2020-241A - Laserfiche WebLink

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F. The following pricing assumptions shall apply for purposes of this Agreement: 1. If Client decides to implement a mandatory generic, mandatory mail, step therapy or other program during the Tenn, ESI has agreed that proposed pricing terns other than rebate guarantees will remain unchanged. 2. ESI must agree to propose pricing based on its broad national retail network that includes all major national and regional pharmacy chains. 3. Pricing is not based upon the assumption that ESI will be the exclusive PBM. Client reserves the right to purchase specialty products from other sources. Client will have the option to select an open or exclusive specialty provider. Additionally, Administrator will work with Client as needed to re -direct specialty medications to a preferred provider. DISCOUNTS 4. The proposed "effective"eg neric discount and theeg neric discount guarantee calculation INCLUDES the following: • MAC Generics • Non -MAC Generics • Single Source Generics • Multi -Source Generics • Generics in their FDC -granted exclusivity period • Patent litigated claims • Generics with limited supply • Generic medications prescribed and/or dispensed in conjunction with a specialty medication 5. All Claims filled in Most Favored Nation states are INCLUDED in discount guarantees. 6. All Claims filled in Waal pharmacies are INCLUDED in discount guarantees. 7. Ingredient Cost (including Member share) is defined as the lesser of the following: • AWP -Discount %; • MAC Price; or • Usual & Customary Price. 8. Discount will always be calculated using this formula (all Claims, including ZBDs): (1- [Ingredient Cost] / [AWP Price]) x 100. 9. "Gross Cost" is defined as: [Ingredient Cost] + [Dispensing Fee] + [Sales Tax]. 10. ESI agrees to apply Client -specific guarantees to all pricing components: • Discounts • Rebates • Admin Fees • Dispensing Fees 11. During the Term, contract guarantees will not change unless one of the following items occurs which could change the economics of the pricing arrangement and would need to be evaluated: (i) a change in assumption or plan design; (ii) change in law; and/or (iii) change in pricing benchmarks. 12. There will be NO dispensing fee applied to Reversed/Rejected Claims. CLAIMS ADJUDICATION 13. There will be no price floors for amount paid on any Prescription Drug Claims. NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS 14