OFFICE OF LABOR RELATIONS EMPLOYEE BENEFITS PROGRAM 40 Rector Street, 3RD Floor, New York, N.Y. 10006 nyc.gov/olr

ROBERT W. LINN BETH KUSHNER Commissioner Deputy Director, Administration RENEE CAMPION SANG HONG First Deputy Commissioner Deputy Director, Operations MICHAEL BABETTE GEORGETTE GESTELY Director, Financial Management Unit Director, Employee Benefits Program

ADDENDUM 2

TO: PROSPECTIVE PROPOSERS

FROM: OFFICE OF LABOR RELATIONS (OLR)

DATE: February 21, 2017

: REQUEST FOR PROPOSALS FOR PHARMACY BENEFITS MANAGER SERVICES FOR THE PICA PROGRAM FOR CITY OF NEW YORK EMPLOYEES AND RETIREES, AND THEIR DEPENDENTS e-PIN 00217P0005 ______

The following are questions from perspective proposers regarding the above referenced RFP. Please continue to check the Office of Labor Relations RFP website for additional addenda:

Question #1: Attachment C-T.3e- Please confirm if the City of New York would consider a reduced pharmacy network which would provide more aggressive discounts if the reduction entailed removing a specific pharmacy chain but continuing to have Independent pharmacies participating?

Answer: No, the City is requesting the broadest retail network offered by each PBM as its lead offering, to correspond to the current program. If any pharmacy chains are excluded from this network, those should be noted in your response. Should a proposer wish to offer an alternative network, this should be done as part of its response to question P.3.6 and any chains excluded should be noted.

Question #2: Attachment C, T.3f- Please confirm that the City’s intention is to utilize the winning PBM’s standard formulary and PBM’s standard UM edits (Step Therapy, PA, QL) Answer: The program intends to follow the winning PBM’s open formulary with regard to tiering of copays (generic, preferred brand, non-preferred brand). The program will, at its sole discretion, adopt individual clinical edits as presented by the winning PBM. The program decides which UM edits to adopt. Furthermore, please note that while the program generally has an open formulary, it does exclude several that one would expect fall under PICA coverage, such as PCSK-9, brand Epipen and Auvi-Q. Please refer to the covered list provided with the RFP for the specific list of covered drugs.

Question #3: Attachment C, T.3f- Open vs Closed Formulary- Attachment D states “Proposals should be based on an open formulary, where utilization is managed through aggressive clinical programs.”, however Attachment C, Section T.3 asks a number of questions about how many are excluded from the PBM’s formulary, how a member can get access to a excluded from the formulary, etc. PBM understands that the PICA program currently does not incorporate any formulary exclusions however these items conflict. Please confirm whether PBM may propose as its lead offer a formulary that incorporates exclusions that function in members’ eyes like a Prior Authorization. Those exclusions would allow the member to submit a Prior Authorization request to allow for coverage of an excluded drug if sufficient documentation is provided by their prescribing physician, as well as appeal a denial of coverage.

Answer: Each proposers lead offering should be based on an open formulary, as described in the response to Question #2 above. Please note that the PICA plan does aggressively manage the formulary through clinical programs that may drive utilization of one drug over another within a class using Step Therapy and Prior Authorization programs, and at time does exclude drugs from the formulary at the plan’s discretion. Per Attachment D, P.3.6, “In addition to the prescription drug pricing outlined above in accordance with the PICA program’s current structure, proposers are permitted to submit one additional prescription drug pricing model under a different pricing structure and/or different formulary restrictions.” Each PBM may propose an alternative pricing scheme that could include closed formulary in accordance with these stipulations provided.

Question #4: Attachment D- Rebates at the Point of Sale- Clients that have implemented Rebates at the Point of Sale are typically clients with a High Deductible Health Plan design or a coinsurance design. There is an administrative fee charged to the client in those situations to account for the float of fronting of future rebates at the time of filling a medication. Due to the PICA program being copay oriented (after the deductible), would PICA consider a financial response which does not incorporate Point-of-Sale rebates, has a lower Admin Fee, and still provides 100% pass through of rebates, albeit on a quarterly basis instead of at the point-of-sale?

Answer: Each proposers lead offering should comply with the requested pricing scheme which include Point-of-Sale rebates. As stated above, proposers are welcome to offer an alternative approach in response to question P.3.6.

Question #5: Attachment D, P.3- Under “Broadest Retail Network”, pricing is requested for “Retail Maintenance Supply Over 83 Days (At 1 Retail Chain Only)”. Please confirm that the City of New York is looking for a proposal for “Mail Service at Retail” whereby City members are able to purchase 84-90 day supplies at either Mail Service or One Retail Chain? Is this plan design currently in place for the City of New York PICA program?

Answer: No. The current plan does not offer Retail 90 for maintenance drugs. The current plan is structured as follows: • All specialty drugs are exclusively filled through the PBM’s specialty pharmacy • However, a small number of drugs are available to be filled at retail immediately based on clinical need. These “stat” drugs include: Brand Name Generic Name Strength • ARIXTRA FONDAPARINUX SODIUM 5MG/0.4ML • ENOXAPARIN SODIUM ENOXAPARIN SODIUM 80MG/0.8ML • FIRAZYR ICATIBANT ACETATE 30 MG/3 ML • FONDAPARINUX SODIUM FONDAPARINUX SODIUM 5MG/0.4ML • FRAGMIN DALTEPARIN SODIUM,PORCINE 15000/0.6 • LOVENOX ENOXAPARIN SODIUM 30MG/0.3ML • For non-specialty drugs, members are allowed 2 fills at retail before they must be filled through mail order.

Each proposers lead offering should comply with the plan design above. As stated, proposers are welcome to offer an alternative approach in response to question P.3.6. Question #6: Attachment D, P.6.3- Specialty Drugs Dispensed at Participating Retail Pharmacies- please confirm if this pricing would only apply in cases where an exception has been granted to allow a member to purchase a Specialty medication at a Retail pharmacy, since there are no fills of Specialty drugs allowed at Retail per the Plan Design.

Answer: The current plan is structured as follows: • All specialty drugs are exclusively filled through the PBM’s specialty pharmacy • However, a small number of STAT drugs are available to be filled at retail immediately based on clinical need (for example, Lovenox). • For non-specialty drugs, members are allowed 2 fills at retail before they must be filled through mail order.

Proposers should provide pricing for any retail specialty dispensing under the above conditions.

Question #7: Attachment G- Please clarify what type of Step Therapy programs are in place for MS, , Colony Stimulating Factors, Growth Hormones, Erythroid , Inflammatory Conditions, Injectable Prostate Cancer? Do the Step Therapy programs target all drugs in each specific category or only certain medications such as non-formulary medications within each category?

Answer: Regarding Step Therapy, the current PBM is targeting non-formulary medications within the category. For example, with the Inflammatory Conditions, the PBM targets not only the non-formulary drugs within the category but also targets at the diagnosis level. Many of these programs are meant to follow the logic of the PBM’s formulary without the strict exclusions commonly in place today.

Question #8: Attachment G- When these step therapy programs were implemented, did the City of New York allow existing members to be grandfathered on their current medication in order to minimize member impact? If yes, please describe the duration and extent to which grandfathering applies. Answer: Some of these programs allowed for grandfathering for a limited time, others did not.

Question #9: Please provide additional detail around the relationship with the Freedom Clinic. It is not noted in the RFP, however on the City’s website is noted as a requirement, the winning PBM required to continue to allow Freedom to fill Fertility medication or can the winning PBM utilize our in-house Specialty Pharmacy to fill Fertility medications?

Answer: No, the plan will use the winning PBM’s Specialty Pharmacy to fill fertility medications for those members eligible to receive them.

Question #10: Attachment G-row 58- please clarify what “Stat Specialty” is and which medications the City allows 2 fills of before requiring in-house Specialty filling?

Answer: Stat drugs include: Brand Name Generic Name Strength • ARIXTRA FONDAPARINUX SODIUM 5MG/0.4ML • ENOXAPARIN SODIUM ENOXAPARIN SODIUM 80MG/0.8ML • FIRAZYR ICATIBANT ACETATE 30 MG/3 ML • FONDAPARINUX SODIUM FONDAPARINUX SODIUM 5MG/0.4ML • FRAGMIN DALTEPARIN SODIUM,PORCINE 15000/0.6 • LOVENOX ENOXAPARIN SODIUM 30MG/0.3ML Question #11: Attachment G- Quantity Limits- please confirm that injectable contraceptives are the only medications covered by PICA that have a quantity limit. If additional medications have a quantity limit, please provide detail on those medications.

Answer: Please see RFP Attachment G for the coverage rules, including the drugs for which quantity limits apply.