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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
Fields
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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C. SERVICES, FORMULARY. <br />1. Base Administrative Services: The following services are the base administrative services made available <br />to Client and its Members pursuant to the Agreement (including this Exhibit A (the "Base Administrative <br />Services'), as applicable: <br />• Administration of eligibility submitted via tape or telecommunication <br />• Eligibility maintenance <br />• Client support system for on-line access to current eligibility <br />• Administration of Client's Plan Design <br />• In -network claims adjudication via on-line claims adjudication system <br />• Designated Account Team <br />• Client clinical and plan consulting, analysis and cost projections <br />• Annual analysis of program utilization and impact of plan design and managed care interventions <br />• Welcome Package and ID Cards for new Members <br />• Standard Member communications <br />• Toll-free telephone access to customer service for the program for use by Members and Client's benefits <br />personnel and representatives <br />2. Additional Administrative Services: Client will pay for additional administrative services (the "Additional <br />Administrative Services") beyond those included in the Base Administrative Services that are requested by <br />Client and provided or made available by Administrator under the program as follows: <br />2.1 Administrative Fees <br />Administrative Services <br />Fees <br />Transaction Fees Payable for Administrative <br />$0.65 per Prescription Drug Claim made by <br />Services(per Article IV.B of the Agreement) <br />Members payable on a bi-monthlybasis <br />Transaction Fees Payable for Administrator's <br />$1.45 per claim <br />Clinical Advantage Program <br />individual prices listed in table below <br />Manufacturer Copay Assistance Programs <br />• Out of Pocket Protection (Accumulation) <br />• No Charge (Not Elected) <br />• Out of Pocket Protection + Variable Copay <br />• No Charge (Not Elected) <br />Assistance Program <br />• SaveOnSP <br />• $0.40 per claim (Not Elected) <br />• Out of Pocket Protection + SaveOnSP <br />• $0.40 per claim(Elected) <br />Reviews and Appeals Management <br />• Low Clinical Value Exclusions (LCV) <br />• $0.30 per claim (Elected) <br />• High Dollar Claim Review (HDCR) <br />• $0.75 per claim (Elected) <br />Initial Determinations (i.e. coverage reviews) and <br />No Charge <br />Level One Appeals for the Coverage Authorization <br />Program, consisting of: <br />Prior Authorization <br />Step Therapy <br />Drug Quantity Management <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />3 <br />
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