Mayor and Council Communications 22-0551 and 25-0358: OptumRx pharmacy benefits administration

What this document is

These are two Mayor and Council Communications from Fort Worth, the memos city staff write to ask the council for authority. M&C 22-0551, dated August 9, 2022, asked the council to "Authorize Execution of an Agreement with OptumRx Inc., for Administration of the City's Pharmacy Benefits for an Initial Term of One Year with Two Optional One-Year Renewal Terms in an Amount Up to $236,000.00 for Each Term" (page 1). M&C 25-0358, dated April 22, 2025, asked for a new one year agreement with OptumRx "in an Amount Up to $237,000.00" (page 1 of the second file). Both are award memos. Neither attaches the agreement.

What it does tell us

The 2022 memo describes RFP No. 22-0067 for a pharmacy benefits manager to "provide claim administration for pharmacy benefits for active employees, retirees, and surviving spouses" (page 1). The city received 11 proposals. The scoring table shows OptumRx at 73.10, CapitalRx at 68.95 and Rightway at 67.57; the other eight, including CVS-Caremark and Express Scripts, were marked not acceptable because they did not score at least 50% of the technical points (page 1). The five criteria were quality of proposal, network and formulary disruption, drug programs, firm experience, and cost. The agreement was to begin January 1, 2023 and run one year, with two one year renewals at the city's option that did not need to return to the council (page 2).

The 2025 memo explains why the final renewal became a new contract. The original pricing "was based on participating in a cooperative agreement organized by Trion," the city's pharmacy benefits consultant at the time. In December 2024 the city hired a new consultant, Prism Health, under M&C 24-1064, and "as a result of this consultant change" the city needed a new agreement with OptumRx for January 1, 2025 through December 31, 2025 with "no renewal terms" (page 1 of the second file). It also notes that a Form 1295 was not required because the contractor is a subsidiary of a publicly traded company, UnitedHealthCare Inc.

The "amount up to" figures sit in the Claims Administration expense of the Group Health Insurance and Retiree Healthcare Trust Funds (page 1 of each memo), which points to administrative fees. The memos do not say how drug claims themselves are paid.

Why it cannot be scored

The memos record that the council approved an agreement and how the bidders ranked. They do not contain the agreement. The pricing that came through the Trion cooperative, the rebate terms, the pass through or spread arrangement, audit rights and termination clauses are all in documents that are not posted. A consultant run cooperative also raises a question the memos cannot answer: what the consultant was paid, and by whom.

A Fort Worth resident can ask the city secretary under the Texas Public Information Act for the executed OptumRx agreements under M&C 22-0551 and M&C 25-0358, including all exhibits and pricing schedules, the Trion cooperative agreement terms that set the pricing, and the city's consulting agreements with Trion and Prism Health. The OptumRx arrangement ended December 31, 2025. The city replaced it with Rightway Healthcare under M&C 25-0845 beginning January 1, 2026, which is catalogued separately and also lacks contract text.