Legislative Matter

Miami-Dade Legislative Item
File Number: 102408

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Clerk's Official Copy

File Number: 102408

File Type: Resolution

Status: Adopted

Version: 0

Reference: R-1134-10

Control: Board of County Commissioners

File Name: ASSOCIATION OF COUNTY

Introduced: 10/4/2010

Requester: NONE

Cost:

Final Action: 11/16/2010

Agenda Date: 11/16/2010

Agenda Item Number: 11A3

Notes:

Title:

RESOLUTION APPROVING THE MEMBER COUNTY AGREEMENT, IN THE FORM ATTACHED AS EXHIBIT C TO THE AMENDED AND RESTATED MANAGED PHARMACY SERVICES AGREEMENT BY AND BETWEEN THE NATIONAL ASSOCIATION OF COUNTIES (NACO) AND CAREMARKPCS HEALTH, L.L.C., FOR MIAMI-DADE COUNTY’S PARTICIPATION IN NACO’S DISCOUNT PRESCRIPTION DRUG PROGRAM AND AUTHORIZING THE COUNTY MAYOR OR MAYOR’S DESIGNEE TO EXECUTE THE MEMBER COUNTY AGREEMENT FOR AND ON BEHALF OF MIAMI-DADE COUNTY AND TO EXERCISE ANY AND ALL RIGHTS CONFERRED THEREIN

Indexes:

NACO CONFERENCE

Sponsors:

Sally A. Heyman, Prime Sponsor

Sunset Provision: No

Effective Date:

Expiration Date:

Registered Lobbyist:

None Listed

Legislative History
Acting Body	Date	Agenda Item	Action	Sent To	Due Date	Returned	Pass/Fail

Board of County Commissioners	11/16/2010	11A3	Adopted				P
REPORT:	Commissioner Heyman explained that this proposed resolution would approve County membership in the National Association of Counties (NACo). She pointed out that one of the privileges of NACo membership was a free discount prescription card, and that this proposed resolution would make those discounts available in the county to NACo members. Commissioner Heyman noted NACo would market this program, as opposed to the County. She pointed out that a concern had been raised regarding the Federal Trade Commission charging Caremark PCS Health with violations in protecting medical information, and the Health Insurance Portability and Accountability Act (HIPAA) violations. Commissioner Heyman explained that these Caremark issues did not involve any NACo members, and that the cases in Florida were legal since legislation allows companies to sell lists of client information. Commissioner Diaz requested clarification regarding the County Attorney’s findings on Caremark’s legal issues. Assistant County Attorney Eugene Shy advised that he reviewed Caremark’s annual report that was filed with the Securities and Exchange Commission (SEC), which explained Caremark’s corporate relationship with its subsidiaries. He advised that, as a subsidiary, Caremark PCS Health was separate and apart from Caremark. He noted that other subsidiaries of Caremark were the ones responsible for the HIPAA violations. Commissioner Diaz expressed concern that the County would attach its name with Caremark. He noted that five other companies expressed an interest in providing this service to the County. Hearing no other questions or comments, the Commission proceeded to vote.

