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Docusign Envelope ID: 4C195600 -904A-41 DA-A041-3005C422FD42 <br />DocuSign Envelope ID: 7CEFA800-59DE-49DA-8C5B-D8DB41083547 <br />(112024 Version) <br />(c) Medicare Part D Covered Vaccine Claims: Medicare Part D Vaccine Claims shall <br />adjudicate at the lower of U&C or the amounts shown in the table below. <br />D. REBATES <br />1. Rebate Amounts. Subject to the conditions set forth in the Agreement, PBM will pay an <br />amount equal to the greater of 100% of the Rebates and Manufacturer Administrative Fees <br />received by PBM, or subject to Client meeting the Plan design conditions identified in the <br />Agreement, the guaranteed amounts set forth in the chart below. PBM shall reconcile the <br />percentage amount set forth above and Client shall be credited for any deficit within 180 days <br />of the end of each Contract Year. If, upon reconciliation, the annual aggregate percentage <br />amount paid to Client for the Contract Year is greater than the guaranteed aggregate <br />amounts, Administrator shall be entitled to make up for, and offset, a shortfall in other Rebate <br />guarantee(s) set forth in this Agreement with such excess annual aggregate percentage <br />amount, and such excess amount shall be applied directly to the other shortfall guarantee(s). <br />BRANDREBATES PER D <br />1 <br />PARTICIPATING PHARMACIES <br />1-83 DAYS' SUPPLY <br />• PPO <br />$280.50 per Brand Drug claim <br />RETAIL MAINTENANCE <br />NETWORK (84-90 DAYS' <br />SUPPLY <br />• PPO <br />$739.50 per Brand Drug claim <br />MAIL SERVICE PHARMACY <br />PPO <br />$739.50 per Brand Drug claim <br />SPECIALTY PRODUCTS <br />PPO <br />$3,281.00 per Brand Drug claim <br />17 <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />