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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 />2. Sponsor will pay MagellanRx for each Covered Pharmaceutical dispensed to a Member through a Retail Pharmacy an <br />amount equal to (a) the lowest of (i) AWP minus a discount plus a Dispensing Fee, (ii) submitted cost; (iii)MAC plus <br />Dispensing Fee, or (iv) U&C, less (b) the Cost Share.These terms also apply to Member-submitted claims.Sponsor will pay <br />for Compound Prescriptions on a separate ingredient cost and Dispensing Fee basis.Retail Pharmacy Claims may not <br />exceed a 35-day supply except at pharmacies contracted for extended days’ supply. <br />3. MagellanRx may add new Specialty Drugs to the Specialty Drug List as they become available in the market at a default <br />price of AWP –12.00% for a 30-day supply until MagellanRx establishes an appropriate contract price. If a Sponsor is <br />enrolled in the MagellanRx Select Savings Program, guarantees for Discount Rates, Rebates, and Dispensing Fees do not <br />apply, and MagellanRx will pay to Sponsor seventy percent (70%) of Rebates received by MagellanRx for Specialty drugs <br />within one hundred and eighty (180) days following the end of each Contract Quarter. Limited distribution drugs dispensed <br />from a pharmacy other than an MagellanRx Affiliate are excluded from the Specialty Drug guarantees. <br />4. MagellanRx (MRx)will pay (credit) to us the Guaranteed Rebates within ninety (90) days following the end of each of our <br />Contract Quarter with MagellanRx, and we shall distribute to each Sponsor any Rebates received unless other terms have <br />been agreed upon in writing between us and Sponsor.Guaranteed rebates do not apply for biosimilars, but MagellanRx will <br />pass through 90% of any Rebates received for biosimilars. <br />Guaranteed Rebates do not include Claims for compound drugs, Claims for products for which a prescription is not required <br />under Law, medical Claims, Claims for Limited Distribution Drugs; Claims for biosimilars, 350B Claims, non-diabetic OTC <br />Claims, Claims for vaccines, Claims from entities eligible for federal supply schedule prices (e.g., Department of Veteran <br />Affairs, Department of Defense, Indian Health Service), Claims for Authorized Brand Alternatives and Authorized Generics; <br />Claims for products used in the detection, prevention, or treatment of COVID-19; Claims for drugs subject to an Emergency <br />Use Authorization (EUA); and Ineligible Claims. <br />MRx will pay Rebates to us on Specialty Drug Claims subject to this Section; provided, however, that if a pharmaceutical <br />manufacturer or aggregator seeks recoupment for a Rebate MRx received and paid to us on behalf of a Sponsor for a <br />Specialty Drug based on such Sponsor’s enrollment in an alternative funding program, then MRx will offset the amount of <br />such Rebates, or Client will reimburse MRx the full amount of any such Rebates, as applicable, promptly upon MRx’s <br />request. For any Sponsors that have terminated under this Agreement, MRx will seek reimbursement of the full amount of <br />any such Rebates directly from Sponsor and Sponsor agrees to reimburse MRx the full amount of any such Rebates <br />promptly upon MRx’s request. <br />Sponsor acknowledges that MRx will pay Rebates to us on Specialty Drug Claims on Sponsor’s behalf pursuant to their <br />Agreement; provided, however, that if a pharmaceutical manufacturer or aggregator seeks recoupment for a Rebate MRx <br />received and paid to us on behalf of Sponsor for a Specialty Drug based on Sponsor’s enrollment in an alternative funding <br />program, then MRx will offset the amount of such Rebates against future Rebates earned by Sponsor, or Sponsor will <br />reimburse MRx the full amount of any such Rebates, as applicable, promptly upon MRx’s request. This provision shall survive <br />termination of this Sponsor’s TPA Agreement with us. <br />(continues on next page) <br />31 <br />Pharmacy Benefits <br />Additional fees, pricing, terms and Conditions as follows are for Sponsors on our contract and <br />are effective January 2025 –December 2025.