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05/20/2025
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05/20/2025
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Last modified
6/19/2025 1:44:47 PM
Creation date
6/19/2025 12:18:07 PM
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Meetings
Meeting Type
BCC Regular Meeting
Document Type
Agenda Packet
Meeting Date
05/20/2025
Meeting Body
Board of County Commissioners
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"Agreement" means this Administrative Services Agreement between Administrator and Client, the Client <br />Application and all other exhibits, supplements, amendments, addenda and/or schedules to this Administrative <br />Services Agreement. <br />"Ancillary Supplies, Equipment, and Services" or "ASES" means ancillary supplies, equipment, and services <br />provided or coordinated by ESI Specialty Pharmacy in connection with ESI Specialty Pharmacy's dispensing <br />of Specialty Products. <br />"Average Wholesale Price" or "AWP" means the average wholesale price of a prescription drug as identified <br />by drug pricing services such as Medi -Span, the drug manufacturer or other source recognized in the retail <br />prescription drug industry (the "Pricing Source'). If the Pricing Source discontinues the reporting of AWP or <br />materially changes the manner in which AWP is calculated or reported, then ESI reserves the right to make <br />an equitable adjustment as necessary to maintain the parties' relative economics and the pricing intent of this <br />Agreement. <br />"Brand/Generic Algorithm 'or "BGA" means ESI's standard and proprietary brand/generic algorithm utilized <br />by ESI, a copy of which may be made available for review by Client upon request; ESI may require that Client <br />sign a non -disclosure with ESI in order to receive a copy of the BGA. The purposes of the algorithm are to <br />stabilize products "flipping" between brand and generic status and to reduce Client, Member and provider <br />confusion due to fluctuations in brand/generic status. Administrator or its Auditor may audit ESI's application <br />of its BGA to confirm that ESI is making brand and generic drug determinations consistent with such <br />algorithm. <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 a <br />generic equivalent and interchangeable with the marketed brand name drug, may process as "Generic Drugs" <br />for Prescription Drug Claim adjudication and Member Copayment purposes. <br />"Business Days" or "business days" means all days except Saturdays, Sundays, and federal holidays. All <br />references to "day(s)" are to calendar days unless "business day" is specified. <br />"Claims Cycle" means the frequency by which Prescription Drug Claims are billed. <br />"Claims Older than 180 Days" means Claims that have not been submitted to ESI within 180 days of the <br />service date of the claim. <br />"Client Data" means Raw Data received by Administrator from Client in connection with the Services. <br />"Contract Year" means the full twelve (12) month period commencing on the Effective Date and each full <br />consecutive twelve (12) month period thereafter that this Agreement remains in effect. <br />"Copayment" means that portion of the charge for each Covered Drug dispensed to the Member that is paid <br />by the Member (e.g., copayment, coinsurance and/or deductible). A Member's Copayment charged for a <br />Covered Drug will be the lesser of the applicable Copayment, AWP discount (e.g. MAC price for Generic <br />Drugs), or U&C. <br />"Cost Share" means the amount which a Member is required to pay for a prescription or authorized refill in <br />accordance with the Plan Design, which may be a deductible, a percentage of the prescription price, a fixed <br />amount and/or other charge or penalty. <br />2 <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS 73 <br />
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