Express Scripts, Inc. Employer Participation AgreementMasterpiece on the Mississippi
Dubuque
band
AI- America City
1
2007 • 2012 • 2013
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Employer Participation Agreement between the City of Dubuque and
Express Scripts, Inc.
DATE: September 5, 2013
In 2004, the Health Care Committee participated in a RFP process for pharmacy benefit
managers sponsored by the Iowa Employer Coalition and conducted by Gallagher Benefit
Services Inc., our benefit and actuarial consultant. There was no cost to the City to
participate in the RFP process. Express Scripts was selected as the pharmacy benefit
manager for the Iowa Employer Coalition.
As a result of negotiations conducted by Gallagher Benefit Services Inc., Express Scripts
agreed to improved financial terms in 2012. The estimated value of the financial
improvement is 6.1 % per year net average over the next three years. The estimated annual
savings is $8,200. Projected savings will come primarily from higher formulary rebates and
larger discounts.
Personnel Manager Randy Peck has been working with Express Scripts for approximately
one year to resolve some language issues, particularly as it relates to the renewal provision.
City Attorney Barry Lindahl has reviewed the applicable provisions of the Employer
Participation Agreement and specifically, the renewal provision, and finds the terms
acceptable.
Personnel Manager Randy Peck recommends City Council approval of the Employer
Participation Agreement, which was effective January 1, 2012, and authorize the City
Manager to sign the agreement.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
Michael C. Van Milligen
MCVM:jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
Teri Goodmann, Assistant City Manager
Randy Peck, Personnel Manager
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Masterpiece on the Mississippi
Dubuque
All - America City
11111!
2007 • 2012 • 2013
TO: Michael C. Van Milligen, City Manager
FROM: Randy Peck, Personnel Manager
SUBJECT: Employer Participation Agreement between the City of Dubuque and
Express Scripts, Inc.
DATE: August 30, 2013
In 2004, the Health Care Committee participated in a RFP process for pharmacy benefit
managers sponsored by the Iowa Employer Coalition and conducted by Gallagher
Benefit Services Inc., our benefit and actuarial consultant. The Iowa Employer Coalition
is a coalition of other Iowa cities and counties. There was no cost to the City to
participate in the RFP process. Express Scripts was selected as the pharmacy benefit
manager for the Iowa Employer Coalition.
As a result of negotiations conducted by Gallagher Benefit Services Inc., Express
Scripts agreed to improved financial terms in 2012. The estimated value of the financial
improvement is 6.1% per year net average over the next three years. The estimated
annual savings is $8,200. Projected savings will come primarily from higher formulary
rebates and larger discounts.
In order to take advantage of the new pricing arrangement, we signed the attached
Letter of Acknowledgement on February 24, 2012. After signing the Letter of
Acknowledgment, we received a new Employer Participation Agreement. The
agreement is effective January 1, 2012. I have been working with Express Scripts for
approximately one year to resolve some language issues, particularly as it relates to the
renewal provision. City Attorney, Barry Lindahl has reviewed the applicable provisions
of the Employer Participation Agreement and specifically, the renewal provision, and
finds the terms acceptable. I request that the City Council approve a motion authorizing
you to sign the agreement.
RP:lmh
EXPRESS•SCRIPTS®
Vag
7A I
February 14, 2012
City of Dubuque '
50 Wes113' Skeet
Dubuque, Iowa 52001
Attn: Randy Peck,
Thank you for selecting Express Scripts as your pharmacy benefit manager (PBM), This letter will serve to confirm that Express Scripts
will manage the costs and utilization of your prescripfori dng benefit plan.
•
While the contracting process has been Initiated, a definitive agreement has not been executed. In order for Express Scripts to be able to
Implement your prescription drug program without a signed contract, Express Scripts requires written confirmation from you concerning the
financial terms dour arrangement .
