Item Description:
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Amd 4 to Agmt PR00004679 with OptumRx, the county's self-insured pharmacy benefit plan's third-party administrator, to include diabetes management solution services and allow data sharing for required Section 111 reporting
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Resolution:
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BE IT RESOLVED, that Amendment 4 to Agreement PR00004679 with OptumRx, who serves as the third party administrator of the county's self- insured pharmacy benefit plan, to include services for Diabetes Management Program at a cost of $195 per counseled member plus $.08 per member per month; and that Optum Rx will support Section 111 reporting by submitting the required Hennepin County data as set forth at no cost, be approved; that the Chair of the Board be authorized to sign the Amendment on behalf of the county; and, that the Controller be authorized to disburse funds as directed.
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Background:
The current diabetes management program is administered by a separate vendor. To adopt a more holistic approach to member health and achieve cost savings for the county, it is advisable to contract this service with the health plan's existing pharmacy benefit manager.
Eligible members will receive complimentary blood glucose meters and testing supplies, continuous monitoring, and provider engagement to address gaps in care. Additionally, they will benefit from pharmacist-led counseling sessions and personalized action plans.
Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 requires certain insurers and self-insured entities to report information to the Centers for Medicare & Medicaid Services (CMS) about Medicare beneficiaries who are covered under their plans or receive payments.
The purpose of Section 111 reporting is to help CMS determine when Medicare should be the secondary payer, ensuring that other applicable insurance pays first.
For Hennepin County, OptumRx will be responsible for this reporting. They are designated as the Responsible Reporting Entity (RRE) and will ma...
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