Addendum to the Administrative Services Agreement with RxBenefits, Inc. Copyrighted
August 19, 2019
City of Dubuque Consent Items # 10.
ITEM TITLE: Addendum to theAdministrative ServicesAgreement
between the Cityof Dubuque and RxBenefits, Inc.
SUMMARY: City Manager recommending approval of an addendum to
the Administrative Services Agreement between the City of
Dubuque and RxBenefits, Inc. that establishes the
prescription drug plan rebates and discounts effective
January 1, 2019.
SUGGESTED DISPOSITION: Suggested Disposition: Receiveand File;Approve
ATTACHMENTS:
Description Type
RxBenefitsAdministrativeServicesAgreement-MVM CityManagerMemo
Memo
Staff Memo Staff Memo
Addendum Supporting Documentation
ExhibitA- ClientApplication Supporting Documentation
Insurance Schedule J Supporting Documentation
Administrati� ServicesAgreement Supporting Documentation
Dubuque
THE CITY OF �
uI�AaMca cih
DuB E � �
I � � I
Maste iece on the Mississi i Zoo�•zoiz•zois
YP pp zoi�*zoi9
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Addendum to the Administrative Services Agreement between the City of
Dubuque and RxBenefits, Inc.
DATE: August 12, 2019
Human Resources Director Randy Peck recommends City Council approval of an
addendum to the Administrative Services Agreement between the City of Dubuque and
RxBenefits, Inc. that establishes the prescription drug plan rebates and discounts
effective January 1, 2019. The estimated annual savings is $72,000 compared to the
2018 discounts and rebates.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
v
Mic ael C. Van Milligen
MCVM:jh
Attachment
cc: Crenna Brumwell, City Attorney
Teri Goodmann, Assistant City Manager
Cori Burbach, Assistant City Manager
Randy Peck, Human Resources Director
Jennifer Larson, Finance and Budget Director
��bu ue I'I
q
THE CITY OF I
AII�Amsrica City
Wt'XNAI.QYF„LIiKAIL
\ ��I
, 2oo�*zozz*zo�3 �
MasteYpiece on the Mississippi zo�.�#�oa.s
TO: Michael C. Van Milligen, City Manager
FROM: Randy Peck, Human Resources Director �
SUBJECT: Addendum to the Administrative Services Agreement between the City of
Dubuque and RxBenefits, Inc.
DATE: July 30, 2019
I have aiiached an addendum io ihe Adr�i�istrative Services Agre�menf between the
City and RxBenefits, Inc. that establishes the prescription drug plan rebates and
discounts effective January 1, 2019. The estimated annual savings is $72,000 i
compared to the 2018 discounts and rebates. The addendum has been reviewed by
Senior Counsel Barry Lindahl and Lane DeVore, Associate Analyst for Cottingham and
Butler. �
�
I request that the City Council approve a mofiion authorizing you to sign the addendum. �
RP/alk
ADDENDUM TO ADMINISTRATIVE SERVICES AGREEMENT
THIS ADDENDUM TO ADMINISTRATIVE SERVICES AGREEMENT (this
"Addendum"), enter ed into effective as of January 1, 2019 (the "Addendum Effective Date"), is made by
and between RxBenefits, Inc. filda Prescription Benefits, Inc, ("Administratoi") and City of Dubuque
("Client"), The parties, intending to be legally bound, hereby agree as follows*
•
1. Administrator and Client are parties to that certain Administrative Services Agreement
dated July 1, 2018 (the "Agreement"),
2, Administiatoi and Client hereby execute this Addendum for the purpose of documenting
that Exhibit A (Client Application) to the Agreement has been amended and restated to reflect,
among other things, new pricing terms. Such amended and testated Exhibit A (Client Application)
shall be attached and affixed to the Agreement as Exhibit A (Client Application) in lieu of the prior
Exhibit A (Client Application) upon execution of' this Addendum by the parties'. authorized
representatives below and shall be In full force and affect as said Exhibit A from and after the
Addendum Effective Date,
3. Except for the amendment and restatement of Exhibit A (Client Application) effected
hereby, the Agreement shall not otherwise be modified, altered or amended in any respect and is
hereby ratified and incorporated herein.
IN WITNESS WHEREOF, the undersigned parties have entered into and executed this
Addendum effective as of the Addendum Effective Date,
ADMINISTRATOR:
RxBene , Inc.
By:
tt •
Name: Lauren Simmons
Title: Director of Compliance and Legal Affairs
CLIENT:
City of Dubuque
By:
Naive: Michael C. Van Milligen
Title: City Manager
•
�xz�z�x�r a.
CLZ�NT APPLICATION
CONTRACT EI+'I+�CTNE DAT�
[IMi'ORTANT—PL�AS�RGAD CAR�I`ULLI': Clieiii;shnt�lci cax�efr�lly review Seclioris A,B atid C oF lhis
�x1►ibit A bolory wl�icl� 1zRve been co�nploted by Atlminist��ato�� i�� o►�deY• to e�zsizr�c the acetYrflcy and
completeness of sncl�iz�formaiion. Client s1tR11��romptly�xoCtfj Administ►�ator of�ny in�ccux��c�ot�oznissio��
witli res��ect to sucl�to�•ms and conclitio��s,if applicRble(including,witltout Iiznit�tio�x,ti�e Client Iix Formntioz�
in Section A). C1ie�at shortld also car•eflrlly x�eview and coanplete Section D of tixis�xltibXt A belovv.]
A. TNI'ORMATION ABOUT CLI�NT
Cliozit Name: IIl2/Pr•imax•y Coz►taci;; Pltoi�e; �
City ot'DubuqlGe Randy Peck 563-589-4125 j
Mail Address: ITR Co►xtnct�mail; rflx:563-690-6025
50 W, 13t1�St, citypers@cityofdubuque.org
Ciiy/St�te/Zip: B911i�xg Coxxtact: Phox�e;
DLI�UClllO�IA 52001 Gina Noel 563-589-4115
Ma'ry�Pl�one: Billing Co�ztacl•�maiC; �ax:563-690-6025
noel cit ofdubu ue.or
Send Iyavoices�tnd Co►if�dent3al Standa��d Re�oY•ts 1;0:
AiYtltorized Webslie Usex•s of Clienl(Use�•'s Narne aaad�-m�til Add►�ess):
Gina Noel, qnoel@cityofdubuqu__e.or�
* Noto: Client anay acld or deloto Authot•ized Website Use�•s by pz�ovxding wz'itto�i uotice of snclt cl��nges 10
AdYn'rr�'rstr�atox•ptu�sit�txt to tlie ttotice provisions of Article VCZ[.I3 of 1:tie Agz•eoznot�t.
�3. P�AN D�SZGN;MEMB�R COST SLIILiARC
Membet�Cost Sliax•e:
�'lease see ctrr•Y•orxt SYrmmaY�y of Benofits,
Client represents at�d wat•a�1nCs that the clesign of Client's Plan as z�eLlected in a Plan Design docunlenC for Clleat
("PDD"),accurately reflects tlie�p}�licable tax'ms of Client's Plan Ior ptuposes oi'tllis Ageeet�.eat. C[ient shall pt�ovide
Aclmit�.ist�•ltoz• with ninety (90) days prioA� written noCice of any pt•oposed clianges to �l�e design oi'Client's �'11n
(including the PDD), which ch�tlges sha11 be consistent with tha scope and nature oFthe sei~vices to Ue pt�ovided by
Adtn.it�lstt�ltot' ttt�der thls Agceemetzt, Cliet�t flgrees that it is responsible for Losses resu(titig fi�om any Iailure to
i�n171einent Plaz�Design oh�nges�vhich �re not communicated in writit�g ta Administrator, In addition, Clien�sh�ll
notiiy Members of ai�y Plai�Design chinges prio�•to the effecCive date of any suc11 chan�es.
C. S�RVIC�S; FORMULARY;PRICING.
1. Base Administrative Services: The following services are the base administrative services made available
to Client and its Members pursuant to the Agreement(including this Exhibit A) (the`Base Administrative
Services"), as applicable:
• Administration of eligibility submitted via tape or telecommunication
• Eligibility maintenance
• Client support system for on-lina access to current eligibility
• Administ��ation of Client's Plan Design
o In-network claims adjudication via on-line claims adjudication system
• Designated Account Team
• Client clinical and plan consulting,analysis and cost projections
• Annual analysis of program utilization and impact of plan design and managed care
interventions
a Welcome Package and ID Cards for new Members
• Standard Member communications
• Toll-free telephone access to customer seivice for the program for use by Members and Client's
benefits personnel and Representatives
2. Additional Administrntive Services: Client will pay for additional administrative services(the"Additional
Administrative Services")beyond those included in the Base Administrative Services that are requested by
Client and provided or made available by Administrator under the program as follows:
2.1 Administrative Fees
Admin,istrative'Serviaes �+'�es '�
Transaction I'ees Payable for Admiuistrative Services $0.65 per Prescription Drug Claim made by �
(per Article IV.B of the Agreement) Members payable on a bi-monthly basis
Transaction Fees Payable for Administrator's Clinical N/A i
Advantage Program �
individual rices listed in table below
Manufacturer Copay Assistance Programs
e Out ofPocket Protection(Accumulation) o No Charge(Not Elected)
• Out ofPocket Protection+Variable Copay • No Charge(Not Elected)
Assistance Program
• SaveOnSP • $0.40 per claim(Not Elected)
• Out of Pocket Protection+SaveOnSP e $0.40 er claim ot Elected
Reviews azid A e�ls Man� ement
• Low Clinical Value Exclusions(LCV) • $0.30 per claim minimum(Not
Elected)
• High Dollar Claim Review(HDCR) • $0,75 per claim minimum(Not
Elected)
Initial Determinations(i.e. coverage reviews)and Level Included in the existing utilization
One Appeals for the Coverage Authorization Program, management PMPM charge
consisting of OR
Prior Authorization
Step Therapy Included in the existing PA charge of$55 per
Dru Quantit Mana ement review
Adminis�rative Services I+ees
Initial Determinations and Level One Appeals for the $55 pet•review
Benefit Review Program,consisting of reviews lrnown as:
Plan Design Related Requests
Plan Exclusion Reviews(clinical or administrative
reviews of non-Covered Drugs)
Copay Reviews
Plan Limit Reviews(e.g. age,gender, days' supply
limits)
Plan Rule/Administrative Reviews/Non-clinical
Reviews
Clinical Benefit Reviews
Direct Claim Re'ect Reviews
Final and Binding Appeals—Level Two Appeals*and/or $0.00 per reviewx(incremental to PMPM fees
Urgent Appeals** or the per review fees above)
*Level One for clients with only one level of appeal * This czdditional fee is applied to each
** Appeals can be urgent at Level One or Level Two initzal determination.
and decisions are final and binding.
External Reviews by Independent Review Organizations-for $800 per review
non- candfathered lans
�BM Services F'ees
Advanced Utilization Mana ement AUM Bundle $0.63/PMPM
Manual/hardcopy eligibility submission $10.00
Member-submitted paper claims processing fee $3.00 per claim
Medicaid subrogation claims fee $3.00 per claim
O ioid Pro ram $0.32/.PMI'M If Elected
ACA Statin "Trend Mana ement"Pro ram $0.03/PMPM If Elected
Combined Benefit Mana ement
Services to manage combined medical-pharmacy benefits $0.10 PMPM per combined accumulator up to
that are not a consumer-directed health(CDH)plan. maximlun of$0.20 PMPM for existing
Services include ongoing management of the data exchange connection with medical carrier or TPA.
platform with the medical vendor/TPA,production
monitoring and quality control,and designated operations Fees to establish connection with new medical
team. Combined benefit types may include deductible, out carrier or TPA are quoted upon request.
of ocket,s endin account,and lifetime maximum.
Networlc Phnrmac Services I
Network Pharmac Audit Pro ram 20%of audit recoveries
i
i
�
i
I
Com rehensive Consumer Driven Health CD Solution
Consumer Choice Plan All services: $0.65 PMPiV1
Technical . Teclmical and Member Advocacy: $0.35
Bi-directional data exchange; dedicated operations;24-hour p�,M
a day, seven-days a week monitoring and quality control; . Health Choices and Drug Choices: $0.30
performance reporting;and analytics p�,M
Member Advocacy
Dedicated CDH member services, open enrollment tools
and member communications library,robust online *these charges would be in addition to any pricing
feattues,and preventive care adjustments if greater than ten percent of Client's
Health Choices total utilization for all Plans is attributable to a
Medication Adherence Monitoring and Outreach and CDHC,
proactive,personalized member communications
Drug Choices
Benefit Coaching,Prescription Benefit Review Statements,
roactive, arsonalized member communications
Medicare Part D—Retiree Dru Subsid S
Part D subsidy enhanced service(ESI sends reports to CMS $1,12 PMI'M for Medicare-qualified Members
on behalf of Client) with a minimum annual fee of$7,500
i Notice of CreditaUle Covera e $1.35/letter+ osta e
Part D Subsidy standard service(ESI sends reports to $0.62 PMPM for Medicare-qualified Members
Client) with a minimum annual fee of$5,000
$1.35/letter+postage
A. Notice of Creditable Coverage
PBM Services�-No Additional Fee
Customer service For Members �lectronic claims rocessin
Electronic/on-line eli ibilit submission Plan setu
Standard coordination of benefits(COB) Software training for access to our on-line
re'ect for rimar carrier s stem s ,
• FSA eli ibilit feeds ,
A. Networlc Pharmac Services . '
Pharmac hel deslc Pharmac reimbnrsement I,
Pharmacy network management . Network develo ment u on re uest �'
B. I3ome Deliver Services
Benefit education Prescri tion deliver —standard ;
• Re ortin Services
�
• Web-based client re ortin — • Annual Strate ic Account Plan re ort
• Ad-hoc deskto ararnetric re orts • Billin re orts i
• Claims detail extract file electronic(NCPDP format) • Inquiry access to claims processing '
s stem I
• Load 12 months claims history for clinical reports and i
re ortin
• Website Sei•vices
Express-Scripts.com for Membeis—access to benefit,
drug,health and wellnass information;prescription ordering
ca abilit ; and customer service
I�n lementation Pacica e and Member Communications
• New Member packets(includes two standard resin ID • Implementation support
cards)
• Member replacement cards printed via web(For hard-
co cards,char es are assed throu h from the PBM
• Clinical
Concurrent Drug Utilization Review(DUR)
Prior Authorization—Administrative
a.Non-clinical Prior Authorization
b.Lost/stolen overrides
a Vacation su lies
2.2 Administrator Clinical Programs
■ If elected,the Low Clinical Value("LCV")exclusion option prevents tmnecessary spending
by removing LCV medications from the formulary without impact to client reUates while
providing equal or more effective medicines at a lower cost. LCV medications are drugs that
treat common conditions that do not provide any additional or superior therapeutic value
when compared to currently existing therapies already in the marketplace.These medications
are excluded in addition to any products that woulcl normally be excluded by PBM Formulary.
This exclusion occurs without affecting rebate minimum guarantees or contracted discount
rates.Administrator reserves the right to�mend, from time to time,the list of low clinical
value medications.The list of low clinical value medications may be updated quarterly. Client
may request a current list of LCV medications.
■ If elected,Administrator's High Dollar Claim Review program("HDCR"),will provide Client '
with umbrella protection against high-cost prescription claims for approved formulary drugs.
Prescription claims over the threshold dollar amount are flaggecl prior to pa}nnent and reviewed '
for clinical appropriateness. This additional level of clinical oversight protects against ,
unnecessary spending, saving clients money and providing improved visibility into claim '
reviews, decision processes, and cost savings.The following may apply; '
■ RxBenefits manages the clinical review process for high dollar claims,providing oversight I
of the process. We communicate trends and savings results to clients through detailed !
reporting and analytics.; ',
■ Review turnaround time is dependent on prescriber activity and whether additional '
information is required. If additionai information is required,the reviewer will attempt to i
contact physician at least once claily for three days; direct contact with the prescriber will ',
discontinue after the third day. The majority of reviews are completed with a disposition ',
within 24 to 72 hours;
� Following a clinical review,one of four actions will occur:the inedication is�pprove�l,the
medication claim is denied, the doctor may decide to wzthdrnw and prescribe a different
medic�tion, or the reviewer can rlismiss the claim due to lack of communication from the i
prescriber; or �
■ If denied,an appeal process is available. !
• Foundational Utilization Management. UM is a bundling of evidence-based clinical programs
commonly used to provide appropriate clinical oveisight of prescription drug claims, UM �
ensures the correct clinical evaluation processes are in place.Appropriate QL promotes FDA-
approved dispensing guidelines by ensuring appropriate quantities are dispensed. ST ensures
the most clinically appropriate item is used fiist as part of adhering to accepted guidelines. �
When faced with two similar agents,the lowest cost option is promoted f rst.PA ensure FDA- I
approved guidelines with respect to indications are being met.Utilizing the PBM or customized i
criteria,RxBenefits has carved out the QL/ST exception review process as well as all specialty
and non-specialty PA reviews to be independently reviewed and documented utilizing a
docttmentation s stem that allows for ease of auditin throu h increased visibilit of clinical I'
Y g g Y �,
decisions. This component requires that a client elect a standard Utilization Management !,
Programs promoted by Adrninistrator. NO'I'E: Must have IIDCR component in place to elect I
this component. The following may apply: I
■ Review turnaround time is dependent on prescriber activity and whether additional 'i
information is required.If additional inPormation is required,the reviewer will attempt to II
contact physician at least once daily for three days; direct contact with the prescriber will I
discontinue after the third day. The majority of reviews are completed with a disposition
within 24 to 72 hours;
■ Following a clinical review, one of four actions will occur:the medication is r�pproverl,the
medication claim is denie�l, the doctor may decide to witFtdraw and prescribe a different
medication, or the reviewer can rlismiss the claim due to lacic of communication from the
prescriber; or I
■ If denied,an appeal process is available, II
■ If elected, PBM's Manufacturer Assistance Program for Specialty Medications ("MAP"), I�
consists oP 1 or 2 components when available, dependent on the specific plan design: (1)
Accumulator Protection using Manufacturer Copay assistance dollars to help lower member
out-of-pocket costs and client costs where funds are not applied to member deductible and
member out-of-pocket maximum totals; and (2) Accumulator Protection Plus Variable Cost- I
Share, where plan changes can maximize available assistance funds to offset plan costs and �,
cover the meinbers' cost-share but does not apply to their deductible and out-of-pocket !,
maximum, yielding high savings potential, or Therapeutic Interchange Programs where the
specialty pharmacy will move members to preferred agents in order to allow the usage of copay I
assistance funds from manufacturers. Requires exclusive specialty pharmacy relationship,
o If elected, the SaveOnSP program is a benefit design change implemented by PBM in ';
conjunction with a third-party vendor, SaveOnSP. Within the SaveOnSP program, certain �
specialty medications are classified as non-essential health benefits. This means that any j
fiinds spent on these drugs no longer apply to the members' accumulators.LZ addition,the i
targeted drugs are assigned higher copays. In all cases, SaveonSP helps the member
coordinate manufacturer-sponsored copay assistance. SaveOnSP targets drugs in six of the �
top ten specialty categories. j
■ If elected, PB1V1's Advanced Opioid Ma�lagementSM program reaches out to physicians, �
pharmacists and patients at key touchpoints to minimize early exposure to opioids and to !
prevent patients from progressing to overuse and abuse.Patients will be required to start therapy �,
with no more than a 7-day supply of short-acting medications (with certain exceptions). �
Member Education will start at the first fill.Doctors will be notified at the poiiit of care when
specific signs of misuse and abuse are observed. I
3. Pricin�. The financial terms set forth are conditioned on such exclusive arrangernent and all other specified lil
conditions set forth in Exhibit A of the Agreement, Client will pay to Administrator the amounts set forth below,ilet
of applicable Copayments. The application of Brand Drug and Generic Drug pricing below may be subject to certain II
"dispensed as written" (DAW) protocols and Client defined plan design and coverage policies for adjudication ancl �
Member Copayment purposes, Sales or excise tax or other governmental surcharge,if any,will be the responsibility �
of Client. �
Members will always pay based on the logic below:
Retail: Lowest of(i)the U&C price,(ii)Plan copayments/coinsurance,or(iii)discounted AWP(inchiding MAC
price,when MAC pricing is applicable).
Mail Order; Lower of(i) Plan copayments/coinsurance or (ii) discounted AWP (including MAC price, when
MAC pricing is applicable).
3.1 Pricin�. ',
(a) Inaredient Cost. Administrator will offer an average aggregate acmual discount as reflected below i�
on Client utilization to be calculated as follows.The pricing below will be implemented as of the Addendum Effective '
Date.The pricing below will be guaranteed upon the start of Client's next Renewal Term as described in Article VI(A)
of the Agreement.
[1-(total discounted AWP ingredient cost (excluding dispensing fees and claims with ancillary
charges, and prior to application of Copayments) of applicable Prescription Drug Claims for the
annual period divided by total undiscounted AWP ingredient cost(both amounts will be calculated
as of the date of adjudication)for the annual period)].
Notwithstanding anything herein to the contraiy: (i)a Prescription Drug Claim that processes at the
Brand rates (Participating Pharmacy Reimbursement Rates) and(Mail Phai•macy Reimbursement
Rates), as indicated on the ingredient cost field of the Prescription Drug Claim's data record, shall
be reconciled as part of the Brand gilarantee balow;and(ii)a Prescription Drug Claim that processes
at the Generic Drug rates (Participating Pharmacy Reimbursement Rates) and (Mail Pharmacy
Reimbursement Rates) lbove, as indicated on the ingredient cost field of the Prescription Drug
Claim's data record, shall be reconciled as part of the Generic Drug guarantee below. The only
Prescription Drug Claims that may be excluded from the reconciliation of the pricing guarantees are
as identified in the "Claims Excluded" colurnn of the table below. All other Prescription Drug
Claims may be included in the reconciliation of the guarantees.
Type of Partic'tpating Mail Claims Excluded �
Guarantee Pharmacy Service
Pharmac
OTC,compounds,U&C claims,Member SuUmitted
Claims, Subrogation Claims,Limited Distribution
AWP— AWP— Claims,vaccines,Specialty Products and/or claims with a
Brand o o high-dollar undiscounted AWP value,biosimilar
18.25/0 25.00/o products,long term care pharmacy claims and/or claims
with ancillary charges and products filled through in-
house or 340b harmacies if a licable
OTC,compounds,U&C claims,Member Submitted
Claims, Subrogation Claims,Limited Distxibution
AWP— AWP— Claims,vaccines, Specialty Products and/or claims with a
Generic 82 25% 85.00% high-dollar undiscounted AWP value,biosirnilar
products,long term care pharmacy claims and/or claims
with ancillary charges and products filled thc•ough in-
house or 340b harmacies if a licable
(b) Dispensin�Fee. ESI will guarantee a maacimum average aggregate annual per claim dispensing fee
on Client utilization to be calculated as follows:
[total dispensing Fee of applicable claims for the annual period divided by total claims for the annual
period].
Type of Pnrticipating Mail Service Cl�ims Excluded
Guarantee Pharmacy Pharmacy/Retail
Maintenance
Networlcx
Generic Drug OTC,compounds,U&C claims,Member
Dispensing $0.75 $0.00 Submitted Claims, Subrogation Claims,
Fee/Claim Limited DistciUution Claims,vaccines,
S ecialt Products and/or claims with a hi h-
dollar undiscounted AWP value,biosimilar
products,long term care pharmacy claims
and/or claims with ancillary charges and
products filled through in-house or 340b
harmacies if a licable
OTC,compounds,U&C claims,Member
Submitted Claims, Subrogation Claims,
Limited Distribution Claims,vaccines,
Brand Specialty Products and/or claims with a high-
Dispensing $0.75 $0.00 dollar undiscounted AWP value,biosimilar
Fee/Claim products,long term care pharmacy claims
and/or claims with ancillary charges and
products filled through in-house or 340b
harmacies if a licable
*Dispensing Fees are inclusive of shipping and handling. If carrier rates(i.e.,U.S.mail and/or applicable
commercial courier services)increase during the Term of this Agreement,the Dispensing Fee guarantees
will be increased to reflect such increase(s).
Guarantees will be measured and reconciled on an annual basis within 180 days of tihe end of each Contract
Year. To the extent Client changes its benefit design or Formulary during the Term of the Agreement, the
guarantee will be equitably adjusted if there is a material impact on the discount achieved. Subject to the
remaining terms of this Agreement, Administrator will pay the difference of Client's cost for any shortfall
between the actual result and the guaranteed result. Guarantees for pricing components are measured and
reconciled in the aggregate across all pricing components. Any dollar savings generated in excess of one
component may be used to offset a short Fall for any other component.
