My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
2025-126
CBCC
>
Official Documents
>
2020's
>
2025
>
2025-126
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
6/23/2025 10:28:09 AM
Creation date
6/23/2025 10:23:56 AM
Metadata
Fields
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
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
49
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />RYAN L. BUTLER, CLERK <br />at the applicable ingredient cost and will be reconciled to the applicable guarantee as set forth herein. The <br />discounted ingredient cost will be the lesser of MAC (as applicable), U&C or the applicable AWP <br />discount. Prescription Drug Claims dispensed at ESI Mail Pharmacy will be adjudicated to Client at the <br />applicable ingredient cost and will be reconciled to the applicable guarantee as set forth herein. <br />3.1 Pricing. <br />(a) In¢sedient Cost. Administrator will offer an average aggregate annual discount as reflected below <br />on Client utilization to be calculated as follows. The pricing below will be implemented as of the <br />Addendum Effective Date. The pricing below will be guaranteed upon the start of Client's Initial <br />Term or Renewal Term (as described in the Agreement) that begins on or after the Addendum <br />Effective Date. <br />[1 -(total discounted AWP ingredient cost excluding dispensing fees and ancillary <br />charges, and prior to application of Copayments) of applicable Prescription Drug <br />Claims for the annual period divided by total undiscounted AWP ingredient cost (both <br />amounts will be calculated as of the date of adjudication) for the annual period)]. <br />Discounted ingredient cost will be the lesser of MAC (as applicable), U&C or AWP <br />discount. <br />The Prescription Drug Claims that may be excluded from the reconciliation of the pricing guarantees <br />are as identified in the "Prescription Drug Claims Excluded" paragraphs below in addition to <br />Prescription Drug Claims dispensed in Puerto Rico, Guam, Northern Mariana Islands, Virgin Islands, <br />Hawaii, Massachusetts, Alaska, West Virginia, and rural pharmacies. Furthermore, prices may vary <br />in certain states for reasons such as most favored nations laws, other state or local legal requirements, <br />geographic location, or other factors beyond the control of Administrator. In those situations, some <br />Claims may be exempt from reconciliation of the financial guarantees set forth herein. All Claims <br />may be aggregated for purposes of such rates. Additionally, under any retail pricing arrangement(s) <br />subject to NADAC pricing, Administrator will retrospectively invoice Client for the difference <br />between Client's contracted dispensing fee and any state mandated pharmacy dispensing fee resulting <br />from claims incurred in any state that mandates the use of NADAC or another pricing benchmarks <br />in pharmacy reimbursement. <br />PARTICIPATING <br />PHARMACY <br />BRAND <br />• <br />PPO <br />AWP – <br />19.85% <br />GENERIC <br />• <br />MAINTENANCE <br />BRAND <br />PPO <br />NETWORK—RETAIL <br />AWP – <br />'I DAYS SUPPLY)" <br />85.85% <br />• <br />PPO <br />AWP – <br />23.25% <br />GENERIC <br />• <br />MAIL SERVICE <br />BRAND <br />PPO <br />PHARMACY <br />AWP – <br />85.85% <br />• <br />PPO <br />AWP – <br />22.35% <br />GENERIC <br />• <br />PPO <br />AWP <br />– 92% <br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY <br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS <br />
The URL can be used to link to this page
Your browser does not support the video tag.