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2023-140
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2023-140
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Last modified
8/4/2023 12:08:17 PM
Creation date
8/4/2023 12:06:37 PM
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
07/11/2023
Control Number
2023-140
Agenda Item Number
8.T.
Entity Name
RxBenefits. Inc. f/k/a Prescription Benefits, Inc
Subject
Addendum to Administrative Service Agreement reflecting improved pricing
and updates effective January1, 2023
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DocuSign Envelope ID: 5332467E-CBEF-4C5D-8BOE-61E38OBDA11B <br />DocuSign Envelope ID: 151ECOCF-B55C-414F-9455-72004347A310 <br />(1/2023 Version) <br />to be eligible for the Protect ROI Guarantee. If this Agreement is terminated prior to <br />the end of a given Contract Year or if the Agreement is terminated in breach of the <br />terms of the Agreement (e.g., insufficient notice of non -renewal is given), then <br />Administrator is not required to meet the Protect ROI Guarantee set forth above. No <br />Protect Guarantee Payment will be paid (a) until this Agreement (including any <br />applicable Client Application) is executed by Client, or (b) if the Administrative <br />Services Agreement has been terminated as of the date that such Protect Guarantee <br />Payment is to be paid to Client. <br />o If Client has not paid any outstanding invoice(s) when payment of the Protect <br />Guarantee Payment, if any, is to be made, such outstanding amounts (including any <br />applicable interest, service charge, or other outstanding amount) may be deducted <br />from the Protect Guarantee Payment. <br />o In the event Administrator fails to meet the Protect ROI Guarantee, the Protect <br />Guarantee Payment described above will be the sole and exclusive remedy available <br />to Client for such failure. <br />2.4 PBM Clinical Programs <br />If elected, PBM's Manufacturer Assistance Program for Specialty Medications ("MAP"), consists of <br />I or 2 components when available, dependent on the specific Plan Design: (l) Accumulator Protection <br />using Manufacturer Copay assistance dollars to help lower Member out-of-pocket costs and Client costs <br />where funds are not applied to Member deductible and member out-of-pocket maximum totals; and (2) <br />Accumulator Protection Plus Variable Cost -Share, where plan changes can maximize available <br />assistance funds to offset Plan costs and cover the Members' Cost Share but does not apply to their <br />deductible and out-of-pocket maximum, yielding high savings potential, or Therapeutic Interchange <br />Programs where the specialty pharmacy will move Members to preferred agents in order to allow the <br />usage of copay assistance funds from manufacturers. Requires exclusive or precision specialty pharmacy <br />relationship. <br />■ If elected, the SaveOnSP program is a benefit design change implemented by PBM in conjunction with <br />a third -party vendor, SaveOnSP. Within the SaveOnSP program, certain specialty medications are <br />classified as non-essential health benefits. In addition, the targeted drugs are assigned higher copays. In <br />all cases, SaveonSP helps the Member coordinate manufacturer -sponsored copay assistance. SaveOnSP <br />targets drugs in six of the top ten specialty categories. SaveOnSP is also available as "SaveOnSP <br />Advantage" for high deductible health plans. <br />■ If elected, PBM's Advanced Opioid ManagementsM program reaches out to physicians, pharmacists <br />and patients at key touchpoints to minimize early exposure to opioids and to prevent patients from <br />progressing to overuse and abuse. Patients will be required to start therapy with no more than a 7 -day <br />supply of short-acting medications (with certain exceptions). Member Education will start at the first <br />fill. Prescribers will be notified at the point of care when specific signs of misuse and abuse are observed. <br />3. Pricing Terms. The financial terms herein are conditioned on an exclusive arrangement and all other <br />specified conditions set forth in this Exhibit A. Client will pay to Administrator the amounts set forth below, <br />net of applicable Copayments. The application of Brand Drug and Generic Drug pricing below may be <br />subject to certain "dispensed as written" (DAW) protocols and Client defined Plan Design and coverage <br />policies for adjudication and Member Copayment purposes. Sales or excise tax or other governmental <br />surcharge, if any, will be the responsibility of Client. <br />Members will always pay based on the logic below: <br />■ Retail: Lowest of (i) the U&C price, (ii) Plan copayments/coinsurance, or (iii) discounted AWP <br />(including MAC price, when MAC pricing is applicable). <br />10 <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />
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