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■ If elected, PBM's Manufacturer Assistance Program for Specialty Medications ("MAP"), consists <br />of 1 or 2 components when available, dependent on the specific plan design: (1) Accumulator Protection <br />using Manufacturer Copay assistance dollars to help lower member out-of-pocket costs and client costs <br />where funds are not applied to member deductible and member out-of-pocket maximum totals; and (2) <br />Accumulator Protection Plus Variable Cost -Share, where plan changes can maximize available <br />assistance funds to offset plan costs and cover the members' cost -share but does not apply to their <br />deductible and out-of-pocket maximum, yielding high savings potential, or Therapeutic Interchange <br />Programs where the specialty pharmacy will move members to preferred agents in order to allow the <br />usage of copay assistance funds from manufacturers. Requires exclusive specialty pharmacy <br />relationship. <br />o If elected, the SaveOnSP program is a benefit design change implemented by PBM in conjunction <br />with a third -party vendor, SaveOnSP. Within the SaveOnSP program, certain specialty medications <br />are classified as non-essential health benefits. This means that any funds spent on these drugs no <br />longer apply to the members' accumulators. In addition, the targeted drugs are assigned higher <br />copays. In all cases, SaveonSP helps the member coordinate manufacturer -sponsored copay <br />assistance. SaveOnSP targets drugs in six of the top ten specialty categories. <br />■ If elected, PBM's Advanced Opioid Managementsm program reaches out to physicians, pharmacists <br />and patients at key touchpoints to minimize early exposure to opioids and to prevent patients from <br />progressing to overuse and abuse. Patients will be required to start therapy with no more than a 7 -day <br />supply of short-acting medications (with certain exceptions). Member Education will start at the first <br />fill. Doctors will be notified at the point of care when specific signs of misuse and abuse are observed. <br />3. Pricing. The financial terms set forth are conditioned on such exclusive arrangement and all other specified <br />conditions set forth in Exhibit A of the Agreement. Client will pay to Administrator the amounts set forth <br />below, net of applicable Copayments. The application of brand and generic pricing below may be subject to <br />certain "dispensed as written" (DAW) protocols and Client defined plan design and coverage policies for <br />adjudication and Member Copayment purposes. Sales or excise tax or other governmental surcharge, if any, <br />will be the responsibility of Client. <br />Members will always pay based on the logic below: <br />Retail: Lowest of (i) the U&C price, (ii) Plan copayments/coinsurance, or (iii) discounted AWP (including <br />MAC price, when MAC pricing is applicable). <br />Mail Order: Lower of (i) Plan copayments/coinsurance or (ii) discounted AWP (including MAC price, when <br />MAC pricing is applicable). <br />3.1 Pricing. <br />(a) Ingredient Cost. Administrator will offer an average aggregate annual discount as reflected below on <br />Client utilization to be calculated as follows. The pricing below will be implemented as of the Addendum <br />Effective Date. The pricing below will be guaranteed upon the start of Client's next Renewal Term as <br />described in Article VI(A) of the Agreement. <br />[1 -(total discounted AWP ingredient cost (excluding dispensing fees and claims with <br />ancillary charges, and prior to application of Copayments) of applicable Prescription Drug <br />Claims for the annual period divided by total undiscounted AWP ingredient cost (both <br />amounts will be calculated as of the date of adjudication) for the annual period)]. <br />Notwithstanding anything herein to the contrary: (i) a Prescription Drug Claim that <br />processes at the Brand rates (Participating Pharmacy Reimbursement Rates) and (Mail <br />Pharmacy Reimbursement Rates), as indicated on the ingredient cost field of the <br />Prescription Drug Claim's data record, shall be reconciled as part of the Brand guarantee <br />below; and (ii) a Prescription Drug Claim that processes at the Generic rates (Participating <br />Pharmacy Reimbursement Rates) and (Mail Pharmacy Reimbursement Rates) above, as <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />7 <br />