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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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lesser of MAC (as applicable), U&C or AWP discount adjudication methodology. <br />PARTICIPATING <br />BRAND <br />$0.65 dispensing <br />fee <br />GENERIC <br />' <br />$0.65 dis ensin = fee <br />I 1 <br />BRAND <br />$0.65 dispensing <br />fee <br />GENERIC <br />PHARMACYMAIL SERVICE <br />$0.65 dipensing <br />fee <br />BRAND <br />$0.00 dispensing <br />fee <br />GENERIC <br />$0.00 dis e sing <br />fee <br />Claims Excluded: OTC, compounds, U&C claims, Member Submitted Claims, Subrogation Claims, <br />Coordination of Benefit Claims, Exclusive and Limited Distribution Products/Claims, vaccines, Specialty <br />Products (other than specialty guarantee), biosimilar products (other than Specialty Product guarantee, if <br />applicable), long term care pharmacy claims and/or claims with ancillary charges and products filled through <br />in-house or 340b pharmacies (if applicable). <br />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 will <br />be increased to reflect such increase(s). Notwithstanding the foregoing, Administrator guarantees that Client <br />will only be responsible for up to a twenty percent increase over the carrier rates of the previous calendar year. <br />At Client's request, Administrator will reimburse Client for any payments made in excess of such twenty <br />percent increase in carrier rates. <br />Guarantees will be measured and reconciled on an annual basis. The guarantees are annual guarantees - if this <br />Agreement is terminated prior to the completion of the then current contract year (hereinafter, a "Partial <br />Contract Year"), then the guarantees will not apply for such Partial Contract Year. To the extent Client changes <br />its benefit design or Formulary during the Term of the Agreement, the guarantee will be equitably adjusted if <br />there is a material impact on the discount achieved. Subject to the remaining terms of this Agreement, <br />Administrator will pay the difference of Client's cost for any shortfall between the actual result and the <br />guaranteed result. For purposes of measurement of any pricing guarantee in this Agreement or Amendments <br />to this Agreement; over performance in any component will not be used to offset performance in any other <br />measured pricing 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 Drug <br />Claim is otherwise excluded above. The application of brand and generic pricing may be subject to certain <br />"dispensed as written" (DAW) protocols and Client or Plan defined plan design and coverage policies for <br />adjudication and Member Copayment purposes. If Medi -Span discontinues reporting Multi -Source Indicator <br />identifiers, Administrator reserves the right to make an equitable adjustment as necessary to maintain the <br />parties' relative economics and the pricing intent of this Agreement. Notwithstanding anything in this <br />Agreement to the contrary, any rebate guarantees set forth in this Agreement will be reconciled using ESI's <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY AND <br />CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />9 <br />
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