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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 />