriptions per client. Since payment for Medi-Cal eligible clients will be denied by the County, the vendor will be reimbursed for subsequent charges once the vendor provides verification of the TAR denial from the State. C. Medi-Cal Report Vendor shall submit a monthly Medi-Cal report containing claim detail on County clients that are being invoiced to the County because of Medi-Cal ineligibility or rejection. The vendor shall provide information that addresses retroactive Medi-Cal eligibility, the dates and amounts of claims that will be credited to the County for expenditures that will be retroactively eligible for Medi-Cal reimbursement. In addition the following shall also be included: 1. Date Claim paid by County 2. Date Claim paid by Medi-Cal 3. Date Claim credited to County 4. Original invoice number and date the original charge is reversed and credited to the Department's program cost center. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 X. Rebates Exhibit G Page 34 of71 Page 30 A. Rebate Reimbursement -vendor shall reimburse County for rebates received on medication paid for by the County. B. Rebate Guarantees -vendor to state if you can guarantee the level of rebate quoted for each drug. C. Rebate Payment Frequency -vendor to state how often it will make rebate payments. D. Rebate Timing -vendor to state how long it will take for County to receive the rebates generated through the program. E. Vendor shall submit a report that will clearly detail the rebates issued to the County. The first rebate report is due the month following the first issuance of rebates to the County. Thereafter, a rebate report will be provided based on the agreed upon rebate payment schedule. In addition, the following shall be included: 1. Percentage of rebate passed on to County listed by Drug Name 2. Date(s) rebate(s) is incurred by Drug Company name 3. Dollar amount of rebate(s) by Drug Company name 4. Amount billed to manufacturers, by manufacturer, by Drug as well as amount of rebate collected for each quarter of every year. XI. Training The vendor shall provide the following training to County staff: A. Provide comprehensive training on all aspects of data reporting and system usage including but not be limited to specific software and querying of data for reports. B. Training must be available to County staff at a minimum once a year for each term of the contract. C. Training will be at no cost to the County. D. Vendor shall provide all training materials. The training materials must be made available in either hard copy or online in printable format. The Vendor shall update the training materials on an ongoing basis as technology and needs change throughout each term of the contract. E. Vendor shall be responsible for all costs, including but not limited to travel and material, associated with providing training to County staff. XII. Invoicing A. Vendor shall work to appropriately bill, including back-bill for prior invoices, all prescriptions that may be eligible under an alternate payer. The County will always be the payer of last resort. B. Vendor will provide DBH with invoicing grouped by Group# and Plan ID #(cost center) or as directed and defined by the County for each program as each program has budget responsibility for the cost of drugs prescribed and dispensed to its clients. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 Exhibit G Page 35 of71 Page 31 Each Department (DBH and DSS) are to receive an invoice from vendor that will include charges broken down by group and plan ID (cost center). C. Invoices shall be submitted monthly by Vendor as both a paper claim and as a data download. D. Invoices shall be accurate and timely and contain all information requested by the County. Vendor is to submit accurate monthly invoices that shall be received by County no later than the 1Oth day of the preceding month. E. Vendor shall maintain history of all invoices, adjustments, and credits during the term of the agreement. F. Each line item on the invoice shall include the following information: 1. Contract Number 2. Group ID number, as defined by the County 3. Plan ID Number, as defined by the County 4. Client Name and Date of Birth 5. Client DMH # (provided by the County) 6. Prescribing Physician's Name 7. Prescribed Drug, dosage, strength, NDC #,date dispensed 8. The number of units dispensed for each drug/dosage. 9. The contract cost per unit for each drug/dosage. 10. Contracted price for each drug dispensed. 11. AWP at the time of sale 12. Discounts 13. Administrative Fee 14. Dispensing Fee G. Vendor will be required to bill all payer sources, including retroactive Medi-Cal, as required, and credit the County to the appropriate original invoice. H. Vendor shall have the ability to provide invoice adjustments or credit memos on a separate invoice from the current monthly invoice that will reference the original invoice. Vendor shall provide a current invoice and a secondary invoice detailing past invoices with line items outstanding due to a client having become Medi-Cal eligible, etc. Vendor shall appoint their Accounts Receivable. representative to work with County staff to resolve payment issues both on the current and the secondary invoice on an ongoing monthly basis. I. County reviews all invoices for accuracy. Payments to vendor for inaccurate invoices may be delayed or suspended until vendor submits a correct invoice. County shall make payment to vendor upon verification of the accuracy of the invoice. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 Exhibit G Page 36 of71 Page 32 J. County shall not pay dispensing or administrative fees when a claim is denied by the County due to other payer source eligibility. K. Vendor shall provide an example of an invoice in the proposal submitted. L. Invoice Reconciliation -Vendor's Account Manager will work with individual DBH Group representatives to resolve aged receivables balances on a monthly basis. This will include issues related to Medi-Cal or any other billing/payment concerns or aged receivables. XIII. Patient Assistance Program (PAP) Vendor may be requested to provide storage and re-packaging of available medication acquired through drug manufacturer's Patient Assistance Program (PAP) as directed by the County. Vendor PAP dispensing fee, if any, shall be stated in vendor's Cost Proposal. At this time, clients thought to be eligible for a PAP are interviewed by DBH staff for eligibility criteria established by the various Drug Manufacturers. A client's application is sent to the Manufacturer and if/when approved, a client's medications are shipped directly to DBH. DBH nurses in turn dispense the medications to the client in accordance with all State approved guidelines. XIV. Technical Requirements Vendor must clearly describe its technical capabilities to administer the County's mental health prescription program. Vendor to provide specific insights into the systems, processes and expertise bidder possesses to ensure the highest level of performance in accordance with the County's requirements. Vendor shall ensure proposed software products are available to DBH twenty-four hours per day, 365 days per year, via a Web browser interface. Vendor's contracted pharmacies shall have software that is "SureScripts" certified. In addition, the vendor's network of contracted pharmacies shall be certified to receive new prescriptions and able to send electronic refill requests (specifically electronic, not by fax) via the Pharmacy Health Information Exchange, operated by SureScripts. XV. Utilization Management A. Concurrent Drug Utilization Review (OUR) -Vendor must briefly describe its concurrent OUR program including the clinical and administrative edits used and how they are applied. How often are the edits updated? (i.e., less frequently than quarterly, quarterly, or more frequent than quarterly?) B. Retrospective Drug Utilization Review (RDUR) -Vendor must describe its online, RDUR program and the types of reports available to County's DBH Medical Directors to review prescribing patterns. Vendor shall have ability to provide reports that will allow the County to review its drug usage data (prescriber, patient, drug, dosage, date of dispense). Vendor to specify edits and guidelines it will u'se for RDUR. C. Generic Substitution -County mandates a generic substitute for brand name drugs whenever possible. Vendor shall be required to administer a mandatory generic substitution for the drugs covered under the Fresno County mental health drug program. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 Exhibit G Page 37 of71 Page 33 D. Prior Authorizations (PA) -Vendor to describe its PA program capabilities including how it functions and the PA's ability to target selected drugs. E. Ad-Hoc Reports -Vendor to describe its ability to provide ad-hoc reports that are not standard pre-formatted. Will this report be available online to County? If not available online, how long will it take to provide any requested information to County? XVI. Formulary Management A. Formulary-Review the list of covered drugs. The Vendor shall administer this list as a Formulary (Exibit A-Formulary) and if there is a generic available, only the generic will be dispensed. Vendor to describe its override process, what that process is and the time estimated to process an override or seek pre-authorization. Vendor to indicate if it possesses the ability to provide reports on all the drugs prescribed that were not on the formulary. B. Limitations/Constraints -Vendor to describe any limitations or constraints in administering the County's formulary. Vendor to propose solutions to work around these limitations/constraints. C. Formulary Updates/Changes-Vendor to describe its ability to accommodate changes, deletions, and additions to the formulary. Outline the steps necessary to implement formulary changes. D. Vendor to specify the amount of time within which you can incorporate formulary changes after receipt of notification. XVII. Client Eligibility A. County can provide a monthly recurring eligibility feed that includes all of Fresno County to the vendor selected to administer this program. Can vendor accept data in any format provided by County? If specific, provide detail. B. County updates its eligibility on a continuous basis. Can vendor accept daily/nightly batch downloads of eligibility changes? C. County requires vendor to provide a web-based online access to vendor's claims adjudication systems for such functions as eligibility updates and reporting requirements to allow County staff to make real-time immediate online eligibility updates for its clients. D. To track online eligibility, is vendor able to provide online capability to allow County staff to track all claim information for clients, including denied medications? E. Eligibility Reconciliation -vendor to describe process and timing for reconciling eligibility discrepancies between vendor system and the County's. F. Medi-Cal eligibility-vendor to describe the extent to which its system can support messaging of Medi-Cal eligibility information to retail pharmacies. G. County will authorize every new prescription each time a script is given, as each County authorization will only be one prescription and a maximum of two subsequent refills. Vendor and contracted pharmacies shall terminate member eligibility every time a prescription and any accompanying refill(s) have been filled. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 XVIII. Customer Service Exhibit G Page 38 of71 Page 34 It is the County's expectation that questions, issues, or problems that may be encountered concerning the provision of services to clients will be managed directly through County's staff; it is not expected that clients will be contacting the Pharmacy Benefits Manager directly. A. Customer Service Facility-vendor to indicate the facility(s) where you propose to support the claims and customer service for this business. Indicate the hours of operation in Pacific Standard Time. B. Customer Service Team -vendor to describe how Customer Service representatives (CSRs) will be assigned to the County account. Describe how staff will be trained to handle the special needs (i.e. nature of the population, limited formulary) of the County's DBH, and identify what back-up resources will be in place. XIX. Account Management A. Account Management Performance Approach -Describe how account management service performance is measured, tracked and reported (e.g. timeliness in the return of phone calls, timeliness in resolving problems). B. Account Manager Commitment and Resume -vendor must provide a resume of the designated Account Manager (include education background and work experience). C. Monthly Meetings-vendor must host a monthly meeting. As part of the meeting, the County will measure customer satisfaction by using customers' satisfaction survey during the term of the contract. Identified areas where service levels can be improved will be presented to the Vendor. Vendor must agree to work with the County in resolving identified issues resulting from the forums or other sources regarding customer satisfaction. Vendor and the County's contract manager will work together to continually monitor the success levels of this contract and resolve issues at the earliest. These monthly forums will be changed to quarterly forums after any initial operational issues are identified and resolved. D. Implementation-As part of the proposal, vendor shall provide a detailed implementation plan that includes activities, timelines and responsibilities. E. Transition -Describe potential issues that will need to be addressed in making the transition for clients from the current PBM to your program. What information and/or support will you require from the County to successfully complete this transition, including how refills and new prescription related issues will be handled? XX. Reporting A. Standard reporting -The County prefers electronic reports. Vendor will describe its standard (no additional cost) account reporting tools available to the County, including the frequency of updates and the methods of accessing/receiving these reports (e.g. web portal, electronic, etc.). B. Regional reporting -it is the. County's expectation the vendor will support reporting at group and cost center levels as well as consolidated reporting for both county departments. Vendor must describe how they will meet this requirement. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 Exhibit G Page 39 of71 Page 35 C. Ad Hoc Reporting -Vendor must provide ad-hoc reporting capability. Vendor to describe available ad-hoc and other reporting capabilities and tools. Is there an additional cost associated with ad-hoc reports and if yes, what is the cost? D. Technical Support-Will you provide technical support in the use of your reporting tools to the County at no cost? If yes, include the hours of operation (in Pacific Standard Time) and days available for technical support. E. Vendor will support reporting at the Group and Plan ID (cost center) levels as defined by the County as well as consolidated reporting for all of County's clients which will be accessed by County's designee(s). XXI. Medi-Cal Billing A. Clients receiving medication as medically indigent often become eligible for Medi-Cal retroactively and their Medi-Cal eligibility could fluctuate from month-to-month. The vendor will be notified when a client becomes eligible/ineligible for Medi-Cal as described below. As Medi-Cal eligibility can be determined retroactively, vendor shall be required to back-bill Medi-Cal for such clients and adjust County invoices accordingly. B. The vendor shall ensure only prescriptions for indigent clients are billed to DBH and unless a Medi-Cal denied TAR/deferred TAR x 2 is provided, or the client has not met his/her monthly Medi-Cal Share of Cost (SOC). C. The vendor shall adjust invoicing every month when a client may become eligible for Medi-Cal retroactively or has Medi-Cal terminated and may become Medi-Cal eligible again. D. For DBH clients who are Medi-Cal eligible, the vendor shall assume responsibility for Treatment Authorization Request (TAR) submission of Medi-Cal covered drugs, non- covered medications, and situations involving over six (6) prescriptions per client. Since payment for Medi-Cal eligible clients will be denied by the County, the vendor will only be reimbursed retroactively for charges when vendor provides verification of the TAR denial to County from the State. E. Medi-Cal Coordination of Benefits -vendor to describe its process for coordination of payment obligations to ensure Medi-Cal pays for covered drugs dispensed to Medi-Cal eligible clients. Vendor to include a description of the type of em ails/messages that the retail pharmacy would receive in this situation. XXII. DELIVERIES Deliveries of medications may be required XXIII. OTHER REQUIREMENTS A. Prescriptions are to be filled for a thirty (30) day supply, unless otherwise indicated. B. Prescriptions for clients shall be prepared in the same manner as that used for the general public using a bubble pack card whenever possible. Some facility sites may need prescriptions prepared in a specific manner as indicated in Specific Requirements Cost Containment. C. Generic substitutions in prescriptions are required unless specified otherwise by a licensed physician or if the substituted generic drug is not available G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 D. The vendor shall utilize the lowest cost generic and brand name meds. Exhibit G Page40 of71 Page 36 E. The County may also use the pharmaceutical services for clients being served by contracted agencies. F. Services being requested in this RFP may be subject to change as County Departments undergo change and reorganization in service delivery. County will disclose any such changes as they occur. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 Exhibit G Page41 of71 Page 37 COST PROPOSAL Vendor Name: Vendors are to complete all cost proposal pages and return with your proposal. Contracted pharmacy shall bill based on the published (Medical Economics, Drug Topics, Red Book) Average Wholesale Price (AWP) minus a percentage. Any additional costs such as minimum per prescription, dispensing fees, and administrative fees should be included. Prices should not be based on acquisition costs. Identify all cost components of total charges. The County is interested in receiving medication for County clients at the most economical rate. Costs for pharmaceuticals and the cost of any services such as developing any Information System and subsequent reporting must be provided separately. List the cost separately for the disposition of all expired or damaged medications if the vendor can provide such services. The maximum amount to be paid by the County under this RFP shall not exceed $250,000 annually. AWP Publication Name: Explain advantages of using this reference book as opposed to other publications: Percentage discount for medication off the AWP cost: Brand Name Generic Minimum cost per prescription Administrative cost/management fee Dispensing fees Disposal fee for expired meds STAT charges, if any Other (explain what services are included in "Other" and the charges/costs associated with services). G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc $ $ $ $ $ $ % % Proposal No. 269-5316 PRICING INSTRUCTION SHEET Exhibit G Page 42 of71 Page 38 Each bidder is provided with a "Pricing" Excel spreadsheet (Exhibit D). Each bidder is required to fill out the attached spreadsheet and provide all requested information. Bidders are to utilize formulas within the excel sheets to arrive at the requested figures. Each bidder's completed spreadsheet shall be accompanied by a narrative statement which delineates the methodology utilized to arrive at the requested figures. Pricing for Brand and Generic medications by NDC shall be disclosed on the attached spreadsheets. Bidders are allowed to modify the spreadsheet to assist in providing the requested information. Example: Sample List of NDC Annual Unit price per pill ad min avg cost of 30 day overall medispan MAC Brand Name Prescriptions after percentage cost monthly prescription cost list pricing Medications discount supply plus admin fee 1. Ability Tab 10 59148000813 149 $1.7854 $1.50 30 $55.06 $8,203.94 $2.10054 mg In the example above, the Medispan list pricing was $2.10054 per pill and the percentage discount off AWP was 15% resulting in a per pill price of $1.7854 per pill. When we multiplied the discounted per pill price ($1.7854) times the monthly supply (30) we arrived at $53.56 and when we added the admin cost ($1.50) the resulting 30 day prescription cost plus admin fee was $55.06. By multiplying the 30 day prescription plus ad min cost figure ($55.06) by the annual prescriptions (149) we arrived with an overall cost of $8,203.94. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc pricing (if appicable) Proposal No. 269-5316 PROPOSAL CONTENT REQUIREMENTS Exhibit G Page 43 of71 Page 39 It is important that the vendor submit his/her proposal in accordance with the format and instructions provided under this section. Doing so will facilitate the evaluation of the proposal. It will limit the possibility of a poor rating due to the omission or mis- categorization of the requested information. Responding in the requested format will enhance the evaluation team's item by item comparison of each proposal item. The vendor's proposal may be placed at a disadvantage if submitted in a format other than that identified below. Bidders are requested to submit their proposals in a binder (one that allows for easy removal of pages) with index tabs separating the sections identified. Each page should be numbered. Each binder is to be clearly marked on the cover with the proposal name, number, closing date, "Original" or "Copy", and bidder's name. Merely offering to meet the specifications is insufficient and will not be accepted. Each bidder shall submit a complete proposal with all information requested. Supportive material may be attached as appendices. All pages, including the appendices, must be numbered. Vendors are instructed not to submit confidential, proprietary and related information within the request for proposal. If you are submitting trade secrets, it must be submitted in a separate binder clearly marked "TRADE SECRETS", see Trade Secret Acknowledgement section. The content and sequence of the proposals will be as follows: I. RFP PAGE 1 AND ADDENDUM(S) PAGE 1 (IF APPLICABLE) completed and signed by participating individual or agency. II. COVER LETTER: A one-page cover letter and introduction including the company name and address of the bidder and the name, address and telephone number of the person or persons to be used for contact and who will be authorized to make representations for the bidder. A. Whether the bidder is an individual, partnership or corporation shall also be stated. It will be signed by the individual, partner, or an officer or agent of the corporation authorized to bind the corporation, depending upon the legal nature of the bidder. A corporation submitting a proposal may be required before the contract is finally awarded to furnish a certificate as to its corporate existence, and satisfactory evidence as to the officer or officers authorized to execute the contract on behalf of the corporation. Ill. TABLE OF CONTENTS IV. CONFLICT OF INTEREST STATEMENT: The Contractor may become involved in situations where conflict of interest could occur due to individual or organizational activities that occur within the County. In this section the bidder should address the potential, if any, for conflict of interest and indicate plans, if applicable, to address potential conflict of interest. This section will be reviewed by County Counsel for compliance with conflict of interest as part of the review process. The Contractor shall comply with all federal, state and local conflict of interest laws, statutes and regulations. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 V. TRADE SECRET: A. Sign where required. VI. CERTIFICATION-DISCLOSURE-CRIMINAL HISTORY & CIVIL ACTIONS VII. REFERENCES VIII. PARTICIPATION Exhibit G Page 44 of71 Page 40 IX. EXCEPTIONS: This portion of the proposal will note any exceptions to the requirements and conditions taken by the bidder. If exceptions are not noted, the County will assume that the bidder's proposals meet those requirements. The exceptions shall be noted as follows: A. Exceptions to General Conditions. B. Exceptions to General Requirements. C. Exceptions to Specific Terms and Conditions. D. Exceptions to Scope of Work. E. Exceptions to Proposal Content Requirements. F. Exceptions to any other part of this RFP. X. VENDOR COMPANY DATA: This section should include: A. A narrative which demonstrates the vendor's basic familiarity or experience with problems associated with this service/project. B. Descriptions of any similar or related contracts under which the bidder has provided services. C. Descriptions of the qualifications of the individual(s) providing the services. D. Any material (including letters of support or endorsement) indicative of the bidder's capability. E. A brief description of the bidder's current operations, and ability to provide the services. F. Copies of the audited Financial Statements for the last three (3) years for the agency or program that will be providing the service(s) proposed. If audited statements are not available, complied or reviewed statements will be accepted with copies of three years of corresponding federal tax returns. This information is to be provided after the RFP closes, if requested. Do not provide with your proposal. G. Describe all contracts that have been terminated before completion within the last five (5) years: 1. Agency contract with 2. Date of original contract 3. Reason for termination G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 4. Contact person and telephone number for agency Exhibit G Page45 of71 Page 41 H. Describe alllawsuit(s) or legal action(s) that are currently pending; and any lawsuit(s) or legal action(s) that have been resolved within the last five (5) years: 1. Location filed, name of court and docket number 2. Nature of the lawsuit or legal action I. Describe any payment problems that you have had with the County within the past three (3) years: 1. Funding source 2. Date(s) and amount(s) 3. Resolution 4. Impact to financial viability of organization. XI. SCOPE OF WORK: A. Bidders are to use this section to describe the essence of their proposal. B. This section should be formatted as follows: 1. A general discussion of your understanding of the project, the Scope of Work proposed and a summary of the features of your proposal. 2. A detailed description of your proposal as it relates to each item listed under the "Scope of Work" section of this RFP. Bidder's response should be stated in the same order as are the "Scope of Work" items. Each description should begin with a restatement of the "Scope of Work" item that it is addressing. Bidders must explain their approach and method of satisfying each of the listed items. C. When reports or other documentation are to be a part of the proposal a sample of each must be submitted. Reports should be referenced in this section and submitted in a separate section entitled "REPORTS." D. A complete description of any alternative solutions or approaches to accomplishing the desired results. XII. COST PROPOSAL: Quotations may be prepared in any manner to best demonstrate the worthiness of your proposal. Include details and rates/fees for all services, materials, equipment, etc. to be provided or optional under the proposal. XIII. CHECK LIST G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 AWARD CRITERIA COST Exhibit G Page 46 of71 Page 42 A. As submitted under the "COST PROPOSAL" section and Pricing Worksheets (Exhibit D). CAPABILITY AND QUALIFICATIONS A. Bidder's comprehensive response and description of services to be provided address all the areas identified in the RFP. Bidder's proposed services satisfy the County's needs to an acceptable degree. B. Bidder provides demonstrated knowledge and awareness of the problems associated with providing the services proposed and demonstrates knowledge of laws, regulations, statutes and operating principles required to effectively provide this service. C. Bidder's degree of demonstrated experience in providing the desired services within a California County. D. Bidder's degree of demonstrated experience in billing and .back-billing Medi-Cal and other third party health insurance providers. E. Bidder's demonstrated ability to provide pharmaceuticals for mental health clients. F. Bidder's staff experience as exhibited in the resumes of the bidder's licensed staff. G. Bidder's ability to describe their proposed method for compliance (i.e. subcontractor, alternatives, options, exception, etc.) in response to this RFP. MANAGEMENT PLAN A. Is the organizational plan and management structure adequate and appropriate for overseeing the proposed services? G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 CHECK LIST Exhibit G Page47 of71 Page 43 This Checklist is provided to assist vendors in the preparation of their RFP response. Included in this list, are important requirements and is the responsibility of the bidder to submit with the RFP package in order to make the RFP compliant. Because this checklist is just a guideline, the bidder must read and comply with the RFP in its entirety. Check off each of the following: 1. The Request for Proposal (RFP) has been signed and completed. 2. Addenda, if any, have been completed, signed and included in the bid package. 3. One (1) original plus eight (8) copies of the RFP have been provided. 4. The completed Trade Secret Form as provided with this RFP (Confidential/Trade Secret Information, if provided must be in a separate binder). 5. The completed Criminal History Disclosure Form as provided with this RFP. 6. The completed Participation Form as provided with this RFP. 7. The completed Reference List as provided with this RFP. 8. Indicate all of bidder exceptions to the County's requirements, conditions and specifications as stated within this RFP. 9. Lastly, on the LOWER LEFT HAND CORNER of the sealed envelope, box, etc. transmitting your bid include the following information: "'" --···-~··-w··•··--•••••w··-·-·-~ County of Fresno RFP No. 269-5316 ! Closing Date: January 15, 2015 Closing Time: 2:00P.M. Commodity or Service: Pharmaceutical Services I -· =·~·--·---·-·-·--~ .. .,.....-... ··-~~ ---·~-·--• _,-.••-••• -•••_,.., ~·-·~-•-rwor • ---· ··---,.. ~""·------~ -"·»~-.::J Return Checklist with your RFP response. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Proposal No. 269-5316 EXHIBIT A PROGRAM LOCATIONS G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Exhibit G Page 48 of71 Page 44 RFP 269-5316 d Exhibit G Page49 of71 Exhibit A FRESNO COUNTY DEPARTMENT OF BEHAVIORAL HEALTH PROGRAM LOCATIONS WHERE MEDICATION DELIVERIES MAY BE REQUIRED OUTPATIENT METRO SERVICES 4441 E. Kings Canyon Road Fresno, CA. 93702 CRESTWOOD PSYCHIATRIC HEALTH FACILITY 4411 E. Kings Canyon Road Fresno, CA. 93702 CHILDREN'S MENTAL HEALTH SERVICES Children's Crisis Assessment Intervention Resolution Center (CCAIR Unit) 3133 N. Millbrook Avenue Fresno, CA. 93703 Proposal No. 269-5316 EXHIBIT B COUN~SFORMULARY G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services. doc Exhibit G Page 50 of71 Page 45 DBH Formulary County of Fresno Exhibit G Page 51 of71 Exhibit B Page 1 of 13 Department of Behavioral Health Drug Formulary 3-18-2014 UTILIZATION CONTROLS The Following Utilization Controls shall apply to this formulary: Paragraphs 1 and 2 are clarifications to section 2.4.14 Utilization Management of the contract. 1. Generic Drugs will be dispensed and billed when an FDA approved generic equivalent for a branded drug is available in the marketplace. 2. Branded drugs may be dispensed when an FDA generic equivalent is not available in the marketplace, or a physician specifically requests a branded drug in accordance with California regulations. 3. All dosage forms, package sizes, strenghts and concentrations approved by the U.S. Food and Drug Administration (FDA) for pharmaceuticals listed on the County of Fresno Department of Behavioral Health (DBH Formulary are considered to be formulary. Page 1 of 13 DBH Formulary County of Fresno -Department of Behavioral Health Drug Formulary 3-18-2014 atomoxetine HCL atomoxetine HCL atomoxetine HCL ne HCL Strattera® RFP DBH Formulary 50 100 25 50 75 100 10MG 18MG 25MG 40MG various various Tablet various Tablet various Tablet various Tablet various Tablet various Tablet Tablet Tablet Tablet Generic Generic Generic Generic Brand Brand Brand Brand Exhibit G Page 52 of71 Exhibit B Page 2 of 13 DBH Formulary County of Fresno -Department of Behavioral Health Drug Formulary 3-18-2014 RFP DBH Formulary 100MG 150MG 200MG 100MG 150MG 200MG 200MG SMG Tablet Extended Release Tablet Sustained Release Tablet Sustained Release Tablet Sustained Release Tablet Extended Release Tablet various various various various various various various various various Generic Generic Exhibit G Page 53 of71 Exhibit B Page 3 of 13 DBH Formulary County of Fresno -Department of Behavioral Health Drug Formulary 3-18-2014 RFP DBH Formulary 7 10MG 15MG 10MG 20MG 40MG 25MG 50MG 10MG Tablet various Tablet various Jab let various Tablet ForesUPfizer Tablet ForesUPfizer Tablet ForesUPfizer Tablet various Tablet various Tablet various Generic Generic Generic Exhibit G Page 54 of71 Exhibit B Page 4 of 13 NOTES DBH Formulary County of Fresno -Department of Behavioral Health Drug Formulary 3-18-2014 duloxetine HCL RFP DBH Formulary 25MG 50MG 75MG 100MG 10MG 25MG 50MG 75MG 100MG 150MG 20MG 30MG Tablet various Tablet various Tablet various Tablet various various various le various various le various le various Generic Generic Generic Generic Generic Generic Generic Generic Generic Brand Brand Exhibit G Page 55 of71 Exhibit B Page 5 of 13 DBH Formulary County of Fresno -Department of Behavioral Health Drug Formulary 3-18-2014 Prolixin® Luvox® Luvox® RFP DBH Formulary 60MG SMG 10MG 20MG 10MG 20MG 40MG 2.5MG/5ML SMG/ML 25MG SOMG Tablet Forest Tablet Forest Tablet Forest various Pulvules/tablets various Partners Concentrate various Tablet various Tablet various Selective Seratonin Selective Seratonin Selective Seratonin Selective Seratonin Exhibit G Page 56 of71 Exhibit B Page 6 of 13 NOTES DBH Formulary County of Fresno -Department of Behavioral Health Drug Formulary 3-18-2014 Tofranil® Tofranil® RFP DBH Formulary 10MG/5ML 10MG Tablet 25MG Tablet SOMG Tablet 25MG SOMG 100MG 10MG Tablet 25MG Tablet SOMG Tablet 10MG Tablet 25MG Tablet Tablet 150MG Tablet 200MG Tablet dispersable SMG Tablet various various various various various various various various various various Oxford Pharmaceutical Services GlaxoSmithKiine GlaxoSmithKiine GlaxoSmithKiine GlaxoSmithKiine GlaxoSmithKiine Generic Generic Generic Generic Generic Generic Generic Generic Brand Brand Brand Brand Brand Brand Exhibit G Page 57 of71 Exhibit B Page 7 of 13 DBH Formulary County of Fresno -Department of Behavioral Health Drug Formulary 3-18-2014 RFP DBH Formulary 25MG dispersable Tablet Tablet Tablet Brand GlaxoSmithKiine Brand GlaxoSmithKiine Brand 28:12.92 Anticonvu Miscellaneous 28:12.92 Miscellaneous Exhibit G Page 58 of71 ExhibitS Page 8 of 13 NOTES Starter Kit DBH Formulary County of Fresno -Department of Behavioral Health Drug Formulary 3-18-2014 Pamelor® Pamelor® HCL Pamelor® Paxil® Paxil® RFP DBH Formulary SOMG 10MG Tablet 20MG Tablet various Generic various Generic Exhibit G Page 59 of71 Exhibit 8 Page 9 of 13 DBH Formulary County of Fresno -Department of Behavioral Health Drug Formulary 3-18-2014 HCL HCL Dividose RFP DBH Formulary 50MG 100MG 150MG 300MG Tablet Tablet Tablet Tablet Exhibit G Page 60 of71 Exhibit B Page 10 of 13 DBH Formulary County of Fresno -Department of Behavioral Health Drug Formulary 3-18-2014 RFP DBH Formulary Exhibit G Page 61 of71 Exhibit 8 Page 11 of 13 DBH Formulary County of Fresno -Department of Behavioral Health Drug Formulary 3-18-2014 sertraline HCL sertraline HCL sertraline HCL RFP DBH Formulary 25MG 50MG Tablet various Tablet various Tablet various Exhibit G Page 62 of71 Exhibit B Page 12 of 13 NOTES Inhibitor Generic DBH Formulary County of Fresno -Department of Behavioral Health 3-18-2014 Exhibit G Page 63 of71 Exhibit B Page 13 of 13 Page 13 of 13 Proposal No. 269-5316 EXHIBIT C TOP NATIONAL DRUG CODE G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Exhibit G Page 64 of71 Page 46 @@ [Q)~ (Q& if~ D ©W©m January 2013 -December 2013 ZOLPIDEM TAB 10MG 49 2 00310028360 SEROQUEL XR TAB 300MG 28 3 00002327030 CYMBALTA CAP 60MG 28 4 59148000813 ABILIFY TAB 10MG 27 5 59148000713 ABILIFY TAB 5MG 25 6 59762490005 SERTRALINE TAB 50MG 25 7 00781540605 LO RAZEPAM TAB 1MG 25 8 50111043401 TRAZODONE TAB 100MG 21 9 13107000334 MIRTAZAPINE TAB 30MG 18 10 00378032701 HALOPERIDOL TAB 5MG 18 11 59762491005 SERTRALINE TAB 100MG 18 12 00378505001 TEMAZEPAM CAP 30MG 18 13 00093576856 OLANZAPINE TAB 5MG 17 14 00378351491 RISPERIOONE TAB 4MG 17 15 00378047301 DIVALPROEX TAB 500MG ER 15 16 50111064801 FLUOXETINE CAP 20MG 15 18 68180045001 QUETIAPINE TAB 400MG 14 19 68382011514 RISPER!DONE TAB 2MG 13 20 13107003234 MIRTAZAPINE TAB 45MG 13 2 2 68180044 907 QUET!APINE TAB 300MG 12 23 00310028460 SEROQUEL XR TAB 400MG 12 24 68180044701 QUETIAPINE TAB 100MG 12 27 50111044101 TRAZODONE TAB 150MG 12 28 50111043302 TRAZODONE TAB 50MG 12 29 59148000913 ABILIFY TAB 15MG 11 30 68382011614 RISPER!DONE TAB 3MG 11 32 63304077401 LORAZEPAM TAB 2MG 11 35 49884087201 FLUOXETINE CAP 40MG 10 36 00093577056 OLANZAPINE TAB 10MG 9 37 68180044801 QUETIAPINE TAB 2 00MG 9 38 00591333130 BUPROPN HCL TAB 150MG XL 9 39 68382009810 PAROXETINE TAB 20MG 9 40 23155010210 METFORMIN TAB 500MG 9 42 00603015 0 21 DOCQLACE CAP 100MG 9 43 65162005310 C!TALOPRAM TAB 20M G 9 45 00093585101 ESCITALOPRAM TAB 10MG 8 ** CONFIDENTIAL •• 25-March-2014 January 20 1 3-December 2013 47 00378200905 BUPROPN HCL TAB 300MG XL 8 48 59746024860 LAMOTRIGINE TAB 200MG 8 49 68382008001 HALOPERIDOL TAB lOMG 8 52 00054252725 LITHIUM CARB CAP 300MG 8 54 50458056201 INVEGA SUST INJ 117/0.75 7 55 59148001113 AB ILIFY TAB 30MG 7 56 00093510556 OLANZAPINE TAB 20MG 7 57 00052214203 SAPHRIS SUB lOMG 7 58 00310028260 SEROQUEL XR TAB 200MG 59 00378351105 RISPERIDONE TAB lMG 7 60 62756079888 DIVALPROEX TAB 500MG DR 7 62 50111064701 FLUOXETINE CAP lOMG 7 66 50458056301 INVEGA SUST INJ 156MG/ML 6 68 63402030830 LATUDA TAB 80MG 6 70 68382003606 VENLAFAXINE CAP 150MG ER 6 75 00054002125 LITHIUM CARB TAB 300MG ER 6 76 65162005410 CITALOPRAM TAB 40MG 6 81 50458055101 INVEGA TAB 6MG 5 82 65162067384 RISPERIDONE SOL lMG/ML 5 85 00093577156 OLANZAPINE TAB 15MG 5 89 13107003134 MIRTAZAPINE TAB 15MG 5 90 00054452725 LITHIUM CARB TAB 300MG 5 91 68382011314 RISPERIDONE TAB 0 .5MG 5 96 59148001013 ABILIFY TAB 20MG 4 97 00052213903 SAPHRIS SUB 5MG 4 Top 100 Totals · Grand Totals ·· . " ,' ,·,' • ~ lf " ( • A • • ~ ** CONFIDENTIAL ** 25-March-20 14 Decembe r 2012 1 65862016005 ZOLPIDEM TAB 10MG 28 2 68382011514 RISPERIDONE TAB 2MG 26 3 00310028360 SEROQUEL XR TAB 300MG 23 4 59148000713 ABILIFY TAB SMG 23 6 003100284 60 SEROQUEL XR TAB 400MG 21 7 59148000813 ABILIFY TAB 10MG 21 8 59148000913 ABILIFY TAB 15MG 21 9 63304077401 LORAZEPAM TAB 2MG 19 10 50111064801 FLUOXETINE CAP 20MG 19 11 00378351391 RISPER!DONE TAB 3MG 18 12 59762490005 SERTRALINE TAB SOMG 17 13 00002327030 CYMBALTA CAP 60MG 16 14 00378505001 TEMAZEPAM CAP 30MG 16 15 50111043302 TRAZOOONE TAB SOMG 16 20 00093577056 OLANZAPINE TAB 10MG 13 2 1 63304077305 LORAZEPAM TAB 1MG 13 22 50111043401 TRAZOOONE TAB 100MG 13 23 00310028260 SEROQUEL XR TAB 200MG 12 2 4 64679072502 OIVALPROE X TAB SOOMG ER 12 25 49884087201 FLUOXETINE CAP 40MG 12 28 00002324030 CYMBA LTA CAP 30MG 11 29 68382011714 RISPERIDONE TAB 4MG 11 31 00093510556 OLANZAPINE TAB 20MG 10 32 59762372201 ALPRAZOLAM TAB 2MG 10 33 31722021430 SERTRALINE TAB 100MG 10 34 00054252725 LITH I UM CARB CAP 300MG 10 36 31722020801 CITALOPRAM TAB 40MG 10 37 16729014701 QUETIAPINE TAB 100MG 9 38 68382011414 RISPERIDONE TAB 1MG 9 43 00185041560 BUPROPION TAB 150MG SR 8 44 00093100301 BUS PIRONE TAB 1SMG 8 45 50111044101 TRAZODONE TAB 150MG 46 65162005310 CITALOPRAM TAB 20MG 8 48 59148001113 ABILIFY TAB 30MG 49 00310027210 SEROQUEL TAB 200MG 51 00093576856 OLANZAPINE TAB SMG 7 ** CONF IDENTIAL ** 25-M arch-20 14 54 0009358510 1 ESCITALOPRAM TAB lOMG 7 57 1 3107000334 MIRTAZAPINE TAB 30MG 7 59 00378032701 HALOPERIDOL TAB 5MG 63 00310027460 SEROQUEL TAB 300MG 6 64 16729015000 QUETIAPINE TAB 400MG 6 65 68180044801 QUETIAPINE TAB 200MG 6 66 16729014912 QUETIAPINE TAB 300MG 6 69 00378200905 BUPROPN HCL TAB 300MG XL 6 73 68382003305 DIVALPROEX TAB 500MG DR 6 78 00603212928 AL PRAZOLAM TAB lMG 6 so 59148001013 ABILIFY TAB 20MG 5 81 00310027910 SEROQUEL TAB 400MG 5 85 00310028160 SEROQUEL XR TAB 150MG 5 86 00093577156 OLANZAPINE TAB 15MG 5 87 00093738301 VENLAFAXINE TAB lOOMG 5 89 00093738698 VENLAFAXINE CAP 150MG ER 5 91 00781591501 CHLORPROMAZ TAB 50MG 98 50111064701 FLUOXETINE CAP lOMG 5 99 00832108100 BE NZTROPINE TAB lMG 5 -Top 100 Totals Grand Totals 958 . . ---~ --~-~----- ** CONFIDENTIAL ** 25-Ma rch-2014 Proposal No. 269-5316 EXHIBIT D PRICING WORKSHEETS G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc Exhibit G Page 69 of71 Page 47 COUNTY OF FRESNO ADDENDUM NUMBER: ONE (1) RFP NUMBER: 269·5316 PHARMACEUTICAL SERVICES December 29,2014 PURCHASING USE Exhibit G Page 70 of71 ssj G:\PUBLIC\RFP\FY 2014-15\269-5316 PHARMACEUTICAL IMPORTANT: SUBMIT PROPOSAL IN SEALED PACKAGE WITH PROPOSAL NUMBER, CLOSING DATE AND BUYER'S NAME MARKED CLEARLY ON THE OUTSIDE TO: COUNTY OF FRESNO, Purchasing 4525 EAST HAMILTON AVENUE, 2nd Floor FRESNO, CA 93702-4599 !CLOSING DATE OF PROPOSAL WILL BE AT 2:00 P.M., ON "ANUARY 15, 2015.1 PROPOSALS WILL BE CONSIDERED LATE WHEN THE OFFICIAL PURCHASING TIME CLOCK READS 2:00P.M. All proposal information will be available for review after contract award. Clarification of specifications is to be directed to: Carolyn Flores, phone (559) 600-7110, e-mail Count Purchasin @co.fresno.ca.us FAX (559) 600-7126. NOTE THE ATTACHED ADDITIONS, DELETIONS AND/OR CHANGES TO THE REQUIREMENTS OF REQUEST FOR PROPOSAL NUMBER: 269-5316 AND INCLUDE THEM IN YOUR RESPONSE. PLEASE SIGN AND RETURN THIS ADDENDUM WITH YOUR PROPOSAL. ACKNOWLEDGMENT OF ADDENDUM NUMBER ONE (1\ TO REP 269-5316 COMPANY NAME: (PRINl) SIGNATURE: NAME & TITLE: (PRINl) G:\PUBLIC\RFP\FY 2014-15\269-5316 PHARMACEUTICAL SERVICES\269-5316 ADD 1.DOC (4/11) ADDENDUM NO. One (1) REQUEST FOR PROPOSAL NUMBER: 269-5316 December 29,2014 QUESTIONS AND ANSWERS Q1. What are the dates of the following: A1. Notification of Finalist(s): February 2-6, 2015 Finalist presentations: Beginning of implementation: Service Go Live: To Be Determined To Be Determined July 1, 2015 Q2. What is the end date of the current agreement? A2. June 30, 2015 Exhibit G Page 71 of71 Page2 Q3. Will there be an opportunity to include proposals for improvement in the RFP response? A3. Yes, the RFP format allows for flexibility in how bidders describe service delivery. Q4. Will there be a continued need for Patient Assistance Program support under a new agreement? A4. Yes. Please reference page 32, Section XIII. Q5. Please describe processes for Medi-Cal eligible clientele. AS. Please refer to Page 29, Section IX Q6. Can the County of Fresno please provide the PDF main RFP document in Microsoft Word format? A6. The County cannot release the RFP document in Word format. Our boilerplate information in the RFP cannot be altered in any way so it is only available in PDF. G:\PUBLIC\RFP\FY 2014-15\269-5316 PHARMACEUTICAL SERVICES\269-5316 ADD 1.DOC Exnibi+ H- t of 1'10 ~·. t. Ali . County of Fresno RFP 269~:5316 . Proposal· for Phar·macy Benefh. Mana·g.ern.ent. January 15, 2015 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 2 of 170 COUNTY OF FRESNO REQUEST FOR PROPOSAL NUMBER: 269-5316 PHARMACEUTICAL SERVICES Issue Date: December 9, 2014 Closing Date: JANUARY 15, 2015 Proposal will be considered LATE when the official Purchasing time clock reads 2:00P.M. Questions regarding this RFP should be directed to: Carolyn Flores, phone (559) 600-7112, e-mail countvpurchasing@co.fresno.ca.us, or fax (559) 600-7126. Check County of Fresno Purchasing's Open Solicitations website at https://www2.co.fresno.ca.us/0440/Bids/BidsHome.aspx for RFP documents and changes. Please submit all Proposals to: County of Fresno -Purchasing 4525 E. Hamilton Avenue, 2"d Floor Fresno, CA 93702-4599 BIDDER TO COMPLETE UNDERSIGNED AGREES TO FURNISH THE COMMODITY OR SERVICE STIPULATED IN THE ATTACHED PROPOSAL SCHEDULE AT THE PRICES AND TERMS STATED, SUBJECT TO THE "COUNTY OF FRESNO PURCHASING STANDARD INSTRUCTIONS AND CONDITIONS FOR REQUEST FOR PROPOSALS (RFP'S)" ATTACHED. COMPANY I r-0£~5 IJJ.rhSf ~~tr!.L &Jici£ ADDRESS tr ,ef-.o l) {!.ld 921(1 STATE ZIP COD CITY ~Ho~t'JMseF? '7(.)