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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 />Contract Year. Furthermore, in the event Client terminates the Agreement outside the terns and conditions in <br />the Agreement, Client forfeits the right to receive any shortfall payments for financial guarantees. To the <br />extent Client changes its benefit design or Formulary during the Term of the Agreement, the guarantee will <br />be equitably adjusted if there is a material impact on the discount achieved. If Client changes to a different <br />pricing option during a contract year (for example, Rebate Reinvestment to Standard), Administrator will have <br />the right to offset the performance of the multiple partial year measurements against one another within the <br />same component during the annual reconciliation. Subject to the remaining terms of this Agreement, <br />Administrator will pay the difference of Client's cost for any shortfall between the actual result and the <br />guaranteed result. Shortfall payments for financial guarantees, if any, will not be paid until this Agreement, <br />including any applicable Client Application, and any amendment(s) or addenda to this Agreement or Client <br />Application, is signed. For purposes of measurement of any pricing guarantee in this Agreement or <br />Amendments to this Agreement, over performance in any component will not be used to offset performance <br />in any other measured pricing component. <br />Notwithstanding anything in this Agreement to the contrary, the Generic Drug guarantees set forth above will <br />include only those Prescription Drug Claims that processed to Client for payment where the underlying <br />prescription drug product was identified by Medi -Span as having a Multi -Source Indicator code identifier of <br />"Y" on the date dispensed (or was identified by Medi -Span as having a Multi -Source Indicator identifier of <br />an "M," "N," or "O" on the date dispensed, but was substituted and dispensed by the ESI Mail Pharmacy as <br />its "house generic"), unless such Prescription Drug Claim is otherwise excluded above. The Brand Drug <br />guarantees set forth above will include only those Prescription Drug Claims that processed to Client for <br />payment where the underlying prescription drug product was identified by Medi -Span as having a Multi - <br />Source Indicator code identifier of "M", "N", or "O" on the date dispensed (except in cases where the <br />underlying prescription drug product was substituted and dispensed by the ESI Mail Pharmacy as its "house <br />generic"), unless such Prescription Drug Claim is otherwise excluded above. The application of brand and <br />generic pricing may be subject to certain "dispensed as written" (DAV) protocols and Client or Plan defined <br />Plan Design and coverage policies for adjudication and Member Copayment purposes. If Medi -Span <br />discontinues reporting Multi -Source Indicator identifiers, Administrator reserves the right to make an <br />equitable adjustment as necessary to maintain the parties' relative economics and the pricing intent of this <br />Agreement. Notwithstanding anything in this Agreement to the contrary, any Rebate guarantees set forth in <br />this Agreement will be reconciled using the BGA. Any generic claim that is considered a Single Source <br />Product will be included in the generic reconciliation. <br />Any generic claim that is considered a Single Source Product will be included in the generic reconciliation. <br />(c) If Client elects PBM's Price Assure program, PBM will automatically integrate the GoodRx discount <br />card at the point of sale for certain non -specialty retail generic claims at in -network retail pharmacies <br />under contract to support the program. Client acknowledges and agrees that PBM may share <br />Client/Member information with GoodRx while providing these services. Member cost for <br />applicable generic claims will be either Client's current Member cost share or the GoodRx market <br />price. GoodRx's cost calculation methodology may not be audited. If not otherwise excluded, Price <br />Assure claims will be included in Client's existing ingredient cost and dispensing fee guarantees. <br />Notwithstanding anything in this Agreement to the contrary, Client understands and agrees that any <br />surplus value on retail generic claims within the Agreement will be applied towards meeting other <br />retail channel guarantees in the Agreement between Client and Administrator. Client acknowledges <br />and agrees that it is solely responsible for ensuring that its implementation of Price Assure complies <br />with any applicable federal and state law including, but not limited to, laws, regulations, rules, <br />ordinances and/or other guidance related to high deductible health plans (including but not limited to <br />IRC Section 223). PBM and Administrator reserve the right to terminate or modify Price Assure <br />without cause and upon notice. Client must notify PBM if they plan to terminate or modify Price <br />Assure enrollment with 60 days' written notice. Client acknowledges and agrees that additional terms <br />and conditions will apply to the Price Assure program which are available upon request. <br />3.2 Specialty Products <br />11 <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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