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2021-109A
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2021-109A
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Last modified
11/17/2021 9:44:33 AM
Creation date
11/12/2021 3:36:05 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Addendum
Approved Date
08/17/2021
Control Number
2021-109A
Agenda Item Number
8.M.
Entity Name
RxBenefits, Inc.
Subject
Addendum to Administrative Services Agreement for RxBenefits and
Express Scripts effective January 1, 2021
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DocuSign Envelope ID: 5B185859-5943-4C41-90BF-OCE5E90FDADD <br />(0112021 Version) <br />Any claim that is considered a single source generic will be included in the generic reconciliation. <br />3.2 Suecialty Products <br />(a) Exclusive Care. ESI Specialty Pharmacy is the exclusive provider of Specialty Products for the <br />reimbursement rates shown on the Exclusive ESI Specialty Pharmacy Specialty Product List. Any <br />Specialty Product dispensed at a Participating Pharmacy (for example, limited distribution products <br />not then available through ESI Specialty Pharmacy or overrides) will be reimbursed at the standard <br />Participating Pharmacy Specialty Product rates shown below. Upon ESI Specialty Pharmacy <br />acquisition of limited distribution products, Members will obtain prescriptions through ESI <br />Specialty Pharmacy. <br />* Dispensing Fees are inclusive of shipping and handling. If carrier rates (i.e., U.S. mail and/or <br />applicable commercial courier services) increase during the Term of this Agreement, the <br />Dispensing Fee guarantees will be increased to reflect such increase(s). <br />(b) ASES. For Specialty Products needing an additional charge to cover costs of all ASES required to <br />administer the Specialty Products, Administrator, ESI or ESI Specialty Pharmacy will bill at the <br />following standard per diem and nursing fee rates set forth below, maintained and updated by ESI <br />from time to time. If ESI elects to bill Client's medical plan for ASES, Administrator will work with <br />ESI to coordinate the invoicing and payment of ASES through Client's medical plan. If Client's <br />medical plan will not cover the cost of ASES billed through ESI or ESI Specialty Pharmacy, Client <br />shall be responsible for the costs of all ASES. If a Specialty Product dispensed or ASES provided <br />by ESI Specialty Pharmacy is billed to Administrator or a Client directly by ESI Specialty Pharmacy <br />instead of being processed through ESI, Client will timely pay Administrator, and Administrator <br />will timely pay ESI Specialty Pharmacy for such claim pursuant to the rates below. ESI Specialty <br />Pharmacy shall have 360 days from the date of service to submit such electronic or paper claim. <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF EXPRESS SCRIPPS AND RXBENEFITS <br />
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