Notwithsta�lding anything in this Agreement to the contraiy, the Generic average annual ingredient cost
discount guarantees set forth above will include only those Prescription Drug Claims that processed to Client '
far payment where the underlying prescription drug product was identified by Medi-Span as having a Multi- �
Source Indicator code ic{entifier of"Y" on the date dispensed (or was identified by Medi-Span as having a
Multi-Source I�ldicator identifier of an "M," "N," or "O" on the date dispensed, but was substituted and �
dispensed by the Mail Service Pharmacy as its "house generic"), unless such Prescription Drug Claim is �
otherwise excluded above. The Brand average annual ingredient discount guarantees set Forth above will '
include only those Prescription Drug Claims that processed to Client for payment where the underlying ,
prescription drug product was identified by Medi-Span as having a Multi-Source I�ldicator code identifier of I
"M","N",or"O"on the date dispensed(except in cases where the tulderlying prescription drug procluct was :
substituted and dispensed by the Mail Service Pharmacy as its "house generid'), unless such Prescription I
Drug Claim is otherwise excluded above.
I
Any claim that is considered a single source generic will be included in the generic reconciliation.
3.2 Specialtv Products
(a) Exclusive Care. ESI Specialty Pharmacy is the exclusive provider of Specialty Products for the
reimbursement rates shown on the Exclusive ESI Specialty Pharmacy Specialty Product List. Any Specialty Product
dispensed at a Participating Pharmacy (for exarnple, limited distribution products not then available through ESI
Specialty Pharmacy or overrides)will be reimbursed at the standard Pai�ticipating Pharmacy Specialty Product rates
shown below. Upon ESI Specialty Pharmacy acquisition of limited distribution products, Members will obtain
prescriptions through ESI Specialty Pharmacy.
In redient Cost Dis ensin Fee
�xclusive�SI SpeciRlty � See Exclusive Specialty Product List $0.00
Pharmac
Participating Pl�armacy Participating Pharmacy Specialty Product $0,75
Specialty Products List
(b) Pricing for ASES is as follows:
(i) For Specialty Products needing an additional charge to cover costs of all ASES required to
administer the Specialty Products, the following standard per diem and nursing fee rates
shall apply, Exceptions to the standard per diem and nursing rates are set forth in (ii),
below, which list may be updated from time to time by ESI. Pricing for home infusion
supplies and services provided at Participating Pharmacies (for example, limited
distribution products not then available through ESI Specialty Pharmacy or overrides)will
be pass through,
Standard Per Diem $65/dose
Standard Nw•sin Fee/First 2 Hours $150
Standard Nursin Hourl $75
(ii) Additional exceptions to AWP Discount Rates and Standard Per Diem&Nursing Fees
AWP
Brand Name Discount Per Diem
EPOPROSTENOL 1•0% $65/cia
REMODULIN 5.0% $65/da
The AWP discount includes Phone Support Nursing, Supplies, Pump, first two training
visits, and Coordination oF In-Person Nursing. In-home nursing that is requested/needed
beyond the first two training visits will be charged at a rate of$150 for the first two hours
and$75 for every hour after.
(c) Specialty Products will be excluded from the non-specialty price guarantees set forth in the ',
Agreement. In no event will the Mail Service Pharmacy or Participating Pharmacy pricing terms specified in the
Agreement, including, but not limited to, the annual average ingredient cost discount guarantees, apply to Specialty '
Products. '
�
(d) Unless otherwise set forth in an agreement directly between ESI Specialty Pharmacy and Client, if I
a Specialty Product dispensed or ASES provided by ESI Specialty Pharmacy is billed to Client directly by ESI
Specialty Pharmacy instead of being processed through ESI and Administrator, Client agrees to timely pay ESI
Specialty Pharmacy for such claim pl�rsuant to the rates above and within thirty(30)days of Client's,or its designee's, I
receipt of such electronic or paper claim fi�om ESI Specialty Ph�rmacy. ESI Specialty Pharmacy shall have 360 days i
from the date of service to submit such electronic or paper claim. j
i
(e) SP�CIALTY PI�T �,FFECTIV� DISCOiJNT GUARANTEE - Administrator guarantees that
the overall annual net effective discount for the products listed on the Specialty Products List will be at least AWP(- �
) minus 19.25% for Client (excluding limited distribution products). Within one hundred and eighty (180) days
following the end of each Contract Year,ESI will calculate the actual net effective discount for the products listed on
the Specialty Products List that were dispensed tlu•ough the mail order channel to determine if the guarantee has been �
met. If tha actual overall net effective discount is less than the guaranteed net effective discount Administ��ator will
reimburse Client the full dollar amount of the difference between the actual and guaranteed net effective ciiscounts.
Client wi11 retain any amount that the actual net effective discotult exceeds the guaranteed net effective discount. The
calculation for the actual net effective discount will be as follows: ((Total Ingredient Cost for the products listed on
the Specialty Products List)divided by(Tota1 AWP for the products listed on the Specialty Products List))minus 1.
This guarantee is contingent on Client's participation in the National Pi•eferred Formulary and an exclusive specialty
arrangement.
3.3 Influenza and Other Vaccinations. Vaccinations shall adjudicate at the lower of:
(a)
Pai•ticipating Phat�macy Participating Pharmacy
INI+LUENZA OTHER VACCINES
Ingredient Cost Participating Pharmacy Participating Pharmacy Ingredient Cost as set
+ Ingredient Cost as set forth in forth in the Agreement
the A reement
Dispensing I+ee Participating Pharmacy Participating Pharmacy Dispensing Fee as set
+ Dispensing Fee as set forth in forth in the Agreement
the A eeinent
Professional Sei•vice Fee
(PSI+�; cost for Pass-Through Pass-Tlu•ough
pharmacist to (capped at$15 per vaccine (capped at$20 per vaccine claim)
�dminister the vaccine claim
Vaccine Program Fee* $2.50 $2,50
er vaccine claim er vaccine claim
* The Vaccine Program Fee will be billed separately to Client as part ot'the administrative invoice according to
the billing frequency set forth in the Agreement. This Vaccine Program Fee will apply to any vaccine claims,
whether at contracted rates or U&C, and is in addition to any per Prescription Drug Claim adtninistrative fee set
forth in the Agreeinent.
OR
(b) the combined ingredient cost, dispensing fee(if any) and professional service fee(if any) that the
Participating Pharmacy generally charges an individual paying cash,without coverage for prescription drug
benefits, plus the Vaccine Program Fee set forth above.
Coverage is subject to Plan provisions. No vaccine claims will be included in any guarantees set forth in the
Agreement and/or amendments thereto.
D. REIiATES
1. Rebate Amounts. Subject to: (i)the conditions set forth in Sections 2 through 4 below and elsewher•e in this
Agreement;and(ii)Client meeting the Plan Design conditions identified in the table below,the following guaranteed
amounts will be payable to Client dtu�ing the Term of this Agreement:
Formulaiy: �SI National Preferred
National Plus Home Delivery Specialty Products
Networlc Products
Rebates per Brand $157.00 per $460.00 per brand $1,150.00 per brand
Rx brand claim claim, claim '
2. Exclusions. Member Submitted Claims, Subrogation Claims, Limited Distribution products, biosimilar
products, OTC products (except for insulin and diabetic supplies), vaccines, claims older than 180 days, claims ,
through Client-owned or 340b pharmacies,and claims pursuant to a 100%Member Copayment plan are not eligible �
for the guaranteed Reb�te amounts set forth in Section 1 above. !
3. Rebate Paytnent Terms. Subject to the conditions set forth herein,Administrator will receive from ESI the li
quarterly Rebate payments within approximately one hundred eighty (180) days following calendar quarter i
adjudicated for Rebates received during the prior calendar quarter. Administrator shall pay Client the guaranteed i
amounts set forth in Section 1 above within approximately thirty(30)days following receipt of the Rebate payments �
fi�om ESI. I,
�
4. Conditions
4.1. ESI contracts with pharmaceutical manufacturers for Rebates on its own behalf and for its own
benefit, and not on behalf of Client. Accordingly,ESI retains all right,title and interest to any and all actual
Rebates received fi•om manufacturers. ESI will pay to Administrator(and Administrator shall pay to Client)
amounts equal to the Rebate amounts allocated to Client, as specified above, from ESI's general assets
(neither Client,its Members,nor Client's Plan retains any beneficial or proprietary interest in ESI's general
assets). Client acknowledges and agrees that neither it,its Members,nor its Plan will have a right to interest
on,or the time value of,any Rebate payments received by ESI during the collection period or moneys payable
under this Section. No amounts for Rebates will be paid until this Agreement is executed by Client. ESI and
Administrator will have the right to apply Client's allocated Rebate amount to unpaid Fees.
4.2 Client acknowledges that it may be eligible for Rebate amounts tmder this Agreement only so long
as Client, its affiliates, or its agents do not contract directly or indirectly with anyone else for discounts, ,
utilization limits, Rebates or other financial incentives on pharmaceutical products or formulary programs '
for Prescription Drug Claims processed by ESI pursuant to the Agreement,without the prior written consent �
of ESI. In the event that Client negotiates or arranges with a pharmaceutical manufacturer for Rebates or !
similat�discounts for any Covered Drugs hereunder,but without limiting ESI's right to other c•emedies,ESI '
may immediately withhold any Rebate amounts earned by,but not yet paid to,Client as necessary to prevent
duplicative Rebates on Covered Drugs. To the extent Client lcnowingly negotiates and/or contracts for I,
discouirts or Rebates on claims for Covered Drugs without prior written approval of ESI, strch lctivity will
be deemed to be a material breach of this Agreement,entitling ESI to suspend payment of Rebate amounts j
hereunder and to renegotiate the terms and conditions of this Agreement. !
i
4.3 Under its Rebate program, ESI may implement ESI's Formulary management programs and ;
controls, which may include, among other things, cost containment initiatives, and communications with �
Members, Participating Phacmacies, and/or physicians. ESI reserves the right to modify or replace such �
programs from time to time. Guaranteed Rebate amounts, if any, set forth herein, are conditioned on
adherence to various Formulary management controls,benefit design requirements,claims volume,and other
factors stated in the applicable pharmaceutical manufactt�rer agreements,as communicated by ESI to Client
fi�om time to time. If any government action,change in law or regulation,change in the interpretation of any
law or regulation, or any action by a pharmaceutical manuFacturer has an adverse effect on the availability
of Rebates,then ESI and Administrator may make an adjustment to the Rebate terms and guaranteed Rebate
amounts,if any, hereunder.
4.4 Rebate Acknowledgment; No Representation; Rebate Limitations. Client acknowledges that I
Administrator is not making any representation,warranty or guaranty of any kind or nature, either express, i
implied or otherwise, regarding the �mount of Rebates to be paid or remitted to Client pursuant to this �
Agreement,except as specifically set forth in writing herein, In addition,Client waives,releases and forever !
discharges ESI and Administrator from any Losses arising from a pharmaceutical company's (a) failure to
pay Rebates; (b) breach of an agreement related to Rebates; or (c) negligence or misconduct. Client
acknowledges that whether and to what extent pharmaceutical companies are willing to provide Rebates to
Client may depend upon a variety of factors, including the content oFthe PDL, the Plan's design featt�res,
Client meeting criteria for Rebates,and the extent ofparticipation in ESI's formulary management programs,
as well as �SI/Administrator receiving sui�icient information regarding each Claim for submission to
pharmaceutical cornpanies for Rebates. Client acknowledges and agrees that ESI may, but shall not be
required to,initiate any collection action to collect any Rebates from a pharmaceutical company. In the event
ESI does initiate collection action against a pharmaceutical company to collect Rebates,ESI may offset any
reasonable costs, including reasonable attorneys' fees and expenses, arising fi•om any such action.
Notwithstanding any provision of this Agreement to the contrary,Administrator shall only be responsible for
pa}nnent of Rebates to Client pt�rsuant to the terms of this Agreement if such Rebates are actually received
by Administrator during the Term of this Agreement. In no event shall Administrator be obligated to pay
Rebates to Client until Administrator receives payment for the same Rebates from ESI. In the event Client
terminates the Agreement outside the terms and conditions in the Agreement, Client forfeits the right to
receive 1ny Rebates received by Administrator on Client's behalf after the date of such termination. Client
acknowledges that Administrator shall not be obligated to pay Client any Rebates described herein until this
Agreement is signed by Client. '
5. Rebate amounts paid to Client pursuant to this Agreernent are intended to be treated as"discounts"pursuant �
to the federal anti-kickback statute set forth at 42 U.S.C. §1320a-7b and implementing regulations. Client is obligated I
if requested by the Secretary of the United States Department of Health and Human Services,or as otherwise required
by applicable law, to report the Rebate amounts and to provide a copy of this notice. ESI will refrain frorn doing i
anything that would impede Client from meeting any such obligation.
6. Plan Particinant Cost Share. Administrator may, but shall not be obligated to, dispense or cause to be
dispensed a prescription even if the prescription is not accompanied by the applicable Plan Participant Cost Share
described above in this Exhibit A. Administrator will refund any amount submitted by a Plan Participant in excess of
the Plan Participant's applicable Plan Participant Cost Share. In the event a Plan Participant submits an insufficient
Plan Participant Cost Share and the Pl�n Pai�ticipint fails to remit the balance of the Plan Participant Cost Share amount
to Administrator (or its designee) within thirty (30) days of Administrator's (or its designee's) i°equest, then
Administrator shall have the right to invoice Client for, and Client shall have an obligation to pay Administrator(or
its designee), the amount of the uncollected Plan Participant Cost Share(s). Client shall, in turn, have the right to
recover uncollected Plan Participant Cost Shares from its Plan Participants at Client's determination. Shipping of
prescriptions submitted without the appropriate Plan Participant Cost Share may be delayed.
E. ESPS INF'LATION PROTECTION PROGRAM
1. IP Pro�ram. The Inflation Protection Program("ESI IP Pro�ram"). Subject to the terms and conditions set
forth in Section 2 balow,under the ESI IP Program Administrator will pay to Client$2.00 per Formul�ry Brand Drug
claim("Client Inflation Pavment"). Subject to the terms and conditions set forth herein, under the ESI IP Program,
Administrator will pay Client the Client Inflation Payment within approximately one hundred and eighty(180) days
following the end of each calendar c�uarter for utilization occurring during such calendar quarter. All non-Formulary
claims and Generic Drug claims shall be excltided.
2. Terms and Conditions of ESI's II'Program.
2.1 Exclusions, The following claims will be excluded fi•om all calculations related to ESI's IP Program:
• Medicare claims,Medicaid clairns and any other government health care program claims
■ OTCs,member submitted claims,subrogation claims,compounds,Generic Drugs,claims submitted
by Client-owned, in-house, or on-site pharmacies,340B claims, claims submitted through a 100%
Member cost-share program,biosimilars, drugs where the quantity or packaging has been changed
by the manufacturer from the prior ye�r,and diugs for which there was no utilization in the calendar
year prior to the calendar year for which the Client Inflation Payment is being determined.
2.2 �SI's Ri�ht of Equitable Ad.iustment. If Client makes material changes to its Formulary or benefit
design that negatively impact ESPs ability to control inflation relative to Client's Farmulary drug mix,
then Client acicnowledges that ESI or Administrator reserves the right in ESI's discretion to make an
equitable adjustment to the Client Inflation Payment.
2.3 The ESI IP Program,and the underlying economics,is separate and apart from rebates and manufacturer
administrative fees, and the amounts desci�ibed above in this Section E will be paid to Client in addition
to any rebate payments to which Client is entitled pursuant to the terms of this Agreement. Client will
not be entitled to receive any amounts related to drug price inflation or a related guarantee other than as
set forth above in this Section E of this Exhibit A(Client Application).
2.4 No payments will be made to Client unless Client has executed this Agreement.
F. EXECUTION BY CLIENT
Client hereby represents and warrants that the information contained in Section A of this Client Application
is true and coned in all respects and Client hereby agrees to the specific terms conditions and financial
ari angements set out m Sections 13 C, D and E of this Client Application, Client agrees that if any Information In
Section A changes, Client will give Administrator prompt notice of such changes. Furthermore Client understands
that this Client Application (Exhibit A,) is a putt of the Administi ative Services Agreement between Client and
Administrator to which it is attached and Incorporated into by reference and that Client is bound by all terms and
conditions of such Administrative Services Agreement,
All capitalized terms used in this Client Application but not specifically defined herein shall have the
meanings given to such terms In the Administrative Services Agreement to which this Client Application is attached
and made a part of
IN WITNESS WHEREOF, Client has caused this Client Application (Exhibit A to the Agreement) to be
executed as of the Effective Date. In the event this Client Application is amended by•the Parties after the Effective
Date, the Parties may substitute such amended Client Applleation for the former Client Application, provided the
Patties set fotth the date from and after which such amended Client Application shall be effective (the date" line at
the bottom of the Administrator's acknowledgment signature block on an amended Client Application shall be web
new effective date with respect to such amended Client Application), The Parties further agree that they will attach
such amended Client Application to this Agreement and provide a copy of this Agreement with the amended Client
Application (Exhibit A) to Administrator and Client for their respective records, Any such amended Client
Application must be signed by Client's authorized representative and acknowledged, agreed to, accepted and dated by
Administrator's authorized 1 epre,sentative
•
CLIENT:
City of Dubuque
By:
Printed Name: Michael C. Van Milligen
•
Its: City Manager
Acknowledged, agreed to and accepted by:
ADMINISTRATOR:
RxBeneft
By:
Printed Name: Lauren Simmons
Its: Director of Compliance and Legal Affairs
•
City of Dubuque Insurance Requirements for Professional Services
INSURANCE SCHEDULE J 'i
1. RxBenefits, Inc. shall furnish a signed certificate of insurance to the City of Dubuque, lowa for II
the coverage required in Exhibit I prior to commencing work and at the end of the project if the I
term of work is longer than 60 days. Contractors presenting annual certificates shall present a
certificate at the end of each project with the final billing. Each certificate shall be prepared on
the most current ACORD form approved by the lowa Department of Insurance or an equivalent
approved by the Director of Finance and Budget. Each certificate shall include a statement under
Description of Operations as to why the certificate was issued. Eg: Project# or Project
Location at or construction of I
2. All policies of insurance required hereunder shall be with an insurer authorized to do business in
lowa and all insurers shall have a rating of A or better in the current A.M. Best's Rating Guide. �
3. Each certificate shall be furnished to the Finance Department of the City of Dubuque.
4. Failure to provide coverage required by this Insurance Schedule shall not be deemed a waiver of �
these requirements by the City of Dubuque. Failure to obtain or maintain the required insurance
shall be considered a material breach of this agreement.
5, Contractors shall require all subconsultants and sub-subconsultants to obtain and maintain during i
the perFormance of work insurance for the coverages described in this Insurance Schedule and �
shall obtain certificates of insurances from all such subconsultants and sub-subconsultants.
Contractors agree that they shall be liable for the failure of a subconsultant and sub-
subconsultant to obtain and maintain such coverages. The City may request a copy of such
certificafies from the Contractor.
6. All required endorsements shall be attached to certificate of insurance.
7. Whenever a specific ISO form is listed, required the current edition of the form must be used, or
an equivalent form may be substituted if approved by the Director of Finance and Budget and
subject to the contractor identifying and listing in writing all deviations and exclusions from the
ISO form.
8. Contractors shall be required to carry the minimum coverage/limits, or greater if required by law
or other legal agreement, in Exhibit I. If the contractor's limits of liability are higher than the
required minimum limits then the provider's limits shall be this agreement's required limits.
� 9. Contractor shall be responsible for deductibles and self-insured retention.
Page 1 of 4 Schedule J Professional Services May 2019
City of Dubuque Insurance Requirements for Professional Services ;
INSURANCE SCHEDULE J continued I
� )
Exhibit I :
A) COMMERCIAL GENERAL LIABILITY ',
General Aggregate Limit $2,000,000 '
Products-Completed Operations Aggregate Limit $1,000,000
Personal and Advertising Injury Limit $1,000,000
Each Occurrence $1,000,000 ,
Fire Damage Limit(any one occurrence) $50,000 ',
Medical Payments $5,000
1) Coverage shall be written on an occurrence, not claims made,form. The general '
liability coverage shall be written in accord with ISO form CG 00 01 or business
owners form BP 00 02. All deviations from the standard ISO commercial general
liability form CG 00 01, or business owners form BP 00 02, shall be clearly
identified.
2) Include ISO endorsement form CG 25 04"Designated Location(s)General
Aggregate Limit"or CG 25 03"Designated Construction Project(s) General
Aggregate LimiY'as appropriate.
3) Include endorsement indicating that coverage is primary and non-contributory.
4) Include Preservation of Governmental Immunities Endorsement. (Sample
attached).
5) Include additional insured endorsement for:
The City of Dubuque, including all its elected and appointed officials, all its
employees and volunteers, all its boards, commissions and/or authorities and
their board members, employees and volunteers. Use ISO form CG 20 26.
6) Policy shall include Waiver of Right to Recover from Others endorsement. :
B) AUTOMO�ILE LIABILITY
Combined Single Limit $1,000,000
C) WORKERS' COMPENSATION & EMPLOYERS LIABILITY
Statutory Benefits covering all employees injured on the job by accident or disease as '
prescribed by lowa Code Chapter 85.
Coverage A Statutory—State of lowa
Coverage B Employers Liability
Each Accident $100,000
Each Employee-Disease $100,000
Policy Limit-Disease $500,000
Policy shall include Waiver of Right ta Recover from Others endorsement.
Coverage B limits shall be greater if required by the umbrella/excess insurer.
OR
_ _ __—__ _ ___ _ __ __ _ __ _Nonelection_Qf_WQrkers'_Compen__sation o_r,Employers'Liability_Coverage_under lowa
- - -- - - - -- - -- - -
Code sec. 87.22. Completed form must be attached.
Page 2 of 4 Schedule J Professional Services May 2019
City of Dubuque Insurance Requirements for Professional Services
INSURANCE SCHEDULE J (continued)
D) UMBRELLA/EXCESS LIABILITY $1,000,000
Umbrella/excess liability coverage must be at least following form with the underlying
policies included herein (General Liability, Automobile, Workers Compensation).
E) PROFESSIONAL LIABILITY $1,000,000
Provide evidence of coverage for 5 years after completion of project. �,
F) CYBER LIABILITY $1,000,000 II�
X yes _no
Coverage for First and Third Party liability including but not limited to lost data and
restoration, loss of income and cyber breach of information.
I
Page 3 of 4 Schedule J Professional Services May 2019
�
i
City of Dubuque Insurance Requirements for Professional Services �
i
'
,
PRES�RVA►TION OF GOVERNMENTAL IMMUIVITIES ENDORSEMENT �
i
1. Nonwaiver of Governmental Immunitv. The insurer expressly agrees and states that the purchase i
of this policy and fihe including of the City of Dubuque, lowa as an Additional insured does not waive any
of the defenses of governmental immunity available to the City of Dubuque, lowa under Code of lowa
Section 670.4 as it is now exists and as it may be amended from time to fiime.
2, Claims Coveraqe. The insurer further agrees that this policy of insurance shall cover only those i
claims not subject to fihe defense of governmental immunity under the Code of lowa Section 670.4 as it ;
now exists and as it may be amended from time to time. Those claims not subject to Code of lowa !
Section 670.4 shall be covered by the terms and conditions of this insurance policy. �',
3. Assertion of Government Immunitv. The City of Dubuque, lowa shall be responsible for asserting
any defense of governmental immunity, and may do so at any time and shall do so upon the timely written
request of the insurer.
4. Non-Denial of Coveraqe. The insurer shall not deny coverage under this policy and the insurer I,
shall not deny any of the rights and benefits accruing to the City of Dubuque, lowa under this policy for ,
reasons of governmental immunity unless and until a court of competent jurisdiction has ruled in favor of
the defense(s) of governmental immunity asserted by the City of Dubuque, lowa.
No Other Chanqe in PolicV. The above preservation of governmental immunities shall not otherwise
change or alter the coverage available under the policy.
(DEPARTMENT MANAGER: FILL IN ALL BLANKS AND CHECK BOXES)
Page 4 of 4 Schedule J Professional Services May 2019
� ((Ih017 Veraion)
i
ADMINISTRATIVE SERVIC�S AG�R���ENT
. i '
� by ancl �otween ' ; ',
RxBenefits, Znc. � ` I�'i
� �
� az�d .
