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Docusign Envelope ID: 921 F7A24-D5CE-4BCC-9F3C-5E7844661266 <br />Please note other optional services can be quoted upon request. <br />43 <br />This document is CONFIDENTIAL AND PROPRIETARY to RIGHTWAY Healthcare. Inc. and may not be reproduced, <br />transmitted, published, or disclosed to others without the prior written authorization of RIGHTWAY Healthcare, Inc. <br />Drug interchange <br />Included to Administrative Fee <br />Annual benefit summary (EOB) <br />53.00 plus postage <br />Clinical communications <br />RIGHTWAY directed included in Administrative Fee. <br />Customized is $3.00 per clinical communication letter plus <br />postage. <br />First Level Appeals <br />Included in Administrative Fee <br />Medical Necessity Reviews (at administrative <br />$600.00 per hour for preparation and participation in <br />or judicial level) <br />external appeals, plus reasonable travel expenses if <br />applicable <br />External appeals (reviewed by independent <br />Costs passed through from IRO to Client <br />review organization or IRO) <br />Creditable coverage determination <br />$2,000 per occurrence <br />Medicare Retiree Drug Subsidy Services <br />Medicare Part D RDS support <br />Annual base charge of $8,500, plus a monthly per Eligible <br />Person fee calculated based on Eligible Persons whom are <br />RDS Program participants and in accordance with the fol- <br />lowing tiered fee schedule: <br />• 1 to 100 total RDS Program participating Eligible Per- <br />son(s) — $1.25 <br />• 101 to 500 total RDS Program participating Eligible <br />Persons — $1.00 <br />Please note other optional services can be quoted upon request. <br />43 <br />This document is CONFIDENTIAL AND PROPRIETARY to RIGHTWAY Healthcare. Inc. and may not be reproduced, <br />transmitted, published, or disclosed to others without the prior written authorization of RIGHTWAY Healthcare, Inc. <br />