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2025-126D
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2025-126D
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Last modified
9/18/2025 10:43:54 AM
Creation date
9/8/2025 1:42:16 PM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
06/03/2025
Control Number
2025-126D
Agenda Item Number
13.D.1.
Entity Name
Rightway Healthcare, Inc.
Subject
Pharmacy Benefit Management Services Agreement
Document Relationships
2025-126
(Cover Page)
Path:
\Official Documents\2020's\2025
2025-126A
(Cover Page)
Path:
\Official Documents\2020's\2025
2025-126B
(Cover Page)
Path:
\Official Documents\2020's\2025
2025-126C
(Cover Page)
Path:
\Official Documents\2020's\2025
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Docusign Envelope ID: 921F7A24-D5CE-4BCC-9F3C-5E7844661266 <br />6.3 Prescription Drug Delivery. PBM shall not require an Eligible Person to receive a prescrip- <br />tion drug by mail order or delivery unless the prescription drug cannot be acquired at any retail Participating <br />Pharmacy in PBM's network for Eligible Person's plan. This provision does not prohibit PBM from oper- <br />ating mail order or delivery programs on an opt -in basis at Eligible Person's sole discretion, provided that <br />Eligible Person is not penalized through the imposition of any additional retail cost-sharing obligations or <br />a lower allowed -quantity limit for choosing not to select the mail order or delivery programs. Idaho Code <br />§ 41-349(1 l)(e)(ii). <br />6.4 In -Person Administration of Prescription Drugs. PBM shall not require an Eligible Person <br />to receive in-person drug administration services from an affiliated Participating Pharmacy or an affiliated <br />health care provider. Idaho Code § 41-349(11)(e)(iii). <br />6.5 Promotional Items and Incentives and Communications. PBM shall not offer or implement <br />pharmacy networks that require or provide a promotional item or incentive to an Eligible Person to use an <br />affiliated Participating Pharmacy or an affiliated health care provider for the in-person administration of <br />covered prescription drugs; or advertising, marketing, or promoting an affiliated Participating Pharmacy to <br />Eligible Persons. If PBM includes an affiliated Participating Pharmacy in communications to Eligible Per- <br />sons regarding Participating Pharmacies and prices, PBM must include information regarding nonaffiliated <br />Participating Pharmacies in such communications and all information must be accurate and of equal prom- <br />inence. This language does not prohibit PBM from entering into an agreement with an affiliated pharmacy <br />to provide pharmacist services to Eligible Persons. Idaho Code § 41-349(11)(e)(iv). <br />7. Conditional Network Participation. PBM shall not condition participation in one pharmacy net- <br />work on participation in any other pharmacy network or penalize a Participating Pharmacy for declining to <br />participate in a specific pharmacy network. Idaho Code § 41-349(1 l)(f). <br />8. Accreditation Standards for Participating Pharmacies. Except for specialty networks, PBM <br />shall not institute a network that requires a Participating Pharmacy to meet accreditation standards incon- <br />sistent with or more stringent than applicable federal and state requirements for licensure and operation as <br />a pharmacy in Idaho. Idaho Code § 41-349(11)(g). <br />8.1 Specialty Network. For participation in a specialty network, PBM shall not require a Par- <br />ticipating Pharmacy to meet requirements for participation beyond those necessary to demonstrate the phar- <br />macy's ability to dispense the drug in accordance with the United States Food and Drug Administration's <br />approved manufacturer labeling. Idaho Code § 41-349(11)(g). <br />9. Formulary. PBM or Insurer shall, at a minimum, upon revising the formulary or Covered Benefits <br />during a plan year, provide a 90 -day continuity -of -care period in which the modified or deleted Covered <br />Benefit continues to be provided at the same cost for Eligible Person for a period of 90 days. The 90 -day <br />continuity -of -care period commences upon notification to Eligible Person. This requirement does not apply <br />if the Covered Benefit is a prescription drug that (a) has been approved and made available over the counter <br />by the United States Food and Drug Administration and has entered the commercial market as such; (b) has <br />81 <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 />
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