!; e~4~£1661?1sf I. I 5 >t!O;pt-; 6ofl} SIGNED BY /')uYiatd 1/ .. tnaJc.: d'Cll. PRINT NAME PD-040 (9/14) 1.1 EXHIBIT H: CONTRACTOR'S RESPONSE COUNTY OF FRESNO ADDENDUM NUMBER: ONE (1) RFP NUMBER: 269-5316 PHARMACEUTICAL SERVICES December 29, 2014 PURCHASING USE Exhibit H Page 3 of 170 ssj G:\PUBUC\RFP\FY 2014-151269-5316 PHARMACEUTICAL IMPORTANT: SUBMIT PROPOSAL IN SEALED PACKAGE WITH PROPOSAL NUMBER, CLOSING DATE AND BUYER'S NAME MARKED CLEARLY ON THE OUTSIDE TO: COUNTY OF FRESNO, Purchasing 4525 EAST HAMILTON AVENUE, 2nd Floor FRESNO, CA 93702-4599 !CLOSING DATE OF PROPOSAL WILL BE AT 2:00 P.M., ON JANUARY 15, 2015.1 PROPOSALS WILL BE CONSIDERED LATE WHEN THE OFFICIAL PURCHASING TIME CLOCK READS 2:00P.M. All proposal information will be available for review after contract award. Clarification of specifications is to be directed to: Carolyn Flores, phone (559) 600-7110, e-mail Count Purchasin @co.fresno.ca.us, FAX 559 600-7126. NOTE THE ATTACHED ADDITIONS, DELETIONS AND/OR CHANGES TO THE REQUIREMENTS OF REQUEST FOR PROPOSAL NUMBER: 269-5316 AND INCLUDE THEM IN YOUR RESPONSE. PLEASE SIGN AND RETURN THIS ADDENDUM WITH YOUR PROPOSAL. ACKNOWLEDGMENT OF ADDENDUM NUMBER ONE (1) TO REP 269-5316 COMPANY NAME: ussoo~ ;j( SIGNATURE: NAME & TITLE: 1.2 G:\PUBLIC\RFP\FY 2014-15\269-5316 PHARMACEUTICAL SERVICES\269-5316 ADD 1.DOC (4/11) 1.2 January 15, 2015 Ms. Carolyn Flores Senior Buyer Purchasing Department County of Fresno 4525 East Hamilton Avenue Fresno, CA 93702-4599 EXHIBIT H: CONTRACTOR'S RESPONSE Re: Request for Proposal for Pharmaceutical Services #269-5316 Dear Ms. Flores, Exhibit H Page4 of 170 US Script is truly excited for the opportunity to respond to the County of Fresno Request for Proposal #269-5316 for Pharmaceutical Services. US Script is a full-service Pharmacy Benefit Manager (PBM) with over 18 years behavioral health experience, and we have built an expertise in designing pharmacy and medication management services to ease the administration and delivery of prescriptions to your unique patient population. As the current provider of PBM services to the County since June 2005, we understand your specific needs and feel our business philosophy enables us to continue to be the right business partner for the County. Our complete response includes the following information for your review in compliance with the entirety of the RFP: • One (1) signed original including detailed responses to the questionnaire, supporting reports and appendices, • Eight (8) copies of the original response • One (1) Trade Secret Binder • Two (2) Compact Discs US Script, Inc. is a wholly owned subsidiary of Centene Corporation, a Fortune 500 Company and leading multi-line healthcare insurance enterprise. US Script values the partnership we have built with you in providing PBM services and look forward to continuing this partnership in the years ahead. If you have any questions regarding our proposal, please contact me at (480) 317-4634 (office) or 480-599-5508 (cell). Sincerely, Jim Hineman Director, Account Management 11.1 EXHIBIT H: CONTRACTOR'S RESPONSE Ill. TABLE OF CONTENTS RFP SECTION IV Conflict of Interest Statement V Trade Secret Acknowledgment VI Certification VII References VIII Participation IX Exceptions X Vendor Company Data XI Scope of Work XII Cost Proposal XIII Checklist XV Reports & Appendices VII.A. 1 US Script GeoAccess Report and Pharmacy Network List VII.A. 11 US Script Participating Pharmacy Agreement V/1.8.8 US Script Sample Invoice XV.A US Script Sample Report Package XV.D US Script Prior Authorization Form XIXB US Script Resumes XIXD US Script Sample Implementation Plan Exhibit H Page 5 of 170 TAB 8 c D E F G H J K L M N 0 p Q R s ([:7], 941 0484 usscri pt. \\\':'N.U:scnpt (C•I" EXHIBIT H: CONTRACTOR'S RESPONSE Conflict of Interest Statement Exhibit H Page 6 of 170 The County shall not contract with, and shall reject any bid or proposal submitted by the persons or entities specified below, unless the Board of Supervisors finds that special circumstances exist which justify the approval of such contract: • Employees of the County or public agencies for which the Board of Supervisors is the governing body. • Profit-making firms or businesses in which employees described in Subsection (1) serve as officers, principals, partners or major shareholders. • Persons who, within the immediately preceding twelve (12) months, came within the provisions of Subsection (1), and who were employees in positions of substantial responsibility in the area of service to be performed by the contract, or participated in any way in developing the contract or its service specifications. • Profit-making firms or businesses in which the former employees described in Subsection (3) serve as officers, principals, partners or major shareholders. • No County employee, whose position in the County enables him to influence the selection of a contractor for this RFP, or any competing RFP, and no spouse or economic dependent of such employee, shall be employees in any capacity by a bidder, or have any other direct or indirect financial interest in the selection of a contractor. • In addition, no County employee will be employed by the selected vendor to fulfill the vendor's contractual obligations to the County. None of the above conflicts of interest are valid nor do we expect them to pertain to US Script, therefore we have no conflicts of interest. Should a situation arise where a conflict of interest may occur US Script will notify Fresno County immediately. Company: Address: Signed by: Print name: Print title: Telephone: Fax: E-mail: US Script, Inc. 2425 West Shaw Aven F no, California 937 Don Howard President (559) 244-3700 (559) 244-3793 dhoward@usscript.com 1877) 941-0484 usscript. W\I.W.USScript.COrll EXHIBIT H: CONTRACTOR'S RESPONSE Proposal No. 269-5316 TRADE SECRET ACKNOWLEDGEMENT I have read and understand the above ''Trade Secret Acknowledgement." Exhibit H Page 7 of170 Page7 I understand that the County of Fresno has no responsibility for protecting information submitted as a trade secret if it is not delivered in a separate binder plainly marked "Trade Secret." I also understand that all information my company submits, except for that information submitted in a separate binder plainly marked "Trade Secret," are public records subject to inspection by the public. This is true no matter whether my company identified the information as proprietary, confidential or under any other such terms that might suggest restricted public access. Enter company name on appropriate line: us Script, Inc. Has submitted information identified as Trade -(:-:::C,--o-m-pa_n_y....,.N7a-m-e)=------------Secrets in a separate marked binder.** Has .1!2! submitted information identified as Trade -:-::(C,....o_m_p-an-y-=-N-:-a-m-e7) ----------Secrets. Information submitted as proprietary confidential or under any other such terms that might suggest restricted public access will not be excluded from treatment as public record. Print Name and TiUe ' f' ·-/ · · aJO 1._:> Date 2425 West Shaw Ave Address Fresno CA 93711 City State Zip **Bidders brief statement that clearly sets out the reasons for confidentiality in conforming with the California Government Code definition. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc V.l EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 8 of 170 Proposal No. 269-5316 Page 10 CERTIFICATION (1) The prospective primary participant certifies to the best of its knowledge and belief, that it, its owners, officers, corporate managers and partners: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency; (b) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Have not within a three-year period preceding this application/proposal had one or more public transactions {Federal, State or local) terminated for cause or default. (2} Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Signature: Date: uruatd l-lbuarrl eF,yPasrd.t;.;t {Printed Name & Title} (Name of Age cy or Company) G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Servlces.doc Vl.1 I r EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 9 of 170 VENDOR MUST COMPLETE AND RETURN WITH REQUEST FOR PROPOSAL Firm: US Script, Inc. REFERENCE LIST Provide a list of at least five (5) customers for whom you have recently provided similar services. Be sure to include all requested information. Reference Name: Betty Hardwick Center ______ Contact: Theron Cole, Chief Behavioral Health Srv_ Address: 2616 S. Clack City: Abilene,----------------State: ..... TX..>.......,_ __ Zip: 79606 ____ _ PhoneNo.: (~) 690-5100 ______ Date: 2006. _________ _ Service Provided: Administration of Behavior Health Services ________________ _ Reference Name: Tropical Texas Behavioral Health. ___ Contact: Beatriz Trejo, Chief Financial Officer __ Address: 1901 S. 24th Avenue City: Edinburg, ___ -_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_ -_-_-_-_-_-_-_-_-~-=st:-at:-e-: -::T;:-;X::-_-_ -_-~z=i-p:----=al;:-:'10=:=_-=._-=._-_-_-_-_-_-_-_- Phone No.: (~) 28/9-7015. ______ Date: 2010. _________ _ Service Provided: Administration of Behavior Health Services Reference Name: Austin Travis County Integral Care. ___ Contact: Patricia Corrigan Strickland, Pharmacist_ Address: 1430 Collier Street ---------------~-~---~~~~-----City: Austin. _________________ State: TX ___ Zip: 78704 ____ _ Phone No.: ( 512_·) '""80...,4_,.-3....,60""'3 ______ Date: 2009. _________ _ Service Provided: Administration of Behavior Health Services. _________________ _ Reference Name: Bell County Healthcare Collaborative __ Contact: Rita Kelley CIHCP Director, _____ _ Address:309 Priest Drive --------------=:-~~----:;~~~-----City: Killeen. _________________ State: TX ___ Zip: 76540 ____ _ Phone No.: (1M_) 618-4193 ______ Date: 2011, __________ _ Service Provided: Administration of Behavior Health Services. ________________ _ Reference Name: Camino Real MHMR. _______ Contact: Erwin Jaloway, Dpty Exec Director __ Address: 19965 FM 3175 North ~~-----------~~~--~~~~-----City: Lytle, _________________ State: TX ___ Zip: 78052 ____ _ Phone No.: ( 1.1Q__) 357-0306 ______ Date: 2002. _________ _ Service Provided: Administration of Behavior Health Services, _______________ _ Failure to provide a list of at least five (5) customers may be cause for rejection of this RFP. EXHIBIT H: CONTRACTOR'S RESPONSE Proposal No. 269-5316 PARTICIPATION Exhibit H Page 10 of 170 Page12 The County of Fresno is a member of the Central Valley Purchasing Group. This group consists of Fresno, Kern, Kings, and Tulare Counties and all governmental, tax supported agencies within these counties. Whenever possible, these and other tax supported agencies co-op (piggyback) on contracts put in place by one of the other agencies. Any agency choosing to avail itself of this opportunity, will make purchases in their own name, make payment directly to the contractor, be liable to the contractor and vice versa, per the terms of the original contract, all the while holding the County of Fresno harmless. If awarded this contract, please indicate whether you would extend the same terms and conditions to all tax supported agencies within this group as you are proposing to extend to Fresno County. D Yes, we will extend contract terms and conditions to all qualified agencies within the Central Valley Purchasing Group and other tax supported agencies. ~ No, we will not extend contr agency other than the County of Fresno. i I Title * Note: This form/information is not rated or ranked in evaluating proposal. G:\Public\RFP\FY 2014-151269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc VIII.l EXHIBIT H: CONTRACTOR'S RESPONSE IX. Exceptions County of Fresno RFP# 269-5316 A. Exceptions to General Conditions US Script has no exceptions to the General Conditions set forth within the RFP. B. Exceptions to General Requirements C. Exceptions to Specific Terms and Conditions US Script has no exceptions to the Specific Terms and Conditions. D. Exceptions to Scope of Work VII.A.3: Exhibit H Page 11 of 170 US Script requests additional information about the County's desired outcome for this request. US Script currently includes an UMDAP indicator on the Patient Prescription Form given to each County consumer prior to a prescription being filled at a contracted pharmacy. VI/.A.4: Traditionally, PAP eligibility is determined by the caseworker and medications are dispensed onsite at the prescribing clinic, so US Script is unsure why an indicator or flag would be necessary for these consumers. US Script requests additional clarification about the desired outcome for this request. XII.G: US Script agrees to bill all payer sources, including retroactive Medi-Cal and other private insurance provided the County captures and provides to US Script all necessary information on any other payer sources to enable us to contact those sources or notify pharmacies of alternate coverage. XII.J: US Script agrees to reverse dispensing fees for claims denied by the County due to other payer source eligibility; however, due to the labor intensive process associated with back billing, US Script will not reverse the administrative fees for denied claims. E. Exceptions to Proposal Content Requirements US Script has no exceptions to the Proposal Content Requirements. F. Exceptions to any other part of this RFP. US Script has no exceptions to any other part of this RFP. IX.1 EXHIBIT H: CONTRACTOR'S RESPONSE X. VENDOR COMPANY DATA Exhibit H Page 12 of 170 Behavioral health service providers face an ongoing challenge of managing ever-escalating drug costs, with ever decreasing state and federal funding, while providing effective pharmaceutical treatment to patients. US Script aligns with behavioral health providers by providing a unique array of services and products designed to meet specific pharmaceutical management goals and control prescription drug costs. We listen to your needs and work closely with you to maximize the value of your prescription benefits while improving quality care and controlling drug costs. US Script brings value to each consumer in the pharmacy benefit management process. We empower our case management team through education, training and strong customer service support. Our pharmacists work to ensure the prescription dispensing process is safe and efficient. Physicians use reports to make informed decisions in today's demanding pharmacy care environment. US Script has extensive experience providing prescription drug services to local governments, particularly those providing care to indigent and at-risk consumer populations. US Script understands the healthcare challenges facing local governments and provides county behavioral health programs with a total package of pharmacy benefit management (PBM) services unmatched by other providers. During the course of our contract with the County, we have developed and assisted in implementing the County's Prescription Assistance Program, "Bridges to Access." Members eligible for this program complete an enrollment form with their Advocate (in this case, a prescribing physician within the County's closed provider network) and present their Bridges to Access patient voucher and prescription to the pharmacy, where they are added point of sale to the US Script's online adjudication system. The County is billed for the reduced co-payment, ensuring the member has access to the most effective treatments while maximizing the County's available benefit dollars. US Script has been the provider of Pharmacy Benefit Management services to the County's DBH program since June 2005 and has provided PBM services to its DCFS program since July 2005. We look forward to the opportunity to continue our relationship with the County and to develop and implement new programs to assist the County in its mission to provide payor of last resort pharmacy benefits to the Fresno County citizens. B. 11irf5es~rrii6ns,iol'an "~SlYnT!Kr'or~feJatesd contr~irunaer wflict1~61cre~1ia · ~-· ~rovidfici.servl~esl .. ~--. ·-~-·· ..... J~ .... ____ . ··---~-Y. ~~-·······--···-. -~-·-... ·----· --···-·-·---~---······ ... JiQ.Q§'*~P-_ __ -~---···-···-----~- US Script provides County Behavioral Health programs with a total package of pharmacy benefit management (PBM) services unmatched by any other provider. Over the past 16 years, US Script and its subsidiaries have built a strong relationship with the Behavioral Health Care Clinics in the states of California, Texas, Arizona, Florida, and Oklahoma, reducing their costs through innovation and the tailoring of our services to the EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 13 of 170 individual Centers as their needs evolve. During that time, we have brought our Behavioral Health clients an economy of scale that none of our competitors can match. · At no cost to clients, US Script developed and provided a premier Prescription Assistance Program (PAP) from MedData Services. This automated program is unmatched in the industry and is currently being used in many State Departments of Health and major hospitals. This one program alone has lowered the costs of medication anywhere from 20% to 40% for the individual Centers while reducing the number of employees required to manage a Prescription Assistance Program. We have also developed the following services specifically for our Behavioral Health clients: • Specialty mail order, • Formulary services, • Prescription Assistance Programs, • Delivery choice, • Free cost analysis data sheets, • Patient prescription history online, • Preordering of refills for arrival at time of patient visit, • Absorption of Medicaid copayment by pharmacy, • Online refill ordering, • No-cost visits to the Centers by pharmacy personnel, • Disease state management, • OTC supplies, • Warehousing of bulk PAP medications at no cost, and • Dispensing of PAP drugs in 30-day supply subsequent to a prescription. US Script brings a history flexible technology and benefit plan design to government-funded benefit programs. ~~criffons.otTile-ualificati8nsrotlfhe .. individ.ual· srovidiii''"' the41~1is:J ~::.z~-P-···-·-~~-·H··-·· Q .. ~ .. • •••• • •"• • ••~ ••• ·-••••••··-····~-·._-_.,{J J?•••••·••••·•• ••• .9 ...... • ·-mhh ••• "•••• • Mm Kev Personnel and Role Backaround and Exoertise Tony Bruno Mr. Bruno joined US Script in 2014 and has Account Executive over 30 years account management and implementation experience working with benefit operations, benefit design consultation, contract compliance and renewals. Philip Carroll Mr. Carroll joined US Script in 2011 and has Account Manager overall responsibility for the day-to-day operations of the County account. He handles escalated service issues, manages the relationship with the County, works with internal teams, and ensures overall client satisfaction. In addition to Mr. Bruno and Mr. Carroll, support will continue to be provided by departments including Benefit, Implementations and Pharmacy Networks; Finance; Information Technology; Prior Authorization and Clinical Pharmacy. EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 14 of170 Please see resumes for key Account Management personnel included in the Reports and Appendices section. ~~15[i~t~escrii~xiot1:'9fJh~iliRl~~r§':[urref\1f2P"~tioriit~~rrd · ai?!JK~;t~lQre?vig~J~:§!'&.i9Et~ Founded in 1999, US Script® is a Pharmacy Benefit Manager (PBM) that delivers a flexible, high-touch benefit supported by innovative clinical programs and analytics. Using our clinical expertise and the flexibility of our proprietary claims adjudication system, US Script offers you a more customized solution than other PBMs. We improve your members' outcomes while saving you money. When you partner with US Script, you receive an expert advisor to help you successfully navigate the complex pharmacy benefit landscape. We operate as a full-service PBM for state-sponsored health plans, behavioral health programs, third party administrators, labor unions and self-funded employers. US Script's full suite of PBM services includes claims processing, pharmacy network management, a 24/7/365 customer service center, benefit design consultation, clinical management programs, formulary and rebate management, specialty pharmacy and mail service, patient and physician intervention, patent pending analytical tools, Medication Therapy Management (MTM), aggressive generic pipeline strategies, and more. US Script offers a variety of options for managing drug spend, rather than a one-size-fits-all approach to benefit needs. At US Script, we understand you need a pharmacy benefit as unique as your members, and working with US Script means partnering with experts who will meet your specific pharmacy benefit management needs and goals. With US Script, you can rely on our expertise to develop and implement the creative benefit management solutions that work best for you and your members. Our proprietary claims processing system, developed and maintained in-house, enables US Script to customize our services to best meet each client's unique needs. At US Script, we know we must be more than a traditional pharmacy benefit manager; we must be your strategic partner in pharmacy benefit claims management. To effectively manage your pharmacy benefit program, US Script offers a clinically sound, multi-pronged solution to maximize your savings while providing your members quality access to care. On January 1, 2006, Centene Corporation (Centene), a Fortune 500 Company and leading multi-line healthcare insurance enterprise, acquired US Script as part of its specialty services division, CenCorp Health Solutions. CenCorp Health Solutions is comprised of innovative companies, spanning the breadth of the healthcare continuum. As part of Centene's leading edge division of specialty companies, US Script upholds a tradition of superior client service and plan flexibility. Today, US Script continues growing rapidly and developing innovative products and services. While our company builds its nationwide presence, we remain committed to local businesses. US Script's driving force continues to be our emphasis on complete customer care, and our employees are dedicated to providing superior service to all our customers including clients, providers, and members. EXHIBIT H: CONTRACTOR'S RESPONSE US Script will provide audited Financial Statements upon further request. Exhibit H Page 15 of 170 US Script has not had any contracts terminate prior to completion within the last five (5) years. B:~o-e\~~it,> II lawsuit~~) ol"Jegal~ac·'i>'', .(s)'ttiaFare c~rrentJY-pei1.9lril*f1 an~~ijly;'Jaws~it(§f2fJ§9'ru ~Gti~~(s ,-.~,, at bave;~~e olved. hirf the last fi~e1-(§b!~.~r~ j1. '1Zoca~~l1 filed, 'rt~ . , .. court .\ .d~c~ket n~I!LQmi ?. Nature ofJh~-L~su LiJ~g~~ There are no pending lawsuits or legal action against US Script or its subsidiaries. G~pes9rf~~~ta'~t:>~Ym.!irifjgfqQI'~ITI§lii~I~9!i:o~v~tlE1~~iiltt,JJliJ~Q"tm:trw1ffi1ii1fi~ii;t~!Jn1[[~<~1, year$:' :t. lfun-wn9 $9urce ~-)~?at~~~~)-alifL~Jn9ii!l!<§l r· Res~,~~~tiqQ~·--· . ·--~,~---·--·----,~~!1 ~--.. lmQaQfJQfii}~I!§talNiabilitY'gfg!gStnizatidlli The only significant payment problem US Script has encountered with the County over the course of the past three years is directly related to notification of Medi-Cal eligibility. Over the course of our contract, we have made great strides developing a billing and invoicing process to meet both parties' needs. We are confident we can continue improving this process and look forward to furthering our collaboration with the County. EXHIBIT H: CONTRACTOR'S RESPONSE XI. SCOPE OF WORK THE SELECTED VENDOR MUST MEET THE FOLLOWING REQUIREMENTS AND PROVIDE A DETAILED RESPONSE THAT DESCRIBES VENDORS PLAN TO ADDRESS ALL OF THE FOLLOWING SECTIONS {VII THROUGH XVII) Exhibit H Page 16 of 170 ~~~~~ma(ieijiiCIDManaaeme~t phe .. sel~i~e~ Vend~t~~~~~~ .c~qtra~t;wittiphat![acies th1g~g~·~ufFres .~ ounty~t~;j~(... . . .. pharmaG~uttcal pr~~~fl8~!pns ~t a 1~Jscounteg.;[ate·.for seyer~l~ mental : .~~:tults and~~v~ ~mg1Jol)~.lly ~istur~~~ ct)ildre~. TtJ.~:majorio/.i~f th~se pfescG.j~tion,s wil ..... f~f1 psychot~~·pid~ .. ph~rma9~.~t1f~ls: how,e~~r. p~escri~~ion~ may.a1s9;;;pe allow~g .. fo~~1~ea~ment~~f.,t!;t;~~~-~ig~~.§~t§ fltlnbu~e~~:~stq~ a psych7~.~r~p19 me~,c~~,~~n~ and ~~Ql.e ~!9alth m1~~~~t\~n~ wtth R~1p~ . ·-·.,1 rutt;tpnza~.IC>ll:: .... Ph~~c;:eu!!~~ls fort~~J:iJ.oVIII ebe r~~!nc;:!~d to.thos9.'qrljg~.hst~£LQ.n ~tyl.§ rnn:nygr;Y:;l US Script is a full-service Pharmacy Benefit Manager (PBM) with over 18 years behavioral health experience, and we have built an expertise in designing pharmacy and medication management services to ease the administration and delivery of prescriptions to your unique patient population. As the current provider of PBM services to the County since June 2005, we understand your specific needs and feel our business philosophy enables us to continue to be the right business partner for the County. We look forward to continuing our partnership in the coming years ahead. ~~r .. R~rmacymtw ~ , -'· .· "···<1(0/. ·' '.:>w" ·. . ,:~~'''. . . ~'"'·"'~,·-,~-~-". "-~-:-:;nw~~.-~-_:,.,··"~·~··-... ·~,~-~~~~~,.-;}~·~JW~~""'"="··"··~·~-.· ·. :."-"P~·:~:·~~~·=·, ~ .. ·Maintain ~ontra~m~ll~'E~!Ofl§hips with Pli~tm.ac;:LE!§Jt!ffi!;!gJJou~~ Fre§og~_QQun!MJifor:tfle. t~r.m.Qf •. J:l~.ic;:QilJr.ap!:. US Script maintains an extensive network of 99 pharmacies throughout Fresno County, including pharmacies in outlying, rural areas. Please refer to Appendix VII.A.1 to see a listing of all Fresno County pharmacies participating in the US Script Open Pharmacy Network. Our Participating Pharmacy Agreement mandates that pharmacies contracted in our Open Pharmacy Network provide appropriate drug product consultation and counseling in accordance with Laws and Pharmacy Standards. B.~:th~i!;)ilityJo"'pi~\ridesa::Cotlnty1paym'"ent·i~diccifur catffiC~mtofm M~tho9'fg I Determihin Abilit 'to Pa ''(UMDAP) to tHe contracted''Barmac ·ffiat iae'ntifi'es eatn ! . g .. y : ...... Y ''nv•· ···>' ..... ,.,, . ,,.., . ..... J~ . ... Y~.~~ PElm~nrj:~"i3y~[Ifi:>r~ VMP~~~E2Jigjbl~~mental health clients! US Script currently includes an UMDAP indicator on the Patient Prescription Form given to each County consumer prior to a prescription being filled at a contracted pharmacy. EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 17 of 170 fA"""'"';:<"~· ~'{"';~"'" -·"", ~ !'''Wfl"""""~",'~'~ "-, ,y~"'W""~~~'" ~-. ····-~~=WtW==--··~~~~~~._..,,w"-, ,--. -·~"· -"::""'~'Yf""""" -~~'=""""kr-·~fi$~':"""~ "'W'"~ ~-'1H~v~,1;the ~pili pr~yi~e<a ~~e~c~i~,tion .. 1f>ssistan~e~r9~ra~~rdi~1tQr~orf'~g· t<?·!f:l~-"7®~-··-· . k~~~:r~~~ P~&~fli~Tis.~~gl!~ll!§J!~m~9 Ei.~c~.ssJg~(llr~~~~nP~~.Q!J,§_!~tt>~li!IJ~fiJJlJrQI!9JtttJ~ .. ~ctufL~:§ ~-__ . --··P-~9-.-~ Traditionally, PAP eligibility is determined by the caseworker and medications are dispensed onsite at the prescribing clinic, so, US Script is unsure why an indicator or flag would be necessary for these consumers. US Script requests additional clarification about the desired outcome for this request. p.·}~pntract~4~r"Phaitf!a~qies ~~~~~l-acfe'Pf,l?!i¥rli2ilCJJ:15Ey;:§ll~w~~Cid~l~~9Qi'tianc~·:t9 Stat~J~1Jd'l¥ed~rg~L!;!i!!~§_Eind·r~g_tiiatlon§: US Script requires our contracted pharmacies to accept prescriptions by all allowed methods in accordance to State and Federal rules and regulations. ~-··~~twQrkQB~oRf=··· · -. vendo.r;.$t1Bif'ofler~its~pst4~gl;li~sea~~~~~fiH~r '"J~e~~rk~ , h·e:~~~~n®r sh~U _§~J:~m -A~QrfiQiet~J~!,Jrf:~illlhltQ[!ts n~~Q~'Qttetail:.l!?h~rmiicie. US Script will continue to offer the County our most commonly used open retail pharmacy network. Please refer to Appendix VII.A.1 for a listing of all Fresno County pharmacies participating in US Script's Open Pharmacy Network. rr:·;!«fhqi~lifia'~m !I~!!9JI§.I:·grm?J9r Within Fresno County, the following national or major retail chains are participating in US Script's Open Pharmacy Network: • cvs • Rite Aid • Target • Target • Walgreens • VONS • Wai-Mart • Sams • Medicine Shop • SaveMart ,~··"=~,~-"'"'" "'""''''7"·~'":7".-... -~~···"w·v~· • •• .· .~.,.--1~~_,_""'"'~"'~ ""-~.:r1.·· "10~._....-.. w···· .• -•• -,_, •• -·. "-__ ...,. __ "'018l0j ~£. •·tj~~~~.f:~ gaver~fge =·For tQe PfC;l~d~~d retail phprmc:~py n.~~ or to provide~~~:·:, peo'Acc~~s aij.~l.!Y~:i~.nUSi!\)g ·alli!zip. c~de~,i~atJ.~.cluci~FrE(sn~ ~ou~. Y·-·-·~:follojXj!z!g;r~t~gg§!l~ ~ll~fP~~:y§'ed: Two .. ghar[IJ~let!?~Wi~~~D· fi~~ mile.s ofxeveryrZI~~Qg~:~ Please refer to Appendix VII.A.1 for a GeoAccess analysis for Fresno County zip codes satisfying two pharmacies within five miles of every zip code. EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 18 of 170 ~-.•. ~ys~msiij~~Ff~P6=~p~~Cflbe~~~e systen1~indpr8~~ssesm!~ce to s~·; -port'~r''7'ltl~ ~­pet~rmin~!ion]!rffi~~~~g.iijg;'ang .. c(;)mmu~lcatioh wi~Q·p.~~icipat!ri9":;!~harm~. . ··Be s... tc i~ ~e~C,tibi~Q.r~he:typ~~ffi.ofermi#ion.·Pr<i~~~ed tg;;,~nff"regillf~.flfr9mJ!ltu~.ttarm_§~·at:~n~:_,mg&f ~!igjl)ifi~Y.~~Lillea!!.~ll- PBM-1 Claims are processed through US Script's state-of-the-art, proprietary POS adjudication system which integrates eligibility verification, prospective and concurrent OUR edits, and custom messaging to the pharmacy. Reject messaging can be customized at the NOC or GPIIevel and linked to medications, reinforcing changes to the formulary or POL. POS messaging linked to medications can also identify preferred drugs and assist pharmacy staff in making recommendations to prescribers. Likewise, individual consumers can be tagged for specific benefit restrictions, allowing for greater management of member benefits. Communication, Eligibility, and POS Messaging All retail and mail order pharmacies in the United States and certain protectorates are connected to US Script's proprietary adjudication system through a highly secured, private intranet. Eligibility verification and claim authorizations are handled solely within the US Script adjudication system online and in real time. Our system is available to adjudicate claims with all contracted pharmacies 365 days a year, 24 hours a day. Currently, US Script manages a Point of Sale (POS) eligibility process for the County. Eligibility is determined at the clinic and consumers are given a Patient Prescription Form to take with them to retail pharmacies. A claim is submitted at the pharmacy, and when the claim adjudicates, the consumer is added to the system at POS. Should the County decide to implement an alternate eligibility model, providing regular eligibility updates to US Script, adjudication would happen as follows: The US Script adjudication process first identifies the plan consumer within its database and then determines eligibility of both the client/plan and the plan consumer. Member identification occurs when the cardholder-10 and consumer's exact date of birth (as submitted by the pharmacy) match that of the consumer within our claims adjudication system. Coverage of the prescription is then determined based on the identified consumer's eligibility records. The consumer's entire eligibility history is maintained within US Script's system so that an accurate determination of coverage can be made regardless of the date the claim is submitted. This is essential when processing paper claims from consumers (e.g. COB) or pharmacies. The system determines that a consumer is eligible for benefits, and then the claim is run through standard edits to ensure that it is processed according to plan design. Each drug is checked against the consumer's integrated drug history, including mail order and retail pharmacy prescriptions, to determine if clinical risks are present. Approximately 2% of all prescription claims result in concurrent OUR clinical alerts to the dispensing pharmacy. If a potentially serious clinical risk is identified, our claims adjudication system sends online "alerts" to the dispensing pharmacy before a drug is dispensed. Claims are submitted individually, although up to four electronic claims can be submitted at one time in a submission. The entire process listed herein takes place at the POS in less than a second. EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 19 of 170 All US Script programs implement proactive drug utilization review at the POS and thorough retroactive analysis of the patient's prescription history. This assures the quality of the service and cost effectiveness of the plans. ~Zt~::~~~!f~t~~!~l~1i~i~~~~~:~~Xa~~i~i~,~~~~:t~9i~a:~~~§jjb!!t~Wi!Lbit!!§~~'ang Currently, member identification occurs when the consumer presents his/her Patient Prescription Form at the pharmacy. Claims submitted against one of the County's programs adjudicate against the County's unique benefit plan design, and claims that do not meet all criteria are rejected, with a POS message returned to the pharmacist indicating the reason(s) for the claim rejection. Ninety-nine percent of all claims adjudicated by the system are processed in less than eight- tenths of a second, after which a message is sent to the pharmacy confirming acceptance or denial of the claim it submitted. Please see Appendix VII.A.11 for US Script's standard pharmacy contract, including payment terms and conditions. Through POS eligibility, the County maintains responsibility to manage eligibility information. US Script provides each clinic location with the Prior Authorization Forms to be completed by the clinic administrator and presented to the pharmacy with the new prescription. The pharmacy submits the information into our processing system, allowing the eligibility submission to be completed and the prescription to process. In addition, we look to the County to provide us with updated eligibility for County consumers as information becomes available to the County. US Script will work with the County to determine the most viable option for uploading of eligibility files. The majority of US Script's clients transmit eligibility this way, and monthly or more frequent eligibility uploads would likely reduce the administrative workload for the County's account for County staff and US Script. We use several techniques to address validation, error correction and acceptance of eligibility data transfer files. The techniques include process controls, programming process verifications and program data validation. Each of these steps has output that is reviewed, and failures are recorded and reported as needed. Process Controls: A file definition is established for the eligibility transfer file. Based upon the definition, a header record, trailer record, and record count will be reviewed for accuracy. If a partial file is transmitted, the error will be identified by lack of a trailer record. Record count is also used to validate' accuracy of the file contents. If the record count exceeds a variance of plus or minus 15%, processing is held until our Information Technology (IT) department receives authorization that the provided file is valid. If process controls indicate that the Client is having a processing problem and has provided an invalid file, appropriate escalation will notify the Client to provide a corrected file. EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 20 of 170 Programming Process Verifications: US Script's IT department has implemented a set of business rules to help them identify when a file has been transferred to the US Script SFTP site. The business rules also indicate when the file can be process, and whether or not the file was delivered as expected. If the file was not delivered as expected, the IT department begins escalation procedures to determine when the appropriate file will be delivered. This process ensures consumer service is not interrupted due to a delivery problem. After processing, the IT staff logs when eligibility data was received, the file it was received in, when the file was processed and any errors that occurred during processing. Finally, the IT staff generates an Eligibility Verification Report that provides a breakdown of consumers by groups and plans associated with the client. A screenshot of the Eligibility Verification Report can be seen below: Eligibility Verification Report Report RPT -006 Printed: 01/1212015 01/1212015 Page: 1 ~@lmffil ~ 171951 Current Member Count: 171953 Difference: 2 %Difference: 0.00% 12331 0 !i'i~·@a!Iij ~ 12331 0 3362 0 !i ~@W·~ ~ 3362 0 74277 0 0 188 0 188 81795 0 81795 0 Total: 171953 0 Program data validation: As each data file is processed, a process log is created. The process log explains every action that affected the database based upon the data processed. The program validation also identifies any errors and logs them in the process log. The process log is provided to clients for their review. A screenshot of a sample process log is provided below: EXHIBIT H: CONTRACTOR'S RESPONSE Eligibility Report for WA Coordinated care Health Plan batch: WCC201501121017 run_date: 01/12/2015 processed: 01/12/2015 10:17 PRODUCTIONrpt level: ********************************************************************************** UPDATE: id: XXXXXXXXXXX XXX XXXX UPDATED: ALT_JD: XXXXXXXXX to XXXXXXXXXXX EXP: UPDATING ADDRESS: id: XXXXXXXXXXX XXX XXXXXXX XXX XX xxxx,xx '"**Population count comparison *** Group: XXXXX Plan: SAMPLE Dept: System: 159,042 AFTER Processing: 159,044 2 Group: XXXXX Plan: SAMPLE Dept: System: 12,909 AFTER Processing: 12,909 0 Total population Before: 171,951 AFTER Processing: 171,953 Percent Difference: .0 newadds:O member updates :1 defunct records :0 member effectivity updates :234 Exhibit H Page 21 of 170 Upon completion of eligibility processing, e-mail notification is sent to the defined distribution list with the Eligibility Verification Report attached. The client receives immediate feedback and knows the status of their consumers after their eligibility data has been processed. 2.--F>edOr-i!l_~]9ibf~tY uQCiates ~to consum-er-d~ta~ wiih Jn~f from -cot!D!Yl US Script agrees to this requirement. Eligibility can be updated as often as the County requires. We currently have clients who update daily, weekly, or as needed as eligibility changes occur. Clients can also update eligibility via our online claims adjudication system. ~: update-cans-umer·eiT9UillJ!if~~~witt1!i:i~~:iDl!t~~aili_~9r~_(ia 4P"Qiiflrr1eliije ·a-ft~irecelvll}9 !!Rctat~s fro_rrtth_E!_~oun~ ~ US Script agrees to update eligibility files within a mutually agreed upon timeline once updates are received fr~m the County. ~--Mainfainhistory-for ead1 consumer-av~!~~ie· toC:fuiine"dTate-:-dir~g_t~~cess-~iffl~ ~ounty__Q_u.ringji}~J~IJ"l-Qf tl1~-~g-~~E1rr:!ent} US Script meets this requirement. Our system maintains the consumer's entire eligibility history and accurately determines coverage, regardless of the date the claim is submitted. 5.-rvfamfaTnaJrC:fatarecorCfs eithe-r cin or -off~1fne tor a mlDlrrl~rn ofse\t~n (!)_~ea[_~~-iri ~ccord~nce tgJ?!~~-~'lc:l £E1.d~r:§1LruJ~~ C!ndJ~gujatio_n~.1 ) US Script agrees to maintain all data records for a minimum of seven (7) years, in accordance with State and Federal rules and regulations. EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 22 of 170 ~C Provfde ~n-ov~ride -R:r_Qy~~j t_q -allo\¥:}tl~~ Q"_ci~~fy t_iie-abilfiyJg_ fUC~gri:.toim-u~~ri~cLi9S_ wile~ b~~degJ -- US Script meets this requirement. Clients have access to our online claims adjudication system through a secure Web portal. Through our online claims adjudication system, plan administrators can access valuable, real-time tools for updating eligibility, administering prior authorizations, viewing live claim data, and running standard reports. A screenshot from our online claims adjudication system can be seen below: Prior Authorization Screen: ,.~ F'tiOt A.uthOIIZdtJOIII"18Jntenance ::! 5 X r~~!!~~fQm~Jlo~~~~~==~,=-~-=======-=======--==.== ~~~--==============~~ I -I =:dJ Relationship Blrthdate r Member ID I II First/ /Last / / Effective Expiration Duration 1 !.) Claim Reference PA Number Starting After (Days) GPI L ____ IL __ J H __ j __ ~~·c.--H_-___ -J,j= ~~~ ..... --~===~~'In I L _J_ --H __ II -!'-----l --.jl_ ----'Q =~~~-;IM;,~~-m~-~~~~s~up~plMW~~L~a~nt~"iy::-:'1~-~-~-~~opP<a;yRR~~~·~li~~M;--~-~~~~-~--:-::::::::;::;:;~~~; Days 1 -11 r----iJ Fixed -----Variable-Amount Daily Issued/mod. by I Jl Supply d Qty l=-j Rate Pctg % Min Max Per Claim Dosage on /r--'-----'--~ ...... 1{1 1Whichever lsG1Greater 9Lesser ll :11 :1 Lil c:=JJ Notes:~[ _i! PA INTERVENTION Code _ Description Short Term Type Issued/mod. by 1 Jill L __ JI:I?===============Iit1Pl~l======~-~-~~;~,~ on·,. --~=====~m111 I.~L. l~ll_ :::::_~::~_~L-~==~~==~~I EXHIBIT H: CONTRACTOR'S RESPONSE Member Eligibility Screen: Last PLANS -·pJifn"Effective--POS Extended Dual Stop Exhibit H Page 23 of 170 Plan ID From Throug!l__ Coverage COB Coverage Loss ~---·--_:_--_::--::.:---=----------~F~"==;F:, ~~91-d~=?~=?_-_-_-___ ::_~~!.:.-------__,; __ j Ql . ~O;;[I.J.J' ~ • ~ _______ II Ql ~ Ql ~====~~~~~~=======~~~~~~~~~~==~~~====~~~==~==~! g ~.----Demonstrate the ability to-adminisfedhe-Cou-nty's ellgTbility requl"rements:-(a)cfient m-ust be County client; and (b) each~cript must be prescribed .fr_o!ll~l}_au!bQflzed CQunty_pJovide_r_and (~ ~aG!lifrug_ must be on the Co_unty~§19rmu!?_r:y_for_Q~tfJ As the County's PBM partner for nearly 1 0 years, US Script has the demonstrated capability to administer the County's eligibility requirements. A consumer is given a Patient Prescription form indicating their eligibility for the County's program. That form is presented to the pharmacy and the consumer is added to US Script's database at POS. At present, US Script maintains a closed prescriber network for the County's DBH programs, and any prescription written by a non-participating prescriber will be rejected at the POS with a message returned to the pharmacist indicating the reason for the claim's rejection. ~---Support a centralized~-consolidated 6iTifng prcices_s_ tilafafso provides-line Ttem -CfetaTI-for all, orug expenditures for each Group as defined by County. Invoicing must be detailed enoug!tt9 ~etermine each Group's spending by specific drug description, National Drug Code (NDC)f ponsumer information, name, physician, Group ID and Plan ID (as defined by the County)!! .Pharmacy_,_~ riumb~r,jf__o_~~ Qr_g f~fill, Q~!_e_fjll~g,_ r:D~trj~ g~!:!Dtity,_d~y_:_s..§yf?R!Y~n_g_billeg art}_QIJntr US Script currently provides this data to the County. A sample of our invoice, including the above requested data, can be seen in Appendix VII. B.a. ' EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 24 of 170 ~~~omJalituily~~tti~Ylt~· -rocesses:-Pr~ced~[eS:::an·d P?Jf~(~~ ,~~rt~ittf~ti~~irHI,~~ fn,~acy ,i9d unty r~gptre,:en~s:c~s well as Statr·con~~entta11¥l~eg <:+;:erttons, f~~ the.~~~~llee,t!rQIJ' rnat~)tt~nanc e Cl11P tran~~tsstqn of Rrotected ·t~formw~ttqfl ... Vel19Q£:Iffiii:J~tf~J!Yl~<:the'~lir!9jl[§ mo~l:r~strictl'(~ r~,Yl~!jgnfo[tf:le gro!ectioi1.91inf9rmatiqnJ US Script meets this requirement. Employees at US Script make every effort to safeguard private health information, including electronic information, from any uses or disclosures in violation of HIPAA privacy rules and policies. Only authorized US Script employees have access to private health information to provide pharmacy claims-processing services, and to assist clients in effectively managing the cost of providing pharmacy benefits for these consumers. US Script has created and enforced a HIPAA policy to prevent individuals who are not authorized to access private health information from inadvertently receiving unauthorized disclosures of electronic private health information. US Script's HIPAA policy requires that: • Employees have their own computer; no one shares a computer • Employees keep passwords private, and do not share access to programs with other employees • Employees position computer screens so they cannot be easily viewed • Employees close all applications and log off the computers at the end of the work day • Only employees are allowed to use fax machines, photocopiers and printers • All passwords are deactivated when employees are terminated or otherwise no longer employed by US Script, Inc. • All computers containing client files and related private health information are equipped with enterprise anti-virus protection software. In addition, our entire network is a "closed system" not allowing outside "viruses" to penetrate. • The HIPAA security officer maintains administrative security for access to programs containing private health information; this includes assigning passwords to authorized employees. • The HIPAA security officer regularly backs up to tape all Client files and related personal health information electronically maintained. Typically, backups are performed on a daily and weekly basis. Backup tapes are stored in a secure location. Electronic Data Interchange (EDI) Transactions and Code Set Standards • The Security Officer implements security measures to ensure electronically transmitted PHI is not improperly modified before disposal. • The Security Officer implements technical security measures to guard again unauthorized access to electronic PHI being transmitted over any electronic communications network. • The Security Officer implements a mechanism to encrypt electronic protected/confidential information whenever deemed appropriate. • The Security Officer identifies all departments and/or employees using electronic communications to access or transmit PHI across an open network and shall encrypt messages so only the recipient can interpret them. • All departments and/or employees using electronic communications to access or transmit PHI shall be able to validate digital signatures on messages received. • The Security Officer has a documented procedure regarding the use of digital encryption. • The Security Officer has a trusted third party issue US Script's digital signature certificate. EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 25 of 170 • The Security Officer has a trusted third party (internal or external) examine the network to ensure no risk channels exist. • The Security Office segregates all encrypted communications from non-encrypted communications. • The Security Officer identifies all department and/or employees using electronic communications to access or transmit PHI and has written procedures addressing security of electronic communications for the transmittal of protected/confidential information. • The Security officer has integrity controls to ensure the validity of the information sent or received when electronic communications are being used to access or transmit PHI. • The Security Officer has a written procedure to ensure integrity controls are included as a mandatory requirement for an information technology upgrades or purchases for electronic communications used to access or transmit PHI. • The Security officer periodically audits software to ensure no covert communications channel is present within its information technology environment. Information Security Management Process US Script has a formal information security management process involving the protection of data and related technology using appropriate analysis and management techniques to mitigate risk and prevent, detect, contain, and correct threats, vulnerabilities, and exposures. Routine system activity reviews, evaluations, and conformance sanctions are in place to support implementation and maintenance of this process. The security management process calls for a risk assessment and analysis to be performed to determine the value of assets and exposures to threats and vulnerabilities. US Script will use available resources, personnel, funding, and tangible assets (computes, space, and time) to conduct an ongoing risk analysis program. US Script will assign, designate, and document an individual as the Security Officer to be responsible for the security management process within the organization. The Security Officer will evaluate each department within the organization to assess the risks and vulnerabilities that could negatively impact the confidentiality, integrity, and availability of electronic protected health information (PHI) held by US Script. This analysis includes all relevant losses that would be expected if the security measures were not in place, including loss or damage of data, corrupted data systems, and anticipated ramifications of such loss or damage. At a minimum, the Security Officer shall: • Inventory and document all internal and external systems and applications that are used to access and house PHI, including PI in storage as well as during transmission, and classify them by the level of risk • Implement and document procedures to prevent, detect, contain, and correct security violations addressing both intentional and accidental risks • Identify and document vulnerabilities to the confidentiality, integrity, and availability of any electronic protected/confidential information and develop a plan for managing the identified risks • Evaluate and document the probability of occurrence of each vulnerability • Assess and document the relevant losses due to risk exposure and prioritize recovery strategies based on the associated risks • Prioritize and document the risks and vulnerabilities identified as part of the risk analysis EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 26 of 170 • Conduct and document a risk analysis addressing both intentional and unintentional risks • Periodically reassess and document the risks and vulnerabilities • Re-evaluate and document US Script's security procedures(s) following any security incident(s) like attempted security breaches, successful or not • Use available risk assessment process to addresses computer viruses, "Trojan horses," and malicious Websites Working with the Security Officer, each department will use this information to manage countermeasures leading to an acceptable level of assurance that systems are secure c.