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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 />(defined herein), and the New Rebate (defined herein), for the drugs impacted by the American <br />Rescue Plan Act of 2021, during each calendar quarter. Impacted drugs are drugs that have a material <br />reduction in price or negotiated rebate due to removal of the Average Manufacturer Price cap under <br />the American Rescue Plan Act of 2021. "Inflationary Factor" is defined as the average year -over - <br />year price increase of the applicable category for the impacted drug. "Anchor Date Rebate" is defined <br />as the Rebate for an impacted drug within the 30 -day period preceding the change in price of such <br />drug. "New Rebate" is defined as the Rebate for an impacted drug within the 30 -day period following <br />the change in price of the impacted drug. <br />4.6 Client's quarterly rebate guarantee payments may be reduced by the Rebate Credit for low list price <br />biosimilars for the remainder of the term of the Agreement. "Rebate Credit" means the aggregate <br />difference between (i) the Rebate applied to the reference or standard list price biosimilar product <br />and (ii) the Rebate applied to the low list price biosimilar product. The difference between the <br />ingredient cost of a reference product or the standard list price biosimilar product and the low list <br />price biosimilar product will be greater than the difference between the Rebate of such reference <br />product or the standard list price biosimilar product and the low list price biosimilar product. <br />4.7 Rebate Acknowledgment; No Representation; Rebate Limitations. Client acknowledges that <br />Administrator is not making any representation, warranty or guarantee of any kind or nature, either <br />express, implied or otherwise, regarding the amount of Rebates to be paid or remitted to Client <br />pursuant to this Agreement, except as specifically set forth in writing herein. In addition, Client <br />waives, releases and forever discharges PBM and Administrator from any Losses arising from a <br />pharmaceutical company's (a) failure to pay Rebates; (b) breach of an agreement related to Rebates; <br />or (c) negligence or misconduct affecting Rebates. Client acknowledges that whether and to what <br />extent pharmaceutical companies are willing to provide Rebates to Client may depend upon a variety <br />of factors, including the content of the PDL, the Plan Design, Client meeting criteria for Rebates, and <br />the extent of participation in PBM's formulary management programs, as well as PBM/Administrator <br />receiving sufficient information regarding each Claim for submission to pharmaceutical companies <br />for Rebates. Client acknowledges and agrees that PBM may, but shall not be required to, initiate any <br />collection action to collect any Rebates from a pharmaceutical company. In the event PBM does <br />initiate collection action against a pharmaceutical company to collect Rebates, PBM may offset any <br />reasonable costs, including reasonable attorneys' fees and expenses, arising from any such action. <br />Notwithstanding any provision of this Agreement to the contrary, Administrator shall only be <br />responsible for payment of Rebates to Client pursuant to the terms of this Agreement if such Rebates <br />are actually received by Administrator during the Term of this Agreement. In no event shall <br />Administrator be obligated to pay Rebates to Client until Administrator receives payment for the <br />same Rebates from PBM. In the event Client terminates the Agreement outside the terms and <br />conditions in the Agreement, Client forfeits the right to receive any Rebates received by <br />Administrator on Client's behalf after the date of such termination. Client acknowledges that <br />Administrator shall not be obligated to pay Client any Rebates described herein until this Agreement, <br />including any applicable Client Application, and any amendment(s) or addenda to this Agreement or <br />Client Application, is signed by Client. PBM and Administrator reserve the right to apply Client's <br />allocated Rebate amount to unpaid Fees. <br />5. Rebate amounts paid to Client pursuant to this Agreement are intended to be treated as "discounts" pursuant <br />to the federal anti -kickback statute set forth at 42 U.S.C. § 1320a -7b and implementing regulations. Client is <br />obligated if requested by the Secretary of the United States Department of Health and Human Services, or as <br />otherwise required by applicable law, to report the Rebate amounts and to provide a copy of this notice. PBM <br />will refrain from doing anything that would impede Client from meeting any such obligation. <br />6. Notwithstanding anything in the Agreement to the contrary, in the event PBM does not receive a manufacturer <br />payment for a particular Brand Drug claim due to its identification by a pharmaceutical manufacturer as being <br />a 340B eligible claim (even where such claim may not meet the definition of a "340B Claim"), ESI may reduce <br />a subsequent Rebate quarterly payment (or reconciliation payment, if applicable) to account for any <br />previously -paid Rebate amounts attributable to such claim up to one year after the Claims date of service. <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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