Board of County Commissioners	11/4/2010	11A1	Deferred		11/16/2010		P
REPORT:	Commissioner Diaz said the intent behind this proposal was admirable; however, he noted concern over CaremarkPCS Health, L.L.C. (Caremark) providing an exclusive managed pharmacy services program for County residents in conjunction with the National Association of Counties (NACo). He noted instances of deceptive business practice lawsuits against Caremark in approximately 28 states. Commissioner Diaz said other companies needed to be considered unless the wording was removed that indicated the NACo card was exclusive for Miami-Dade County and did not contain the County logo. Commissioner Heyman noted this was a free NACo member benefit that should be made available to County residents. She pointed out that Broward County saved its residents $4 million in one year and NACo had reported more than $329 million in savings over a five-year period. Commissioner Heyman said this would be another option for residents to save money on prescription drugs in addition to the existing Blue program and State insurance card. Chairman Moss noted support for the proposal; however, questioned whether a method existed to obtain a greater comfort level over the Caremark concerns presented. Assistant County Attorney Eugene Shy responded that the Board could not change the relationship between parties since the agreement was between NACo and Caremark and Caremark was the designated provider. He said the County participated in the Contract pursuant to the member County agreement attached to the Item. Mr. Shy said that further investigation of Caremark could be initiated; however, it would not impact this agreement. Commissioner Seijas questioned the method Broward County used to determine their realized savings. Commissioner Heyman responded that she was unaware of the formula utilized to determine the savings. She noted a free identification card was issued to constituents and the card contained a NACo program code associated with Broward County. Commissioner Heyman said the Broward County usage figures were reported by Broward County Commissioner Ilene Lieberman and the NACo data was from the NACo e-News dated October 26, 2010. Commissioner Diaz questioned the ability to have three different exceptions to the contract. Assistant County Attorney Shy responded that a member county participated in the NACo/Caremark contract pursuant to the member-county agreement. He said this agreement was executed by NACo, Caremark and Miami-Dade County upon Board approval. In response to Commissioner Diaz’ inquiry whether any County liability existed, Assistant County Attorney Shy responded that he was unable to guarantee that someone would not file any litigation. He said language was included in the contract that would protect the County against potential liability. Commissioner Diaz noted he did not feel comfortable with an exclusive arrangement, particularly if the County’s name was associated with the card. Commissioner Heyman noted this was a legal document and was consistent with similar agreements that other counties had negotiated. She said the agreement excluded marketing responsibilities and marketing costs and included the use of three languages. Commissioner Heyman noted the County name could not be removed since it was a County specific program and usage was measured based upon participation. She also noted the agreement was reviewed by a bi-partisan Congressional committee and was an option for County residents to save money. Assistant County Attorney Shy responded to Chairman Moss’ question whether the County Attorney’s office had reviewed any of the concerns raised by members of the Commission at today’s (11/04) meeting and if so, what was the outcome. He said that he had not personally reviewed the Caremark cases; however, they were reviewed by other attorneys in the Office. Ms. Janet Perkins, Executive Director, Office of Healthcare Planning, commented that the County Attorney was requested to review Caremark cases; however, the review of business ethics practices could not be evaluated and as a result the County Attorney had requested more time and defined parameters. Chairman Moss noted that although he agreed with the concept, he was not prepared to support this proposal until all issues had been completely vetted. Commissioner Heyman asked Assistant County Attorney Shy to determine the legal ramifications of the County partnering with NACo and CaremarkPCS Health, L.L.C., to provide a discount prescription drug program and to determine whether any other counties that partnered with NACo to provide such programs were negatively impacted. She asked Mr. Shy to present his findings to the Board of County Commissioners at the November 16, 2010 meeting. Commissioner Diaz asked Assistant County Attorney Eugene Shy to determine whether any providers other than Caremark were solicited to provide alternative discount prescription drug programs. There being no further questions or comments, the Commission proceeded to vote.