~,>~cc~ijlifiNian~gim1inf~P'd .. G~~to~·er,$&rVi~,~ r .. ,t~~rjijty a~ll~ccount~·ana~W who w~l.f be ~~sp&n~Tbt~~fQdb~~~J~fl!~ill~§~nslbl]Iti~~ em.~fWill.h2yg ·aamiQi§.![~g~uthor!Th'.,Linder !fli§. contr~QIJ The County's contract will be handled by Account Executive, Tony Bruno, as well as Account Manager, Philip Carroll. Mr. Bruno has over 20 years experience in healthcare and PBM account management and holds overall responsibility for the strategic management of the County's account. Mr. Carroll also has significant experience healthcare and PBM account management experience with a focus on Fresno-area clients; he handles the day-to-day management of the County's account. To ensure our clients receive consistent service excellence, your Account Manager, Philip Carroll, will act as the County's primary point of contact for all inquiries. In addition to working with Tony Bruno and Philip Carroll, US Script's Customer Service team will play a vital role in support of the County's daily account activities, pharmacy support, and consumer support. The team is fully cross-trained on all accounts to provide maximum coverage and support. When you call our toll-free phone number with a request, Customer Service logs it in our Everest tracking program. An assigned representative tracks incoming requests daily and assigns the tasks to the appropriate department. The County is notified of each progression of the request, and the system allows for an increased capacity for status reporting, therefore ensuring our clients' satisfaction. US Script's two-pronged approach to account management guarantees that our clients interact with appropriate specialists at each stage of contract management. Mr. Bruno and Mr. Carroll handle the overall management of the account, and our Customer Service department completes the account management solution by providing ongoing support for daily requests through documented procedures and an efficient software application that tracks ongoing progress and upcoming deadlines. Using this account management approach, we are able to provide the most efficient and timely response to your requests and ensure information is drawn from the most appropriate personnel. For pharmacists, physicians, and County consumers, US Script provides 24 hour a day access to live Customer Service Representatives via the US Script Call Center. At present, US Script employs over 350 individuals nationwide, with headquarters located in EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 27 of 170 Fresno, California. US Script remains committed to our long-standing clients, and our growth enables us to provide enhanced service to those clients. The team continuing to support the County includes representatives from Account Management; Benefit, Implementations and Pharmacy Networks; Finance; Information Technology; Prior Authorization and Clinical Pharmacy. -~~·· n~~~"':' ••• •••r,.~--~":'~";._,,_..,.~--' "'W~~W"'"""'"~--~~} "~•;, =w:-"~"' •,--~ rige,meJ)ts fd~~lang~age/cult~tal "' ~-ta11ce;,,i~l~e.~ 'be:~rovi~ed via ~~jttem,;fax, '~nd. 'lephqij~ reqyests~frbniit9ffl , d li~!?nsed P.~Xsicia~: \/E:lD~~-~ _r_qyjg~~te~9f:iQtiOI}§_lrj J_Eha[magy_f3.~g.!JiatiQD~} US Script's diverse staff of Customer Service Representatives can communicate fluently with consumers in English, Spanish, and Hmong. US Script also provides clients, providers, and consumers access to the AT&T Language Line via the US Script Customer Service Center. This service provides over-the-phone interpretation, where Language Line interpreters listen to the consumer, analyze the message, and convey its original meaning to pharmacy staff. If a Representative determines that a caller is unable to speak a language known by US Script staff, or if the caller prefers that the call be conducted in a foreign language, the Representative informs the caller to remain on the line while an interpreter is contacted to assist in the conversation. Additionally, we provide TTY capabilities and access to services during non-business hours. 'For written communication, US Script employs certified language translators that can translate documents to any language necessary to communicate effectively with your plan consumers. Once a communication piece is approved, it is sent to the translation service. The service returns the translated document and a certificate verifying the accuracy of the translation. US Script currently offers many of our consumer communication pieces in Spanish. ~·-:~-«-:-~-'~1-i:J ~he~~:~r'reie.V~~:c'". ~llf'to-p~f,fo~grcosf audif~ o~!lrwqlces arid,~l~~nyadjusfminti feq~tr~,., correct ~~r Corree\t~ns ~pall b~ made not mqr~Jh?tn~!~' (6Q) .d~y,§_~ft~ll poti:fll:a to -~qrrf?~ eiy~fl. fr<:frn Cbun!)l; · US Script agrees to this requirement. US Script provides the County currently the ability to query online claim data history via Discoverer as well as our secure web portal. This is the current arrangement in place for the County to access this data and will continue to be available during the next contract period. Access can be granted to multiple users and restricted to allow as much or as little viewing ability as the County chooses. County staff have the ability to run reports, view eligibility and transaction history. If needed, training for this feature is provided by representatives from our Benefits, Implementations, and Networks department. EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 28 of 170 The County can currently query online claims data via our online claims adjudication system as well as Discoverer. Once accessed, this data can be downloaded and exported into an Excel file for review. Any information captured and stored, including medication and dosage, is available for review by the County. P::Maifif~in.tb~~-ca~abmtY tci:~prQk!~i=.rrumtfily·deta!J~cfWe~~ruRtiori·.a[qgG~~ifn~f~ t~ Coun :l ·· · · · · .. '-·-,.~ty.-:.l US Script currently provides monthly claims data to the County via SFTP website and will continue to do so. Data accessed via Discoverer can be exported to Microsoft compatible software. ~~~~ovj~e-a?E~s~to t~2J1ni~rrsuppQct§!art~9-~!i: r~f?rmii~J9~<t:~Ef§l&o~~q9Jt~ibln9.tl:l_[~~ 9f amy.:J~roP..os~a repQr:tJI\9 s~st~.!Il~ US Script will provide access to technical support staff to respona to any questions on the reporting system. Training will also be provided to County employees if needed in accessing the reporting system. fx:··~·u"'~j:e~l werfdor ~,~.~~~ meet t,he 1~lt§wfn9 'r€i.qulretl}~[l~~ ~-Medi~eal Eligibility a'nd Billing' prients r~~ei~i~g medic~~~on~s meaJC8[ffndrgenf'pft~~~ec{jme ~Qffi'l~,fo . edl!Cafi~~rJ~,prL ~hall ;be ~~~Pg~sible !or ~(l!i~g~\~[\11edi-Cal~~hen, the clie~tl:i~' [\11~~i-Cal elig'i.pl ~~!;·Cat:eugiot!~~ tor ciJ~n~~"!llayir,emam q.i~t?J~tent orm~¥~~uctuate fro~.~~10'11\~7t~"=fYlonth. , .... ,a. ll!JP'1t~JY. ~as1~, P?~n~wlll no!!fY.t~.~:ve~·aor"'en,~ •. f?l!~nt becom~s .~hg~bl~lJneiJgt~le for ~~~~,1:-C · 1 M~di-CaL.,, ~hgJ.g,ll!ty·.qan oe de!~.[ITll~~dretroaCtJVe,ty:.and;;vendbr §I} all bedreg~lreqtto:J>§tg~:_ t-::C~I':§I_!}Q aqjl;(st inv.oip~§.':~~@J:Qkig!Y u~~tQJg:[JreviouS<Q}QOth§J US Script understands this requirement and is currently providing this service to the County. We will continue providing this service as outlined above. s~'"'Fre~1rr1~fiorization Requ~Sf<T:~Rl for .. DBH,~~.f:l~:·~~~s'~'Jientswho ar~.Wedj~9alel'iglbie,· theve·n~itor1>~~p~~fi~)~f9,~j?~n~~billtYf§fl ~re~tme:nt'7Ai.l!~e>ri~~!i9.~~e~iiJ$St ~AR),,,~uq~issi~p .of·~~~i~~al. cov~rea •ar~gs; ~~pn~~?X~.~~~ me.9.!qatro.!ll~. ~nd s~!lJat~~~:s, •Q.~plw~g overst~J6) g,resc~~~t1pQ~P~:~~1.fl!eqt:kSI,nce•paym~ntf91l ~e·~lzCa!~~hgtf?le chents'-!111 ~~ideQI~d ~yt~eFCou~ty; t~e ver(Jor ~Ill q :W~~g ~gb §l.JJ?~egy~nt charg~!).one?e t,he~y~n~()rJ2I9Vtaes verification of!1th rom¥:!1:l~·~~.t§IJ~~ US Script will continue to work with our contracted pharmacies to provide this service to the County. c~ mriiledl"2c~ai·Be'Q~ ~eq~9r ~~ali:s~~rri'lt~a rrltl'htHry:Medi""CarrepdlfCQhtaini~Ci~tail~l~~~Pd"• : ~,~-~~~tfiafaf§ ~ei,~~ iq~~JR~~zt>!~ t~@,CO.Q.J;)ty,because dfM~~i-Cal:ii~eligibi~itys~_r rejectj~p: . . .,, >""' .·.· .. q,;~. J:?IQYJ<t~JnfQI!Jl~Yon;that .. ~esiretrqactlvei!Meq!J-Cal:±ru!g!~l~!Y,J!IJ!t€i~!~s.e~n9amQ.YfltSeJ EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 29 of 170 As the incumbent PBM vendor, this is a service US Script currently provides and will continue to provide to the County. US Script will reimburse the County for rebates received on eligible medications paid for by the County. ~--~,~~~eb~!rc3m:a_r~11teeS!!~_IidorJ9:_§rate if v9!1~gM~rintE!il~~J~vg{f9fi~~~t~rrui9~~a t~n ~C19I"Ldru~~ Our rebate agreement is based on a pass-through basis. US Script will guarantee that the County will receive 75% of all rebates earned through the County's utilization. ~;1retiat~J~~fmenf1F:t~ffue~cv~. v~<Nlt<!:~tater:i1lOW91f~-n~.tt:Win~~i5~:~· paY.!Tle,~l Rebate payments are made in quarterly increments. n--Re6~~{~ Ti!li ... lng··~··vefinbrJo si~e~how1'Qogiitwij[ful<~1i?i~To'r~.ciiie~~e~at~ IC~neratedtlitob h the ·r:c ramJ g-·-~-·---·~--9-.... -Q~g ....... . The County's first payment generally represents approximately 50 percent of the rebates billed to manufacturers for that quarter. The second payment generally represents approximately 75 percent of the rebates billed to manufacturers, and the third payment generally represents 95 percent of the rebates billed to manufacturers. ~-·. y~n~g,(~~il·suom~1-:fe~~~~lrcle~llfct~t~lfH1e_ rebate~J~i~~~t9li~~unt}'~ •. ,. [h~i~rst·rebat~ r~po J~(~~ue ~ne ""!2!:lt~~t?.llowmg t~e. fir~vs~,~~n<?~tof ·rel5at~ .. t.?: ~-~~~ J~~unty~. . ""'•! [h~~~after, a ~~R epart w111. be ~,~ovr(f~qJ?.CI§JldAm the agtE!~_cttJ.PQn .• r:~~.;;Qaymel1ts_c..h~9ulej L!:tJIJ!.ditiQI'h tfi.~r· :~tt~ha.IIJ>,.~jJ1cL~d~,d~ f-~Yw-w•• "~'~-.,1~":"""'~'"4~4"'"'"' ,n-UY ·~~·~~~'f'.~~""----~<Y Y-="-''""·~~..,.~.,,·~"T--¥"'' ''"' 1~. -~~rcentag~"?f~'eJil~~::r?assea o~ to c;(pun~Jist~~ by qnJ9 ~~-ITI§ ~-Q~te~$)·r:~~te~~). ,•,s. !Q,~UCGea .bv+;~rug~co.rnpan~.,,r~.~ ~.:.····~~;~~~~~tt~ihfHlf~6~~~~~:p;.,;~s{§~iJt£2~:~~1\le1T~§~mQ.~ g_oii~Q!.~.!:t[or e~.m!g~rter'9f. eyefY,:Yea~3 We are unable to provide the requested level of reporting detail request above to the County. We are able to provide information on rebates collected for each quarter but not down to the drug or manufacturer level. Should this be of particular concern to the County, US Script will be happy to discuss possible alternate solutions during contract negotiations. We currently have in EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 30 of 170 place with the County rebate payout rates applied to the County's specific rebateable claims volume to generate rebate payouts. US Script can provide this service, using our wholly-owned Verified Internet Pharmacy Practice Site (VIPPS) certified mail service pharmacy, RxDirect, Inc. When and if medication(s) come into the clinic, they are shipped to our mail service pharmacy and inventoried there. This system eliminates the need to store large quantities of medication at your facility, requires clinics to keep fewer medications on hand, and frees up clinic staff. The PAP Inventory Programs works as follows: 1. The clinic ships all stock bottles received from manufacturers to our mail service pharmacy. A form is supplied to clinic to transfer these drugs to the mail service inventory. 2. Once received by our mail service pharmacy, a pharmacy technician will log into the online PAP program, check in the drugs received by drug name, and fax a receipt to the clinic. 3. When a clinic needs a medication from their inventory of PAP medications, a clinic staff consumer faxes an order form to our mail service pharmacy. The staff consumer can order up to a 30 days supply of medication at a time. If drug is not available in inventory at the time of the order, mail service staff will fax clinic to let the staff consumer know there was insufficient inventory. 4. The drugs in the PAP inventory can be used for any patient who qualifies to receive medication through a prescription assistance program, including patients who have not been officially approved by the Manufacturer. If the clinic dispenses PAP inventory medications to patients who have not officially been approved for assistance, the clinic will replenish the inventory by sending medications to our mail service pharmacy when approval and medications are subsequently received. Example: Your inventory sheet shows that you have 1200 Depakote ER 500mg tablets, and you have a new patient that needs a prescription for that medication. A clinic staff consumer orders the initial 30 days supply from the PAP inventory at our mail service provider, and then sends an application for prescription assistance on behalf of the client to Bristol. When the medication comes in for that patient, the staff consumer ships the medication to our mail service provider to replenish the borrowed stock. As you participate in the PAP Inventory Program, your inventory will continue to grow, eliminating the waste of medication that can result from unclaimed medications or changes in the dosage or strength of the treatment. The US Script Account Management team will continue to provide comprehensive training on our data reporting and system software package as needed. Ja-:-~·. tfaTnlngj!:iust-ti~ av.s!hi6re to coun~ stai(~lm!trrt~~""ye~r·to~~s~~t~~Qf tllEi ~nt'r~~~~~ EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 31 of 170 Training will be provided by the US Script Account Management team for County staff as needed but no less than one time a year for each term of the contract. ~,::~r~IJiilQ'"~IU Q~toc>:~g§J·t9l~~~~~.2IJ:iiti~ The US Script training provided to County staff will be at no cost to the County. ~.;~:cX!en~W:Sfiallji:fovi~~i!ftr~~~9-,ma,;~aisJ••The"'tra __ -~m~t~~!ai$:~~srBem~.~~~~~rJie'i~ f31ther h~~9 C()~~ ~.~tonll~~,':ln prrnt~ble !~.~rnat..>}~h~Ve -• • r shall ~[idat~1*t~e,:·traml~g m~~.!3~!g!!) od ~'"LQ!l!QOII}g basrs a~Jeonnolqgy..§Dc! ne&Q_~ obang~Jhrc/ugJJQ~ao!Jt~JJTl ofJn~ieontr:~ptJ Any training materials needed for training of County staff will be at no cost to the County and available in either hard copy or online in a printable format. Any updates to the materials as a result of updated technology or system changes will be available throughout each term of the contract. US Script is responsible for all costs of the training including but not limited to travel and training materials. US Script understands the County will always be the payer of last resort and agrees to appropriately bill, including back-billing, and billing all prescriptions that may be eligible under an alternate payer. ~~~·~···-~~,'"-"'-x~~~~1)l!"w"-. ~~w~•""-·-_,..-,-, '"~»-,~'~''0. '' . ·~··•··•,,u-~-·=·"~"•'-___,.,~'f"@)'?"-~'''"M=~··~····• ,.""""''".)'"""'"~'if?J)~'~....,..~~'""''"""''",.,,_,_•" B: Vendpr_w!J,~i~rp~!~e DBH W,~th i~yoicing groupe~bYjfF9~~# and PlaniE?!-;~(9~;~tc(#pter) .o~ ~ij ~lrE!~~ed•".~Qd"defined .bytpe q~unty•fore~oh .. ~r:ogrc:tm as<eaqf}J:>tQQra~get·Tg§pgn~IRtli!M tor~~:~ C~~t of•drugS pre~~ri~~~;<UJ9 dispensedto:,if~. cli~pts~~.c-·· .. ··"········.·· _ ··"····-~·~~YR ~ach. De~ar;t~~nt~~BH .and 19SS}:3~re ~~"reG9iv~,e1n li!Yc)l~Jr;:om:li~m~ .. P!aJhat~mJngJgg_~-~~'a.rg~.§ . ,r<l~~n sl!it\'m.i.~~g[QJ::IQ. ClQctP.lC1n.LO~(CQ§~tc;:~r:t~er).: US Script agrees to this requirement. As the current PBM vendor to the County, invoices are broken down as agreed upon by the County and US Script. Please see Appendix VII. B. a for a sample invoice. p'.•.·tn,v6fc~i:§h~JfB~§!!9lD1~~5rhomthl~ .. biV~ndorasJ).Qlli.~~P.iii!!f£~YI!t§!iCf··.a~~·~~f~ ~_Q~/'QIQ§g) US Script currently provides bi-monthly reporting to the County as both a paper claim and as a data download. The data download is available at our SFTP secured site. D.]nVOi~~s~~.~TI .~~.ac;:~~.taT n~~t!f!ie!ra .. i''•· • _.,,. ·~·a~j~;n.r~g~estedbY the·CciUg!yl . Wendor is:!Q~~l,J.Qrriit"~gg~'at ... _ JltQIYJJj:Vo1c;:~: !!J.§t S.b_<i!ll .. __ :.~~ved bMr.CP,Ytl .. !Y rJ.QJ§JerJt!f!!l ·thE! EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 32 of 170 US Script agrees to this requirement. Currently, the County receives all invoices no later than the 4th business day of each month. ~Yen.9$?~-'1~naii~~[[fii~QiiQEalftlwol~~-ii~j!!st!VJDi§i@n"<lcr~<fits.:d•:J'ilo~6e]er!TI~of@~ ~greg_m~ot. US Script agrees to this requirement. r~--~,~ach~!Jpe'Jterrt:g11Ih~JnYo!Ce~~ti9!Un91ud~~thel2iioV[Ij9:]1llfOrmation: 11. ~pnt@ct Numg~r; ~~-··· o~~Jo:hum~~,:, .. • :.W6y th~fto~~ @: r ''· r;t.:IIJ ~~Jnb~~+a,. .)ir;t~~ br;J+the ~CouQty fcl. QhentNameap.~Dat~.of<!31rtli p. <guent'·bM!ml•# c~~.qvia~~ .gytne]Sou!lWJ: 8. .P,(es~ribin +Phy~iciaJ;i's Npme t ,•'''\''', ~ ;,' ,:'• '.'•,," P'fhP' "<~'o/CNW"~,~~'o/~:"'"'"'-"''":wh''""'-)""'~~-""~"'~~~~"""! V· J?r~~crib · rug;d~~~gel~~trength,·J~DO#,·date dis,e~Qse'Q ~· l;he:num A++<: of unit~:"lis~~.Q~~~ for~~ch ~rlug~d~~A~ p. J$be ·c~pt~~ct' ~~~t.per un~~lltor ea~h>~rug19.psag~1 ~ o~ Cont~pted P.n~~~:for ~a?.tt~IIJQ:'rhsp~Q~~.r ~ 1. ~V\(.~:!at t~e tJm~.!Qf.§§i§ 112,:<,!Pisc~.~nt~-~------. 'TFf%?1 :13 .. Administrative Pee i ·.(•lt'Wjl,,, , : . :,p'ilpH·, , "-"' ~4:•Pi~gensin9feE1 I US Script currently provides bi-monthly billing including the information requested above. A sample of our current invoice can be viewed in the Reports section as Appendix VII.B.8. ~~·}<~r)~~r·wili ti~lJQUirai:t·r ·. J:alrpa~~urce~.~ir1~!~~1n:ti~r~tiQ:@9~M~~J~g§J:~si§=r~g.IJ!reJ!l ~nd:'Jcr~~diMhe~QIJ.f1!~ to&the. PIQQriate~gri9!Pal invoig~~ US Script agrees to bill all payer sources, including retroactive Medi-Cal and other private insurance provided the County captures and provides to US Script all necessary information on any other payer sources to enable us to contact those sources or notify pharmacies of alternate coverage. R~~~~'tfen<18(~q,9!!llayErft1e'a6l~ty-~9::rpr~vide-l~~~~c~1JfdJUsfments·a··:'r~~r;m~mq~ <)!ii~~ mvotce frQm tf1le•currentmont~ly mv01ce that,wllf reference the. or I®IRVOice.: ~eg~pr s~allp~?v' ... -~~~rre~t:inv~!~?.~Vd a.~econda1 11~Vdi2~~~~i~i.!l9Q;;PaStiihVtnC~t~~.g~~, 1ten:ts outstand!p~ '··w·~~ tsta chant ~~"~~~;1 pepprtJe f\18dl"®al ehg1bl,~~ :~t~'¥§¥~~~~gr /~ppo1~t the•,r; ~ccqunts Rec~~YI:l9!~,~~Jl~esen~atl~~ to_~~rk,!%'th gpunty staff to r~S1Q!V.~ pay:rn ~-P~!h~n 11}~ P.!,JJ!~Qt.tP~t'a~~~EtC~ri~.Ciry£![1YQ~~!!:{ln_..:<Jggqii}Q lllOQ~~!y,._gg~t§i As the incumbent PBM vendor, US Script currently provides this service to the County and will continue to do so. """~~ ~~~ ~-.--*"'~iF~"1t''~':""'"'"_",..........,., ..• -,~~.--,···· ., »~»"-.~»f ~·-~~?;'"';;~"~~"'""'P~'":;"'~":""::":.;~,'T::"~· -~~»·•:···;·~·=--~--,H.....,~-.-·· -. . .·-·"~---.~---v-"·. • ""~' --~. -, u--'~ '" , <·-'"~ ~· ~g.~ntY,~~fevi~ws all invq~ce~ ~or ~.~~ura~y. ~~yments tq vendor f~r ina,9cu~~te iq~oic~~.ma,~ be ~e1e1yed d~ s~~.B~P~~~ ~~til ~~%mddr:~submits a c~rre?t ip'!Qi~c{ GQ~Jtl!Y ~~~I! m~!<~]:>_CiYm~nt~q ~encfor -umon 'v~nficat!QI1 :QfJije_C1.99Yr.§.~Y~;Qf tM~ lnVQJ~ EXHIBIT H: CONTRACTOR'S RESPONSE US Script understands this requirement. Exhibit H Page 33 of 170 r-c.ouo!Ysil n'oti1aydis~nsmQ70ra~liji~triti'[~··teliw~na:Qfalllil§]enle~~~Jtl~ ~-Qyrjty_~u~J !l~rJt?Y~r. §QJ1rq_~~~!ig!ql!l!Y.:! US Script understands the County program is the Payor of last resort and will not pay a dispensing or administrative fee when a claim is eligible for benefits under another program. Please see Appendix VII.B.8 for a copy of our current invoice to the County. L:-:;l.;pvoiCe"Rfcori~i!it:ltion-:;;;Wend'or· cco~rif:M8rlaii~r vrilfwoi"~~WJ11!f1ilCI)~J.Puan5 ... ..\ ro49 repr~~e~t~tivesto,.t~sdl~eag~CJ req~iv·. les &alances~c)'~·~a rJ)QDtftW· b~sisd~ThiS;Will) cluf;fd issu!i~.r~J~teQ!fQ rVtedi~~~~ .~ny_q(her.:t>]!im~lRaYro~nt conc~rn~tor ag:~<((~aol.~§r .... --- As the incumbent PBM vendor, US Script currently provides this service to the County and·will continue to do so. ~I j ' , < lJ'' , ~,.,w,• , •: :' ,''~ '•:"'/,_" ~-,,·,~~"~P"~~"t"""'"-"-""~~") ~·~~'""~ """-~'""'''~f~=0'c"ey.-• y.• ""'~~~~,_..,.."':""""'""• ~e~138?r may b~fe~IJested td'iRfoyide st~.f~geand~~~;.P~fkagihg ;; '· ~ilablej· e~j~ationac~J;Jireg thrq~gh drug 'l!)1pr,tufactlj~~(s;j:?atleqt~As~Jstance P;~qgram (P~J~): .. d1rect. _j!JE:t9.ouQtyj Venabr P;~P. dispep~ing!{ee, if.anyw;!;~hall be s.t~te<fin vendo~~~:Cost Propo. ~t. t~i~ ~i!fi~. ?J!~Jlt!>i~~otiijN t~~b~ eligibl~,;for~:;PA~.':arE:1,1~~~te~iew:~;,p~;~~s.' . _a~;~§r:-.~ljgibif~tM ~nt~I'a ~f;tabh~ne~i>Rythe'va~!·~~sJ::>rug'~~n~ractu~ers:,~~f': ~~~·~nt·s:rappl~~~;t~.~*~~~s sentt~:~'hEL-­~aflHf~Gl!lrer,:and·,yyvi1~!iJ;approv~~' a cltent'~,m~!Gattons are SQI~P~~(ijlrectly t ,.,.13,~~·,: D§t! rur~~s in.turnrgj~p-~n_§~_1tle m~diq~\iOIJ.§;Jo ttl~ cliei)t i1J .. ~£QQUClance'wittf?!J§!~t QQrov~g gui(j_elin.~.§~ US Script can provide this service, using our wholly-owned Verified Internet Pharmacy Practice Site (VIPPS) certified mail service pharmacy, RxDirect, Inc. When and if medication(s) come into the clinic, they are shipped to our mail service pharmacy and inventoried there. This system eliminates the need to store large quantities of medication at your facility, requires clinics to keep fewer medications on hand, and frees up clinic staff. The PAP Inventory Programs works as follows: 1. The clinic ships all stock bottles received from manufacturers to our mail service pharmacy. A form is supplied to clinic to transfer these drugs to the mail service inventory. 2. Once received by our mail service pharmacy, a pharmacy technician will log into the online PAP program, check in the drugs received by drug name, and fax a receipt to the clinic. 3. When a clinic needs a medication from their inventory of PAP medications, a clinic staff consumer faxes an order form to our mail service pharmacy. The staff consumer can order up to a 30 days supply of medication at a time. If drug is not available in inventory at the time of the order, mail service staff will fax clinic to let the staff consumer know there was insufficient inventory. EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 34 of 170 4. The drugs in the PAP inventory can be used for any patient who qualifies to receive medication through a prescription assistance program, including patients who have not been officially approved by the Manufacturer. If the clinic dispenses PAP inventory medications to patients who have not officially been approved for assistance, the clinic will replenish the inventory by sending medications to our mail service pharmacy when approval and medications are subsequently received. Example: Your inventory sheet shows that you have 1200 Depakote ER 500mg tablets, and you have a new patient that needs a prescription for that medication. A clinic staff consumer orders the initial 30 days supply from the PAP inventory at our mail service provider, and then sends an application for prescription assistance on behalf of the client to Bristol. When the medication comes in for that patient, the staff consumer ships the medication to our mail service provider to replenish the borrowed stock. As you participate in the PAP Inventory Program, your inventory will continue to grow, eliminating the waste of medication that can result from unclaimed medications or changes in the dosage or strength of the treatment. ~llnrarRe~uTr~meniS ~ '!\0L'', ,' ''"+ ,:·, '"·:' ','' ''' ,.__.,«"""'""··~··--<""*~~""~··-""""-·" -·"'-'~~"'""""----·--·····"··~-..~~·~ ·•v·~-"-""""'"""-o"~"''-··-·".····:"'":· w.•-"•···;·""""":""-.· .. ··~"~"""'"". ,.._.--"-·~··:··~·;• . .-?"~ I. en~o.r t ~!rarl~.;de.~~~ber.4!~ ~~~n~i~!~! caerbilme~ t~n;.~_dOJ,\!liS~~~. tl"l.~l·~Q.¥,~~:~.:w~n~~l h~altn pre~.~np pr;(;)graoo~ .\{~pqg~,:to prov1de; spec1fic 1ns1ghts mto•the~:Syste!lls;~Qroce~Se$~and ~x~~.rtis 'ia~~r p~~~e~'es,t&t7~te th;e highesHevel1:.(:)fQer\forraau~~11!L~~~Qrd~hq~~ith~ ~_gunty:s;r?_,gyir~rJ:t~JJt§J tJen~or .snarr ensure' proposed sofiWare~prOci~pfs~are~a\iaTfal:i~!3F:I?~Ei!lty:-fQ.\Jtt!2t.ir§_i!~rCia"i~ ~65.day§_p_er ye~r;. v.i~ ~VY-~t>:~f9~~LJnterf~~ ~eri'~oi-'S:rconffact~~~p-fi~q[~1i~lf~eM~~~-trr~t'1s;1!§-ure~cfl~ts~~certifie({;.~ lqi.~i:Jdi~!QPJ~ th~:\t~ndgr'sn~twor~ oficontr:acted+phar:maci~s.st).~ll .. b~.~~sert!J!1?d·w··:re~eive,new·jl)i"escEiptio~.~a~,p r,bl~~~o ~endelectroriicr~fill·f~~ue.~~~ ( ~e~ci~,~~fliiY~~Q!}j.Q, "bot''t)y'fax~'lvia\ttl\le .l;lt;larTJl~QYUJ-ieatttf ,,nfg~mattol) E~~hange;;.gp~,?ted byl§J!L~$£DP!§) ' US Script meets these requirements. Our online claims adjudication system is available to clients, pharmacists, and providers 24 hours per day, 365 days per year, including holidays. As part of our standard contract requirement, all pharmacies must have SureScripts-certified software. US Script's clinical team will provide Drug Utilization Review (OUR) services. OUR is a structured, continuous program which reviews, analyzes, and interprets medication use against established medical standards and criteria. US Script's OUR program integrates prospective, concurrent, and retrospective analysis. Combined, these methods create an effective force to enhance the safety, appropriateness, and cost effective use of pharmaceuticals. The County's OUR program will be tailored to meet the specific needs of plan consumers. Based on prior consumer utilization, US Script will develop a program to address established EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 35 of 170 OUR criteria, known or suspected problems, and areas representing high cost or safety concerns. Concurrent OUR includes those edits automated through the claims adjudication system such as drug-drug interactions or drug-disease contraindications. This form of review is automated at the POS and typically does not involve manual review. Rather, the adjudication system alerts dispensing pharmacists of potential problems, and it is left to the professional discretion of the pharmacist to evaluate alerts and determine if medication should be withheld or dispensed. All of the edits in US Script's system can be programmed as hard, soft, or "message only" edits. In many instances, the plan sponsor chooses to defer to the dispensing pharmacist at the pharmacy to make clinical decisions regarding the dispensing of medication. However, US Script can code clinical edits as a hard edit at the plan sponsor's request. Please see the table below for a list of US Script's standard hard and soft edits: Stage Member Eligibility: Identifies the consumer within the US Script database and determines eligibility of both the client/plan and the consumer. Members' entire eligibility Hard Edit history is maintained allowing accurate determination of • coverage regardless of the date the claim is submitted. This is essential when processing paper claims from consumers rmacies. Provider Participation: Determines if the pharmacy is in the US Script Pharmacy Network and if it is a retail or mail order rovider. Prescriber Participation: Confirms the prescriber participates in any client-defined exclusive prescriber networks. Timely Submission: Requires a claim to be submitted within a client-defined period of time following the date of service. Post-dated claims are also blocked. Duplicate Claims: Validates resubmitted claims against the original submission. Those having identical data will be processed as duplicate paid claims and return the same pricing response as the original submission. Rejection occurs if claim data is different from the nal. • • •* • • Soft Edit Message Only Edit EXHIBIT H: CONTRACTOR'S RESPONSE Stage Quantity/Supply Limits: Verifies that the quantity and estimated day supply values submitted by the pharmacy are within specified plan limits. Client-defined default limits are available at the retail/mail level and maintenance/non-maintenance levels. Maximum and minimum limits can be further defined through the following properties: Drug properties (e.g. therapeutic class, legend/OTC, brand/generic, DEA Class, formulary status, route of administration, compounds and others) Member properties (e.g. age, relationship, specific consumer, gender) Pharmacy/physician (e.g., specific pharmacy or pharmacy network and/or specific physician or physician network) Claim properties (e.g. DAW, Other-Coverage indicator) Limits can be at the claim level or per time period based Other client-defined limits available using the properties list above include: Maximum benefit amount (e.g. $500 of smoking deterrent per year) Maximum number of packages Maximum number of fills Drug Exclusions: All exclusions are client-defined and can also be defined using the above listed properties. The following types of drug therapy risks are checked in the concurrent OUR system: Drug /Drug Interactions: Detects potentially harmful drug interactions, e.g., combined use of the blood thinner Coumadin (Warfarin) and the antibiotic Flagyl (Metronidazole) will place the patient at risk for a major bleed. Drug /Inferred Disease Conflicts: Detects potential aggravation of existing disease or condition. Detects conditions where the therapeutic effect of a drug may be altered, e.g., Asthma and Beta-Blockers with more sophisticated examples if identifying potential drug therapy treatment of drug induced disease (Digoxin Toxicity). Hard Soft Edit Edit •* •* •* Exhibit H Page 36 of 170 Message Only Edit • • . . . EXHIBIT H: CONTRACTOR'S RESPONSE Stage Hard Soft Edit Edit Therapeutic Duplication: Detects when a prescribed drug contains ingredients that provide the same therapeutic effect as a previously prescribed drug, e.g. Zantac and Prilosec for peptic ulcer disease or combined use of Benzodiazepines (Valium and Xanax). Over Utilization: Detects when duration of therapy of consecutive prescriptions is outside safe and effective ranges, e.g., prolonged use of anti-ulcer agents, nicotine replacements, narcotics, sedative/hypnotic agents. Drug Dosage: Detects when dosages are outside generally recognized safe and effective ranges as defined by an individual's age. Early Refill: Detects early refill attempts. Override can be put in place based on client preference through NCPCD Submission Clarification Codes: 3 (vacation supply), 4 (lost Rx), 5 (therapy change) and 6 (starter •***. dose). Allowances for retail and mail can be defined as percentage based or fixed number of days and client-defined. Late Refill: Detects past due refills. *With override through Prior Authorization system **Optionally a hard edit with overrides through the Prior Authorization system ***Override allowed by pharmacy or through Prior Authorization system Exhibit H Page 37 of 170 Message Only Edit • • e** • As part of the service we receive from MediSpan, OUR edits are updated weekly. Additionally, plan specific edits can be added on an on-demand basis. A sample report package has been provided in Appendix XV.A. r. ..:.:.R· .. ·· w.·.'e· tro·····s .. -.pe~t,iy~ .. -. ;Qi1JQ:····W·····.···.t·i .. ilz.~tiqn:'R." •... evie. ··w··.• ... ·-rRQJJR}7~ ·V·e· n ... -. dd·"······.·:···m··· ... ·· .. u. §.~!~~s~i.be. ~.i·t·s·.··.·. -.().· ".·.'··f·i·h· . . • · pr~~~~~~a~Ci'ffie ~ s R~rer58its ~~ail~~le ~?;'Coun~·~]~"~'1l\~edl~til Di~ectp~~ tqg~v1~w. _ .. ., pres~nb1pg patter ·.\(~ndor shall have"ablhty to prov1d~ rer;>.orts t~at Will allow ·· Colin~ to Eevi~w it$'clru .. s~ ... data (p~~~q~~~er;·'patient, d!J!g .. dq$ag~~~!~1dat~?9!9i~PE?!!f?~ di·d·· ro §pecLty_~c:lit§, •· uide!ine.~it1~ill.use foLRQQBJ US Script's Retrospective OUR program evaluates both current and past claim data to obtain insight to individual member medication use, physician prescribing habits, and pharmacy dispensing habits. Claims are reviewed for therapeutic appropriateness, cost-effectiveness, quali~ of care, fraud and abuse, over/underutilization, potential adverse drug events, appropriate dose and duration, and outcomes management. Once analysis is complete, intervention for prescribing and dispensing is recommended in order to assure quality patient care for future outcomes. Outreach letters are used to correct inappropriate prescribing and dispensing practices. This is often a prescriber-focused communication letter that is used to address specific issues such as: inappropriate member utilization, prescribing patterns outside clinically accepted guidelines, updates on evidenced based criteria, cost-saving strategies, availabili~ of cost effective alternatives, and drug alerts (i.e. recalls, black box warnings). EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 38 of 170 Additionally, member-focused communication letters are used to address concerns surrounding medication adherence. Outreach is conducted in order to provide optimal patient care which ultimately lowers health care costs for members and plans alike. US Script's Clinical Services Department facilitates the DUR programs by pulling claims information from our data warehouse in order to identify specific areas of inappropriate utilization. Retrospective DUR reports are used to target specific members and prescribers for intervention. Program performance is determined by reviewing the member claims history to determine whether the targeted intervention resulted in a successful change in therapy. US Script's 2015 DUR program will offer educational outreach and quality data results in an effort to improve patient outcomes and provide cost-savings to plan sponsors. The quality outcomes section will align with HEDIS®-driven measures that will be populated through use of retrospective pharmacy claims data. US Script's Retrospective DUR programs helps physicians and consumers determine the safest, most cost effective drug therapies for treatment. These programs vary based on the specific utilization of the health plan consumers. As part of US Script's standard reporting package we provide detailed information on OUR statistics and activity as listed below in response to question XX.A. :•"'.-,.'"fWk'(I~-·>'""";"W"••""""~'"'!'"c•~~~--, "')"-~•""!P""~:W...,.,..,"""""=~··="""""""~'.~'"'~T'>'~""'~""-'" "~-·"~'<"•:'•")""~.• -·~--"-"""Y" 110'->:= ~ U ~-~~ P::'.~~eri~ric ~WJ>stitution~ (;gi:Jnty ma~q~tes·a gen,~r,ic~~Libstitute::t~r. d name~,drugs .. ~ -~--~ Wh~,~ever po~~bl~\£ Vendqr~,Qall be req_~iregto admirii§(er,~,J1l~ndat .,. ,,,95ai!~Iif_ st,~_b.§!tlut!Qitfofj !M&i1frl!g_§-g~ed:\!!Dsi~r~he·Firesm:g_Q_olln~.mental h~-~llh dftugJ\!ft29t§lm. US Script's policy is to substitute a brand name medication with a bioequivalent generic, unless the prescription directs the pharmacist to dispense the brand name drug only. We can administer a plan-specific generic substitution policy. As with other plan design elements, US Script's PBM-1 platform is capable of supporting a wide variety of generic program options. If our clients opt for a mandatory generic program, US Script can create the program according to the client's specifications. Plan options for generic dispensing include: US Script administers a mandatory generic substitution for drugs covered under the Fresno County mental health drug program ~~--"',~,rnir:AutH:<ifrlzaliO~(~ A~'~Yr'-o-rt~·aas'"2rlbe1lffs-Pl:\tp"fQ9r~~Pi~!f!f~iio~v~mg-tt~~~i J!llgtipJ]~ 5l.Dd tbe R~'.s aQlli!YJ~L... .. !§.~!~Q!~Q..Qmg~ US Script's Prior Authorization Program is incredibly flexible and can define prior authorizations sensitive to time, drug, patient, and physician requirements. Prior authorization requirements are typically defined during benefit design set up, but can be adapted in real-time if a particular area of utilization needs to be targeted. US Script's Prior Authorization department is composed of a group of 25 PA technicians and 9 PA Triage technicians nationwide who specialize in clinical decision-making. The pharmacists manage high-cost and non-formulary medications by making important evidence-based decisions that support both patient care and cost containment. Our Prior Authorization Program is tailored to meet your overall plan needs. Prior authorizations can be sensitive to time, drug, consumer, and physician requirements. US Script's Prior EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 39 of 170 Authorization Triage Department of pharmacists and pharmacy technicians review physician requests and ensure that criteria are met before authorizing treatment. The County may also choose to administer its own prior authorization program via our PBM-1 online application. During plan design and implementation, the County can choose who administers prior authorizations and the actions necessary to override a claim denial. Please see Appendix XV.D for a copy of our standard Prior Authorization form, which can be customized to meet the County's needs. A Prior Authorization Report is also included in our standard report package in Appendix XV.A. ~~'""~~=~acR~,po~s4~t:~~o'r'l? ~~~critte'ffs1~~o-~f:C?vide,a. 'v . c·rep~ tt1a~:~r~7:~eit,-,,", hta~.dard~p~~~~orm~tte~.'ASW~II·,l,~•s'repon:~t~.e av~11a91e o~hne :1gtC n~g!llfin ~Y~t~or:JJ~ .~w .IQ[l9 Wlll·'ltJ~Js~J!U1tQVIQ~i.~!JY1~9~Q m.forma!!onJotCoUIJ.fy?i Reporting is an important part of ensuring appropriate utilization of your prescription dollars. US Script provides usable, actionable, real time information and the customized reporting capabilities you need to target specific data and trends and to actively manage your pharmacy benefit. Effective strategies are developed and implemented based on the results from the following reports: Ad-Hoc Reports -Customized reports detailing information specific to individual issues. Simple ad hoc report can be completed within 5 days of when the request is received. Larger more complex reports may take longer, but generally most report requests are completed within 3-4 weeks. Ad hoc reports are customized to provide the level of analytical information needed by the Client. Should the County request an ad hoc report, US Script personnel will work with the County to ensure that the delivered report meets the County's needs and requirements. Please refer to Section XII. Cost Proposal for additional information about the cost associated with ad hoc reports. r~~~~~~z-~~e:~'!\.of~pveyed drUQS~··.·.fhe~~rfd~:f~~nad}TifnJSter ttliS, I F~.f:~,t,~taw,(EX~ibit 1~ ~ •• ~~rm;~r.aryJ:rand.if}he(f is ~;,generic availa~!~. ~~!Y t~,f, .. g~~~~r!g ~lspl9nsep .. \{.~l:)dort.to Cl~scn~.~,it~,r~vernde proce~~· wryfl~ th!=!t>pr:0 cess~ts a~d~ the time·'~stiJti:~1ed3tp·prdcess"~n oyerri~.~· orseek'pre-autho~izatiqD ct.~~rto .... LU pos$esse'~th~~:§bili~ to1provillle · r~f!!Q.tl~'Q.nJ~tlU!I~-d(!:!g§Jr~¢ri ' e~e'l1n -~-1;1~ t2rmQI?.ry) US Script has extensive experience managing custom formularies meets this requirement. Please refer to our response to question XV.C for additional information about our standard generic policies and optional generic programs. Claims submitted for drugs not on the County's formulary will be reported to the County as part of our standard reporting package. US Script's standard reporting package is provided in Appendix XV.A. EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 40 of 170 US Script has extensive experience coordinating Prior Authorization programs. We have Clients who manage their own Prior Authorizations, clients who delegate Prior Authorization management to a third party, and clients who prefer to have US Script manage the entire Prior Authorization process. Based on the County's requirements, US Script will work with the County prior to implementation to coordinate how all Prior Authorizations will be handled. As previously stated, US Script's Prior Authorization Program is incredibly flexible and can define prior authorizations sensitive to time, drug, patient, and physician requirements. Prior authorization requirements are typically defined during benefit design set up, but can be adapted in real-time if a particular area of utilization needs to be targeted. Alternately, you may choose to administer your prior authorization program yourself via our PBM-1 online application. During plan design and implementation, you choose who you want to administer your prior authorizations and the actions necessary to override a claim denial. ~-:1:iniit~tior1~{q~ristra :::;yen~or~io>~scri6e:~!}yilfiiitat,~flsoi;~~~r8liJl§Jri:~C:irfi10ist~!n9 Jhe Cou~ty's fotm~!ary=~ en9.9r1Q:ilil2rogg§~ sojuti9bJ2~wdrR~rot<~m::IJag~ llilli.t!lJ!.QJ1sL<;9D§~r.9i!lJJ2~ US Script does not anticipate any limitations or constraints in continuing to administer the County's formulary. p~".,;;\~_oriTrrua~,1,~pa~teSI~,tian§es ;;f¥~ooort~;1::~esctiba·i~fa1?1iity To,ac~~Jn:mocfal~,~hatfi99s!~~ . ~eleJions, an9f€!9.c:l.rttQD§JlQJD~ ~grrlitl!l§ry :_Qutltn~Jh~§t~Q§:.m~.~§§a~~!Q .'rnPI~m~!!!J9r!DYJ€!~ /::han9.~§J US Script's proprietary online claims adjudication program allows for easy accommodation of changes, deletions, and additions to the County's formularies. Any formulary change implementations will be determined by US Script and the County during benefit plan design in order to meet the County's specific needs. o:'nvendor~ffiis· ecr···the1~amountof tfm~tWIIFlin.whicfl'·au· can .. lncor··a~fOrmula·· :cnan"",.es ~:recalbt Qf.~Qtift~ati~Rr~-· ·~··---·· ···-.. ·-· _YS:. __ .•... · ·"·······-'P:..=.;.;:; ... -.-···· · · ·ry~_g_·~ Formulary changes can be made within 30 days of receipt, depending upon the complexity of the request. US Script can accept data in any format provided by the County. [~}~o-unlrui>Ciatesits ·~!Jjl't)U!!Y.:i~rJircq6!irr~Cii!i~~Sls{.tcan;:\79n<JBF~Wm9HiiyJ?~t~ti ~!)!Q§SfS,Q}:~J!g1t>.UJ!Y.~§_I}g~§] US Script can accept daily/nightly batch downloads of eligibility changes. EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page41 of170 ,,_._~:"!:"-. -""'"!c -,~--#'-·;~~·-·. ,:,:''":"'C'C'::'"''iiTfW";"''"·~.-:':• =·<=~·····~=m•"'4~, ·~· -· ~;ro~., ~-~"m~.,~"""""'~~·=·<~."-·-·).\f!'~~···u····-··-.r~<]!<.l';f"*"i"',."'"''""""". ":-'"""='5 C. ~~Gounty~.r~g~~ire~~;~ei)dor t .... ovidEf<!~web~oased onlir;te acce~§jlo vend9~'s cla,ill1~ · ~dji!Jdic~'j,pn ~yst~~~·for s~tt,~r ?"9~,!()~8'1:as e!!9ibilio/ ?~~ates,~nq·~~Po~!nciJ~equi~hi~~6!§:'1~ID[g~ ~OUR!Y_§~J!ff tq,::m<:!J<~ real:-bm~.lmi'J!l~Q!~te·.on~n~~!!glbtlltyJ!Q'CiatEts fQQls che.r:~ts~ The CouRty curreRtly has this access. Please refer to our respoRse to SectioR VII. AdmiRistratioR, for additioRal detailed iRformatioR about the oR liRe access US Script provides to our ClieRts. US Script provides oRiiRe access to the CouRty via Discoverer as well as via our secure web portal. Access caR be graRted to multiple users aRd restricted to allow as much or as little viewiRg ability as the CouRty chooses. CouRty staff have the ability to ruR reports, view eligibility aRd traRsactioR history. If Reeded, traiRiRg for this feature is provided by represeRtatives from our BeRefits, lmplemeRtatioRs, aRd Networks departmeRt. · Please see our respoRse iR SectioR VII.B AdmiRistratioR for detailed iRformatioR about our eligibility testiRg procedures. US Script's claims adjudicatioR system caR be programmed to iRclude multiple levels of POS messagiRg, iRcludiRg messagiRg regardiRg Medi-Cal eligibility. IR order to Rotify pharmacies of a member's altemate coverage, the CouRty will Reed to provide aR iRdicator iR the eligibility file to alert US Script that the member has primary iRsuraRce coverage. ~-~===:·····H·~·-·-:· -.-~ ···· ··· ·~"·--· · __ ~,. ···'"~~·:~wcw:r-~""')0fY::~......,...,.~-~·-"""'~"'--~ · ""-""" .-. "·-'"'-'"·.·."::·--··-··.·. "'~l'".""\J"-"":'::'':'"Jiq:~·rr~':t'illV''x1·'wm.~. ~~·=4 G. ,,9ounty. wHI:,authorize>every new. pre~cription eaphtirae a'script1is\gjven'i as each CouRty ~uthdrizatiOR Will only b~, OR~,;,prescriptiqn;an9r~ mS.xim~m of'two;~UbSelquent refills .. \leRdQfSDd S;ontracted phatmaciessha(l'terffiinatemember pligipili\Y:every time a preSCriptjon and iny'accompanying rpfill(s) 'have<peen .fillpdJ US Script meets this requiremeRt. Similar plaR desigRs require that eligibility be termiRated oRce a prescriptioR has beeR filled. SiRce the CouRty seeks to allow oRe iRitial fill aRd two subsequeRt refills with a 30 days supply maximum, US Script could automate eligibility to term iRate after 91 or 100 days. US Script is coRfideRt we caR work with the CouRty to determiRe aR automated process to meet the CouRty's Reeds aRd serve its coRsumers. EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 42 of 170 ~v1o; -gustomerSiOt1Ce It istitne ~ount}t's e>lpectationthaPquestions~lssues~'c)fj~prOblems01haFm'ay,be:erlcounter'"" pon~errfi.~9 th~'4 prov!si" " f s~.P,ices tb;,~li~nt~1"wiil ~e rljana~~~d ~ir~~t~~ithr~~~h Sq9~ty's. ~l"!~t exQe_ "_?i ~-~cJ?ntac!mgdthe Pt!mm§gY.:IBen~ft!s Ma_I"!?Q~r dtr~~!!M~ ~:;,~s19.P"'er's~rvl!pe ~~91nwrr v~pdor te .. mCiicatei!he f~CilltYtsfwl1~rtrYo·-" Q.~~Ufsu·RRPH ~he,.elaim!r!3nd;.c~t6me~~servic~. fOt th_i~))us[!gey§£:.1ndjeate lb~L~:~urso~Qf!Q .~JQn 1 in e~cifjQ Standa.r~'Time~ US Script's primary call center is located in our Corporate Headquarters in Fresno, California, and our secondary call center is located in Orlando, Florida. US Script provides members, pharmacies, and prescribers with 24/7/365 access to live Customer Service Representatives. ,~~~~'~"''"•~-:~--~=• ••·-·~-'~)?