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Proving What’s Possible in Healthcare <br />This document contains important terms and conditions which are incorporated by reference into and becomes <br />part of the terms of your contract with us. ©2024, Healthcare Management Administrators, Inc. <br />29 <br />Accord Formulary Rebates <br />Description Price <br />Retail 30 Pharmacy $313.20 <br />Retail 90 Pharmacy $659.51 <br />Mail Order Pharmacy $848.44 <br />Specialty Drugs*$3,815.72 <br />NetResults Formulary Rebates <br />Description Price <br />Retail 30 Pharmacy $339.75 <br />Retail 90 Pharmacy $749.38 <br />Mail Order Pharmacy $936.17 <br />Specialty Drugs**$4,117.53 <br />**Specialty Drugs: Guaranteed Rebates do not apply for biosimilars, but <br />MRx will pass through 90% of any rebates received from biosimilars. <br />2025 Additional Fees, Pricing, Terms & Conditions* <br />Pharmacy Benefits <br />*Please Note: <br />•Other fees, terms and conditions apply –please see the Add’l Fees, Pricing, Terms & Condition section. <br />•Full terms and conditions will be available for review by client, in internal and PBM contractual <br />documents, at time of signature. <br />•Standard implementation requires a minimum of 90 days prior written notice. Specialty Select Savings <br />Program may require additional lead time. <br />. <br />Rebates as follows are for Sponsors on our contract and are <br />effective January 2025 –December 2025.* <br />Administrative Fees-Paid Claim <br />Description Fee <br />Non In House Pharmacy $0.00 Per Paid Claim <br />In House Pharmacy 15% or less Processing $1.95 Per Paid Claim for 15% or less processing in house <br />In House Pharmacy 15% -25% Processing $2.95 Per Paid Claim for 15% -25% processing in house <br />In House Pharmacy 25% or more Processing $3.95 Per Paid Claim for 25% or more processing in house