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2020-241A
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2020-241A
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(b) Pricing for ASES is as follows: <br />(i) For Specialty Products needing an additional charge to cover costs of all ASES required to <br />administer the Specialty Products, the following standard per diem and nursing fee rates shall <br />apply. Exceptions to the standard per diem and nursing rates are set forth in (ii), below, which <br />list may be updated from time to time by ESI. Pricing for home infusion supplies and services <br />provided at Participating Pharmacies (for example, limited distribution products not then <br />available through ESI Specialty Pharmacy or overrides) will be pass through. <br />Standard Per Diem $65/dose <br />Standard Nursing Fee/ First 2 Hours $150 <br />Standard Nursing Hourly $75 <br />(ii) Additional exceptions to AWP Discount Rates and Standard Per Diem & Nursing Fees <br />Brand Name AWP Discount Per Diem <br />EPOPROSTENOL 1.0% $65/da <br />REMODULIN 5.0% $65/da <br />The AWP discount includes Phone Support Nursing, Supplies, Pump, first two training <br />visits, and Coordination of In -Person Nursing. In-home nursing that is requested/needed <br />beyond the first two training visits will be charged at a rate of $150 for the first two hours <br />and $75 for every hour after. <br />(c) Specialty Products will be excluded from the non -specialty price guarantees set forth in the <br />Agreement. In no event will the Mail Service Pharmacy or Participating Pharmacy pricing terns <br />specified in the Agreement, including, but not limited to, the annual average ingredient cost discount <br />guarantees, apply to Specialty Products. <br />(d) Unless otherwise set forth in an agreement directly between ESI Specialty Pharmacy and Client, if <br />a Specialty Product dispensed or ASES provided by ESI Specialty Pharmacy is billed to Client <br />directly by ESI Specialty Pharmacy instead of being processed through ESI and Administrator, <br />Client agrees to timely pay ESI Specialty Pharmacy for such claim pursuant to the rates above and <br />within thirty (30) days of Client's, or its designee's, receipt of such electronic or paper claim from <br />ESI Specialty Pharmacy. ESI Specialty Pharmacy shall have 360 days from the date of service to <br />submit such electronic or paper claim. <br />(e) SPECIALTY NET EFFECTIVE DISCOUNT GUARANTEE - Administrator guarantees that <br />the overall annual net effective discount for the products listed on the Specialty Products List will <br />be at least AWP (-) minus 19.25% for Client (excluding limited distribution products). Within one <br />hundred eighty days (180) following the end of each contract year ESI will calculate the actual net <br />effective discount for the products listed on the Specialty Price List that were dispensed through the <br />mail order channel to determine if the guarantee has been met. If the actual overall net effective <br />discount is less than the guaranteed net effective discount ESI will reimburse Client the full dollar <br />amount of the difference between the actual and guaranteed net effective discounts. Client will retain <br />any amount that the actual net effective discount exceeds the guaranteed net effective discount. The <br />calculation for the actual net effective discount will be as follows: ((Total Ingredient Cost for the <br />products listed on the Specialty Price List) divided by (Total AWP for the products listed on the <br />Specialty Price List)) minus 1. This guarantee is contingent on Client's participation in the National <br />Preferred Formulary and an exclusive specialty arrangement. <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />10 <br />
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