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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
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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: 513185859-5943-4C41-90BF-OCE5E90FDADD <br />(01/2021 Version) <br />Discounts <br />Rebates <br />Admin Fees <br />Dispensing Fees <br />10. During the Term, contract guarantees will not change unless one of the following items occurs which could <br />change the economics of the pricing arrangement and would need to be evaluated: (i) a change in assumption <br />or plan design; (ii) change in law; and/or (iii) change in pricing benchmarks. <br />11. There will be NO dispensing fee applied to Reversed/Rejected Claims. <br />CLAIMS ADJUDICATION <br />12. There will be no price floors for amount paid on any Prescription Drug Claims. <br />REBATES <br />13. Rebate revenue will not have any impact on discount guarantee reporting and/or true up. <br />14. Rebates will be paid for brand Prescription Drug Claims and at a flat minimum dollar -for -dollar guarantee <br />basis <br />15. Contract rebate guarantees are not subject to change as a result of known brand patent expirations. <br />16. The rebate guarantees are not subject to formulary percentage criteria. <br />DATA <br />17. Audit files will be supplied to Client and Client's consultant directly from the source system and should include <br />all Prescription Drug Claims processed including, but not limited to, paid, reversed and denied Prescription <br />Drug Claims. <br />18. ESI will provide the above-mentioned extract at no charge to Client. <br />19. At no charge, ESI must be able to transfer data to Client's other vendor partners (e.g., medical plan <br />administrator, stop loss vendor, disease management vendor, catastrophic claimant advocate, etc.), with an <br />appropriate non -disclosure agreement in place. <br />20. ESI can provide the fully identified NCPDP expanded format to Client's consultant on a monthly basis at no <br />additional charge for use by both the InfoLock team and the Pharmacy Analytics Team. <br />21. InfoLock Data feeds that are in place will be honored even after termination at no cost to Client or Client's <br />consultant. In other words, if the Agreement is not renewed following the Term, InfoUck must still receive <br />the 4th quarter data even though it will not be available until after termination of this Agreement. <br />AUDITS <br />22. Third Party Audits- Client may employ a third -party auditor, at Client's sole cost and expense, to conduct <br />audits of the terms of this Exhibit A. including, but not limited to: <br />Pharmacy Claims transactions <br />Financial performance guarantees <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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