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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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D. REBATES <br />Rebate Amounts. Subject to: (i) the conditions set forth in Sections 2 through 4 below and elsewhere in this <br />Agreement; and (ii) Client meeting the Plan Design conditions identified in the table below, the following <br />guaranteed amounts will be payable to Client during the Term of this Agreement: <br />REBATES PER BRAND Rx <br />FORMULARY: ESI NATIONAL PREFERRED <br />NATIONAL PLUS NETWORK <br />$180.00 per Brand claim <br />RETAIL MAINTENANCE NETWORK <br />84-90 DAYS' SUPPLY <br />$430.00 per Brand claim <br />HOME DELIVERY PRODUCTS <br />$529.00 per Brand claim <br />SPECIALTY PRODUCTS <br />$1,400.00 per Brand claim <br />The Extended Days' Supply pricing set forth in this Agreement shall be subject to certain requirements, <br />as follows. Extended Days' Supply shall mean; (1) for all lines of business other than Medicare or <br />EGWP, any supply of a covered drug of 84 days or greater; and (2) for Medicare or EGWP, if applicable, <br />any supply of a covered drug of 35 days or greater. Certain Participating Pharmacies have agreed to <br />participate in the extended (84 — 90) day supply network ("Maintenance Network") for maintenance <br />drugs. Rebate Amounts in the 84 — 90 Days' Supply column in the table set forth above are applicable <br />only if Client implements a plan design that requires Members to fill such days' supply at a Maintenance <br />Network Participating Pharmacy (i.e., Client must implement a plan design whereby Members who fill <br />extended days' supply prescriptions at a Participating Pharmacy other than a Maintenance Network <br />Participating Pharmacy do not receive benefit coverage under the Plan for such prescription). If no such <br />plan design is implemented, Rebate Amounts for such days' supply will be the same as for Prescription <br />Drug Claims for less than an 84 days' supply, and Rebate Amounts for an 84 — 90 days' supply in the <br />table set forth above shall not apply, even if a Maintenance Network Participating Pharmacy is used. <br />2. Exclusions. Member Submitted Claims, Subrogation Claims, Coordination of Benefit Claims, Exclusive and <br />Limited Distribution Products, biosimilar products, OTC products (except for insulin and diabetic supplies), <br />vaccines, claims older than 180 days, claims through Client -owned or 340b pharmacies, and claims pursuant <br />to a 100% Member Copayment plan are not eligible for the guaranteed Rebate amounts set forth in Section 1 <br />above. <br />3. Rebate Payment Terms <br />Subject to the conditions set forth herein, Administrator will receive from ESI the quarterly Rebate payments <br />within approximately one hundred eighty (180) days following calendar quarter adjudicated for Rebates <br />received during the prior calendar quarter. Administrator shall pay Client the guaranteed amounts set forth in <br />Section 1 above within approximately thirty (30) days following receipt of the Rebate payments from ESI. <br />4. Conditions <br />4.1. ESI contracts with pharmaceutical manufacturers for Rebates on its own behalf and for its own benefit, <br />and not on behalf of Client. Accordingly, ESI retains all right, title and interest to any and all actual <br />Rebates received from manufacturers. ESI will pay to Administrator (and Administrator shall pay to <br />Client) amounts equal to the Rebate amounts allocated to Client, as specified above, from ESI's <br />general assets (neither Client, its Members, nor Client's Plan retains any beneficial or proprietary <br />interest in ESI's general assets). Client acknowledges and agrees that neither it, its Members, nor its <br />Plan will have a right to interest on, or the time value of, any Rebate payments received by ESI during <br />the collection period or moneys payable under this Section. No amounts for Rebates will be paid until <br />this Agreement is executed by Client. ESI and Administrator will have the right to apply Client's <br />allocated Rebate amount to unpaid Fees. ESI will retain Manufacturer Administrative Fees on <br />Specialty Products. <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY AND <br />CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />13 <br />
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