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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 />ESI from sharing any such "bona fide service fees" earned by ESI, whether wholly or in part, with any ESI <br />client. <br />"Representatives" of a Party means such Party's directors, officers, managers, employees, agents and other <br />representatives. <br />"Service Data" means Client Data and De -identified Data <br />"Services" means the provision, maintenance, and support of the services set forth in this Agreement and the <br />Client Application, including the improvement, augmentation, and development of such services and <br />Administrator's other products and services, including through the use of artificial intelligence, generative <br />artificial intelligence and/or other automation technologies. <br />"Set -Up Forms" means any standard Administrator or PBM document or form, which when completed and <br />signed by or on behalf of Client (electronic communications from Client indicating Client's approval of a Set - <br />Up Form shall satisfy the foregoing), will describe the essential elements adopted by Client for its Plan. <br />"Single Source Products" means a prescription medication that is: (i) approved by the FDA under a generic <br />drug ANDA application and is licensed and then currently marketed by only one generic drug manufacturers <br />under separate ANDA applications; or (ii) subject to patent litigation. <br />"Specialty Product List" means the list of Specialty Products applicable (exclusive or open) to Client, <br />maintained and updated by ESI from time to time. The Specialty Product List is available to Client upon <br />request. <br />"Specialty Products" means those injectable and non -injectable drugs on the Specialty Product List. Specialty <br />Products, which may be administered by any route of administration, are typically used to treat chronic or <br />complex conditions, and typically have one or more of several key characteristics, including frequent dosing <br />adjustments and intensive clinical monitoring to decrease the potential for drug toxicity and increase the <br />probability for beneficial treatment outcomes, patient training and compliance assistance to facilitate <br />therapeutic goals, limited or exclusive product availability and distribution (if a drug is only available through <br />limited specialty pharmacy distribution it is always considered a Specialty Product), specialized product <br />handling, and/or administration requirements. <br />"Subrogation Claim" means subrogation claims submitted by any state or a person or entity acting on behalf <br />of a state under Medicaid or similar United States or state government health care programs, for which Client <br />is deemed to be the primary payor by operation of applicable federal or state laws. <br />"Term" shall mean the time period between the Effective Date and termination of this Agreement, including <br />the Initial Term, as extended by any Renewal Term (as such terms are defined in Article VI.A). <br />"Usual and Customary Price" or "U&C" means the retail price charged by a Participating Pharmacy for the <br />particular drug in a cash transaction on the date the drug is dispensed as reported to ESI by the Participating <br />Pharmacy. <br />ARTICLE II — ADMINISTRATIVE SERVICES PROVIDED <br />A. Administrator shall administer the prescription drug benefits provided by the Plan, subject to all of the terms <br />and conditions of this Agreement, as the same may be amended or supplemented from time to time. <br />B. Administrator shall provide such assistance as may reasonably be necessary to Client's personnel in <br />enrollment of eligible employees and former employees and dependents eligible under the Plan. Administrator <br />shall maintain up-to-date eligibility status records on all enrolled Members as submitted by Client for purposes <br />of appropriate adjudication of Prescription Drug Claims under the Plan. <br />6 <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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