•
Subject to the requirements below, Express Scripts will implement the financial terms set forth on the attached pricing, to be effective as of
'January 1, 2012, provided Ihls letter Is received signed by an appropriate officer of your organization prior to January 1, 2012, in addition,
this pricing is conditioned upon a one (1) year term with ESI as your exclusive PBM.
•
The,parlies understand there are extra - market industry, legal, government and regulatory activities which may lead to changes relating to,
or elimination of, the AWP pricing Index that could alter, the pricing intent under this Agreement it the Pricing Source changes the
methodology for calculating AWP or replaces AWP, or If, as a result of such change, ESI utilizes another recognized pricing benchmark
other than AWP (e.g., to Wholesale Acquisition Cost), then Participating Pharmacy, CuraSatpt and Mali Service Pharmacy rates, rebates
and guarantees, as applicable, Will be modified as reasonably and equitably necessary to maintain the pricing Intent under this Agreement.
ESi shalt provide Sponsor With at least ninety (90) days notice of the change (or if such notice is not practicable, as much notice as Is
reasonable under the circumstances), end written Illustration of the financial Impact of the pricing source or index change (e.g., specific
drug examples). If Sponsor disputes the Illustration or the financial impact of the pricing source, the parties agree to cooperate In good
faith to resolve such disputes.
Express Scripts' policy prohibits the processing of subsidy reports as well as payments of such items•as rebates, guarantees, commissions
or other similar payments until a contract is fully executed, Please also note that we may not be able to bbl for manufacturer rebates for
any quarter for which a wr0ten contract Is not In place. do if a legal contract is nol in place by the time we bill the manufacturers (usually
within two weeks of the end of a calendar quarter) we may not be able to bill tot rebates for your program for that quarter.
Express Scripts looks forward to a long and mutually satisfying working relationship with you. if you have any questions, please contact
Pat Burns at 314- 996 -0910. Please sign and return this letter via fax to Ellen Wynne at 800- 287 -0359, and mail the original to her
attention at the address below. '
Sincerely,
jc4-+n^f"
Caw -Qu.„
Victoria L. Wheeler
Vice President, Account Management and Sales Support Services
1.800.769 -3968, Ext. 344168
ArA
Agreed to this ay of , 20 d
company. City of Dubuque, Iowa
Signature: Lys
Printed Name: Michael C. V .n Milligen
T'i18: City Manager
One Express Way . St. Louis, MO 63121 . 314. 996.0900. www.express- scripts.com
EMPLOYER PARTICIPATION AGREEMENT
THIS EMPLOYER PARTICIPATION AGREEMENT (the "Employer Participation Agreement ") is
made as of January 1, 2012 (the "Effective Date "), by and between CITY OF DUBUQUE ( "Employer ") and
Express Scripts, Inc., a Delaware corporation ( "ESI "), for the purpose of delineating the terms and conditions
under which ESI will provide certain pharmacy benefit management services to Employer under the Coalition
Umbrella Agreement (as defined below) between ESI and Gallagher Benefit Services, Inc.
RECITALS:
A. Gallagher Benefit Services ( "GBS "), a Denver corporation, manages healthcare vendor relationships
on behalf of the Employer and its counterparts who participate in coalition purchasing programs;
B. ESI and GBS have entered into that certain Pharmacy Benefit Management Agreement dated
effective as of January 1, 2012 (the "Coalition Umbrella Agreement ");
C. The parties acknowledge and intend that the Coalition Umbrella Agreement is incorporated herein by
reference. Defined terms used herein shall have the same meaning assigned to such terms in the
Coalition Umbrella Agreement; and
D. Employer desires that ESI provide ESI Services to the Employer in accordance with the Coalition
Umbrella Agreement.
NOW, THEREFORE, in consideration of the foregoing Recitals, which are incorporated herein by
reference, and in consideration of the mutual covenants herein contained, the parties hereto agree as
follows:
1. ESI'S Obligations. ESI agrees to comply with the terms and conditions as set forth in the
Coalition Umbrella Agreement.