<'~~"~"'''"' ~' ,~·-"~~-·~,'"""';:-'""-:":''~pi~~·'" ,'•':"":'"··~·~;w~~"'<"'~~·w.::~ B. >'Cust~mefService Team·~~ve ." r to·aescribe,how Custeme •· ice ~il(~e · ~"~~.~g~~a.to.·t~.e ~P.l1ntt'a?G9~~t::''9e~9:ribe'p()\ft/,itaff~wm.. ,rai~ed pe~~-~ (ce·. nq~wre.:of the;RoP~!attoq,;IImLt~9 fqrm\!l~rY.tQf thg~@Q~, ,:',s .. Q~t.:., !?.a¢tfl!P .. :t~soiJ'r¢~§lLIJ: P!~~ ~~nt~IY,es .(@s~] andle ttl~ sg~c~J .. Q icJ~iJtl~~Y!b§~ US Script requires certification, degrees, and other relevant training experience. To encourage continuing education US Script offers a progressive tuition reimbursement program to our employees so that our staff is constantly striving to better understand the health care system and become an even better support to our clients. Additionally, US Script staff receives annual training from our Quality and Compliance Department to ensure staff is up to date on all ethics, compliance, and HIPAA requirements. US Script staff are encouraged to complete a series of mandatory and non-mandatory courses through our parent corporation's training website, Centene's Cornerstone Learning program. Through Cornerstone Learning, staff are able to access job related courses as well as general courses to continue education and grow within the company. US Script staff are required to set annual goals, including educational goals, which reward business knowledge development. Initial Training The initial training program for newly hired Customer Service Representatives (CSR) is a three week session during which trainees are: • Expertly trained to use the customer database and phone systems • Thoroughly trained on proper telephone etiquette techniques • Taught the fundamentals of each benefit plan design, formulary, drug exclusions, capay strategy, and eligibility rules • Provided easy access reference information to aid in identifying the correct formulary, capay structure, and other benefit summary information for each group Each trainee must achieve milestones throughout the three week training program to continue in the program. The Call Center Manager assesses each trainee's customer service skills, in addition to ensuring they have met each technical milestone. Trainees who achieve satisfactory technical scores but who score low on customer service do not move on to the next level. After the formal three week training program, the CSR focuses on practical development for a 90 day period. EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 43 of 170 During this demonstration period, CSRs are required to show continued development and milestone achievement. Beyond the probationary period, CSRs undergo monthly recurring training and are required to complete our customer service training program, Call Center Success. Ongoing Training On average, each CSR receives 45 hours of additional training per year on changes affecting services or programs (for example annual formulary additions and deletions, plan designs for newly implemented groups, changes in plan designs for current groups, and trends in member and provider calls). The duration of each class varies from three to four hours. The call center team will be specifically trained on the County's benefits system. CSRs will provide the County members, pharmacists, and prescribers with information regarding covered medications, generic alternatives, locating a pharmacy, capay responsibility, how to order mail order prescriptions, prior authorization requests, and more. XJi;;;A""E'Ount:nn~ifaemenl ll(.~ ,i+ft;cc~v~nt Mana~'~menf P. rm~nc~>~ppr5ac~.~D~s:Cri~~!\po~~gceq1tnf~~~nalenj~~fs~lyic§ pe.rt~rm·a~ce;j~'!tme~sur~f:J~ tr . ..··• g~r~~~d (et9. tiq)~~jJi~§~)!l!th~;!f~~y.t!).ofpllg_ri~ ccill~tl !ith~!In§~.t~§QM!tig_ru:C>t?le!fis In addition to a formalized annual performance review, Account Management staff performance is tracked and monitored on an ongoing basis based upon the timeliness of response to client requests. Clients submit requests via our "My Account Manager'' system. This system allows the requestor to set the priority level to high, medium, and low. That priority level then determines how quickly a representative will respond. High priority requests are reviewed and responded to within one business day. Once submitted, all requests are logged in our Everest tracking program. An assigned representative tracks incoming requests daily and assigns the tasks to the appropriate department. Clients receive updates at each progression of the request, and the system allows for an increased capacity for status reporting, therefore ensuring clients' satisfaction. Our Customer Service department provides ongoing support for daily requests through documented procedures and an efficient software application that tracks ongoing progress and upcoming deadlines. Using this account management approach, we are able to provide the most efficient and timely response to your requests and ensure that information is drawn from the most appropriate personnel. -•·w·"~~·-~"'~ ~,•--_,»<'">~~'"'~,="~~-~ "''--.--~-"··-· ....-~-,-.~~~'f:J\'~YWI~"~,~'J;"''--"='';~" ·~·;\•F->' • ~ tManager Gommitf:ner'!~?f'!cf,;~esume; vendor m!:lst prpvide':a rEt§.u!l":~<;Pf ,:.=::=:..:.A-:.:c=· kountMSl'-J.?g~r::Onclyde ectucation bac~ground:...?fld~VI[ork ~~p~[~~n<;e t Resumes for Tony Bruno and Philip Carroll have been included in Appendix XIX.B. EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 44 of 170 p~·:~!Ofontll~iy ~~tiri,~s-?ve~~!~mu;~fhOs~ a~()rltt1iy m~efiJ1~~~A~'i>a' tt1&;f;h~~~~n~~'~e cqu~~ r•lkmea~~re C~S'<?Ii'{lers~t·sfa:ctto~!iP~ usmgi~ustomers:?satt~~f,iCfto~ s ' trkcf3Y du~·~~ the;f~rll]()f th~ pon,~!acb'h lde~l!fiei:f'~re.,~~wh~r~ ~rrv•ce,,t>rev:Js ca,~,lb~ ·~P~qJ(ed W:!l~ Rr~!1Pre~£:n~ei:f to tftrVrn~ ~e~~or QJUstr1~r~eto ~:~~k Wit~ t~,~.Cou~ty 1~ r~s<;>,lvt~Qttde~~tfie~stss(J~~ r:esultt.fl8 1 ~ro~ th~ [or~,ms.o~,ot~~fsource · ega~~tng,;~ust~mer1,$atts~~ttpn, 'V,;t'\Cfor;,;ani:f;~ije C<>un~~~cantr:~~,-. fllag~ger"Will "¥<?fkif6Q_ Jp+~ntinually.ITIQQitQI,tl:t~ succe§s]~y§Js.~of!bJ~contr~ctand r~S:ght,~ ;ssu@s ~! !he'earu~stl US Script agrees to this requirement. As a Fresno-based company, US Script is uniquelypositioned to provide face-to-face service to the County. We will meet with the County on a schedule appropriate to satisfy any of the County's ongoing needs. r-">'"'"''"" --:~~._.,_, '"-,~~ , ."~~'"H~·~·· ~"~""'"'~'~'w'~.,~~-,-.if:'~·W(=~"""-~~·~ ·.' -~~~~"-~'""~ "" "<.','';•""?'~''~~~--"" .'·' ~w,p;;~r;-~'"'"-~·; p. r~11,mpte!"e~!~tiori~!.;.A.S. pa~~t?ft~e prp~psar;,·ven~~~ _s,n~l~l?r~~~a.Cf~j~iJ~9 im~l:!!~l1t£J!!Qll (21ar:t!tt~L!~.f:!es .a~::!tVItJeS,J!m~ltf!.!iS ana I~JitQ!]§!btlttt~§,' . Please refer to Appendix XIX.D for a sample implementation plan. Please note that as the incumbent PBM vendor, our sample implementation plan focuses on implementing benefit plan design changes. ~:,~Jra~~~flofi:~~ne¥rl~~~pot~Rflal·.issu~~tRa.fwill 'neecHal>~~,aaaJ~ssecrin" m~a~<1ij9.t~ran§16or! (or,~~ientsfrom,!h~;;g~rre~t PB,M t<~,;;youll2progr~m:11}':'fh~~~inf?fma!i~~ a~gto~;;~!:Jppo'ft·wi~,yo\~ r!3qutre fr~m !~~~ C.C),~nty to sy~ce~s,fully COQ)Qiete,thts trar:t§t!IQIJ,.IJJ~Iudg no~_r~fill_§,ql)Cf n~~ m:~§criJ21!mi!.~~teg i.ss~e~rwill:be .h£1DsJJed~ As the incumbent PBM vendor, US Script does not anticipate any transition issues should the County continue to work with US Script. US Script welcomes the opportunity to discuss how we can best serve the County and its consumers. ,,._,...-.,~ "~~~-~~', -~";·;---r':'::r"J !XX. Reoortin~ ~-','§)tandard rep . , ~fFie c6"lmti'preter~fe'nic'repoFts~' Vendor will des~rib ffiHdarCi rno!:£1~djt(c>nal COSt).· .COl:!f1t ~~porting tools availa~le t unfY:, inclui:fing the fre C~)or-~P-.®1~~ ~n.<t thf;!.!!l~~9ce§§~l}g/r~~~jyjngJiiies , ( eig~~b J2Q!'t£1l,_.E!Ie_ctro_njQ,_~jQ1j Reporting is an important part of ensuring appropriate utilization of your prescription dollars. US Script provides the usable, actionable, real time information and the customized reporting capabilities you need to target specific data and trends and to actively manage your pharmacy benefit. Effective strategies are developed and implemented based on the results from the following reports: Standard (Available On-Demand via PBM-1 online) Annual Pharmaceutical Benefits Summary (Report) Members With Benefits>=$100 (Text) (Single Grp) Members With Benefits>=$100 (Text) (All Grps) Member Utilization Summary (Text) Too 25 Druos Bv $ (Text) Too 25 Druos Bv # (Text) Top 25 Druos Bv TPA (Text) OUR Reports EXHIBIT H: CONTRACTOR'S RESPONSE Top Physician By$ (Text) Physician By Drug Prescribed (Text) Physician/Prior Authorization (Report) Physician/Prior Authorization (Text) Quarterly Current Quarter Statistics (Report) Current Quarter Statistics (Text) Member Utilization by Age Group (Report) Member Utilization by Age Group (Text) Utilization Distribution by# of Claims (Text) Drug Product Type Comparison (Text) Drug Therapy Comparison (Text) Days Suppl}'_ Distribution (Text) Claims Data by Therapeutic Class (Text) Top 1 00 Drugs by # of Claims (Text) Top 1 00 Drugs by Plan Paid Amount (Text) Exhibit H Page 45 of 170 A brief description of the information included in these reports follows in the table below: Top 25 Quarterly Therapy or As Class Needed Top25 Physicians Claim Detail by Physician Claim Detail by Member Reject Codes Potential Savings Report Quarterly or As Needed Quarterly or As Needed Quarterly or As Needed Quarterly or As Needed Quarterly or As Needed This report groups claim information at a therapy level. This is defined as the first 10 digits of a drug's GPI code. It allows an overview of the highest prescribed drug classes or the highest cost drug classes. Report includes claim counts and costs to the plan. This report groups claim information by the prescriber. It includes the claim counts and costs to plan. Shows a group claims ordered by physician. Each line has the member, the drug dispensed, the quantities, and the cost to the plan. Shows a group claims ordered by member. Each line has the drug dispense, the quantities, and the cost to the plan. This is a set of reports that analyze rejects for a plan. It is used to show the number of times the plans rules intervene with the progress of a transaction. This report will analyze past claims against a new co-pay structure. It is used to see the savings or the increased cost in modifying co-pays from their current rate. Group Setup Quarterly Report or As Needed Quarterly Quarterly Reports Member Quarterly Utilization or As Report Needed Plan Quarterly Summary or As Report Needed Claim Detail Quarterly by Pharmacy or As Needed EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 46 of 170 A report that explains all setup information for all plans that a group has active. It includes all drug restrictions, pharmacy networks, pricing information and co-pay rates. A collection of reports that are generated for each quarter. They include an overview of the plan for that quarter and year to date, members approaching benefit limits, drug usage patterns and per member per month reports. Shows prescriptions filled for a particular cardholder, and any dependents, for a given period. Report focuses on drug and dosage information rather than billing information. This report summarizes your benefit options including co- pays, networks, restrictions and pricing. Shows your groups' claims submitted by a specific pharmacy. These reports are provided monthly or quarterly and can be seen as Appendix XV.A. s .. J~e91enai1iPQf!in9:~'ffls :~~eounfi~~expectaf!O~ t~~-venaor"'¥fii:~~~i>:Onre~.~.rti,R1far9ro~Q ~n~~~~osfcent ·· · e'i~ts as s conso,IJgated rep· mgzf9l.PQ!h g(;>On!Yt<;i~p?rtments~: V~ndQ...!i l!Li,J_§tSt~~ · ~Jtl~~'--·· ~t thisj"~g!Jlr~men US Script currently provides the County with regional reporting that includes reporting at the group and cost center level as well as consolidated reporting for county departments. Our sample invoice is included in Appendix VII.B.8. r:~{'d. ~e>c ·Re,5oq!~g,ii~venao~usi;proy.l?e~a7ho 9 ·!~P8,~inij1~RiP1Sin~:~~v~o~§f;aP" a~?riE~ r~aJiable0~d~q~.paf\\:fOt~ar r ,rt1np;capab11lt1eS and tooJs. :lsJ!J~r~~S!IJ~ddltlonaf1i90~t:~§§QQ~€,it~jj W!tl:! ,ad.,h:oc r~p;a~r!§ ~llittf 'i .h£1tt§Jhe~ cost~ Simple ad hoc report can be completed within 5 days of when the request is received. Larger more complex reports may take longer, but generally most report requests are completed within 3-4 weeks. US Script also offers designated program administrators access to Discoverer, our powerful online, ad hoc reporting tool. This Web-based reporting system provides real-time generation of canned and custom ad hoc reports through an easy-to-use Windows application that incorporates a report Workbook Wizard, pre-formatted graphics, and charts. Ad hoc reports run by your team from our website run within seconds. Please refer to Section XII, Cost Proposal for pricing information for ad hoc reporting. EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 47 of 170 Yes. US Script will provide the County with access to technical support should our Client Services department be unable to sufficiently address the County's question. There will be no additional cost for technical support; however there will be additional fees for ad hoc reporting. Please refer to Section XII, Cost Proposal for pricing information about ad hoc reporting. ~en~pr . upport'(~poijiJ1g aFihe<;3rout>,;•an~J'-tairiD. osTcent~rinevefs efined: ~ ,,,,_,,,,, ' ' ~,· .~~ "": , ';:: }:',;'' "" ,,,,,, .' "'" / ' . . '··-"·~<>'41 ' P<t~pty as Vv' . s con§.olidat~ttr~BertingJorall·of §ouJL ' .J1!~;whiru:l~wiiiJ?er cf.@~l)edc ~Yn!Y~ ~~~1§~ US Script agrees to this requirement. US Script agrees to this requirement, provided the County terminates eligibility online as soon as it receives notice of Medi-Cal eligibility and provides US Script with evidence of Medi-Cal coverage by the 301h of the month proceeding its receipt of invoice by US Script. J3~~6~·~~ndQftfiatren~ij!"e~~~y;IJ!i~scriptiof1~tai::J,r~l9~pFcrt~·re··611fe&]~ .. Q~tr~~l'i:.unle~§::~ ~E!dtiCal'denied T&.~g~t~rrda JbR ~t4~·l§~Qrovideq;.·.or 1t'!~J~li~nth5!§_JJQt,meF:Jiis~J;ler ·mQ!lthly ~gj.:g~J§_I}~u~ Qf~ost!fSQg) A US Script agrees to this requirement. r~~"""'""'~· ~-"·=·· ' ' t ~~ ~~ ~ •• ···I<-.:";"'~""'~~"lfi$]:":~~~.,..."""""~':'' •.... ...,.....,. ~· ·-~~,-, :'-'~'"'"'or.-::.~·'"~"'~ft""~~l\0'1fZT;"IW""";)~1xt~~y•:""IT"""''~~···=c-·-~·-·~-·-,-~~·,-~ · · "''" --j p. Tne ~ .. iP~.~~~sg~,.l;::adjust i~voici~g e:v~rY I)J~nth!~~~!llta cli~ht~ay lleto~~ ~tigil:il~ · edi'- ~~q~tg!!y~J~ or_l:1~s I\IJ~gt~Q~L!~I!Tit®!~d(fJ~D<Llll§YJ2~£9!'Til~:M~.&QJ~.G.SL~ItgJbl~t~9-~tn~ As the incumbent PBM vendor, US Script currently provides this service to the County and will CQntinue to do so. . .· r:~lilpB lients-who-~ are-Medf.:caTeliQil)Je~· th~: ve · ·. .. + Jatr ~r . mefftAu!)ori:z:~tiQQ,8~. J,A~~:~u~'mis~ion ~,;M~~~:~, :uu.~~:; re<.i medicatiQns,, and· situatfdhs i . . . . . . ov~r six (6) prescriptiQns;pe . ~i~~:p~ymen~forr~edi~f;.at·E!tigibt~·clie~ts V'li!f'ba'~eni:'ci, b~{tn~: ~p~nt~1Jfi~0.ye~·a9r ~!!:' ~Vb€J retmburs~d retr:oayttyeJYt~for .£tJarges when ·vegdor.JP.LQYid~~L\f.~f!ftgattQRQ.fJI}~:J A(ide!)tal tg ~Q!J!ltylmm.tu~, St!!t!i:1~ US Script agrees tQ CQntinue WQrking with QUr Pharmacy Network to provide this service to the County. EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 48 of 170 ~·:~~~di.:q~fecror~ 'tioQ,{~>rs?.rl~flfs'=:yena<?fto-d~~h~ it~:pro~ssf~'~oafdi~~tlonyf>f -~-i11 pbli~?tions tq1 ~nsu~~.'M~~i::Qalp~~s for"~ov~J~d dt~gs"di~p~ose~"'~9 M~di:-~al ~Ugible qlie ,, ,, ~eri~W;to:o inc1,~,def ~;,deS:c[trutg'[i~Q( th~JyQe ot~majJ§[mess~g§§l~:~t tl:l~lr~{~fi~rm~~y wo'ul~ receivein~~t§ituat19r1 The County must include an indication that members have alternate coverage in the eligibility files for US Script to review claims for Medi-Cal coordination of benefits (COB) opportunities. When a member attempts to fill a prescription at the pharmacy, US Script's online claims adjudication system will check for alternate coverage and send a message back to the pharmacy to bill Medi-Cal or other available insurance as needed. US Script has worked closely with state programs to develop coordination of benefits processes that appropriately adjudicate claims. For example, for one plan serving a dual eligible population, US Script developed a process to take eligibility data from enrollment tapes and subdivide members in each area to those with and without Medicare coverage. Members with Medicare coverage are recorded in the system as dual eligibles, and POS messaging is returned to the pharmacy to indicate Medicare as the primary insurer. In this way, US Script is helping guarantee compliance with regulations that stipulate that federal money is used for the primary benefit, and the plan sponsor as the secondary. US Script is confident our experience in this area will aid us in developing a COB process that meets or exceeds the County's needs. ~ii]5ELZIVERiES b~n~~r!es~rn~~gt~!fons+ma~]~riYK~~ US Script agrees to this requirement. US Script's retail pharmacy network includes locations with delivery options available, and our mail service facility is able to ship medications based upon client-designated restrictions and requirements. US Script agrees to this requirement. s,,,~res tio\rs to~~rcne~Jis~Jif~;pre~~redJI11hErsalll~:·m.~rn' . '·x,.tused,fci~~lli~';f ·-~~l public u .. g a;~pb~l~:pack ca[d. ~~~~~ever ~ossibl~,. SgWe"fi9ili · ites maY,:f!e~~~~iP~ imions, QI~P~r~d 1n a .. sQeciJ!~J:Tl~JlJJ.§ras ln'(ilcatE;!si.J!t§J:1e9!flc RegUir~..m~flt~_QQ.st Qonta1ome ~ US Script agrees to this requirement. ~:Gen~rF~i~~~stlttltfofiS\1in ·Pf:escrfRtf9i)~iar~~qulred ~~§P-~9lfiecL9il1e~·se,hY-aJIIcens~ 'Qhy~lgg~~oi: iftlle sybstjt~J~g~g~r:tcl¥ri~Q[ug is.not ~yaii~I:>I~J US Script agrees to this requirement. p:····:~hei'en::~~9r ~!i~fl!t!f~erfowesrco§£g~n~Qjing]fr.an~n~m~Jn~~ US Script agrees to this requirement. EXHIBIT H: CONTRACTOR'S RESPONSE US Script agrees to this requirement. Exhibit H Page 49 of 170 f~';§e~~~~~-~~ln~::{~queste~li-thi~::R6.R .. max::be.:sObj~t fo "cflanQe:a· Cljl~-\i~ty-~ipaft~~f( .. _, ~mcl~r:gd>charJg~.Qctr§mJ9§ni~~1!on" in .§~!Y!~~· d~.ll~r:Y~ :92~qn_tY.WiiLcli ~~,:~.!:tS!:~u~!ll&ti~!lg~ astltigy_gg~ US Script agrees to this requirement. EXHIBIT H: CONTRACTOR'S RESPONSE Proposal No. 269-5316 COST PROPOSAL Vendor Name: US Script, Inc. Vendors are to complete all cost proposal pages and return with your proposal. Exhibit H Page 50 of 170 Page 37 Contracted pharmacy shall bill based on the published (Medical Economics, Drug Topics, Red Book) Average Wholesale Price (AWP) minus a percentage. Any additional costs such as minimum per prescription, dispensing fees, and administrative fees should be included. Prices should not be based on acquisition costs. Identify all cost components of total charges. The County is interested in receiving medication for County clients at the most economical rate. Costs for pharmaceuticals and the cost of any services such as developing any Information System and subsequent reporting must be provided separately. List the cost separately for the disposition of all expired or damaged medications if the vendor can provide such services. The maximum amount to be paid by the County under this RFP shall not exceed $250,000 annually. AWP Publication Name: Medi-Span Explain advantages of using this reference book as opposed to other publications: With over 35 years experience, Medi-Span offers authoritative drug databases and is the leading provider of drug information for thousands of healthcare organizations. Percentage discount for medication off the AWP cost: Brand Name Generic Minimum cost per prescription Administrative cost/management fee 16 75 $ N/A $ N/A % % 1.75 Brand Dispensing fees Disposal fee for expired meds STAT charges, if any Other (explain what services are included in "Other" and the charges/costs associated with services). Ad-hoc reporting $150 per hour G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc $ 2.00 G~muic $ $ $ p. Xll.1 EXHIBIT H: CONTRACTOR'S RESPONSE Xll.2 ExhiMH Page 51 of 170 EXHIBIT H: CONTRACTOR'S RESPONSE I " ,' 7 ;, " ! unt prtce 1 , ' jPER PILL ; 'iili ~' :~ costof30day Annual tRatlng of Geilerlc' J percentage ad min avg monthly prescription plus Annual lt:~~,k~" ! !. , 'MACpricing (if appicable) Sample List of Brand Name Medications NDC Prescriptions ll(fappJfc';\b~~}Jl,;,:§)discount cost supply admin fee overall cost ~4~0~.s=E=R~O~Q~U~E~LT~A~B~3~0~0~M~G~---------+5~4~8~6~8-~5~4~84~-~0----~--~--46 r$~--9-.2-6~$-----1~~---3-0+------2-78-.-94~~~1.~6~73~.6~2, Note: Per Pill $ 41.QUETIAPINE TAB 400MG 68001-181-00 6 $ 16.74 $ -30 503.60 3,021.60 42.QUETIAPINE TAB 200MG 68001-182-00 6 $ 10.87 $ -30 327.25 1,963.53 43.QUETIAPINE TAB 300MG 68001-180-00 6 $ 5.52 $ -30 166.73 1,000.35 44.BUPROPN HCL TAB 300MG XL 67767-142-30 , 6 $ 4.01 $ -30 121.40 728.42 45.DIVALPROEX TAB 500MG DR 00245-0182-15 6 $ 2.68 $ -30 81.72 490.31 46.ALPRAZOLAM TAB 1MG 59762-3721-03 6 $ 0.81 $ -30 25.53 153.20 47.ABILIFYTAB 20MG 24236-991-28 5 $ - $ -30 1.25 6.25 48. SEROQUEL TAB 400MG 67046-666-30 5 $ - $ -30 1.25 6.25 49 SEROQUEL XR TAB 150MG 64725-0281-1 5 $ - $ -30 1.25 6.25 50.0LANZAPINE TAB 15MG 00093-5770-56 5 $ 16.73 $ -30 503.12 2,515.58 DELIVERIES Cost Per Delivery (generics and brands) Annual Deliveries Total Annual Delivery cost 360 I OTHER CHARGES Amount Total Other charges TOTAL COST OF GENERIC MEDICATION, DELIVERY, & OTHER CHARGES 144,916.25 Total 144,916.25 $ $ $ $ 0.83 $ 0.87 $ 0.14 $ $ $ $ 13.35 Exhibit H Page 52 of 170 Dispensing Fee $ 1.25 $ 1.25 $ 1.25 $ 1.25 $ 1.25 $ 1.25 $ 1.25 $ 1.25 $ 1.25 $ 1.25 $ 1.25 Methodology Narrative: In the examples above, we used the lesser of either the Medispan list price minus the percentage discount off AWP (AWP-65%) or the applicable MAC price to arrive at the unit price per pill after percentage discount. We then multiplied the discounted price times the average monthly supply and added the administrative fee ($0.25) and the dispensing fee ($2.00) to arrive at the 30 day prescription plus administrative fee and dispensing fee cost. To determine the annual overall cost, we multiplied the cost of the 30 day prescription plus administrative and dispensing fees field times the number of annual prescriptions. Xll.3 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 53 of 170 Proposal No. 269-5316 Page 43 CHECK LIST This Checklist is provided to assist vendors in the preparation of their RFP response. Included in this list, are important requirements and is the responsibility of the bidder to submit with the RFP package in order to make the RFP compliant. Because this checklist is just a guideline, the bidder must read and comply with the RFP in its entirety. Check off each of the following: 1. X 2. X 3. X 4. X 5. X 6. X 7. X 8. X 9. X The Request for Proposal (RFP) has been signed and completed. Addenda, if any, have been completed, signed and included in the bid package. One (1) original plus eight (8) copies of the RFP have been provided. The completed Trade Secret Form as provided with this RFP (Confidential/Trade Secret Information, if provided must be in a separate binder). The completed Criminal History Disclosure Form as provided with this RFP. The completed Participation Form as provided with this RFP. The completed Reference List as provided with this RFP. Indicate all of bidder exceptions to the County's requirements, conditions and specifications as stated within this RFP. Lastly, on the LOWER LEFT HAND CORNER of the sealed envelope, box, etc. transmitting your bid include the following information: County of Fresno RFP No. --'2=-6=--=9'----5-=--3'-1__:6 __________ -ll• Closing Date: January 15, 2015 I Closing Time: -=2::.::c..::.O=-O_P-'-'.M-'-'-'-. ______________ _,!• Commodity or Service: Pharmaceutical Services I .J Return Checklist with your RFP response. G:\Public\RFP\FY 2014-15\269-5316 Pharmaceutical Services\269-5316 Pharmaceutical Services.doc p. Xlll.1 EXHIBIT H: CONTRACTOR'S RESPONSE Reports & Appendices Table of Contents Exhibit H Page 54 of 170 RFP SECTION TAB XV Reports & Appendices L VII.A. 1 US Script GeoAccess Report and Pharmacy Network List M VII. A. 11 US Script Participating Pharmacy Agreement N V/1.8.8 US Script Sample Invoice 0 XV.A US Script Sample Report Package P XV.D US Script Prior Authorization Form Q XIXB US Script Resumes R XIXD US Script Sample Implementation Plan S (&,.Tl,' 941 0484 usscri pt. ' .. V\V\·1/ U~script t~On; EXHIBIT H: CONTRACTOR'S RESPONSE County of Fresno Managed Care Accessibility Analysis December 17,2014 A report on the accessibility of the US Script Open Pharmacy Network for the zip codes of County of Fresno Exhibit H Page 55 of 170 Appendix VII.A.1 p.1 US Script Open Pharmacy Network-County of Fresno Table of Contents EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 56 of 170 Pharmacy locations ....................................................................................................................................................... 1 Accessibility summary ...................................................................................................................... ............................. 2 City detail information .................................................................................................................................................. 3 Appendix VII.A.1 US Script Open Pharmacy Network-County of Fresno Pharmacy locations 20 miles 0 Pharmacy locations (154) EXHIBIT H: CONTRACTOR'S RESPONSE US Script Open Pharmacy Network 110 pharmacies at 154 locations Exhibit H Page 57 of 170 Appendix VII.A.1 1 US Script Open Pharmacy Network-County of Fresno Accessibility summary Pharmacy group: Zip code group: Access standard: All zip codes: EXHIBIT H: CONTRACTOR'S RESPONSE Accessibility analysis specifications . US Script Open Pharmacy Network 110 pharmacies at 154 locations (based on 154 records) County of Fresno 105 zip codes 2 pharmacies within 5 miles 105 (100.0%) 71.4% with access 28.6% without access ' Exhibit H Page 58 of 170 2 - Average distance to a choice of pharmacies. for all zip codes Number~f 1 2 3 4-5 pharmacies " Miles 5.0 7.1 8.1 8.6 9.1 Key geographic areas ' All zip codes Total number of ,Percent Average distance City zip codes w wo to 2 pharmacies FRESNO, CA 64 98.4 1.6 1.1 CLOVIS, CA 4 100.0 0.0 1.5 SHAVER LAKE, CA 2 0.0 100.0 37.7 AUBERRY, CA 1 0.0 100.0 27.7 BADGER, CA 1 0.0 100.0 26.1 BIG CREEK, CA 1 0.0 100.0 42.3 BIOLA, CA 1 0.0 100.0 7.2 BURREL, CA 1 0.0 100.0 9.0 CANTUA CREEK, CA 1 0.0 100.0 18.4 CARUTHERS, CA 1 0.0 100.0 9.2 Appendix VII.A.1 EXHIBIT H: CONTRACTOR'S RESPONSE US Script Open Pharmacy Network-County of Fresno City detail information County of Fresno .. Total nu-mber of County/City/Classification zip codes _ FRESNO -CA AUBERRY RURAL BADGER RURAL BIG CREEK RURAL BIOLA RURAL BURREL RURAL CANTUA CREEK RURAL CARUTHERS RURAL CLOVIS URBAN RURAL COALINGA . RURAL' DEL REV RURAL DUNLAP RURAL FIREBAUGH RURAL FIVE POINTS RURAL FOWLER RURAL FRESNO· URBAN ... SUBURBAN -RURAL HELM RURAL HUME RURAL . Pharmacy group: US Script Open Pharmacy Network Access standard: 2 pharmacies within 5 miles -- 1 ----. - 1 1 --~------------ ' 1 1 ' 1 1 -- 3 1 -- 1 1 ' ··.' 1 1 -. 1 1 ----- '. 41 6 ---~- 17 1 1 .. Pet w 0.0 ~---.- .- 0.0 0.0 0.0. 0.0 --~ 0.0 0.0 Exhibit H Page 59 of 170 All zip~odes Average distance to pharmacies wo 1 2 100.0 8.0 27.7 100.0 "26.0 26.1 100.0 23.9 42.3 100,0 6.4 7.2 100.0 0.4 9.0 100.0 17.9 18.4 100.0 2.5 9.2 3.1 ---,--r- 100.0 o:o .. 0.5 0.7 --- 100.0 0.0 4.1 4.1 .. 100.0 o;o 0.7 0.7 100.0 0.0 2.9 3.9 . - 0.0 100.0 27.5 27.5 0.0 100.0 16.1 24.9 -~- 0.0 100.0 13.6 15.4 100.0 0.0 0.6 2.6 100.0 0.0 0.6 0.8 100.0 0.0 1.0 1.3 ~-.. -~ 94.1 5.9 1.6 1.7 0.0 100.0 15.0 15.0 0.0_ 100:0 37.5 37.5 Appendix VII.A.1 EXHIBIT H: CONTRACTOR'S RESPONSE US Script Open Pharmacy Network-County of Fresno City detail information County of Fresno County/City/Classification FRESNO-CA HURON RURAL KERMAN RURAL KINGS CANYON NATIONAL PK RURAL LAKESHORE RURAL LATON RURAL MENDOTA RURAL MIRAMONTE RURAL MONO HOT SPRINGS RURAL PARLIER RURAL PIEDRA RURAL" PRATHER RURAL RAISIN CITY RURAL REEDLEY RURAL RIVERDALE RURAL SAN JOAQUIN RURAL SANGER RURAL , ' SELMA RURAL SHAVER LAKE "RURAL SQUAW VALLEY RURAL Pharmacy group: US Script Open Pharmacy Network Access standard: 2 pharmacies within 5 miles - - ---- ' ---- Total, number of zip codes 1 1 1 1 1 1 1 .1 1 1 1 1 1 1 1 1 1 2 1 Pet w 0.0 0.0 0.0 0.0 -·---- 0.0 '100.0 0.0 0.0 100.0 0.0 0.0 0.0 100.0 ----.-- o.o 0.0 100.0 100.0 0.0 0.0 Exhibit H Page 60 of 170 -All zip codes Average distance to. pharmacies wo 1 2 100.0 0.3 16.1 100.0 4.9 5.3 100.0 32.5 32.5 3.2 - 100.0 29.3 47.4 100.0 11.2 11.3 0.0 0.8 1.3 100.0 26.5 26.5 100.0 44.4 61.3 0.0 0.7 3.2 100.0 18.7 19.5 100.0 4.3 17.5 100;0 7.3 11.5 0.0 0.7 0.8 100.0 1.6 8.6 100.0 14.4 14.5 0.0 0.2 1.1 0.0 0.7 0.8 100.0 19.0 37.7 100.0 16.8 16.8 Appendix VII.A.1 EXHIBIT H: CONTRACTOR'S RESPONSE US Script Open Pharmacy Network-County of Fresno City detail information ·County of Fresno -- County/City/Classification FRESNO-CA TOLLHOUSE RURAL TRANQUILLITY RURAL Pharmacy group: US Script Open Pharmacy Network ( Access standard: 2 pharmacies within 5 miles Total number of zip codes 1 1 Pet w 0.0 0.0 Exhibit H Page 61 of 170 All zip codes · Average distance to pharmacies wo 1 2 100.0 4.9 24.2 100.0 9.3 10.0 - 3.3 Appendix VII.A.1 --1 ' EXHIBIT H: CONTRACTOR'S RESPONSE GeoNetworks Report ·- Exhibit H Page 62 of 170 \\centene\citrix\crX_XA6S_Redirect\deap~daca\My Documents\County of Frel)no Geo 12.17.rpt. · Summary Information: Date created: December 17, 2014 Version: Release 2 2013 Author: Company: County of Fresno Network: US Script Open Pharmacy Network Notes: Tables: " Employee tables: Records: Provider tables: Records: Zip Code Expor ... \Finance PG Check November 2014.accdb 106 USS Open Ne ... \CNC Member Disruption_20141202.accdb 65536 Calculations: - Started at: 18:20:56-December 17, 2014 Elapsed time: 6 seconds Completed at: 18:21:02-December 17, 2014 Calculation method: Estimated driving distance Capacity option: Unlimited Printing: Started at: 18:20:56-December 17, 2014 Elapsed time: 6 seconds Completed at: 18:21:02-December 17, 2014 Pages printed: 5 of 5 (all pages) Appendix VII.A.1 Name CVS PHARMACY# 05422 CVS PHARMACY 1106772 CVS PHARMACY II CVS PHARMACY CVS PHARMACY CVS PHARMACY II CVS PHARMACY CVS PHARMACY CVS PHARMACY CVS PHARMACY CVS PHARMACY# CVS PHARMACY# RITE AID PHARMACY 06476 RITE AID PHARMACY 06289 RITE AID PHARMACY 05872 RITE AID PHARMACY OS861 RITE AID PHARMACY OS865 RITE AID PHARMACY 0629S RITE AID PHARMACY 06378 RITE AID PHARMACY OS863 RITE AID PHARMACY OS862 RITE AID PHARMACY OS869 RITE AID PHARMACY 04072 TARGET PHARMACY TARGET PHARMACY TARGET PHARMACY TARGET PHARMACY TARGET PHARMACY WALGREENS 1112707 WALGREENS 114907 WALGREENS 112702 WALGREENS 1113871 WALGREENS WALGREENS 115847 WALGREENS 116082 WALGREENS #6386 WALGREENS 116942 WALGREENS 117266 WALGREENS #7204 WALGREENS 11965S WALGREENS 1110335 WALGREENS 1110243 WALGREENS #12281 WALGREENS 1111877 VONS VONS VONS VONS WAL-MART PHARMACY WAL-MART PHARMACY 10-2001 SAMS PHARMACY 10-4704 WAL-MART PHARMACY 10-2985 WAL-MART PHARMACY 10-5634 4987 N FRESNO ST 599S E KINGS CANYON RD 7096 N WAVE 6750 N CEDAR AVE 1113 E CHAMPLAIN AVE 3011 E SHIELDS AVE 1325 W SHIELDS AVE 1302 FULTON MALL 4077 W CLINTON AVE 728 W SHAW AVE 6800 N MILBURN AVE 2990 E NEES AVE 4S93 N CEDAR AVE 5574 E KINGS CANYON 4224 E SHIELDS 2011 W SHAW AVE 1101 FRESNO ST 8027 N CEDAR AVE 6074 N 1ST AVE 1210 N BLACKSTONE AVE 379S W SHIELDS AVE 2020 E COPPER AVE 3173 E SHIELDS AVE 5740 N BLACKSTONE 31SO W SHAW AVE 7600 N BLACKSTONE AVE 66SS N RIVERSIDE DRIVE 4172 N 1ST ST 2840 ASH LAN AVE 1344 W CLINTON AVE 1016 W SHAW AVE 1219 N CEDAR AVE 610 E NEES AVE 626 S CLOVIS AVE 4810 E KINGS CANYON ROAD 6010 N FIG GARDEN DR 897S N CHESTNUT AVE 701S NWAVE 6885 N WILLOW AVE 2424 N BRAWLEY AVE 2420 N BLACKSTONE AVE 2950 N FOWLER WAY 4771 WASHLAN AVE 4343 N BLACKSTONE 8949 N CEDAR AVE 5638 E KINGS CANYON 7733 N FIRST ST 3680WSHAW S125 E KINGS CANYON 7663 NO BLACKSTONE AVE 7065 N INGRAM AVE 685S N WILLOW AVE EXHIBIT H: CONTRACTOR'S RESPONSE City State Zip Code . Ph.;me Fa~J! · FRESNO CA 937273971 559-255-9009 FRESNO FRESNO FRESNO FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA 93726 93727 93711 93710 93720 93726 9370S 93721 93722 93704 93722 SS9-227-7137 559-2S2-1124 S59-436-0471 559-436-4231 FRESNO 5S9-299-3115 559-298-1649 FRESNO 5S9-434-2158 SS9-434-2167 FRESNO 5S9-224-2965 559-229-6165 FRESNO SS9-224-6963 559-22S-3830 FRESNO SS9-233-7311 S59-233-0640 FRESNO SS9-271-3177 5S9-271-3182 FRESNO 5S9-226-148S 5S9-226-42S5 FRESNO 5S9-451-3486 SS9-261-9975 FRESNO N N N N N N N N N 937206008 S59-297-4306 FRESNO N 937262S40 S59-222-2472 S59-222-249S FRESNO N 937274526 SS9-458-0S34 S59-4S8-0976 FRESNO N 937267120 559-229-6024 559-229-8093 FRESNO N 937113404 559-224-0920 559-225-0114 FRESNO N 937063235 559-441-0998 559-441-1088 FRESNO N 937204827 559-431-1002 S59-431-1099 FRESNO N 937105405 SS9-431-5231 SS9-431-0224 FRESNO N 937033606 SS9-44S-0694 S59-44S-1480 FRESNO N 93722S247 SS9-271-S030 S59-271-S041 FRESNO N 93730 93726 93710 93711 93720 93722 93726 93705 S59-433-1290 FRESNO S59-222-6287 S59-490-4201 FRESNO SS9-431-8650 559-431-86SO FRESNO SS9-276-8926 559-276-8926 FRESNO SS9-490-0031 SS9-490-4316 FRESNO 5S9-490-S568 FRESNO SS9-243-0121 559-243-0313 FRESNO 559-225-8700 S59-225-2430 FRESNO N N N N N N N 93705 SS9-264-8693 559-264-2157 FRESNO N 937113701 5S9-229-2361 559-261-0748 FRESNO Y 93703 93720 93727 93727 93722 93720 93711 93720 559-498-8283 559-498-0252 FRESNO 559-431-1102 559-431-1607 FRESNO 559-251-0106 559-251-0243 FRESNO 559-458-0129 S59-458-0193 FRESNO 5S9-271-4923 559-271-4930 FRESNO 559-32S-6417 559-325-645S FRESNO 5S9-440-1401 559-440-1407 FRESNO S59-322-0698 FRESNO N N y N N N N N 93722S109 559-277-5912 93703 559-244-0974 937279148 5S9-291-7589 FRESNO N FRESNO N FRESNO N 937224307 559-274-0559 FRESNO N N N 93726 559-243-0163 559-243-0723 FRESNO 93720 559-438-13S6 SS9-438-6S94 FRESNO 93727 93720 93711 93727 93720 936SO SS9-458-0240 S59-458-0248 FRESNO N S59-439-1016 S59-439-0S81 FRESNO N 5S9-277-8274 559-277-8196 FRESNO N 5S9-2S2-9518 559-252-3S01 FRESNO N SS9-446-0196 559-431-0747 FRESNO N FRESNO N 93710S949 SS9-862-206S SS9-298-7371 FRESNO N Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain 39 39 39 123 123 123 123 123 123 123 123 123 181 181 181 181 181 181 181 181 181 181 181 207 207 207 207 207 226 226 226 226 226 226 226 226 226 226 226 226 226 226 226 226 227 227 227 227 229 229 229 229 229 ExhibltH Page 63 of 170 5633436 124S478494 5635593 5643336 5789S2 569460 S23197 504919 504933 504907 508727 519047 5628613 5624499 501521 509969 519819 520127 522551 522626 52S937 567377 595491 56347SS 562531 S68672 5600122 5615666 S650127 S05682 512271 566793 S74106 574233 562872 559560 S60967 585301 5602037 5614688 S624261 5626544 5630377 563512S 5635822 503931 510277 S74663 578130 5299S9 540826 S63658 565602 5647005 1659504678 1S78839791 1518900851 1447292263 1922042753 1255373080 1962445221 19624457S9 1225071S82 1770S26030 1477732014 1245306182 1942319371 1881703239 1003925S38 1467S61993 1457460990 13665S1806 1174632616 1437269297 1942319306 1306073762 1992727689 1346262037 1821010422 1487676011 1871915736 1306851670 1831104108 1023024692 1578578860 1295740587 144726S731 1457366734 1396751962 124524S570 1427065481 1609881614 1043389018 1811103443 1336316884 1336379031 1811220411 1407885478 1134165764 1528004306 11644S3973 1770500191 1033136353 1831116177 1588681837 1518209162 Appendix VIlA 1 WAL-MART PHARMACY COSTCO PHARMACY MEDICINE SHOPPE MEDICINE SHOPPE MEDICINE SHOPPE PHARMACY MEDICINE SHOPPE PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SIERRA PACIFIC ORTHOPAEDIC & SPINE CENTE UNIVERSITY MEDICAL CENTER CARE CENTER PHARMACY FRESNO PHARMACY COMMUNITY MEDICAL ARTS PHARMACY NORTHWEST MEDICAL PHARMACY BOWERMANS PHARMACY BULLARD PHARMACY PHARMERICA ADVANCED FAMILY PHARMACY COMMUNITY FIRST PHARMACY VINA PHARMACY TOUS PHARMACY PRIMARY CARE PHARMACY CEDAR PHARMACY AND MEDICAL SUPPLIES INC PILL BOX PHARMACY CHESTNUT PHARMACY MODERN DRUG COMP DISCOUNT PHARMACY AND MEDICAL SUPPLY RAY FISHER PHARMACY, INC. FRESNO VAMC PHARMACY BROOKS HEALTH CARE VISTA PHARMACY WINTONS PHARMACY CALIFORNIA CANCER ASSOCIATES FOR RESEARC BK PHARMACY CORP SUNNYSIDE PHARMACY BK PHARMACY CORP MANOR DRUG CARE RX PHARMACY ALIXARX-CA HUB JEFFREY K SHINODA PHARM D INC DMR EXHIBIT H: CONTRACTOR"S RESPONSE 4150 N BLACKSTONE AVE 4500WSHAW 219 E OLIVE AVE 4845 E BUTLER AVE 4009 N MARKS AVE 2484 E GETTYSBURG AVE 659 E NEES AVE 7075 N MARKS 1107 E CHAMPLAIN AVE 6797 N MILBURN 5750 N FIRST ST 2425 N BLACKSTONE AVE 1630 E HERNDON AVE 290 N WAYTE LANE 1570 E HERNDON 4917 E KINGS CANYON RD 2041 DIVISADERO ST 4770 W HERNDON AVE STE 101 3131 S WILLOW AVE 2026 W BULLARD 4910 EASHLAN AVE 5191 N 6TH ST 3636 N FIRST ST FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA 2308 N FRESNO ST FRESNO CA 3250 E OLIVE AVE FRESNO CA 5551 E KINGS CANYON RD FRESNO CA 6767 N CEDAR AVE FRESNO CA 2608 E ASH LAN AVE FRESNO CA 7075 N CHESTNUT AVE STE 104 FRESNO CA 3044 TULARE ST FRESNO CA 703 N FULTON ST FRESNO CA 6629 N BLACKSTONE AVE 2615 E CLINTON AVE 3410 WASH LAN AVE 4233 E TULARE ST 1377 E HERNDON 1791 E FIR AVE 3126 E GETTYSBURG AVE 5689 E KINGS CANYON RD 540 E HERNDON AVE 5795 N FIRST ST 302 E BULLARD AVE 4727 W SHAW AVE 6121 N THESTA 2425 WEST SHAW AVE FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA FRESNO CA 937263807 559-470-6969 559-470-6970 FRESNO 93722 559-276-2S95 559-276-1738 FRESNO N 937283129 559-268-8258 559-268-1807 FRESNO N 937275015 559-255-3301 559-255-2912 FRESNO N 93722 559-226-1201 559-226-2623 FRESNO N 93726 93720 93711 93720 559-222-6276 559-222-4388 FRESNO N 559-446-0715 559-446-0278 FRESNO N 559-439-1211 559-439-3520 FRESNO N 559-433-0283 559-433-0321 FRESNO N 93722 559-261-4126 559-261-4129 FRESNO 93710 559-435-7903 559-435-8279 FRESNO 93703 559-229-3119 559-229-3182 FRESNO 93720 559-256-5200 559-256-5376 FRESNO 93701 559-459-4592 559-459-6110 FRESNO 93720 559-437-7370 559-437-7322 FRESNO 937273812 559-255-8085 559-255-2342 FRESNO 937012013 559-485-2323 559-485-8554 FRESNO 93722 559-271-6370 559-271-6371 FRESNO 93725 559-256-7988 866-514-2911 FRESNO N N N N N N N N N N 93711 559-438-0111 559-438-0350 FRESNO N 93726 800-499-9079 559-294-3879 FRESNO 937107502 559-222-8303 559-222-1082 FRESNO N N 93726 559-229-6000 888-727-9111 FRESNO N 937032239 559-224-5210 559-225-5902 FRESNO N 937021033 559-268-2547 FRESNO N 93727 559-452-0420 FRESNO N 937104402 559-437-3700 559-437-3777 FRESNO N 937263207 559-492-2162 559-283-8441 FRESNO N 937200356 559-317-6720 559-353-2042 FRESNO N 93721 559-266-0701 559-266-2438 FRESNO N 937283405 559-268-0712 559-268-0722 FRESNO N 93710 93703 559-437-3800 559-437-3838 FRESNO N 559-228-5339 559-228-5339 FRESNO N 937224440 559-233-4663 559-638-9652 FRESNO N 937023098 559-255-3071 559-255-5058 FRESNO N 93720 93720 559-435-1950 559-435-7241 FRESNO N 559-326-1219 559-326-1229 FRESNO N 93726 559-228-1888 559-228-0211 FRESNO 93727 559-251-8601 559-251-8727 FRESNO 93720 559-438-2888 559-438-0711 FRESNO 937106294 559-431-4142 559-431-4357 FRESNO 937105299 559-261-9888 559-261-9487 FRESNO 937226209 559-277-4100 FRESNO 93710 559-435-2425 559-438-4372 FRESNO 93711 FRESNO N N N N N N N Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Chain Independent Independent 229 299 307 307 307 307 310 310 310 310 310 310 540 603 603 603 603 603 630 630 631 712 783 783 783 783 783 783 783 783 783 783 869 904 904 904 904 5651674 598790 576453 585325 585717 589905 547820 597027 510796 5615933 5625869 5625871 5636533 507472 569042 551160 510570 514390 523402 563379 591277 5646712 5696008 541878 547793 5631482 5638056 5641243 5648160 532728 547995 532754 550207 561870 532867 565599 5622522 904 513425 904 532829 904 5628524 904 524377 904 5645203 905 5649871 Independent 5615123 Independent 9900021 Exhibit H Page 64 of 170 1609287127 1659481265 1427160340 1962514885 1104910512 1326071572 1649259987 1376522607 1629057963 1134109176 1861536948 1770627853 1285669655 1518988575 1497813901 1780714089 1841377934 1801982798 1144325556 1619978921 1205869872 1831439967 1285676585 1164421988 1134128655 1093961211 1811217177 1881989564 1427300664 1760455711 1487653994 1700878030 1366400244 1760417232 1154490878 1326117052 1750394342 1215921515 1952438525 1710176045 1407889819 1457600215 1033530977 1497807945 Appendix VII.A.1 EXHIBIT H: CONTRACTOR'S RESPONSE US SCRIPT, INC. PARTICIPATING PHARMACY AGREEMENT Exhibit H Page 65 of 170 This Participating Pharmacy Agreement ("Agreement") is entered into by and between US Script, Inc. ("US Script") and the undersigned pharmacy ("Pharmacy"). This Agreement shall become effective as of the date set forth on the signature page hereto when fully executed by both parties ("Effective Date"). WHEREAS, US Script is in the business of prescription benefit management, providing, managing, and administering pharmacy programs (including but not limited to pharmacy claim administration and maintenance of a contracted pharmacy network) on behalf of certain entities, including, but not limited to: health insurers, carriers, managed care plans, and medical service plans; third party administrators; self-funded employer groups; discount plans/programs; workers' compensation; and other health related entities and/or plans ("Plans"); and WHEREAS, Pharmacy owns and/or operates one or more pharmacies licensed to provide pharmacy services in the state(s) in which Pharmacy operates; and WHEREAS, US Script desires to engage Pharmacy to provide prescription drug services to Members enrolled in Plans at the location(s) set forth at Exhibit A hereto; and Pharmacy desires to accept the engagement by US Script to provide prescription drug services to Members enrolled in Plans under the terms and conditions set forth in this Agreement; NOW THEREFORE, in consideration of the mutual covenants hereinafter set forth, the parties hereto agree as follows: 1. DEFINITIONS A. "Average Wholesale Price" or "AWP" means the benchmark price established by Medi-Span, or another nationally available reporting service of pharmaceutical prices as selected by US Script ("pricing source"), based on the 11-digit National Drug Code (''NDC") of the Covered Medication dispensed by Pharmacy, which shall be adjusted by US Script as described below. A WP does not represent a true wholesale price, but rather is a fluctuating benchmark provided by third party sources. US Script shall update the A WP pricing on at least a weekly basis with data received from the pricing source, which if not received timely could result in delays. B. "Brand" means the designation of products as "brand" under this Agreement as determined by US Script under its then current standard policies. C. "Claim" means a request for payment by Pharmacy in the format required by US Script for Covered Medications rendered to Members. D. "Claims Processing System" means the electronic claims processing system utilized or designated by US Script to process and adjudicate Claims in connection with the provision of Covered Medications to Members. E. "CMS" means the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services. F. "Copavment" means the amount (which may be expressed as either a percentage of the cost of a specific service or a specific dollar amount) that a Member is obligated to pay for a Covered Medication at the time the Covered Medication is provided, pursuant to his or her Plan, which amount shall be deducted from Pharmacy's reimbursement hereunder, including any deductibles and/or other ancillary charges. G. "Covered Medications" means those Pharmaceutical Services to which a Member is entitled to receive in accordance with and subject to the terms and conditions of the Plan (including any quantity, refill, or other limiting provisions), including all services usually and customarily rendered by a pharmacy in the Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 66 of 170 normal course of business, including but not limited to dispensing, counseling, and product consultation. H. "DAW" means the "dispense as written" codes as developed by NCPDP, as it may be revised from time to time. I. "Eligible" means a Member entitled to receive Covered Medications under the Plan. J. "Formulary" is a list of pharmaceutical products, quantity limits, and clinical guidelines for determining coverage of such products, as developed, published, and periodically revised by US Script and/or Plans in their sole discretion. K. "Generic" means the designation of products as "generic" under this Agreement as determined by US ( Script under its then current standard policies. L. "Laws" means all local, state and federal laws and regulations and other constitution, charter, act, statute, law, ordinance, code, rule, order, government specified standards and instructions, and other legislative or administrative action of the United States of America or any state or any agency, department, governmental authority, political subdivision, or other instrumentality thereof or an applicable decree or judgment or order of a court. M. "Maximum Allowable Cost" or "MAC" means the maximum amount at which Pharmacy will be paid for a Covered Medication, which lists of drugs and pricing may be established and amended by US Script and/or Plans in their sole discretion. Applicable MAC may vary by Plan. N. ''Manual" means the US Script pharmacy policy and procedure manual published by US Script, as amended and/or supplemented by US Script from time to time upon thirty (30) days' notice to Pharmacy, which sets forth US Script's policies and operational procedures required to be followed by Pharmacy in providing Covered Medications to Members under this Agreement. The Manual will be provided or made available to Pharmacy by US Script in written or electronic format. The current Manual is available at www.usscript.com. 0. "Member(s)" means an individual who has enrolled in a Plan with which US Script has contracted to manage pharmacy benefits and/or services. P. "Member Identification Card" means the identification card, temporary identification form, or enrollment application provided by US Script or Plan to the Member that identities an individual as a "Member". Q. ''NCPDP" means the National Council for Prescription Drug Programs, which is a pharmaceutical industry trade association. R. "Pharmacy Standards" means standards that meet the greater of (a) the pharmaceutical care, skill, and diligence that is customarily rendered by pharmacies in the United States (if measurable, or if not measurable, that is customarily rendered in the largest geographical area for which it is measurable), or (b) the pharmaceutical care, skill and diligence that is customarily rendered by pharmacies as a group, including in both instances the code of ethics as adopted by the state pharmaceutical-association and/or pharmacy board in the state in which Pharmacy is located. S. ''Pharmaceutical Services" means prescription drugs approved by the Federal Drug Administration, over-the-counter ("OTC") drugs, devices, supplies, and related professional services and items provided by pharmacies pursuant to applicable Laws and Pharmacy Standards. Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 67 of 170 T. "Usual and Customary" or "U&C'' means the lowest price the Pharmacy would charge to a cash-paying customer with no insurance for an identical Pharmaceutical Service on the date and at the location that the product is dispensed, inclusive of all applicable discounts, promotions, or other offers to attract customers. U. "Wholesale Acquisition Cost" or "WAC" means the price, as reported to Medi-Span by a drug manufacturer, at which wholesalers may purchase drug products from that manufacturer. US Script shall update WAC pricing on at least a weekly basis with data received from the pricing source, which if not received timely could result in delays. 2. PROFESSIONAL/CREDENTIALING REQUIREMENTS A. Pharmacy Locations. Pharmacy shall provide US Script as Exhibit A hereto, in the format and manner requested by US Script, information about Pharmacy, including, without limitation, Pharmacy's locations and operating hours. Pharmacy shall provide thirty (30) calendar days prior written notice to US Script of any change in location, significant change in the operating hours, closing, or change in ownership of Pharmacy. Upon request from US Script, Pharmacy will provide an updated, complete listing of its Pharmacy locations. Pharmacy certifies that its service location(s) meet the requirements of the Americans with Disabilities Act, and all state and local requirements pertaining to adequate space, supplies, sanitation, and fire and safety procedures, which are applicable to health care facilities. B. Pharmacy Credentials. Pharmacy agrees to timely complete any credentialing and re-credentialing forms required by US Script, and to provide any credentialing documentation, upon request by US Script, including but not limited to internal quality assessment protocols, state licenses and certifications, and federal agency certifications and/or registrations. Pharmacy shall notify US Script in writing within ten (10) calendar days of any change in its credentialing information or its ability to satisfy the requirements of this Section 2, including, but not limited to, any actual or threatened suspension, revocation, condition, limitation, qualification, or other action or restriction on Pharmacy's license(s), certifications, or permits or any other disciplinary action taken by the State Board of Pharmacy or other licensing authorities over Pharmacy and/or any situation that may reasonably interfere with Pharmacy's duties and obligations under this Agreement. C. Licensure/Certification. Pharmacy represents and warrants that Pharmacy and each of its pharmacists are duly licensed and qualified to operate a pharmacy pursuant to all applicable Laws and are in good standing with all federal, state, and local regulatory bodies. Pharmacy further represents and warrants that all personnel employed by or contracted with Pharmacy: (i) are licensed or certified and supervised (when and as required by Law), and qualified by education, training, and experience to perform their professional duties; (ii) act within the scope of their licensure or certification, as the case may be; and (iii) shall remain in compliance with all applicable terms of this Agreement. D. OIG/GSA Exclusion Lists. Pharmacy locations and pharmacists who are sanctioned by the Office of Inspector General (OIG) or the General Services Administration (GSA) and/or are not eligible to participate in Medicare, Medicaid, or other federal or state health care programs are not eligible to provide Covered Medications under this Agreement. Pharmacy represents and warrants that it has not been excluded from participation in federal or state health care programs, is not the subject of any pending exclusion proceeding, and has not been adjudicated or determined to have committed any action that could subject Pharmacy to exclusion from a government program. Pharmacy shall notify US Script promptly upon receipt of notice of (a) exclusion or proposed exclusion from a state or federal health care program, or (b) adjudication or other determination that Pharmacy has committed any action which could lead to exclusion from a government program. Pharmacy shall review the OIG and GSA exclusion lists upon hire of any employee, contractor, or agent that will be providing services to US Script directly or indirectly ("Covered Individual"), and periodically thereafter (in all events no less than monthly), to ensure that all Covered Individuals are not excluded from government funded health care programs. Pharmacy shall provide US Script with a certification or attestation by an officer Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 68 of 170 or director of Pharmacy of compliance with this Section upon US Script's request. Pharmacy shall notify US Script immediately upon receipt of any information indicating that Pharmacy or a Covered Individual has been charged with a crime relating to healthcare or is facing a proposed debarment, exclusion, or other adverse action, in which case, Pharmacy shall immediately remove any such Covered Individual(s) from direct responsibility for, or involvement in, services provided to US Script related to government health care programs, and will take appropriate corrective actions. This Section shall refer to and include members of Pharmacy's board of directors and any key management, executive staff, and any major stockholder. E. Insurance. Throughout the term of this Agreement, Pharmacy shall maintain in full force and effect general liability, professional liability, and workers' compensation insurance, in form and amounts as shall be reasonable for the industry and for a provider of pharmacy services of the size, type, and location of Pharmacy. In all events, professional liability insurance shall be in an amount not less than $1 million per occurrence and $3 million in the aggregate, or such greater amount required by Law and Pharmacy Standards. Pharmacy shall, upon request and upon any policy renewal or change, submit evidence of same to US Script. If Pharmacy has a "claims made" policy, Pharmacy shall, upon its termination, purchase a ''tail" policy or obtain replacement coverage which insures for prior acts, including losses arising from occurrences during the term of this Agreement. Such tail policy shall have the same limits as the "claims made" policy and shall extend the claims reporting period for the longest period for which coverage is available. Pharmacy shall provide US Script with not less than thirty (30) calendar days prior written notice of any cancellation, non-renewal, or material change to such policy(ies). Pharmacy shall notify US Script immediately in writing if its insurance is canceled, lapsed, or otherwise terminated. F. Offshore Operations and Activities. Pharmacy represents and warrants that it and its subcontractors do not, and shall not, perform any operations or activities under or in connection with this Agreement at a location outside of the United States, without the prior written approval of US Script. G. NCPDP Membership. Pharmacy shall maintain an active membership with NCPDP. In the event of a conflict or missing information from Pharmacy and the information on file with NCPDP regarding Pharmacy, US Script may rely on the information on file with NCPDP regarding Pharmacy, including for purposes of directories and payments hereunder. 3. NETWORK PARTICIPATION A. Network Participation. Pharmacy shall participate in all networks in which: (a) Pharmacy agrees to participate by accepting or executing an amendment or addenda hereto upon and after execution of this Agreement; and (b) at US Script's discretion, Pharmacy shall be deemed to have accepted participation and corresponding rates in any network in which Pharmacy adjudicates a Claim in that network. By signing this Agreement, Pharmacy acknowledges and agrees that, with this Agreement, Pharmacy has received Exhibit C, Exhibit C-l,and Exhibit C-2, has read these exhibits, and agrees to the terms and conditions set forth therein, which are incorporated herein, without requiring a separate signature thereon. At any time, Plans may utilize, change, or be removed from networks. Plans may or may not utilize all pharmacies in a network. B. Network Termination. Pharmacy may be excluded from participating in a network with respect to any specific Plan, and upon thirty (30) calendar days prior written notice to Pharmacy (or such longer period as required by applicable Law), Pharmacy may be removed from participating in a network with respect to a specific Plan. C. Non-Retail Pharmacy Services. Pharmacy acknowledges and agrees that participation under this Agreement as a non-retail pharmacy (such as, but not limited to, specialty, long term care, home infusion therapy, etc.) is subject to additional and sometimes different provisions and/or rates, which will be set forth in an applicable Exhibit B and Exhibit C hereto. Accordingly, Pharmacy acknowledges and agrees that by executing this Agreement and checking the appropriate box on the Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 69 of 170 signature page hereto, Pharmacy has received and read the applicable Exhibit B(s) and Exhibit C(s) and agrees to the terms and conditions set forth therein, without requiring a separate signature thereon in order to be effective. In the event Pharmacy fails to check the appropriate box on the signature page hereto and thereafter provides services hereunder as a non-retail pharmacy, Pharmacy shall be subject to the terms and conditions set forth in the applicable exhibit, at US Script's sole discretion. D. 340B. The 340B Pharmacy Addendum to Participating Pharmacy Agreement, attached hereto as Exhibit E, is hereby incorporated into the Agreement. Notwithstanding the foregoing, if Pharmacy is neither (i) a 340B covered entity with an in-house pharmacy nor (ii) a 340B contract pharmacy as defined by the federal Health Resources and Services Administration (75 FR 10272, March 5, 2010), Exhibit E does not apply to Pharmacy. Ifpharmacy is neither (i) nor (ii) defined herein, please indicate by initialing here: ____ _ 4. PHARMACY SERVICES AND OBLIGATIONS A. Eligibilitv Verification. Prior to filling any Covered Medication, Pharmacy shall require the patient to present his or her Member Identification Card. In addition, Pharmacy shall verify that the Member is Eligible to receive Covered Medications through the Claims Processing System. Pharmacy shall not submit a Claim through the Claims Processing System until it has preliminarily determined that Member is Eligible and that the prescription is valid, dated, and signed by a licensed prescriber, if legally applicable. US Script shall not be liable for any item Pharmacy provides to any person who is not Eligible. B. Dispensing Covered Medications. Pharmacy shall dispense Covered Medication(s) to Members in accordance with this Agreement (including but not limited to the Manual and all applicable Exhibits hereto, and any applicable addenda and amendments hereto), the prescriber's directions, the Plan requirements, the Formulary, and applicable Laws and Pharmacy Standards in a culturally competent manner. Pharmacy also agrees to dispense a temporary supply of Covered Medication(s) to Members in accordance with the applicable Plan requirements when required by the Plan or Law. In dispensing a Covered Medication, Pharmacy shall: (i) provide appropriate drug product consultation and counseling in accordance with Laws and Pharmacy Standards, (ii) obtain and respond to all Claims Processing System messages, (iii) consider all drug utilization review ("DUR") messages sent through the Claims Processing System, and (iv) use its independent professional judgment in accordance with Laws and Pharmacy Standards with the evaluation of such messages and the delivery of Covered Medications to Members. All products utilized in providing Covered Medications to Members must be in compliance with applicable Law, including those of the Federal Food and Drug Administration. When dispensing Covered Medications to Members, Pharmacy shall provide to Members all ancillary supplies appropriate for the administration of the medication dispensed at no additional charge (i.e., disposal containers, needles, syringes, alcohol wipes, etc.) Pharmacy shall use commercially reasonable efforts to maintain an adequate supply of drugs, devices, supplies, equipment, and other items to provide Covered Medications. C. Claims Processing System Capabilities. Pharmacy shall provide and maintain, at its expense, the equipment, software, and communications network transmission capabilities necessary to submit Claims and to receive processing messages, DUR messages, and Formulary information via the Claims Processing System. Pharmacy shall have capabilities to provide and receive data in the most current NCPDP specifications and requirements. D. Claims Submission. In each instance in which a Covered Medication is provided to a Member, Pharmacy shall submit a Claim for the Covered Medication to US Script electronically via the Claims Processing System in accordance with the terms of this Agreement (including those cases where the Member pays I 00% of the cost share of the Covered Medication) unless otherwise directed by or agreed to in writing by US Script. Pharmacy shall not submit a separate Claim for a Covered Medication which should have been dispensed and covered as one Claim but due to inadequate Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 70 of 170 supplies or other issues is dispensed and covered on different dates or at different times as multiple Claims. All Claims shall be submitted promptly after providing the Covered Medication, and in no event later than ninety (90) calendar days after the date that the Covered Medication is dispensed (or such longer period required by applicable Law). Failure to timely submit a Claim may result in non- payment of such Claim. Pharmacy must submit all required information for the Claim, which includes but is not limited to: the Member's identification number; quantity of the medication dispensed; days' supply dispensed; Pharmacy's NCPDP, provider, and NPI number; the eleven (11) digit NDC of the actual bottle size, package size, or container from which the medication was dispensed from Pharmacy's stock; the correct DAW code in accordance with NCPDP specifications; the valid prescriber's NPI number; tax amounts; and the Pharmacy's Usual and Customary charge of the medication dispensed. E. Claim Adjustments. Pharmacy shall electronically adjust all credits, duplicate claims, returned, and unclaimed prescriptions within ten (10) business days after the original fill date. This includes, but is not limited to, reversals and re-submittals for "return to stock" or partial fills, where the Covered Medication is partially filled and the remainder is not retrieved by the Member in a reasonable period of time, in which case Pharmacy must electronically reverse and resubmit the actual quantity of the Covered Medication received by the Member. F. Claim Certification. For each Claim submission, Pharmacy represents and certifies that the Covered Medication was provided to the Member and the information submitted is accurate and complete. G. Non-Electronic Claims. In accordance with Section 4.D above, Pharmacy shall electronically submit all Claims for Covered Medications dispensed to Members hereunder to US Script via the Claims Processing System. In the event the Claims Processing System is temporarily inaccessible, Pharmacy will make reasonable attempts to retransmit the Claim. In the event that the Claims Processing System is unavailable due to a major service disruption, Pharmacy may submit Claims for Covered Medications using a magnetic tape or a paper CMS 1500 form, in accordance with standard NCPDP specifications and requirements until such time as Pharmacy is able to resume electronic claims submission. Prior to submission of non-electronic Claims, Pharmacy shall contact US Script to verify the status and anticipated duration of any Claims Processing System service disruption. H. £-Prescribing. Pharmacy shall utilize NCPDP D.O Field 419 DJ-Prescription Origin Code for each claim submitted to US Script so that the source of origin for prescriptions can be identified and reported. Pharmacy shall support and comply with electronic prescription standards adopted by CMS as such final standards are effective with respect to Members, and as such standards may be revised from time to time, including but not limited to: (i) NCPDP Script for communications concerning prescriptions or prescription-related information between Pharmacy and prescribers; (ii) NCPDP Script 8.1 for communications concerning medication history between US Script, Pharmacy, and prescribers and refill status between Pharmacy and prescribers; (iii) NCPDP Telecommunication Standard D.O for communications concerning eligibility between US Script and Pharmacy; and (iv) the prescriber's NPI. I. Compliance with US Script and Plan Programs. Pharmacy shall use commercially reasonable efforts to participate in any initiatives developed by US Script or Plans, which initiatives may include, without limitation, programs for DUR, Formulary management, generic substitution, disease management, and utilization management. Without limiting the generality of the foregoing, Pharmacy shall use commercially reasonable efforts to contact the prescriber to encourage Formulary compliance and to request authorization to change to a therapeutic equivalent Formulary drug to the extent permitted by Law and subject to the professional judgment of the pharmacist. Pharmacy shall not recommend non- Formulary medications to prescribers or Members for the purpose of obtaining Pharmacy discounts, rebates, or other incentives. Pharmacy agrees, subject to applicable Law, to encourage and promote the use of Generic drugs in lieu ofBrand name drugs where Generics are available at less cost than Brand medications and it is in compliance with the applicable Plan and its Formulary. Pharmacy agrees to cooperate with and participate in: (i) all applicable Plan prior authorization policies and protocols; and (ii) all quality management programs, accreditation, risk management, utilization management Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 71 of 170 programs, credentialing, recredentialing, internal peer review systems, internal and external audit programs, grievance procedures, case management programs, and other administrative policies and procedures communicated to Pharmacy via the Claims Processing System and/or as established and described in the Agreement (including the Manual and any amendment or addendum hereto). J. Rebates. US Script and/or Plans shall have and retain the right to submit all Claims for Covered Medications dispensed to Members to pharmaceutical companies in connection with rebate or other similar programs. Pharmacy shall not submit any Claims for Covered Medications dispensed to Members to any pharmaceutical company for the purpose of receiving any rebates or discounts, or the like. K. Non-Discrimination. Pharmacy shall not differentiate or discriminate in the treatment of any Member as a result of his or her enrollment in a particular Plan, or because of the Member's race, color, creed, national origin, ancestry, religion, health status, sex, marital status, age, disability/handicap, sexual orientation, source of payment, or any other basis prohibited by Law. Pharmacy shall provide Covered Medications to all Members during regular hours of operation of Pharmacy and in the same manner, in accordance with the same standards, and with the same availability as that offered to other customers of Pharmacy. L. Professional Judgment. Nothing in this Agreement is intended to limit a pharmacist's professional judgment or violate applicable Law. No provision of this Agreement or any part of any Plan shall be construed to require any pharmacists to dispense any medication or specific type of medication to any Member if, in the pharmacist's reasonable professional judgment, such medication should not be dispensed to such Member. Accordingly, notwithstanding anything to the contrary in this Agreement, Pharmacy and its pharmacists must exercise sound professional judgment at all times when providing Covered Medications to Members. Pharmacy or pharmacists may refuse to provide Covered Medications to a Member based on that professional judgment, which must be documented. Pharmacy shall be solely responsible for its professional services rendered. In this regard, Pharmacy acknowledges and agrees that to the extent US Script provides DUR information or messages to Pharmacy: (i) such information contained in DUR messages is derived from third party sources and is not independently developed by US Script or Plans; (ii) the usefulness of DUR and other Formulary information is necessarily limited by the amount of patient information input into the Claims Processing System as a result of Claims processing, the amount of information provided by Plans, and the thoroughness and accuracy of industry information and information provided by third parties; (iii) DUR messages and Formulary information are intended as an aid to, and not a substitute for, the knowledge, expertise, skill, and judgment of prescribers, Pharmacy, pharmacists, and other health care professionals; (iv) Pharmacy, prescribers, pharmacists, and other health care professionals are responsible for acting or not acting upon information generated and transmitted by US Script; (v) US Script does not control the health care decisions made or actions taken by Pharmacy, prescribers, pharmacists, other health care professionals, Plans, or Members; (vi) the DUR messages and Formulary information may not contain all currently available information on health care or pharmaceutical practices; (vii) US Script is not responsible for failing to include information in a DUR message or in Formulary detail, for the actions or omissions of contributors of information to US Script, or for misstatements or inaccuracies in industry materials utilized by US Script; and (viii) all warranty disclaimers and exclusions made by contributors of information or data to US Script shall apply hereunder. M. Member Complaints and Grievances. Pharmacy shall cooperate in good faith with US Script in the investigation and resolution of Member grievances and complaints with respect to customer service, any irregular billing practice or procedure, overpayment, fraud or abuse, non-compliance with Plan's policies and procedures, or any other issue, concern, or complaint of a Member, including promptly providing US Script with requested documentation and information related thereto. Pharmacy shall make every reasonable effort to resolve oral or written grievances in an informal process and shall maintain a written record of all Member grievances and complaints. Such record shall include the name of the complainant, date and substance ofthe grievance, and its resolution and date ofresolution. Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 72 of 170 Pharmacy shall provide a written action plan that addresses service issues related to all complaints and grievances filed by Members, with a copy of the written action plan to US Script within thirty (30) calendar days of receipt of the Member grievance or complaint. N. Quality Assurance. Pharmacy represents that it has established an ongoing quality assurance/assessment program that shall include, but not be limited to, credentialing of employees. US Script may monitor and audit Pharmacy's compliance with this Section for quality assurance purposes to ensure compliance upon prior notice to Pharmacy. 0. Manual. Pharmacy agrees to comply with the Manual, which is incorporated herein by this reference. 5. COMPENSATION AND FEES A. Pavment for Covered Medications. Pharmacy agrees to accept as payment in full for Covered Medications provided to Members in accordance with this Agreement amounts provided for in this Agreement, including the applicable Exhibit C hereto and any rate addenda or amendments entered into or agreed to by the parties on and after the effective date of this Agreement. Claim rates are determined based upon Claim type, such as Brand, Generic, and a drug on the MAC list. A WP discounts and dispensing fee pricing for Brand and Generic drugs that are also drugs on the MAC list will be based on the lesser of the Brand, Generic, or MAC reimbursement. Pharmacy hereby assigns to Plan and US Script, all of Pharmacy's recovery, reimbursement, or subrogation rights along with other benefits that may be payable with respect to a Member. B. Timing of Payment. Subject to the terms and conditions of this Agreement, payment for Covered Medications provided to Members (less Copayments) will be made to Pharmacy thirty (30) calendar days following receipt by US Script of a Claim. Accompanying each payment will be an explanation of such payment, including reasons for adjustment, if applicable. Payment detail will be provided to Pharmacy on tape in NCPDP format or in such other format acceptable to US Script. C. Pavment Responsibilitv. US Script shall arrange for Plans to pay for Claims. Pharmacy acknowledges and agrees that US Script operates only as an intermediary between Plans and Pharmacy with respect to payment due under this Agreement and that Claim payment amounts due hereunder are the sole and exclusive responsibility of Plans. Pharmacy further acknowledges and agrees that US Script is not obligated to pay Pharmacy for Claims relating to a Plan if a Plan fails to provide US Script with sufficient funds related to Claims for payment, and US Script has no liability to Pharmacy for non- payment or for any delay in payment from a Plan. Pharmacy agrees that it shall have no claim against US Script, and shall not seek payment from US Script, above or beyond the amount of payments made to US Script by the applicable Plan. In the event of non-payment by a Plan, US Script is not required to commence litigation or other legal proceedings against a Plan to obtain payment. D. Government Related Payments. Pharmacy agrees to comply with all applicable Medicare, Medicaid, and other Laws (including CMS regulations and instructions). Pharmacy further agrees to comply with all Laws applicable to individuals and entities receiving federal funds and all other applicable federal and state Laws (including governmental issuances), including but not limited to all applicable federal and state anti-kickback statutes and all federal and state privacy and security requirements. When providing Covered Medications to Members of a Medic.aid, Medicare, or other government Plan, Pharmacy shall accept as payment in full the lesser of: (a)' the contracted rate and fees set forth in the applicable Exhibit C, amendment, or addenda hereto; or (b) lesser of the amount set forth in the applicable government fee schedule or government allowed amount. E. Collection from Members. Except to the extent inconsistent with or otherwise required by applicable 1 Law, upon Member's receipt of a Covered Medication, Pharmacy shall collect and retain from the Member the lesser of (i) the Pharmacy's Usual and Customary price, (ii) the applicable Copayment for the Covered Medication, or (iii) the applicable contracted rate hereunder (no zero balance logic applies Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 73 of 170 unless otherwise permitted by the applicable Plan). Except for infrequent and isolated waivers for charitable purposes or when otherwise directed by US Script in writing, Pharmacy will not waive, discount, reduce, or defer the amount for which the Member is responsible, in whole or in part. Unless otherwise directed in writing by US Script, in no event shall Pharmacy collect any greater amount than that indicated via the Claims Processing System, and Pharmacy shall not impose on Members any charges other than the Copayment related to the dispensing of the Covered Medication. In no event will Pharmacy seek to collect Copayments from US Script or Plans. In some cases, administrative, transaction, access, or other types of fees may apply with respect to Members. When applicable, Pharmacy shall collect from Members at the point of sale any such fees as communicated to Pharmacy via the Claims Processing System, which fees may be debited from amounts owing to Pharmacy under this Agreement. F. Member Hold Harmless. Pharmacy agrees that under no circumstances (including, but not limited to, nonpayment, insolvency, or bankruptcy of US Script or a Plan, or breach of this Agreement) will Pharmacy bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against any Member directly or indirectly for Covered Medications, except for Copayments. This includes situations where payment to Pharmacy is denied because Pharmacy failed to comply with the terms ofthis Agreement. This provision shall survive the termination of this Agreement regardless of the cause given rise to termination. This provision supersedes any oral or written contrary agreement now existing, or hereafter entered into, between Pharmacy, a Member, or persons acting on their behalf. This paragraph is to be interpreted for the benefit of Members. In the event Pharmacy violates this provision, Pharmacy shall promptly refund the amount collected in violation of this Agreement to Member, Plan, or US Script, as directed by US Script in writing. G. Sales and Use Taxes. Pharmacy may request reimbursement via the Claims Processing System of the proper amount of any taxes, assessments, and/or similar fees ("Taxes") of a governmental authority payable with respect to any sales or dispensing of Covered Medications to Member. In no event does this give Pharmacy any additional or greater rights than those allowed by Law. In no event shall US Script be liable for any Taxes or the determination of the amount of Taxes. Pharmacy shall be responsible for timely making payments to the appropriate taxing authority of Tax amounts due. H. Service Fees. For the services US Script provides to Pharmacy under this Agreement, including but not limited to (i) a toll-free telephone support service, (ii) support service via email, (iii) prior authorization support, (iv) claims adjudication and payment, and (v) real-time administrative overrides and claim reversals, US Script charges Pharmacy a service fee (the "Service Fee"). The Service Fee will be calculated on a per paid claim basis, which shall include each paid claim that Pharmacy sends to US Script. The Service Fee shall be in the amount set forth on the applicable Exhibit C. These Service Fees will be immediately due and owing by Pharmacy to US Script and US Script has the right to deduct such amounts from any amounts payable to Pharmacy. Any modifications to this Service Fee requirement must be in writing and signed by an officer of US Script. I. Withhold/Recoupment. Pharmacy shall promptly pay any amounts due hereunder and any payment or portion thereof determined to have been paid in error and thus due and owing to US Script and/or Plan. Pharmacy shall pay late fees at the rate of the lesser of one and one-half percent per month or the highest percent allowed by Law from the payment due date until paid in full. US Script shall have the right to deduct the amount of such charges, overpayments, penalties, and/or late fees from amounts due to Pharmacy hereunder. In the event no such deduction is made, Pharmacy shall pay such charges, overpayments, and/or penalties to US Script within thirty (30) calendar days of the receipt of an invoice therefore. Pharmacy shall immediately notify US Script of any payment made in error. Pharmacy agrees not to attempt to affect an accord or satisfaction through a payment instrument or accompanying written communication and not to conditionally or restrictedly endorse any payment instrument, and US Script shall not be bound by any such attempt or endorsement. Claims submitted to US Script with information that is inaccurate and/or unverifiable are subject to reversal and recovery up to the total amount of the Claim. Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 74 of 170 J. Penalties. Pharmacy agrees that to the extent US Script and/or Plans incur penalties that result from Pharmacy's actions, inactions, or other failure to comply with this Agreement and/or applicable Law, Pharmacy shall immediately owe and pay any such penalties imposed upon US Script and/or Plans, including but not limited to fees, interest, damages, judgments, financial obligations, or other charges, unless otherwise prohibited by Law. K. Payments to Third Parties. US Script may remit payment due hereunder to third parties in accordance with assignment, lien, court order, or such other documentation received by US Script pursuant to which monies owed to Pharmacy under this Agreement have been assigned to, are due to, or are directed to be paid to that third party (i.e., assignee, bankruptcy trustee, liquidator, government, etc.). Payments to such parties shall satisfy the obligation to Pharmacy for payment under this Agreement. In the event Pharmacy is aware of such third party requirements, Pharmacy shall promptly notify US Script in writing of such and provide US Script with the name, address, and tax identification number of any such third party, including relevant documentation related thereto. Pharmacy shall promptly notify US Script in writing of any changes to such third party requirements. L. Suspension of Payments. US Script may withhold payment due hereunder: (a) as directed by Medicare, Medicaid, or other governmental entity; and/or (b) in cases where there is reasonable suspicion of fraud or willful misrepresentation. In such cases, the Claim amounts shall not become due and owing hereunder until: (a) such amounts are allowed to be paid by Medicare, Medicaid, or other governmental entity; and/or (b) the suspicion of fraud or willful misrepresentation has been fully resolved with a determination of no fraud or willful misrepresentation by US Script, Plan, or a court of competent jurisdiction. M. Pricing Benchmark. Upon thirty (30) calendar days written notice to Pharmacy, US Script (at its sole discretion) may utilize different pricing benchmarks (i.e., WAC instead of A WP) for all or some of the pricing of Claims hereunder; provided, however, the change to the new pricing benchmark(s) maintains comparable pricing as existed prior to such change. N. Payment Disputes. Pharmacy must notify US Script in writing of any alleged error, miscalculation, discrepancy, or basis for disputing the correctness or accuracy of any Claim (whether paid, denied, rejected, reversed, or otherwise) within ninety (90) days after the remittance advice is sent to or made available to Pharmacy, except as otherwise required by Law or permitted by US Script in writing. Otherwise, Pharmacy will be deemed to have confirmed the accuracy and correctness of the Claims processed and/or paid during that time. In no event will US Script have liability above or beyond Claim amounts during such ninety (90) day period. This Section does not apply with respect to any overpayments made to Pharmacy. 6. RECORDS AND AUDITS A. Maintenance of Records. For a period of seven (7) years, or such longer period as required by Law, from the date the Covered Medication was dispensed, Pharmacy shall maintain pharmacy, financial, administrative, and other records ("Records") relating to the provision of Covered Medications to Members in accordance with this Agreement, Plan requirements, and applicable Laws and Pharmacy Standards, inch.iding, but not limited to, original prescriptions; daily prescription logs; wholesaler, manufacturer and distributor invoices; prescriber information; patient profiles; and patient signature logs for all Covered Medications dispensed to Members. A signature log must contain, at a minimum, the prescription number, the date the Covered Medication was delivered to the Member or his/her representative, the signature of the Member or his/her representation, and authorization for the release of the information to US Script and Plan. Payment may be withheld, denied, or charged back for Claims where records are not maintained and available as required hereunder. B. Access and Audit Requirements. Upon reasonable notice and during Pharmacy's regular business hours, and subject to all applicable state and federal Laws regarding the confidentiality of records, US Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 75 of 170 Script, Plans, government regulatory agencies, and their authorized representatives shall have the right, for the term of the Agreement and for three (3) years thereafter (or such longer or shorter period required by Law), to review, audit, examine, and reproduce any of the Pharmacy's Records for compliance with this Agreement, including but not limited to: accuracy of Claims, appropriateness of billing, investigation of Member grievances or complaints, compliance with quality assurance and other US Script and Plan programs. C. Audit Process. Pharmacy shall cooperate in good faith with all Record requests and audits and shall provide US Script, Plans, government regulatory agencies, and their authorized representatives access to Pharmacy's premises and Records for such purposes. Pharmacy shall provide Records or copies of Records requested by US Script, Plans, government regulatory agencies, and their authorized representatives within twenty-one (21) calendar days (or such longer or shorter period required by Law or applicable regulatory agency), from the date of a written request for such records. All records shall be provided at the sole cost and expense of Pharmacy including, without limitation, any costs associated with making excerpts or transcripts, copying, reproducing, shipping and/or mailing of records. Overpayments could result from inaccurate submission of Claim information or other non- compliance with the terms of the Agreement or an applicable amendment or addendum hereto, including, but not limited to NDC number billed not in accordance with NDC number dispensed; NDC number of units billed does not reflect units identified on manufacturer package and reported by applicable third party pricing source for each NDC; inaccurate submission of days' supply for quantity of medication dispensed; days' supply or quantity dispensed does not reflect the prescription order, ethical use, exceeds or is not in accordance with Plan requirements. If it is determined through audits or otherwise that overpayments have been made to Pharmacy under this Agreement, any such overpayments shall become immediately due and owing by Pharmacy. D. Record Requests. Upon US Script's request, Pharmacy shall cooperate with US Script in responding to any subpoenas and/or other record requests US Script receives related to Pharmacy, and Pharmacy shall promptly provide such requested information and documentation. 7. COMPLIANCE. A. Compliance with Laws. Pharmacy must comply with all applicable Laws, including, without limitation, the following, which are incorporated by reference: (a) Federal Acquisition Regulations ("FAR") 52.203-12, "Limitation on Payments to Influence Certain Federal Transactions" (31 USC Section 1352); (b) FAR 52.222-26, "Equal Opportunity" (E.O. 11246), (C. Section 2012(a)); (c) FAR 52.222- 36, "Affirmative Action for Handicapped Workers" (29 USC Section 12101 et seq.). B. Regulatory Compliance. Pharmacy acknowledges that various federal and state mandates may apply with respect to this Agreement and the services provided to Members of Plans. Such mandates are included in addenda to the Manual and may provide specific, different, and/or additional contractual provisions applicable to some of the services, Members, and/or Plans ("Regulatory Addenda"), all of which are incorporated herein by this reference. Pharmacy agrees that by executing this Agreement, Pharmacy has received the Regulatory Addenda, has read such Regulatory Addenda, and agrees to the terms and conditions set forth in such Regulatory Addenda, without requiring a separate signature thereon in order to be effective. The provisions in the Regulatory Addenda only apply if they are required and then only as those provisions relate to Members whose Plan is governed by the applicable provisions. In the event of a conflict between this Agreement and an applicable Regulatory Addendum, the Regulatory Addendum shall control to the extent required by Law. Pharmacy represents and warrants that it is, and shall remain, in compliance with all applicable Laws, including but not limited to those Laws referenced in the Regulatory Addenda. Pharmacy acknowJedges and agrees that the Regulatory Addenda may be amended and/or supplemented with additional addenda by US Script from time to time upon written notice to Pharmacy. Regulatory Addenda shall be provided or made available to Pharmacy by US Script in written or electronic format. Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 76 of 170 C. Compliance Program. US Script encourages Pharmacy to have its own compliance program that satisfies federal government guidance. US Script requires Pharmacy to act in an ethical and compliant manner, consistent with the codes of conduct and any applicable fraud, waste, and abuse policies and programs of US Script and Plans (as updated from time to time). Pharmacy shall promptly report in writing to US Script compliance concerns and suspected and/or actual violations of Law or policy related to this Agreement, including but not limited to forged or stolen prescriptions. Pharmacy acknowledges that there will be no retaliation for the reporting of compliance concerns or misconduct. Pharmacy acknowledges that US Script or Plans may report potential fraud involving Pharmacy to federal or state agencies or their designees. D. False Claims. Under the Deficit Reduction Act of 2005, certain entities are required by Law to establish policies and provide information regarding the federal False Claims Act and similar state laws, an employee's right to be protected as a whistleblower, and policies and procedures for detecting and preventing fraud, waste, and abuse in state and federal health care programs ("DRA Policies"). Any contractors, subcontractor, agent, and other person which or who furnishes or otherwise authorize the furnishing of Medicaid health care items or services, performs billing or coding functions, or is involved in monitoring of health care provided by these covered entities is required to adopt their DRA Polices, as may be amended from time to time. US Script will provide or make available to Pharmacy the DRA Polices. To the extent Pharmacy or any of its employees or subcontractors furnish or otherwise authorize the furnishing of Medicaid health care items or services, performs billing or coding functions, or is involved in monitoring of health care provided by these covered entities, Pharmacy shall comply with the DRA Policies and shall require its employees and subcontractors to comply with the DRA Policies as required by Law. E. Administrative and Other Legal Actions. Pharmacy shall promptly notifY US Script in writing of any legal or administrative action filed or claim made against Pharmacy arising from this Agreement by a Member or other and any legal or administrative claim made or action filed against Pharmacy that otherwise could affect the ability of Pharmacy to perform its obligations under this Agreement. 8. INDEMNIFICATION AND LIMITATION OF LIABILITY A. Indemnification by Pharmacy. Pharmacy shall indemnifY, defend, and hold US Script, Plans, and their respective officers, directors, agents, representatives, and employees harmless from and against all liabilities, claims, losses, obligations, actions, demands, costs, and expenses, including attorneys' fees, which may arise out of any breach by Pharmacy of this Agreement or any negligence, gross negligence, or willful misconduct, in act or omission, of Pharmacy, its employees, agents, contractors, and representatives in connection with any services performed under this Agreement, including but not limited to: (a) failure of Pharmacy to act in accordance with Pharmacy Standards, Law, or this Agreement, (b) any actual or alleged malpractice, negligence, misconduct, act, omission, or responsibility of Pharmacy, (c) the provision of pharmacy services, or the sale, compounding, dispensing, manufacturing, packaging, storage, or use of a drug or device dispensed by Pharmacy, (d) data related to payment and other data or information provided, submitted, transmitted, or certified by or on behalf of Pharmacy in connection with this Agreement, and/or (e) the breach or alleged breach by Pharmacy of any representation, warranty, or covenant of Pharmacy as set forth in this Agreement. B. Indemnification by US Script. US Script shall indemnifY, defend, and hold Pharmacy, its officers, directors, agents, representatives, and employees harmless from and against all liabilities, claims losses, obligations, actions, demands, costs, and expenses, including attorneys' fees, which arise out of any breach by US Script of this Agreement or any negligence, gross negligence, or willful misconduct, in act or omission, of US Script, its employees, agents, contractors, and representatives in connection with any services performed under this Agreement. C. Limitation ofLiabilitv. Notwithstanding any other term of this Agreement, in no event shall US Script be liable to Pharmacy for special, indirect, incidental, exemplary, consequential (including but not Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 77 of 170 limited to loss of profits) or punitive damages arising from the relationship of the parties or the conduct of business under this Agreement (even if US Script has been advised of or has foreseen the possibility of such damages). 