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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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discharges ESI and Administrator from any Losses arising from a pharmaceutical company's (a) failure to <br />pay Rebates; (b) breach of an agreement related to Rebates; or (c) negligence or misconduct. Client <br />acknowledges that whether and to what extent pharmaceutical companies are willing to provide Rebates to <br />Client may depend upon a variety of factors, including the content of the PDL, the Plan's design features, <br />Client meeting criteria for Rebates, and the extent of participation in ESI's formulary management programs, <br />as well as ESI/Administrator receiving sufficient information regarding each Claim for submission to <br />pharmaceutical companies for Rebates. Client acknowledges and agrees that ESI may, but shall not be <br />required to, initiate any collection action to collect any Rebates from a pharmaceutical company. In the event <br />ESI does initiate collection action against a pharmaceutical company to collect Rebates, ESI may offset any <br />reasonable costs, including reasonable attorneys' fees and expenses, arising from any such action. <br />Notwithstanding any provision of this Agreement to the contrary, Administrator shall only be responsible for <br />payment of Rebates to Client pursuant to the terms of this Agreement if such Rebates are actually received <br />by Administrator during the Term of this Agreement. In no event shall Administrator be obligated to pay <br />Rebates to Client until Administrator receives payment for the same Rebates from ESI. In the event Client <br />terminates the Agreement outside the terms and conditions in the Agreement, Client forfeits the right to <br />receive any Rebates received by Administrator on Client's behalf after the date of such termination. Client <br />acknowledges that Administrator shall not be obligated to pay Client any Rebates described herein until this <br />Agreement is signed by Client. <br />5. Rebate amounts paid to Client pursuant to this Agreement are intended to be treated as "discounts" pursuant <br />to the federal anti -kickback statute set forth at 42 U.S.C. § 1320a -7b and implementing regulations. Client is <br />obligated if requested by the Secretary of the United States Department of Health and Human Services, or as <br />otherwise required by applicable law, to report the Rebate amounts and to provide a copy of this notice. ESI will <br />refrain from doing anything that would impede Client from meeting any such obligation. <br />E. ESI'S INFLATION PROTECTION PROGRAM <br />1. IP Pro¢ram. The Inflation Protection Program ("ESI IP Program"). Subject to the terms and conditions set <br />forth in Section 2 below, under the ESI IP Program Administrator will pay to Client $2.00 per Formulary Brand Drug <br />claim ("Client Inflation Payment"). Subject to the terms and conditions set forth herein, under the ESI IP Program, <br />Administrator will pay Client the Client Inflation Payment within approximately one hundred and eighty (180) days <br />following the end of each calendar quarter for utilization occurring during such calendar quarter. All non -Formulary <br />claims and Generic Drug claims shall be excluded. <br />2. Terms and Conditions of ESI's IP Program. <br />2.1 Exclusions. The following claims will be excluded from all calculations related to ESI's IP Program: <br />• Medicare claims, Medicaid claims and any other government health care program claims <br />• OTCs, member submitted claims, subrogation claims, compounds, Generic Drugs, claims submitted <br />by Client -owned, in-house, or on-site pharmacies, 340B claims, claims submitted through a 100% <br />Member cost -share program, biosimilars, drugs where the quantity or packaging has been changed <br />by the manufacturer from the prior year, and drugs for which there was no utilization in the calendar <br />year prior to the calendar year for which the Client Inflation Payment is being determined. <br />
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