2. Employer Obligations. Employer acknowledges that it has read and hereby agrees to the terms
and conditions set forth in the Coalition Umbrella Agreement, which Employer acknowledges are
hereby incorporated into this Employer Participation Agreement by reference. Furthermore,
Employer agrees to the following:
a) Financial Responsibility /Payment Terms. In accordance with the Coalition Umbrella
Agreement, Employer will pay to ESI the fees due under the Coalition Umbrella
Agreement pursuant to the payment terms set forth in the Coalition Umbrella
Agreement. Employer has sole responsibility for timely payment of such fees. GBS may
facilitate the payment process, but Employer retains all financial responsibility for timely
payment of the applicable fees.
b) Member Authorizations and Disclosures. When such services are requested by
Employer, Employer will obtain all Member authorizations required by law for ESI to
perform any ESI Services provided for in this Employer Participation Agreement or in
any addendum or amendment hereto, and for ESI to contact Members, Members'
physicians, and Participating Pharmacies in order to promote therapeutic and generic
substitution opportunities and to perform any other ESI Services or activities
contemplated by this Employer Participation Agreement that may require such contact.
Employer shall provide ESI with Members' addresses and such other information as may
be reasonably necessary to facilitate such communications.
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195733.4
Employer will disclose to Members any and all matters relating to the plan design that
are required by law to be disclosed, including information relating to the calculation of
co- payments, coinsurance amounts, deductibles or any other amounts that are payable
by a Member in connection with the plan design.
c) Confidentiality. Employer will hold the terms and conditions of this Employer
Participation Agreement confidential except to the extent disclosure is required under
applicable law. Employer will not share the terms of this Agreement with its consultant
or other third party without the express permission of ESI and GBS.
3. Term and Renewal. The initial term of this Employer Participation Agreement shall commence
on the Effective Date and remain in effect through June 30, 2013 (the "Initial Term "). Thereafter,
this Employer Participation Agreement shall automatically renew for successive one (1) year
terms unless terminated by either party as described in Section 4 of this Employer Participation
Agreement.
4. Termination of Employer Participation Agreement. ESI and Employer may terminate this
Employer Participation Agreement as follows:
a) Non - Renewal Upon Notice. Not less than ninety (90) days prior to the end of
the Initial Term or any renewal term of this Agreement either party may notify
the other party in writing that it desires to terminate this Agreement effective as
of the end of the then current term. Notwithstanding any provision in this
Agreement to the contrary, this Agreement is terminable "without cause" by
either party.
b) Breach or Default. Either party may give the other written notice of a material,
substantial and continuing breach of this Agreement. If the breaching party
has not cured said breach within thirty (30) days from the date such notice was
sent, this Agreement may be terminated at the option of the non - breaching
party. If the amount of time commercially reasonable for the breach to be
cured is longer than thirty (30) days, this Agreement may not be terminated by
the non - breaching party pursuant to this provision until such commercially
reasonable period of time has elapsed; provided, however, that in no event will
such period exceed sixty (60) days.
c) Non - Payment. Notwithstanding anything to the contrary herein, ESI (and its
wholly -owned subsidiaries) shall have the right to terminate this Employer
Participation Agreement or suspend performance hereunder (and the Coalition
Umbrella Agreement) and cease providing or authorizing the provision of
Covered Drugs to that Employer's Members upon forty -eight (48) hours written
notice if Employer fails to pay ESI or provide a deposit, if required, in
accordance with the terms of this Agreement. ESI attempts collection through
written and verbal communications with Employer prior to sending the notice
described herein.
d) Move to Fully Insured Plan. In the event Employer moves to a fully insured
plan which includes both pharmacy and medical coverage, Employer may
terminate this Agreement upon ninety (90) days written notice of the move to a
fully insured plan.
