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A TRUE COPY
<br />CERTIFICATION ON LAST PAGE
<br />RYAN L. BUTLER, CLERK
<br />"Covered Drug(s)" means those prescription drugs, supplies, Specialty Products and other items that are
<br />covered under the Plan, each as indicated on the Set -Up Forms.
<br />"Databases" means any and all databases in which all or any portion of the Service Data is stored.
<br />"De -identified Data" means de -identified or anonymized data derived by Administrator from the modification,
<br />arrangement, aggregation, reconfiguration, manipulation, compilation, processing, reformatting, and/or
<br />parsing of Client Data.
<br />"Dispensing Fee" means the amount payable by Client as a dispensing fee per prescription or authorized refill
<br />to a Member as set forth on Exhibit A to this Agreement.
<br />"Eli ig bility Files" means the list submitted by Client to Administrator in reasonably acceptable electronic
<br />format indicating persons eligible for drug benefit coverage services under the Plan.
<br />"ERISA" means the Employee Retirement Income Security Act of 1974, as amended, and the regulations
<br />promulgated thereunder.
<br />"ESI Mail Pharmacy" means a pharmacy owned or operated by ESI or one or more of its affiliates, other than
<br />an ESI Specialty Pharmacy, where prescriptions are filled and delivered to Members via mail delivery service.
<br />"ESI Specialty Pharmacy" means Accredo Health Group, Inc., Express Scripts Specialty Distribution
<br />Services, Inc., or another pharmacy or home health agency owned or operated by ESI or its affiliates that
<br />primarily dispenses Specialty Products. When the ESI Mail Pharmacy dispenses a Specialty Product, it shall
<br />be considered an ESI Specialty Pharmacy hereunder.
<br />"Exclusive or Limited Distribution Product" means a Specialty Product that is not generally available from
<br />most or all pharmacies but is restricted to select pharmacies as determined by a pharmaceutical manufacturer.
<br />"FDA" means the United States Food and Drug Administration.
<br />"Fees" means, with respect to Client, all the fees specified on the applicable Exhibit(s) attached hereto and all
<br />other amounts due by Client hereunder, which Client (or, if applicable, any Member) is required to pay
<br />pursuant to the terms and conditions of this Agreement. In the event ESI, Administrator and Client agree upon
<br />a modification of the Fees from time to time, Client shall be responsible for timely communicating such
<br />changes to Members and for obtaining the necessary consents, if any, required from Client and/or Members
<br />in order to implement the new pricing.
<br />"Formulary" means the list of FDA -approved prescription drugs and supplies developed by ESI's Pharmacy
<br />and Therapeutics Committee and/or customized by Client, and which is selected and/or adopted by Client.
<br />The drugs and supplies included on the Formulary will be modified by ESI from time to time as a result of
<br />factors, including, but not limited to, medical appropriateness, manufacturer Rebate arrangements, and patent
<br />expirations. Additions and/or deletions to the Formulary are hereby adopted by Client, subject to Client's
<br />discretion to elect not to implement any such addition or deletion through the Set -Up Form process, which
<br />such election shall be considered a Client change to the Formulary.
<br />"Generic Drug" means a prescription drug, whether identified by its chemical, proprietary, or non-proprietary
<br />name, that is therapeutically equivalent and interchangeable with drugs having an identical amount of the
<br />same active ingredient(s) and approved by the FDA, and which is identified as such in ESI's master drug file
<br />using indicators from First Databank (or other source nationally recognized in the prescription drug industry
<br />used by ESI for all clients) on the basis of a standard Brand/Generic Algorithm utilized by ESI for all of its
<br />clients, a copy of which may be made available for review by Client or its auditor upon request.
<br />"HIPAA" means the Health Insurance Portability and Accountability Act of 1996, as amended, and the
<br />regulations promulgated thereunder.
<br />NOT FOR DISTRIBUTION. THE INFORMATION CONTAINED HEREIN IS CONFIDENTIAL, PROPRIETARY
<br />AND CONSTITUTES TRADE SECRETS OF ESI AND RXBENEFITS
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