�
;
. City of Dubuc�ue Xowa �
' � �
EFF�CTIV�AS OF; J��ly 1, 20�8 � ` ��
�
a
r
iYOT COR DCS'I'RIBUTCOY, TC�1�IiYi'OCii�[r1TC0`f CONTAIN�D I�I�Ii�TY[5 COYL'ID�NTIAL,PROPIZI�TARy
a1YD CONSTITUT�S TRrID�S�CRGTS Or�SI tlNb R,`CB��(�I�ITS
. � ,� �
f
,
a
A,DMINZS'��.2E1TXV�S��'+.VICCS AGR��M�NT � ;
TkIIS Al71YZXNISx1�ATi��S�RVIC�S�A.G�.���'z�NT, <<�tea effect(ve ns of 12;01 ani, locnl tinte in I � ;
Birmingltnm,A(nUnm�nn July 1,201Q("L�fFective 17�to,�),Is tn�t<le nnd entered by t�nd��ef�veett�txB�►�e�'its,Tnc.,�tn ,
� coc oration "Admtnistratot"), flttd Clty af'Duuuc�ao Xa�vn ("Cl�en';), �Administcatoc nnd Cliaut nre , �
Alnbam� p � `
snmotimes referred to he►'ein individullly as a"P�rt "nncl cotlectivaly�s tt�e Pn►hes. i
�
, Reclti�Is. • ' �
p, Cliant lifls inclic�ted tt desi��e to anter iuto 1 contcactual calationshi�w[th Adminish�ltor in ocder to ' � ',
procw�e the�dministratlon of pcescciptiou drug benofits to Client's Men�be�•s(def ned below)6y Client's exeautton of i I ',
� this Agceement(da�ned ba(ow),Including without liinitation tlie Client npplicntion nitnc(ted to this Agceeme�it and i � i
� tncorpornted hePeln by refecence ns Exh[bit A(the"Client Ap (Ic� ation"), 3
�, Adminlstrator desiras to adm[nister.tlie.prescription dcttg benefits s�ecified•in Client's Plan (
descr(bed herein in a minfskerlal c�pacity,subject to all the te���ns nnd conditions theceof;and I
C, Administr�tor has antaced into nn ngreement with an indenendent, tliicd-party phacmaay benefit i �
managec,Express Scrlpts,Tnc.(heretnafter ceferred to as"PB� "oc",E�S "),fo��the purpose of being able to pcovide a ; i
n e t w o e l c o f p l t a r m a c t e s and re[nted pharntacy banefit����nagement progcams and services for,utllizationby Cliant and �
its Menibers as admIutsterad through Admtnistrator woeking in'conj unc t ton wl t h C l i e n t,a l t a s m o c e f i d l y p r o v i d e d f o c ; i
lii this Agreement. , • � i
' ' ` Ag►�eecnent , : �
• i
' I
I�(O'VY,'X'kICRP�OR�In consideration oEthe inutual covennnts,duties an.d oblig�ttions made by tlie Parties
herein and other good and valuable consideratioti,the ceceipt and sufficiency af'wlitcti [s hereby ncicnowledged,the : i
Pact[es,intan ding to be legally bound,heceby�agcea as follows: � �
�
ARTXCT��Y—CCRTAIN DCrINITTONS ' : i
A, The iniCially cnpltalized�erms below(n tltis Secttoa A of Article I shflll have ttie following meanings when : �
used in this Agreement, In nddttion,thaca are other InitialLy cRpttnlized terms that are defined in otlier parts � i
of this A greement snd such terms shu(l have tha rneanings ascribed to them in saclt othar parts of tlits ;
Agrea�nent wlienevec they are used tn t h is Agreemen t, ' � �
"AEre�ment"means ttils Administcattve Services tlgreement batwean Administcatoe snd Client,the Client � j
Appllcation �n d a l t o t her ex hibits, su p plements, lmendments, �ddenda and/oc schedules to this ; �
' Admintstrative Services Agreement. ; ',
'�Ancillary Supplies Enu(pment �nd Servicas"or"AS�S"means nnctllaey suppties,equipment;and services � ;
pcovi de d or e o o e d i n�t e d b y ES[S pectattyPliacmacy tn connectiott wltli BSI Specialty Pharmaay's dispenstng ! i
� of Specialty Products.ASES may include all or some of the following;telaphontc and/o��in-person train lt�g, ' '
nucslnp�cl[nical servlces, in-houle infusion and related support, pattenl monttaring, medication pumps,
tubing, syringes, gnuxe pads, shnrps cont�iners, llncets, test sh�ips, othee supplies, t�nd durable medicfl! � �
equl�ment.The aforementionad list is itLustrAtive on(y(not exhnustive) nnd mny include other suppllas,
eqt�ipinent,and services based on tha patient's needs,pcese��iber instructions,pnyer renuirements,and/or the
. Specialty Product manufletu�er s requirements,
� '°Aveca�e�Vholesale Prlce"or"AWP"means the aver�ge wholesala price of a prescciption drug as identified
by drug prtcing sacviees sucli ns Medt-Spnn or other source recognized in tl�e i�etail peescciption drug Indust►y j
selected by ESI(the"Prtcing Sourca"). The appttcable AWP shall be the l t-dlgit NDC for the product on
the dt�te dispeused,and for presccintions filled in Participating Pliftrmncies,Mail Service Pharmacy nnd ESI ;
• - � 5paci�lty Pharmacy,Actu�tl nackuga size will be used for dispensing, PBM will not charge C(ient n higher ;
A1�VP_price bnsed on rep�►cic�ged products and nctual package size will be used for dispensing at P�►rticinnting i
--- -- - -------- - - --
Pharmacies (retaiO;tvIail Service Pliarmacy-'ana-ESi=Specialty-P-hlrmacy.--_AW1'-_u�ed-to-ca(e��ate_t e
- ---- _ _ _
NOT�ORD[STRCI3UTIOY. 'TIIC i�UTCST[tAll'S C GT OC CSIA�`(D LL�CBCNGC TS��L���OPRCGTARY
a,rtn co�sx z
• , .
�'rascrlption Drttg CI�Im;ls the cuerent,post-sotttement AbV�', IFtha Prlcliig Soucoa dlsoontinties t(ie rapocting
� ofAWP<or mnterially bhanges the manner•In whlch AWP ls cRlcttl�ted,thett�SI reservos tlta rlght to mafce i
• �mequfttibla ttciJustmeut as ilecessary to•mainta(n the partias'ralativa economic's and the prlotng Intent of tl�fs
Agreemettt, � � � . . , .
"�rAnd/Qeneric Algor(thm" oc "BGA" tneans ESI's staudard and pi�o�riafary brand/ganeric algorithm i �
, utll(zed by ESz,a copy of which may ba mnda��vailable fot�revIetiv by Cliant upot�request, The purposas of � �
tha ulgorlthm Rre to i�tllIza a compeehensiva nnd loglca(algorlthm to'datec�thine the�brand or genaric stnhts of
products in the EST tn�ster drug fila using�oombinatlon of industry stnndard attcibutas,to stabilize products � � '
� "fllppi'ng"between brand and genarfc status as may be the.oftsa when e singla Indloator Is used from Industcy � �
. pc(cing sources,and to rednce Cllent,Mamber and p��ovidar confiision d�ie�to fluatuatlons!n brnnd/generic �
status, � , . . , ;
� � �"Brand Di�ug"means n prescriptlon drug ldanti�ed as�such In ESI's mastec•drug•file using Indicators fi�om i
Flrsf Databank(or other�sourca natIonally recognIzed In.the presct�Iption dciig IndusEry usad by�SI foc nll ;
o(lants)on the basls of a standard Brand/Qenec(c Algocithm utplzed by ESI..for all of,lts ollents, a copy of
� � which tnny •be made �vailable for .revlew by Aclmtnistrator, .Cllant, or .•its Auditor upon `
cequest, Notrvlthstand(ng the £oregoing, cectaln�cesceiption drug medioatlons'that ara l(cansad and the�i i
eur��ently tn�i�keted as brnnd �namo drugs, whai�a�thera exiSts .lt lenst orre (1) competing p��escrlptlon �
mediast(on that is�ganartc equlvalant and Intarehangeabla wltl�tlio markated brftn�l nnma dcug,may prncess
ss"Generio Drugs"foc Proscrintion Drug Claitn ncljudlcstion•attd Ivlembai�Copayment purposas,
. "Bus(ness A�ivs"or"business elays"11101t1S�NII,(IEIyS BXCa�f�EItLIPd�ys;St�ndlys, and��'ederal holidays. Al(
� ra�'eeeuoas to"d1y(s)"are to ealandar days unless"businass dfty"•is speolflad, .�
"Contraat Yeae"me�ns tha fidl twelva(12)month pariod commaneing omthe Effec.ttva Dste snd e�ch flill
consecutive trvalve(12)month peelod theeelfterthat thls A.gt�eementrem�ins in effect, '
"Copavmant" means tlt�t portlon of the charge fot�each Covered Dcug dispansad to tl�e Member that ls tlie ;
responsibilIty�of tha Member(e.g,, cop�ymant,colnsucanca��nd/or ilaductibla).as inclIc�ted oti the Set•Up. i
. Forms, ,. • •
. �°Cost Share"maans the.amount wlilah fl Nzambar is requirad to pa'y foe�pcascription or authot9zed raEill fn
flCCOl�d�nce ruIth the Plan Design,which may be a deduoti�le,a pecC0l1tflg0 Of f�le.�rescriptlon prlce,a fixed
amount and/or other chacge oc pennity, � .
"Covecad Dru�fsl"manns tl�osa pcescclption dt'ugs,suppl(es,Spect�lty Products,(if saleoteci an the Set,Up � '
Fot�rns)1nd'othec it�ms th�t�ce ooveee�d undec the P'resarlptiou Drug�Pcogc7ni,eloh as lnd'tontad on tlte Set•
[Jp Focros,
"Dispetisin.g Fee" means tha �ttioutit payabla by Glient�s a dispensing fee per pcasct�lptton oc�utho��izad
ra�il to a Mamber ns sat forth on Exhibit to tlils Agraemant, •
"Eliefbility Flles" me�ns tlie list submitted by Cliei�t to Administratoc in raasonnbly nocept�b(e electronlc
� forin�t(ndicnting peesons eligible for drug bauaElt covernge services tulder tha Cliant's PIRn.
' RI5 " means the Employee Retirerneut Income Seaurity Aat of 1974, ns amanded,and tha eagulltlons
,.. . promu(gnted theret►nder,
. ' 'BSC N�t(onn(Plus Netwoef<"meflns ESI's bro�dest P�eticipnting Phnrmacy netwot�k,�
�Tlte ESI Nntlon�l Ptus Network tivt�s hlstoricnlly referrad to ns the"EN50 Net�vork"in ESPs nahvork pcovlder ngreantents wlth •
Partieipating Phnrmncias,and is subJect to titture nnme clinnge,
NbT COR DTST[LInU�'[Ot(� TI�IC IYPORI�W'1'ION C�iVTr�I`!�D T•I�I2�IY IS COYI'ID�NTIr1L,PROPRI�TARY �
r1ND COYSTITUT�S TRr1D�SCCR�TS Or CSC r\ND I2;CB�NCI'1TS
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. "L�S�Spacfaltv Phat�tn�oY" tne�tns�CucaSc�•lpt, !ac„Acccedo�Ianitl�Grou�,Tnc,,L�xpress Scrlpts S'pecinity , ,
Distci6ution Sat�vices;Ino.,ot�nnotlier l�l�ne�n�aY o�'home hetilCh t�gency wholly-owned ot�opernted by ESI o�� i
' � one or ulore of lts affilintes tl�at�ciul�rity dispensea 5pecinity P►'oducts or.��rovides secvlces ce(ntad Cltereto; ,
nt�ovidecl,ltowevee,fli�twliou the 1VZ'afl Sarvica Ph�tcm�cy clishenses a S��ecialtyProduct,[tsl�alt 6e cousldere�l : ,
nn�SI S��eclalty Plinem�cy heceundec, , : 1 ,
" ees"n�eans,wlth caspeot to Cltenh,all the fees specified on ti�e nppllcable xltibtts�ttac[ied herato and nll : � �
otlier n►1�otuits due by Gttent lieeeunder,'whiah Client (or, if appllaable, �ny Mamber) is cec�uiced to pny � �
pucsuant to the terms and oondltions of tlils Agroement. Tn the event�SI,A.dmtnistrator.nad Cltent agcee ; i
upon a ino c{if"tcnflon of the Fees fi•oni Eima to tiine,Client sfia(l ba res�onsibla for Cimely coniuiuniclting suoh I
changes to Membees�nd foc obtaining the necess�cy consents,if any,requit'ed fcom Ct tant an d/oi�Mem bers � '
, i n o�'d e c t o i u�p l a manf the new prtcing. , ' ; I
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"Formulnr "meatis the llst of FDA.-a�proved prascrlptioit dru�s and supplies developed by ES['s S'harmacy �
aud'�ltaeapautics Comiitlttee nud/or customized by.Client,Rnd wfilcli is,se(ecEed nnd/oc�dopted by Cliant, �
The deugs�xnd siipplies Included a«tlxe Pormulflry wlll be mo.dtfted.by ESY from t�me to tinia as a t•esult of �
� faotors,Including,but not lI'�nited to,'medical npp�opeiateness,m�nufacture►Rebata arcangements,and patant i �
. expir�tions, Additions and(ar deletions to tha�Foctnulacy ara hacGby ndopted by Client,sab,ject�to Client's i i
discr.etion to elect not to hnplement sny such nddttion oc daletion fhrougt�ttta Set-Up Focm process,which �
such alectlo�shall ba considered n Cllent change to tlie Foctnulacy, . . ; �
. � ,. • • io rfetai ornon-proprietary � �
� "C3eneric Dcu�"means a preseciption diug,whether ldentiEied by its chemical,p� p y,
name,that ls Chaeape�iticRlly enuivfttent nnd Intereh�ngeable�wtth drugs having an identioal flmount of.Y(te ; ,
snme nct[ve ingced[ent(sJ and nppcoved by the FDA and whioh is identified ss sttoh in�SI's mRstei�dcug�'ite ; �
using iudlcators from F(cst JJnt�►banlc(or othec source nattonnlly reeo�nized(n tlie prascrtption dcug industcy �
used by ESi for all clients)on tha basis oPft stand�ard Brand/Geuecic Algocith�m utilized by ESI for all o�its
olients,.a copy of.whtch may ba made available�for ceview by Administcator, Client or Its Auditor apon
rec7,uest. '
°�HIPAA"tne�ns.tlie��Health Insur�ince I'octabtlity and Accountability Act of 1996, as amended, anci the � �
regu(ationspcamutgatedthereundar,. � � '
"Losses�'me�ns any�and all liabilities, damages,claims,anttses of action,,judgments, demands,peaalties, i '
f ines,nssessmen ts,o o s t s,e x penses,fees(ino(uding withottt lltnitation attorneys' fees and othe4 professional ' i
fees)and other losses of any kind oc,nature whatsoever, �
"MAC"o►•"Muximum Al(owable Cost"conslsts oEa list of off-patent clrugs subject to maxtmum allowa6le : ,
cost paymant schedules developed or'selected by ESI. The payment schedu[es speci£y the maximum unit ;
iugredte�it cost pnyable by or on behalE of Client and its Members for ctcttgs an tlte MAC List. The MAC ; �
List and paymenl sohedutes ace fi•equently updated. �
"MAC Llst" nleans n tist oFoff-patent presot�iption drugs oc su�plies subject to maxiinum ceimbursement � I
payment schedutes developed or se(eated by ESI. - ;
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"Mail Set�vice Phai�macv"means a pharmacy wholly-owned or oparlted by L�SI or one or more oFits affiliates, f ;
otlier tlian an ESI Specialty L'ltacmncy, rvliere pcesoriptlons nre filled and delivered to Mombecs vin mall ; ;
;
delivery s�rvica, ! �
"Mnnuflcturer Admintstcntive Fees"means thosa�dministeative fees pafd by mttnttfflctucers to,ESI pursuant � �
to n contract betwean ESI and the manufnctucec in connection with ES['s ndmittlstering,invoicing,allocating
and collecting the Rebntes under tha Rebate progrflm. , i
"Mem�ei" melns ench person who is eliglble to receive prescription drug benefits as indtcated by or on ' ;
' ' behnlE oE Client in the Eliglbility Files. !
I�QT COR DCSTRIBU`�D O�IST TUTCS TRe1A�SO CRCT OC.CSC A�ND RXB�N p X�S CAL,P[tOPRIGTA[tY
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"Nlembar Submltted Claim"menns a papec olalm submltted by aMember#'or Covered Deugs,dlspensed by R i
ph�rmacy for�vl�tch the Member puid c�sh, , �
� "��ss-TheouQh"theans tl�e nctuRl Ingrediant cost and dispensing fee amount paid byESI foi�the Prescription . '
Driig CI�Itri wlien�the.alaltn ls nc�t�dicnted to tlie Particlpating P}iarm�cy, as sat foi�tli in tlte spacIfic
� �ParERcl�at[ng Ph�rmacy remittances relatad to Glient's alaims� . . �
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"PDL"tne�ns the PBM Performnnce Drug List,whicl�is a list of pceferrad pharmnceuticat pcodttots,created �
�nd maintnlnecl by PBM,fls�mended fi�on�tlme to time,whialz;(a)has been approved by PBM's pliacmlcy j
flnd therapeutlos convnittea; �tnd(b)ce£lacts.'PBM's caoommendations�s to whlch phat�inaceu{Ic�tl pi�oducts i
should be given favorabla consldarntlon by pinns and thei��parttolpnnts,
"�'lrtioipatin�Pl�flt�maov"meflns nny l(censed z�efall pharm�cy with�vhich ESI or one or more oE'its affiliates �
• has executad an ngreement to provlda.Coveced Deugs to Membecs,but sltall not includa any mnfl ocdea�or ;
� speciftlty pharmaay nffiliated wltlt �ny suah k'�t'tieln�ting Pharmacy, Patticipating Pharmacles aee :
inclependept contr�ictors ofBSI, , , , ;
. "Plan"maans tha self fundecl prasorlptlan drug banaflt plan(s)adminlstei�ad nnd/or sponso��ad by Client,
� "Plan Adrninistrflto�^'cneahs the Plan sponsar or commlttea das(gnatad by the Plan sponsor wlth a�aspeot to , ;
tha Plnn,.as�contemplltad by Sectlon3(lG)(A)ofERISA, . . . � ;
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• "Plan Deslen"means.drug covet�age,cinys'su�ply limttation,Cost Shace,F.ormulary(including Formu(ary i
drug,selection and ralativa cost indlc�tton)nnd othoc Prasaription Drug Progt��m apacificfltions appT(cable to �
the Prescrlption Drug Program dasignated£or Client ns set forth In this Agreement or otherwisa doeumented
, . betrvean tha PaetI09; ' , . . _.
"PMPM" nte�ns par Mambcr per montli fea, iP appllcab'(e, as detecmined Uy Administrator from the
Bligibility�'iles, •
"�'rescc[�tion Dru�,Claim" means ft Member Subm(tted Clalm, Subrogatlon Claim or clalm fol� pnyment �
submltted to ESI by a Pnrticipating Pltarmloy,IvI�11 Service Pharmaoy,or ESI Speaialty Plincmacy as n result
of dlspansing Coveced Drugs to a Ivlember, • ' ' '' 1
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"Preset�tption Deug Progr�m"means the spenlflo pharmacy banefit mnn�►gamant services and benef[t dasign
ndopted by,and applicable to,Client under thts Agcaerttant, � .
"PrCma��y Mombe[^'maans each Membar,exaluding Metnbars who nre qunlifiad dependants,
"Protected Ha�lth Informatlon"or"PHI"shall have the me�i�ing given sucl�term by HIPAA,bui Ilmited to
th�t Information cceated oe received by PBM ln its cap�aity �s t� subcontraator ta Administratoc or by
, Adminish��tor ln lts cflp�city ns n bnsiness nssociate to tho Plau.
"Rebates"ma�n retrospect(va formulai�y cabntes thlt�ce pnid ta ESI pucsuant to tha tarms of a formulary
rebate contcact negotlateci independently by ESI with n pliarmacattticnl man�ifncturec�nd directly nttributable •
to tlie tttilfzfltiott of ceetain Cov,ered Dcugs by Metnbers, Rebatas do not inc(ude Manuflchu�ar Administc�tive
•Faes; produdt discaunts or feas relntacl to tha peqaurcinant of pi�esoelption drug inventories,BSI Speo(alty
Phnemacy or the iv[all Seevica P(iacmacy; faes reoeived by ES[froin phacmaceutlaal mflnuft�cturers fo��c�re
mnnngement or othec sacvices provlded in connection avith tha dispensing of products;or othei�fea-for-seevioe
ai�rRregements�vheraby,ph�rm�cautical mnnuf�ict�u�ecs genecsliy report tha faas pnld to ESI or lts�f�li�tes foc
seev[ces t'endecad as"bonn fide secvlca fees"pursuant to faderal l�ws pnd regttlat(ous(colleqtivaly, '�Other
Phnrmn Revettue"), Suah t��vs and ��e�u(atlons, ns well As ESI's contracts with phartn�ceutic�l
mnnufncturecs,gener�lly prol�iblt ESI fl�om sharing nny such"bona flde servica fees"aacned by$SI,wltether
wholly or in p�rt,with any�SI client; BSI ceprasents ancl watmants that it wlil not enter into 1ny ngreement
with a phnrmnceutic�l manufacturer foc Other Ph�rtna�avenue wlth the Inteut to reduce Rebates, '
NOT I'OR DCSTRIBUTIOY, TII��YTORYIrlTIOV CQNTr1fY�D EI�R�IN IS COt�tT(D�N'CCAL,PROPRIL;'Z'r1RY
r1ND COiYSTT'I'UT�S TRe\DC S�CR�TS OI`�S[AND R�CBCN�['lT5 � '
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:"Reqrase, ntntives"oF n�'ncty�ne�ns sttoh�'arty's direatacs,afficers,mt��lagat's,em�loyees,�tgents flnd othec ' �
repcosentativos. ' '
"S�t-Up Focihs"�naans�ny stt�ndflrd A.dministrntoc�or PBM documetit or fact�►,which when cotn�letect nnd � �
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stgtieci by oi•on beftalf of Cl(ent(electt�onia coinmuiucfltians fi�onl Clieul indlcating CI(ent's appcoval oE n i I
Set-�Jp Fo��m sliall stttisfy tlie focegoiug), wtll describe the esseuttttl elements adopted by Cltent �'oc lts ;
Pcescrl��tiott Dcug Progeam,iuclud(ng im�le�nentltion cutes,cova►'nge ttnd Uettefik designs,nnd cllntcal flnd
firend pcogcatns,as may be nn�ended by Cl[ent front ttme to time,.
. . ►oved U tlta FDA.undec a gene►�ic i
"StnQla Source•Pcodttcts"ma�ns a pcescription tnecltoation thnt Is;(l)npp' Y
cleug ANDA np�ticatiotY and ts licensed�nd then cucce��tly mt�rlcetad Uy only oae genecic drug manufacturecs
under sepaeate ANDA apAUc�tions;or(ii)subJect to pntant lltlgatlon. I
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• "�pecialCv Product List" (for those Clients thnt nee �i c���e��exclusiVeaac open)opt n,�mni talnediat�ct � I
Pcad�icts and thete eeimbucse�nent t'ates ttader tha app' ( �
updated by ESL from time to tln�e, The Specillty Product List is t�vatlabla to CLlent upon�'equesE, i 4
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� •"Specialtv•Pcodticts" means�t(iose inJeatabla and non•ii�iebtable �rugs on t he Spoaia t t y P r o d u c t L i s t. ;
S p e c i fltry Pcoducts t ypicnlly h�va one or ►nore oP several key chacacteristics, inclttding franuent dosing I i
. - adjustments Rn d intensive c l in[c n l m o n i t o r i n g f o d e a r�ase t h e�p o t e n t i n t f o r d r u g t o x l c i t y and Increase the
�robab[lity foc benafic[al tceatmanf oUtcorttes; intansiv.e patient t��aining and•comp(tance ass tstauca to f I
fac i l t t t t t e t k i e t a p e u t i a g o�l s; t i mited oc exclusive product availability nnd dtstribtttion; speclalized product '
handling.and/or administr�tion requicemants and/oc cost in•axcess of$S00 foc n 3 0 day s u p p t y,.• . �
. "Subeoaation Clntm"means subrogation claims s ob s�ft��d overnrnent heaith cn a p og0ams,£or wh oh Client � �
of n state undec Medicaid or stmllar United Stfttes g � ;
� is deemed to be the prlmary payor by operation of ahplicable federal oe state laws, ;
' "'L'erm"shall mean tha titne peciod bet�veeu the�ffective Date and termination of this Agreemant,including ; ;
, �
the Init[al Tecm,as e#ende d by any Ranewa l T e r m{�s s u c h tacros nre defined in A►�ticle VLA). ' '
"Usual aud Customar�Price"or"U&C"me�►ns the cetail price charged by n Partiei�at(ng Phacmacy for the : ;
p a c t i c u l�r d r u$i n t t c fl s h t e a n s action on the d�te the dcug is dis�.ansed as repacted to ESI by the 1'acticipftting . �
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ART[CLC CL--A.DMINTSTI2ATXVG S�RVICCS PROVID�D �
A, Administrator shatl administer the prescent��as he�s rne may be ame ded�om t ine't time subject to all of i
the tarms ftnd conditions of this Agceem ,
a, �1.dministcaCor shall provicle such essistan�c��a�st e�Y �QyeBs Annd dependentsYelig bte nui dereCthenPinn.
en�•otlment of eligtble employees and p
Administraror shall maint�ein up-to-date e(igibllity slatus cecords on all enrolled Membecs as sub�nitted by
Citent for pucposes of n�peopriata adjudic�tion of Presa��iption Drug Claims under the Pl�n,
�, Administcator shdlt iss�te(or cause to be issued)peesccipt�Cttent,�s�vidence oE s�ch NIe betl�employ e's
anrol[ad tn Client's Ptan�nct who is declnred eligible by ,
. entitlement to prescript[on drttg card bene�"its undec the Pl�n, �
p, Upon reftsanable renuast, Adminlstratoi sttall�provide Client wtth costs proJections and analyses af i
Pcescription Drttg Claims �tnd such othec stntistical dat�, �s m�.y ceasonably be renuested by Client in i
connection with Cllent's tnanagement,oversight and control of the Plan, .
