Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, 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:
title
Adopt a resolution authorizing an amendment to the agreement with the Health Plan of San Mateo for pharmacy benefits administration, extending the term through December 31, 2025, and increasing the amount by $480,000 to an amount not to exceed $680,000.
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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 adults and Medi-Cal members carrying a “share of cost,” i.e., clients not covered by the Medi-Cal funding structure and for whom BHRS is financially responsible.
On May 23, 2024, the Director of Behavioral Health and Recovery Services approved an agreement with HPSM for the term of January 1, 2024 through December 31, 2024, for BHRS to utilize HPSM’s pharmacy benefits administration services for clients requiring psychiatric medication, in an amount not to exceed $200,000.
DISCUSSION:
HPSM will continue to administer the pharmacy benefits provided to BHRS indigent adult clients and Medi-Cal members carrying a share of cost.
It is now necessary to extend the term for an additional year through December 31, 2025, and increase the maximum amount by $480,000 due to an increased use of long-acting second-generation antipsychotics, which improves adherence, and for HPSM to continue to provide the services described above.
The amendment and resolution have been reviewed and approved by County Attorney as to form.
It is anticipated that 84% of clients who receive services will be maintained at current or lower level of care.
PERFORMANCE MEASURE:
|
Measure |
FY 2023-24 Actual |
FY 2024-25 Estimated |
|
Percentage of clients who receive services that are maintained at current or lower level of care |
84% 4213 of 5016 clients |
84% 4213 of 5016 clients |
EQUITY IMPACT:
This contract will significantly benefit a critically underserved community of behavioral health clients who experience severe mental illness and lack insurance coverage. National data highlights that racial and ethnic disparities persist with Hispanic, Black, American Indian and Alaska Native (AIAN), and Native Hawaiian and Other Pacific Islander individuals more likely to be uninsured compared to their White counterparts. In 2022, nonelderly AIAN and Hispanic individuals had the highest uninsured rates, at 19.1% and 18.0%, respectively. 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 Pharmacy Benefits Manager 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 amended agreement is January 1, 2024 through December 31, 2025. The amendment increases the contract amount by $480,000 to an amount not to exceed $680,000 for the two-year term. Of the increase, it is anticipated that $400,000 will be funded as follows: $350,000 by Realignment and $40,000 will be Net County Cost. These funds are included in the BHRS FY 2024-25 Adopted Budget. Similar arrangements will be made for FY 2025-26 Recommended Budget.