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04/12/2022 (2)
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04/12/2022 (2)
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Last modified
6/17/2022 10:28:51 AM
Creation date
6/17/2022 10:11:24 AM
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Meetings
Meeting Type
BCC Regular Meeting
Document Type
Agenda Packet
Meeting Date
04/12/2022
Meeting Body
Board of County Commissioners
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(b) DispensingFee. ESI will guarantee a maximum average aggregate annual per claim dispensing fee <br />on Client utilization to be calculated as follows: <br />[total dispensing fee of applicable claims for the annual period divided by total claims for the annual <br />period). <br />Type of <br />Guarantee <br />Participating <br />Pharmacy <br />Smart90 <br />Walgreens <br />Network" <br />extended (84-90) <br />days' supply <br />Mail <br />Service <br />Pharmacy <br />Claims Excluded <br />OTC, compounds, Member Submitted <br />Claims, Subrogation Claims, vaccines, <br />Specialty Products, biosimilar products, <br />long term care pharmacy claims and <br />Generic <br />products filled through in-house or 340b <br />Drug <br />$0.80 <br />$0.00 <br />$0.00 <br />pharmacies (if applicable), Devices; <br />Dispensing <br />Direct/Member Submitted Claims, Non- <br />Fee/Claim* <br />Traditional Providers <br />(MilitaryNeterans/Home <br />Infusion/LTC/TribaVIndian/Urban), <br />U&C Claims, Reversed/Rejected <br />Claims <br />OTC, compounds, Member Submitted <br />Claims, Subrogation Claims, vaccines, <br />Specialty Products, biosimilar products, <br />long term care pharmacy claims and <br />products filled through in-house or 340b <br />Brand <br />pharmacies (if applicable), Devices; <br />Dispensing <br />Dispen <br />Dispenaim* <br />$0.80 <br />$0.00 <br />$0.00 <br />Direct/Member Submitted Claims, Non - <br />Traditional Providers <br />(MilitaryNeterans/Home <br />Infusion/LTC/TribaVIndianNrban), <br />U&C Claims, Reversed/Rejected <br />Claims <br />* Dispensing Fees are inclusive of shipping and handling. If carrier rates (i.e., U.S. mail and/or applicable <br />commercial courier services) increase during the term of this Agreement, the Dispensing Fee guarantees will not <br />be increased to reflect such increase(s). <br />Guarantees will be measured and reconciled on an annual basis. To the extent Client changes its benefit design or <br />Formulary during the term of the Agreement, the guarantee will be equitably adjusted if there is a material impact on <br />the discount achieved. Subject to the remaining terms of this Agreement, ESI will pay the difference of Client's cost <br />for any shortfall between the actual result and the guaranteed result. For purposes of measurement of any pricing <br />guarantee in this Agreement or Amendments to this Agreement, over performance in any component will not be used <br />to offset performance in any other measured pricing component. <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />?4 84 <br />
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