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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: 58185859-5943-4C41-90BF-OC E5E90FDAD D <br />(01/2021 Version) <br />ESI/Administrator receiving sufficient information regarding each Claim for submission to <br />pharmaceutical companies for Rebates. Client acknowledges and agrees that ESI may, but shall not <br />be required to, initiate any collection action to collect any Rebates from a pharmaceutical company. <br />In the event ESI does initiate collection action against a pharmaceutical company to collect Rebates, <br />ESI may offset any reasonable costs, including reasonable attorneys' fees and expenses, arising from <br />any such action. Notwithstanding any provision of this Agreement to the contrary, Administrator <br />shall only be responsible for payment of Rebates to Client pursuant to the terms of this Agreement <br />if such Rebates are actually received by Administrator during the Term of this Agreement. In no <br />event shall Administrator be obligated to pay Rebates to Client until Administrator receives payment <br />for the same Rebates from ESI. In the event Client terminates the Agreement outside the terms and <br />conditions in the Agreement, Client forfeits the right to receive any Rebates received by <br />Administrator on Client's behalf after the date of such termination. Client acknowledges that <br />Administrator shall not be obligated to pay Client any Rebates described herein until this Agreement <br />is signed by Client. <br />5. Rebate amounts paid to Client pursuant to this Agreement are intended to be treated as "discounts" pursuant <br />to the federal anti -kickback statute set forth at 42 U.S.C. §1320a -7b and implementing regulations. Client is <br />obligated if requested by the Secretary of the United States Department of Health and Human Services, or as <br />otherwise required by applicable law, to report the Rebate amounts and to provide a copy of this notice. ESI <br />will refrain from doing anything that would impede Client from meeting any such obligation. <br />E. The following pricing assumptions shall apply for purposes of this Agreement: <br />1. If Client decides to implement a mandatory generic, mandatory mail, step therapy or other program during the <br />Term, ESI has agreed that proposed pricing terms other than rebate guarantees will remain unchanged. <br />2. ESI must agree to propose pricing based on its broad national retail network that includes all major national <br />and regional pharmacy chains. <br />DISCOUNTS <br />3. The proposed "effective"eg_neric discount and theeg neric discount guarantee calculation INCLUDES the <br />following: <br />MAC Generics <br />Non -MAC Generics <br />Single Source Generics <br />Multi -Source Generics <br />Generics in their FDC -granted exclusivity period <br />Patent litigated claims <br />Generics with limited supply <br />Generic medications prescribed and/or dispensed in conjunction with a specialty medication <br />4. All Claims filled in Most Favored Nation states are INCLUDED in discount guarantees. <br />5. All Claims filled in rural pharmacies are INCLUDED in discount guarantees. <br />6. Ingredient Cost (including Member share) is defined as the lesser of the following: <br />AWP -Discount %; <br />MAC Price; or <br />Usual & Customary Price. <br />7. Discount will always be calculated using this formula (all Claims, including ZBDs): <br />(1- [Ingredient Cost] / [AWP Price]) x 100. <br />8. "Gross Cost" is defined as: [Ingredient Cost] + [Dispensing Fee] + [Sales Tax]. <br />9. ESI agrees to apply Client -specific guarantees to all pricing components: <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF EXPRESS SCRIPTS AND RXBENEFITS <br />
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