' ' " �, Admtnistrntoi• shall invoice Client 'for'th� Trnnsaation F�es and�any othertfe sepayable by Cl ent under
------_ _ --.--___ --=Pcescclpti9n-�.c�g_-Cla�ms due,p[us mont Y__- —_-_ - - _ _-- - - ----- - -- - - �
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Article IV hereof nnd/or the Client App tca ton. - --
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� . NOT�OR DCSTRIBU'CCOY, TEC�T��TGSI'�C�AD�SOCRk�CS�OC SICILYD R'�BC`IC[�ITS•Ie#G,PROPR[CTAitY
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ARTICL��I�IM bU�'I�S.O�CS�T�IVT . . ,
A, Client shal( 0e�solely responstbla £or datermining the ellgibillty o.f ita employeas �nd thair.:dependents to �
pacticfpate�nd reaetva benafits under.tlia Plnn. . , ,.
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B, Admiuistrator l�as establlshed��nd sha(l inaintain a website•locnted Rt w�vw,rxbenafits,com(tha"Wabsita") i
• •" through•which C(lent shall hflvo tha ab111ty to aceass, revise and update the.ellgibllity and etu�ollment
' information of�Cl(ent's Iviembars, Client agraes that 3t shall be solcly responsible :for effoctiug t(meiy
� cevfslons and�updates to the enroll�nent in�ormntion throttgh tho:Webslte(or, In the altea�native;tliro«gh a
•sacure fila tclnsfec protocol($p)site or vin seour.e alaatronla data ftle in a�Pormat nccap.tnble to Adnalnis4rator
� ��de(ivered to Administrator,via eLectrontc�nnll)�ud sh�ll be raspohsible for tha accuraay.of the enrollmant
Information Rnd any and atl revisions and updates to tha enrol(mant information, Upon becaming awace of
ac��ors ln the anrollmeut lnformation,Client ahall prompt(y correct tl�e inforination�s uecessaey through tlte . �
WeUsl�e or Vig.otlie��accaptable alteenattve menns provlded foc.abova in thls Artiola III.B,,Ad'm(nlstratoc �
shall not ba rasponslble foc�'casaclption•Drug C1alms payments tnade to Members or ineligibla.and foi�mer
employeas oE C(tent who ace no lo�tger oc, ff appllcabla; should uavar huve bann Matti6ecs, blsed on ;
, infoematlon that is o��was tnaccueflte;was not updated oc not updated on a tlmaly bns(s,or othe���visa revised �
� as requi'red by Client ot�thls'Agreemant, Admlhlstrator agrees that•r.e�isloas�ncl updatas to the anrollmant �
br�other applioable�vtamber'or.Prascriptfon Drug.Claim infdPitiAtion made as desorlbed a�ova will ba �
consldarecl For purposes of thls Agreement revisad an�uptlnted withtn•48 N�oucs d£.►�eaeIpt by Administrator ;
of wcttten notloe�'rom Client of auch�revlsion.o��update,��'oc emergancy revlstons and i�pdatas that need to
ba effective on.tha same dny end inot tlie next business�dny, Cllent must�c�ll�In or Pax sucli cav(stons and
� updat�s to AcIminlst��ator durin�Administrator's normal business hocirs�nd follow up wtth Administ��ator as • ;
approprinte to ensure such revIslons�nd updatas became affective on tlie s�mo day to tl�e extent reasonflbly
possible, In ndditlon,•to the extent such emergancy cavlstons ara communicflted by Client to•Adminlstrator
or�lly(e,g,,v(a talephona),Gltent agrees(�nd it sha(I be.Clietit's sole rasponstUlltty)to•provida Administcator
wlth a writtan dascription in re�sonable detail setting foi�th the.emergenc.y revisIons�and/or updates within�8
houcs aftei�such emargancy revls[ons/ttpd�tes wece ocally communlcKted by Cllant to Adminlstrator, i
� C, Administrator will provlda unIque nlphanumerlc pnsstivords(" asswords'')to Cllent that wlll parmit Client �
to nccass,rsvlse,and upd�te the enrollment lnfocmatlon on the Webshe, Cltent wi(l distelbuta tlta Passwords .
to the 1ncllviduals nam8cl on t(ia list of authot�ized usars(the'.`Usacs"),wlitch(s lncluded Ia Sectiou A of the
• Client Appllc�tion. C(Ient Is casponsible for.nll uses of the Passwords,whether or not authorized by Cltent. ��
Cilant Is cesponslble for maintalning.tlie coii�dentiality oEt(�e Pass�vords and ansuring that tlta Users maintaln ;
suoh confidantiality also, Cliant�grees to 1�nmadIataly noti£y Administcatac of flay ttaautho��izad usa of tha
Pesswot�ds o£wh(cft Cl(ent beoomas a�vat�o oc has a t'easonable b�sis to balieve to h�va occucrecl, Cliant sh�ll '
Indamulfy, daFend aad hold hacmless Adminlsti��toc and lts Repeesant�tivas from�ttd,agn(nst �tll Losses
easultIng 4om,arising out of oc re(eting to�ny unnutlzorizad use or ftccess,exce�t wliera such I,osses result
solely from the willfii(or[ntentional aat�or mis6onduct or negliganae of Administrntor, To nmend ttte list oF
� Usecs,Client must notify Adminlstrltor in writing of such nmendmant(s), �Vithltt ona(1)buslness day nftet�
the business day on which Adminlstcator cecalvas suoh amendment(s)in writing from Cliaut,Administcator
wlll denctiv�►ta the Pnsswocd(s)issued to any deiated Ussr{s)nnd will nativate�nd issue new Password(s)foc
any naw User(s) idantffied by Client, NotwithstandIng nnything in tl�is Agreoment to the contr�ry,
Administrntor shal!not(�nd Client ncknotivledgas�nd unclecstands thnt Administrafoc shnll tiot)ba llable or- �
otherwise held responslbie�for fi�audulent Prescriptian D��ug Cl�i�ns submitted by any lYtembar,nthei�third
. p�rty aoting or p.urporting to act on any Mamber's belinif or any unnuthoclzed party using flny N[ember's
presoriptlon dcug,csed,infocmation or otherwise,
D, Cliant expressly undecstnnds,acknowledges nnd agrees thflt any nnd all informatiou,datn,documaut�tion ae
software dlsclosed by Administrator end/or PBM In kha coucse o£conducting Its bus(ness and peeforming
adminlstr�tive nnd ralated saevices foc Iviembers nnd/or Client are confidantial nud propriat�ry to, nnd a
valulbla tt�ada secret of,Administrstor and/ot�PBNI and th�t any dlsclosuee or unauthoclzed usa p thnt(s,aity
usa otlaec thnn to avalu�ta Acimintstratoc's perfnrmanca uneler this Agceainant-witl causa (r��ep�rnble harm
. nnd dam�iga to Administr�tor�nd/or PBM, SubJect to !aw and the provislons of this Section IfI,D„ Cliettt
shell not, dlrectly or ind(rectly, t�elanse oe disclosa oc othertiv(se use or �ttampt to use nny patiant�specific
prescription inform�tion, trade seccets, peopr(etnty softwAre�nd technlcfll processing, fin�neial, pricing oc ,
NOT rOR DISTRIIIUTIOY, TEI�IN�0121tiIt11'TON CO`ITAIN�D FIGRCIN IS COYCID�NTTAL,PROPRIGTARY
e1�Iri CONSTCTUT�S TR:\D�S�CRCTS OP�SI AND R.�DCN�CITS
, 7
,
ot(�er confidenCill infocm�tion o�Administrator andbr PBM o�tniued�y Cllatit from Adm(nistrntoc nnd/or �
PBM(1�eg�rdless of tlie eeasou such informfltton r�vns providod o�•oblaiuecl) to nny other p�i'lj/oi' for�the �
bene�t vf�try ot(ter p�rty�wlt(tout tlta nrloc�v�'ittan consent of Administcntor nnd/oc PBM,wlttali cousettt m�y
' be wiChhetd by Adu1[nistt�ntor�ndloe P13M i�a thefr sola��i�id�absolute dtscretian,Any Confidentt�tl Infonn�tion
sh�ll �t nlL times rem�in the exclusiV� �ropeety 9E the Party p��ovlding st�ch Informtition nucl slintl,`u�an + :
rec�uest,be retucaed to the P�rty pcovid(ng sucl�Confldeittial InPo►��n�ttlon,If disctosttre oF any Con�dential , �
� �' 'in�foeuintlon is�•enutred by taw;nrioc to disclosuca,the Pni�ty uE�on wliom suah request foc disc[osuca is made
' �shalL notl�'y tl�e Party wha peovided the Confidanttal In£ormation nnd the�'nrty wlio pcovlded tlie�onf'idential
� Infocmatlon shall liave five business days in wlYlcli to ta(ce sucli action as�il deems nppropclAte fo resist suclt �
� disclosu�'e,and tn tha event it tllcas no suoh action,the Pacty u��on whom t(ie cenuest for disclAsuc�was mada � i i
may disvlose tl�e Confidential infoenintion witltout nny linbllity to tlie Party wlia providad tha Confidential �
�
Informatton. �. � � ` � � ;
. , .., , , ! ;
. E, ' Client ax�cessly cepcesents flnd w�rennts t(iat(t)tt hns provided notice to Its em�loyees nnd their dependents • + �
re gnrdin g pactic(pation In the Plan niid Gl[ent's dtsclosure or anticip�tied dIsctosura of em�loyea.oc clepenctent i I
�..� .
c o n f i d e n t l�l l n f o rmatiou ta Administcator in connectlou with the Plni��►n d app liaa b le law, an d u t t h n s
o b t at�ed all re qui�•ed.eonsenfs and/ac otk�ec•appcovals oc authocizations(eit itar In wc l t itlg or t hrou g h o p t-o u t I i
� proceduies)fi�oiii eaoh Pctntlry Metnbec or,if applicabte,eac h denen den t Men�ber or o t h a c a p p l i c a U t e p�c ty, �
� • cegncding such dlsclosuces�'to Adtninistrato►�foc pucposas of this AgceernenC nnd the seevtces provtded to � �
•Ctient and Mambers het�eanttac,ftnd relAEing to tlie iise and�disalos�u�e oP information by Adminlstcator or : i
•othec npp(icable:ptileties;tncluding without lI'mitntion�EHC under FIfi'AA 4s•permitted under this Ag�•eement . ; ;
� oc ns�ofherwise re�sonably necessar'y to e£feat Rndlor carry out the purposes Rnd intent of thls Agreement�nd •' i
l(ie secvices to b'e pecformed�nd cendared by•Administratoc;PBM, Client or other np�(icabla third par.ties i I
with cespeat to thls Agreem,ent, Fucther,to the axtent npplicable,.Ctieut hereby authortzes PBM io contcact :
• • with ph�cmaceutical companies for Rebates ns a groitp purahnstng orgAnization foc the Plan, PBM nnd/oc ; �
• Administc�itor mny use,disctose,reproduce oc adapht�iformntion ohtained in connectlon witli tlits Agreeinent, ; i
including Prescrintion Dcug Clatms as well es eliglbtllty infocinaCioit,which ts not ident[fi�ble on a Member , '
basis, PBM and/or�Administrator shalt rn�iintain the confidentia(itY�of this informltton to tha axtent required :
by applicable t�w and may notuse the infocmatlon In any way prohibtted by applicable lt�w, �
;
. �
F, Shot�ld Cllent identify ecconepus, tnlstalcan or Incocrect Prescriptipn.Drug ��a�mg p�Yments made by , i i
Adminlstcatar, refiinds ln the amount of nny such erroneous 1'cescription Drug Claims paymauts to Cliant
m shall be m�de by Admtnistratoc within�30 days aftec cecetpt by Admii�istratoc of wcitten notiee from Cliant ;
idantifytng sttcli errocs aud•pcoviding reasonable do.cumantation to support them. ClIant acknowledges, ; ,
covenants and ngrees thlt such cefunds mnde by Administcnto�`Rs proVlded ii�this Article LIt,F sh�ll be the
� sole and exclusive reriiedy oP Client nnd any Member ag�inst Admtntstrator,Its Repeesenfatives or any tliird
'pai�ty(includin�PBiv�resuttitig fcom any sueh erroneous,tnistskan or incoi rect Presociption Drug Claims :
. p�yments m�de by or to Adminlstratac, and Client furthar.eovenants and agcees �to hold harmtass nnd ;
• ind�mnify Administratoc nnd its Rep�•osent�tives Eor any Lossas beyond such ce£unds claimed by any p�rty , ,
from Admintsfcator, Tha Pat•tlas aclrnowtedge that Aclministcator may seel< to cecover nny avarp�yments � j
from the Ivlembers, the providers'of sarvice oc any othec pflrty u��justly enrich�d as a result o£sucl� ; ;
o v e c p a yinents nt an ytime aftac notioe or awaceness of any such arroc. ; �
. � i
G, Without lim(ting the geuei�ality or scope of any other pcovision oPthis Agreement,Administrltor shall not ba � ;
hald responsible or llnbla foc nny perFormance stnndaed oc obtlgation ranuirecl oF lt Itereuudar if Ctiant(or i i
Cltent's designee(s)) oc any Member falls to provtde Ad�nfnist��atoi� wlth aecurate, tlmely and complete � ;
Informntton as nacessary and/or requ(red to meet nny such pecformanoe sfandard or obligatlon uuder this
Agreatnent or otherwise. ,
ARTICL�IV-G[NAIYCCAC.ARRANGCMGNT �
A, Administrator wltl invoice Cltant every two(2)waeks for tf�e applicable Fees payable for the previous two �
(2)weelcs. Admitttstcator witl invotce ClianC for the Transaction Fees,as applicable and regardless of the ;
' ' ' amount of Pcescription Drug Cla(�ns activtty,if nny, A(I Invo[ces will ba dua nnd pnyab(e 7 days from rece'ipt
_ _ _ ___ _.________ by Glient and slialt in no event be received by Admin[strator later thnn the due date stated in the invoice. -
Refer to Article V,below,�oc ru[es npp[icAble��I�te paqmEnt of invo'tees; Client sh�ll=not(and a�LcnQwledgas__--___-__-_-_ __
lYOT�OR D[STIi[BUT,Np COVST[TUTCS TLZr�.D�SO CRG S OC SC AND RXBCYGC TS�A���R4PRCGTARY '
8
th�t It she(l not)have any right to offset nny.disputed amounfs or�tnounts due and/or payabla oa�purported
to.be due�nd/or plyable Pi�om Acim(nlstrator�nd/or PBM fi�om Any p�yments of Client exaept fls s�ecifically
eppcoved In writing by Adminlstratoe.
• . ;
B,• Administrntor m1y charga Cileut adminlst��atlon fees(�)pei�Metttber,employee par ca(endar month pay�ble
on a monthly basfs,and/or(b)per Prascriptlon Drug Claim made by Membars pny�ble on a bi�monthly basis
(collectively,tha"Transactton Feas"), The xr�nsnction Faes to be paid by Cfient to Adminlsh�ator t�ndac this
Agreemetit are as speclfied In tha Client Applleation, , ,
C. ClIent acicnowledges and i�nderst�nds that PBM, througli Its contcnctunl nrcflngament witli Adm(nistrator, ' !,
gttarnntees cet•tain Rebates es set forth In the Cliant Application, xha Pat�tles furthar nolu�owledge snd � 'i
understand that no Rebntes or simila��dlscotmts or payments will be paid to tfte Parties with raspact to t►ny '
Prascription Dcug C(alms reimbursed an a unit basis by Iviedlcafci sgenctas oc pthec federal oe state.healthcare
pt•ogr�ms. ;
' i
D, Client acknorvladges and is �rvaca that Admtnistrator, pursu�tnt to its conti'ftCtIIA�flgCeemant wlth PBM, is � I
palci by PBM nn ndmtnistrative secvices cradit p�yment per mflll and ►'OtRII Pl�esoeiptlon J�i�ug Clalm I I
ndministered by Admintstcato��on bahalEo�ench Memboi�ln tfie Plan(tha"PBM Sarviaa Credi");.��ld(b) j
may n(so raaeiva fi�om PBM a one•tline par Mamber ianplamentation snd marlceting aradlt payniat�t ciaslgnad
to reimhurse AdminIstrator foc sotual expenses aud out-of pooket costs Incurred by Adm(nistratoc to tnacket
• Aud impleinent PDM pcoduats and servIces�and trai�sltlon Client (and its Membees) to PBM's bettefit
offarings(the`� n plamentatIon Credlt"). It shnil be Administrato�°s responsibillty to obta(n and collect such •�
�'BM Serv[ce Credit 1nd the Implemantation Credit directly from PBMand C(tentshall have no responsibility
(paymant or otlieewlse)with respeat to stioh ceadit dtie to Administrator, The Pneties acknowledge nnd agree
thflt (�) Administrntot�shall be raspons(ble for any and all teansition and Implemantntton costs it Incurs �
� (excluslva'of nny Implemantation Ccedit recelved by It as desct4bed nbove)witfx respack to tha mnticating nnd
tcansition of Client(And its Members)to beneflt offarings ndministeeed by Administcntoe;For C(iant,Rnd(2)
Cllent shall ba ��esponslbla for any nnd nll trt�nsltion nnd iinplemetttatlan costs it Incurs witli respect to the I
transit[on and implementation of suah baneFit offarings, To the extant appllcablo to tha Parties, it ls the
. Pacties' iutenttoti that, foc purposes of tha Pedera( Ant(-ICicicGacl< Statute and.any reqtiieed govsrnment
repoi�ting, tha P�M Serv(ce Crodit �nd.Imp(ament�tlon Ccedit shal! constltute nnd shall ba treafad by i
Adminlstratoc and Cllent�ts a dlscottnt aglinst the pr[oe�o,Fdrugs;wlthin tl�e meaning of42 U,S.C.§ 1320a- '
'1b(b)(3)(A). By exect�ting thls Agreamant, aach of Admfnisti�ntoe and Cllant l�ereby agrees that tlia PBM
Sorvlca Credlt and aiiy Implamontation Ccedit shall be so treltad aud repoetad,as and to tha axtent applicable
to eloh such Party.
C, Ctient Aalcnawledgas thAt Administrltoc mny, ln lts sola disci'etion,oom��ensata bcokers �nd/or thlyd-p�rty
consult�nts fl�om monles reoaived oe duo to be received by Administentoi�pursuant to the peovIstons of this ;
Agceament, � ,
F, Client exp��assly ac!<nowledges, agi�ees, understattds aud confirms that (I) Administrntor racaives oc•n�ay
raceive fees, Reb�►tas;comn�lssions, pflyments nnd other remunecation fi�om and throu�h varlous sotu�ces,
includIng Client�nd PBM, (i1) Adminlstcatoe has dlsclosed to Client hereitt th�t it��eceives or may recaiva
• such fees, Rebates, commisslons, p�yments and other remuneratlon fi•on� suoh soueces, nnd (ili) upon '
. censati�ble ndvance weltten request by Client tUco�igh its autliocized Representntive,Administrator ngrees to
provide Client w(th flny edditional inFormntion or dflta within Administrator's possession oc contral,
inoluding wlthout 1lmitation spec(fla payment or finnnoial lnformation, ref�t3ng to this Agreement nnd the
terms hereof,both ln connection�vlth the axecution of this Agt�eement by tha Parties.as oFtl�e Bffective Date
nnd theceafte��during tha Tarm of this A�raemant,whether oi•not lii connection with ftny filing with respect
to Client's platt or otl�orwlsa required of Client or the PlEin ttnder appllonble Inw, pt�ovided thlt such '
, informat(on wlll ba made avallab(e by Adminlstcnto��at mutually convenient�nd reasonable timas, intecvflis '
and pinces�nd at no out,of pocicet cost or expense to Adminish�ator, In tha avent any informfltion reques.tad
• by Client pursunnt to sub-section (Iii) of thls Article IV,F ts sttbJeet to an obligfltlon or covenant of
confldentiality, Administrltoi•agrees to e:cercise comrnarcillly ceasonable efforts (p��ovlded, ho�vevac, that
such efforts shnll not a�eclulre Administentor to incuc�ny out-of�pockat cost ot•expensa)to obtain permission
oc consent to disclose to Cllent any such infocmatlon in Administrator's possesslon andlot�controi,subJact to
YOT TOR DISTRIBUI'TON� TfI�IYI'OI2aY[AT[OY COVTr1INCD E1�R�C�(TS CpVI'[DC�lTIf1L�PC20PRI�Tr1CtY
f\IYD COYST[TU'I'�S Titt\D�SCCR�1'S Or CSC e\ND IL�B�iV�.�ITS
9
t
f
' i
, . � i
i • �
I
' ' �
Client'sexaoutioci of a con�dantinlity ngreeutent�vith Admit�.istr�toc nnd nny otl�ar a�plic�tble pncly in a focm
. reasont�bly�tece�it�►ble to Aduttnistcator�ad nuy snolt othec applIa�b(o paity rlciuttuist��ator tn�ty pay Clteut's �
benetit ndVisor a servtce fee w(lich may�e in tlte form o�'n eom�nlssioit, maciceting fea, incentiva Pt'other
nllowlnce� Natwltl�stt►nding nuy��covisiou of tliis Ag�'eetnent to tlie contcacy,Admlk�Istcator sltnll only be
responslble foc pnyment of Rebntea�'Co Client pursunnt to flte�ter�its of this Ag►'eetneut lf sttch Rebates t�re ',
� Rctunlly received by Admin(stcatoc dui•tn�the'�e���n of th'is Agt'eetnetit.T��no eveut sh�ll Admint$tr�tor be i
� obltgafed tio pny Rebates ro.Client unlil�Ad►ninistcltoc reCOlves payutent for tha sama Rali�tfes fromPBM,In I
Client focfalts ,
tlte event CtienC ta[mivates the Agreoment ouEsi�e.�tae�l`im��o a on��Clte it's�beha Egafter the d�tle oF sucl� '
the right to ceceive Rny Rebates eeceIveci by �
tet►nin�ttbn, ClienC �alcnowledges that Adm[�iistratoc shall not be obtlgated to �ay Clieut nny Rebates '
des
criUed hacei�i until this Agreement ts sigtted by Cltent. •
� I �
" A.RTICLG'V-�.ATC PA'SIiVIGNT � i
, ,
A, if the Fees fot Praseciption Drug C[aI�s,fl��b t���ient�aiid received bytAdm nistcator by tlne due dflter�ha � I
provtdad for inthls A.gceement ate n .p Y ,
' applicable invoioe,then"Cl(ent shall nay'Adtitinistrator a service cl�arge eqttal to FiVe.percent(S%)(or the
inaxlmum a�»ount aLlorVnble uiider applioable law If such amottnt is less than 5%) of a(L tl�en��st due
amounts,,Zn addition•to�ucli'sarviaa'oharge,nny pAst dice amounts(lnb(usive oEsettiice charges)will incuc �
' Intecast bagtnning on tha due iiaEe nnd dol}t(ntti�ig tltereaftec untit fully paid at a rate of ten paccent(LO%)per
annum (or the maxini��m 'smount ftlLowable ttndei• npplioabLe law'iE such ftmottnt is less thnri tan peccent � i
�LO%��. ' + ' � �
Furthermoca, (f paytnent of the Fees fot Pcescciption D��ug C(�ims, the Tennsaction�Fees o� any other f j
B. ; ,
appLtcabte p�y►nents plyable by G l ien t nre n o t r e c e�v e d b y t h e d u e a a t e .a f t l i e a p plic�ble=invoice, ' '
�Ac[tninistrafot� tn�iy, at'its option, ceasa or sitspend tlie p�ovision of administrat[ve services pcovided by t ,
Administcatpr under thts Agreement,;�n d danc tiva te �i l l p r e s c r i p t i o n d c u g c a r d s 'i ssued to the Mern bers. ;
Cocisutt Articte V[for Administrator'.s option t�nd right to ter(inate thi�Ag�em licablensecvtce�chalrgesf and ' � �
to�make full anci timety plyment oE such chaeges and'fees includin an a�p I i
lnterest)to Admtnisfei�tor. . , � ; 1
C,• If at ftny time Admtntstratoe reasonably�detecmines fhat C(ient may have dtfficulry meating its financiai ' ; '
comtnitments under this Agreement, Administcator m1y cenuest from Ctient financiat �nformatton, j
reasonabte assurancas,or both,satisfaotory to Administrator es to Ctient's nbility to ttmely and fu(ty meet its ;
commitments nnd responsibtlities hereunder. Such assucftnces may (nctude, withaut Llmitatian, ;
Adminfstratoc cequ[ring Client ro make a depos(t in such amount reasonabty suffcient in Administratoe's i
,�uclgment to secura Cllent's'pay�ient oblig�tions, I£Cltent provides Administratoc•wttlt sucli a deposit,
� Aiiministcator.may apply the depos[t to past due balnnces and shntl retucn tha rem�ining deposlt,Lf any,after I
the termtnatiou oEthis Agceement nnd tlie payment of a(l lmounts payable to Adminlstratorheraunder, Any
depos'it m�de by Client heeettndec shall not be deemed a Plnn asset . . ;
D, Adminlstratoe's fntluce to charge or collect a seivice charge�nd/or intecest from Client shall not waive oc �
otherwise liirit in�ny cespect any futuce cight of Adminlstratoc tindec this Agreement to oharge or coilect a
seevica charge nnd/or inEerest Erom Client, .
