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2020-241A
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2020-241A
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Last modified
3/5/2021 2:03:08 PM
Creation date
12/7/2020 1:21:53 PM
Metadata
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Template:
Official Documents
Official Document Type
Addendum
Approved Date
11/17/2020
Control Number
2020-241A
Agenda Item Number
8.H.
Entity Name
RxBenefits, Inc. f/k/a Prescription Benefits, Inc.
Subject
Addendum to administrative services agreement (originals w/ Suzanne Boyll)
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Type of <br />Guarantee <br />Participating <br />Pharmacy <br />Mail Service <br />Pharmacy / Retail <br />Maintenance <br />Network* <br />Claims Excluded <br />OTC, compounds, U&C claims, Member <br />Submitted Claims, Subrogation Claims, <br />Limited Distribution Claims, vaccines, <br />Generic Drug <br />Specialty Products and/or claims with a high - <br />Dispensing <br />$0.75 <br />$0.00 <br />dollar undiscounted AWP value, biosimilar <br />Fee/Claim <br />products, long term care pharmacy claims <br />and/or claims with ancillary charges and <br />products filled through in-house or 340b <br />pharmacies if applicable) <br />OTC, compounds, U&C claims, Member <br />Submitted Claims, Subrogation Claims, <br />Limited Distribution Claims, vaccines, <br />Brand <br />Specialty Products and/or claims with a high - <br />Dispensing <br />$0.75 <br />$0.00 <br />dollar undiscounted AWP value, biosimilar <br />Fee/Claim <br />products, long term care pharmacy claims <br />and/or claims with ancillary charges and <br />products filled through in-house or 340b <br />pharmacies if applicable) <br />s Dispensing Fees are inclusive of shipping and handling. If carrier rates (i.e., U.S. mail and/or applicable <br />commercial courier services) increase during the Term of this Agreement, the Dispensing Fee guarantees <br />will be increased to reflect such increase(s). <br />Guarantees will be measured and reconciled on an annual basis within 180 days of the end of each Contract <br />Year. To the extent Client changes its benefit design or Formulary during the Tenn of the Agreement, the <br />guarantee will be equitably adjusted if there is a material impact on the discount achieved. Subject to the <br />remaining terms of this Agreement, Administrator will pay the difference of Client's cost for any shortfall <br />between the actual result and the guaranteed result. Guarantees for pricing components are measured and <br />reconciled in the aggregate across all pricing components. Any dollar savings generated in excess of one <br />component may be used to offset a short fall for any other component. <br />Notwithstanding anything in this Agreement to the contrary, the Generic average annual ingredient cost <br />discount guarantees set forth above will include only those Prescription Drug Claims that processed to Client <br />for payment where the underlying prescription drug product was identified by Medi -Span as having a Multi - <br />Source Indicator code identifier of "Y" on the date dispensed (or was identified by Medi -Span as having a <br />Multi -Source Indicator identifier of an "M," "N," or "O" on the date dispensed, but was substituted and <br />dispensed by the Mail Service Pharmacy as its "house generic"), unless such Prescription Drug Claim is <br />otherwise excluded above. The Brand average annual ingredient discount guarantees set forth above will <br />include only those Prescription Drug Claims that processed to Client for payment where the underlying <br />prescription drug product was identified by Medi -Span as having a Multi -Source Indicator code identifier of <br />"M", "N', or "O" on the date dispensed (except in cases where the underlying prescription drug product was <br />substituted and dispensed by the Mail Service Pharmacy as its "house generic"), unless such Prescription <br />Drug Claim is otherwise excluded above. <br />Any claim that is considered a single source generic will be included in the generic reconciliation. <br />3.2 Specialty Products <br />(a) Exclusive Care. ESI Specialty Pharmacy is the exclusive provider of Specialty Products for the <br />reimbursement rates shown on the Exclusive ESI Specialty Pharmacy Specialty Product List. Any Specialty Product <br />dispensed at a Participating Pharmacy (for example, limited distribution products not then available through ESI <br />Specialty Pharmacy or overrides) will be reimbursed at the standard Participating Pharmacy Specialty Product rates <br />
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