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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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shown below. Upon ESI Specialty Pharmacy acquisition of limited distribution products, Members will obtain <br />prescriptions through ESI Specialty Pharmacy. <br />(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 <br />shall apply. Exceptions to the standard per diem and nursing rates are set forth in (ii), <br />below, which list may be updated from time to time by ESI. Pricing for home infusion <br />supplies and services provided at Participating Pharmacies (for example, limited <br />distribution products not then available through ESI Specialty Pharmacy or overrides) will <br />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 <br />Ingredient Cost <br />Dispensing Fee <br />Exclusive ESI Specialty <br />See Exclusive Specialty Product List <br />$0.00 <br />Pharmacy <br />Participating Pharmacy <br />Participating Pharmacy Specialty Product <br />$0.75 <br />Specialty Products <br />List <br />(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 <br />shall apply. Exceptions to the standard per diem and nursing rates are set forth in (ii), <br />below, which list may be updated from time to time by ESI. Pricing for home infusion <br />supplies and services provided at Participating Pharmacies (for example, limited <br />distribution products not then available through ESI Specialty Pharmacy or overrides) will <br />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 <br />AWP <br />Discount Per Diem <br />EPOPROSTENOL <br />1.0% $65/da <br />REMODULIN <br />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 terms specified in the <br />Agreement, including, but not limited to, the annual average ingredient cost discount guarantees, apply to Specialty <br />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 directly by ESI <br />Specialty Pharmacy instead of being processed through ESI and Administrator, Client agrees to timely pay ESI <br />Specialty Pharmacy for such claim pursuant to the rates above and within thirty (30) days of Client's, or its designee's, <br />receipt of such electronic or paper claim from ESI Specialty Pharmacy. ESI Specialty Pharmacy shall have 360 days <br />from the date of service to 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 be at least AWP (- <br />) minus 19.25% for Client (excluding limited distribution products). Within one hundred and eighty (180) days <br />following the end of each Contract Year, ESI will calculate the actual net effective discount for the products listed on <br />the Specialty Products List that were dispensed through the mail order channel to determine if the guarantee has been <br />met. If the actual overall net effective discount is less than the guaranteed net effective discount Administrator will <br />reimburse Client the full dollar amount of the difference between the actual and guaranteed net effective discounts. <br />
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