02/07/2023 - Laserfiche WebLink

Home Browse Search

.. .. ...... "measis,a paper claim submitted by a;Memlw for Cctyeroli,-Drugs dispense(fwe 'UWtMW etssh" means the actual inglreaTient cost and Aspewing fee amount paid by t" t i t 1 tem when the Claim is adjudicated 6tt the ft.ficipeft Pharmatc#s as sm . in to Veaft. . Participating Pharmacy remittances related to t Mat's *dins. "PDL" means tltE P$ Pa%rmance bft List, ghi+e:h 4s u liBtd pharmaceutical products, created and maintained by PBM, as amended from tittle to time, which--#,o ba been approved by PBM's pharmacy and therapeutics committee; attd ( 000 w10 v* h=pharmaceutarOAl.p6p ticts should be given favorable considetadlot► bit Ob*their parUca articip"g Prharnmcv" rnvatts. any i ar Vbarnmcy with whicbM w aa'tpag Mebo s til fates has executed an agreement to pilot £b ,-to Members but lace fpclude any mail order or specialty pharmacy affiliated with any such 'l�ticipating Pharmacy: Pa"Wpating Pharmacies are independent contractors .a '=. "means the self-funded prescrip* M dft b06WW#) administered and/or sponsored by ctieftt. *"Pl. en Adm'mt "stratoe' means the Plan sponsor or committee designated by the Plan sponsor with respect to the Plan, as contemplated by Section 3 (16)(A) of ERISA. 1,TJW Desien" means drug coverage, days' supply linii eflotx, C69 $hare; irormulay(fa ludilfg Pormuh ry C divg,sattection and relative cost indication) and other PrescriptionV"OProgram specifications applicable to j thaftecription Drug Program designated for Client as set forth.;' 06r Agreement orotherwise documented between the Parties. "PMPM" mom per Member per month fee, if applicable, as determined by Administrator from tliR: EIigibility Flies. I "Prescription Dru Claim" means a Member Submitte$ p g ftikk SaWogolift inn or claim for payment i submitted to ESI by a Participating PharniW, Mail Service Pharmaey;uril $pW_Wty Pharmacy as a result of dispensing Covered Drugs to a Member.: 12m.w iption Drue Program" means the specific pharmacy benefit management services and benefit design sdopW by, and applicable to, Client under this Agreement. "Primary Member" means each Member, excluding Members who are qualified dependents. "Protected Health Information" or "PHI" shall have the meaning given such term y. 11M but l mi * that information created or received by PBM. ' capacity ty $ s} Gontractot#*dminstritor dtit Administrator in its Cap&* as a business assoO68*116 the Plan. "Rebates' mean retrospective fort�r rebates that are paid to ESI pursuant to the terms of a formulary rebase conttaot negotiated indjriy ESI with a pharmaceutical manufacturer and directly attributable to the utiii2ation ofcertain CoveredHrugs by Members. Rebates do not include Manufacturer Administrative Fees; product �t dloda*..or fear related to the procurement of prescription drug inventories, ESI Specialty Pharmacy ,-fees received by ESI from pharmaceutical manufacturers for care Pharma ala' � Mail Service P managementor other services provided Ifivonnection with the dispensing ofproducts; or other flee-for-service arrangementswhereby pharmaceutical manufacturers generally report the fees paid to ESI or its affiliates for services rendered as "bola fide service fees"` pursuant to federal laws and regulations (collectively, ' Other Pbffi= Revenue"). Such laws and regulations, as well as ESIts< contracts with pharmaceutical nuingfOott rers,.generally prohibit ESI from sharing any such "bona fide sawke fees" earned by ESI, whether wh4y`or in part, with any ESI client. ESI represents and warrants that it W1 not enter into any ag pmt t i %fts pharmaceutical manufacturer for Oth r Pharma Revenue with the i ttmtt tat to uce Rebaipt:: Vtowangntt tON' lil�i 3" } IEIS tWREIN IS CONFIDE Q TW. MTRAI NVC -T F ESI AND RXBENEFITS 79