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Docusign Envelope ID: 4C195600-904A41DA-A041-3005C422FD42 <br />DocuSign Envelope ID: 7CEFA800-59DE-49DA-8C5B-D8D841083547 <br />(1/2024 version) <br />Non -MAC Generics <br />Single Source Generics <br />Multi -Source Generics <br />Generics in their FDC -granted exclusivity period <br />Patent litigated claims <br />Generics with limited supply <br />Generic medications prescribed and/or dispensed in conjunction with a specialty medication <br />4. Ingredient Cost (including Member share) is defined as the lesser of the following: <br />AWP -Discount %; <br />MAC Price; or <br />Usual & Customary Price. <br />5. Discount will always be calculated using this formula (all Claims, including ZBDs): <br />(I- [Ingredient Cost] / [AWP Price]) x 100. <br />6. "Gross Cost" is defined as: [Ingredient Cost] + [Dispensing Fee] + [Sales Tax]. <br />7. ESI agrees to apply Client -specific guarantees to all pricing components: <br />Discounts <br />Rebates <br />Admin Fees <br />Dispensing Fees <br />8. During the Term, contract guarantees will not change unless one of the following items occurs which could <br />change the economics of the pricing arrangement and would need to be evaluated: (i) a change in assumption <br />or plan design; (ii) change in law; and/or (iii) change in pricing benchmarks. <br />9. There will be NO dispensing fee applied to Reversed/Rejected Claims. <br />CLAIMS ADJUDICATION <br />10. There will be no price floors for amount paid on any Prescription Drug Claims. <br />REBATES <br />11. Rebate revenue will not have any impact on discount guarantee reporting and/or true up. <br />12. Rebates will be paid for brand Prescription Drug Claims and at a flat minimum dollar -for -dollar guarantee <br />basis <br />13. Contract rebate guarantees are not subject to change as a result of known brand patent expirations. <br />14. The rebate guarantees are not subject to formulary percentage criteria. <br />DATA <br />15. Audit files will be supplied to Client and Client's consultant directly from the source system and should include <br />all Prescription Drug Claims processed including, but not limited to, paid, reversed and denied Prescription <br />Drug Claims. <br />16. ESI will provide the above-mentioned extract at no charge to Client. <br />22 <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />