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Docusign Envelope ID: 4C195600 -904A-41 DA-A041-3005C422FD42
<br />DocuSign Envelope ID: 7CEFA800-59DE-49DA-8C5B-D8DB41083547
<br />(1/2024 Version)
<br />(') Specialty Rebates may be contingent upon following the ESI clinical days' supply. If client moves
<br />to a 30 day supply limit for specialty claims, Specialty Rebates may be impacted.
<br />tzl The Extended Days' Supply pricing set forth in this Agreement shall be subject to certain
<br />requirements, as follows. Extended Days' Supply shall mean; (1) for all lines of business other than
<br />Medicare or EGWP, any supply of a covered drug of 84 days or greater; and (2) for Medicare or EGWP,
<br />if applicable, any supply of a covered drug of 35 days or greater. Certain Participating Pharmacies have
<br />agreed to participate in the extended (84 — 90) day supply network ("Maintenance Network') for
<br />maintenance drugs. Rebate amounts in the 84 — 90 Days' Supply row in the table set forth above are
<br />applicable only if Client implements a Plan Design that requires Members to fill such days' supply at a
<br />Maintenance Network Participating Pharmacy (i.e., Client must implement a Plan Design whereby
<br />Members who fill extended days' supply prescriptions at a Participating Pharmacy other than a
<br />Maintenance Network Participating Pharmacy do not receive benefit coverage under the Plan for such
<br />prescription). If no such Plan Design is implemented, Rebate amounts for such days' supply will be the
<br />same as for Prescription Drug Claims for less than an 84 days' supply, and Rebate amounts for an 84 —
<br />90 days' supply in the table set forth above shall not apply, even if a Maintenance Network Participating
<br />Pharmacy is used.
<br />2. Exclusions For Non -Specialty Rebates: Specialty Products, Member Submitted Claims, Subrogation
<br />Claims, Exclusive and Limited Distribution Products, COVID test kits and antivirals, vaccines, OTC
<br />products (excluding insulin, diabetic strips, and test strips), claims older than 180 days, products filled
<br />through in house pharmacies, 340b Claims, COB claims, and claims pursuant to a 100% Member
<br />Copayment plan are not eligible for the guaranteed Rebate amounts set forth in Section D.1 above.
<br />Exclusions For Specialty Rebates: Member Submitted Claims, Subrogation Claims, Exclusive and
<br />Limited Distribution Products, COVID test kits and antivirals, vaccines, OTC products (excluding
<br />insulin, diabetic strips, and test strips), claims older than 180 days, products filled through in house
<br />pharmacies, 340b Claims, COB claims, and claims pursuant to a 100% Member Copayment plan are not
<br />eligible for the guaranteed Rebate amounts set forth in Section D.1 above.
<br />3. Rebate Payment Terms. Subject to the conditions set forth herein, Administrator will receive from
<br />ESI the quarterly Rebate payments within approximately one hundred twenty (120) days following the
<br />end of a calendar quarter for Rebates received during the prior calendar quarter. Upon receipt,
<br />Administrator will credit Client's account. For Prescription Drug Claims dispensed through in-house
<br />pharmacies, if applicable, Rebate payments shall only be paid if ESI is billing pharmaceutical
<br />manufacturers on behalf of the in-house pharmacies.
<br />4. Conditions
<br />4.1. PBM contracts with pharmaceutical manufacturers for Rebates on its own behalf and for
<br />its own benefit, and not on behalf of Client. Accordingly, PBM retains all right, title and
<br />interest to any and all actual Rebates received from manufacturers. PBM will pay to
<br />Administrator (and Administrator shall pay to Client) amounts equal to the Rebate amounts
<br />allocated to Client, as specified above, from PBM's general assets (neither Client, its
<br />Members, nor Client's Plan retains any beneficial or proprietary interest in PBM's general
<br />assets). Client acknowledges and agrees that neither it, its Members, nor its Plan will have
<br />a right to interest on, or the time value of, any Rebate payments received by PBM during
<br />the collection period or moneys payable under this Section. No amounts for Rebates will
<br />be paid until this Agreement, including any applicable Client Application, is executed by
<br />Client. PBM and Administrator will have the right to apply Client's allocated Rebate
<br />amount to unpaid Fees. PBM will retain Manufacturer Administrative Fees on Specialty
<br />Products.
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<br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY
<br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFM
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