Title:
Consider and take action on a resolution authorizing Addendum No. 1 to the Interlocal Agreement with the Galveston County Health District d/b/a Coastal Health & Wellness to expand eligible pharmacy services and establish payment for required medical visits (Director of Human Resources and Civil Service)
Background:
Approval of this item will authorize Addendum No. 1 to the existing interlocal agreement with the Galveston County Health District d/b/a Coastal Health & Wellness to expand the 340B pharmacy program to eligible non-specialty medications that provide a net financial savings and to establish City payment for required medical visits.
Human Resources reports that the program has generated $75,633.57 in savings during the current fiscal year. Participation is voluntary. Employees who elect to participate have a $0 copay for medications provided through the program; however, employees enrolled in a high-deductible health plan may receive the $0 copay only after satisfying the applicable plan deductible. Only medications that produce a net savings under the City's prescription benefit will be included in the program.
The proposed addendum expands the program beyond specialty medications by allowing non-specialty medications when the parties mutually determine that a medication is clinically appropriate and results in a net financial savings under the City's prescription benefit. The parties may establish and revise the list of eligible medications through written mutual agreement without further amendment, provided Coastal Health & Wellness can replenish the medication through the 340B Program in the manufacturer's full package size.
The addendum also establishes a flat rate of $190 for each required medical visit. Covered individuals must complete an initial appointment to establish care and an annual medical visit every 12 to 18 months. Coastal Health & Wellness will not bill the covered individual's insurance for a required visit. Additional services will be billed to the individual's medical insurance, and the City will not be responsible for costs not covered by insurance.
Coastal Health & Wellness will invoice the City monthly and identify the covered individual and date of service for verification. The City must remit amounts due within 30 calendar days after receipt of an invoice. Medical information or files may not be released to the City without the covered individual's written consent.
The City and the Galveston County Health District entered into the original interlocal agreement effective September 30, 2024, for limited pharmacy services involving specialty medications. Addendum No. 1 also clarifies that references to the Galveston County Health District in the agreement refer to Coastal Health & Wellness, a d/b/a of the District, particularly for 340B Drug Pricing Program components.
CONTRACT ORIGINATION:
Attachments:
1. Proposed Resolution
2. Addendum No. 1 to the Interlocal Agreement
3. Fully Executed 2024 Interlocal Agreement for Limited Pharmacy Services Involving Specialty Medications
FUNDING
{X}Expenses will be charged to the Employee Benefit Fund Health Insurance Payments account #40301650-54650