9. TERM AND TERMINATION A. Term. The term of the Agreement shall commence on the Effective Date and, unless earlier terminated in accordance herewith, shall continue for an initial one (1) year term. Following the initial one (1) year term, the term hereof shall be automatically renewed thereafter for successive one (1) year terms on January 1 of each year. B. No Cause Termination. US Script may terminate this Agreement at any time by providing at least one hundred eighty (180) days prior written notice of its intention to terminate this Agreement. C. Termination for Breach. If there is any material default by either party in the performance of the terms and conditions of this Agreement, the non-defaulting party may terminate this Agreement (in whole or in part with respect to the applicable Plan, network, or Pharmacy location) upon sixty (60) calendar days' prior written notice to the other party, provided, however, that the defaulting party has not cured such default within ten (1 0) calendar days prior to the end of such sixty ( 60) calendar day period. D. Immediate Suspension or Termination. Notwithstanding the above, this Agreement may be immediately terminated or suspended (in whole or in part with respect to the applicable Plan, network, or Pharmacy location) by US Script in the event of any of the following: (i) Pharmacy breaches any representation or warranty of Pharmacy under this Agreement; (ii) Pharmacy fails to maintain appropriate licensure, registration, certification, and/or good standing as required under this Agreement and/or Law; (iii) there is reasonable suspicion of Pharmacy's negligent or fraudulent submission of incorrect or false Claim information; (iv) Pharmacy's insurance required hereunder is canceled, lapsed, terminated, or otherwise suspended without replacement coverage; (v) Pharmacy is indicted or convicted of a felony, fraud, and/or submission of false claim information; (vi) Pharmacy fails to cooperate with US Script in resolving Member complaints or grievances or if, in US Script's sole discretion, US Script receives an excessive amount of Member complaints or grievances concerning Pharmacy; (vii) Pharmacy is listed on the OIG or GSA exclusion lists or is sanctioned under or expelled from participation in the Medicare, Medicaid, or other government programs; (viii) Pharmacy fails to satisfy any or all of the credentialing requirement of US Script; (ix) Pharmacy is guilty of any conduct tending to injure the business reputation of US Script; (x) Pharmacy makes an assignment for the benefit of its creditors, becomes unable to pay debts when due, files a petition in bankruptcy, whether voluntary or involuntary, and/or a receiver or trustee is appointed for the transfer or sale of a material portion of Pharmacy's assets; and/or (xi) US Script or a Plan determines that the health, safety, or welfare of Members is jeopardized by continuation of this Agreement. E. Effect of Termination. In the event of termination, suspension, and/or breach of this Agreement, in addition to all other rights and remedies US Script may have at law, equity, or under this Agreement, US Script shall have the right to: (a) suspend any and all obligations of US Script under and in connection with this Agreement; (b) impose reasonable investigation and handling fees, and/or (c) offset against any amounts owed to Pharmacy under this Agreement or under any other agreement between US Script and Pharmacy, any amounts required to be paid by Pharmacy to US Script. Pharmacy acknowledges the rights of US Script to notify Plans and Members of termination or suspension of this Agreement or Pharmacy's participation in a particular Plan or network. The parties will cooperate in good faith to promptly resolve any outstanding financial, administrative, or Member service issues upon termination of this Agreement. 10. DISPUTE RESOLUTION Appendix Vli.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 78 of 170 A. Pharmacy Appeals Process. Pharmacy shall attempt to resolve any controversy or claim with or against US Script arising out of, or relating to, this Agreement through the appeal procedures outlined in the Manual. B. Good Faith Dispute Resolution Negotiations. If, after exhausting the applicable provider appeals process, Pharmacy is dissatisfied with the outcome, or if US Script has a controversy or claim with or against Pharmacy arising out of, or relating to, this Agreement, the parties shall attempt to resolve the dispute through negotiations between designated representatives of the parties who have authority to settle the dispute. · C. Arbitration. If the matter has not been resolved within sixty (60) calendar days ofthe party's request for negotiation (and the appeals process has been exhausted for Pharmacy), either party wishing to pursue the dispute shall submit it to binding arbitration conducted by the American Health Lawyers Association ("AHLA") in accordance with its expedited procedures under the AHLA Arbitration Rules. Such arbitration to be held in Fresno, California before a single arbitrator. In no event may any arbitration be initiated more than one (1) year following the sending of written notice of the dispute. The parties shall share equally the fee of the arbitrator, excluding the filing fee, if any, incurred in commencement of the proceeding. The arbitrator shall render a written decision within 30 calendar days of the hearing. The arbitrator shall award attorneys' fees and costs, excluding the arbitrator's fees and any filing fees, to the prevailing party. The arbitrator shall have no right to award any punitive or exemplary damages or to vary or ignore the terms of this Agreement and shall be bound by controlling law. The award of the arbitrator will be fmal and binding on the parties, and judgment upon such award may be entered in any court having jurisdiction thereof. The existence of a dispute or arbitration proceeding shall not in and of itself constitute cause for termination of this Agreement. Notwithstanding any dispute arising under this Agreement, each party hereto shall continue to perform its obligations hereunder pending the decision of the arbitrator. This arbitration provision shall be the sole and exclusive method of handling any and all disputes, claims, and controversies arising out of or related to this Agreement. This provision shall survive any termination of this Agreement. Each party shall bear its own costs related to the arbitration except that the costs imposed by the AHLA shall be shared equally. D. Failure to Act Timely. If Pharmacy fails to demand or initiate any legal remedy within the time frames prescribed in this Section 10 and the Agreement, US Script's last determination on the disputed issue(s) shall be deemed final and binding, and the disputed issue(s) shall be conclusively deemed to have been waived by Pharmacy and shall not be the subject of any further internal, external, judicial, arbitral, or other dispute resolution process. Once the decision is deemed final, nothing in this Agreement shall prevent US Script or its representatives from pursuing remedies available to it, including without limitation a judicial remedy, to collect any amounts owed to US Script or a Plan by Pharmacy. E. Non-Disparagement. US Script and Pharmacy shall not publicly disparage the other. 11. MISCELLANEOUS A. Confidential and Proprietarv Information. Pharmacy and US Script shall comply with all federal, state, and local Laws applicable to the confidentiality, use, disclosure, and maintenance of Members' personal information ("Confidential Information"). Except as required by Law, Pharmacy, on behalf of itself and its officers, employees and other representatives ("Representatives"), also agrees to treat as confidential, and to take reasonable precautions and care to prevent unauthorized use and/or disclosure of the terms of this Agreement and any other information relating to US Script's business operations and services ("Proprietary Information") obtained in the performance of this Agreement and not part of the public domain. Proprietary Information shall include US Script's databases, software, layouts, designs, formats, procedures, processes, applications, systems, technology, files, compilations, exhibits, publications, protocols, information pertaining to Plans, and Formularies. All Proprietary Information remains the exclusive property of US Script. Nothing in this Section shall prohibit either party from Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 79 of 170 discussing reimbursement or payment issues with a Member. Nothing in this Section shall prohibit US Script from discussing reimbursement or payment issues with a Plan. If Pharmacy or its Representative receives a demand or request to disclose any Confidential Information or Proprietary Information pursuant to the terms of a court order, subpoena, interrogatory or other legal process, such Confidential or Proprietary Information may be disclosed to the extent required; provided that (i) Pharmacy promptly notifies US Script of the existence, terms and circumstances surrounding such demand or request prior to the disclosure of any Confidential or Proprietary Information and provides US Script with a copy thereof; (ii) Pharmacy assists US Script's efforts to obtain, if and to the extent available, whatever protective order or other relief that US Script desires to be obtained with respect to such demand or request and (iii) such Confidential or Proprietary Information is not disclosed more than three days prior to the last date it may be disclosed without violating such court order, subpoena, interrogatory or other legal process, as such date may be modified by any order or other relief obtained. Upon termination of this Agreement, US Script may request the return of its Confidential and/or Proprietary Information in the possession ofPharmacy. Within thirty (30) calendar days of the request, except to the extent that Pharmacy has a legal obligation to retain such Confidential and/or Proprietary Information in its possession, or if such return is not feasible, Pharmacy shall destroy such Confidential and/or Proprietary Information and provide certification of such destruction. Pharmacy further agrees that it shall be responsible for any breach of this Section by its Representatives. Pharmacy agrees that monetary damages would be difficult to ascertain in the event of any breach of this Section and that monetary damages alone would not suffice to compensate US Script for such breach. Pharmacy agrees that in the event of a violation of this Section, without limiting any other rights and remedies, an injunction may be brought against Pharmacy for breach or threatened breach of this Section, without the requirement to post bond. Pharmacy shall be required to guarantee the confidentiality of all Confidential and Proprietary Information pertaining to US Script, Plan, and Members. Pharmacy shall reimburse US Script for all of its costs and expenses (including, without limitation, reasonable attorneys' fees) incurred by US Script in connection with a violation or threatened violation of this Section. B. Use ofName and Marks. Pharmacy consents to the use of Pharmacy's name and other identifying and descriptive information (i.e., address, telephone number, and hours of operation) in provider directories and in other materials and publications produced for marketing, administration, and/or operations of US Script and/or Plan in all formats, including, but not limited to, electronic media. Pharmacy may use US Script's name, logos, trademarks, or service marks in marketing materials or otherwise, upon receipt of US Script's prior written consent, which US Script shall not unreasonably withhold. Pharmacy and US Script shall not otherwise use each other's name, symbols, trademarks, or service marks without prior written approval. C. Relationships. It is understood that Pharmacy is an independent contractor and in no way is Pharmacy to be considered an employee, partnership, joint venture, agent, or representative of US Script or Plan. It is further understood that Pharmacy provides specific services to Members in exchange for an agreed upon fee. This Agreement shall not create, nor be deemed or construed to create any relationship between US Script, Plan, and Pharmacy other than that of independent contractors, contracting with each other solely for the purpose of performing this Agreement, and each party shall be liable solely for their own activities and neither US Script nor Pharmacy nor Plan shall be liable to any third party for the activities of the other party to this Agreement. The relationship between Pharmacy and Members is that of pharmaceutical provider and patient. D. Third Partv Beneficiaries. Nothing in this Agreement shall be construed as, or deemed to create, any right or remedy in any third party, and no third party shall have any right or cause of action under this Agreement, including any Member, except as otherwise specifically provided herein. E. Communications. Pharmacy hereby provides its written and informed consent to receive from US Script and its affiliates communications, advertisements, and solicitations in connection with this Agreement via facsimile, telephone, and email at the respective address(es), telephone number(s), and e-mail address(es) provided in connection with this Agreement. Such communications may include, Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 80 of 170 but are not limited to, additional rate addenda, information concerning the efficacy and quality of prescription drugs, and other educational materials. F. Governing Law. This Agreement shall be deemed to have been made and shall be construed, interpreted, and enforced in accordance with federal law and the laws of the state of California, without regard to conflict of law principles. Notwithstanding any language to the contrary contained in this Agreement, in the event that this Agreement does not contain a particular provision required by Law, or any provision of this Agreement is deemed to be in conflict with any Law, then this Agreement, as applicable and to the extent required by Law, shall be deemed amended to comply with Law and any conflicting provision deemed stricken. G. Notices. Notices required to be given pursuant to this Agreement related to breach, dispute, non- payment by US Script, and termination shall be in writing, postage prepaid, and shall be sent by certified mail, return receipt requested, or by an overnight delivery service which provides a written receipt evidencing delivery, to the following addresses: To US Script at: Attn: Pharmacy Contracts US Script, Inc. 2425 West Shaw Avenue Fresno, California 93711 PharmacyContracts@usscript.com To Pharmacy at: The corporate address shown on Exhibit A hereto. All other notices pursuant to this Agreement shall be in writing and shall be given in accordance with the notice requirements above or by facsimile, email, or US Mail, postage prepaid, to the other party at the facsimile, email, or mail address designated above. All notices called for hereunder shall be effective upon receipt. Notwithstanding the foregoing, notices shall be deemed accepted and effective using any other method of delivery upon mutual written consent of the parties. H. Assignment. US Script may assign, transfer, delegate, or subcontract its rights or obligations under this Agreement to its partner(s), affiliated companies, successors, or assigns. This Agreement, being intended to secure the services of Pharmacy, shall not be assigned, subcontracted, delegated, or transferred in any manner by Pharmacy. Without limitation, this provision prohibits the transfer of this Agreement in connection with any sale of Pharmacy. This Agreement will be binding upon and inure to the benefits of the parties, their agents, and permitted successors and assigns of the parties. I. Waiver. The failure of any of the parties to insist upon strict performance of any of the terms of this Agreement shall not be deemed a waiver of any of their respective rights or remedies, and shall not be deemed a waiver of any subsequent breach or default in any of the terms contained in this Agreement. All of the rights and remedies provided herein are cumulative and not alternative and shall not be deemed to be waiver of any rights or remedies either party may have at law or in equity. J. Severabilitv. In the event any provision of this Agreement is held to be invalid, illegal, or unenforceable, the remainder of the provisions of this Agreement shall be construed liberally in order to effectuate the purposes hereof, and the validity, legality, and enforceability of the remainder of the provisions shall remain in full force and effect. K. No Conflict. Pharmacy represents and warrants that neither the execution of this Agreement nor the performance of its obligations hereunder will result in any breach or default under its organizational Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 81 of 170 documents or under any agreement or other legally binding instrument, license, or permit to which it is a party or by which it may be bound. L. Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed to be an original, but all of which together shall constitute one and the same instrument. M. Non-Solicitation. During the term of this Agreement, or any renewal thereof, and for a period of six ( 6) months from the date of termination, Pharmacy shall not advise, counsel, or solicit any Members to end enrollment with Plans utilizing US Script or switch between different pharmacy benefit delivery systems, and will not solicit any Members to become enrolled with any other pharmacy benefit manager ("PBM"), for any reason, including, but not limited to, compensation level, the termination of this Agreement between Pharmacy and US Script, or the health status of the Member. Nothing contained in this Agreement shall be constructed to require Pharmacy to recommend any procedure or course of treatment that Pharmacy deems professionally unacceptable. Neither US Script nor Plan will penalize Pharmacy for open provider-patient communication regarding appropriate treatment alternatives. Neither US Script nor Plan will penalize Pharmacy for discussing medically necessary or appropriate patient care. N. Insolvency. Pharmacy shall notify US Script immediately at any time if Pharmacy (i) makes a general assignment for the benefit of its creditors; (ii) becomes unable to pay its debts when due; (iii) files a petition in bankruptcy, whether voluntary or involuntary; and/or (iv) is otherwise impaired financially and is unable to perform its duties hereunder. 0. Headings. The headings of the various sections of this Agreement are for reference purposes only, and do not, expressly or by implication, limit, define, or extend the specific terms of the section so designated. P. Survival of Obligations. Provisions of this Agreement that are not fully performed or capable of being fully performed on the effective date of the termination or expiration of this Agreement, including but not limited to the member hold harmless, records and audits, insurance, indemnification and limitation of liability, non-solicitation, and confidentiality provisions, will survive termination or expiration of this Agreement regardless of the cause giving rise to termination and shall be effective thereafter until fully performed. Q. Entire A~rreement. This Agreement, including all attachments, exhibits, addenda, amendments, and the Manual (all of which are incorporated herein by this reference) constitutes the entire agreement between the parties and is referred to collectively herein as the "Agreement". Any prior oral or written agreements, promises, negotiations, or representations concerning the subject matter covered by this Agreement are superseded and of no force or effect, including but not limited to any and all prior rate addenda, amendments, rate sheets, exhibits, and the like. R. Amendments. No alterations or modifications to this Agreement shall be valid unless made in writing and signed by both parties hereto; provided, however, US Script may, from time to time, amend this Agreement with thirty (30) calendar days' notice to Pharmacy or such greater or lesser time required by Law. If Pharmacy objects to the amendment in writing, Pharmacy may immediately terminate this Agreement (or the applicable Plan or network participation by Pharmacy) by providing written notice of such. In the event Pharmacy does not provide such written notice to US Script prior to the effective date of the amendment, Pharmacy will be deemed to have consented to the amendment, in which case a separate signature thereon is not required in order to be effective. The parties understand that amendments hereto may be subject to the approval ofPlan(s) and/or governmental agencies. S. Force Majeure. The parties shall be excused, discharged, and released from performance under this Agreement to the extent that all or part of the Agreement cannot be performed due to causes which are outside the control of US Script and Pharmacy, and could not be avoided by the exercise of due care, Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 82 of 170 including but not limited to acts of God, acts of a public enemy, acts of a sovereign nation or any state or political subdivision or any department or regulatory agency thereof or entity created thereby, acts of any person engaged in a subversive activity or sabotage, terrorist activity, fires, floods, earthquakes, explosions, strikes, slow-downs, lockouts or labor stoppage, freight embargoes, or by any enforceable Law. The foregoing shall not be considered to be a waiver of any continuing obligation under this Agreement, and as soon as the adverse conditions cease, the party affected thereby shall fulfill its obligations as set forth under this Agreement. T. Pharmacy Services Administration Organization ("PSAO"). PSAO means an entity that provides administrative services to Pharmacy and which Pharmacy has authorized to contract on behalf of participating pharmacies. If the entity executing this Agreement is a PSAO entering into this Agreement on behalf of one or more pharmacies, by signing this Agreement, PSAO acknowledges and agrees that it has received the PSAO Addendum attached hereto as Exhibit D and agrees to the terms and conditions set forth therein, without requiring a separate signature thereon. In the event PSAO fails to check the PSAO box on the signature page hereto but nonetheless is a PSAO, PSAO acknowledges and agrees that it is subject to the terms and conditions set forth in Exhibit D. If the entity executing this Agreement is Pharmacy (not a PSAO), by signing this Agreement, Pharmacy represents and warrants that it does not belong to an affiliated group of pharmacies that obtain the administrative services of a PSAO. If Pharmacy later obtains the services of a PSAO, PSAO or Pharmacy shall notify US Script in writing immediately and this Agreement shall terminate on the Pharmacy effective date (as defined in the PSAO Addendum), in which case Pharmacy represents and warrants that it has authorized its PSAO to bind Pharmacy, individually and as part of an affiliated group of pharmacies, to all the terms and conditions of the PSAO's agreement with US Script. Upon US Script's written request, PSAO shall provide US Script with evidence ofPSAO's authority to bind the Pharmacy. In the event Pharmacy utilizes the services of a PSAO, Pharmacy shall indemnify US Script, Plans, and their respective shareholders, officers, directors, employees, and agents, and the successors, representatives, and assigns thereof, and hold them harmless from and against, any and all liability, loss, damage, settlement, claim, injury, demand, judgment, and expense, including attorneys' fees, arising directly or indirectly from: (a) failure of Pharmacy to act in accordance with its agreement with PSAO, and (b) any dispute between Pharmacy and PSAO. Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 83 of 170 By checking the appropriate box(es) below, Pharmacy attests that it is participating under this Agreement as one or more of the following (as designated): 0 Retail Pharmacy 0 Specialty Pharmacy (Pharmacy must check this box if Pharmacy intends to dispense Claims for US Script- identified specialty products under this Agreement.) 0 Home Infusion Pharmacy 0 Long-Term Care Pharmacy, as defined by CMS 0 340B Pharmacy By checking the box below, the undersigned is executing this Agreement as a PSAO: D PSAO Pharmacy is not authorized to add, delete, or make any modifications to this Agreement (whether typed, hand-written, or otherwise) without the prior written consent of US Script. Any such modifications to this Agreement without the written authorization of US Script shall be invalid and shall have no effect. IN WITNESS WHEREOF, the parties have duly executed this Agreement as of the date set forth below. Pharmacy US Script, Inc. By:------,------------,----:- (Signature) (Date) By:-=~----:----------~~-- (Signature) (Date) (Print Name and Title) (Print Name and Title) Pharmacy Legal Name: ____________________________________________________________ __ NCPDP/NPI or Chain ID: ___________________ _ Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit A Pharmacy Locations Exhibit H Page 84 of 170 A list of all pharmacies must be provided below or on diskette or in an excel spreadsheet, including the following information for each location: • NCPDP# • NPI# • Physical address • Mailing address • E-mail address for customers • E-mail address for notice under this Agreement • Website address for customers • Phone number • Faxnumber • Federal tax ID number • Store hours • Languages available • Accept e-prescriptions • Description of ancillary services (i.e., compounding, 24 hour service, delivery, refill reminders, online refills, drive-thru, etc.) Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit B Non-Retail Pharmacy Addenda Exhibit H Page 85 of 170 Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit B-1 Specialty Pharmacy Addenda Exhibit H Page 86 of 170 This Specialty Phannacy Addendum ("Specialty Addendum") is an addendum to the U.S. Script Participating Pharmacy Agreement ("Agreement") and is by and between US Script and Pharmacy. This Specialty Addendum is effective as of the Effective Date of the Agreement. WHEREAS, US Script and Pharmacy entered into and executed the Agreement, under which Phannacy agrees to furnish Phannaceutical Services to Members of Plans. WHEREAS, Phannacy is a duly licensed phannacy authorized to provide specialty medications and services to patients. WHEREAS, US Script and Phannacy desire to amend the Agreement as set forth in this Specialty Addendum to provide for specialty Phannaceutical Services to Members of Plans. In consideration of the mutual promises herein, by executing the Agreement, the parties agree as follows: 1. Definitions. Except as expressly provided herein, all capitalized terms used in this Specialty Addendum shall have the meanings set forth in the Agreement or in any applicable amendment or addendum thereto. For purposes of this Specialty Addendum, the term "Covered Medications" shall mean (in addition to the meaning as defined in the Agreement) specialty medications as determined by US Script in its sole discretion. 2. Specialty Pharmacy Locations. Phannacy shall identify to US Script those Phannacy locations providing specialty Phannaceutical Services under this Specialty Addendum in a format and manner acceptable to US Script. 3. Accreditation and Licensure. Phannacy acknowledges and agrees that the "Accreditation and Licensure" provision of the Agreement applies to this Specialty Addendum and extends to each phannacist, technician, nurse, and other staff providing Phannaceutical Services under this Specialty Addendum. 4. Representations and Warranties. Phannacy acknowledges that it completed US Script's Specialty Pharmacy Services Application, which, along with Phannacy's responses, is incorporated herein by reference. Phannacy represents and warrants that its responses to the Specialty Phannacy Services Application are accurate, including but not limited to Phannacy's description of: A. Strategies to minimize waste of antihemophilia factor products and costs; B. Processes for handling emergent needs for antihemophilia factor products after normal business hours and estimated delivery time ofproduct(s); C. Ongoing provision of performance reports as provided in sample format prior to Addendum execution; D. Adequate inventory and/or access to all designated disease state specialty medications and processes to transfer member care to appropriate alternate specialty pharmacy for limited distribution drug when Pharmacy is unable to dispense; E. Financial assistance program and/or hardship support; F. Nursing coordination for home services. 5. Compensation. Claims under this Specialty Addendum will be paid to Phannacy in accordance with the Agreement and the applicable Exhibit C for specialty phannacy rates (as may be amended from time to time in accordance with this Agreement). 6. Additional Obligations of Specialty Participating Pharmacies. A. Specialtv Medication Orders. Phannacy shall accept prescriptions orders from Members and prescribers via the U.S. mail, commercial carrier, electronically (e.g., electronic prescription order; e- prescribing), or such other means allowed by Law. Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 87 of 170 B. Adequate Supply of Specialty Medications. In the event Pharmacy does not have the Covered Medication in stock, Pharmacy shall make arrangements to obtain the Covered Medication for dispensing in a timely manner (but will use best efforts to get Covered Medication dispensed within 48 hours of receipt of prescription) to Member at no additional charge. C. Ancillary Supplies. When dispensing Covered Medications to Members, Pharmacy shall provide to Members all ancillary supplies appropriate for the administration of the medication dispensed at no additional charge (i.e., disposal containers, needles, syringes, alcohol wipes, etc.). D. Specialty Claim Submission. Pharmacy shall submit Claims in accordance with the Agreement or as otherwise instructed by US Script. Pharmacy acknowledges and agrees that Plans may utilize this Agreement and the pricing hereunder in connection with Plans' prescription benefit plan(s) and/or medical benefit plan(s). In the event a Plan desires to utilize this Agreement and the pricing hereunder in connection with its medical benefit, US Script will provide written notice of such to Pharmacy, along with instructions for submittal of the Claim if such submittal differs from the submittal requirements under this Agreement, as well as any other requirements or instructions. Pharmacy further acknowledges and agrees that for Claims submitted to a Plan in connection with a medical benefit plan under this Agreement, Plan may make payments directly to Pharmacy hereunder. Pharmacy acknowledges and agrees that Claim payment amounts due hereunder are the sole and exclusive responsibility of the Plan. In no event shall US Script be obligated to pay Pharmacy for medical benefit Claims. US Script has no liability to Pharmacy for nonpayment or for any delay in payment from a Plan. Pharmacy shall look solely to the Plan for payment. E. Shipping. Pharmacy shall provide timely delivery (and in all events will use best efforts to get Covered Medication dispensed within 48 hours of receipt of prescription) at the address designated by the Member at no additional charge. All Covered Medication shall be dispensed in a manner to assure the integrity of the Covered Medication per manufacturer specifications, including temperature controls. F. Risk of Loss. Pharmacy acknowledges and agrees that it is responsible for all lost or missing Covered Medications not received by Members. Pharmacy shall reship any such lost or missing Covered Medications upon notification of such occurrence at its own cost and shall not bill US Script, a Plan, or a Member any amount for such reshipped Covered Medications (including without limitation, any Copayments). G. Member Copayments. Pharmacy will accept personal checks, cashier checks, and credit cards as well as other standard methods of payment for prescription orders from Members. H. Toll-Free Access. Pharmacy shall provide to Members, US Script, and Plans toll-free telephone access to a pharmacist twenty-four (24) hours a day, seven (7) days a week. In addition, Pharmacy shall provide to US Script and its Plans toll-free telephone access to customer service representatives during the same hours offered to other users of Pharmacy, which must be at least during normal business hours of Pharmacy. I. Recordkeeping. In the place of maintaining a signature log, Pharmacy may maintain other records of receipt of Covered Medications by Members. Such records must contain, at a minimum, the prescription number, the date the Covered Medication was delivered to the Member or the Member's representative, the signature of the Member or the Member's representative to whom the prescription for a Covered Medication was delivered, if applicable, and authorization for the release of the information to US Script and/or Plan. In the case of deliveries by express carriers, Pharmacy shall maintain the express carrier's confirmation that the delivery was received ('signature required'). J. Pharmaceutical Care Management. Pharmacy shall provide pharmaceutical care management as required by US Script, applicable pharmaceutical manufacturers, and/or Plans, which shall at a minimum include, but not be limited to, Member access to nurses and other support personnel, Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 88 of 170 monitoring and maintenance programs, compliance programs, educational information to Members on a new therapy and Members currently on a therapy, disease management programs, patient assistance program information to Members who have exhausted coverage, and intervention programs, as applicable, unless otherwise prohibited by US Script. K. Reports. Upon US Script's request, Pharmacy shall provide US Script with reporting related to Claims. L. Performance Standards and Guarantees. In the event a Plan has specific performance standards and/or performance guarantee requirements with respect to specialty Pharmaceutical Services, US Script will provide thirty (30) days written notice of such to Pharmacy ("Plan Performance Standards"). If Pharmacy objects to any such Plan Performance Standards, Pharmacy may terminate its participation under this Specialty Addendum with respect to such Plan by providing written notice prior to the effective date of such Plan Performance Standards. In the event (a) Pharmacy fails to provide written notice to US Script of objection to such prior to the effective date of the Plan Performance Standards or (b) Pharmacy continues to submit Claims after the effective date of such Plan Performance Standards, Pharmacy will be deemed to have accepted such Plan Performance Standards as if it had given its express written consent thereto, without requiring a separate signature in order to be effective. 7. Pharmacy Participation and Performance Requirements. If Pharmacy or US Script identifies that Pharmacy has not complied with any requirement or service level in this Addendum, Pharmacy shall submit a corrective action plan to US Script within fourteen (14) days of receipt of notification from US Script to correct the deficiency. Upon U.S. Script's approval of the corrective action plan, Pharmacy shall immediately implement the plan. US Script, in its discretion, may audit Pharmacy's compliance with the corrective action plan within a reasonable time as determined by US Script. Pharmacy understands and agrees that its compliance with each of the requirements in this Addendum is a material condition of Pharmacy's participation in the US Script's specialty medication network(s); In accordance with the Agreement, US Script may terminate this Addendum for Pharmacy's failure to meet or exceed any requirement. Without limiting the foregoing, Pharmacy shall comply with the requirements and service levels below. A. Pharmacy shall at all times exhibit clinical expertise in specialty therapies associated with Members' chronic conditions and disease specific care coordination to help promote quality, safety, and clinical effectiveness for key therapeutic categories such as: hemophilia and other blood disorders, multiple sclerosis, rheumatoid arthritis, oncology, transplants, immune deficiency, hepatitis C, and others as identified by US Script. B. Pharmacy shall provide Member's access to a currently licensed pharmacist or nurse 24 hours a day, 7 days a week, 365 days per year, either through a direct toll-free phone line or a medical answering service. C. Pharmacy shall provide therapy management and care coordination programs and services, including, but not limited to: Provision of educational information and medication administration training for Members; Care coordination to assist Members with refills and claims inquiries; Registered nurses and pharmacists on staff to promote adherence and educate Members on potential side effects of medications and address other pertinent Member clinical inquiries; Live, one-on-one contact, either in person or by telephone, with each Member at each refill; Documentation of the therapy management contact and patient profiling, focusing on the appropriateness of the specialty medication therapy and care, prevention of drug-drug interactions, and non-adherence; Follow up with prior authorizations and proactive renewal services to help ensure continuous uninterrupted therapy without the use of auto- refills; and Intervention programs to include communications with Members' physician(s). D. Pharmacy shall provide monthly documentation of services meeting or exceeding the following performance standards: a. Turnaround time: 99% of medications delivered by need date as identified by the Member or his/her physician as documented on the order. b. Temperature Sensitive Products: 100% of all temperature-sensitive medications shall be dispensed directly to the Member under appropriate conditions to ensure stability and quality standards. c. Dispensing Accuracy: 99.9% of prescriptions filled with no errors. Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 89 of 170 8. Entire Agreement. All of the terms and conditions established in the Agreement, except to the extent expressly inconsistent with this Specialty Addendum, shall govern all services provided by Pharmacy under this Specialty Addendum (including, but not limited to, limitations on liability, indemnifications, audit rights, no third party beneficiaries, Claims payment, confidentiality and proprietary information). On and after the date of this Specialty Addendum, each reference to the Agreement shall mean the Agreement as amended hereby with respect to specialty Covered Medications and Pharmaceutical Services. Except as specifically amended hereby, the Agreement shall remain in full force and effect and is hereby ratified and confirmed. Except as expressly provided herein, the execution, delivery, and effectiveness of this Specialty Addendum shall not operate as a waiver of any right, power, or remedy of US Script pursuant to the Agreement existing as of the date hereof, nor constitute a waiver of any other provision of the Agreement or the Specialty Addendum. This Specialty Addendum supersedes any oral or written agreement entered into between Pharmacy and US Script concerning the subject matter covered by this Specialty Addendum. 9. Termination. This Specialty Addendum may be terminated in accordance with the "Termination" provisions of the Agreement, effectuating a termination of this Specialty Addendum only. Termination of this Specialty Addendum shall not affect any right or obligation accrued prior to the effective date of termination. Unless this Specialty Addendum is terminated as a result of the termination of the Agreement, termination of this Specialty Addendum by either party shall not affect any other provision of the Agreement to the extent not relating to this Specialty Addendum and shall not impact Pharmacy's participation in other US Script networks. Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit C Fee Schedules Exhibit H Page 90 of 170 Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit C-1 FEE SCHEDULE Exhibit H Page 91 of 170 Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit C-2 Exhibit H Page 92 of 170 Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit D PSAO Addendum Exhibit H Page 93 of 170 This Pharmacy Services Administration Organization Addendum ("PSAO Addendum") is an addendum to the Agreement and is by and between US Script and the PSAO undersigned on the Agreement. This PSAO Addendum is effective as of the Effective Date of the Agreement. By executing the Agreement, PSAO agrees as follows: 1. Promptly upon execution of the Agreement, PSAO shall provide US Script with a list of participating Pharmacies for which PSAO is authorized to enter into the Agreement on behalf of such pharmacies, in a form and format that is mutually agreeable. US Script shall have the right to reject any participating Pharmacy under the Agreement, including if, such participating Pharmacy was previously covered under another agreement with US Script that was terminated by USScript or any other reason as determined by US Script that such participating Pharmacy should not participate under the Agreement. 2. By signing the Agreement, PSAO is entering into the Agreement on its own behalf and on behalf of the participating Pharmacies. PSAO represents and warrants that it has authority to enter into the Agreement on its own behalf and on behalf of the participating Pharmacies and, for the term of the Agreement and any renewals thereof, shall continue to possess the authority to individually bind each participating Pharmacy to the terms of the Agreement and any addenda or amendments thereto. Participating Pharmacies shall be deemed to have accepted all terms and conditions of the Agreement. PSAO shall promptly provide to US Script evidence of such authority upon US Script' request. 3. US Script shall send all amounts due and owing to Pharmacies under the Agreement directly to PSAO. PSAO represents and warrants that it has authority to collect any payments due under the Agreement on behalf of the Pharmacies and, for the term of the Agreement and any renewals thereof, shall continue to possess the authority to collect such payments on behalf of the Pharmacies. Based upon such representation, warranty, and instruction, US Script shall send one check to PSAO's designated address for all amounts due and owing to all Pharmacies under the Agreement, less any deductions or offsets authorized under the Agreement. 4. PSAO acknowledges and agrees that US Script may rely on the NCPDP DataQ file to manage the Pharmacy relationship with PSAO. It is the responsibility of the PSAO and Pharmacy to update their records with NCPDP. 5. PSAO agrees to distribute and/or make available to participating Pharmacies, from time to time, materials and other documentation presented by US Script and not otherwise sent directly to participating Pharmacies, including Plans communications and the Manual. Nothing herein shall limit US Script's right to communicate with, or provide the US Script information directly to, a participating Pharmacy. 6. PSAO shall develop, implement, and maintain efficient and accurate procedures for notifying participating Pharmacies of their obligations under the Agreement and any amendments or addenda thereto. Additionally, PSAO will take reasonable steps to assist in efforts to resolve issues related to a participating Pharmacy's noncompliance with the Agreement or any Plan or Program and educate Pharmacy's regarding any program or other matter deemed necessary. 7. PSAO acknowledges and agrees that they are responsible for submitting all appeals on behalf of the participating Pharmacy and shall develop, implement and maintain efficient procedures for receiving, screening and communicating appeals to include MAC appeals to US Script. 8. PSAO shall indemnify US Script, Plans, and their respective shareholders, officers, directors, employees, and agents, and the successors, representatives, and assigns thereof, and hold them harmless for, from, and against, any and all liability, loss, damage, settlement, claim, injury, demand, judgment, and expense, including attorneys' fees, arising directly or indirectly from: (a) failure ofPSAO to act in accordance with its agreement with Pharmacy(ies ), and (b) any dispute between PSAO and Pharmacy(ies ). Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE ExhibitE Exhibit H Page 94 of 170 340B PHARMACY ADDENDUM TO PARTICIPATING PHARMACY AGREEMENT This 340B Pharmacy Addendum (the "Addendum") is by and between US Script, Inc. ("US Script") and the undersigned pharmacy ("Pharmacy") and amends that certain Participating Pharmacy Agreement (the "Agreement") entered into by US Script and Pharmacy. US Script and Pharmacy may hereinafter be referred to collectively as the "Parties" or individually as a "Party" to this Addendum. RECITALS A. Pharmacy is either (i) a pharmacy operated by a 340B Covered Entity and is eligible to purchase certain outpatient drugs at reduced prices for use by its qualifying patients from drug manufacturers who have signed a drug purchasing agreement with HHS in accordance with Section 340B or (ii) contracts as a contract pharmacy with 340B Covered Entities who are eligible to purchase certain outpatient drugs at reduced prices for use by its qualifying patients from drug manufacturers who have signed a drug purchasing agreement with HHS in accordance with Section 340B. B. Some of the Plans to which US Script provides pharmacy benefit management services have Members that are also 340B Program Members and such Plans are state-funded Plans that by Law are required to determine if Claim is for a 340B Covered Drug and, if it is, to reimburse the pharmacy for that Claim at the 340B Drug Price. C. US Script and Pharmacy desire to amend the Agreement so that Claims for Covered Medications to 340B Program Members of such Plans are identified appropriately and reimbursed at the 340B Drug Price. In consideration of the mutual covenants herein and other good and sufficient consideration, Pharmacy and US Script agree to the following terms and conditions: 1. DEFINITIONS All capitalized terms shall have the meaning applied to them under the Agreement unless otherwise defined below or within this Addendum. A. 340B Covered Drugs means those outpatient drugs that are available at reduced prices for use by 340B Program Members from Suppliers who have signed a drug purchasing agreement with HHS. B. 340B Covered Entity means an entity defined in Section 340B of the Public Health Service Act, 42 U.S.C. § 256b(a)(4). C. 340B Acquisition Cost means the 340B Covered Entity's actual purchase price that it is contracted for with a Supplier to acquire a 340B Covered Drug. D. 340B Drug Price means the 340B Acquisition Cost plus the applicable dispensing fee. E. 340B Price Claim means a Claim that adjudicates at the 340B Drug Price under this Addendum. F. 340B Program Member means Member as defined in the Agreement who is also a person who qualifies as a 340B patient ofPharmacy in accordance with Section 340B of the Public Health Service Act. G. HHS means the United States Department of Health and Human Services. H. Section 340B means Section 340B ofthe Public Health Service Act, 42 U.S.C. § 256b(a)(4). Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 95 of 170 I. Supplier means a drug manufacturer, distributor, or wholesaler of 340B Covered Drugs designated by the 340B Covered Entity as the supplier from whom 340B Covered Drugs are purchased by the 340B Covered Entity. 2. PHARMACY OBLIGATIONS A. Pharmacy Locations. Pharmacy agrees it will submit Claims for 340B Covered Drugs dispensed to 340B Program Members under this Addendum at only those Pharmacy locations (s) listed on Attachment 2, which shall identify such Pharmacy locations by NPI or NCPDP #, address, and state pharmacy license number(s). B. Pharmacy as a Covered Entity. Pharmacy represents and warrants that it: (i) is a Covered Entity as defined in Section 340B or (ii) has entered into a written agreement with a Covered Entity to serve as a contract pharmacy and dispense 340B Covered Drugs on behalf of such Covered Entity. Pharmacy further represents and warrants that it shall only submit Claims under this Addendum for 340B Covered Drugs dispensed to 340B Program Members. Pharmacy agrees to notify US Script in writing immediately in the event its status changes as a Covered Entity or a contract pharmacy and/or it is no longer licensed to provide outpatient medications and services to 340B Program Members, and US Script shall have the right to terminate the Agreement and/or this Addendum immediately. C. Additional Pharmacy Representations and Warranties. Pharmacy represents and warrants that it shall not: (i) submit Claims for 340B Covered Drugs dispensed to 340B Program Members under any other US Script network, or (ii) use this 340B network and pricing for patients who are not 340B Program Members. D. Claims for 340B Covered Drugs. i. When submitting a Claim to US Script at the point-of sale, Pharmacy must indicate in the Submission Clarification Code (420-DK) field(s) the value 20 if the Claim is for drug purchased pursuant to Section 340B. ii. Pharmacy and US Script acknowledge that Pharmacy may not know at the point-of-sale that a Claim is for a drug purchased pursuant to Section 340B. Pharmacy agrees that it has audit and review processes in place to retroactively identify all Claims for drugs purchased pursuant to Section 340B. When Pharmacy identifies such a Claim, Pharmacy shall reverse the original Claim for such drug and shall resubmit the Claim to US Script indicating in Submission Clarification Code (420-DK) field(s) the value 20 that the Claim is for a drug purchased pursuant to Section 340B. Pharmacy understands that US Script also may have audit and review processes in place to retroactively identify all Claims for drugs purchased pursuant to Section 340B. When US Script identifies such a Claim and notifies Pharmacy, Pharmacy shall reverse the original Claim for such drug and shall resubmit the Claim to US Script indicating in Submission Clarification Code ( 420- DK) field(s) the value 20 that the Claim is for a drug purchased pursuant to Section 340B. E. 340B Pricing. With each Claim for a drug purchased pursuant to Section 340B, Pharmacy shall submit the 340B Acquisition Cost in Basis of Cost Determination (423-DN) and BASIS COST VALUE 05. F. Acquisition and Tracking of 340B Drugs. Pharmacy is responsible for its own inventory tracking and management and drug replacement. The parties agree that nothing in this Addendum is intended to affect Pharmacy's acquisition of medications from any source, including the Federal Supply Schedule and/or participation in the 340B Drug Pricing Program. Further, nothing in this Addendum requires Pharmacy to acquire drugs from any particular source. 3. COVERED MEDICATIONS TO 340B PROGRAM MEMBERS Appendix VII.A.11 I EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 96 of 170 Pharmacy shall provide 340B Covered Medications hereunder in accordance with the terms and conditions of the Agreement and all applicable federal, state, and local laws. 4. CLAIM SUBMISSION, ADJUDICATION, AND COMPENSATION A. Claim Submission. All Claims under this Addendum shall be submitted by Pharmacy through US Script's Claim Processing System in accordance with this Addendum and the Agreement. Pharmacy shall include its U&C with each Claim. i. Post-Adjudication Identification of Claims. Pharmacy shall review all Claims submitted under the Agreement, but not submitted under this Addendum, post-adjudication to determine if any such Claims are for a 340B Covered Medication dispensed to a 340B Program Member, in which case Pharmacy shall reverse such Claim and resubmit it through US Script's Claim Processing System within thirty (30) calendar days of the original Claim submission in accordance with this Addendum and the Agreement. B. Claim Adjudication. US Script shall adjudicate each Claim in accordance with the Agreement and this Addendum. For approved Claims, US Script shall adjudicate such Claims based on the lower of: (1) the 340B Drug Price, (2) the negotiated reimbursement rate as specified on the Reimbursement Schedule attached at Attachment 1 hereto, and (3) Pharmacy's U&C. C. Claim Reimbursement. When a 340B Program Member receives a 340B Covered Drug, after deducting the 340B Program Member Co Pay and applicable fees and amounts owed to US Script by Pharmacy hereunder, Claims will be compensated pursuant to the terms and conditions of the Agreement, this Addendum, and the applicable Reimbursement Schedule attached hereto as Attachment 1, and Pharmacy shall accept as payment in full the lower of: (1) the 340B Drug Price, (2) the negotiated reimbursement rate as specified on the Reimbursement Schedule attached at Attachment 1 hereto, and (3) Pharmacy's U&C. D. Ovemayments/Fees. Any overpayments made to or otherwise received by Pharmacy or amounts owed by Pharmacy to US Script, including but not limited to fees, ~dministrative charges, and claim overpayments and reversals may be deducted from amounts otherwise payable to Pharmacy. Alternatively and in US Script's sole discretion, US Script may invoice Pharmacy for such amounts, with payment due from Pharmacy to US Script within thirty (30) calendar days after Pharmacy's receipt of the invoice. 5. COMPLIANCE WITH LAW Pharmacy and US Script, itself and on behalf of 340B Covered Entity, agree to comply with all applicable federal, state, and local laws with respect to this Addendum and the services provided by each under this Addendum and each is aware that there may be the potential for civil or criminal penalties for certain violations of the law. 6. TERM AND TERMINATION A. This Addendum shall commence on the Effective Date and shall continue thereafter until terminated pursuant to the Agreement. B. In the event of any changes in applicable federal or state laws or regulations that would have a material adverse effect on the 340B Program or the legal responsibilities of Pharmacy or US Script, the Parties agree to negotiate any required changes to this Addendum in good faith. If the Parties are unable to reach a mutual agreement regarding any required amendment of this Addendum within thirty (30) days after such new law or regulation becomes effective, either Party may terminate this Agreement upon written notice to the other. Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE 7. ENTIRE AGREEMENT Exhibit H Page 97 of 170 All of the tenns and conditions established in the Agreement, except to the extent expressly inconsistent with this Addendum, shall govern all services provided by Pharmacy under this Addendum. This Addendum, along with the Agreement and the Attachments hereto (all of which are incorporated herein), represents the entire understanding and agreement of the Parties as it relates to subject matter of this Addendum. There are no other agreements or understandings between the Parties, either oral or written, relating to the 340B Program and/or 340B Pharmaceutical Services. Pharmacy is not authorized to add, delete, or make any modifications to this Agreement (whether typed, hand-written, or otherwise) without the prior written consent of US Script. Any such modifications to this Agreement without the written authorization of US Script shall be invalid and shall have no effect. IN WITNESS WHEREOF, the parties have duly executed this Agreement as of the date set forth below. Pharmacy: ____________________________ _ US Script, Inc. By: ______________________ __ (Signature) (Date) By: ______________ ~----------- (Signature) (Date) (Print Name and Title) (Print Name and Title) PharmacyLegalName: ____________________________________________________________ __ NCPDP~IorChainTID: __________________________________________ ___ Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Attachment 1 to Exhibit E Fee Schedule Exhibit H Page 98 of 170 Appendix VII.A.11 EXHIBIT H: CONTRACTOR'S RESPONSE Attachment 2 to Exhibit E List of Pharmacy Locations Exhibit H Page 99 of 170 Appendix VII.A.11~ script .2425 W Shaw·,6.ve; Fresno Cl.\ 93711 Period End: 11/3.072014 TPA: Fresno CountY DBH Group: 19 Managed Care G/L DeptJD: INVOICE NUMBER 397017 PRICING SUMMARY Brand/Sin9ie-Sou(Ced Brand/Mu!ti-Sourced Brand/DAW-Approved Total-Brand Ganerio·AWP-Prlced Generic-MAC-Priced Generic-Other-Priced Total-Generic Total BILLING SUMMARY Ingredient Cost Adjustment Net ingredient Cost Patient Payment Dispensing Fees Sales Tax Total Admin Fees Billed Amount AMOUNT $1,862.65 -$171.46 $1,691.19 $0.00 $31.25 $0.00 $1;722.44 $4.00 $1,726.44 TRX'S PERCENT AMOUNT 3 8.33% $905.37 0 OJJO% $0.00 0 0.00% $0.00 3 8.33% $905.37 4 11.11% $0.00 29 80.56% $817.07 0 0.00% $0.00 33 91.67% $817.07 36 100.00% $1,722.44 AVG-AMOUNT 51.74 -4.76 46.98 o.oo o.a1 Q.OO 47.8)) 0.11 47.96 lllulti~Source: N=Brarld/Single"source, c=srand/Co-licensed, O=Brand/Qriginal, generics avail., G'=Generic :::ost Basis; A=AWP, F•MAC, l=lngr Cost Submitted, U=Usual & Customary, .C=Contract, s=state MAC PERCENT 52.56% 0.00% 0.00% 52.56% 0.00% 47.44% 0.00% 47.44% 100.00% AVG-RX 301.79 0.00 0.00 301.79 0.00 28.17 0.00 24.76 47.85 Page 100 of 170 'Exhibi!.H Run Dc§l~e'f1~/00>14 Page 1 of8 Remit to: U~ Scrlpt.l,nc, 1591 Pays ph ere Circle Chicag_o, Illinois 60674-0015 Appendix VII.B.B p.1 2425W ShawAve,'Fresno CA 93711 Period. End: 11/30/2014 TPA: Fresno County DBH Group: 19 Managed Care MemberiD Full Name Plan 56302666 000031434 lOOOOOOO<X Blrthdate: 04/09/1973 009423265 JOOOQOOOOOO( Blrthdate: 06/06/1967 000031386 JOOOQOOOOOO( Blrthdate: 11/14/1980 000031755 XXXJ()(lOOO(l(x Blrthdate: 09/1 B/1991 563026660023542XXXJ(){)OOO(l( Blrthdate: 12/04/1988 9443171001 l()(l()C)oooOOi B!rthdate: 02/20/1976 .NABP Rx Number N R Date Fltled 5628524 0114618 N 11/0412014 Pharmacy name: BKPHARMACY CORP PresCriber name: STEINBACH, KENNETH 5628524 0114620 N 11104/2014 Pharmacy name: BK PHARMACY CORP Prescriber name: STEINBACH, KENNETH 0504907 0370782 N 11103/2014 Pharmacy name: CVS PHARMACY Prescriber name: AMIN, MAYURKUMAR 0559560 1876045 N 11/25/2014 Pharmacy name: WALGREENS #6082 Prescriber name: STEINBACH, KENNETH 0559560 1876047 N 11/25/2014 Pharmacy name: WALGREENS #6082 Prescriber name: STEINBACH, KENNETH 0529810 7246778 N 11/2412014 Pharmacy name: WAL-MART PHARMACY 10-1882 Prescriber name: RAESE, JOACHIM 0574233 1992832 N 11/24/2014 Pharmacy name: WALGREENS Prescriber name: CASTILLO, MANOLITO 0574233 1992832 N 11/24/2014 Pharmacy name: WALGREENS Prescriber name: CASTILLO, MANOI:ITO 0574233 1992833 N 11/24/2014 Pharmi!CY name: WALGREENS Prescriber name: CASTILLO, Mb.NOLITO Q574233 1992833 N 11/24/2014 Pharmacy name: WALGREENS Prescriber mime:· CASTILLO, MANOLITO 0574233 1991997 N 11/1812014 Pharm!lcy name: WALGREENS Prescriber name: SIEVERT, DWIGHT 0574233 19919W N 1.1118/2014 NDC Description 00310-0282·60 SEROQUEL XR TAB 200MG 59762-4910·05 SERTRALINE TAB 100MG 68180-0352·09 SERTRALINE TAB 50MG 00310-0284-60 SEROQUEL XR TAB 400MG 59762-4910·05 SERTRALINE TAB 100MG 59148-0008·13 ABILIFY TAB 10MG 00781·2823-01 F~UOXETINE CAP 10MG 00781·2823-01 FLUOXETINE CAP 10MG 68180-0447-01 QUETIAPINE TAB 100MG 68180'0447·01 QUETIAPINE TAB 100MG 55111..()264-81 OLANZAPINE TAB 15MG ODT 55111..()264·81 OLANZAPINE TAB 15MG ODT llulli~Source: N=Brand/Sihgle•source, C=Brand/Co-licensed~ O=Brand/Orlglnal, generics avail.. G=Generic :::ost Basis: A=AWP, f:;:MAC, l=lngr Cost Submitted, U=Usual & Customary, C=Contract, S=State MAC Metric Qty 14 14 7 14 14 14 70 ·70 14 -14 14 ·14 Page 101 of 170 ExhlbitH, Run Dift@9e~/2@14 Page 2of8 Renilt·to: US Script lnc,1591 Paysphere Circle Chicago, Illinois 60674c0015 Days Patient Billed Multi-Cost supply Pay Amount SourcaBasls DAW 14 $206.29 N A 14 $4.75 G F 7 $2.84 G F 14 $316.94 N A 14 $4.75 G F 14 $382.14 N A 14 $11.34 G F ·14 ·$11.34 G F 14 $82;64 G A -14 -$82.64 G A 14 $361.71 G A ·14 -$361.71 G A Appendix VII.B.8 p.2 2425 W Shaw.Ave, Fresno GA.93711 Period End: 11/30/20.14 TPA: Fresno County DBH Group: 19 Managed Care MemberiD Full Name 0094.15621 lOOOOOOOOOOC Blrthdate: 09/30/1959 009002644 lOOOOOOOOOOC Blrthdate: 04/17/1975 009304389 xxioooOooocx Slrthdale: 08/24/1968 000031658 lOOOOOOOOO<X Birlhdate:: 10/28/1968 NABP RX Number N R Pharmacy name: WALG.REENS Prescriber name: SIEVERT, DWIGHT 4929901 0597255 N Pharmacy name: WALGREENS #7131 Prescriber name: SIEVERT, DWIGHT 0504907 0373816 N Pharmacy name: CVS PHARMACY Prescriber name: CASTILLO, MANOLITO 0504907 0373816 N Pharmacy name: CVS PHARMACY Prescriber name: CASTILLO, MANOLITO 0504907 0373816 N Pharmacy name: CVS PHARMACY Prescriber name: CASTILLO, MANOLITO 0504907 0373816 N Pharmacy name: CVS PHARMACY Prescriber name: CASTILLO, MANOLITO 0569460 0472399 N Pharmacy name: CVS PHARMACY Date Fillec! 11/10/2014 11/18/2014 11/18/2014 11/18/2014 11/18/2014 11/W2014 Prescriber name: CASTILLO, MANOLITO 0569460 0472399 N 11/18/2014 Pharmacy name: CVS·PHARMACY Prescriber name: CASTILL(), MANOLITO 0569460 0472401 N 11/18/2014 Ph;Jrmacy name: CVS PHARMACY Prescrlb:er name: CASTILLO, MANOLITO 0567377 1063035 N 11/26/2014 Pharmacy name: RITE AID PHARMACY:05862 Prescriber name: BROWN, KIMBERLY 0595491 1068764 N 11/1212014 Pharmacy name: RITE AID PHARMACY 05869 Prescriber name: tEE, EUGENE 0595491 1068768 N 11112/2014 Vlulti,.Source: N=B~and/Single-source, . C=Brand/C!J·Iicensed, O=Brand/Original, generics avail,, ::ost !3asis: A::AWP, F=MAC, l=lngrCost-Submitted, U=Usual & Customary, C=Contract, NDC Description 65162-0053·10 CITALOPRAM TAB 2DMG 00378-0473-01 DIVALPROEX TAB 500MG ER 00378-0473-01 DIVALPROEX TAB 500MG ER 55111-0534·05 DIVALPROEX TAB 500MG ER 55111-0534·05 DIVALPROEX TAB 500MG ER 00378·5050.01 TEMAZEPAM CAP30MG 00378-5050-01 TEMAZEPAM CAP30MG 59762-3722-01 ALPRAZOLAM TAB 2MG 00093-5105-56 OLANZAPINE TAB 20MG 65862.0375-01 ESCITALOPRAM TAB 20MG 50111-0433-01 TRAZODONE TAB50MG Gi=Generic S::Stat'e' MAC Page 102 of 170 ExhibitH ,Run D<fi@JJe:11~1{):af/!@14 Page 3of8 Remit to: US Scrtpt Inc:, 1591. Paysphere Circle Chicago, Illinois 60674-0015 Metric Days Patten! Billed Multi-Cost Qty Slippiy Pay Amount SourceBasls DAW 14 14 $3.70 G F 28 14 $52.41 G F -28 -14 -$52.41 G F 28 14 $52.41 G F -28 -14 ·$52A1 G F 14 14 $4.40 G F -14 -14 -$4.40 G F 28 14 $8.12 G F 14 14 $396.56 G F 14 14 $53.43 G F 14 14 $3.07 G F Appendix VII.B.8 p.3 2425 W Shaw Ave, Fresno CA·93711 Period End: 11/30/20 14 IPA: Fre~Qb .County DBH Group: 19. Managed Care MemberiD. Full Name 9553141CC56302lOOOOQOOOOO( Birlhdate: 01/16/1992 000031695 lOOOOQOOOOO( Blrthdate: 03/22/1980 009557790 lOOOOQOOOOO( Blrthdate: 07/08/1984 NABP Rx Number N R Date Filled Pharmacy name: RITE ·AID PHARMACY 05869 Prescriber name: LEE, EUGENE 0574233 1993297 N 11/28/2014 Pharmacy name: WALGREENS Prescriber name: WHITMAN, MICHAEL 0574233 1993297 N 11/28/2014 Pharmacy name: WALGREENS Prescriber name: WHITMAN, MICHAEL 0574233 1993299 N 11/28/2014 Pharmacy name: WALGREENS Prescriber name: WHITMAN, MICHAEL 0520127 0580052 N 11/17/2014 .Pharmacy name: RITE AID PHARMACY 05865 Prescriber name: CASTILLO, MANOLITO 0520127 0580053 N 11/17/2014 Pharmacy name: RITE AID PHARMACY 05865 Prescrlbemame: CASTILLO, MANOLITO 0532867 .0478953 N 11128/2014 Pharmacy name: VISTA PHARMACY Prescriber name: WHITMAN, MICHAEL 0532867 0478953 N 11/28/2014 Pharmacy name: VISTA PHARMACY Prescriber.name: WHITMAN, MICHAEL 0532867 0478953 N 11/28/2014 Pharmacy name: VISTA PHARMACY Prescriber name: WHITMAN, MICHAEL 0532867 0478953 N 11/2812014 Pharmacy name: VISTA PHARMACY Prescriber name: WHITMAN, MICHAEL 0532867 0478953 N 11/2.8/2014 Pharmacy name: VISTA PHARMACY Prescriber name: \IVHITMAN, MICHAEL 0532867 0478954 N 11128{2014 111ulti-Source: N=Brand/Single-source, C=Brand/Co-llcensed, ·O=Brand/Original,.generlcs av~H., ~stBasls: A=AWP, F=MAC, l=lngrCostSubmitted, U:::Usual & Customary, C=Contract, NDC 31722..0251-90 31722-0251-90 31722-0251-90 00093-5770-56 13668..0006..01 68382·0114·05 68382'01 1'4..05 13668..0040·60 13668.0040.60 13668..0039,05 65862.:0595-05 G=Generlc S=S1ateMAC Description ESCITALOPRAM TAB 20MG ESCITALOPRAM TAB 20MG ESCITAi.OPRAM TAB 20MG OLANZAPINE TAB 10MG ZOLPIDEM TAB 10MG RISPERIDONE TAB 1MG RISPERIDONE TAB1MG RISPERIDONE TAB 4MG RISPERIDONE TAB4MG RI&PERIDONE TAB 3MG DIVALPROEX TAB 500MG ER Page 1p3 of 170 Exhibit;H Run Dal@9e~JO:aJ/W14 Page 4 of8 Rell)it to: US Script Inc, 1591 Paysphere Circle Chicago, llllnols.60674-0015 Metric Days Patient Billed Multi-Cost Qty Supply Pay Amount SourceBasls DAW 14 14 $53.43 G F -14 -14 -$53.43 G F 14 14 $53.43 G F 14 14 $188.90 G F 14 14 $2.48 G F 14 7 $23.33 G F -14 ·1 -$23.33 G F 14 7 $55.11 G F -14 -7 -$55.11 G F 14 7 $42.63 G F 28 14 $52.41 G F Appendix VII.B.8 p.4 2425W ~haw Ave; Fre~no CA !:13111 Period End: 11/30/2014 TPA:. Fresno CountyDE!H Group: 19 Managed Care MemberiQ Full Name NABP Rx Number N R Pharmacy name: VISTA PHARMACY Prescriber name: WHITMAN, MICHAEL Date FHied 0532867 047895<! N 11/28/2014 Pharmacy name: VISTA PHARMACY Prescriber name: WHITMAN, MICHAEL 0532867 0476954 N 11/28/2014 Pharmacy name: VISTA PHARMACY Prescriber name: WHITMAN, MICHAEL Plan 56302666 Totals: NDC Description 65862-0595-05 DIVALPROEX TAB 500MG ER 65862-0595-05 DIVALPROEX TAB 500MG ER Claim count 36 , Vlui.II"Source: N...;Br?!!dl$1ngle-soi.uce; C=Brand/Co-Jicensed, .O=Brand/Original, generics;·avail., G=Generic ::Ost'BE)sis: A=AWP, F=MAC, l=lngrCostSubmltted, U=Usual & Customary, C=~ontract, S=State·MAC Page 104 of170 Exhibit:H Run 0al@!WP~toaf/W14 Page 5 of8 Remltto: US Script Inc, 1.591 Paysphere Circle Chicago, lllinois.60674"0015 Metric Days Patient Billed Multi· Cost Amount sourcfi!Basis DAW Qty Supply Pay -$52.41 G F 28 14 $52.41 G F $1,722.44 Appendix VJI.B.B p.5 2425 W Shaw Ave, Fresno CA 93711 Period End: 11/30/2014 TPA: !=resho County DBH Group: 19 · Managed Care MemberiD Full Name Report Totals: NABP Rx Number N R. Date Filled NDC Vlulti-Source: N=BI'and/Single-source, C=Brand/Co-licensed, 0-BrandlO~ginal, generics avail., G=Generic ::ost B,asis: A=AWP, F=MAC, l=lngr Cost Submitted, U=Usual & Customary, C=Contract, S=State MAC Description Claim count 36 Page 105 of 170 EXhibit.H Run Dat\!Qe'@J04/W14 Page 6 of8 Remit to: U~ Script Inc, 1591. Paysphere Circle Chicago, Illinois 60674-0015 Metric Days Patient Billed Multi-Cost Qty Supply Pay Amo.unt SourceBasis DAW $1,722.44 Appendix VII.B.8 p.6 2425 w Snaw Ave, Fresno CA.93711 Period End: 11/30}2014 TPA: Fresno County DBH Group: 19 Managed Care Summary by Plan Claim count Plan .56302666 36 Summary Totals: 36 Patient Billed Pay Amount $0;00 $1,722.44 $0.00 $1,722.44 4ulti-Source: N=Brand/Slngle~source, C=Brand/Co-licensed, O=Brand/Original, generics ~vail., G=Generlc :Ost Basis: A=AWP, F=MAC, l=lngr Cost Submitted, U=Usual & Customary, C=Contract, S=Sta!e MAC Page 106 of 170 ExhlbitH Run Da:tl!9e1f~JQ0J/W14 Page 7 ofB Remit to: .US Script Inc; 1591 Paysphere Circle Chicago, Illinois 60674"0015 AppendixVII.B.8 p.7 2425W Stia"V Av.e, .Fresno CA 93711 P!3riod Eric!: 11/30/2014 TPA: Fresno County DBH Group: 19 Managed Care ti DAILY TRANSACTION ANALYSIS MEMBER UTILIZATION ANALYSIS NUM TRX'S Monday 2 Tuesday 2 Wednesday 2 Thursday 2 Friday 2 Saturday 2 Sunday 3 Total --1-5 CODE DIAGNOSIS DESCRIPTION BYTRX'S 253.000 PSYCHOSES 271000 MIGRAINE 252000 DEPRESSION 254010 INSOMNIA 251000 ANXIETY 8 12 4 0 11 0 1 36 TOP 10 TOTALS BY COST 253000 PSYCHOSES 271000 MIGRAINE 252000 DEPRESSION 251000 ANXIETY 254010 INSOMNIA TOP 10 TOTALS PERIOD TOTAL TRXIDAY 4 6 2 0 6 0 0 2 Total Members TRXS I Member Cost I M.ember Utll Members Pet Total Uti! Member PRIMARY DIAGNOSIS UTILIZATION ANALYSIS RANK 1 2 3 4 5 1 2 3 4 5 TRX'S 11 7 5 3 1 27 11 7 5 1 3 27 36 %TOT TRX'S 30.6 19.4 13.9 8.3 .2.8 75.0 30.6 19.4 13.9 2;8 8.3 75.0 100.0 UTL TRX'S BILLED MBRS U·MBR AMOUNT 5 2.20 $628.09 2 3.50 $52.41 5 1.00 $19.11 2 1.50 $2.48 1 1.00 $8.12 15 1.80 710.21 5 2.20 $628.09 2 3.50 $52.41 5 1.00 $19.11 1 1.0Q $8.12 2 1.50 $2.48 15 1.80 710.21 13 2.77 $1,722.44 ·l:'lultf•Source: N=~rarid/Single~source, C=Brand~Co:licensed, O=Brand/Origlnal, generics ;:'~Vail., G:::;Generic ::osrBasis: .A=AWP, F"'MAC, l=lngr Cost Submitted, U=Usual & Customary, C=Contract, S=State MAC %TOT B-AMT 36.5 3.0 1.1 .1 .5 75.0 36,5 3.0 1.1 .!) .1 75.0 100.0 2;023 0.02 0.85 0.64 13 COST/ TRX 57.10 7.49 3.82 0.83 8 .. 12 26.30 57;10 7.49 3~82 8.12 0.83 ---26.30 47;95 Page 107 of 170 ExhibitH Run Oat@Se11~/Wl4 Page 8 of8 Remit to: us Script Inc, 1591 Paysphere Circle Chicago, Illinois 60S74,0015 %-GEN TRX!S 100.0 100.0 100;0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 91:7 AppendixVII.B.B p.B EXHIBIT H: CONTRACTOR'S SCfl Integrity. Innovation. Outcomes. EXHIBIT H: CONTRACTOR'S RESPONSE MHMR Reports Monthly Summary 3 Multi Source Code Summary 4 Brand/Generic Summary 5 A-Typical Drug Summary 6 A-Typical Drug Summary by Physician 7 PAP Drug Summary 14 MHMR Comparison-Brand vs. Generic 15 MHMR Comparison-ATypical vs. Non-ATypical 18 MHMR Comparison-PAP vs. Non-PAP 21 Exhibit H Page 109 of 170 EXHIBIT H: CONTRACTOR'S RESPONSE MHMR Client Monthly Summary April-June Exhibit H Page 11 0 of 170 usscript Monthly Summary -Rx Count Monthly Summary -Ttl Price 600 400 April May . -RxCount Total . June 416 402 411 $40,000 $20,000 : ' $0 _; 232 213: 204 April $25,765 $22,100 ------- May -Price 18.11 17.93 17.16 -------- June $33,543.96 $25,765.49 $22,100.32 1,~229 1.7.7:4-$81,409.71 ** CONFIDENTIAL ** I \ j EXHIBIT H: CONTRACTOR'S RESPONSE MHMR Client MultiSource Code Summary by Price Paid $30,000 $23,348 $20,000 $10,000 $0 MultiSource Code Summary by Rx Count M = Brand -Co-Licensed (Generic may be available) N = No Generics 0 = Generics Available Y = Generic Drug Excludes PAP Plans 20XX ** CONFIDENTIAL ** :-M LJN -0 .• Y EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 112 of170 MHMR Client usscript Brand/Generic Summary by Total Price $40,000-. 8 A: $20,000 .. $17,359. - ~ $4,741 $0- April May June -Brand -Generic Brand/Generic Summary by Rx Count 400 .... c:: ::::J 8 200 ~ 0 ~===~ April Price Price Rx Count ·Patient Copay TTL Pri'ce Rx_ Go·unt Memb'er Copay --.. - - 26 May -Brand -Generic $9,529.87 33 $0.00 $24,014.09 .$0.00 ---" -- 26 $0.00 $19,640.51 $0.0.0 -- ** CONFIDENTIAL ** 26 June 26. $0.00, $17,3s9.o7i -r,_ EXHIBIT H: CONTRACTOR'S RESPONSE MHMR Client Atypical Summary by Total Price· $40,000 Q) u •t: $20,000 c.. ~ $0· April May June -Atypical -Non-Atypical Atypical Summary by Rx Count 313 317 ~ :::> 8 200 ~ 0 April May June !Atypical I· I I c:---. . I Non-Atypical i I I I I I Total !·Price I ... !Price% ' ' · 1RxCount r~~ili~ers ,:PUPM !:Price I - /:Price% iRx:Count 'utilizers !PUPM Pri<le Price 0/o lb(Co,unt: ut_i;lizers -Atypical -Non-Atypical ~-----. -lr---------,r~·-- L_____ April 11 May J June _ .. . L-.-----~--.. h·. . . .. I $26,128.38 $18,836.13 $14,649.62 78% 73% 103 85' 93 79· $280.95 $238.43 $7,415.58 $6,929.36 22% 27% 313 317 ** CONFIDENTIAL** 313 EXHIBIT H: CONTRACTOR'S RESPONSE QUETIAPINE TAB 25MG ~~----~-~"lT ---l~u-_2ii ______ jL ___ --~~--------___,_.<-.-.~-L_ __ .:J Jeffrey CLOZARIL TAB 3 100MG CLOZARIL TAB 25MG OLANZAPINE TAB 10MG OLANZAPINE TAB 20MG OLANZAPINE TAB 5MG QUETIAPINE TAB 100MG QUETIAPINE TAB I· 400MG 3 2 1 5 2 1 Exhibit H Page 114of170 -&of-~81 ----=-=' 84. $1,988.04' 84 $772.71 60 $598.80 7 $170.05 150 $995.10 60 $207.72 30 $41.06' j--. -------------- l Jl -<r-_----_------l~~;~~~EL -T~~-,.-----~~~-60r·'-~~683-~-~--· - -~~~--~' -L__ -- -L~--~l 535jL$6,~7.47 12453365441 Bach Russell CLOZAPINE TAB 1 28 $89.10 I l ' 1 . 100MG CLOZAPINE TAB 3 84 · $274.83 I I 1 I I I I ,. I -'-- 25MG OLANZAPINE TAB 10MG QUETIAPINE TAB 100MG QUETIAPINE TAB 200MG QUETIAPINE TAB 300MG QUETIAPINE TAB 400MG QUETIAPINE TAB 50MG ** CONFIDENTIAL ** 1 30 $896.19 2 60 $249.06 2 60 $584.15 3 90 $545.95 2 37 $984.73 2 60 $238.58: 1346353398 Sprague EXHIBIT H: CONTRACTOR'S RESPONSE SEROQUEL 400MG- SEROQUEL TAB 1 30 SOMG -~~~-~--_ -~-]~1 ----------~-=:Jc: 1sT S09iT )[.__ --_-,----~-------~-~--- -~L-~ -- Thomas ABIUFY TAB lOMG CLOZAPINE TAB lOOMG OLANZAPINE TAB 2.SMG OLANZAPINE TAB SMG OLANZAPINE TAB 7.SMG QUETIAPINE TAB lOOMG QUETIAPINE TAB 200MG QUETIAPINE TAB 25MG QUETIAPINE TAB 300MG QUETIAPINE TAB 400MG QUETIAPINE TAB lOOMG ** CONFIDENTIAL ** 1 30 3 84 13 367. 24 697 1 30 7 210 6 157 8 177 1 30 1 30 4-120 Exhibit H Page 115 of 170 $370.37 $4,~9~~6-~ $606.14 $870.33 $2,100.53' $5,595.89• $292.13 $862.20 ~---- $1,267.38 1 $543.89 $255.43' -----~ $300.02 $443.00 EXHIBIT H: CONTRACTOR'S RESPONSE ** CONFIDENTIAL ** Exhibit H Page 116 of 170 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 117 of 170 RISPERIDONE TAB 1' 7 $23.80 3MG RISPERIDONE TAB 1 7 $18.95 4MG SEROQUEL TAB 5 127 $1,565.82 200MG SEROQUEL TAB 2 37 $1,073.54 300MG I I , 1--------.,~~-1~~-JL __ · __ SEROQUEL TAB 1: 7 $138.62 400MG 11--~· ------~r---~&OJ_i~ &371' ·· $9,77s_ -~c)R_i, .JL ~~---· __j~-""L . ,..__[ --~-~-~-::.:1 flss8764310 J Ibad ~ Samina I ABILIFY TAB SMG 1 7 $83.38 OLANZAPINE TAB 1 7 $170.05 20MG OLANZAPINE TAB 1 30 $478.20 SMG QUETIAPINE TAB 1 30 $103.86 100MG QUETIAPINE TAB 1 30 $195.05 200MG QUETIAPINE TAB 1. 30 $300.02 400MG QUETIAPINE TAB 1 7· $58.11 SOMG L.____, ___ . _ _j~tal lr -___ -~_:-_l___J: ·---__ _ ____ -=_J __ ----_ 7~t-_ -i~HL:·~iiiB:&~ 16S9l02495 ji WILKENFELD . BYRON CLOZAPINE TAB 2: 56 $522.79 100MG I I I I J OLANZAPINE 10MG OLANZAPINE 1SMG OLANZAPINE 20MG OLANZAPINE SMG QUETIAPINE 100MG ** CONFIDENTIAL ** TAB TAB TAB TAB TAB 3 21 $259.77· 2 60 $897.20 4 120 $2,987.95 2 60 $398.04 3 90 $311.58· EXHIBIT H: CONTRACTOR'S RESPONSE QUETIAPINE 200MG QUETIAPINE TAB 300MG OLANZAPINE TAB 20MG QUETIAPINE TAB lOOMG QUETIAPINE TAB 200MG 1 QUETIAPINE TAB ) 25MG I QUETIAPINE TAB (.. l 300MG I QUETIAPINE TAB 400MG l SEROQUEL TAB 1 2 2 1 1 2 1. 1 30 37 14 7 14 7 30 Exhibit H Page 118 of 170 $509.87' $5~914:~] $99.45 $661.11, $63.50 $111.62 $36.52, $218.84 $86.68 $478.07 I' 300MG I SEROQUEL TAB 1 30 $561.66: "'===-)rrotal · --r -__ .---~-~:-~r~~------~Jr~~~c-~---i53Jli~~::~·~9l L07913251 Khan ' Ismat QUETIAPINE TAB . I 30 $255.43 300MG -hotal __ . --r~,-~-=-.-~_--__,~--·---~--------Jl i]L_·3~C$2s5.~ r=1=7=31=_g""'3=~~~,_B_e __ "-_"-"" _j';i,rly _____ ___,..j~~~APINE -TAB___ 3--90: ____ $31l.s8' ** CONFIDENTIAL ** EXHIBIT H: CONTRACTOR'S RESPONSE QUETIAPINE 200MG QUETIAPINE TAB 1 2SMG QUETIAPiNE TAB 4 300MG QUETIAPINE TAB 1 400MG RISPERIDONE TAB 5 4MGODT SEROQUEL TAB 1 100MG -Polawyn ABIUFY TAB 10MG 2 ABIUFY TAB 1SMG 1 ABILIFY TAB20MG 1 CLOZAP!NE TAB 10 100MG OLANZAPINE TAB 2 10MG QUETIAPINE TAB 3 100MG QUETIAPINE TAB 2 200MG QUETIAPINE TAB 8 l 300MG I QUETiAPINE TAB 2 i I 400MG RISPERIDONE TAB 1 I 2MG I I I SEROQUEL TAB 1 LJOm! 100MG SEROQUEL TAB 1 1 400MG --"'lr-'":' '--'lf~~---------i~l jl I, ~-_ll ** CONFIDENTIAL ** 30 120 30 140 30' 14 7 7 175 14 44 60 217 37 7 7 30 Exhibit H Page 119 of 170 $60.94 $1,055.82 $449.53, $1,331.42 $97.43 $287.40 $143.70 ~------~- $201.98 . --~-----' $1,379.16 $340.10 $167.36 $222.05 $2,213.69 $386.70 $20.70 $49.62 $1,122.33, &~i ' • $&,_534.~91 EXHIBIT H: CONTRACTOR'S RESPONSE ** CONFIDENTIAL** Exhibit H Page 120 of 170 MHMR Client $40,000 ; $20,000 $0 400 ~ ::J 8 200 ~ 0 EXHIBIT H: CONTRACTOR'S RESPONSE PAP Summary by Total Price · April May -Non-PAP -PAP-Eligible - PAP Summary by Rx Count 22 April May -Non-PAP -PAP-Eligible 20XX April June Exhibit H Page 121 of170 usscript June June $19,916.65[ ·-·---------i---···------------+----I ----------------·---, 389 38o I 387! 1,156: IFIA'P-E:ngil:»l~---·!TTc"P;ice ------$5;848~84\ ______ $4-,6i2.31T _______ "$"19~535.17-1 l r ~-~-~;;t ___ T 27 1 ---------22 1 -----------24r~----~---~~-~ ~=--~3 1 c-=-"l~~L . -s33;54i:~L--~~s~7s:.4sjj~._1~~~[~---._ -:-l~1 [TOia_Js -:-----:v-l!Rxcount~~--.-41s1L..--------4o2j; ._ · · ; :·4111!-. ----_ -_-1,229, --> ---'~-~ --~-~ 1....----'---'-•~---'-~ ** CONFIDENTIAL** TPAID EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 122 of 170 Brand 98 30 $29,172.8~:­ $297.68 56 $520.94 19, 30 $8,348.03. $439.37 13 $642.16 3,374 30 $78,922.50 ·. $23.39 1,219 $64.74· 1,841' 28 $21,442.89 $11.65, 577 $37.16 115 28 $30,200.02 $262.61 78 $387.18 ** CONFIDENTIAL** usscript Generic_ 2,580 30 $68,356.42 $26.49 ·- EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 123 of 170 $10,989.33' $14.79: 284 $38.69_ 148 29 $2,740.90 $18.52 64 $42.83, 163 24 $73,845.52 $453.04 114 $647.77 85 23' $20,396.10 $239.95 56 $364.22- 18 21 $4,610.36 $256.13 14 $329.31 ** CONFIDENTIAL ** usscript Generic 30 $10,974.00 $22.49 227i 163 $154.81 --$2'!.35 PO : -~-164.56 EXHIBIT H: CONTRACTOR'S RESPONSE Brand NaN NaN 0 NaN 33 8 $3,887.23• $117.79 29 $134.04 NaN NaN 0 NaN ** CONFIDENTIAL** Exhibit H Page 124 of 170 usscript EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 125 of 170 usscript TPA ID I Non-Atypical 68' 29 $26,606.38. $391.27 38 $700.17 71 29 $14,636.74 $206.15 44 $332.65: 751 29 $73,715.21. $98.16 379 $194.50 531 29 $32,075.97 $60.41. 236 $135.92 192 24 $40,721.86. $212.09' 118 $345.10 ** CONFIDENTIAL ** 838 $10,~~~:i:lllll=i 218 $46.66 :.225 $110_.26 ' 8,911 8,160 28 $110,161.19 $13.-5ol 1, ~ -~( 29' $34,259.56 ~ ·-"'-. -. $47.12 254 $134.88j $127.00 919 28 $7'4,981.42 -$81.5.~ ' -298 -$25:1;.62 EXHIBIT H: CONTRACTOR'S RESPONSE TPAID Atypical $9,449.76 $37.65 146 $64.72• 100 27 $729.33· $7.29 46 $15.86· ! 235 I 24 $87,824.18 I $373.72 153 $574.01' J 286' 23 $59,614.13 $208.44 178 $334.91 21 17 $5,472.58 $260.60 18 $304.03 ** CONFIDENTIAL ** Exhibit H Page 126 of 170 usscript 1,049 27i · ·$27,245.98 I $25.971 . ·. 1641 $166.13 519 121 22 $3,635.47 $30.05 58 $62.68 -170 ~164.56 . 754 142 .2.1 . $9,108,05 . . . ·ili64.14 :' 60 $151.80 EXHIBIT H: CONTRACTOR'S RESPONSE · Atypical 1 7 $28.71 $28.71 1, $28.71' 68 11: $5,721.13 $84.13 60 $95.35 NaN NaN 0 NaN ** CONFIDENTIAL** Exhibit H Page 127 of 170 usscript 1401 $36.43 $1:0,82'~ .. 25 -. $'26.27 14.4 $75_.1S EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 128 of 170 usscript PAP-Eligible 2,604i 30 $73,213.51 $28.12 662 $110.59, 893: 30 $16,810.39 $18.82 223' $75.38' 5,846' 28. $115,452.79 $19.75 1,572 $73.44; 2,759, 1,683 28. 28 - $69,687.23 $16,544.61 $25.26 $9.83 600 $116.15 819 28 $47,328.96 $57.79 276 $171.48 ** CONFIDENTIAL "* EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 129 of 170 usscript 30 $11,978.04. $22.60. 244 $49.09 1,010· 27 $26,329.56' $26.07 164 $160.55_ 600 25 $53,926.65 $89.88 227 $237.56 1,156 22 $61,874.60 $53.52 453 $136.59 125 21 $4,790.62 $38.32 56 $85.55 PAP-Eligible 701 30 . ,_ ~---- $9,985.29: ---1 $14.241 269 $J7.1i[ 139 29 $1,645.75 73 24 $19,535.17 $267.61 ** CONFIDENTIAL ** --- 1,149 27 $2'1,975.-31_ I I EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 130 of 170 usscript ~~-. "--==~-~"~-=-~'':: :~ ~~~~~=c7 =o-.=----"-' PAP-Eligible $11.73 3 $23.46. 38( 14- $7,194.69 $18.88 143 $50.31 0 NaN. $0.00 NaN 1 $0.00 ** CONFIDENTIAL ** $23.40 412. 13 \ ''_··._ . . ·· A . ·. ' Sample Client _ Traditional vs Specialty (Ttl Cost) 82.76 o/o ~-- · .... i7.24% ,/----~ , ~ _!raditional -Specialty , Brand vs Generic (Ttl Cost) _ -Brand -Generic --~, -·~ ~ ~-~-_,..~.~ --~ Ext Day vs std Day (Ttl Cost) ' ,. -Sid Supply -Ext Supply · Form vs Non Form (Ttl Cost) _ EXHIBIT H: CONTRACTOR'S RESPONSE u~¥ipt. Book of Business* Traditional vs Specialty (Ttl Cost) ·-Traditional -Specialty Brand vs Generic (Ttl Cost) '~-Brand -Generic Ext Day·vs_St:d Day (Ttl Cost) BoB -Std Supply -Ext Supply -Form vs Non Form (Ttl Cost) 85.95% • ~ -~-~ 477 137 19 $870,397' $1,824.73: $1,S97.3S @ Q Total S?,!'§i;ll, 'ili6',568' 864· 4SJ04'7_,4l.l, ;>}l'Ms $66 5--J, . . Brand vs Generic Prescription~ ~:~~-] --------------- 12,999 3,732. _Ge~l 44,702 12,835 507 $3,822,539 ' 824· $1,224,872 $294.06; $27.40' $238.36: $24.14' '(ot~l • 5,7,;!(o:t, --1.65;5§8 1,.s3:I -$~,1D4.?;'1:n ]$;~'7 48• $'66 s,i. -"'-. ~ To~ai 5'7, ~9;1 -t.i[~~8 1,, f~?.~ '!5 104\7 ,4J;l, $8:7 .48· $'6:6 -li'l, ---~~~~ ~~~~- * US Script's Book of Business -Commercial Employer Segment ** CONFIDENTIAL •• 21-January-2014 EXHIBIT H: CONTRACTOR'S RESPONSE ussefipt. Sample Client Annual Perform-ance by Quarter January 2013 -December 2013 Group Summary Jan-Mar Apr-Jun Jul-Sep Oct-Dec PMPM $121.64 $120.52 $124.34 $116.53 f_~n_e_ri~ __ F=_il_l-~a~----~==------------~ _ _jLi _: __ -__ 76_._7o_o_val,L1~--------=-_7_7._4_4_01~_,1,_-____ 7_7_.3_7_0J._jolr--.-78.35% 77.47% Member Cost Share 12.07% 11.91% 11.72% 12.15% 11.96% E_~rmula;y_FiURa~~~---__ -----. _-__ ---l! _93.96~%!C--93.89~L 92.522°/~L __ 9_1_.8_8_7a_va ____ 9_3_.o_G_0A_,o Average Lives per Quarter 3,473 3,491 3,508 3,459 3,483 ~~~e (Piim"PaldAmo-unt) -_ -. ·1; $1,267,225.13\l $1,262,13_7.24\1 $1,308,702.1211 ~1,209,346.5611 $5,047,411.05! -----~L----------~ ~~~------~L--------~ Group Cost PMPM by Quarter Jan-Mar Apr-Jun Jul-Sep Oct-Dec -Plan Cost PMPM Key Metrics by Quarter 100% 94% 94%• 93% 92% ..l ..l 77% 78% 80% 77% 77% 60% 40% 20% 12% 12% 12%- 12% 0% ---·--· -·---·------·~·---~ -. --··------~ Jan-Mar Apr-Jun Jul-Sep Oct-Dec .........., Member Share -Generic Rll Rate -:s-Formulary Rll Rate ** CONFIDENTIAL ** 21-January-2014 EXHIBIT H: CONTRACTOR'S RESPONSE ussefipt. Sample Client $235.11 !Generic Fill Rate !I 72.99%j Member Cost Share 12.05% 12.46% 15.92% 12.99%' 13.25% .__IF_o_rm_ul_a_ry_Fi_II_R_a_t_e _____ _._..j)~....! --"---9_1_._67_%/_o,L! __ ~·· _9~._C_· _· __ 1o_o_.o_o_0A_,o]~....[_·~~-.. _1o_o_.o_~_%_,o],_j ___ 9_8_.1_o_oli_,oj Average Lives per Quarter 8 6. 5 7 · 6 :1T:ot:a:l P:r:ic:e:(:PI:a:n:P:ai:d:A:m:o:u:nt:)::~'Jir ---:-$73,-=56-::-:9:-~6=-4,)1r ---::$,.....2,-::c50-:3-.5::-1.,jjr ---$-3,-1-05-.-13-,jj'-.. --$-8-, 9-2-5.-3oll . $18,103.58j PLAN 2 PMPM $173.91 $304.46 $448.31 $489.68i $347.09 ..... !G_e_n_er_ic_F_iii_R_a_t_e ______ __,/C.__ __ . _6_2_~_50_0A_o,~! ~.-.~~~~-·,__7-_3-._3-_3-0__,YI-aj'!,_r-=--=--=--=------7~5~.8~6~0A_,o..,j,_[' ______ -_-_-=8=4=.-0_9=0/l=oj'--1.---_ -_ -_-_ -_ --7=7=.1=4=0/i=o] Member Cost Share 9.07% 9.30% 10.60% 10.82%; 10.13% jFormulary Fill Rate II 10o.oo%jl 10o.OOOiijr.-98._28%11 · 1DO,oo%JC'-·. -· ~-9_9_.2_9~0/i-'ol Average Lives per Quarter 3 4 · 4. 2. 3 !:;;;jT;;;;;;ot=a=l P;;;;;;r;;;;;;ic=e=(;;;;;;PI=a=n=P=ai=d=A=m;;;;;;o=u=nt=)==\(r----$~1-,5-65-.1-7-,!'1 ___ $3--,-65-3-.~-.7![ $5,379.71\1 ~ . $2,938.08\j $13,536.43] PLAN 3 PMPM $59.85 $65.21, $68.22 $58.41 $63.00 !Generic Fill Rate j[. 78.60%!t 81.23%r 80.80%!1 82.59%1! 80.82%j Member Cost Share 15.01% 13.71% 13.31% 14.33%' 14.05% !Formulary Fill Rate · II '96.07%11 95.94~o]l 95.51 °?~1[ 93.05%JI 95.15%1 Average Lives per Quarter 399 417 421 407 411 !::!T=ot=a=l =Pr=ic=e=C=P=Ia=n=P=a=id=A=m=o=un=t=>===!!l"===$7=1=,7=o=5=.3=@l~L==$=8=1,=5=13=.4=:=!oj!"===$=86=· ,o=9=6=.1=8~/[==$=7=1=,3=1=4.=o-=:!81L!::::I =· =$=3=1=o=,6=2=8=.9::=:!6j PLAN 4 PMPM $219.71 $211.98 $214.78 $212.25: $214.70: =~G=e=ne=r=ic=F=i=II=R=a=te=============="JI:-:_-_-:_-_.-7_5-=-.-4_4-=_%]-o~~~~---_-_-::~_7-=_6-=_. 7-=-2~0A....,oJC7~,-~ --~7-7-.3-1-0A-,oj!..-----7-6-.4-7-01i'ol Member Cost Share 11.03% 11.66% 11.54% 11.62%; 11.46% !Formulary Fill Rate .jj 92.75°/o!L 9~..__[ ____ 9_o_.5_2_0A,_JojL.:j : __ ~_9_1~.3_7_0A_Joj,_! ~~--9_1_.8_5_0__,Yoj Average Lives per Quarter 350 349 344. 341• 346 fTotal Price (Plan Paid Amount) · $230,475.~1 ;:i=;$"".2""2-1,_7_3=2.=2=3J ... [==$2""'2'"'1"",4""3=3=.9-=~2jL_$_2_16""',""'92""'0'"'.""'17..!j.=.! =-$-8=9_0_,5_6_1_._4ii0l1\ PLAN 5 PMPM $106.09 $107.41 $104.72 $96.12' $103.58 [Generic Fill Rate !! 76.73%j[ 76.77%1[ 77.71%!1 78.30%j'[ ~ 77.38%! Member Cost Share 12.71% 12.16%. 12.35% 12.91%: 12.52% j kF_o_rm __ u_la_ry __ F_ii_I_R_a_te ___________ ~·Jl,l~----·-9_4_.o_o_~_oJJLI _______ 9_3_.8_4_~~~~~~L-------9_2_.7_7_%~ojfL_ ______ 9_2_.1_8_%~oJ.f~-------9_3_.2_o_o~~~ Average Lives per Quarter 1,769 1,785 1,808 1,787' 1,787, !Total Price (Plan Paid Amount). II $563;009.0ijj-$5_7_5-,0-91-.-62-.j'l--$5_6_8-,1-1._,1:,_o2'j["-. -$-S-15-,3-0-1-.9-5J'I.--$~~2-,2~2-1,-5-13-.-60..-,j PLAN 6 PMPM $140.15 $135.26 $152.67 $143.46 $142.86 E·-~-ne-r-ic_F_ii_I_R-at-e--~---------:_1lrl------7-6-.9-3-%'oll=====~-~·-:~95=~~oj=··=====·=76=·=36=%=ojj=======7=7=:9=l=%:1J=======7=7.=2=9:=o/4 ** CONFIDENTIAL ** 21-January-2014 EXHIBIT H: CONTRACTOR'S RESPONSE ussffipt. Sample Client Jan-Mar Apr-Jun lui-Sep Oct-Dec Member Cost Share 11.20% 11.28% 10.59% 10.99%' 11.01% 93.98%1! . 93.98%11 92.17°1aJI 91.12°/~.1 9l.80%1 944 931 927: 915: 929 Elary Fill Rate J[ Average Lives per Quarter $39~,900:9211 $377,643.011[ ' .. $424,57~.161[ . $393,946. 98ll $1,593,067 .0~ \Total Price {Plan ~aid Amount) .· \\ ** CONFIDENTIAL ** 21-January-2014 Sample Client ussetipt. EXHIBIT H: CONTRACTOR'S RESPONSE Specialty Claims -Total Paid (Plan vs Member) $250,000 $219,981.59 $200,000 $211,784.96 $198,068.08 $150,000 -Plan Member $100,000 -Plan $50,000 •·: I I $6,370.35 $7,242.74 $8,691.98 $6,989.67 $0 ----~-~ -·~-~¥, Jan-Mar Apr-Jun Jul-Sep Oct-Dec Traditional Claims -Total Paid (Plan vs Member) $1,200,000 $1,050,352.28 $1,068,139:29 IIi IIi • $1,000,000 $l,o47,24i54 -41 $1,011,278.48 $800,000. $600,000 -Plan Member $400,000 -: -Plan $200,000 $167,593.99 $164,971.70 $163,323.99 $160,201.79 $0 ---"----. -·-.. ·--"··-.---, ... -·-- Jan-Mar Apr-Jun Jul-Sep Oct-Dec Brand Claims -Total Paid (Plan vs Member) $1,200,000 $933,961.82 $1,003,395.80 $1,000,000 -• .. ··--··· .. $800,000, $9}2,034.68 $953,146.74 $600,000 -Plan Member -Plan $400,000 $200,000 ·-:. -$89,019.39 $86,951.38 $88,440.57 $86,622.84 $0· ; --·--·----· . -. ---~--~ .. -- Jan-Mar Apr-Jun Jul-Sep Oct-Dec q, Generic Claims -Total Paid (Plan vs Member) $350,000 $330,102.56 $333,263.31 $305,306.32 $300,000 $250,000. : . - $256,199.82 $200,000 j__ -Plan Member -Plan $150,000. '. $100,000 ·! $84,944.95 $85,223.11 ; $50,000 .L --~ ~ .-----· $1)3,~15.~!; $80,568.62._ --~-·----···· Jan-Mar Apr-Jun Jul-Sep Oct-Dec ** CONFIDENTIAL ** 21-January-2014 Sample Client ussCript. EXHIBIT H: CONTRACTOR'S RESPONSE Key Indicator Compar.isons and Trends -Plan to Book of Business (BoB) $2,500 $2,000. $1,500 $1,000 $500 $0 $80 . $60 $40 $20·; $0 $350 $300 $250 $200 $150 $100 $50 $0 $35 $30 $25 ... $20 '-- $15. $10 _:_. ! :January 2013 -December 2013 · Specialty Price Per Claim (Plan vs Member vs Book of Business) $2,075.30 $1,841.61 $1,718.31 $1,707.48 $1,576.85 $1,635.33 $1,687.09 $1,504.00 $239.32 -. $222.89 $222.98 $211.85 __ $60.10 __ ._. ----see eo_ • . _!i6i!.99~ ... Ji&9.26 -· Jan-Mar Apr-Jun Jul-Sep Oct-Dec Traditional Price Per Claim (Plan vs Member vs Book of Business) II $73.44 • $45.14 $20.94 $11.75 Jan-Mar Ill $279.04 ... $215.10 _ p,;_,;n Jan-Mar $30.25 ·: . $23.52 $14.45 . $7.71 Jan-Mar $74.30 • --· $75.53 ... $68.86 $49.75 $50.86 • -· -· $49.88 $14.84 $13.60 $14.22 $11.55 $11.67 $10.91 Apr-Jun Jul-Sep Oct-Dec Brand Price Per Claim (Plan vs Member vs Book of Business) $289.90 . :41 $245.70 • $53.n $~7.0~ Apr -Jun $310.46 • $252.21 • $52.60 ... $~7.3fi_. Jul-Sep ... $297.39 -.. $242.24 $50.81 . -$77.03 . Oct-Dec Generic Price Per Claim (Plan vs Member vs Book of Business) $29.91 .$2~59 $8.36 -$7~58 Apr-Jun $27.63. $~ $23.71 ~ $7.71- cto.:: 0") •• ., ....... &.. Jul-Sep ** CONFIDENTIAL ** $22.09 $8.17 -~--"-$6.95·--- Oct-Dec ... ~~---~--- -Plan Member -Plan BoB Member . -BoB . -Plan Member -Plan BoB Member -BoB --Plan Member -Plan -BoB Member -BoB -Plan Member -Plan BoB Member -BoB 21-January-2014 EXHIBIT H: CONTRACTOR'S RESPONSE ussffipt. Sample Client Key Indicator Comparisons and Trends -Plan to Book of Business (BoB) 100% 80% 60% 40% 20% -)·- Oo/o 100o/o 80% 60% 40% 20% Oo/o . --. - 100% 80% 60% 40% 20% T Oo/o _1 ___ ·--... 80% 40% -- January 2013 -December 2013 Specialty DJo Paid (Plan vs Member vs Book of Business) 85% 88 % 87% 15% 3% • Jan-Mar 87% ~ • 74% 26% 13% Jan-Mar "91% -·. 80% 20% Uo/o 12% 13% -· ·--· ·-· ··--~~~----~ ~ _a_q~ ~ 3~~-~~· Apr -Jun Jul-Sep Oct-Dec Traditional DJo Paid (Plan vs Member vs Book of Business) 23% 13% Apr-Jun 86% • 23% 14% Jul-Sep 86% Ill 22% 14% Oct-Dec Brand Dfo Paid (Plan vs Member vs Book of Business) 91% 92% 92% -···-• • 82% 83% . .. "83% 18% 17% _17'Yo -----___ 9,ro_ Jan-Mar . 9_o/o __ Apr -Jun . -S% Jul-Sep _8% ..•. -. Oct-Dec Generic Dfo Paid (Plan vs Member vs Book of Business) 80% •• ,.. ------EB~B-~o/ou-trl ... +-----· • .. -7s% I ; 1JEtFi • 75% 75% 74% 75% 26% ** CONFIDENTIAL ** -Plan Member --.Plan BoB Member -BoB -Plan Member -Plan BoB Member -BoB -Plan Member -Plan .. BoB Member -BoB -Plan Member -Plan BoB Member -.BoB 21-January-2014 Sample Client 3,540 ; 3,520 I· 3,500-;- 1 3,480·~j -- I 3,481 3,460 --~ . ! 3,440 _, ----.•.. 3!~~? .. _ - EXHIBIT H: CONTRACTOR'S RESPONSE ussEfipt. January 2013 -December 2013 Membership by Month 3,52T 3,483 3,480 1/2013 2/2013 3/2013 4/2013 5/2013 6/2013 7/2013 8/2013 9/2013 10/2013 11/2013 12/2013 $135 $130. $125 $120 $115· l .. i $110 I $124.82 $119:_90 $105 __ !___ ---------•. 1/2013 ·---~------· ------·---.-·- 1,700 '. I 1,650 I i 1,600 .! .. 1,550 1,500 $300 $280. I $260- $240· 2/2013 1,593 1,5" / -~ •. -·~ ---·--------' 1/2013 2/2013 $284.81 $220 __ , _____________ _ 3/2013 3/2013 . PMPM by Month $132.33· $124.93 $113.38 4/2013 5/2013 6/2013 7/2013 8/2013 9/2013 10/2013 11/2013 12/2013 Utilizers by Month - 1,648 1,547 4/2013 5/2013 6/2013 7/2013 8/2013 9/2013 10/2013 11/2013 12/2013 PUPM by Month $283.68 $250.45 - 1/2013 2/2013 3/2013 4/2013 5/2013 6/2013 7/2013 8/2013 9/2013 10/2013 11/2013 12/2013 •• CONFIDENTIAL ** 21-January-2014 EXHIBIT H: CONTRACTOR'S RESPONSE usseri 2,945 2,942 66 84.6% 84.5% 1.9% $5,047,411.05 $4,177,013.59 $870,397.46 -- 57,701 57,224 477 $120.77 $99.95 $20.83 BoB Specialty* $87.48 $72.99 $1,824.73 12.0% 13.6% 3.3% I $1,596.761 t I --------- 12.3%1 ----··---- * BoB -US Script's Book of Business -Commercial Employer Segment ** CONFIDENTIAL ** 21-January-2014 EXHIBIT H: CONTRACTOR'S RESPONSE Sample Client 2 3 4 5 6 7 8 9 10 Lantus (Insulin) 377' 75 , Crestor (HMG CoA Reductase Inhibitors) 453 100, Nexium (Proton Pump Inhibitors) 295 67 Advair Disku (Sympathomimetics) 301 99 Cymbalta (Serotonin-Norepinephrine Reuptake Inhibitors (SNRis)) 271 51 ,Revatio (Pulmonary Hypertension -Phosphodiesterase Inhibitors) 12 Abilify (Quinolinone Derivatives) 114 29 Atorvastatin (HMG CoA Reductase Inhibitors) 1,107 226 Tracleer (Pulmonary Hypertension -Endothelin Receptor Antagonists) 13' l'.;p 10 l'otals --. -,. -~ " --. -" ----" -" . Top 10 Drugs -By Total Cost -Humira Pen U L.antus -CreStor -Nexium C:.J Advair Disku -Cymbalta __J Revatio -Abilify -Atorvastatin , -Tradeer ' $80,000 $100,000 $120,000 **CONFIDENTIAL** ussCript. $140,000 2.4% 2.4% 2.3% 2.2% 1.9% 1.9%' 1.8%, 1.8% 1.8% ----------- I $160,000 $319.92 $263.48 $389.56 $364.10 $351.52 $7,853.91 $813.05 $82.79 I; 21-January-2014 EXHIBIT H: CONTRACTOR'S RESPONSE Sample Client Top 10 Drugs by Total Rx Count January 2013 -December .201~ 1 Hydroco/apap (Opioid Combinations) 2,440:c_~ 2 : Levothyroxin (Thyroid Hormones) 1,475:[ 3 Lisinopril (ACE Inhibitors) 1,309[ 4 Metformin (Biguanides) 1,226 [' 5 Atorvastatin (HMG CoA Reductase Inhibitors) 1,107,[' 6 Omeprazole (Proton Pump Inhibitors) 909 E 7 : Azithromycln (Azithromycin) 816:[ 8 , Alprazolam (Benzodiazepines) 785 [ 9 • Amlodipine (Calcium Channel Blockers) 715[ 10 Zolpidem (Non-Barbiturate Hypnotics) 680 [ Top 10 Totj!ls • • -" -" . ~ ~ " " " Grand Totals . -~ " -" " " 1111 Hydrooo/apap D Levothyroxin -Usinopril -Metformin CJ Atorvastatin -Omeprazole __j Azithromycin · -Alprazolam 1111 Amlodipine IIIIZolpidem 500 Top 10 Drugs -By Total Rx Count 1,000 1,5QO ** CONFIDENTIAL ** 21.3% 12.9%, 11.4% 10.7%. 9.7% 7.9% 7.1%. 6.8% 6.2% 5.9% ussffipt. 760 $13,847.60 1 $5.68 250. $416.36. $0.28 269 $1,492.34. $1.14 267 $1,959.12 $1.60 226 $91,648.88' $82.79 245' $24,252.79 i $26.68 641 $3,833.54' $4.70 204 $445.33 $0.57 143 $1,772.29 $2.48 138 $618.74 $0.91 :::::£: -~~~ ,... ·:v 2,000 2,500 21-January-2014 EXHIBIT H: CONTRACTOR'S RESPONSE usseript. Sample Client Top 10 Pharmacies by Rx Count Chain Name 1,495 76.6% 5,374 ;----!----·-·--------·---·----,L·-----1-----!-·--··- 1 532\ 80.1% I 1,842, $372,370.85. 7,4271 ____ !_ ___ ----i _____ J __ -__ !____ -----1--·------;----·---r--- ! 000 ; PHARMACY ) 473 1 78.3% i 1,771; $325,248.32 j : ______ _!_ ____________________ . __ 1 _____ ;__ ____ -;.-. __ j __________ , --+--------+----·---.. -+---·- 1 000 I PHARMAcY I 334 t 82.7%! 616! $122,751.17; -------------------------~----~~M; .. __ ' -~-·---1--~-----( --~-----. ·-, I 000 I PHARMAcY ------1-------~6 L __ :~·~---~~l--~93,81~~~'--2,292 $16,011.09 ____ j__ $42.88 ~8~-L--~~-823~~: r;;;-; PHARMA~ 190 1 76.8% I 5191 $95,106.16 i 1,716 1 $16,466.26, 31 $155.45[ 2,2351 $111,572.421 ~-0~~---~-PHA~;A~-------------~-~~--9o ~---;:8:3%f --·32-s+ ---~~64:198~90[_ 1,172 ! $15,245.62 i -----0-; -------;o~or----1;491r---$79;444.521 !-~~-~ PHAR~~------~==~--~-~-l-6~-__ ____ $659,138.341 840: $61,284:G9T------rn]-$523.049~,-1,415 1 $720,423.03-i !lioo--FARMAcv ! sJ! $99,749.6;[----739f"$13,63il.2at-·--·or $0.00 1 969 i $li:G79.9s1 r ooo--·; 'PHiiRMAC:v __________ ----~------ssj---:;;:s;:;---2o_2 i-----$26.,336.62 \ --696-;---$12-:124.71~----3~ $1,629.26 ! 898 j --$38.46u3 j ! I + ! l : , ~ ~ j j :-·---=-~-=~-=:~-~~~=~~--Top~~:_ =~~~--· --77.6-t.( --~~~~C~~~~~·~~q~~~~~T~1,1"~~-2~~-1 ____ --~z_i-~~-~8.84 j 53,880 ~f4:7~2,262:84 i : Total i 77.5%1 12,999! $3,822,539.04 i 44,7021 $1,224,872,01 J 477/ $870,397.46! 57,701! $5,047,411,051 L _______ --~---~-----·------L ______ --·'-------~---_____________ ! _________ _t _____ ~..!__-------~----L.__.~ 16 i $4,312.96 $583,398.69 I 1 ~ $146.37 $493,093.68 I ! I $66,794.95 4 $206.31 --ii89,546.l2~ •• CONFIDENTIAL •• 21-January-2014 EXHIBIT H: CONTRACTOR'S RESPONSE ussefipt. Sample Client $53l,803.63l I 0000000000 . 226, t-------··---·---i---------<------------~--',------i-----------; ' $482,162.23! (-iia-oo-o-ooooo PHARM'Acv _______ -----~--1i26[-----$3o1,-7-8_1. .. o8--+----------+----------+-------+-----------+------+-----------, ' . _____ j_ _____ .L_ __________ • ___ i _____ -$421,392.08, 1 6951 $196,716.041 2159: --}------$274,'63a-.6-51 :---------1------------·------------; ----+ ----·-· ---------1------__ ,._ ----·-----------i'---·---i . -i 3181 $183,196.58/ 6841 ro0o0000000 PHARMACY ----~---457~---$l4s~268.43T""·-----,---------1,808 ~-OOoClOoOOoO IPH-A-RM_A_C_Y ____ ----------t-· --25-i ... --$184,·6-9-·0--.3--5-,;---------,;---------------!-. -----jf------------+-------2-5--i------ -·---.. ·---------------~-··--·-·-~-------~---··----------,-------------+--~~-/-------------+' --------"ji---------------' : 0000000000 j PHARMACY ; 378 i $135,329.76; 1422! $39,924.58 1,002 _., ___ -------~---------------------------l--------J. -~---------- ! 0000000000 I PHARMACY ! 578! $102,205.59! 1953: $53,031.07 iooo-o-oo_o_o_o_o (P"HA-RM-Acv _________ ---1---3-isl----$92:86o:691" ____ 817(-------- '--·-----~ --------------------~----·--'--------__ J ____ T_ ----------;r-----·+·------------+----+-------, ! Top 10: 5,433! $2,167,387.291 17,054, :----·-----·-·-·--G~-;;;:;;; Total i 12-;999i-$3,822,s39~c:i4i-44,702 -$1,224,872.01: '----------------*--. ___ ...!._ ... -~····-------~~--~------'-------------L' ------'--~-----------'-------'---------___; Top 10 Pharmacies by Rx Count Total Cost $531,803.631 ~---~ PHARMACY ----~---------t---·---·-· ;------------r------1 ~-------1 4,85 $421,392.081 ----+-·--2-,854 !-----$274,638.651 ---~;___ I ---·--·--·----~------2-,5--3--i1 -----~$1~23~=~ $97,301.56 i ! 0000000000 PHARMACY -----------·r---695j--$!96-:7-i6~o;t·· 2159 ~-----------+-~--------·----~-·-··------r------· __.)~ ----------·-.............. .! .. ____________ --+ 0000000000 PHARMACY I 578 I $102,205.59! 1953 $53,031.07' ··-{----------------~----------->---------+-·-··-·· .... _____ J _______ l _____ ---··-·--' 0000000000 PHARMACY I 2921 $63,156.10 I 1590 i $34,145.461 $0.00 1,8821 I . I ' I 1---------·- : oooooooooo 1 PHARMACY ----· ----------~---457 j. ---$14a;268~43i--1351! -------$47~331.55 $3,852.37 1,808 $195,599.981 r--------! . ' . ' ----·--+-----+----~--------i------1------···-------->, oooooooooo 1 PHARMACY -------r--378'1 ____ $135,329.76:----1422---$39,924.58 $473.64 1,8oo $175,254.341 r--~--~-l -------------~------; _______ ---------~!------+-----------+--·-·-1··------------+----i ~ 0000000000 I PHARMACY ; 3421 $55,356.461 $27,983.591 $0.00 , 1,778 ~---l _______ ··---------------~ _______ l____ ---1--------+-------------l-·----l------------j----:-----·-·---1 ' 0000000000! PHARMACY I 300! $60,976.54 $35,864.29: $0.00 1,429 ~OiloOOOoooo ;·PHAA"M'Acv ______________ ·i ---31.-i! ··$67,657.74! l.oB7r--$36,292.7o[---- ------~-1~-~----------~-~~------~ ·---~-------------t-------[--------~~-----+-----\------- ' Top 10 ~ 5,800; $1,481,565.65; 20,735[ $653,792.5~ 41 [ :o~.< • .<:a"·"u :-----------------c.--;~-;.~ Tot;if -12-;9991--$3~822;539.04: 44-;7oif $1,224~7iii1l ··-~:77 ------"~-----{----------1 : ______________________________ l_ _____________ ! _______ __!_ ** CONFIDENTIAL ** 22-January-2014 EXHIBIT H: CONTRACTOR'S RESPONSE ussenpt. Sample Client 2.2%: ----------1------- +--------f-------r-----------i-_!._!oloj 1.1%1 227 $63,971.04 131 1 --$6~s28.s-~r~ __________ , ________ s481 ____ $63'.226~43]r-·---:--- r------j-------------------------+------~---------------- 6,288[ $1,134,138.46 i L__ ___ -_-_----~-=._ __ T_o~_-_s~~~~ $5~~~~-~~1~~r -~~----'-~ --------'------------'-- Top 10 Prescribers by Total Rx Count •• CONFIDENTIAL •• 22-January-2014 EXHIBIT H: CONTRACTOR'S RESPONSE Sample Client ussetipt.. 1 2 3 4 5 6 7 8 9 10 • Humira Pen (Anti-TNF-alpha-Monoclonal Antibodies) 67 9' $141,243.18 :e_-~ Revatio (Pulmonary Hypertension -Phosphodiesterase Inhibitors) 12 $94,246.92: c Tracleer (Pulmonary Hypertension -Endothelin Receptor Antagonists) 13 1' $90,443.43 :C _ Copaxone (Multiple Sclerosis Agents) 18 3' $78,760.26 t=·. En brei Srclk (Soluble Tumor Necrosis Factor Receptor Agents) 33 4 $70,443.41 [~ Truvada (Antiretrovirals) 25 3 $40,093.75 [ 'Orencia (Selective Costimulation Modulators) 17 2 $36,060.3-1 t Tecfidera (Multiple Sclerosis Agents) 7 $32,273.50 I En brei (Soluble Tumor Necrosis Factor Receptor Agents) 13 $27,674.70 '[ Atripla (Antiretrovirals) 12 $23,379.12 [ Top 10 li,;tals · . Top 10 Specialty Drugs -By Total Cost -HumlraPen c:JRevatio -Tracleer -Copaxone CJ Enbrel Srclk -Truvada __JOrenda -Tecfldera -Enbrel -Atripla 16.2% 10.8%' 10.4% 9.0%' 8.1% 4.6% 4.1% 3.7%· 3.2% 2.7% -,---;;.--·---~ ;r--:-----....?/ .. ----::,;;~--~~~~YL _ ·· · 7 ~---;"L--~-~~..L._-----;~---..,..--~~---.-o . l-J. $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 $140,000 $160,000 $2,108.11 $7,853.91 $6,957.19 $4,375.57 $2,134.65 $1,603.75 $2,121.19 $4,610.50 $2,128.82 $1,948.26 ** CONFIDENTIAL ** 22-January-2014 Sample Client EXHIBIT H: CONTRACTOR'S RESPONSE ussCript. January 2013 -December 2013 ~Drug Name I Rx Count I %Total Utilizers! Total Cost I Cost Per Rx; 1 2 3 4 5 6 7 8 9 10 . Humira Pen (Anti-TNF-alpha-Monoclonal Antibodies) 67.[.:. ..... _ 26.9% Enbrel Srclk (Soluble Tumor Necrosis Factor Receptor Agents) 33 [~ 13.3% . Tacrolimus (Immunosuppressive Agents) 29[ 11.6% Truvada (Antiretrovlrals) is[· 10.0% Enoxaparin (Heparins And Heparinold-Uke Agents) 19 [ 7.6% Copaxone (Multiple Sclerosis Agents) 18 L 7.2% Orencia (Selective Costimulation Modulators) 17 [ 6.8% Sandlmmune (Immunosuppressive Agents) 15 [ 6.0% Tracleer (Pulmonary Hypertension -Endothelin Receptor Antagonists) 13 [ 5.2% En brei (Soluble Tumor Necrosis Factor Receptor Agents) 13 [ 5.2% Top 10 Totals , " -~ . -" --" " " . " Top 10 Specialty Drugs -By total Rx Count -HumiraPen 1:=! Enbrel Srdk -Tacrolimus -Truvada QEnoxaparin -Copaxone __JOrenda -Sandimmune -Tracleer -Enbrel 0 20 40 ** CONFIDENTIAL ** 9 $141,243.18 $2,108.11 4 $70,443.41 $2,134.65 3 $6,857.30 $236.46 3 $40,093.75 $1,603.75 8 $3,810.69 $200.56 3 $78,760.26 $4,375.57 2 $36,060.31 $2,121.19 2 $13,485.73 $899.05 $90,443.43 $6,957.19 $27,674.70 $2,128.82 60 80 22-January-2014 EXHIBIT H: CONTRACTOR'S RESPONSE Sample Client ussefipt. 2 HMG CoA Reductase Inhibitors 2,810 558 $242,:343:17 .r- L. 78.6•;·:c_-$86.24 3 Opioid Agonists 1,180 294 $227,065.21 [=_-80.4%:c_ $192.43 4 , Proton Pump Inhibitors 2,064 476 $198,319.61 ·[_ 79.3%,C_ $96.09 5 Sympathomimetics 1,099 424 6 :Serotonin-Norepinephrine Reuptake Inhibitors (SNRis) 951 154 $181,213.57 ·c 7~1% f $164.89 $176,988.92 c S1.9%'C $186.11 7 •.Anti-TNF-alpha-Monoclonal Antibodies 74 12 $157,159.10 [~ 0.0% $2,123.77 8 Anticonvulsants -Misc. 1,248 215 $147,117.02 .[~ 6l.5%C_ $117.88 9 , Angiotensin II Receptor Antagonists 1,089 210 $137,555.00 [_- 33.4%t ____ $126.31 10 , Antihypertensive Combinations 1,426 266 $124,424.82·[ 63.i% c· $87.25 -Jop~ io "rota I • ~" ,-• " " --" ------- -Insulin C:J HMG CDA Reductase Inhibitors -Oplold Agonlsts -Proton Pump Inhibitors 0 Sympathomlmetics Serotonin-Norepinephrine • Reuptake Inhibitors (SNRis) __JAnti-TNF-alpha-Monoclonal Antibodies --Anticonvulsants-Misc. -Angiotensin II Receptor Antagonists -Antihypertensive CDmbinations Top 10 Therapeutic Classes -By Total Cost --•• ·-" -" -·-• " --•W• ---•••" - ----, : ., 5,842 ,2,343 ,065 $100,000 $150,000 $200,000 $250,000 $300,000 ** CONFIDENTIAL ** 22-January-2014 Sample Client usseript. EXHIBIT H: CONTRACTOR'S RESPONSE Top 10 Therapeutic Classes by Total Rx Count January 2013-December 2013. Rank Therapeutic Class I Rx Count I Utilizers Total Cost GFR least Per Rx 1 Opioid Combinations 2 HMG CoA Reductase Inhibitors 3 Proton Pump Inhibitors 4 , ACE Inhibitors 5 . Thyroid Hormones 6 Selective Serotonin Reuptake Inhibitors (SSRis) 7 Beta Blockers Cardio-Selective 8 Nonsteroidal Anti-inflammatory Agents (NSAIDs) 9 Antihypertensive Combinations 10 Benzodiazepines ~ " -" '" l'op lO'T,otal · "" -----~ " 2,815 c_ 2,810 [_~ . 2,064 c· 1,883.[ 1,870i[ 1,834 [, 1,470 '[- 1,436 [ 1,426' [ 883' 558 476 374 290 364 262 699 266 1,280 l. 363' --- $20,769.52 99.5% :C-_- $242,343.17 · 78.6% ~C_" $198,319.61 79.3% ,c=--- $4,455.68 99.1%!C __ $1,934.28 73.So/o .[·_- $41,383.32 97.9% !c,-~ $33,192.83 82.7%;c _: $63,518.64. 84.8% c. $124,424.82 G3.7cYo'[_ $2,845.80 99.2%~C $7.38 $86.24 $96.09 $2.37 $1.03 $22.56 $22.58 $44.23 $87.25 $2.22 -$733, t87.6''i' " ~ .. --- Top 10 Therapeutic Classes -By Total Rx Count -Oplold Combinations C) HMG CoA Reductase Inhibitors -Proton Pump Inhibitors -ACE Inhibitors CJ Thyroid Hormones -Selective Serotonin Reuptake Inhibitors (SSRis) _J Beta Blockers cardlo-Selective -Nonsteroidal Anti-Inflammatory Agents (NSAIDs) -Antihypertensive Combinations -Benzodiazepines •• CONFIDENTIAL •• 22-January-2014 r -. " \ s EXHIBIT H: CONTRACTOR'S RESPONSE • USSCfl Integrity. Innovation. Outcomes. O~R Exhibit H Page 150 of 170 EXHIBIT H: CONTRACTOR'S RESPONSE Table of Contents Executive Summary Reports Plan Summary Report Savings Summary Report Prior Authorization Report Drug Utilizations Reports 4 5 6 Top 100 Drugs by Total Dollars 9 Top 25 Therapy Classes by Claim Count 12 Top 25 Pharmacies by Claim Count 13 Exhibit H Page 151 of 170 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 152 of 170 Executive Summary Reports usscript. Plan Summary Report EXHIBjiij~tW~r~Wi~~f.~ONSE From 11/01/2012 to 11/30/2012 Report: ERlfibTriiPO Ffrrra~J~~~~1o92o12 Totals: 2,361 2,255 106 0 502 1,857 2 1,419 942 879 1,063 1,397 2,460 $71.92 27.2 $88.09 $207,969 $31,046 $176,923 --------------------------------------------------------------------------------------------------------Average--------------------------------------------------------------------------------------------------------- Month Retail Retail Mail Mail Special Special Brand Brand Generic Generic Brd E Brd E Maint Maint Days Price Days Price Days Price Days Price Days Price Days Price Days Price Non-Maint Non-Maint Days Price : . I I ',I I I I I ·, I I Contract Information: The number contained in the contract information section reflects any member that had any window of eligibility within the period. The total numbers are not a sum of each month. It is the average count of the number members that had eligibility within the entire period of the report. Cardholders and dependents are listed separately, as vvel/ as, a total number of lives for the period PM/PM: The per member per month (PM/PM) ratio shows average amount of utilization. The amount uses the total cost of scripts including capay. Formula uses is Total Cost/members/months. Cardholder= Member Note Avg Price RX: Capay: BrdEq: Special: Drug Price plus dispense fee per RX The amount paid by the member including deductible Brands dispensed when a generic equivalent available The claims processed using special contract rates This report is based on Rx Dispensing Date. Totals could change if claims or reversals are subsequently submitted and the dispensing dates are within this range. Invoices are based on period close dates and may not balance to these amounts usscript. EXHIBIT H: CONTRACTOR'S RESPONSE Savings Summary Report From 11/01/2012 to 11/30/2012 -Savings vs Submitted Amounts - %of Calculated Average Avg Avg Amt Amt Saved Pet #ofRXs AIIRXs Total Cost Cost/RX Qty Days Requested Saved perRX Saved Totals: 2365 100% $206,162 $87.17 49.1 27.2 $258,932 $52,770 $22.31 20.38% NewRXs: 1277 54.00% $92,387 $72.35 51.2 23.4 $118,215 $25,828 $20.23 21.85% Refill RXs: 1088 46.00% $113,776 $104.57 46.7 31.7 $140,718 $26,942 $24.76 19.15% Generic RXs: 1852 78.31% $68,111 $36.78 50.1 26.2 $92,734 $24,623 $13.30 26.55% Brand Equiv RXs: 3 0.13% $281 $93.54 50.0 30.0 $332 $51 $17.16 15.50% BrandRXs: 510 21.56% $137,771 $270.14 45.4 31.0 $165,866 $28,095 $55.09 16.90% Maintenance RXs: 1424 60.21% $147,195 $44.57 103.4 33.1 $189,322 $42,127 $29.58 22.25% Non-Maint RXs: 941 39.79% $58,968 $62.66 55.9 18.3 $69,610 $10,643 $11.31 15.29% Savings vs. Submitted Amounts This section compares amounts requested by the pharmacy with amounts actually billed to the plan. Savings vs. Full AWP Price This section compares the full AWP price of the drug against the amount billed to the plan Type indicate the network type of the pharmacy. Values are Retail, Mail, or All. All dollar amounts are based of Drug cost only. Brand Equiv RXs refers to brands drugs filled when a generic equivilant was available Note This report is based of invoice close dates. Exhibit H rtJWoW4 i?fPf9oaa Date: 12/20/2012 -Savings vs Full AWP Price- Amt Saved Pet FuiiAWP Saved PerRX Saved $349,428 $143,266 $60.58 41.00% $165,990 $73,603 $57.64 44.34% $183,439 $69,663 $64.03 37.98% $177,842 $109,731 $59.25 61.70% $345 $64 $21.48 18.67% $171,241 $33,471 $65.63 19.55% $235,163 $87,969 $61.78 37.41% $114,265 $55,297 $58.76 48.39% usscript. T50419930 T50419930 Spse Spse Crdh Spse Spse Spse Spse Spse Spse Spse Spse Crdh Crdh Spse EXHIBIT H: CONTRACTOR'S RESPONSE Prior Authorization Report From 11/01/2012 to 11/30/2012 ClAUS TAB20MG 1299052 11/30112 ATENOLOL TAB50MG 381283 11/21112 DIOVAN TAB 160MG 3361768 11/20112 FLECAINIDE TAB 100MG 6782700 11/01112 PRISTIQ TAB 100MG 7143083 11/08/12 PRISTIQ TAB 100MG 7143083 11/08112 PRISTIQ TAB 100MG 7143083 11/08/12 PRISTIQ TAB 100MG 7143083 11/08/12 PRISTIQ TAB 100MG 7143083 11/08/12 PRISTIQ TAB 100MG 7143083 11/08/12 MONTELUKAST TAB 1 OMG 955966 11/18/12 MONTELUKAST TAB 10MG 3331949 11/10/12 MONTELUKAST TAB 1 OMG 3331949 11/10/12 PANTOPRAZOLETAB40MG 955967 11/18/12 Note 8 180 60 60 60 60 60 60 60 60 30 30 30 30 8 90 30 30 30 30 30 30 30 30 30 30 30 30 Exhibit H Page 155 of 170 Report: RPT-137 Printed: 12/21/2012 Page: 1 157.70 Allow early refill-Vacation supply 07/04/12 157.70 Allow early refill-Vacation supply 07/04112 19.94 Allow early refill-Dose change 11/20/12 11/21112 188.76 Allow early refill-Dose change 11/20112 11/20/12 42.20 Allow early refill-Dose change 11/01/12 11/01/12 275.28 Allow early refill-Dose change 11/08/12 11/08/12 275.28 Allow early refill-Dose change 11/08/12 11/08/12 275.28 Allow early refill-Dose change 11/08112 11/08/12 275.28 Allow early refill-Dose change 11/08/12 11/08/12 275.26 Allow early refill-Dose change 11/08/12 11/08/12 275.26 Allow early refill -Dose change 11/08/12 11/08/12 134.40 Allow excluded drug 07118/12 07/18/13 134.40 Allow excluded drug 08/10112 08/10/13 134.40 Allow excluded drug 08/10/12 08110/13 73.15 Allow excluded drug 10/11/12 10/11/13 This report is based on Rx Dispensing Date. Totals could change if claims or reversals are subsequently submitted and the dispensing dates are within this range. Invoices are based on period close dates and may not balance to these amounts usscript. Crdh Crdh Dep Dep Dep Crdh Spse Spse Crdh Dep Crdh Spse Dep Dep EXHIBIT H: CONTRACTOR'S RESPONSE Prior Authorization Report From 11/01/2012 to 11/30/2012 NEXIUM CAP40MG 2101833 11/01/12 NEXIUM CAP40MG 2101833 11/01/12 NEXIUM CAP40MG 369207 11/03/12 NEXIUM CAP40MG 301371 11/19/12 MONTELUKAST TAB 1 OMG 6546768 11/13/12 MONTELUKAST TAB 10MG 3341079 11/21/12 NEXIUM CAP40MG 361781 11/27/12 OMEPRAZOLE CAP20MG 6778155 11/04/12 VITAMIN D CAP 50000UNT 7438669 11/02/12 MONTELUKAST CHW 5MG 6770581 11/20/12 MONTELUKAST TAB 1 OMG 6551135 11/06112 MONTELUKAST TAB 1 OMG 6549682 11/28/12 OMEPRAZOLE CAP20MG 2620506 11/15112 LANSOPRAZOLE CAP 30MG DR 2089079 11/28/12 Note 30 30 30 30 30 30 60 30 30 30 30 30 30 30 30 30 8 28 30 30 30 30 30 30 120 30 60 30 Exhibit H Page 156 of 170 Report: RPT-137 Printed: 12/21/2012 Page: 2 10/11/13 166.90 Allow excluded drug 07/27/11 166.90 Allow excluded drug 07/27/11 166.90 Allow excluded drug 06/04/12 06/07/13 357.65 Allow excluded drug 06/04112 06/07/13 134.55 Allow excluded drug 07/03/12 07/03113 134.40 Allow excluded drug 07/27/12 07/27/13 166.90 Allow excluded drug 07/22/12 07/22/13 14.49 Allow excluded drug 10/11/10 2.55 Allow excluded drug 08/15111 124.99 Allow excluded drug 08/01/12 08/01/13 134.55 Allow excluded drug 07/11/12 07111/13 134.55 Allow excluded drug 11/07112 11/07/13 79.89 Allow compound RX 11115/12 11115/13 61.19 Allow compound RX 08/20/12 02/16/13 This report is based on Rx Dispensing Date. Totals could change if claims or reversals are subsequently submitted and the dispensing dates are within this range. Invoices are based on period close dates and may not balance to these amounts EXHIBIT H: CONTRACTOR'S RESPONSE Drug Utilization Reports Exhibit H Page 157 of 170 usscript. 68546031730 COPAXONE KIT 20MG/ML 2 58406043504 ENBREL INJ 50MG/ML 3 50419048858 NEXAVAR TAB 200MG 4 59011042010 OXYCONTIN TAB 20MG CR 5 00173069600 ADVAIR DISKU AER 250/50 6 00088222033 LANTUS INJ 100/ML 7 00085128801 NASONEX SPR 50MCG/AC 8 58406044504 ENBREL SRCLK INJ 50MG/ML 9 59310057920 PROAIR HFA AER 10 00597011530 MIRAPEX ER TAB 3MG 11 00088221905 LANTUS INJ SOLOSTAR 12 00169750111 NOVOLOG INJ 1 00/ML 13 00378303001 DOXYCYCL HYC TAB 150MG 14 15584010101 ATRIPLA TAB 15 59148000613 ABILIFY TAB 2MG 16 59148000813 ABILIFY TAB 10MG 17 00002446430 CIALIS TAB 20MG 18 00173069500 ADVAIR DISKU AER 100/50 19 00051846233 ANDROGEL GEL 1.62% 20 00002327030 CYMBAL TA CAP 60MG 21 63459022530 NWIGIL TAB 250MG 22 00025152531 CELEBREX CAP 200MG 23 00002324030 CYMBAL TA CAP 30MG 24 00051848888 ANDROGEL GEL PUMP 1% 25 00006026718 MAXALT TAB 10MG 26 00002840001 FORTEO SOL 600/2.4 27 59148000713 ABILIFY TAB 5MG 28 00186504031 NEXIUM CAP40MG 29 00069422030 VIAGRA TAB 100MG 30 00003421511 ONGLYZA TAB 5MG 31 55111019630 CLOPIDOGREL TAB 75MG 32 00002751001 HUMALOG INJ 100/ML 33 13548013250 ACANYA GEL 1.2-2.5% 34 53885024510 ONETOUCH TES ULTRA BL 35 43386055102 TINIDAZOLE TAB 500MG 36 63304082890 ATORVASTATIN TAB 20MG 37 00456321060 NAMENDA TAB 10MG 38 00597000160 AGGRENOX CAP25-200MG 39 00173078302 LOVAZA CAP 1GM 40 00003161112 BARACLUDE TAB 0.5MG 41 00074918990 TRILIPIX CAP 135MG 42 00173069700 ADVAIRDISKUAER500/50 EXHIBIT H~ CONTRACTOR'S RESPONSE lop ,oourugs oy Tofal DOllars Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Generic Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Brand Generic Brand Brand Brand Generic Generic Brand Brand Brand Brand Brand Brand From 11/01/2012 to 11/30/2012 7 9 10 17 36 1 6 3 4 3 1 7 8 4 7 3 6 4 2 2 1 2 5 4 3 6 5 4 6 7 2 2 5 6 Note 3 23.52 120 680 540 170 289 3.92 403 180 117 140 120 30 90 90 65 480 375 210 90 270 210 600 39 2.4 60 180 51 150 180 80 200 1000 120 210 240 240 600 30 180 180 630 4,122.67 521.05 73.01 3.93 4.12 12.82 7.10 521.05 5.01 10.39 15.49 12.80 14.87 59.41 19.46 18.43 24.69 3.32 4.24 6.16 14.37 4.79 6.01 2.09 31.28 505.49 19.46 6.39 22.38 7.35 5.92 13.25 5.26 1.01 8.41 4.68 3.98 3.95 1.57 31.04 5.17 5.12 1.45 This report is based on Rx Dispensing Date. Totals could change if claims or reversals are subsequently submitted and the dispensing dates are within this range. Invoices are based on period close dates and may not balance to these amounts. The amounts are gross claim amounts. 3.0 23.5 120.0 ~·J 97.1 60.0 17.0 17.0 3.9 11.2 180.0 19.5 46.7 30.0 30.0 30.0 90.0 9.3 60.0 93.8 30.0 30.0 45.0 52.5 300.0 19.5 2.4 30.0 36.0 12.8 50.0 30.0 16.0 50.0 166.7 120.0 30.0 120.0 120.0 120.0 30.0 30.0 180.0 Exhibit H ~POft:15!Rtlfr:I(J~ Printed: 12/20/2012 Page: 1 12368.02 12255.08 8761.36 382.05 247.42 217.86 120.73 2042.51 56.07 1870.73 302.05 597.36 446.22 1782.29 5~3.66 1658.78 229.29 199.37 397.51 184.89 431.09 215.45 315.41 628.04 609.96 1213.18 583.66 230.05 285.32 367.44 177.59 212.06 263.06 168.65 1009.53 140.39 477.84 474.29 187.83 931.14 154.97 922.41 12,368.02 12,255.08 8,761.36 2,674.32 2,226.78 2,178.55 2,052.40 2,042.51 2,018.58 1,870.73 1,812.29 1,792.09 1,784.86 1,782.29 1,750.98 1,658.78 1,605.06 1,594.96 1,590.04 1,294.23 1,293.27 1,292.70 1,261.62 1,256.08 1,219.92 1,213.18 1,167.32 1,150.25 1,141.27 1,102.33 1,065.54 1,060.31 1,052.24 1,011.92 1,009.53 982.73 955.67 948.58 939.15 931.14 929.82 922.41 usscript. 43 68382000801 LAMOTRIGINE TAB 100MG 44 50458009801 B...MIRON CAP 1 OOMG 45 64679031401 CLOPIDOGRB... TAB 75MG 46 64764024060 AMITIZA CAP 24MCG 47 00173075000 TREXIMET TAB 85-500MG 48 00173083113 LEVITRA TAB20MG 49 66582041431 ZETIA TAB 10MG 50 63304082990 A TORVASTATIN TAB 40MG 51 00037024330 ASTEPRO SPR 0.15% 52 55253080230 MODAFINIL TAB 200MG 53 00002446230 ClAUS TAB 5MG 54 00591333105 BUPROPNHCL TAB150MGXL 55 00002879959 HUMALOG KWIK INJ 1 00/ML 56 00591377519 ATORVASTATINTAB20MG 57 60505257909 ATORVASTATIN TAB 20MG 58 00078035934 DIOVAN TAB 160MG 59 00088250033 APIDRA INJ U-100 60 00093742698 MONTB...UKAST TAB 10MG 61 66582031231 VYTORIN TAB 10-20MG 62 55111012290 ATORVASTATINTAB20MG 63 61958100301 RANEXA TAB 500MG 64 63481068706 LIDODERM DIS 5% 65 68180033107 ZIPRASIDONE CAP20MG 66 00078036034 DIOVAN TAB 320MG 67 58468013001 RENVB...A TAB BOOMG 68 00051845030 ANDROGB... GB...1%(50MG) 69 00071101668 LYRICA CAP150MG 70 00006027754 JANUVIA TAB 100MG 71 63402019310 LUNESTA TAB 3MG 72 59417010710 VYVANSE CAP70MG 73 65862053750 LEVOFLOXACIN TAB 500MG 74 10370011610 ZOLPIDEM ER TAB 12.5MG 75 00002322930 STRA TTERA CAP 40MG 76 00008122230 PRISTIQ TAB 100MG 77 00310075290 CRESTOR TAB 20MG 78 16729009401 MYCOPHENOLATCAP250MG 79 00093204656 PIOGLITAZONE TAB 45MG 80 64720032110 METAXALONE TAB BOOMG 81 00378520193 MONTB...UKAST TAB 10MG 82 55111028050 LEVOFLOXACIN TAB 500MG 83 00093585101 ESCITALOPRAMTAB 10MG 84 63304031230 PIOGLITAZONETAB 30MG EXHIBIT H; CONTRACTOR'S RESPONSE lop .oourugs oy Total Dollars Generic Brand Generic Brand Brand Brand Brand Generic Brand Generic Brand Generic Brand Generic Generic Brand Brand Generic Brand Generic Brand~ Brand Generic Brand Brand Brand Brand Brand Brand Brand Generic Generic Brand Brand Brand Generic Generic Generic Generic Generic Generic Generic From 11/01/2012 to 11/30/2012 2 5 4 4 2 6 6 7 1 7 4 3 7 6 5 1 5 3 5 2 2 5 1 2 2 1 3 3 4 4 2 3 2 2 2 4 3 5 2 Note 180 150 210 36 40 180 180 210 30 210 510 45 210 300 210 70 270 150 150 180 90 90 150 270 300 210 90 90 120 41 120 90 120 120 540 60 270 120 34 150 60 120 4.96 5.92 4.19 24.30 21.80 4.83 4.68 3.99 26.65 3.80 1.55 17.04 3.59 2.50 3.57 10.29 2.66 4.72 4.68 3.84 7.60 7.59 4.52 2.51 2.25 3.11 7.18 7.12 5.32 15.44 5.21 6.89 5.01 4.97 1.10 9.86 2.19 4.81 16.94 3.69 9.09 4.52 This report is based on Rx Dispensing Date. Totals could change if claims or reversals are subsequently submitted and the dispensing dates are within this range. Invoices are based on period close dates and may not balance to these amounts. The amounts are gross claim amounts. 630.0 90.0 30.0 52.5 9.0 20.0 30.0 30.0 30.0 30.0 30.0 127.5 15.0 30.0 50.0 42.0 70.0 54.0 50.0 30.0 90.0 45.0 90.0 30.0 270.0 150.0 105.0 90.0 30.0 40.0 10.3 30.0 45.0 40.0 60.0 540.0 30.0 135.0 30.0 11.3 30.0 30.0 916.22 446.26 177.59 220.23 218.70 436.07 144.94 140.39 119.73 799.62 113.92 197.90 255.66 107.73 125.11 149.97 720.32 143.75 236.22 140.39 345.29 341.92 682.81 135.63 677.38 337.26 326.77 646.21 213.48 212.81 158.24 156.20 310.07 200.57 298.04 593.19 295.87 295.08 144.40 191.94 110.83 272.56 916.22 892.52 887.95 880.90 874.80 872.13 869.64 842.34 838.11 799.62 797.41 791.60 766.98 754.10 750.63 749.87 720.32 718.75 708.65 701.95 690.58 683.84 682.81 678.15 677.38 674.52 653.53 646.21 640.44 638.42 632.96 624.80 620.13 601.72 596.08 593.19 591.74 590.15 577.60 575.81 554.15 545.12 --------------------------------------------- usscript. EXHI!¥T H1otH~;!T~T?c~'l\'~!JiSPONSE op rugs y o a o ars From 11/01/2012 to 11/30/2012 85 00093505006 86 00430075227 87 68382013201 88 00007337213 89 00169633910 90 00093738656 91 00093681673 92 00591039760 93 65597010790 94 00591271701 95 65862044830 96 55111012190 97 63304082790 98 00299384904 99 67425000775 100 53885024450 PIOGUTA/MEr TAB 15-850MG Generic 2 A SA COL TAB400MGDR Brand 270 1.99 TAMSULOSIN CAP 0.4MG Generic 4 330 1.60 COREGCR CAP40MG Brand 2 120 4.41 NOVOLOG INJ FLEXPEN Brand 2 30 17.36 VENLAFAXINE CAP 150MG ER Generic 3 120 4.32 BUDESONIDE SUS 0.5MG/2 Generic 1 120 4.30 DICLO/MISOPR TAB 50-0.2MG Generic 2 180 2.85 BENICAR HCT TAB 40-25MG Brand 2 120 4.24 METHYLPHENID TAB 36MG ER Generic 3 90 5.60 VALACYCLOVIR TAB 500MG Generic 5 142 3.50 ATORVASTATINTAB 10MG Generic 5 150 3.29 ATORVASTATIN TAB 10MG Generic 5 150 3.29 CLOBEX SPR0.05% Brand 125 3.89 BEPREVE DRO 1.5% Brand 2 20 24.14 ONErOUCH TES ULTRA BL Brand 5 450 1.07 Note This report is based on Rx Dispensing Date. Totals could change if claims or reversals are subsequently subrrnted and the dispensing dates are within this range. Invoices are based on period close dates and may not balance to these amounts. The amounts are gross claim amounts. Exhibit H ~jl0ft:16~(J~ Printed: 12/20/2012 Page: 3 60.0 271.31 542.62 270.0 536.15 536.15 82.5 132.28 529.12 60.0 264.53 529.05 15.0 260.47 520.94 40.0 172.92 518.77 120.0 516.31 516.31 90.0 256.13 512.26 60.0 254.57 509.13 30.0 167.92 503.76 28.4 99.51 497.57 30.0 98.76 493.80 30.0 98.76 493.80 125.0 486.45 486.45 10.0 241.43 482.86 90.0 96.31 481.57 usscript. Top IZ5HBliher.&~~~laim Count From 11/01/2012 to 11/30/2012 Report: Rfbij:li~ 1!17 Printe£ige 1Btlm17'Al012 Page: 1 3940 *HMG CoAReductase Inhibitors•• 107 7 33.68 $66.89 114 $7,625.71 5.42 4.16 2 6599 *Opioid Combinations** 104 . 0 13.06 $20.91 104 $2,174.25 4.95 1.19 3 2810 *Thyroid Hormones•• 74 4 33.08 $7.46 78 $581.63 3.71 .32 4 3610 *ACE Inhibitors** 72 4 33.16 $7.48 76 $568.56 3.62 .31 5 0340 • Azithromycin** 74 0 5.22 $18.49 74 $1,368.06 3.52 .75 6 2599 *Combination Contraceptives-Oral** 64 31.42 $42.96 65 $2,792.19 3.09 1.52 7 4420 *Syrnpathomimetics** 63 2 24.89 $103.86 65 $6,750.74 3.09 3.69 8 5710 *Benzodiazepines•• 58 2 24.57 $5.53 60 $331.71 2.85 .18 9 5816 *Selective Serotonin Reuptake Inhibitors (SSRis)** 56 4 34.00 $39.85 60 $2,390.94 2.85 1.31 10 3699 *.Antihypertensive Combinations** 54 4 34.14 $82.76 58 $4,800.35 2.76 2.62 11 6610 *Nonsteroidal .Anti-inflammatory Agents (NSAIDs)** 49 25.88 $56.52 50 $2,825.97 2.38 1.54 12 3320 *Beta Blockers Cardio-Selective** 39 4 35.21 $28.17 43 $1,211.33 2.05 .66 13 2725 *Biguanides** 39 2 32.20 $11.78 41 $482.95 1.95 .26 14 4220 *Nasal Steroids** 40 0 27.38 $67.06 40 $2,682.20 1.9 1.46 15 6020 *Non-Barbiturate Hypnotics** 39 0 28.95 $43.81 39 $1,708.43 1.86 .93 16 7510 *Central Muscle Relaxants** 36 2 28.00 $24.79 38 $942.14 1.81 .51 17 3760 *Thiazides and Thiazide-Like Diuretics** 30 33.87 $4.73 31 $146.64 1.47 .08 18 3615 *.Angiotensin II Receptor .Antagonists** 27 4 37.74 $107.89 31 $3,344.63 1.47 1.83 19 6510 *Opioid Agonists** 29 1 26.83 $149.98 30 $4,499.41 1.43 2.46 20 2710 *Insulin** 28 2 31.17 $264.21 30 $7,926.18 1.43 4.33 21 0120 • Am inopenicillins •• 28 0 9.46 $6.83 28 $191.29 1.33 .1 22 0500 *Fiuoroquinolones •• 28 0 8.86 $85.04 28 $2,381.25 1.33 1.3 23 3400 *Calcium Channel Blockers** 26 1 32.22 $10.19 27 $275.09 1.28 .15 24 7260 *.Allticonvulsants-Misc.•• 26 30.67 $78.52 27 $2,120.02 1.28 1.16 25 4399 *Cough/Cold/Allergy Combinations •• 24 0 9.25 $20.44 24 $490.59 1.14 .27 SUBTOTAL FOR TOP 25 1214 47 664.89 $1,356.14 1261 $60,612.26 SUBTOTAL FOR ALL OTHER CLASSES : 807 34 4,063.20 $47,288.02 841 $1-22,536.81 TOTAL FOR PLAN: 2021 81 4,728.09 $48,644.16 2102 $183,149.07 Note Code: Theraputic Classification for the drug class This report is based on Rx Dispensing Date. Totals could change if claims or reversals are subsequently AvgRx Cost: Average amount per script for the drug cost and dispense fee only Total Billed: Total amount of the drug cost and dispense fee submitted and the dispensing dates are within this range. Invoices are based on period close dates and may not balance to these amounts usscript. T 25 P @<HIBIT H: CQNTRACTOR'S RESPON~I • C t op uarmacy lJispensmg -Dy (.; a1m oun From 11/01/2012 to 11/30/2012 Exhibit H R~ :11Rf'JtjfQ7 Printed: 12/21/2012 Page: 1 Total Dollars: % Total By RX: %Total by Ant: Avg. Qty: 43 34 31 20 19 28 21 13 14 9 11 7 7 6 5 9 6 4 $7,612.33 144 5,618.18 $5,493.63 139 4,391.48 $3,757.19 131 3,728.47 $2,735.29 103 3,011.05 $2,450.05 102 2,274.89 $4,347.14 74 2,429.88 $9,917.04 $2,600.34 $1,784.64 $922.53 $1,405.14 $494.33 $770.00 $922.84 $1,097.89 $2,268.64 $822.40 $113.44 60 4,216.45 57 1,592.45 49 47 30 27 23 24 25 18 13 13 506.18 740.60 443.52 640.54 413.64 670.15 734.85 677.69 144.60 445.50 Total calculated price for all RXs for Phamacy (including copay) Percentage of RXs by Phamacy vs. total RXs Percentage of dollars by Phamacy vs. total dollars (including copay) Average quantity dispensed in each RX by Pharrracy 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 1.27 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Avg Day Supply: Avg. Cost Per Rx: C-11: DAWOvn:l: Note $13,230.51 $9,886.38 $7,485.66 $5,746.34 $4,724.94 $6,777.02 $14,133.49 $4,192.79 $2,290.82 $1,663.13 $1,848.66 $1,134.87 $1,183.64 $1,592.99 $1,832.74 $2,946.33 $967.00 $558.94 187 174 162 123 121 102 81 70 63 56 41 34 30 30 30 27 19 17 8.90 8.49 8.28 6.35 7.71 4.81 5.85 3.69 5.76 3.03 4.85 4.35 3.85 9.07 3.33 2.69 3.00 1.47 2.66 1.07 1.95 1.19 1.62 0.73 1.43 0.76 1.43 1.02 1.43 1.18 1.28 1.89 0.90 0.62 0.81 0.36 25.8 23.9 23.7 25.1 25.0 22.9 86.5 22.3 28.0 21.3 21.7 20.2 22.8 20.6 22.9 26.7 24.8 22.6 $70.75 10 $56.82 5 $46.21 7 $46.72 0 $39.05 5 $66.44 3 $174.49 $59.90 14 $36.36 0 $29.70 4 $45.09 2 $33.38 $39.45 $53.10 2 $61.09 $109.12 8 $50.89 0 $32.88 0 Average Nurrber of days supply dispensed by Phamacy for each RX Average total price for each RX by Pharrracy (including rrentJer copay) Total# of C-11 Controlled RXs dispensed from Phamacy Total# of DAW1 (Physician) and DAW2 (MentJer) Overrides This report is based on Rx Dispensing Date. Totals could change if claiii"B or reversals are subsequently subrritted and the dispensing dates are within this range. Invoices are based on period close dates and lillY not balance to these arrounts 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 usscript. EXHIBIT H: CQNTRACTOR'S RESPON~ • Top 25 Pfiarmacy Dlspensmg -oy (;la•m Count From 11/01/2012 to 11/30/2012 Exhibit H R~ :1tRPJtjf~7 Printed: 12/21/2012 Page: 2 Brand RXs. Generic RXs. Brd Equiv. RXs. Total Rx Percent of Totals Avg Day Avg Cost DAW Rank Pharmacy Name NABP Cnt Amount Cnt Amount Cnt Amount Billed Count By RX By Amt Supply Per RX C-11 Ovrd 20 2 $666.37 14 1,004.63 0 0.00 $1,671.00 16 0.76 1.07 28.8 $104.44 0 0 21 $188.76 14 74.84 0 0.00 $263.60 15 0.71 0.17 28.5 $17.57 0 0 22 6 $1,035.11 8 6.17 0 0.00 $1,041.28 14 0.67 0.67 23.1 $74.38 0 23 4 $341.54 9 390.71 0 0.00 $732.25 13 0.62 0.47 31.2 $56.33 0 0 24 8 $910.40 5 161.75 0 0.00 $1,072.15 13 0.62 0.69 21.6 $82.47 0 0 25 6 $754.06 7 911.74 0 0.00 $1,665.80 13 0.62 1.07 29.6 $128.14 0 0 SUBTOTAL FOR TOP25 $108,958.80 1820 672.69 $1,569.83 SUBTOTAL FOR ALL OTHER Pharmacies: $46,816.41 282 2,299.75 $31,430.02 TOTAL FOR PLAN : $155,775.21 2102 2,972.45 $32,999.85 Prior Authorization Request Form for Prescription Drugs EXHIBIT H: CONTRACTOR'S RESPONSE usscfipt FAX this completed form to 866-399-0929 0 R Mail requests to: US Scriot PA Dept /2425 West Shaw Avenue I Fresno, CA 93711 I. Provider Information II. Member Information Prescriber name (print): Member name: Office contact name: Identification number: Group name: Group number: Fax: Date of Birth: Phone: Medication allergies: Ill. Drug Information (One druq reauest per form) Drug name and strength: Dosage form: Dosage Interval (sig): I Qty per Day: Diagnosis relevant to this request: Expected length of therapy: Medication History for this Diagnosis A. Is member currently treated on this medication? D yes; How Long? [go to item B] Dno [skip items B & C; go to item D] B. Is this request for continuation of.a previous approval? D yes [go to item C] Dno [skip item C; go to item D] C. Has strength, dosage, or quantity required per day increased or decreased? D yes [go to item D] Dno [skip item D; indicate rationale for continuation in Section IV and submit form] D. Please indicate previous treatment and outcomes below. Drug Name Dates of Therapy Reason for Discontinuation (include strength and dosage) 1 2 3 4 NOTE: Confirmation of use will be made from member history on file; prior use of preferred drugs is a part of the exception criteria. The US Script Formulary is available on the US Script website at www.usscri~t.com (access from Members Section of homepage, then click on Searchable Formulary/US Script). IV. Rationale for Request I Pertinent Clinical Information (Required for all Prior Authorizations) Appropriate clinical information to support the request on Provider Signature: I Date: the basis of medical necessity must be submitted. US Scnpt will respond v1a fax or phone Within 72 hours of rece1pt of all necessary mformat1on, except durmg weekends or holidays. AppendiX XV.D p.1 Requests for prior authorization (PA) requests must include member name, ID#, and drug name. Incomplete forms will delay processing. Please include lab reports with requests when appropriate (e.g., Culture and Sensitivity; Hemoglobin A1C; Serum Creatinine; CD4; Hematocrit; WBC, etc.) EXHIBIT H: CONTRACTOR'S RESPONSE Anthony Bruno Exhibit H Page 165 of 170 2425 West Shaw Avenue Fresno, CA 93711 (559) 244-3700 ext. 27101 abruno@usscript.com EMPLOYMENT HISTORY Account Executive, US Script, Inc. Tempe, AZ 2014-Present Serve as the primary contact for assigned accounts, interacting with client contacts to facilitate problem resolution and promote high client satisfaction Communicate regularly with internal staff during implementation regarding client needs and requests, contractual obligations, projected enrollment levels, work procedures changes, and other elements of a successful implementation Develop and administer project plan, incorporating client information and contractual agreements, to support successful contract implementation for new clients and new programs Manage account renewals, develop client contracts, lead site visits for existing and prospective clients and manage terminating accounts Support completion of quarterly and annual outcome reports and present reports to client Director, Account Management, 2013-2014 Community Care Health network, dba MMN Scottsdale, AZ Provide client leadership as well as key account support with a focus on growth and retention. Primary liaison directing internal departments to support regional medical groups and national health plans to assess medical needs of their patients and plan members. Senior Account Manager, 2008 -2013 Healthways Chandler, AZ Responsible for growth, maintenance, and quality of client relationship for assigned key accounts. Primary client contact; responsible for customer satisfaction. Ensured client retention. Developed and executed strategic plans designed to ensure client retention and promote integration and expansion of existing product solutions. Created and presented programs targeted for Regional and Executive Directors to consistently message SilverSneakers Value Proposition. Facilitated cross-functional team that coordinated the development, UAT and implementation of new member eligibility format and automated load process replacing over 40 individual files with one (1) common file. Reduced time required to process client eligibility monthly by mover 50% and eliminated over 90% of incoming data errors. Coordinated effort to redefine client requirements allowing for introduction and implementation of new billing and utilization reporting, which allowed for on-time payment and elimination of all past due deliverables. National Account Executive 2006 -2008 CVS Caremark (formerly Caremark) Scottsdale, AZ Led client renewal process, including pricing, contract and amendment negotiation Sustained client and consultant relationships with regional coalitions, TPA collectives, public sector, and Fortune 500 groups. Appendix XIX.B p.1 EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 166 of 170 Directed planning and growth of key accounts via management of existing program services. Analyzed data, prepared reports, contributed to sales presentations. Senior Implementation Manager Caremark (formerly Advance PCS/Advance Paradigm) Scottsdale, AZ Prepared detailed agendas and facilitated on-site implementation "kick-off' and requirements discovery meetings. 2002-2005 Served as dedicated implementation manager for leading high-volume TPA to eliminate complaints while introducing client-specific standards for ID card submissions, clinical and benefit design options. Streamlined implementation timeline from 90 to 30 days and recorded consistently high client satisfaction survey scores. Migrated over 100 funded and 175 discount Rx card programs requiring development and production of 2,500 client approved card designs. Senior Account Manager, 1999-2001 NDC Health Information Services Phoenix, AZ Oversaw production and on-time delivery of customized market share and pharmacy network performance reports for Top Ten pharmaceutical manufacturers. Managed and resolved operational, billing, service, and data inquiries to ensure client satisfaction. Presented and negotiated two year contract extension to Wyeth-Ayerst for new/expanded services worth over $3.7 million. Shifted over 50% of monthly ad-hoc deliverables to production processes, reducing cost of delivery an dpreventing payment of contractual penalties resulting from manual errors. Member of cross-functional executive committee developing policies and procedures to prevent workplace violence. Senior Account Manager, 1996-1999 Advance Paradigm Dallas, TX Provided lead responsibility and served as primary point of contact, coordinating activities impacting operation of mail and retail pharmacy programs. Directed employees responsible for responding to daily operational issues, providing management and training. Conducted annual and semiannual client meetings to review program cost trends, monitor operational efficiencies and recommend benefit design enhancements. Contributed to implementation and start-up of largest mail service program for a large union client. Account Manager, ValueRx Albuquerque, NM 1994-1996 Directed growth, retention, and quality of client relationship for assigned book of business located across United States. Oversaw 175 prescription benefit programs for TPA, carrier and Fortune 500 groups including Alcoa Aluminum and Nestle USA. Appendix XIX.B p.2 EDUCATION EXHIBIT H: CONTRACTOR'S RESPONSE Exhibit H Page 167 of 170 Account Executive, Division Analyst and Territory Manager, Arizona Public Service Company Phoenix, AZ Client contact responsible for satisfaction and retention of key accounts. Prepared segment analysis, identifying threats and opportunities. 1982-1992 Produced annual marketing plan detailing potential growth/up-sell products and identifying key decision makers. University of Arizona, B.S., Business Education (emphasis in marketing and management) Appendix XIX.B p.3 EXHIBIT H: CONTRACTOR'S RESPONSE Philip L. Carroll Exhibit H Page 168 of 170 2425 West Shaw Avenue Fresno, CA 93711 (559) 244-3700 ext. 23707 pcarroll@usscript.com EMPLOYMENT HISTORY Account Manager, US Script, Inc. Fresno, CA Dedicated to entire book of commercial business Serve 26 commercial groups Serve 23 Third Party Administrators Participate in proposals, products demonstrations and presentations 2013-Present Participate in internal account management team meetings and extended team member meetings as related to client strategic objectives and escalated services issues Client Services Liaison, US Script, Inc. Fresno, CA Manage and strengthen client relationships and ensure satisfaction levels are met. Work with internal teams and constituents as required Serve nationwide as the face of US Script with ongoing communication to clients as necessary to maintain and grow relationships; ensuring client retention Participate in proposals, products demonstrations and presentations Participate in internal account management team meetings and extended team member meetings as related to client strategic objectives and escalated services issues 2011-2013 Director, Business Development, Oakhurst Healthcare & Wellness Centre 2010-2011 Oakhurst, CA Established and maintained professional relationships with healthcare facilities Instrumental in developing a mutually beneficial referral network Provide community support to two additional affiliated area facilities Oversee and coordinate actions of admissions personnel while identifying needs of potential patients and assisting in their transfer Account Executive, HealthCare California 2009-2010 Fresno, CA Worked closely with medical practices and hospitals to identify patient needs and adequately utilize available services Served as liaison between clinicians, office staff, and referral sources to ensure successful and expedient communications Integral in the creation of community based service projects to heighten awareness of public health concerns Appendix XIX.B p.4 EDUCATION PROFESSIONAL AFFILIATIONS EXHIBIT H: CONTRACTOR'S RESPONSE Admissions Coordinator, Valley Healthcare Center Fresno, CA Exhibit H Page 169 of 170 2008-2009 Received, assessed and respond to patient inquiries from all area hospitals Created and maintained patient Face Sheets, patient information, and census data for facility use Coordinated patient needs in continuum of care with all departments Built and nurtured relationships with hospital social workers and discharge planners as well as managed communications for community and family inquiring about facility B.S. Kinesiology, California State University Fresno, 2008 • The Aging Network Senior Living Network Home Services Council Appendix XIX.B p.S usscript D eliverable IT k as D urat1on Obtli'Jty, otFi'esrio'lrrlblententation Plan r,~ , . '!1:. r~' I~,: ~1: '~ 't· County of Fresno/US Script Contract Award Notification 1 dav Signature of Contract 25 davs Pharmacy Network Establish Pharmacy Network 1 day GCII>_ Analysis 1 dav Identify Kev pharmacies 1 dav Contract with pharmacy outliers 5days First Notification to new pharmacies 1 day Final Notification to pharmacies if applicable 1 dav Benefit Design -Review and Revisions Benefit Enrollment Form completed and signed 4 days Review Assigned Group Numbers 1 dav Review and Revise Plans Set Up, if applicable 5 davs Run test claim 5 days Production 5 days Prior Authorization Process Who can initiate? 1 day Where and When to call 1 dav Turn Around Time? 1 day Denials Appeals process 1 dav Eligibility Review/Establish Eligibility Format 1 dav Generate Eligibility Files 5 davs Load Test Eligibility Files 5 days Test Eligibility Files for Format 5 days Billing Criteria Finance Notification 1 dav Rep_orting Review existing report options 1 day Set up report requirements 1 day Training Fresno County 5 days Post Implementation Follow Up Performance Meeting 1 day Process flow review 1 dav System review 1 dav Operations review 1 dav EXHIBIT H: CONTRACTOR'S RESPONSE Start Finish Kev Resources liiii;,;; .• :r.,.··~ '\~# # ~i •. pg,•;~;~; '··''' ·:; -~· ... ·s:; -, 4/1/15 4/2/15 Sales/Marketing 4/2/15 4/27/15 Client Relations 4/28/15 4/29/15 Phannacy Network Dept. 4/29/15 4/30/15 Phannacy Network Dept. 4/30/15 511115 4/30/15 5nl15 Phannacy Network Dept. 5n/15 5/8/15 Phannacy Network Dept. 5/10/15 5111/15 Phannacy Network Dept. 4/27115 5/1/15 Account Management 5/4115 5/5/15 Account Management 5/3/15 5/8/15 Account Management 5/10/15 5/17/15 Account Management 5/17/15 5/24/15 Account Management 5/10/15 5/11/15 CllenUPhannacy Relations 5/11115 5/12115 ClienUPhannacy Relations 5/12/15 5/13/15 ClienUPhannacy Relations ClienUPhannacy Relations 5/13115 5/14115 ClienUPhannacy Relations 5/3/15 5/4/15 ClienUUSS 5/4/15 5/9/15 ClienUUSS 5/10/15 5/15115 USSIT 5117115 5/24/15 USSIT 5/10115 5/11/15 5/5/15 5/6115 ClilenUPhannacy Relations 5/6/15 5nl15 Account Management 5/17/15 5/24/15 Benefits, Implementations & Networks Account Management 6/8/15 6/9/15 ClienUPhannacy Relations 6/9/15 6/10/15 ClienUPhannacy Relations 6110/15 6/11115 ClienUPhannacy Relations 6/11/15 6/12/15 ClienUPhannacy Relations Status ·~:·. ';Y~ ;;:· :· Comments , .,..;,. "[':;;, '\. ;;,; w«;>;., : Exhibit H Page 170 of170 :., . ; .r;':· ·'. Appendix XIX.D p.1 SELF-DEALING TRANSACTION DISCLOSURE FORM Exhibit I Page 1 of2 In order to conduct business with the County of Fresno (hereinafter referred to as "County"), members of a contractor's board of directors (hereinafter referred to as "County Contractor"), must disclose any self-dealing transactions that they are a party to while providing goods, performing services, or both for the County. A self-dealing transaction is defined below: "A self-dealing transaction means a transaction to which the corporation is a party and in which one or more of its directors has a material financial interest" The definition above will be utilized for purposes of completing this disclosure form. INSTRUCTIONS (1) Enter board member's name, job title (if applicable), and date this disclosure is being made. (2) Enter the board member's company/agency name and address. (3) Describe in detail the nature ofthe self-dealing transaction that is being disclosed to the County. At a minimum, include a description of the following: a. The name of the agency/company with which the corporation has the transaction; and b. The nature of the material financial interest in the Corporation's transaction that the board member has. (4) Describe in detail why the self-dealing transaction is appropriate based on applicable provisions of the Corporations Code. (5) Form must be signed by the board member that is involved in the self-dealing transaction described in Sections (3) and (4). (1) Company Boatd'Membeti:fifortnation: Name: Job Title: . . . . (2) Company/Agency Name and Address: Date: Exhibit I Page 2 of2 , (J) · Discl~stire {Pleas~ des crib'~ the"llature of the s-elf-dealing transaction you ,a're ~tpariy.foJ':~: ,,. '-, ( 4) Explain whyth.is self.:.dealihg l;ransaction is consistent with the r.eq'Q.irements ()f , :: , . • · , Corporations Code 5233. (a): .· · · · : .·:,. · ,.: (5) A,.uthQi:izedSigjlature Signature: Date: