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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
Metadata
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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-61 E380BDAl 1 B <br />DocuSign Envelope ID: 151ECOCF-B55C-414F-9455-72004347A310 <br />(1/2023 Version) <br />4. Reservation of Rights. Administrator expressly reserves (and Client hereby confirms, acknowledges and <br />agrees to such reservation) the right to modify or amend financial provisions in this Agreement (including <br />without limitation this Client Application/Exhibit A) in the event of - <br />4.1 <br />f <br />4.1 A change in the scope of services to be performed by Administrator or PBM or the assumptions <br />upon which the financial provisions included in this Agreement are based (including PBM's pricing <br />provided to Administrator) and/or: (1) any new — or change in existing — state or federal law or <br />regulation, or the interpretation thereof, and/or; (2) any government imposed or industry wide <br />change that would impede Administrator's ability to provide the pricing described in this <br />Agreement, including without limitation any prohibition or restriction on the right of Administrator <br />or any third party's ability to receive rebates from PBM and/or pharmaceutical manufacturers. <br />4.2 Implementation or addition of a high deductible health plan/consumer-driven health plan option. <br />4.3 Implementation or addition of a 100% Member paid plan. <br />4.4 A change in the coverage of Medicare eligible Plan Participants, irrespective of the resulting change <br />in total number of Members. <br />4.5 A change to the methodology by which AWP is calculated or reported. <br />4.6 A change in PBM's PDL or the PBM Prescribing Guide or Administrator's alignment with such <br />PDL or PBM Prescribing Guide. In any event, Administrator will use its commercially reasonable <br />efforts to provide Client with 30 days' notice prior to addition or removal of a drug from the PDL <br />or PBM's Prescribing Guide. In the event safety concerns or regulatory action require PBM to <br />remove a drug sooner, Administrator shall notify Client of the removal of a drug from the PDL or <br />the Prescribing Guide within three (3) business days. <br />4.7 Termination of Administrator's contractual arrangement with PBM. <br />F. DEFINITIONS <br />Effective as of the Addendum Effective Date, the following definitions are either deleted and replaced with <br />the following or added to the Agreement, as applicable: <br />'Brand Drug" means a prescription drug identified as such in ESI's master drug file using indicators from <br />First Databank (or other source nationally recognized in the prescription drug industry used by ESI for all <br />clients) on the basis of a standard Brand/Generic Algorithm utilized by ESI for all of its clients, a copy of <br />which may be made available for review by Administrator, Client, or its Auditor upon request. <br />Notwithstanding the foregoing, certain prescription drug medications that are licensed and then currently <br />marketed as brand name drugs, where there exists at least one (1) competing prescription medication that is <br />a generic equivalent and interchangeable with the marketed brand name drug, may process as "Generic <br />Drugs" for Prescription Drug Claim adjudication and Member Copayment purposes. <br />G. 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 />20 <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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