e) Termination of the Coalition Umbrella Agreement. If GBS terminates the
Coalition Umbrella Agreement, Employer will also have the option to terminate
this Employer Participation Agreement as of the effective date of the date the
Coalition Umbrella Agreement terminates. In the event the Coalition Umbrella
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195733.4
Agreement is terminated, ESI will cease offering Coalition pricing to Employer,
and will offer different pricing (based on Employer's size, utilization, market
conditions, etc.) if the Employer wishes to enter into an Agreement with ESI. If
the parties cannot agree on revised pricing terms, either party may terminate
this Employer Participation Agreement upon ninety (90) days prior written
notice.
f) Obligations Upon Termination. Upon notice of termination of this Employer
Participation Agreement, the parties will mutually develop a run -off plan
providing for: (a) Employer notification to Members of the timing of any
transition to a successor pharmacy benefit manager at least thirty (30) days
prior to the effective date of such termination; (b) ESI provision of open Mail
Service Pharmacy refill files and standard claims data and PA files for
transition to the successor pharmacy benefit manager in accordance with then
existing industry protocol; and (c) whether Employer elects for ESI to process
Participating Pharmacy or Member Submitted Claims for prescriptions filled
during the Term but filed with ESI after the effective date of termination
( "Termination Date "). Employer will continue to pay ESI in accordance with this
Employer Participation Agreement and the Coalition Umbrella Agreement for
any Fees for ESI Services provided during the term and any run -off period.
ESI will continue filing for Rebates for claims incurred prior to the Termination
Date and will pay Employer Rebates for such claims in accordance with the
Rebate payment schedule set forth in Exhibit B of the Coalition Umbrella
Agreement.
5. HIPAA. The parties agree that as relates to use and disclosure of PHI, electronic transaction
standards and security of electronic PHI under HIPAA, they are subject to the terms of a
separate Business Associate Agreement.
6. PMF. ESI has agreed to pay a Pharmacy Management Fund ( "PMF ") to Employer in the
amount of $5.00 per Member implemented as of the Effective Date of this Employer
Participation Agreement to reimburse Employer for the actual, fair market value of expenses
incurred by Employer in transitioning to ESI, subject to the following:
(i) Employer must submit adequate documentation of implementation expenses
within 180 days of implementation, at which time a final reimbursement of eligible expenses will
be made.
(ii) Employer represents and warrants that: (A) it will only use the Implementation
Payment as reimbursement for its actual implementation expenses incurred in transferring to ESI
(including amounts Employer owes to GBS for transition services); (B) the amount of the
Implementation Payment is equal to or less than the fair market value of the actual
implementation expenses incurred by Employer in transitioning to ESI; and (c) the expenses are
reasonable and consistent with the fair market value associated with such expenses in an arm's
length transaction. Implementation Payments may not be used in connection with the Medicare
Part D program unless otherwise agreed by ESI. Employer may elect to have its payment
directed to GBS if indicated to ESI in writing. ESI intends to amortize the Implementation
Payment over the Initial Term of the Agreement on a straight -line basis, unless otherwise
required by law or accepted accounting principles. Employer shall notify and disclose the amount
and the terms of the PMF to Members and other third parties to the extent required by applicable
laws and regulations. If Employer terminates this Employer Participation Agreement for any
reason other than EST's uncured material breach, Employer shall reimburse ESI the unamortized
portion of the PMF. Any payment made to ESI by Employer pursuant to this Section will not be in
lieu of any other rights or remedies ESI may have in connection with the termination of this
Employer Participation Agreement.
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195733.4
7. GBS Management and Consulting Fees. Employer hereby confirms that GBS is
providing management and consulting services on behalf of Employer in connection with the
pharmacy benefit management program administered pursuant to this Employer Participation
Agreement. Employer hereby directs and authorizes ESI to facilitate, on behalf of Employer, the
payment of a monthly fee in an amount equal to $0.12 per each approved Prescription Drug
Claim processed by ESI for Employer during such month ( "Management and Consulting Fees ").
ESI agrees to facilitate the payment of the Management and Consulting Fees subject to the
following:
(a) Employer has executed this Agreement and Employer is current in its payment
obligations to ESI.
(b) Employer hereby represents and warrants that the GBS Fees are fair and reasonable for
the actual services to be performed by GBS in connection with Employer's prescription drug
program; are commensurate with other consulting fees in the industry; and are not in violation of
any law or regulation, including ERISA. ESI will not pay per prescription fees on Medicare
subsidy utilization.
(c) ESI will comply with any request by Employer to stop GBS Fee payments. Employer shall
hold ESI harmless in connection with any dispute between GBS and Employer regarding GBS
Fees.
8. Thompson Reuters Fees. Employer hereby confirms that Thompson Reuters ( "TR" or
"Auditor ") provides services for the benefit of Employer, in connection with the pharmacy benefit
management program administered pursuant to this Employer Participation Agreement. In
addition to the GBS fee described herein, Employer hereby directs and authorizes ESI to
facilitate, on behalf of Employer, the payment of a monthly fee to TR, in an amount equal to $0.18
per approved Prescription Drug Claim processed by ESI for Employer during such month. ESI
agrees to facilitate the payment of the TR Fees to TR subject to the following:
(a) Employer has executed this Agreement and Employer is current in its payment
obligations to ESI.
(b) Employer hereby represents and warrants that the TR Fees are be remitted on behalf of
Employer are fair and reasonable; are commensurate with other TR Fees in the industry for the
actual services to be performed by Broker in connection with the Employer's prescription drug
program; and are not in violation of any law or regulation, including ERISA. ESI will not pay per
prescription TR Fees on Medicare subsidy utilization.
(c) ESI will comply with any request by Employer to stop TR Fee payments. Employer shall
hold ESI harmless in connection with any dispute between TR, and Employer regarding TR Fees.
9. CHECK APPLICABLE BENEFIT PLAN BELOW:
TRADITIONAL
❑ PASS THROUGH
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195733.4
10. Employer Information.
Employer Name: City of Dubuque
Contact Name: Randy Peck
Address: 50 W. 13th Street
Dubuque, IA 52001
Telephone No.: 563 - 589 -4125
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their
respective duly authorized officers or agents as of the date first above written.
EXPRESS SCRIPTS, INC. CITY OF DUBUQUE
By; By: /
Print Name: Print Name: Michael C. Van Milligen
Title; Title: City Manager
Date: Date: 'L l
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195733.4
ATTACHMENT 1 TO CLIENT AGREEMENT
FINANCIAL DISCLOSURE TO ESI CLIENTS
This disclosure provides an overview of the principal revenue sources of Express Scripts, Inc. ( "ESI "). In
addition to administrative and dispensing fees paid to ESI by our clients for pharmaceutical benefit management
( "ESI ") services, ESI derives revenue from other sources, including arrangements with pharmaceutical
manufacturers, wholesale distributors, and retail pharmacies. Some of this revenue relates to utilization of
prescription drugs by members of the clients receiving ESI services. ESI may pass through certain manufacturer
payments to its clients or may retain those payments for itself, depending on the contract terms between ESI and the
client.
Network Pharmacies — ESI contracts for its own account with retail pharmacies to dispense prescription
drugs to client members. Rates paid by ESI to these pharmacies may differ among networks (e.g., Medicare,
Worker's Comp, open and limited), and among pharmacies within a network, and by client arrangements. ESI
agreements generally provide that a client pay ESI an ingredient cost, plus dispensing fee, for drug claims at a
uniform rate. If the rate paid by a client exceeds the rate contracted with a particular pharmacy, ESI will realize a
positive margin on the applicable claim. The reverse also may be true, resulting in negative margin for ESI. ESI also
enters into pass- through arrangements where the client pays ESI the actual ingredient cost and dispensing fee paid
by ESI to the pharmacy. In addition, when ESI receives payment from a client before payment to a pharmacy, ESI
retains the benefit of the use of the funds between these payments. ESI may charge pharmacies standard
transaction fees to access ESI's pharmacy claims systems and for other related administrative purposes.
Brand /Generic Classifications — Prescription drugs may be classified as either a "brand" or "generic;"
however, the reference to a drug by its chemical name does not necessarily mean that the product is recognized as a
generic for adjudication, pricing or copay purposes. ESI distinguishes brands and generics through a proprietary
algorithm ( "BGA ") that uses certain published elements provided by First DataBank (FDB) including price indicators,
Generic Indicator, Generic Manufacturer Indicator, Generic Name Drug Indicator, Innovator, Drug Class and ANDA.
The BGA uses these data elements in a hierarchical process to categorize the products as brand or generic. The
BGA also has processes to resolve discrepancies and prevent "flipping" between brand and generic status due to
price fluctuations and marketplace availability changes. The elements listed above and sources are subject to
change based on the availability of the specific fields. Updated summaries of the BGA are available upon request.
Maximum Allowable Cost/Maximum Reimbursement Amount ( "MAC ") — As part of the administration of the
ESI services, ESI maintains a MAC List of drug products identified as requiring pricing management due to the
number of manufacturers, utilization and /or pricing volatility. The criteria for inclusion on the MAC List are based on
whether the drug has readily available generic product(s), is generally equivalent to a brand drug, is cleared of any
negative clinical implications, and has a cost basis that will allow for pricing below brand rates. ESI also maintains
correlative MAC price lists based on current price reference data provided by FDB or other nationally recognized
pricing source, market pricing and availability information from generic manufacturers and on -line research of national
wholesale drug company files, and client arrangements. Similar to the BGA, the elements listed above and sources
are subject to change based on the availability of the specific fields. Updated summaries of the MAC methodology
are available upon request.
Manufacturer Formulary Rebates, Associated Administrative Fees, and ESI Service Fees — ESI contracts for
its own account with manufacturers to obtain formulary rebates attributable to the utilization of certain brand drugs
and supplies (and possibly certain authorized generics marketed under a brand manufacturer's new drug application).
Formulary rebate amounts vary based on the volume of utilization as well as a client's benefit design and formulary
position applicable to the drug or supplies, and in certain instances also may vary based on the product's market -
share. ESI often pays an amount equal to all or a portion of the formulary rebates it receives to a client based on the
client's ESI agreement terms. ESI retains the financial benefit of the use of any funds held until payment of formulary
rebate amounts is made to the client. In addition, ESI provides administrative services to formulary rebate contracted
manufacturers, which include, for example, maintenance and operation of the systems and other infrastructure
necessary for managing and administering the ESI formulary rebate process and access to drug utilization data, as
allowed by law, for purposes of verifying and evaluating the rebate payments and for other purposes related to the
manufacturer's products. ESI receives administrative fees from the participating manufacturers for these services.
These administrative fees are calculated based on the price of the rebated drug or supplies along with the volume of
utilization and do not exceed the greater of (i) 4.58% of the average wholesale price, or (ii) 5.5% of the wholesale
acquisition cost of the products. In its capacity as a ESI company, ESI also may receive service fees from
manufacturers as compensation for the performance of various services, including, for example, formulary
compliance initiatives, clinical services, therapy management services, education services, medical benefit
management services, and the sale of non - patient identifiable claim information. These service fees are not part of
the formulary rebates or associated administrative fees.
