2020-241A - Laserfiche WebLink

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3.1 Pricing. (a) Ingredient Cost. Administrator will offer an average aggregate annual discount as reflected below on Client utilization to be calculated as follows. The pricing below will be implemented as of the Addendum Effective Date. The pricing below will be guaranteed upon the start of Client's next Renewal Term as described in Article VI(A) of the Agreement. [1 -(total discounted AWP ingredient cost (excluding dispensing fees and claims with ancillary charges, and prior to application of Copayments) of applicable Prescription Drug Claims for the annual period divided by total undiscounted AWP ingredient cost (both amounts will be calculated as of the date of adjudication) for the annual period)]. Notwithstanding anything herein to the contrary: (i) a Prescription Drug Claim that processes at the Brand rates (Participating Pharmacy Reimbursement Rates) and (Mail Pharmacy Reimbursement Rates), as indicated on the ingredient cost field of the Prescription Drug Claim's data record, shall be reconciled as part of the Brand guarantee below; and (ii) a Prescription Drug Claim that processes at the Generic Drug rates (Participating Pharmacy Reimbursement Rates) and (Mail Pharmacy Reimbursement Rates) above, as indicated on the ingredient cost field of the Prescription Drug Claim's data record, shall be reconciled as part of the Generic Drug guarantee below. The only Prescription Drug Claims that may be excluded from the reconciliation of the pricing guarantees are as identified in the "Claims Excluded" column of the table below. All other Prescription Drug Claims may be included in the reconciliation of the guarantees. Type of Guarantee Participating Pharmacy Retail Maintenance Network (84-90 Days' supply) Mail Service Pharmacy Claims Excluded OTC, compounds, U&C claims, Member Submitted Claims, Subrogation Claims, Limited Distribution Claims, vaccines, Specialty Products and/or claims with a AWP — AWP — AWP — high -dollar undiscounted AWP value, Brand 18.25% 21.00% 25.00% biosimilar products, long term care pharmacy claims and/or claims with ancillary charges and products filled through in-house or 340b pharmacies (if applicable) OTC, compounds, U&C claims, Member Submitted Claims, Subrogation Claims, Limited Distribution Claims, vaccines, Specialty Products and/or claims with a AWP — AWP — AWP — high -dollar undiscounted AWP value, Generic 82.25% 82.25% 85.00% biosimilar products, long tern care pharmacy claims and/or claims with ancillary charges and products filled through in-house or 340b pharmacies (if applicable) (b) Dispensing Fee. ESI will guarantee a maximum average aggregate annual per claim dispensing fee on Client utilization to be calculated as follows: [total dispensing fee of applicable claims for the annual period divided by total claims for the annual period].