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2025-126
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2025-126
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Last modified
6/23/2025 10:28:09 AM
Creation date
6/23/2025 10:23:56 AM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
06/03/2025
Control Number
2025-126
Agenda Item Number
13.D.1.
Entity Name
RxBenefits, Inc.
Subject
Administrative Services Agreement for the administration of prescription drug benefits
Document Relationships
2025-125
(Agenda)
Path:
\Official Documents\2020's\2025
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A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />RYAN L. BUTLER, CLERK <br />Client acknowledges that it shall not be entitled to audit documents that Administrator is barred from <br />disclosing by applicable law or pursuant to an obligation of confidentiality to a third party or that are <br />not under the direction or control of Administrator. Administrator will make 100% of claims available <br />to Client or a mutually acceptable third party retained by Client to audit the processing contract. <br />Client further acknowledges that there shall be a blackout period for audits from November 1 — <br />February 1 each year. <br />Client acknowledges that government agencies, including without limitation federal and state <br />governmental payors, may seek eligibility or similar data from Administrator or PBM regarding <br />Members and may submit to Administrator or PBM claims for reimbursement for prescription drug <br />benefits provided to such government agencies (or their agents) to Members ("Government Claims"). <br />Client authorizes (a) Administrator and PBM to provide such data as requested by government <br />agencies, including without limitation federal and state governmental payors, and/or their authorized <br />agents and (b) Administrator and/or PBM to process such Goverment Claims. Client acknowledges <br />that Administrator may advance payment for Government Claims on behalf of Client during the Term <br />of this Agreement. Client shall reimburse Administrator, in accordance with Client's payment <br />obligations under this Agreement, for all amounts advanced by Administrator for payment of <br />Government Claims. Client acknowledges that Government Claims submitted by or on behalf of a <br />state Medicaid Agency or other governmental payor shall be paid by or on behalf of Client if <br />submitted within three (3) years from the original date of fill unless a longer period is required by <br />applicable law. In addition, Government Claims submitted by or on behalf of a state Medicaid agency <br />or other governmental payor may not be denied on the basis of the format of the Government Claim <br />or failure to present proper documentation at the point-of-sale. Client shall also reimburse <br />Administrator for any adjustments or reconciliations to previously processed Government Claims <br />that may be payable to government agencies in accordance with applicable laws and regulations. The <br />administrative fee for processing Government Claims shall be invoiced at the paper submitted claim <br />rate already agreed to by the Parties or as otherwise agreed upon in writing by Administrator and <br />Client. Administrator reserves the right to (a) terminate these services upon ninety (90) days prior <br />notice to Client, or (b) delegate these services to a third -party claims processor other than PBM. <br />Notwithstanding any provision of this Agreement to the contrary, Client acknowledges and agrees <br />that Client shall be solely responsible for processing and making payment of any Goverment Claims <br />applicable to Client and its Members received after the effective date of the termination or expiration <br />of this Agreement. <br />Confidential and Proprietary Information. <br />1. The term "Confidential Information" includes, but is not limited to, this Agreement or any <br />information of either Client or Administrator (including without limitation its designees) disclosed <br />or made available before the Effective Date, now or in the future (whether oral, written, electronic, <br />visual or fixed in any tangible medium of expression) relating to either Party's services, operations, <br />systems, programs, inventions, techniques, suppliers, customers and prospective customers, <br />contractors, costs and pricing data, trade secrets, know-how, processes, plans, designs and other <br />information of or relating to either Party's business. Confidential Information does not include <br />Protected Health Information, the use and disclosure of which is governed by Article IX (Licenses; <br />Intellectual Property) and Article XC (ERISA, COBRA & HIPAA Duties) (including Exhibit B of <br />this Agreement. Furthermore, the following categories of data shall not be considered Confidential <br />Information under this Agreement and shall not be subject to the confidentiality or non-use <br />obligations contained herein: Pharmacy ID, NDC, Drug Name, AHFS Class, Delivery Method <br />(mail/retail), Date of Service, Days' Supply and Metric Quantity. <br />2. Administrator and Client shall not disclose or make use of any Confidential Information except as <br />permitted under this Agreement without the prior written consent of the non -disclosing Party, which <br />consent may be conditioned upon the execution of a confidentiality agreement. Each Party may <br />disclose Confidential Information of the other Party only to its authorized Representatives who have <br />a need to know the Confidential Information in order to accomplish the purpose of this Agreement <br />and who (i) have been informed of the confidential and proprietary nature of the Confidential <br />17 <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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