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the prescriptions filled under the plan. Various incentives are negotiated between the PBM and
<br />the pharmaceutical companies, and often the medical plan receives rebates. Currently, the
<br />County's medical plan contracts with Florida Blue who utilizes Prime Therapeutics as the
<br />pharmacy benefit manager (PBM). Under the current PBM contract with Prime Therapeutics,
<br />there are no financial or contractual guarantees, and there is no way to confirm if Indian River
<br />County is getting the full value of what has been negotiated with manufacturers/retailers, Indian
<br />River County receives pharmacy rebates throughout the year, however, no detail is provided to
<br />assess the value of the rebates. Because of the substantial pharmacy expense and available
<br />opportunities for improvement and savings, Lockton recommended the County pursue revising
<br />the PBM arrangement.
<br />Indian River County authorized Lockton to proceed with obtaining PBM proposals as well as work
<br />with Florida Blue to revise the current PBM arrangement through Prime Therapeutics. Lockton
<br />took the proposals and analyzed the pharmacy claims for the period October 1, 2016 through
<br />September 30, 2017 for the following PBM providers to determine projected savings:
<br />1) Prime Therapeutics (Discounted Renewal Offer)
<br />2) CVS/Caremark
<br />3) OptumRx
<br />4) Express Scripts.
<br />While the renewal offer from Prime Therapeutics results in a discount from the current
<br />agreement, the renewal offers from the three other providers result in even greater savings
<br />(17.60%, 19.24%, and 17.62°/x) above the renewal offer from Prime Therapeutics.
<br />An excerpt from the renewal analysis is provided below. The full analysis is available in Human
<br />Resources.
<br />Clam Dates Analyzed 10/1/2016 to 9/30/2017
<br />Indian River County R --g offer
<br />PrrmeTher.peuh-
<br />Overview of Plein Cost
<br />�—
<br />CVS --A 0^-R,
<br />Esgr.ee Soipls
<br />Gress Claim Ameent Paid by Ernpieyer $5,614,917
<br />L— We — C.J—y -$682,106
<br />$5,135,407
<br />$5,139,133
<br />$5,144,231
<br />-$682,108
<br />-$682,108
<br />-$682,108
<br />Cbims Amevm Paid by Empieyer $4,932,809
<br />$4,453,299
<br />$4,4S7,02S
<br />$47162,123
<br />Pkn Potmeial Implementatim Fees f— kv-4—it $o
<br />Plus UM Pmfage J Co..ec" Fees $o
<br />li Admkustrati.e / Trmnacti— Fees $o
<br />L— Rebate mrd Credm f— PSM -$665,774
<br />$50,000
<br />$50,000
<br />$50,000
<br />$D
<br />$0
<br />$45,141
<br />$32,274
<br />$32,274
<br />$32,274
<br />-$971,635
<br />-$1,040,906
<br />-$1,026,464
<br />Met Amevnf Paid b Em a ee $4,267,0;5
<br />Average Amount Paid
<br />A.erege Net Cest Per Cb,im $85.60
<br />$3,563,939
<br />$71.78
<br />$3,498,393
<br />$7046
<br />$3,563474
<br />$71.76
<br />Nee Ameurd ►aid PEPM $21643
<br />Sevisys Compered to Ima,mb.m N/A
<br />Percentage S..igg C.mpored t. iocr,mbew N/A
<br />$180.43
<br />r • .
<br />$177.12
<br />$180.39
<br />r
<br />ANALYSIS:
<br />When evaluating the PBM proposals, major considerations were the disruption to members, ease
<br />of implementation and integration with Florida Blue, as well as the savings resulting from
<br />improved contractual terms with performance and financial guarantees. Based on these
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