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195733.4
ESI Subsidiary Pharmacies — ESI has several licensed pharmacy subsidiaries, including our specialty
pharmacies. These entities may maintain product purchase discount arrangements and /or fee - for - service
arrangements with pharmaceutical manufacturers and wholesale distributors. These subsidiary pharmacies contract
for these arrangements on their own account in support of their various pharmacy operations. Many of these
subsidiary arrangements relate to services provided outside of ESI arrangements, and may be entered into
irrespective of whether the particular drug is on one of ESI's national formularies. Discounts and fee - for - service
payments received by ESI's subsidiary pharmacies are not part of the ESI formulary rebates or associated
administrative fees paid to ESI in connection with ESI's ESI formulary rebate programs. From time to time, ESI also
may pursue and maintain for its own account other supply chain sourcing relationships not described below as
beneficial to maximize ESI's drug purchasing capabilities and efficiencies, and ESI may realize an overall positive
margin with regard to these initiatives.
The following provides additional information regarding examples of ESI subsidiary pharmacy discount
arrangements and fee - for - service arrangements with pharmaceutical manufacturers, wholesale distributors, and third
party data aggregators:
ESI Subsidiary Pharmacy Discount Arrangements — ESI subsidiary pharmacies purchase prescription
drug inventories, either from manufacturers or wholesalers, for dispensing to patients. Often, purchase
discounts off the acquisition cost of these products are made available by manufacturers and
wholesalers in the form of either up -front discounts or retrospective discounts. These purchase
discounts, obtained through separate purchase contracts, are not formulary rebates paid in connection
with our ESI rebate programs. Drug purchase discounts are based on a pharmacy's inventory needs
and, at times, the performance of related patient care services and other performance requirements.
When a subsidiary pharmacy dispenses a product from its inventory, the purchase price paid for the
dispensed product, including applicable dispensing fees, may be greater or less than that pharmacy's
acquisition cost for the product net of purchase discounts. In general, our pharmacies realize an overall
positive margin between the net acquisition cost and the amounts paid for the dispensed drugs.
ESI Subsidiary Pharmacy Fee - For - Service Arrangements — ESI's subsidiary pharmacies also may
receive fee - for - service payments from manufacturers or wholesalers in conjunction with various
programs or services, including, for example, patient assistance programs for indigent
patients, dispensing prescription medications to patients enrolled in clinical trials, various therapy
adherence and fertility programs, administering FDA compliance requirements related to the drug,
product reimbursement support services, and various other pharmacy programs or services. As a
condition to having access to certain products, and sometimes related to certain therapy adherence
criteria or FDA requirements, a pharmaceutical manufacturer may require a pharmacy to report selected
information to the manufacturer regarding the pharmacy's service levels and other dispensing - related
data with respect to patients who receive that manufacturer's product. A portion of the discounts or
other fee - for - service payments made available to our pharmacies may represent compensation for such
reporting. In addition, ESI may sell non - patient identifiable claim information it maintains as a ESI or
through one of its subsidiaries to data aggregators or manufacturers on a fee- for - service basis. All
reporting activities are conducted in compliance with applicable patient and pharmacy privacy laws
Other Manufacturer Arrangements — ESI also maintains other lines of business that may involve discount
and service fee relationships with pharmaceutical manufacturers and wholesale distributors. Examples of these
businesses include a wholesale distribution business, a group purchasing organization, a drug sample fulfillment
company (Phoenix Marketing Employer), and a medical benefit management company. Compensation derived
through these business arrangements is not part of the ESI formulary rebates or associated administrative fees paid
to ESI in connection with ESI's ESI formulary rebate programs. Services related to these arrangements are
provided to manufacturers irrespective of whether a drug is on one of ESI's national formularies.
THIS EXHIBIT REPRESENTS ESI'S FINANCIAL POLICIES. ESI MAY PERIODICALLY UPDATE THIS EXHIBIT
AND THE FINANCIAL DISCLOSURES CONTAINED HEREIN TO REFLECT CHANGES IN ITS BUSINESS
PROCESSES; THE CURRENT FINANCIAL DISCLOSURE IS AVAILABLE UPON REQUEST AND ACCESSIBLE
ON EXPRESS - SCRIPTS.COM FOR CLIENTS & ADVISORS.
7 195733.4
City of Dubuque Insurance Requirements for Professional Services
1.