ARTCCLC VI-T�CiNC AND TC[LNCCNATCON
" A, The initinl taem of thts Agreement n���C°�meriod of ona`l(1)yee r�nfter�the Effecdvte D�te�(the"Initial tTeinne)
soonerterminakedaspcovidedlie�ei , 4 p
• Untess ettlter Pacty glves the other Party written notice oF(ts iatention to tecminate (gtven in the manner
' presccibed in Article VIiI.B below)at least ninety(94)��Y3�n ft�v�nce of tlie axptration of than appticable
Ci�itial Term or Renewat Term(ns the casa may be), fhe Tecm of fhts Agreement shall automatica(ly renew
and extend for�tdd(tional one(L)yeac reaawal teettls(ench,.1"Renew._ a�T�rm'�)W►thout any addit(onn(�ct �
� � on the pact of elther Pt�cty(ttn(ess sooner teetninited ns provided here(n and subject ta ths consequences�of
- - - - -- - --
_
- -- - -- - -- - -- _ - --__-_ .- -_ _ -=_-- _ == =
- flny such'ter�riir►ation),==Aclmtniste�toe-may-tecminat� this_Agreement �t any_time If its contraa ua
lYOT rOR D[STRLBUT[ON. OYS'L'ITU CSITReOD�S�CCt�S OC C[AND 12XR�tY�CCTS����e�OPRIGTACtY
AND C ��
arrnngement with�B1VI termtnates by glving 1t le�st ninety(90)d�ys.pcior wrItfen notica oFt(.�e terinination
of this Agreamant to Cllent, � • ;
B, �ither Ps�rty may terminate fhls Ageeement upon wrlttan notica to the ofhec Party if,as n rasult of any change
in law,the rlghts or obllgations of tha requesting Party wonld be matei�Inlly and advacsely af#'aoted, Any such
tacminntion sliall be effeotive on the d�ty(nunedlataly preoeciing tha offectiva date of such olt�nge (tt(ayy,
• subJect fo the,provisions of(rnniediately fol(owing senteuca, Notwlthstanding the.foregaing sentence, the
Pai�tles hareby �gree to tise prompt, good fnitl� efforts to cenegotiate the terms of this Agreamant, If tlte
Parties successfully concliida sucli.negotiatlons�prinr to tha affective dlte of the change in�law, thls
Agraement sl�all not terminata and shnll be nmended to raf(ect tl�a nagotlated terms mtttually agi�aed upou by
the Parties, In tl�a avent the Pa��tles ace un�ble to suacassflil(y conalude and reach mutttal agreement througli
suoh good faith nagotiatlons,thls Agceement sl�al(tarminate ns providad ftbove and haraln, . ;
� � � �
C, On attd nfter the data of tertnination of this Agreemant, Adininistrutor eliall.be obligated to complate stto(� '
administ��ative servIces provided fot� ln thls Agt�ea'tnent ns hnve been commenced peior to Eha clata.of �
termin�tion. Thecefore, PresccipNon Dt�ug Clalms Incucred or reported ftt�ec tha date of ferminfltion are the
sole responslbility of Ctiant and�re not the responslbility of Adminlstrntor, Furtl�a��tnoee,terminatian of thls
Agraament shall not�ralie.ve Client of.lts•obllgatlon to p1y Adminlstrator.for any outstanding Prescrlpt(on .
Dcug Claims, charges, fees (including wIthout llmit�tlon any appficable seivfce oharges), interest and
ceasonnble collection costs and attot•neys' fees incui�red by Administratot�nssoo[aked wtth such oollactions, '
Upon terminatiocx of this Agraemant,Administrntor shall not hflve�ny ob(igatiou to ti�ansItion Claims files ' '
�nd/or hlstories(or othar lnformation hcior to,such information baing socubbed ofPBM's or Admhtistrator's '
confid.antial,propciatary,oi;trftde secret lnfor�natlott)to tlie extant thflt they cont�in PBM and/or Administrator �
cost,peleing ancUoe other proprleta��y,�n�nclal infor�n�tton to Cltant's new prasci�lption benefit tnanager or ' I
�ny othec thicd paety, �Vtth eespect to any tiles requested by Client or Its new pcescclptlo�beua�t mnnager, , ;
• any associated chaeges.sh�ll ba the,easponstblllty of Client, �. , . � �
�
D, Aclinlnistcator m�y,tn its sole aud nbsolute d(scration,suspend performance oc terminnte thls Agreament flt I
any t3me without giving flny advnnce notice,wt�itten or otherwlsa,to Cliant(ot�to any othec parly)and without i
pen�lty or Il�bllity for eny Lossas If(1)Cllant fails to make tima(y payment of tha F'ees far Prasorlptlon Drug '
,Clnims,tlxa Transaotlon�ees oc flny othe�'ttpplioabla paymenEs owed to Adminfstcator 1�z Rccordnnca w(th the
tarms and condittons of thls Agreemant oc, If requested, doas not provide a deposit to AdministrRtor as
pcovided In A�•ttate V,C�bova,(2)C(lent malces an asslgnment for tlia benefit of aredltocs,(3)Cliant[s tlie '' �
suUJect of a voluntary or involuiitttry petition for bank��uptcy oc 1s ndJudio�ted insolvent or banla�upf,or(4)a ; �
receivaG�oc h�ustea is��pointed for any poetion of Cliant's prope��ty, � ; (
� E, Termination of thls Agt�eement shail not tertn(ti�ta eitlier Party's i�iglits and obligations under ArtIc(e ITZ,C, �
' Article TCI,A, Acticle IV (Fln�nciaf Areangsmant), Articla V (Lflta Pnyment), Article VI,C, Artiola VIY i
(Indemnifle�t[on),Article VLTI,B(Notices),Article VIII,C(Applicable T,�w;'Vsnua;Consant to Jw4sdlctlon),
Acticle VIII,D(�ntice Ag��aement; Constructlon),A��ticle�/IIT,F(Relatlonsl�ip of the Parties),Article VIII,I :
(Confidential and Propcietary Informntlon),'Articla IX(BRISA, C013T2A&KIPAA Dutles) nnd tlie Cliant �
App(icfltion(t�s nmencled,If npplic�ible), nnd�ll suoh rights�nd oblig�tions shnll express(y sw�vlve any such
termination,
. �
ARTICLC VII--IND�NTNZ�'ICA.T[ON AND�NSURANC�
A. Bxcapt as otherwlsa pcovided In thls Agi�eement, Client�nd Admin(strntor ngt�ea to ktold h�rmlass flnd to
Indemnify each otlier nnd each other's Raprasantativas#i�oitt nn<i agnlnst�ny Losses arising out of or related
to the indemnlfying Party's breaeh or violation of this Agi�eemant.
B, Cllant seknotivleclges tliat;(1}Adm(nlsti�akor�nd its Representatives do not bc�c any liabilIty forLossas undar '
the Pl�n;(2)Admin(strntor nnd Its Rapresentatives do not insure noe undeew�4ta the(iability oEClient undar
tlte Plnn; �nd (3) Adminlstrntoc's execution of this Agraement shall not ba deamad ns tha nssumption by
Aclministrntoi�or tts Reprasantatives oEnny responsibilities,ob(Igatlons ot�dut(es other than thosa raquired oE '
Administcatar pucsuant ta the express terms nnd conditions of this Agceement, '
NOT L'OI2 DISTRIBUTCO�, TII�INI'ORY[E1.TION CONTAIY�D I•I�ItCIN IS COYrIDCiV'CTAL,PROPRI�Tr1RY
A,YD COiYSTITUT.�S T2tlDC SCCRCTS Of CSI AiYD R�CBC`f�T'ITS
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�G. Client�fiict(ier��gcees to kiokl liticm(ess �ncl Co iudenuiify Adi�nt«lst���lbl��ncl its R.e�cese�tt�►tives fcoui �nd � j
against nit I,osses�rising out aF oa�in connectio►�w(th(1)Cllent's deF�tult iu�the pe►�focmncice of nny duty, � ' ;
� requlre�ne►tt o►�a�ligltion oPClieut unde��tliis Agceemenl',the Plau oc other4vise otived to Cliettt's am�loyees I '
and=tl,letc t{epeudeilts (4vltetltet�or not in calatton to tliis Agreament dr the Platt), (2) the tiegligent nets oc
� a►nlsstohs of�any'Rapresentntive of Ct�ent(wltethec.oe not in'celation.to thls AgcsanienE o4�-the Plnu)or(3) �
any:t'opcesentations;�warr�nttes,'covenants or stateinenl•s,wliet[iec wrltton,oral'orothacwise,made'by Cltent � j �
to 1 t s R a p r e s a n f a t i V e s nnd/oc their cle pande��ts. . �
p, E�ch Pacty's 11i1bility to the otltec Pnrty and its Repcesentati��rth s,bte�ch o Violflt an ofe octfli(tatre��to i j
pcoxinlate Losses�oattsed by o►'�cising f�otn fi�� i��demnifytng Y ; ,
, pocforin, nny tertn ot°�r.ovision ofChis A$rea►nent. In'no evant whntsoevee shnll eitttec Party oe nny of its ,
Re��cesetitatives 6e ltable fot�t�ny inctirecf,speci�l,[iiolctental,consequential,exemplary or punitive d�n�ngas i
([n e�eh aase,to the£ultest extant ttiat sueh damages may ba waived by coutract under a�plicable law), ac
� '�iiyclamages for•lost pcolits rel�ting�to�.relationship with ft third pacty,liowevar oflused or arisIng,whetl�ec I :
.� o�•n'ol•ttiey have been infarmed of the posetbillty of theic occurrenea, f �
��r, � ,Adm[nistcator shall at�i(l titnes durin�thepe►focmnnoe oFtliis Agree ni t cne to ttme,tbe rev sed by Clienty � I '
� � the attadhed Tnsuc�nce Schedule,ns suoh Insucanca Soliad�de may,f�o ;
, , . ,. . ' I �
ARTCCL'G VIII•-�G�N�RAL�'ItOVISI0N5 ' • •t ` '
� � . ' �wlthb�it rior notfce to any MemUer, i ; ,
A, CCianges iii Agreomori E. T h ts A g r e e m e n t m a y b'e a m e u d e d�t a n y t t m e, p ` ;
by niiitunl wrttten agreement executed'by Adminis'tratoc(thcoiigh tts dtil'y'�ttth'o'cized Representlt(ve) an d �
Clienf(theough [ts dulq ftttthocized lteprasentat[ve);' No emploXee, agent or othar Represantative o£ I f
AdministrntoG• is autltoi�izad to ameiid or vac�the terins and coiiditions of this Agceement oc fo make any i
agreement oc protnlse not specificatly contained heretu or.to waive any provis(on heceof othec tttan by the , �
means presccibed�bove In this Art[c1a VIIT.A, , . � �
B, Nottces, Any notices to b�given hareundec sha(L be deemed su�ctenCly'givan when tn wrtting and (1) ` I
• actually delivare d to t he Par ty to be i t o t i�0 d a r;(2)pl�oed in an enve(ope dieected to the Pacty to be notified i �
nt the following addresses,and depositad in the United States ►natl by certifed.oi�registered m�il, postage ' i I
• prepaid: ' • . : , � �
, �
� If to Administcntor ftt; I�cBeneflts,Tna, , �
' Atfn,Legn( � . .� ,
� 3�00 CoEonnade 1'kwy.,Ste.600
� Birminghnm,AI.�35238 ' . .
If to Client ntt � City of Dubuque Iowa
� • ' Attn:
50 W. L3tli St, . .
. Dubuc(ue,IA 52001 i
Such addresses may be ch�nged by eltherB��Client sh tt acC as�agent of it employees(a d sttch amployeese '
otherParty ns peovided in this Articte V[CL ;
� dependents,As and whenever appltc�tble)to receive all notices to them hereunder and to notify the employees i
� and their pn��ticipating depenclents�ffected thareby. Ct also sh�ll be tha i�esponsibillty of Client to notify�►ll
employees(and their dependents)�af the expication oc tecminattoa oP thts Agraa�nant by a Party pursuant to i
Article Vt or otherwiso. In the clss oP changes[n,or terminntion oE,tha Agreement,notlae to or by Client
shall be deemed to constitute notice to utl employees of Client and their dependants,and no further notice
need be given by Admtnistrator to sny etnployeo or dependent in ocder to effectuate any change [n, or
termination oF,thts Agreement or the benefits or coverage provided for heraln ac mnde avaliable hereby.
� � � �, Appl[cnblo C;nw;Vouue} Consent to Jui�iscCtetinn, This Agreement shall be governed by,and co�istrued
— � ------ '
------anc1 i�terpreted in accordanca with,-the-inteenaLl�vs.of the State of Iowa without regard to conflicts oE law
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principles thereof. The Parties agree that tha exclusive venue foc any action,s�ut,clatni,coun�e��ct�iiiir,cross�_ -°= ____ -
IVOT CO[i D[STRIBUTI0�1. TT�IC X TUTCS TItAD�SOCl2GTS�OC CS[AND R.�CBC CC[TS Cr\L,C'I20PRI�TAItY
r1ND CONST t2
claim or otharwise witli re"speot to tEtis Agcaement and/.or tl�e subJectmatter haeeoPsliall be in t1�e Iowa District �
Court for Dubuque County and eaah Pnrty]cnowiiigly ttncl voluiitarily heneUy submits nnd cot�sents to�the
Juclsdictiou of said court ovar suah Party oud hereby exprassly waives �nd ra(eases any aqd all defenses,
claims oc otl�er rigl�ts or remedies it mfly h�ve or inay assei�t or aUage to astablish th�t Jurisdiotlon or vanue i
in said court ls fn ecror,Impropec or otlaerwise invnlid In nny raspect. As such,each PArty agraes thnt said �
court shall have inpersonnm3ui�Istllctlon over if and consants to secvloa ofprocass in any tnanner authocized �
by Iowfl]aw, �ach Party furtlter covenants tiot to stta ths othar Pacty(ar sucli otharParty's Repcesentatives) '
in any coui�t or jurisdiction other than said couet, ;
D, �iifiro Agreoment;Constructioli, , � ,
1. This Agceement(as ciaflned in Articla I(Cactai�a Deflnitlons))constitutes the entlre agreenrent and I
undacatanding oF tha Partias and suparsedes any prIoc oral oe�vritten comniunlafltian batwean the
Pachies wiCh t�aspect to the subject mnttee I�e►�eof. All�Recitals to tlils Agraemant sat forth abova ttncl
� nll E�tlblts atfachad heceto sre hereby inco►•porated Inta and made a pact of tl�is Agi�eament, ;
2, In the event any.provislon of this Agreement shnll f�a determinecl invfllid oc iinenforcelble, suah
Inv�lidity, o��unenforaenbillty.sl�a(t not tnvalidate oc rettder unenforcaable the entira Agreement,but '
rathet�thls Agreernent shall be construed�as 1Pnot contt�infng tha hnrticul�c Invllid oe unenforce�b(�
provisfon or�rovisions and tlia rights and obllgations of the Pacties sh�il be construed nnd anforced
� nccordingly; pi�ovidad,that If tha invalldatlon or unenforcenbility of such provls(on(s)shall,in the
raasonabl0,good fRltli o�pinion of eltl�et�Pacty,hava�mAterlal ndversa effeat on suoh Pnrty's rIghts
ot•obllgatfot�s undai•thts Agreement,tl�en the Agceemant may be tecminnted by sucli P�rty upon
tlilrty(30)dlys advanca wr(tten notice by such Party to the othec Pacty.
3. The P�rtles hei�eto agree that no pcov(sions oF tltls Agi�eemant oc nny relnted documaut shnll be
constcued for or aga(nst oi�inteeprated fo tha advantaga or dlsadvnnt�ge of any rarty heceto by any
court or othectivfsa by i�e�soti of any P�rty's hnving oi'baing deemed to iiave struatttred or dcaftad
slial�provision, each Party haceby axpcessly ncicnowladging Its pncticipation nnd/or•tts ci�lit and
' abtilty to pflrtfaipate, in the struotuciiig attd dcaftfng Itereof, The PArtlas fiu�ther aol<norvledge thatc
(i)this Agreament is the pcodttct of good falth, arm's length nego.ti�tions betwaen them; �II�SLICII
Paeties possess siiUstantially aqual ba�gaining powae;and(Iii)aach Party has had the opportunity to �
obt�in the advfoe of legal counsel regarding the negotiations and executlon of this Agreament,
4, This Agreement is not a third pnrty bene�clary conh�act, noc sh�tll this Agreament c��eate (or be
oonstcued or deemed to oreata) nny��ights a�remadIos, rvhethar legal, aquitabla or otherwise, on
beh�lFof Membars or nny other third partias�s agninst Administeator, �
5, This Agreement is not a contcaet of Insln�anoa and Administcator ts not�n Insurer or underweiter oF
C(ient's li�ibility undar,or with raspvct to,the P(nn, Exoept�s otherwise provldad in this Ag��eement,
Cllent has�nd rvll[cetaln tl�a�ilt(mata respansibllity foc p�yment of Proscciutlon Drug Claims ttnd
other expenses undat•tl�a Pl�in.
G, The article nnd sectlon liendings contalned In thts Agreamettt�tre solely for the purposa of cefet�euca,
nce not part of the �greemant of tha parti�s and sh�►ll not in any wny nfFact the me�nin� or
' Interpcetntion of this Agt�eemant,
E. AuEhorlty;Counte��pn�•ts, The signatoetes to this Agceamant a�ch ropcesent and w�ct�ant that he/she has full '
corpo��flta oi�compnny autliaclty to slgn this Agceemant on bah�lf of his/hac�raspectiva Pnrty aud to lag�((y
bind and abligate such Party by so signing, Aciditlonally, upon s�ieh signature 6y such nuthor(zed
signatory(las) af Client in e�ich s(gnature blac!< of th(s Agcaement (nncl tlie Cllent Appllention and the
Business Associ�te Agreament matle fl part'of this Ageeetnant), Clieut capresents, avnrr�nts,covenants and
agrees that it h�s tho necessary porvee and sutltority,corporate,company oc othec�vise(and thnt alf nacassacy
�ction h�s been tnlcen for Client),to enter lnto this Agreemant and such ott�er ngeaemeuts and�to consumtnata
tha transactions provided for hecein nnd thareln. This Agreement (Inclttding tha exhlbits haceto) m�y be
executed sfmultnneously in nny number of oounterpai;ts, anch of rviitch shnll be deemed an originni, but�Il
YOT FOR DISTRTDUTiON, TFIC INrOR�if\TIOV C0�'I'r\IN�D kT�12�IN IS COt(T'ID�iVTIr1L,PROPRI�Tr1RY
t1YD COVSTITTIT�S TRAllC S�CRGTS OT CSI A.ND 12,''C13CN�I�ITS
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' of whiclt sllall constituta one nnd ttio same instcumeut. .��osiinila siguatures o��slgtintu��es transmitted by i �
elecCronia m�►il shall be ctee�ilad to be origin�l signatucas forall�ucposes, j
, � ; �
F. Relatiousl�i��oP tl►e�'arties, � ' . . . � l
�., Adtninistcator and,Ces is ttor sliall sutch�'nttyoc its RapresatltFttives�be cousttuecl to be bytt�uyPacEy �
noc its Re��eosentat�v , ! !
to tltis Ageeemettt oc by �uy thiecl p��'h'� fln einptoyee,Jot►�t vent«cec, pnctnei, �eincipnl, �gent, ,
' master,ssevant,�iduciary nc ot(ier[tapresetitative o�Clte othee Party. Neither Pnrty is authorized to ; �
assunie oc create any obligltions,duHes oc(iabilittes,expcesa or ttnplied,on beha[f of or Intlie name �
of the other Pflrty, except as otherwise expressly provided to the contrary�in tl�is Agreement. � i
Client acknowledges,agcees und tindeestnnds that Administ��afor,on the one linncl,flud ;
E'urtliectnoee, i
PBM and nny ottier contraoting pacties ofAdminlstrator,on tha othec hand,are ttttafftlialed entiC(es ` i I
n«d indopendent p��'ties w ho are s o l e l y i n d e p a n d e n t a o n t c a c t o�,s of oue anothec. , f , i
. i i �,,
2, C[ient��c(cnowledges that:(i).Client sliall be cesponsi6le,in lts sole clisccetion,foc the selactton of i
auy consultants or.expacts to pro.vtde ndvice to Client as to llnbilities under the Plan or duties or {
. obligations o�the•P(an or Cl[ent undar applicable Inw or otlierwise;nnd(I[)Client is not contracting i
harauadec with Ad�nlnistrator �ac the pcoviston�of�anY such advica by Acltn'tnistrntoc, To the '
, contcary, t(ie Pacties exprassty ackn4wledge th�t Administrator will not provlde sach �tdvica�to
� Clie�it, nad thnt neltltei�Party kas any oblig�tion or cesponsibility to ndvlse the other Party �bout �
sttoh othec Pflrty's complianca.at~aoncomptiance with any law,cegulation,stntttte,rule or otltarwise
(inoluding without limitation under E12TSA,the Interna(Revenue Codo,the Public Henith Services � ti
Ac t an d/or a n y r e g u l ation with res pect to the nny of the foregotng). �
' C ient ex resst acicnowledges�nd agrees that:(i) Administratoc is not(nor sh�ll it be deemed to I !
3, l p Y ,
be at s�nytime)n"�idttatacy"foc any purpase u n d e c E R I S A,t h e j�`ca�ble stftte el w,comenott law oc ' ! !
Pu b lic H�a l t h S a c v ices Act(and any regu[ations tliereunder),app � ,
� otherwise;(ii)�Administcator ts not(nor'shall it ba deemed to be at�ny Nme)t he a dm tn ls tcn toc o f i i
the Pl1rc fot�an y purpose;(iii)Ctient(and not AdminIsteRtoc)possesses and axpcessly cetlins at nll `
times during this Agreement nnd thareafter.the sole attd absolute authortty an d responsibility to � �
� design, amend, tecminata, rnodify, in whole oE� in pa�'t, �l(or any poction of the Plan, including ;
withouG limitation the sole nnd absolute authority to confrol and admialster the Pl�n nnd any assets I i
o f t he P l�n,�n d s u c h a u t h o r i ty a n d c e s p a n s l b l l t t y c a nnot be da[a gatsd to Administrator; and(tv} , ,
Client(Rnd not Administrator) has complete discrationacy, binding and�nal nut tior ity to cons tcue � f
t ha terms oE the P[an, to interpret a�ribtguous Plan linguage, to make factual deterininations I
' i•egacdtng the.p�yment�of Prescciption Drug C[a t�ns ot'pcov lsion o f b�n e f i t s, t o r e v iew denled ,
Pcescription Drug Claims and to cesolve complaints by Me►nbers, I
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(, L�ach Pacry hereby certifies and shlll perform its dttties and obligntions under this Agreement in a i
mnnner thnt compfies wlth all.fedarnl,stnte,locnl 1ud other(�ws nnd regulatians appllaable to such 1
Pacty and its paefor�nance hereuader,(naluding wltliout limltntion the fadarnl nntl-kicicb�cic statute 1
set focth at 42 U.S,C.§1320a•7b(b)("Anti•CCicicbnck Statute"),the Publtc Contcicts Anti-ICickb�ek ;
Statute,and/or the fedecnl"Stnck Law"set focth at 42 U,S,C,§ t395nn("St�rk Lnw"),as and to the �
extent appticable to each sttcl►Party. Eaoh Party is responsib�e for obtalnittg.[ts own legal advice ;
concarning its aompliance wlth applieable laws. [f Admin(strator's pecformnaee of[ts duties and
ob[ig�tions undec this Agreernent is mnde mateeially mo�e bttrdensome vr axpansiva due to a change
In fedecal,stnta or loaal laws or regulltions or the interpcetation or enforcement theceaP,the Parttes
shntl,at the option of Administrator,nego'tiate promptly and in good falth�an appcoprinte adjustme�it
to the fees,costs,expenses and/or charges paid to Administratoc hereunder or othec nmendment to
tL�Is Agreemenk reason�bly necessary in tight of tho change ln law or regulation ar the interpcetntion
or enforcement thereof Cf the.Pnrties cannot�tg�'ee on si�ch ndjusted smounts or amancled terms,
' then eithat•Pacty may terminate this Agceement upon thicty (30)days prior w�•itten notice to tl�e
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NOT I'O[t D[STRIQUT[ON�COiVST TUTGS TCtr1D�SO C[tC S OC CSI�YD[tYB NG I1'S CrIL,P[t0['[i[CTALtY
AiYD �'�
,
.2. � 'Naithet•PDM izor Adininistr�tor shzil ba ob(igated at eny time.to provida tha pcescciptlon drug �i
• banefit nnd related services identi�ed in thls Agreeniant to,Clieut or Client's MemUars if Client oi�, '�
If�pplicable, Memba��s, are loalted In n st�tte reqtdring a prescrlptton bene�t niflnager to be a
• fiduoi���y to Cllent or Membars, ln any c�pavaty, eontcflry to or Liconsistent with the tarms �nd
. � Fondltiotis spscifically ldenti�ed in�this Agc�amant, In tl�a event any at�ta law or 1�egulatlou requires
. PBM or Administcptor to.ba a�'tduciary to Cilent oi�ft lYlamber coutr�ry to or,inconslstent wltlt tha
. � te��ms and ca►idittons ldentifle�l 3n tl�(s Agceert�ent,Adntlnistrntor nzay elect iiot to provlda such
• presci�Iptian deug banvfit and related services(danti�ed In this Ag��eement to the lmpncteci Mambecs
upon thlrty(30)dlys prior wrifteti tLotice to Cllent.