Health, Public Safety & Intergovernmental Cmte	10/14/2010	2B	Forwarded to BCC with a favorable recommendation				P
REPORT:	Assistant County Attorney Gerald Sanchez read the foregoing proposed resolution into the record. It was moved by Commissioner Rolle that the Committee forward this proposed resolution as presented. Commissioner Diaz seconded this motion for discussion. Commissioner Diaz spoke in support of this proposed resolution conceptually, but noted he did not support the proposed agreement with CaremarkPCS Health, LLC (Caremark) to provide the services set forth in the Managed Pharmacy Benefit Services Agreement. He noted, in his research of Caremark, he found problems in the past. Commissioner Diaz questioned if staff was aware of those problems. In response to Commissioner Diaz’ question, Ms. Janet Perkins, Executive Director, Office of Countywide Healthcare Planning, noted staff had not researched Caremark recently; therefore, staff was not aware of any problems with them. Commissioner Diaz informed the Committee members and Ms. Perkins of an investigation in Seattle, Washington of the CVS Pharmacy Caremark by the Federal Trade Commission. He noted it was required to pay a $2.5 million Health Insurance Portability and Accountability Act of 1996 (HIPPA) violation for failure to keep patients’ information confidential. He also pointed out that in 2008, CVS Caremark settled a lawsuit for unacceptable business practices in the amount for $38.5 million, which covered over 28 states. Commissioner Diaz stated he did not want the County’s name to be associated with Caremark. He suggested that another provider be identified or that the County create its own discount card plan, similar to this concept. Chairwoman Heyman as the sponsor, provided an overview of the intent of this proposed resolution, which she noted was to create a discount drug program at the County level. She noted the joint effort with the National Association of Counties (NACO) to save its constituents millions of dollars each year. Chairwoman Heyman stated that it was strictly voluntary and referenced other available discount drug programs. She noted membership for this program was free for County residents and included another option for the uninsured. Commissioner Diaz reiterated his concerns and noted he opposed the County entering into an agreement with Caremark to provide this service. He withdrew his second to the motion by Commissioner Rolle. Commissioner Barreiro spoke in support of this proposed resolution. Hearing no further questions or comments, the Committee proceeded to vote on this proposed resolution as presented.

County Attorney	10/4/2010		Assigned	Eugene Shy		10/6/2010

County Attorney	10/4/2010		Referred	Health, Public Safety & Intergovernmental Cmte	10/14/2010

Legislative Text

TITLE
RESOLUTION APPROVING THE MEMBER COUNTY AGREEMENT, IN THE FORM ATTACHED AS EXHIBIT C TO THE AMENDED AND RESTATED MANAGED PHARMACY SERVICES AGREEMENT BY AND BETWEEN THE NATIONAL ASSOCIATION OF COUNTIES (NACO) AND CAREMARKPCS HEALTH, L.L.C., FOR MIAMI-DADE COUNTY�S PARTICIPATION IN NACO�S DISCOUNT PRESCRIPTION DRUG PROGRAM AND AUTHORIZING THE COUNTY MAYOR OR MAYOR�S DESIGNEE TO EXECUTE THE MEMBER COUNTY AGREEMENT FOR AND ON BEHALF OF MIAMI-DADE COUNTY AND TO EXERCISE ANY AND ALL RIGHTS CONFERRED THEREIN

BODY

WHEREAS, many uninsured and underinsured residents of Miami-Dade County need prescription drugs but such residents either do not have access to health insurance providing prescription drug benefits or do not have the ability to pay for such drugs; and
WHEREAS, pursuant to Section 1.01A6 of the Charter for Miami-Dade County, this Board is empowered to provide �uniform health and welfare programs�; and
WHEREAS, this Board desires to provide a discount prescription drug program for the benefit of residents in Miami-Dade County; and
WHEREAS, the National Association of Counties (�NACO�) and CaremarkPCS Health, L.L.C., have entered into an Amended and Restated Managed Pharmacy Benefit Services Agreement (Consumer Card Program) (�Agreement�), pursuant to which Agreement NACO makes available a discount prescription drug program (the �Program�) to counties which are members of NACO (�Member County�) at no cost; and
WHEREAS, the Program will provide a network of Participating Pharmacies, clinical services, drug utilization review, formulary services, and other services as more particularly set forth in Section 1 of the Agreement attached hereto and made a part hereof; and
WHEREAS, Miami-Dade County is a Member County of NACO and this Board desires to participate in the Program for the benefit of the residents of Miami-Dade County; and
WHEREAS, to participate, the County must become a party to the Agreement by executing the Member County Agreement attached as Exhibit C to the Agreement,
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby approves the Member County Agreement providing the Miami-Dade County�s participation in NACO�S discount drug program, and authorizes the County Mayor or Mayor�s designee to execute the Member County Agreement, in counterpart, with authority to exercise any and all rights conferred in the Member County Agreement or Agreement.