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2024-136
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2024-136
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Last modified
11/26/2024 2:04:55 PM
Creation date
7/11/2024 11:58:20 AM
Metadata
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Template:
Official Documents
Official Document Type
Addendum
Approved Date
06/18/2024
Control Number
2024-136
Agenda Item Number
12.C.1.
Entity Name
RxBenefits, Inc. (f/k/a Prescription Benefits, Inc.)
Subject
Addendum to Administrative Services Agreement for Group Insurance FY 24/25
Document Relationships
2024-137
(Cover Page)
Path:
\Official Documents\2020's\2024
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Docusign Envelope ID: 4C195600-904A41DA-A041-3005C422FD42 <br />DocuSign Envelope ID: 7CEFA800-59DE-49DA-8C5B-D8DB41083547 <br />(1/2024 Version) <br />limited to, laws, regulations, rules, ordinances and/or other guidance related to high <br />deductible health plans (including but not limited to IRC Section 223). PBM and <br />Administrator reserve the right to terminate or modify Price Assure without cause and upon <br />notice. Client must notify PBM if they plan to terminate or modify Price Assure enrollment <br />with 60 days' written notice. Client acknowledges and agrees that additional terms and <br />conditions will apply to the Price Assure program which are available upon request. <br />3.2 Specialty Products <br />(a) Exclusive Specialty. If Client elects exclusive specialty, then ESI Specialty Pharmacy is <br />the exclusive provider of Specialty Products for the reimbursement rates shown on the <br />Exclusive ESI Specialty Pharmacy Specialty Product List. Any Specialty Product <br />dispensed at a Participating Pharmacy (for example, Limited Distribution Products not then <br />available through ESI Specialty Pharmacy or overrides) will be reimbursed at the standard <br />Participating Pharmacy Specialty Product rates shown below. Upon ESI Specialty <br />Pharmacy acquisition of Exclusive or Limited Distribution Products, Members will obtain <br />prescriptions through ESI Specialty Pharmacy. <br />(b) Precision Specialty. In situations where regulations prevent implementation of Exclusive <br />Specialty arrangements, Client may implement a Precision Specialty arrangement where <br />the ESI Specialty Pharmacy or a Specialty Precision Network participating retail pharmacy <br />are the exclusive pharmacies that may fill Specialty Products for Members (other than <br />Exclusive or Limited Distribution Products not available at the ESI Specialty Pharmacy or <br />a Specialty Precision Network participating retail pharmacy). <br />(c) Dispensing Fee for Specialty Products. <br />* Dispensing Fees are inclusive of shipping and handling. If carrier rates (i.e., U.S. mail and/or <br />applicable commercial courier services) increase during the Term of this Agreement, the <br />Dispensing Fee guarantees will not be increased to reflect such increase(s). <br />(d) SPECIALTY NET EFFECTIVE DISCOUNT GUARANTEE Administrator <br />guarantees the overall annual net effective discount for the products listed on the Specialty <br />Products List (excluding Limited Distribution Products) pursuant to the table below. <br />Within one hundred and eighty (180) days following the end of each Contract Year, <br />Administrator will calculate the actual net effective discount for the products listed on the <br />Specialty Products List to determine if the guarantee has been met. Client will retain any <br />amount that the actual net effective discount exceeds the guaranteed net effective discount. <br />The calculation for the actual net effective discount will be as follows: ((Total Ingredient <br />Cost for the products listed on the Specialty Products List) divided by (Total AWP for the <br />products listed on the Specialty Products List)) minus 1. This guarantee is contingent on <br />Client's participation in the National Preferred Formulary or Basic Formulary and an <br />exclusive, precision, or open specialty arrangement, as applicable. For Exclusive Specialty <br />guarantees to be reconciled annually and any shortfalls paid, Client must be enrolled in the <br />Exclusive Specialty program for the entire Contract Year. <br />Average Annual Ingredient Cost Guarantee: AWP- 19% <br />Open Specialty Arrangements <br />14 <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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