3, �flch P�rty,ttpon givlug prompt writtan notio.a tha��aof to the othec P�cty,shnll not be 1(ab(e for dalay
• or failura to perform heceunder, if such delay or failure is due to a cnuse o,c causes bayond the
• � � re�sqnnble.00ntrol of such P�cty (� "Foroe Ivtfljeure Evant"). �or purposes of thls Agreeinent, s
•.S�occa•Majeura�vent may Includa,but shall not be llmlted to,•acts of God pe the public enetny,#ire, '
� �lood, storms, axplosion,•aaetl�qttalce, war, #eerorJsm, malicious miscltief, acaident, transpo��tation
� tia-ttp,rtot or aiv(1 Insurrectlon,atnbnrgo,boyeott,Ioclo-out,striko oe labot�d(sh�cb�nce,slowdorvn �
� . or l�bor stoppaga of sny Icind or netof any governmant,focaign pt�dornastic, Eaoli Pai�ty sh�(1 hnve ' '
� . , the�opt(on;but not the obltgatiotr,ta tarmtnata thls Agceantant(n its entirety iE tha other Pat�ty fa(Is � i �
to perForm any materIal obllgatlon oEthls Agceament f�ecause of#ha oaourrance of a Focce MaJeure �
Event and aIther (i) tha ather Pflrty' does�not ctu�e•such bralch �vithin Yhi��ty (30) d�ys �fte�•the i
, ' occurrence of tha Focc.e Ma)eune Evant;or�31)such fallura ls not re�sonaUly subJect to attre w(tliin
� � such period, xhs non-b��eachin�P�rty mtist.provlda tivrltten notiae of tecanlnitlon to tha brasching � '
. Party, .
. • � �
H, A,ecess to'Tttformntioat;A.iidlt Rigiats; Goveriamexat�:goncy Submlttecl Clalms. �
� � l. Adm1n(stratoc and Ciient wili ailow sach�othar ralsonabla �ccess•nt ceasanab(a times to
�idmlutstr�tive information rellCing to this Agreement nnd tha Parties'respectiva duties,obllgat(ons �
nnd bene�ts descrlbed l�arein,upon tlie giving of ceasonable�tdvanca not(ca by the requesting P�rty �
(sub}ect to any limtt�tions wit(t raspact to inFormat(on that is not in the possession or control of
- Admfnlsh�ntor or Is othacwise subjeat to a covenRnt�of confidentlllity,fn favoc of a third pacty), Tha
raquasting Paety agrees to execttte n confl�(antlAllty agceemant in focm and content sntisfactoiy to
hhe disolosing Party as a condition p��acadent'to b'eing pecmlttad suali s�ccess to suoh(ufocmat(on,
• 2, Client,or a mutually s�cept�ble indapc�ndant,thlyd party�ctditoc eatnined�y Cllent,may conduct,
. •rvith.nt le�'st eixty(GO) days prlor wcitten notice aud nt GIIanNs sole cast nnd sxpense, nn nnnual
Pcescri�tlon brug Claims,�udit o�A.dminlstrator's data thnt direot(y relatas ta Pa�escciption Drug
Clalms blllings fo�'tlte prior Agceement yea��, Tha scopa nnd mnnnai�oFsuch a Prasci�Iption Drug
. , Cl�ims audit(iuclu�iing�pplicabla guido(Ines nnd ttmal(nes)�shall be as re�sonably detarmined by
Admiuistratot�nnd com�nunlcntecl to Client�sufflclantly In nclv�nca of�ny such audit,Client agrees
, t1�At it will exeo«ta(and shall cause nny mutually nccaptabla tndap�ndant,third p���ty n�iditor taldng
plrt in any suoh nudit to execute) �t con�dentfaltty ageeament ln form Rnd content ce�sonnbly
� accaptable to Administc�tor prior to oonducting nny suoh nudit, Any cequest by'Cllant to paemh an
� nuditor to perfoi�m�n �udit.rvill constitute Client's direction t�nd�uthoi�lz�tion to Adminlsti�ntor to
discloso PHI to nuditor. In the event oFan audlt by a mutua(ly ncoeptavle Indepenclent third p�rty,
Administrator and Cllent shull ba provided�4itlt n copy of 7ny proposed audit report or other written
. matacinls documenting such�udit and Adminlstrntor wlll hnve a eeasonable opportualty to conut�ent '
on flny siich report ot•written matariafs documenting slich audit before such.ace finallzed. Upon �
finallzatlon of nud(C results and ag��eement betrvean Client nnd Administrator on eny Identified
adJustments oi�disccep�ncies,if any,the peciad undec reviaw wI(1 ba consldered closed by the Pacties '
tind such ag��aed upon ndjustment p�yments, If�ny, sh�►ll be pnid by the nppropi�(flte party withln
thirty(30)days oPexecution by the Plrtles of nn approp��i�te raleflsa document covei�ing tha Rudit�
period, Client nolcnowledges that ft shull not be entitled to nttdlt cloeunients that AdmInish�ator is '
b�cred fi•om disclosing by applicabla law or pursu�nt to nn obllgat(on of conEielentiallty to n tfiicd �
p�trty oe tl��t ace noC undec tfia ciii�ection oc conh�0l oFAdministc�tor,Administcator wil!m�ke!00% '
NOT COR DISTt2IBUT[ON, TFI�IYCORNIATION CONTATY�D fL�It�[N I5 COVTIDCyTI.\L�P120PRI�Tr\RY
t1lYD COiYSTITUT�S TRAD�SGCit�T5 QI'tST AND R,`CB�iYEI'ITS
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o�cln[u�s availnUfe to lhe Cli�nl or n ntutu��l[y nccept�bla tliird p�cty t'at�linad by ClieGtC to�tud[C the ` ,
. • processittg abnte�ct, ' ' ' �
� 3. . Clieatt nc(cnor�vled�es tliat governntenC ngendias, iitalta►�t�fromt(Adlninistrnto�oc l'AM►eg rd�ig ' �
govaru�nentat pnyors, utay seelc etigi�il(ty oc s�mt n
IVfenibecs t�h�l may sub�illt to Adini►ilstrator oc PI3M olt�tms foc�•eimbucsement foc pcascriptiou dcug i i
benafits provlded to suah 6avertimant ngencies {or theic'�►ge�V�ae such cla n,�s`i�e�n tasted bY I
Clnims"), Client �utho��(zes (a) Admint'strnto��and PRM to p' . ; ,
governtnonE agencias, inchiding�vithout llmitatton fedeeal nnd stnta goveet�mental�nyors,nnd/oc ,
tttete �utliorized agents and (b) Adininistcltow�nad/oc PBM to pcocess such Governinent C(�tims,
Cliont flulcnowledges that Adtntnistratoc may ad'v�tnce payment for Govecnment Claims on behllf
oF Cltent d�u'ing the Tehtn of thts Agceement. Client shall tei�nbucse Adminlstrator,in accocdanca
with Client's hay�netit oblignkions under tliis AgrOetneut,£oe nll amount§advnnoed by Admtnish•ator � ''
foc pftyniant of Glovecntnettt Claims. Gflent ncknowledgas that Ciovet�nment Clalms submitted by �
oc on behslf oE a state MedicAid'Agenay oc ot(�er govern�nent�l p�yoe shall be pn(d by or on belialf ;
� • bf Cltent if submitted within tlicee(3)years fcom the origlnat dtlta'of fll(ttnless a(ongec�eciod is ; i
i�ec(uit�ed�by nppli�able law, Li addittot�,Go�varnnient Claims sub�uitted by oc on behalf of a state• I
� �M:edtaaid ngency oc oCher govarnmentll p2yoc m�y nqt be dented on the basts o�f f Cl ent sliall ttleo ; ! �
Govern�ient Claf►n or fai luc�to'prese n t p r o p e r d o d u m e n t a t i o n n t t h e p o t n t•o£s a t � �
•caimbuc�e Administcatoc foc any,adJ ust�nants oc raconclliaBions to pceviously pcooessed Ciovarnment i ,
� Gl�ims thftt rriay�be payable to governmant ngancies in accordance�with n p plioable iaws nnd ! ;
• i•egitla�ions;Tlle administrativa fea Fot•pt�ocessing dovecnment Ciaims shalL be lnvoibed at the�aper ' '
su6m(ttad c(al�n rate Rtceady ngreed to by the Partias or as othe►�wise agreed upon in wrifing by , ,
Administrntor and Glient. Admin(st��atoc reserves the cight to (�) terminate these services upon ; �
�ninety(90)days.'prlo►�notice to Client or(b)deleg�te these sarvioes tv n tliird pai�ty cllim's proC(ient � ' '
other than PSM. Notwlthst�►nding any pravision oF thts Agreement to the coutracy, , ;
acknowledges nnd agrees that Clieat shall ba'solely respons(bla for pcocossing and malcingpaymeiir �
oEany C�a�e►'nment Clnims applicabla to Cltent and its Members reaeived sfter the e�fective dnte of
the termination or 'expiration of thts Agreement, ;
. ,. ;
�. Con�doutlnl and Proprietary[nformntton, • ' � ; ,
�, The tarm;"Confideatial Infor'mation" includes, biit [s not tfmlted to, thts Agreem�nt or any ' '
information o£atther Cltent or Administrator(Inaluding without limitation tts designaes)(wheChec ;
oral,•wrltten, eLectronlc,Visual o�� fixed in any tangibte medium oE expression) relattng to eitlier i
• pacty's services, opecations, systams, pragrnms,�inventtons, techn[quas, suppliers, customers and
, ' pcaspecdve customoi�s, contractoes, costs and pricing d1ta, trt�de�secrats, know�how, processes, �
, plans, des(gns and othar informaEiou of or calnting ta etther party's business. Confidentl�l
Znfot�maEton iloes�not (nclude Protected Heatth Information; the use and dtsclosure oF which is ! .
�govecned b�Arttc(e IX.0(inotuding�xhlbiC B)of thts Agceement.�Wittio.ue ltmittng the focegoing
� in any way,Client acknowtedges�►nd Rg�'��s, Eoc Itself and i�s Rapresentativas, thnt the fo(lowing
finanotal flelds constltute ConLidenttat[nfocmation o E,Administrato�•for purposes of tltis Agreement
and shall not be disclosed by Client to any third parties witito.ut the expcess,prioi�written consfltlent
Adnt(nistentoi^ (a) total AWP;(b) ingeedient cost; (o)dlspenstng fees; (d) drug eost; (a) p
� • arnout�t paid;(�j total ttmount paid;(g)sales tax;(h)U&C chacges;(l)apeatalty indicator; and(j)
bcnnd/generic lndicator,
2, Administrntor and Cfient shal[not disclose or make use of any Gonfidentlal Cnform�tlon exoept as �
per�nitted under thls Agceement�vifhout the pcior written conaent ofthe�non-disclosing party,which
consaut may be conditioned «pon tha executton of a.confidentiality sgraemant, Bach'party m�y
' disctose ConEidential[nfor�nation oFthe other party onty to its authorixed Rehresent�tives who have
' a need to know the Conftdentittl[nformt�tion in ordeC to accomplish t[ia pttrposa of th[s Agreement
nnd who (i) hnva baen tnformed of the confidential and proprietary nature of the Conf'tdenttat ;
' ' � Tnformafion; 4nd (ii)with respect to Representatives, have ag►�eed itt writing not to disc[ose it to ;
_ ______ _ ___________ __ __ _ o�hers and to treat it in accordance with the requirements of thts Section. Administc�.tor or Cl�ent, ;
[YOT r0[t DCST�iIB(1 A��D COVST TUTG TRrOD�SO C[tC S 0�GSC AND RXB N�C TS t���PROPRCGTAIiY
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fls appllonble, shnll bo raspons(ble to tha ofhar P�rty foc �ii brench oF t(ils A rea� I
i�aspaative�tepcessntnt(ves,
Y g nent by Its �
�
3, Tho forago(u�shaU not�pply to suah Con�ldantl�l ZtrPorm�floii to tlia extaut� (I)tha lnforin�tion ls `
� � . oe beoomas�onoi�fllly�vnf(abla ae lu�own�o t(to puhltc tl�eough no fault oP tl�a recelving pnrty;(iO ' � '
• tho Informatlon wt�s Alrafldy lcnawn by oi�nvflllnble to tha raoalving pnrty peloe.fo tlie dlsolosu��a by � � '
tho oll�oi�pnety on a non•oonfldent(fll bns(s; (lll) tha lnfoe�nfltlott is subsaquently dlsa(osed_to tha ' '�
��acalying nnrty byn tl�ircf party wlio fs not under n.ny ob!(gntfon oPcanflcle.nt)�IJty ta the cl(so(osing � ' '!
pn��ty;(Iv)the 1iifQemation l�ns nlrondy been o��ls 1ter0El�0P liidepauc(ently noc�ul��ed or davalopad by . I
tlta reoolv)n��pnrty wlthout vlolnt(ng flny cnnfidentlnllly ngreaiilaut oe ofhor eln�llac obllgntlon;or , ; ' �
(v) tlta lirFormntlau is re qulred Eo �a c(lsolosacl puesuant to n e a w�t o e�a e,�A ti y Con fi dent in l � � �
Inforutt�tlon sl�all at ell tlmas i�etnain the exoluslve propeety o�Fthe Pnrty pcovlcling suah(nformatlon � ' ;
nnd sl�nll upnn ro ueat be rahu�uod to tha P�rt � I ;
, , n , y pravlding suoh Con£'idoutial lnfocmntlo�i, If ! i
� disalostu�a of�ny ConE"idautlal 1nFoe�nnt(oit ls�requlrad by(aw,nr(or to dlso(osu4'o,tito�Arty«pott � i �
rvlioin suol�ceqttasE;For disafosure Is mnde sliall�totlfy tlie Pflrty�vlto pravlctod tha Can�ldeutini ' � �
znform�tlon nnc�the Pfl��ty w(to provlded tite Confldentlnl Infoematlon shall hnva f[vo business tl�ys ; ' '
• �In whloli to tnl<e suoh not(on ns lt doams�tppronei�ta to rasist suolt�iis�losura; nnd ln tlie avent 1t (
. tnlcas no suolt aotlott, 2he Pnr�y upon whom the renuast fqe disalos�tre wns.mnde mny diaolosa the ;' �
, Con#iclontlfll .Cnfocm�ttlon without �ny II�U(llty to tha �'ni�ty who provlded.the Gonfident(nl �
• � Infocm�tlon, .
, • � ;
� �, �V(thaut IImlting�ny othe��righls and t�etnedlos avnl(nUle iindar tlzls A,g��eemant oc othe��tiyise, nny � � �
unnuthorizad clisatosiu�a or usa of ConFdentl�l X���o��mntlon avoulcl oausa Adml�iistrntar or Cllent,fls ; �
. �ppllo�ble, l�nmedln�a nncl lccapart�ble It�ury or loss tl�flt mny not ba nclaquately aom,pensatad w(th ' ;
• mouey cia�nngas, Acoorclingly,If elthor Pncty f�ils to ootnpfy wlth khis Art(ale VIII,I(Con�ldantlal � !
�n�l I�roprlotncy Tnforrnntlai�),tha otl�ec P�i'ty�4�II�0 011tltl@(I t0 BE6IC t0 O�tftlq 3p00IEI0�)BPFor�nnnce �
� _ . , , inoluding(ntinadl�te Isst�flnoa of n temporary restcnining orcler or prell�nln�cy(c�unation anforoing �
tl�ls Agraoment,����i to�ui���na�,t eo���,ossas cnused�y tha�refloh,�[ul to saolc to obtaln nuy otlzar '
' remedlas pravlcled by Isw�r ln equlty,
�
J; �.sslguntout, Nellhar pat•ty m�ty asslgn thls Ag��eelnettt 4Ylthout tlia pPior wrltten aansent of tha other party, '�
pcoviclacl 'suolt ooiisant tivll) uot be uncansanably �,vlfhhalcl, kZo�vevac, Adntliilstl'ntol� niny nss(gn thls ' '
Agce�mantoe dolagata the dutles to ba parPocmad by or baha(PofAdm(nlstrntor under thls Agreamentrvlthout
tlia aonse�rt of Cllent ns pn��t o#'tha snle o�'t�ll,ot�aubstntztlally all,.of tho nssets o'f Adtnlnlsh�atoi�o��slinil�c •
sn(e or disposltlou ofAdniinlstrator thnt�vould,upan oonsumtnation,ba deemed to const(ti►ta�n nss(gnment �
of tlils Agroainont undac np�llanble lnw� � � i
. , � �
!<, Dlscloauz�e oFXufor��intlon ta Tl�li�d Pnrtles� Cllant�alcnot,vlod�as,utttleP3tfltl(19 Eltl(I fl�l'009�IlBC It Irifly�0 '
�tooasynry or deslrnble foi�Aciminlstrntor to dlso(ose Informntlou obfntned El�om, provided by oe oklideyvfse � �
regnrdlttg or relnting ta Cllant, Cllsut's 1'lan, and/oe Clle��t!s atnplayoes Ancl iv�ambacs (exolttding any ;
Informntion Ehnt oonst(tutas PIII uncfa��ITIPt1A)to.oertflfn vandoea,oonsu(tnnts,bt�olcat�s oP ather thlPd��qetles i
in connaotlon rv(th rldm(n(st��ntor's set�vicos, dut(es �nd/oc obll�atlons eettde��ed by, or ra�ulrod of, ;
Adminlsh�ntor undar thls Ag��eenient oe atliorwlsa eeleCing to lts pv��Eormanea haeaunder, ,
�.R'�'IC�,G IX��RZ5A,CODRfI E1ND TTIPAA DCITI�S i
A, �RCSt1„ Tf Cllent'a offar(n�of tl�a Frescriptlon D��u�Pcogrnin provldecl foc In th(s Agt�eetnant ooustltutes �
pnet oFn"welfaee pinu"rvithln tha meaning of Sectlon 3(l)of tho EftTSA,lt(s uuderstood nttd ngraed tht�t �
tha duties of Cllont nnd Adminlsti�toc nca ns follo4vs; :
l, Plnn nnc!Suu�mnry pascr(ptlon, 1t s1i�11 be tha c(uty of Clfent(�nd not tlie duty of Aclminlstrntoc)to
, flu�nisf�nny Pl�n,sumitf�ry pinn desorlption oc sunlrnncy of n�nterinl modiEic�tlons to N[ambers nucl �
beneEto(t�rlas es t�equlired by �R[SA �tnc[ nny ragulntlous uncler It, [t sh�ill ba the duty of
E�dmin(ste�tor to provfcle Cllont,ttpon PO(�U88C,tivl�lt fl sUfutriney of�enaflts nvnlln�le unclar the Pinn
E'or usa In co��junctlon tiv(th tha summary��l��i dasc��lpt(o��stnd summa��y oCm�tsrini mocllfia�Nons,
, � .
�10T GUIt DIS'I'R[HUTCO�, 'TCI�C`frORl�IrITCON CON1'etIY�D Z�I�ItC[�Y TS CO�YGIDCNT[AI,,PItO�'RI�TARY
rIVD CQNS'1'['I'U'�'CS 7'RrIDC S�CR�'CS pC rSi AND R�CBCNCTI'fS
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2, rlununl nucl Suilirnfiry'Anuunl i'�eportst IC atinLl�o c(ie.cluty of,C�la�it to•tln�nl�li hny nnnunl rapocts � ,
• tn pnrttoipnnfs nncl/ae�overuntontni ngeaol�s fls renuli�il bYnztlSt�,tl�e Inte't�fj�ll Rovauue Cada nnd . � �
nny��agulntlons tlieroundeG�, It slinll ba tha duty of Admin,�st��nfo��to aetid�ta Cilauf,upou Cllant's �
'rondonn�la cec�ttest,'sudh l'nfor�nattoa whioh A�dw(utst�rator li�s'wlllitn�tts hQssessla,c�as rvilt pei�mlC� '
� � CIl'e►tk to tpalta•th� Rn�x�!nl l�epoi��v�, It�shnll bo the.duty nf Cllant to pcovlde;tlie lv�ambers wit(t i
• .au[ntttnry nn�lau�(cepocts fls cenu(rad by��tISA.�uil�tny i�e�ul�tio�is uiid���lt�� i �
'3, PIE�u Atl�uln(stentoc; Tt�l's sx�cassly undo��staoil nnd flgccocl1by tho P�ttctfes"to tltls A�gt�eomeut tht�t any �
'nnd nil tlutlas frsat�naii'by Fi�S�. niicl �iny cagidntlo'ns��tlivieanilac �o•,tlie Plan Admiu(strator
� Inoluding,but'�l'ot llirittaci�o,tliosa dutias.spaoified tn the Plnn slinlf ba deamea�or ptu��oses of thls
Agreeinent�s�utles of Client nnct not tfiose oFAcitnl'ntstc�ttoc, ; �,
. , ,
' �, CociClnqnt(o��Covorngo, It is nlso ax�i��e'ssly qncfaestopd nncf ngi'aad by tl►e,�'n��tlas•tb thls Agrea�nent thal ,
, , tha'6otii�l(flnce'tvlCh ca►ttfnunClon covorn�e reni�fi�oinenfs lniposad on grou�y hanitlt hi�ns�y�ItISA, tlta ;
'Ititarn�l S{aVe4ttt�Code�tic{the Pu�llc�onith Se�vlca t,l6E:((uoluiting tho�.eegtilat(ot�s tho��oundee)sl�all be the' �
sola bb.11gnttdu df Cllout unde�� tl�ts �geaeutan� nnd not tho abllgattou oF Adm(nish�atoe, � T'uctl�ar, I i
' �.dmin(st�'atorwlltnotnooept�nyitientdl��eotlyfi�om�nyoinployeao��otme�atnployeo(ordepond�qtofsuoh , i
' aniployea o���foeniai�amploy�e� tlint Is e l lg l b la fo.��'a'vu C ln t t�t t�o t t c o V a c a g� t i n d a� t h s�P t�n, I f s h t t l t b e t h o �
, c e s n o d s t b i l l t y o F C l t e n t;(�tttcl'not Admftttatratoe),�oc suc1�ot[iar th[��¢���rt,��cdmini"sti�ato��hnndliug kha gt�oup '
he�lCh'pl�tn of�vhloh tfta Prescelptlon Drug l�ro�rnui Is n p�ict,to colleot t he pre�n lums duo't 1'oin t ha e m p t n y e o i
oc foclnar ent�loyee(oe ctapo�ldeuE of such eutliloyae or focmer omhloyea)£oc contlnu�ttton aovarage nnd to i
sattsfy nny�a�id�all,ntlier CODItA,'d�ittes and eesponslblllt[es ca.lnting thereto, �
C, lITPAA auid S'rivncy.ancl See�u4ty, . ; . ♦ � ' �
f ;
'1, . Cl(aut shnl�ba aotaly rasponslbla foc any nna nl( dutCes�end rasponsibllities ahpllcflble.to Client � i
' • unde�'f�[P A A flnd e lm t lnc st�ta'I�w thnti tnay n�hly Fo tha Pl�esot�(pCiou Di'ug Pcogrnm ofPerecl undar ;
thls Agreeuient nt nny tlme,lnaludlitg�but not Ilmltecl to those�co�islona flppllonUle to Cllent relnting '
to paett�blllty,alon•dlsaclminntlon,prtV�oy nnd a�ourlty� xha�aetlas wlll onusa n HIPAA Buslnass � i
Assootato,A�reamen t In t lie foc m n t t a o h e d h e c a t o n s L�x h l i t B, ' �
2, Presorintion Dc�►g G(nEnis,ns�vall�ns e(lgl6[llty lnforu�atton,r�vhloh Is de�lclenClfted In nacardflnoe ;
�vtt(i�ITPAA flnd oEhee npp
Iloiibta l�w,�ud tivhtch ts not IcIenEl�'i�bla on�Me�n6at�bnsts,inny be �
� 'usecl,disqlosed;ra�eoduced,��dnpted ocsold byP�tvl nnd/oe-Ad�nlnlstrtttoe,Suc(t.da»tdan�(Cad cintn
' •may be provided to natlon�lly reoognlxad dat� integr�tlbit �cins to su1�poct nnneopriato �
adtnlnlst��ntlon oF PBM's dcug�nnunge�naiit progcnms�ns.this banahtnfle[<ing•d�lt�eii�bles PB[vI fo �
oom(�Ara ngninst vthec clrug populntion sets attd see(�to Imj�eova programs attd sei�vtaes foe cllents �
or othaewlso, : ' '; ' ' �
' . XiV'4y1TlY�SS�VIZ�����', �dminCstefltor ��id Client hnYe'oflused•thls Agceomant to� ha oxacutad nnd "
deltvarecf bytheli'caepeotiva Ri�tliorized Re��resantnttvos ns of the�Efeotiva Dnte,
' A,dminlst��ntort Gllent; .
