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2018-015A1
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Last modified
12/21/2020 11:37:35 AM
Creation date
5/9/2018 1:10:52 PM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
01/23/2018
Control Number
2018-015A1
Agenda Item Number
12.D.1.
Entity Name
RxBenefits
Subject
Administrative Services Agreement for Prescription Benefits
Alternate Name
Health Insurance Drug Benefits
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D. REBATES <br />1. Rebate Amounts. Subject to: (i) the conditions set forth in Sections 2 through 4 below and elsewhere in this <br />Agreement; and (ii) Client meeting the Plan design conditions identified in the table below, ESI will pay to Client the <br />following guaranteed amounts: <br />Formulary: <br />ESI National Preferred <br />National Plus <br />Smart90 Walgreens <br />Home <br />Specialty <br />Network <br />Network" extended <br />Delivery <br />(84-90) days' supply 0) <br />Rebates per Brand Rx <br />$148.00 <br />1$430.00 <br />$430.00 <br />$1,075.00 <br />(1) Smart90 Walgreens Network <br />Certain participating pharmacies have agreed to participate, together with the Mail Service Pharmacy, in the Express <br />Scripts' "Smart90 Walgreens Network" extended (84-90) days' supply network for maintenance drugs (such <br />participating pharmacies and the Mail Service Pharmacy are hereinafter collectively referred to as "Express Scripts' <br />Smart90 Walgreens Network"). Pricing in the 84-90 Days' Supply column in the table set forth above is applicable <br />only if Client implements a plan design that requires members: (i) to fill maintenance drugs (based on Express <br />Scripts' standard list of identified maintenance drugs) in extended (84-90) days' supply quantities only (i.e., no 30 <br />day fills except for initial courtesy fill(s)); and (ii) to fill such extended days' supply at either the Mail Service <br />Pharmacy or a participating pharmacy in the Express Scripts Smart90 Walgreens Network (i.e., [Client) must <br />implement a plan design whereby members who fill maintenance drugs for less than an extended (84-90) days' <br />supply or who fill an extended (84-90) days' supply at a participating pharmacy other than an Express Scripts <br />Smart90 Walgreens Network participating pharmacy do not receive benefit coverage under the Plan for such <br />prescription). If no such plan design is implemented, the pricing for such days' supply will be the same as for <br />prescription drug claims for less than an 84 days' supply, and pricing for an 84-90 days' supply in the table set forth <br />above shall not apply, even if an Express Scripts Smart90 Walgreens Network participating pharmacy is used. The <br />copayment amount must also be level between the Smart90 Walgreens Network and the Express Scripts Mail Order <br />Pharmacy. <br />Smart90® Walgreens is an innovative plan design that motivates members to fill 90 -day supplies of their <br />maintenance medications. Members have the choice to fill 90 -day supplies through Express Scripts' home delivery <br />pharmacy services or at Walgreens pharmacies. When members do so, plan savings increase due to more <br />aggressively discounted pricing compared to non -preferred retail pharmacies. <br />How Smart90 Walgreens Works: <br />Members obtain 90 -day supply of maintenance prescriptions <br />via home delivery from Express Scripts or at one of more than <br />8,000 Walgreen's pharmacies. <br />• Member pays the same 90 -day copay whether filling through the Express Scripts Pharmacy or through one of <br />the Walgreen's pharmacy locations <br />Members who continue to fill 30 -day supplies of maintenance medications or use a non -preferred pharmacy after two <br />courtesy fills pay 100% of the prescription cost. <br />2. Exclusions <br />Member Submitted Claims, Subrogation Claims, biosimilar products, OTC products, vaccines, claims older <br />than 180 days, claims through Client -owned or 340b pharmacies, and claims pursuant to a 100% Member <br />Copayment plan are not eligible for the guaranteed Rebate amounts set forth in Section 1. above. <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />27 <br />
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