902795-Pharmacy Benefit Management Services

Alameda County Behavioral Health Care Department is the county-operated provider serving approximately 50,000 patients annually with serious and persistent mental illness through its system of care. ACBHD administers this care through a combination of county-operated community support centers, and contracts with private community-based organizations. Currently, there is a network of approximately 45 psychiatrists serving uninsured, MediCal and MediCare patients (adults, youths and children) at nearly 40 programs as well as at certain day treatment and transitional age youth programs. Additionally, under the Affordable Care Act, ACBHD has added 15 programs under its Low Income Health Plan (LIHP) called the Health Program of Alameda County (HealthPAC) Behavioral Health Care Specialty Service, expanding its coverage of uninsured patients requiring mental health treatment. ACBHD is the payer of last resort when it is determined that the patient being served does not qualify for programs sponsored by government agencies such as MediCal & MediCare. The Contractor will administer coverage for all prescriptions written for uninsured and HealthPAC Behavioral Health Care Specialty Service patients seen by the network prescribers of ACBHD. In addition, Contractor will provide these services for Medi-Cal clients with a denied medication Prior Authorization Request (PA) or Share of Cost (SOC), Medicare Part D clients whose medication is non-formulary or a denied appeal, and Medicare Part D clients' medication co-pays. The Contractor will also administer ACBHD use of drug companies' Patient Assistance Programs (PAP) and the Federal 340B drug purchasing program. During the 2024-2025 fiscal year, ACBHD provided a total of approximately 1,600 prescriptions for 650 uninsured patients, filled through 45 retail pharmacies, with no mail prescriptions filled. Pharmaceuticals costs were estimated to be $135,000.