� ' �2sBauoflEs,Cuc, ^ Ctty of Dtitiuc�uo Iow��
�y, ,
�yt "
Prlttted Nnnle:Ln�u�en Slmmons __ Pilntad N�me;Nlichael C Van Milligen ' i
[ts;Df�aatoc of Comnllnnoe nn<(Le�nl�ffnles Its,Citv Manager
� . . . , . , [C,ChlGtt f((Cllenc'flppllcallon)Fol�o�vs] ' �
. �
h'OT I�0[t D[STRCDUT[0�1, '�'[TCtNrOR�trlTIOY CONTA[NCD FIPStCIY I5 COYI�'ID�NTIAL,PROPIt[CTARY ,
� AIYD C�tVSTITUTCS TI2e1D�SCCZt�`CS 00 GSI rIND ZtXBCNGFITS- IS
. . • �X.�IIBX'z'A . . � �. . ., � ..
' . . . .CLI�NT A]'PLXCA`Z'ZON .� :. � . i
. . • . ., , �
[INIPO�i.TA.NT—PL.CA.S�I2.�AD CAR�S�'UI,LY; Clleitt sliould cnraTully revl'e�y Secttot�s A,B anil C of tliis �
rxlilblt A be(otiy �vhlcli lanve beon completed by Adm{nistrntor ln oa�dea• to ensure tho ACCilrncy nnd �
completeiiess of sticli Irifoa�mntfon, C1lent'sltnll pa�omptly iiotlfy Aclministrafor oT nr�y innecurncy or omisslon �
tiyitli respect to sucli tercns and cond(tlons,IF nppticnblo(luclttding,wlthout lim9fntlon;the C1leut I�iformatioi� '
lu Sectlan A). Client sl�ould nlso c�refully revlew nncl eon�pleteSectibn A of thls�xhib3f belo�v,]
A. 1�Y�'ORNiE1.TI0N ABOTJT CLI�N'�
� Clloa�tNamo; � � � kIlt/1'rimnry ConEaet: • 'Phonet . '
. City ofDubuque Io�vfl ' ',
. " ' I
Mnll Adciress: Ti�,Contnct�mniL . �� T'nx;,�r i
. ,
SO W.1�3tkt St, ' •
� • i
, � y
� ''City/Stnte/zip� ' Billing Contnctr , � Pl�onc+e �
. �
Attbuque,�A 52001 . ' ;
Ma(n Plio�ie; BfUtng Coiitnct�mail; �'nX; '
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Setad Tnvotces nnct,ConFtdenCfnl Stnncln��d Repot�ts to; �
� . .. , . . �
Autho�'tzed'4VebsiCe TJsers oP Client(Tlsor's Naine nncl�-mn3l Addecss); !
* ote; Cliotat mny ndcl or clelete Auti�orixed ti�absite Use��s by providing�vritteta itotice of sucl� cha,►tges to
Adminlstcntor pursunaat ta the notfce provislons.of A.rticle VTiT,B of tl�e A;greement, .
B, PLAN D�SiGN;iVI�IVIB�R C05T SHAR�. . ,
l�Iotttbor Cost S(�nce: .
Plense see curre�xt Summnry of Boueftts.
. Client repcasents and wnrrattts tl�1t the das(gn of Client's Plan �s reflacted 1n a�'lan Design document foc Cliant
("PDD"),Accurately reflects the npplicable tecros of Cltent's�laii for purposes�ofthis Agreamont, Cl(ant shall provlde
Adnilniste�tor 4vifkt nlnaty (90) days �rtor written notice of nny peopased changes to thc design of Cllent's Plan
(Inoluding tha PDD),which changes shali be consistent�vith tlte scope und nntuee of tlta services to Ue p�rovidad by
Admtnlstt•afot� ttnder this Agreatnent, Cltent ngt�eas that it is responsible for Losses resulting from nny f�ilure to �
Implement Plan Design chnnges whlch nre not communicntad in�vciting to Adminlstcntar. In fldd(tloia, Cllent shall
notlfy Niambet�s of�any Plan Design changes p��ior to the effective dnte of�ny such ch�nges,
YOT�rOR D[STRIBUTION. TCLC TYI�ORi�1�1TI0�Y COiYTt1[Y�D�L�R�[Y IS COYI�'IDGYTIAL,PROPRI�Tr�RY �
r\ND CO`lSTITCJTCS TRr1D�S�CR��'S Or�S�t\ND I2?CI3�NCTT�'S
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C, S�RVZC�S��ORIV[TJLARY�1'ItICING GUACtA.IYx���� �
(, �3ase Admt��istrn@ive 3ervices; Tlio fal(owittg e rient�including El ts Exhibit�A)(tl e"Bnse Ad ni�'tstc�tbve ;
ta Client nnd Its Men�bers pucsuaut to the Agte ( � ;
. Sarvtces"),as applicab�e: � . , i I
. ' � ' � �
• Adniinistr�tion o�eligtb�lity subtni(ted Via tapa or,'tclecommunicatiau i �
� . �(igtbility maintenance � • � , ' � ;
• Client suppoct sy'stam �oi�on�llna nccess to cucrent eli�ibtltty I
� . Ad�nin(stention of C(tent's�'lan Design j
. In-netrvork clnims fldJudic�tion via on-liue cl�iins adjudication syste�n • i
. Designated Account Team � j
• Client olinicAl nnd.ntnn consulting,nn�►lysis and cost projections ;
. Annual analysis of pcogeRm uti(Iz�i.tion �ud tmpact of plan design and nianaged cace �
i�ite�tienttons � '
. Welco�ne Pncicage�nd ID Cards for new Members � ,
. Stand�rdMen�baccon�municatlons `
. •Toll-fi�ee telephone access to�customer se�vlca Poc the progcam for usa by Metnbars And Client's I i ,
benefits personnel 1nd Representadves i � !
2, Addltt�nnt Admi�►istrnttve Sarvieess Client will pay for Rdditfonal administcative secvtces(the", �idltional � i
Administrat[ve Sa�wicas")beyond thosa includeci.in the Base Administrattva Seevices that ara renuested by � ;
Client�ncl pro.vtded oc made nv�ilable by Adrninistrntor undec fha progrnm as foltows: ;
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2.1 Acimtuistrattve P'ees i �,
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PBM Secviees-No Adclit�onnl�eo 'gl'sohonic claitns 'rocessin � . �
Customar service for Membecs' � pl'an setu ' � �
Lleefronic/on�ltne eli ibilit �ubini�ston ` �
Standacd coocdinatiori of be}tefits(COB) Soft�vare tcalning for acoess to ouc on-line system(s) ; i
�
re ect for cimar a�ccter . '
� FSA eli ibtlit fee'ds . •� . �
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Net�vorlc�ha►�mnc Set�'vtces ' phfl�.m�a reimbucsemant � , �
Phacmac hal desk � : � . , N�CWork devel� ment it on re uast ' '
Ph�►rinac"networlcmana ement , `
, �
Flome Del[ver Se►�vices prescri tion delivec -standttrd :
BeneEit educ�tion • '
�
Re ortin 5e►Nices Annunl Stcflte te Account Plan re orE i
Wab-bhsed client re octtn - g�«�n i�e orts '
Ad-hoc deskto nrametcic re orts
CIEII[t18[IetAII eXtCaot fde elechontc NCPDP format . In uic acaess to etaims rocess[n s stem
Load l2 months claitns histocy'for ctinical rapo►�ts and
re ortin �
Website Sorviees
Express-Scripts,00m—accesontact diceotory�sales�nd dupng open enrollm itt to enable tMembers to av altiate ;
aligtbility update capability,c resc��i tion bene�'it pinn options '
' marlcetin�informution,and banefit and e�lcollmant P P j
sti orC secured throu lt Rislc Base'Authent[altion
, Bxpress-Scripts,com foc Mem6ars—access to benefit, . _ � � �
� dettg,health and wet(ness tnformntlon;prescription ,
- - --- - - - - --
- =orae►�in ca abi(it �=and customer=s�r.vtce-__- --:- -- - -
lYOT G'OLt DCSTRCBCIT[OIY. TEISTITUTGS TLtrOD�SC CIi�TS OI'SC AYD 127CRCP[�I'CTS IrIL,PROP[�CCTAR.Y
t1ND CO�I 20
• ,
Im�lementntion Pnckn c n�itl Membor Carnmunlcntions
New Me��ber pacl<ets(Inoludes two st�ndncd resin ID Implementatiou support '
cards)
Meutbec ra lacemeitt c�rds rintad vla wab � ' �
Cli�tic'rt! �
' Goncurrent Drug Utllizatfon Review(llUR) Tnchided at no charge
P��ior Autl�arization—Adminlstr�t(va '
n,Non•cllnlcal PrforAutho��izltion .
b,Lost/stoten averrides
� c,V�catlon su lies I
�
�'HM Se��vices • I�'ces• I
, � , i
Transaotion Faes Payabla foc AdministcAtive Services $O,GS per Presoriptlon Drug Claim mAda by Mambars !
' er Artiola IV,B of the A reament n ftble on a bI-month) b�sis
Member-submitted papec claims processing fea $2,50/olaim �
Madicaid subro ation ol�ims fee �$2.50/c(aim �
A,dvenced Ut[Ilzation Managamcnt(AUM.Btmdle) $0,G0/PMPM Yeac 1 ' � � '
$0,631 PMPM Ye�r 2 ; ',
$O,GG/PMPM Ye�r 3 �
Contbia�ecl Beueftt Mnnn em'ei�t . ',
.Services to mnnage combined medical-ph�emaoy $0,10 PMP1vI per combined Accumiilator u��to, i
benaftts t(iat are not a consumec-dG�eeted hellth(CDH) maxlmum of$0,20 PNIPM for exfst(ag connectlon with ;
plan, , medical ca�•riar or TPA, ;
Servicas Include ongoing manngement of the data ;
e>cah�nge pl�tform with tite medioal vendat�/TPA, Fees to establish connection with new medicnl cttri�ier or �
produotion monitoring nnd quallty control,�nd TPA are c�uoted upon cequest. . ' �
dasignatod operaflons tenm.Combtned benefit types . I
mny Incit�da deductiUle,ottt of pooket,spending�ccount, • �
�nd lifetime muxlmum,
�
, Networlc Plan��mnc Se►wices �
Netrvorlc Pl�ncmac Audlt Pro t�nm 20%of audit recnvaries � f
Revlc�vs and A eals Mnnn omont ' I
In(ti�l Determinations(1.e,cover�tga cevlews)and Laval Inaluded tn tha extsting ut(liz�t(on m�nagement PMPM
Ona Appeals foe the Covecnge Authorizntion Program, chnrge
conslsting of; • �� '
Prior Authorizat(on Inol«ded in tha axistitt rA c(tflr a of$S5 ai�rey�eyy
• Step Thernpy g g p .
Dru uant(t Mnnfl ament .
Tnitinl Detecminations nnd Level One Appeals for the $SS par cevietiv
Bene�t Revlativ Program,consisting of cevletivs Icnorvn �
ns;
Plan Design Rel�ted Raqttests
Plnn Exchislon Revietivs(clinic�f or ndministrative
ceviaws of non•Covered Drugs)
Copay Ravletivs ,
Plan Limit Reviaws(e,g,nge,gendar,dnys'supply ' '
llmits) '
Plnn RulelAdminlstr�tive Reviews/Non-clinlc�l '
Revie�vs
Clinlca!Benefit Reviews ' �
Direct Cln[m Re ect Ravietivs
NOT fOR DISTRCBUT[OY, Tk7�IYI'OR�lr1TTON CON1'r#TN�D FI�[tCIN IS COiYrID�N'['Yr1L,PROPRICTARY
r\ND COt fSTIT1IT�S T[tt\DC S�CRCTS OT'CSI tllYD RXB�N�P'[TS
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PBIVI Set'vices
�ces � � 4 �
Fiu�l ttttd Bindiug Appe�fs--I.evel Two Appettls*and/or $0,00(�ec revtew�(�necemental to PNIZ'M fees oc tlie pec , �
• raviaw fees sbove) ' �
Ut'geiit Appeals** is a `l�od to encli i�iitinl
*L,eVel Oue foc clients w(th only one level oFnppoll '�`�I�is ttddltloiaal k'eo �p � i '
�`k An�0il�5 Cfltl b9 lU�geut at�.aysl One ot�Level 'detcrmiuntton. � � ;
Two and decistons�ce fin�l and binding, • • i li
V
Lxterusl RevIe4vs by Inclependeut Review Organizations- $a00 per revlew � �
foc uoti•• randfalhered l�ns . ! i
Compeel►ensive Coi�sunter Driven I�[enitli(CD�I) � i
Solution • � I
Consumec Choice Pl1n All serviees:$O.6S PMPM i
Tec(�ntcal Technical nnd Member Advocacy:$0.35 PbIPM � �
� ��-directionaL ciata exc(�an�e;dedicated opecntions;24- He�lth Choices and Drug Choices;$0,30 PN1l?M : I
, houc u day,seven-days�week monftoring and nuality . • . ;
controt;pei•Focmanca reporting;and analytics . !
Membec Advocacy ' : '
Dedioated CDH membec saevices,onen eiu�ollment tools � '
t�nd Member com�t�mications librliy,robust online
i
features,and preventiva care � ; �
Heatth Choices • • � �
MedicaEion Adhe►�enca Monito�9ng�nii Otttreach and �
proactive,pecsanTlized Member comm.unlcations ; i
' ' Deug Choices ' .
BeneE►t Co�ching,Pcescciption Bene£'it Raview , ; ,
Statements,pronctive,personallzea Member . � ; �
commttnicattons ' • ' I
Medtcs►re Pnrt D—.Reticee Dru Sub'sid' RDS
Pnrt D subsidy enhlnced service(ESZ sends reports to $�l n2 PMP tM`fti Me of$7,50�0 1����Membecs with a '
CMS on behalf of Client) $�,35/letter+ osta e � '
i Notice of Creditable Covera a . ;
� Part D Subsidy standacd service(ESI sends ceports to $0.62 PMPM for Medicare-qualifted Members with a ,
m,inimum annual fee af$5,000 4
Client) $1.35/letter+post�►ga -
A, Notice of G►�editable Covecage `• �
;
, 3, pcictng, Tha�int�ncif►t tecros set fof he A c eem�tent CI ent�w ll pny�to�Adminis�trator tlte ntu`ounts sel•forth ' �
specLE'ied condltions set Pocth in Exhibtt � I
below,net of applicnble Cop�.ymen�s. The applicntion of Bc�nd Drug�nd Cieneric Drug pric(ng balow may be j
suUJept to certain"iiis�ettsed�ts wnet��n'"ID�Aw�Sales o lexci e tnx oe othec gov`ern nenga[su charge�,�f any�rvill be
adjudic�tion and Mamber Copay p P �
the cesponsibility otCtient. � �
Members will ttlw�ys pay based on the logic belowt
Ratflil: Lowast of(i)the U&C pcice,(ii)Plan copayments/coinsiu�ance,oe(iii)d(scounted AWP(inetuding MAC
p.rice,wlien MAC pcialn�ts applicable), �„� ;
� N[ail O��de�: Lowec of(1) Plan coplymentslcoinsurnnce or u discounted A4VP (ine(uding MAC price,whon 1
MAG pricing is appllcahle).
3.1 Prieine Grinrnntees. .
(a) C�redient Cost Guflr�ntee. ,Adminlsfr�tor will�uarantee nn nvernge aggregate nnnual disco�utt ns
� reflected below on Cliant utilization to be c�ticul�ted ns follows;
lYOT COR DCSTRCI3UTCOY. TEI'G IyCO CStT�p S��RCT3COC�CS A�KD CL'�f3G G['CTS CtIL,PItO['[2[CTARY
AYD COCYST[T 22
[l�(total dlscaunted AWI' ingredient cast�(axcluding dispensing faas and claims with anclllsry ';
cha�ges, nad prlar to npplication of.Copeyments) of applicabla Prescriptiou Drug Claims for tha
annual peciod divlded by total'uncllscounted A�JP ingcecllent cost(both atnou��ts wlll ba calaul�tad
As of tha dlte of adjudicatiott)foc tha npmtal parlod)]. .
Notwtthsfnnding anyth3�ig heee(n to tlre contrary;(i)a Presoription Drug Claim that processes ut the
Brand r�tes (PacticIp�ting Phnrm�oy Re(inbursament Itates) ai�d (M�ll Pharmacy Raimbtu�semeut
Rntes),as Iudlcatad on the ingi�edient cost fiald of tha Prescription brug Cln(m's dat�recocd,shnll
be ceconciled�s part of tl�e�rand gu�rentee below;attd(ii)�Prescrlption Drug C(aim that procasses.
nt tlze Ganeric Dcug t�ates (ParEloipating Phaemacy Reimbiu�semcnt Tt�tes) and (Mail P���rmacy
Relmbursement Rates) abova, ns indicatad on the ingt�edient cost flold of tlie Prescription Drug .
Cl�lrn's data record,shlll be reconailed fls �act of the Ganarla Drug gunt�antee below, The only
Prescr(ptlon Drug Clalms tli�t sli�ll•ba excluded from tlie i�econaill�tton of tha pric[ng guai�antaes
ni•e�s identlfied tn the"Cla(ms�xoluded"column of tlie table below. All othar Prascription Dcug ;
' Clalms shal(b�lticluded ln tha reconcillation of tlae gu�rantees,
' Typo of �'nctictpaCl�ig Mnll . C(nlms�xcludoci
Gunrautee �'hnrmncy Sorvice
Phaentac � �
OTC,compounds,Membec Submitted C(aims, '
� AWP— ,�yyp_ Subrogation Claims,vacaInea,Speolalty�Produots, � '
Bi's���1 ��80a�o 2�80% biosimilec products,tong term c�ice phArmacy claims�nd ; ;
• produots fllled through In-house or 340b pharmacies((f ' II
appllcabla) �
qTC,conipo�inds,Meinb�r Submltted Claims; I %
A�VP— q�,Vp_ Stibrogntion Claims,vaoolnes,Spacifllty Products, ' i
Geueric o o blos(mllne peoducts,long term c�tre�harm�cy olaims nnd. �
81,80% 84,80% p��oducts filled through In-house or 340b pharmacies(if
a lic�bla '
(b) D'ispens(ne Fee, BSI wlll gunrantae a m�xlmum avarabe�ggi�egate nnitunl per cl�titt�dlspensGtg:fee
� � • on Cllent utilizntion to be oalculatad ns follows;
[total dlspensing fee of�ppl'icab(e claims for the annu�tl paciod divided by tot�l clai�ns foc tlie anniial
• pertod�, '
Type of Pnrticigntiug Nlnil Sor�vice Clnims�xchidecl
Guarnntee Pl�nrmnc 1'linrmnc �
' �TC,compounds,Member Submltted Clflims,
Generic Acug Subrogation Clnims,vaocines,Spec(a(ty Procl�wts,
bis�ensing �0.80`: ' $0.00 biosim[lt�r produots,long tecm cnce phnrmacy '
I'ce/Cinlm cl�ims and products filled thcough in-house oe
340b li�rmacies lf a (ict�ble
OTC,compounds,Membec Submtttad Clalms,
• Bt�nud Sttbrogntion G(�ims,vaccfnes,Spaciafty Products, :
D1s�ensing $0,80 $0,00 bloslmifnr produots, long teem care pharmncy
['eelClnini ' claims nnd p��oducts filled through In-house or
340b harm�cles i�a licable
�Dispens(ng Fees�re inc{usiva o£shfpping at�d handling, If c�rcier r�tes(i.a,,U,S,tnail and/or 1ppllclble
commerclnl courler sarvines)lncrease ducing tha Tecm of this Agreemant,the Dlspensing Fee guarantees
� wlll be Iucreasad to ceflect such Increase(s),
C}uerenteas�vill be nte�isuced and reconciled on nn annual U�sls within l80 d�ys of the and oFeflch Conte�et
Yent�, To the extent Client chflnges lts bene�t desIgti oc Focu�u(�ry during tlie Tacm oP the Agreetnant, the
gu�r�tntae will be equitably nd,justed if there is �ninterinl implct on tha discount ncliieved, Sub,ject to the
YOT P'O[t DISTR[BUTIOY, T[•T�IVr0I2itiG.1Ti0Y CONTEITN�D E]�R�IN T5 COYrID�YTTr#L,Pl20PRI�'CrIRY
rIND COYSTITUTGS'I'I2t1DC SGCRLTS O.F�SI t1lYD(Lr,QCN��ITS •
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renlliniug teem�nf this Ag�'eemaut,Adnzinistrator wilt pay tha ctlf£eeeuae pf ClieuC's cast�oc flny shoctk'ntl � �
� bett�vean_tha�ctunl��esult nnd the gaacanCead��esult, (3u�icnnteas foi�pciaing components nce iuensticed and ; i
r e c o u c[t e d i n t t t e a g g re g�ta�ct�oss�ll p�iciug com�onents,� Auy dollac snV(ngs geuecflted in oxoess of one I ,
compot�ent ntay be used Yo oEfsek a sl�ort f�ll fo�:flny otl�e�componen C. •� : � � I
� � �
' Notwi'thstandi�tg nnytl�tng in t(iis Agceetnent to tlxa cot�tc�tcy, tlio Qene�ic �tvec�tga �nnual�ingrecll0ut cost , i i �
discoun t'gct a e�n t e e s s e l fortli abave will lnolucle only tftose Prescrlptlon Diug Gtatms tliak pcacessed to Client ; ,
:Foe plyment whaca the undeelytng pcescciptton drug pcoduct w�s tdenttfied�y�ivledl-Spnn�s hnv ittg'a Mu l ti- i � ;
Source Indicntor code Identifiet�oE"Y"on lhe date dis�eused(oc�wtis identiCted�by Medi-S�ati ns havin�fl ; i i
Multi•Soucoe Indic�toc ide�ttfiec oL an"NI,""N," or"0"�on tlia dttte dispensed,but was subst(tufed and , ; i
dispensed by the Ma1[ Servlce Pliarmacy as tl•s "ho�ise get�eric"), unlass suoh Presaci�tion Dcug Cla(m is : ' �
i �
otherwise excluded �bove. The Brand �tvecage anuual ingr�client t{iscbunt guacnutees sat fai�tli nbove wlll , , �
'inctude only'those Prascciption Drug�Claims•thlt processed to Client far paytnent where the undertying , ' } i �I,
prascrfpCiou drug product was identifted by Meclt-Span us hnving�i Ivlulti•Soucce Indicatoc coda,identifter oF �
"M","N",or"O"on the date dispensecl(except in cases�wheca the unelaclying prescripCto«drug��'o��«��WRs
I
substituted aud cl.ispensed by the Mnil Service Ph�rmacy as its"hotise ganecic"),unless such PrescrIption � �
Dhug C(1im is othecw[se excluded nbova, � • ;
Any claim that is considered a single source genaric will be inclttded In the generic reconcilintion. ' ' , ' !
�
3.2. SneciattV Prodacts . �
(a) . Exclus�,_ive C�ra:.ESI Specialty P(iflct�acy is the exclustve providei�of Specialry Products£or the � �
reimbucse�nent rates shown on tlie�xclusive ESI S�ecialty Pharmacy SpecialEy Product List, Any Specialty P�'oducf �
clispet�sed�tit a P�ctiotpKt'icig �'harm�►cy(for exntnpla, llmited distributiou products not then nvailabte through�SI �
Specialty Phncmaqy oc oVaci'Id�s)wilC ba ceiuiburse.d at tlie st�ndai�d Pa��ticipntiug Pliat�macy Speclalty Product cates
sho�vn below. Upon ESI S�ecialty,Pli�emacy acquisition of limitad distributiott products, Members will obt�►in , i
pcescriptlotts throu�h ESL Specialty PUflrmncy, • '
�
Iii cedi�ettt Cost Dis ensin I�'ee � i
�xclustve�SI Specls►l.ty Sae Exalusive Speal�[ty Prodttct Llst . $0,00 ,
Phn rmae .