Insurance Schedule C
shall furnish a signed Certificate of Insurance to the City of Dubuque, Iowa for the
coverage required in Exhibit I prior to commencing work and at the end of the project if the term of work
is longer than 60 days. Providers 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 Iowa Department of Insurance or an equivalent. Each certificate shall include a
statement under Description of Operations as to why issued. Eg: Project # or Lease of premises
at or construction of
2. All policies of insurance required hereunder shall be with a carrier authorized to do business in Iowa and
all carriers 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 contracting department of the City of Dubuque.
4. Failure to provide minimum coverage 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. Subcontractors and sub subcontractor performing work or service shall provide a Certificate of Insurance
in accord with Exhibit I.
6. All required endorsements to various policies shall be attached to Certificate of insurance.
7. Whenever a specific ISO form is listed, an equivalent form may be substituted subject to the provider
identifying and listing in writing all deviations and exclusions that differ from the ISO form.
8. Provider shall be required to carry the minimum coverage /limits, or greater if required by law or other
legal agreement, in Exhibit I.
9. Whenever an ISO form is referenced the current edition of the form must be used.
Page 1 of 3 Schedule C, Professional Services April, 2013_2.Doc
City of Dubuque Insurance Requirements for Professional Services
Insurance Schedule C (continued)
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
a) Coverage shall be written on an occurrence, not claims made, form. All deviations from the
standard ISO commercial general liability form CG 0001, or Business owners form BP 0002,
shall be clearly identified.
b) Include ISO endorsement form CG 25 04 "Designated Location(s) General Aggregate Limit"
or CG 25 03 "Designated Construction Project (s) General Aggregate Limit" as appropriate.
c) Include endorsement indicating that coverage is primary and non - contributory.
d) Include endorsement to preserve Governmental Immunity. (Sample attached).
e) Include an endorsement that deletes any fellow employee exclusion.
f) 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 2026.
B) AUTOMOBILE LIABILITY $1,000,000 (Combined Single Limit)
C) WORKERS' COMPENSATION & EMPLOYERS LIABILITY
Statutory benefits covering all employees injured on the job by accident or disease as prescribed by
Iowa Code Chapter 85 as amended.
Coverage A
Coverage B
Statutory —State of Iowa
Employers Liability
Each Accident $100,000
Each Employee- Disease $100,000
Policy Limit- Disease $500,000
Policy shall include an endorsement providing a waiver of subrogation to the City of Dubuque.
Coverage B limits shall be greater if required by Umbrella Carrier.
D) UMBRELLA LIABILITY $1,000,000
Umbrella liability coverage must be at least following form with the underlying policies included
herein.
E) PROFESSIONAL LIABILITY $1,000,000
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City of Dubuque Insurance Requirements for Professional Services
Preservation of Governmental Immunities Endorsement
1. Nonwaiver of Governmental Immunity. The insurance carrier expressly agrees and states that the
purchase of this policy and the including of the City of Dubuque, Iowa as an Additional Insured does
not waive any of the defenses of governmental immunity available to the City of Dubuque, Iowa
under Code of Iowa Section 670.4 as it is now exists and as it may be amended from time to time.
2. Claims Coverage. The insurance carrier further agrees that this policy of insurance shall cover only
those claims not subject to the defense of governmental immunity under the Code of Iowa Section
670.4 as it now exists and as it may be amended from time to time. Those claims not subject to
Code of Iowa Section 670.4 shall be covered by the terms and conditions of this insurance policy.
3. Assertion of Government Immunity. The City of Dubuque, Iowa 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 insurance carrier.
4. Non - Denial of Coverage. The insurance carrier shall not deny coverage under this policy and the
insurance carrier shall not deny any of the rights and benefits accruing to the City of Dubuque, Iowa
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, Iowa.
No Other Change in Policy. The above preservation of governmental immunities shall not otherwise
change or alter the coverage available under the policy.
SPECIMEN
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