Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health, and Recovery Services
Subject: Amendment to the Agreement with Health Plan of San Mateo for Pharmacy Benefits Administration
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with the Health Plan of San Mateo for pharmacy benefits administration services for the term of January 1, 2026 through December 31, 2026, in an amount not to exceed $500,000.
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BACKGROUND:
Since 2010, Behavioral Health and Recovery Services (BHRS) has utilized the Health Plan of San Mateo’s (HPSM) pharmacy benefits administration services for BHRS clients requiring psychiatric medication. The services are provided to indigent adult clients not covered by the Medi-Cal funding structure and for whom BHRS is financially responsible.
DISCUSSION:
HPSM, as a Managed Care Plan, possesses significantly greater purchasing power than BHRS and has access to state-approved formularies that are unavailable to BHRS as a Mental Health Plan. HPSM is able to negotiate adding the BHRS indigent line of business into their larger Pharmacy Benefits Manager (PBM) contract and pass on the advantageous contract rate for BHRS indigent claims processing. HPSM is best positioned to procure psychiatric medications at the lowest possible cost, which is critical for BHRS's indigent clients, whose care represents 100% Net County Cost. A PBM or commercial vendor would be unlikely to accept this contract without building in a profit margin or administrative fees, which would increase costs to the County and undermine BHRS’s objective of minimizing expenditures for this fully County-funded population.
A waiver request was reviewed by County Procurement, which recommended submission to this Board for approval.
The agreement and resolution have been reviewed and approved by the County Attorney as to form.
The resolution contains the County’s standard provisions allowing amendments to the County’s fiscal obligation by a maximum of $25,000 (in aggregate).
It is anticipated that 95% of indigent clients that receive prescriptions will access medication services through the HPSM PBM.
PERFORMANCE MEASURE:
|
Measure |
FY 2025-2026 Actual |
FY 2025-26 Estimated |
|
Percentage of indigent clients prescribed medications who access pharmacy services through the HPSM PBM |
90% 132 of 146 clients |
90% 132 of 146 clients |
COMMUNITY IMPACT:
This contract will significantly benefit a critically underserved community of behavioral health clients who experience severe mental illness and lack insurance coverage. Clients will receive services through BHRS outpatient clinics, which provide bilingual and bicultural behavioral treatment tailored to diverse needs. This agreement enables BHRS to collaborate with the PBM contracted by HPSM, facilitating medication dispensing and processing across a countywide pharmacy network. This ensures equitable access to pharmacy services for underserved and vulnerable populations in San Mateo County.
FISCAL IMPACT:
The term of the agreement is January 1, 2026 through December 31, 2026. The amount of the agreement is not to exceed $500,000 for the one-year term. Funds in the amount of $500,000 are included in the BHRS FY 2025-26 Adopted Budget. Similar arrangements will be made for future years. One hundred percent of this agreement is funded by Net County Cost.