My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
2020-241A
CBCC
>
Official Documents
>
2020's
>
2020
>
2020-241A
Metadata
Thumbnails
Annotations
Entry Properties
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)
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
48
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
indicated on the ingredient cost field of the Prescription Drug Claim's data record, shall be <br />reconciled as part of the Generic guarantee below. The only Prescription Drug Claims that <br />shall be excluded from the reconciliation of the pricing guarantees are as identified in the <br />"Claims Excluded" column of the table below. All other Prescription Drug Claims shall <br />be included in the reconciliation of the guarantees. <br />Type of <br />Guarantee <br />Participating <br />Pharmacy <br />Retail <br />Maintenance <br />Network <br />(84-90 Days' <br />Supply) <br />Mail <br />Service <br />Pharmacy <br />Claims Excluded <br />OTC, compounds, U&C claims, Member <br />Submitted Claims, Subrogation Claims, <br />Coordination of Benefit Claims, Limited <br />Distribution Claims, vaccines, Specialty <br />AWP — <br />AWP— <br />AWP— <br />Products and/or claims with a high -dollar <br />Brand <br />18.25% <br />21.00% <br />25.00% <br />undiscounted AWP value, biosimilar <br />products, long term care pharmacy claims <br />and/or claims with ancillary charges and <br />products filled through in-house or 340b <br />pharmacies if applicable) <br />OTC, compounds, U&C claims, Member <br />Submitted Claims, Subrogation Claims, <br />Coordination of Benefit Claims, Limited <br />Distribution Claims, vaccines, Specialty <br />AWP— <br />AWP — <br />AWP — <br />Products and/or claims with a high -dollar <br />Generic <br />82.25% <br />82.25% <br />85.00% <br />undiscounted AWP value, biosimilar <br />products, long term care pharmacy claims <br />and/or claims with ancillary charges and <br />products filled through in-house or 340b <br />pharmacies if applicable) <br />[Remainder of this Page Intentionally Left Blank] <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />
The URL can be used to link to this page
Your browser does not support the video tag.