Meeting_Body
FINANCE, BUDGET, AND AUDIT COMMITTEE
SEPTEMBER 17, 2026
Subject
SUBJECT: PHARMACY BENEFIT MANAGEMENT FOR THE WORKERS’ COMPENSATION PROGRAM
Action
ACTION: APPROVE RECOMMENDATION
Heading
RECOMMENDATION
Title
AUTHORIZE the Chief Executive Officer to award a firm fixed unit rate Contract No. PS134759000 to Matrix Healthcare Services, Inc., dba MyMatrixx, to administer and manage pharmacy benefits, and process and pass through prescription medications for Metro’s Workers’ Compensation Program (the “Program”) in the Not-To-Exceed (NTE) amount of $9,672,000 for the initial three-year base term, $3,256,000 for the first, one-year option, and $3,320,000 for the second, one-year option, for a total NTE amount of $16,248,000, effective October 5, 2026, subject to the resolution of any properly submitted protest(s), if any; and
Issue
ISSUE
Metro does not have an established Pharmacy Benefit Management program to efficiently manage workers’ compensation (WC) claims. A dedicated contract is an effective tool to control prescription costs, ensure injured employees receive safe, injury-related medication, and streamline the WC claims management process.
Background
BACKGROUND
Metro’s FTE workforce of 12,300 employees reports an average of 1,600 WC claims annually, with approximately 2,400 open claims currently managed. The WC division administers the following California mandated benefits:
Medical Care – Treatment to help an employee recover from a work-related injury or illness, including physician visits, diagnostic tests, medications, medical equipment, and necessary travel costs.
Temporary Disability Benefits – Wage-replacement payments for employees who are unable to perform their usual job duties during recovery.
Permanent Disability Benefits – Payments for employees who do not fully recover from their work-related injury, providing compensation for a measurable permanent loss of physical or mental function.
Death Benefits – Financial supp...
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