Participating I'hncmncy Pactici��ting Pharmacy Speclatty Product $0,80
' SpecialtyProclucts • List • .
(b) � Pcicing for ASES is ns follows: • .
' (() Fot�Speetalty P►�oducts nasding an ndditiant�l�chacge to cover�eosts of alI ASES required to
adniinister the SpeclaLty Producta,tha folLowing stanctnrd pec diem nrtd nursing fe�rates
. shall a�ply, Excepfions to t[ie stand�rd pec d(am nnd nursing rates•ace set focttl in(Ii), �
below, wliich list may be updated from time to time by ESI, Pricing for home Infusion ,
supplles nnd se�vtces .provided at P1rEiciplting Pl�armacies (for example, ltmited � �
' dist�,tbution pcoducts no�than aYailnble thcougii ESI Spacillty Phncmacy oc overrtdes)will •
be pass thcough,
Stnndard Per Dlem $G5/doso �
� ,St�ndacd Nurstn Pee/E[cst 2 EIours $150 '
5tandacd N«rsin Etotu�l �75 �
((O Addition�l axceptlons to AWP Discount Rntes�nd StTndacd Pec Diem&Nursing Feas �
�
AVVP
' I3rand Nnme Dtscount Per 17[am
- - - --- - -- - ----------- - 1.0%-.--_-_ -_=---$651dT -------_--__--_=-- =
- --
_ _ _ - - -- -�'�PR�5TENOL'=__—_- _ _
HOT�OR DCSTItCBUTION, TI3G IYCOaMATCOIY CONTAIY�A ETCRCIN[S CQYCIDG�'l'CAL,PROPR[�Tr1ItY
AND CdYS'�LTUTL'S TLtr\DG SGC[tCTS OC GS[AND IL�CBCNCCITS 2�
. .
� ' . REMODUL,IN . .5,0°l0 ' $GS/da : i
T(�a AWP dlscount Includes Fhone.Support Nursing, Supplies,Pump, �rst two tr�ining �
visits, and Coocdinatton of In-Parsoa Ntu�sing, In-homa nursing that ls requested/needed � �
beyond the first two tra(hIng visits yvlll b'e ahnrged.nt n rate of$150 for the fiist two hoin�s ' �
�nd$7S for eveiy hour ni�ar, • , • I i
i
(c) Specialfy Products w111 be exoludec! fi�om the non-spactalty price guar�nteas sat f�t�th ln tha
Agreamant, In no event wIll the M�tll Servioe Plt�rmt�oy or�'artiolpating Pl�artn�cy pcicing tei�ms specIfied ln the �
Agreement, fncluciing; but not limiteil to,the annual avarage ingrediant cost discount guai�aiitees,npply to�Specillty ' i
Products. •
, . . . . , , i
(d) Unless othocwise sat foeth in an ngraement directly between ESI Specialty Pliflrmacy nnd Client,if j
a 5pecinity Prodttct cltspensed or AS�S provIded by EST Spealnity Pliarmacy is billed to Clieiit dlrect(y,by BST I
Speclalty Pharmacy lnstead of being procossed through EST and Ad�nfnistratoc, Client agrees to tlmafy�p�y�Sz �
Speoi�tltyPharmlcy for suc}i ol�im�iirsua�zt to tt�e i�Rtes.a,bove and wfthln thtety.(30),days of ClIent's,oe lts destgnee's, � i
recaipt of sucli electronia ar p�tpar clalin fi�om ESI Specislty.Pl�armacy, BSI Speotalty Pharm�cy shall h�ve 360 days '
fl�om the date of se�vlca to submlt such electeon(o or papar ol�iim, ' �
' • � � ;
(e) SP�CIA�,TY N�'I'�6T�CTZV�bTSCOUNT GTJARANT��-Adm(nisteatoe gunc�utees thnt tl�a o'vecal! '
�nntial net e£fective dlscount for the products listed on the Speclalty Produats�Ltst will be at le�st A�VP (-) minus �
18,55%foc G�lient(exaluding lfmited,d(stributinn peoduots), �4�lthln ona hundred nnd eighty(180)dnys following the � !
end of elah Contraot Yaar,ESI wtl(calculata tha nctual net affactive dlscount for the pi�oduets.iisted on the Specia,lty i
Pcoducts T�Ist that wera dispensed to datarm(ne iF tlia guarnntea has been mat, IF tt18 ftOfL1A�OVOPnU ttat affectiva ' '
disco�uit is less than the gu�tranteed net effective discount Administratoc wtll reimbursa Client tha f�dl dollac amotmt '
of the dtfferenca bvtwaen the actual ancl gua�'anhaacl net affectiva discounts, Cllent will retain�ny nmouut thnt the • �
actual nat a£fective discount axceeds tha guai•a.ntee'd net effeotive disaount� Tlie calcttlntioq foc the Rottial net sf�ectiva i ;
dlsoount will be as follows; ((Total Ingredieut Cost for tlia products Ustad on tha Specialty Pt�oduots List)divlded Uy ' '
(Total AWP for the products listed on the Speolalty Proclucts Llst))minus L, This guacnntee is aotttingent otz�Iient's
pnctloIpntion In tlia National Pcaferred Foi�mulary�nd nn exo[ustve speainity arr�ngement, ;
3,3 Influenzn nncl Other Vnceiunt(ons, Vncclnations shall adjudionte�t the lower of: ;
. �A� , .
Pm�!!clpnll�rg P/im�n�ncy ,Pnrficl/�ultilg Pl�ar���nqp '
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IiVTLT1�NZt1 .• OTCICR VACCIN�S �
In�rediant Cost Partlal��tting Phacui�ny Ingrecllei�t Pnrt(olpating Phnitnnoy Cn�rediant Cosh ns sat Porth
+ Cost as set.Forth In t}ta A reemant . in tha A raomant
Dlspousing rco Pncticipqtiiig PhnCmncy.• Purdcipnt(ng Phnrmncy D1s�ehsing Pea ns sat fortli �
� �D(spansing Pee ns sat forth!n the in tlie Agraemei�t
' A'reament � '
Profossionnl Soiwlco roe
(PSC);cost forplinrmncisf Pnss-Through Pnss-Through
to atl niliilstur tUe vnccinc cn ed nt�fi lS ec vnocine clnfin cn ed at$20 ar vnccina claim)
Vnccinc�'ragrnm Tco* ' $2,50 $2,50
. er vacclne e(nim er vncoine clnlm
� Tha�/ncoine Progrnm Fee rvill be bllled sepnc�tely to Clieut as plrt of tha�dmi�tlstrntive(nvolca flccorciing to
t(ie billing fi�equenay set forth ln the Agreemant. Th(s Vflccina Pcogram Fee will apply to any v�chtne clnims,
rv(ietliar nt oontt�aeted,eates or U&C,nnd is In nddition to�ny per Prescr(ption Dri�g Claim ndministcntive fee set
fo�fih ln the Agcea►�nent, .
' . OR '
� i
NOT i�Oft D[SxRtBUTI�N. T[4�IIYFORNIATIOi f CONTt1TY�b T�I�RCIN IS COiYI�'ID�NTTAL,PROPRI�TARY
eltYD CONST[TUTCS TI2t\DC S�C�CTS OI'GSI r1ND R;CBCIYGCI'['S
2S
� f '
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�(b) tlie co�nbtuect ingcedtent aost,ctis�ensiug.fee(if nny)flntl professiounl seevica fea(if Any) tliat tl�a i i
. PKcticip�tiugPl�nemttay generttlly chnrges nn(t�ctividull plying cash,without coverlge fac prescription clrug j
beneficg,plus,tlta Vt�coina Pragrnm�ee set foctli above.� f
. i �
� Cover�ge(s suGject to Plan pcpvision�. No v�icaiha elnlms avi[l�e incl�uted in nuy gut��'nntees seE fortl�in the I i
,Agceenteut nnd/ot�nmeudmenta theceto, � , �
D. RCBATGS � ;
�i
1, Rebnte Amounts. Subject to:(i)the cqnditions set facth in Sections 2 thcottglt h belory�nc!elsewhere ln thls � � i
� I
� Agreetnent;attd(ti)Clieak tneeting the Plan Destgu conditions identlfiecl in the t161e below,tha followIng guaratiCeed i ;
; I i
amounts will be payable to Cliettt ducing tlie Tecin of this Ag��eatnent; � �
, � ; �
. , � �
�'ox�mulacys CSIIVntlo�inLPcoforred • �
hTntionnl Plus ' �Iomo Delivery Snocialty Pcoctucts � 4
P[etrvorlc ' �roctucEs .. i
; ; i
Rebntes pe�• Braud $148A0 per brnad $430A0 �iec bcand .$L,075.00 per b�and ctaim � i
�,x . .claim . . claim. i �
�Xclus�otis. Member Su6mitted Claims,Subrogntfon C(11ms,btosim(lnr products,OTC products,vaoaines, � � '
2. ---. !
clatms oldar than 180'days,claims throughClienC-owned oc 340b pharmacies,nnd claims p4u•suantto a 100%Membac i I
� Copaytnent pl�n ace not eltgible for the guacanteed Rebate amo�ints set fortli in Section 1.above. i ; ,
Adininisl•rntor wiU A�eceive fi�omESZ the � �
3, Rebate Pnvment Tecros. SubJeet to the canditions set foeth hecein,L80 d� s fall.owing cfllend�r c�uarter , � ��
quartecly Rebate pnyments withln appcoxtmately ona luuidced e(ghty � ) Y ;
adj«dic�ted£or[Zebates received during the prioc ca[endai'nuarter,•Administratoc shall pay C(ient tha guacanteed
amo�mts§et Forth ln Seat(on 1 nbove within appt'oximntely thtrty(30)days foltowing ceceipt of�the Rebat�payments
fi•om ESL
q, Condttions � '
h,l,65t contcacts with ph�rtnRceutical manufacturers for Rebftfes on its own bah�►(�ttnd foc its own beuaFt,
and not on belialf of Clieut. Accordingly,ESI retains all right,title and interest to nny and all aotual
Rebatas received fi•om manuE�cturers, �SI will pay to Administcatoc(nnd Admit1tstentor shall pay to i
Cl�ent)�.mounts equKl to tha Rebste ntnounts allacfltec[to Cllent,as specified flboVe,from�SI's genecal . � .;
nssets (neither Client, its Membars, nor Ctietit's Plan cetains ftny beneficiat or propcietRcy tnterest in , i
B S[''s ganeral assets), Client aclrnowledges and agcees that tielther it,its Ntembers,nor its.Ptatt wtll have �
a r[ght to intecest on,or tEie tinte value of,any Rebate pflyments receive d b y E S I d u r i n g t h a c o t l e c t i o n ; ;
paciod oc maneys pfty�►ble under this Section. No atnounts for Rebn4es wlll be paid until this Agreement ,
Is axecutad by Client, ESI nnd Administr�tor w'ill have the right to �pply Client's allocated Rebate i �
. amo�mt to.unpa[d Fees, ,
4.2 Client ac(rnowfedges that it may be eligtble for Rebnte amounts under thts.Agceement only sa (oug as : ;
C l i e n t,i t s n f f i t f n t a s,a r i ts a gents do not contract directly or tndirectly witli anyone else Eor discounts, , i
utitixation limtts, Rebfltes or other financial (noentives on p hnrmaceu t icl l pr o d t t c t s o r f o r m u l a r y
progcams foc Prescriptton Dcug.Cla(ms proaessed.by ESI pursuant to t he Agreement,wlthout tha prior
wcitten consant of ESL In the event that Client negot(ates or arrauges wit(i � pharmaaeuti��l
manufncturer for Rebates or similar discounts foc any Goveced Drugs hereunder,but without limlting
ESC's rlght to other remedies,�SI m�y[�nmediate(y�vithl�oLd any Rebate amotutts earned 6y,but not yet i
paid to, Client as necessa�y to prevent dupltontive Rabates on Cavered Drugs. To tha extant Cliant
knowingly nagotiates and/ar contracts for discounts or Reb�tes on clnims For Covered Drugs without
� ' pcior writtan appro'al�nf�E fl��inent of LCtebatel amoc�int nhereunder and�to I enegatiuke the erms t►nd
- - ---- -- - -- - - -- --- - - - entitling��I to s�sp 1?Y - - - --- ---- - - --- _ -
- -_- - - --------- _-_-___-_- �
-- - - - - - - - -
— - ---- - _ _ _ �
oonditlons of this Agree[rient�
lYOT rOR DCSTR113UT[ON, TFCG[[�ICO[tibltlTCON CONTA[NCD EX�LtGIN IS COYCIDCVTIt1,L,PROP[t[�TrtRY
r\ND.CQ�lSTCTUTGS TRADG SGCRGTS OC GSI rlvD R.�CBCNCCLTS Z�
• • 4�3 Under its Rebata peogram,ESC may Impl.ement BSI's��'oa:tniilacy mansgemarit pPOgCflp7S iit1C� CO'tltl�ols,
� . which.may inc(ude, st�ong oth'ec things, cost.containmant��lnitlatives, and communlcatlons �vitli li
� . Members,P.articl[l�tingP.harmnoies,nnd(oc pliysicians.•ESI caseives tlta l�iglitto modlfy or rep(�ce such �
. • •� progi�ams.Fi�oin time.to ttme, Gusranteed:�R�bate.nn�q�iuts,If any, set fort(i herel,n, ace conditioned on
ndlierance to various�ormulary tnanageinent�cotitrols;b'anaft.design.requlcemanhs,o111ms voluma,nnd •
other t'actors stated in tlie app(Icable phnrnlaceutioal m�nuf�ctucei�agreemeuts,Rs commiinicnted by ESI �
t4 C[ient fi�qm time to titne, If:auy.govarnment ftct(on, ol�ange ln �pw•or cegulatton, change in the
� Interpretatlon of nny'law oc regulatlon;oc�ny saGlon by:a pharm�oeuttcal m�nuf�attu•er hns an adverse
• effect on the availaUility of RebRtes,then ESL and Admfnistcatoc may�a€�ke nn�d�ustment to fihe Rabata •
, tai�ms and guaranteed Rebate amounts,if�ny,hareunclee, � ' '
. � � 4,4 I�ebahe Aaknow(edgment; No Repcesentation; I�eb�ta Limltations. Client acknowleclges t(�at ;
.Adminlstcatot� ls not making flny represenfatiot�,�wacranty.•or,guaranty o£a�y.kind o��natura, etthai� j
, express,lmplied o��atlierwisa,re�ardhig tha ftmount of I�abntes to ba pn(d or remitt�d to ClIent pursu�nt ' �
,to.this Agraement,axcep't,as sNecifiefllly sat foi�tli Iq wcltl�tg hecain, Ttt addltion,Client watvas,.ra(e�ses �
and fore'ver dischnt�ges LSI a�d Ad�ninIstrator fi�om nny Losses nrlsing from a ph�it�tnaoeutic�l comp�ny's !
(fl)f�ilure to p�yRaUatas;(b)bre�elt of an agraement relatad to Rebatas;or(a)neglfgance or misconduct,
Clieitt naknot,yledges.tltnt.whethec nnd to what ex�ettt pharmaca�iticnl companies are willing to pcovfcie
Rebates to Cltant may depand upon a variety oFfflctors, inaluding tha contaut oP•the PDL, tha Plan's
deslgn feah�ces,Cllent me�at(ng critea�i�for Rabates, and the axte.nt,o.f parttctpatIptt ln�SI'�,formulnry `
mflnagament progcatns, as �vall ns E51/Adminlsh�ator recaiving suffio(ent lnfot'IT1�1fI0t1 lregarding each �
� Claim£or subinission to pharmnoeutia�(•companias foc Ra.bntas, ClIeitt ackttowledges and ngraes that
� � ESI may, buC shnl! not ba requii•ed to, (nitiate any collectlon aotton to aollect Rny Rabates.froin a '
� phaemncautic�l•eompnny, In the e'vent BSI doas initiate•collectlon action ngait�st a hharmeaeutioal
com�any to collect RaUates,ESI may offset nny t�ansonable costs,lncluding rensonnble flttorneys'fees
. � anct expenses, flrlsing.from any such�ct(on.. Notwitlistanding nny.provIsion of this Agreamant to tlie I
contrai�y,Adminlstrnto��shali only be responsIbla for payment oFRabntes to Cllant ptu�suntit to the terms � '
, of this Agreement if such Rebntes nca actually raceived by AdminiStr�tor d«ring tho Tarm of thls
Agt�eement, In no event sha[I Admtnistrator be ob!(gstad to pay Rabatos to Cllant t►ntiC Administratoc
�receives payment for the sfttne Rebatas fi�om ESI,In tl�a eveht ClIent terinlnates tha�.gcaemen't outside ;
the farins nnd oonclltlous icx the Agreement,Cltattt forfelts.tlio rig}tt to recelve flny Rabutes eeeaived by
, Adminlstentor on Clienk's behnlf �fter tho date of such tarminatlan, Cllent acknowladges th�t
AdminlstcAtor shal(not be oblignted to.pay Cltent�ny Rebates dascribed haeein until this Agreament Is
. ' sigt�ed by Client, �
5, Rcbata amoi�nts paid to Cliettt purs���nt to this Agreament ni�e intended to be tre�ted as"cilscounts"p�irsuant
to the fader�l nnti-klckbnolcst�itute sat focth nt 42 U,S,C,§1320a-7b 1nd implemanting regiQat(ons, Client ls oblig�ted
, lf requested by the Seorat�ey of tha Unitad States Departmant of Healtl�nnd Humnn Servlces,or as otherwisa requirad
by �pplfcabla law, to report tlie Rebate nmounts 1nd to prov(de t�copy of thls notice, EST will refi��(n from daing �
enythLig ttint wottld impede C(ient from ineeting any such obligation, �
G. �SI'S INrLA'CION PROT�CTION�'ROGRAM '
L IP Pra,�ra�. The Infl�tion Pcotecklon P��ogram("LSI IP Pco,�rn")may ba elected by ClIent upon its pcior
wcitten cequest to Adm(nIstcstar, subject to the terms nnd conditions of tha ESI IP Progcnm sat forth in Saction 2
belo�v, SubJect to tha terms and conditions set foi•th below,uudar the ESI LP Program Administr�ttoe�vill pay to Client
$2,00 per Formulnry Brnnd Deug claim ("Client Infletion Pn��enP'), Subjeot to the terms and conditions sat forth
l�erein,under the ESI IP Program, Administrator will p�y C(iant tlia Client Inflntion P�yment withlti approximately '
one hundred and elghty(180)days fo(lotiv(ng Nie end of e1ct� c�lendar quartec for utllizfltion occurring during.sueh�
calendne qu�trter, All non-Farmul���y clnlms and Qenecic Drug clafms shall be excludad,
2, Terms nnd Couditfous of GSC's IP P��oer»cr�, �
2,l Excluslons, The Following clnlms w(ll ba excluded Fco�r�all en(au(�tions related to EST's[P Program;
NOT T'OR DISTRIBCJTIOY, TIfG INrORl�It1TTON COVTAINGD FICR�TY IS COYI'IDCYTIAL,PROP:[21�TARY
r1ND CONST[1'UT�S'L'Rr1D�S�CR�TS OG'CSI AND IL`CBCNCrITS
� 27
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Med(c�(d claims n.ucl atiy other�overnment healC(i cara�i�ogram alnlms i
� Ntedicnce cl�iius, ,
� OTCSy tl18111�0P subu�itled c(aims,subrog�tion clnln�s,coinpouct<ts,GeueclaDrligs,cl�i�us subwitted i
��y Client�ownecl,lti=hbttse,or au-site pharmaetes,�3405 cl�iius,cl�ims subniitted thrnttgli n L00% f i
lvieinUec cost-shtire�rogrnm,Gioslmllt�rs,ciru�s wl�e��e the,niiautiGy or paakaging has been oht�nged ,
by the mauiifRctiu�er fi�otn ttie prioc y��ir,fluii cicitgs�or which fhere Was no s�til[z��tio��in the c�leudar � � i
yenr prior to the cnlenc(ac yeac foc whioh'tha Glie«t Zuflatloa Payment ts�eing detertutned, � i
2,2 ESI's Ri�htofEquitnb(e tl.diustnteut,Tf Client makes matac(at changes td its kor�nuln►'y ar beneCtt des[gn ! ; �
tht�t negat'ive ly tinpac t E S C s n b i t i t y t o c o n t rol infl�tion relativa to Clienf's Foemu[aiy•dcug ulix, then ! i �
Glient i�alcnow(edges tht�t�S[oc Ad�►inish�ator reserves the ctght in ESI's discretlon to matce an equ itl b le i ,
adjustment to tlte Cllettt Inflation PnYt�1ont. ;
�
' 2,3 'Che ESI Il'Progcam;�ihd the undeclying ecotiomies,is separ�te and�p�ct fro�n rebates n�id�nt�nufacturec ' I
�idmiiustr�tive Fees,�nd tha_t�mounts described above in this Seotton L��wltl be paid to ClienC�in addition
. 'to nny r�bata paymerits to whlclrClient'is entitLad pUrsl�aht to the terms o�thia A�i'ecment. Ctient wifL I t
' : not be entiBled to reaelvo any amounts celated ta drttg prioe tuflation or a celated gulcnntee other thftn as t
set�ortli nboVe(n this Se.otion L�oFthls xh� ibl�A(C�ientAppLidation).' j
, 2,�k'No'payinents will be�nade to Client tinless Cltent has'�n executed this Agreemant, �
. . �
�, � ��C�CUTCONB'Y�CLI�LYT � ' � � . • � ,
. Ctienl•hereby represept3 At1Cl WaCPnnfs,th�tt the informatiomcantalned ta Sectlou A oEthis Client A.pplication � ;
Is true and coreect in all respaots snd.Ctlent hereby agcees to the speolfia tarms,condttiotis and fin�ncia(arrangements ' i
setout lu Seotions B;'C D and E ofthls Client Appllcation, Client ngrees thatif anCli nt unde standseth t t shCllant : � '
Cltant will gtve Adm[�iistcator pcampt notica oF such changes. ��n�thermore,
Applicatton.(ExhibitA)is a p�►'E intogb d e�eca cteVand�that tant s�bound byttn(l(tfat�ms and�ondit otnstof such :
it Is attached t�red incorporatsd Y . � i
Administratlye Services Agreemenk ' . i ;
' ' All cnpltaltzed�terms used�iu thls Cllent Applioation but'not speoifically defined herein shall hnve the � �
meantngs given to suctt terms'in the Administrativa Services Agreement to which this Client Apnliontlon is�►ttached ; ''
and made n part of. � � � ;
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- - - - - - - I
NOT 6'OR DISTCtILiUTCONCOiVST TUT S T[tAD�S CRCTS Ot'S�[�\ND RXB N�CITS CA6,PROPR[GTrI[tY ,
A.ND 28
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XIY 1�'Yz�'N�SS�V.Tz�'It�OT', Glte�it has oaused this Clleut A.ppllontlon xhibit to the Agceemant)to ba � � �
exeottted as af the L�ffaotfva pttte, I«tha evau�th(s Clleut App(iontlon ds�tnanded by tha PaPEI89 flROP tha�£fective . ' I
bnta, tho Pftrtlos ma,y substltuta si�oli ntnended Cllont Ap�lioat(on For tha foi�utae Cllent Applio�t(ot�,pt�ovlded t(�a � � I
P�etlas set forth tha date fi�om�nd�i�er wl�ioh siiolt�mauclad Cllant App(fontton shall ba effaoElvo(!ha"date"Ilue nt I �
tlte bottom of the,A.dtnittisEraiot�'s aaknnwledgmeu�slgnntuea bloolc ott an flmanc(ed Ctiant Appl[oatlon ahn((be suoh i
tiaw e:Ffsotive dnte rvlth respaot to suoh nmendad Cllent Appl(cntlon), xl�e Pnrties flu'CIiOI�ngt'08 fllAt tI10Y tiy((1 Ei�RO}� �
suol�amenclad Cliont Ap��llontlon to t61s A.�reatnant nncl provido Et oopy of thls Ag��eontent wlth tlta eniendod Cllent �
A.ppliontton ( xhlbl ) to Adminlsl•t�al•or and Cllant for tlzelr a�as��eotiva reoorcls, Any suolt amanded CUent � �
A.ppllaatlon ntust be slgnod by Cilent's nutlioeizod rept�eeentntiva nncl nolcnowladged,ngeaed t0,nooeptad auc(d�hod by ' �
Ad�t�lnistrntor'�nuthoefzecl repcaseut�tiva,
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