2020-241A - Laserfiche WebLink

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Client will retain any amount that the actual net effective discount exceeds the guaranteed net effective discount. The calculation for the actual net effective discount will be as follows: ((Total Ingredient Cost for the products listed on the Specialty Products List) divided by (Total AWP for the products listed on the Specialty Products List)) minus 1. This guarantee is contingent on Client's participation in the National Preferred Formulary and an exclusive specialty arrangement. 3.3 Influenza and Other Vaccinations. Vaccinations shall adjudicate at the lower of: (a) * The Vaccine Program Fee will be billed separately to Client as part of the administrative invoice according to the billing frequency set forth in the Agreement. This Vaccine Program Fee will apply to any vaccine claims, whether at contracted rates or U&C, and is in addition to any per Prescription Drug Claim administrative fee set forth in the Agreement. OR (b) the combined ingredient cost, dispensing fee (if any) and professional service fee (if any) that the Participating Pharmacy generally charges an individual paying cash, without coverage for prescription drug benefits, plus the Vaccine Program Fee set forth above. Coverage is subject to Plan provisions. No vaccine claims will be included in any guarantees set forth in the Agreement and/or amendments thereto. D. REBATES 1. Rebate Amounts. Subject to: (i) the conditions set forth in Sections 2 through 4 below and elsewhere in this Agreement; and (ii) Client meeting the Plan Design conditions identified in the table below, the following guaranteed amounts will be payable to Client during the Term of this Agreement: Formulary: Participating Pharmacy Participating Pharmacy INFLUENZA OTHER VACCINES Ingredient Cost Participating Pharmacy Participating Pharmacy Ingredient Cost as set + Ingredient Cost as set forth m forth in the Agreement the Agreement Dispensing Fee Participating Pharmacy Participating Pharmacy Dispensing Fee as set + Dispensing Fee as set forth in forth in the Agreement the Agreement $157.00 per Professional Service Fee $460.00 per brand $1,150.00 per brand (PSF); cost for Pass -Through Pass -Through pharmacist to (capped at $15 per vaccine (capped at $20 per vaccine claim) administer the vaccine claim Vaccine Program Fee * $2.50 $2.50 per vaccine claim per vaccine claim * The Vaccine Program Fee will be billed separately to Client as part of the administrative invoice according to the billing frequency set forth in the Agreement. This Vaccine Program Fee will apply to any vaccine claims, whether at contracted rates or U&C, and is in addition to any per Prescription Drug Claim administrative fee set forth in the Agreement. OR (b) the combined ingredient cost, dispensing fee (if any) and professional service fee (if any) that the Participating Pharmacy generally charges an individual paying cash, without coverage for prescription drug benefits, plus the Vaccine Program Fee set forth above. Coverage is subject to Plan provisions. No vaccine claims will be included in any guarantees set forth in the Agreement and/or amendments thereto. D. REBATES 1. Rebate Amounts. Subject to: (i) the conditions set forth in Sections 2 through 4 below and elsewhere in this Agreement; and (ii) Client meeting the Plan Design conditions identified in the table below, the following guaranteed amounts will be payable to Client during the Term of this Agreement: Formulary: ESI National Preferred Retail Maintenance National Plus Network Home Delivery Specialty Products Network Products (84-90 Days' Supply) Rebates per Brand $157.00 per $375.00 per brand $460.00 per brand $1,150.00 per brand Rx brand claim claim claim. claim Certain Participating Pharmacies have agreed to participate in the extended (84 — 90) day supply network ("Maintenance Network") for maintenance drugs. Rebate Amounts in the 84 — 90 Days' Supply column in the table set forth above are applicable only if Client implements a plan design that requires Members to fill such days' supply at a Maintenance Network Participating Pharmacy (i.e., Client must implement a plan design