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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 />The Prescryptive Difference: <br />•An engaging mobile experience integrated in real-time with benefit plans and healthcare providers, empowering <br />consumers with information and choice <br />•A subscription-based flat fee that includes prior authorizations, clinical services, etc. <br />•100% pass-through pricing on prescriptions and rebates <br />•Flexible plan: a formulary and pharmacy network design tailored to meet plan sponsors’ needs and objectives <br />•Rich analytics and insightful data about plan performance, cost savings and employee health trends <br />Special Considerations: <br />Reimbursement Rates: Reimbursement rates quoted are average effective pharmacy network rates including <br />dispensing fees, before rebates. <br />Prescryptive bills actual pharmacy reimbursement rate paid to pharmacy without spread. <br />Additional Fees for Service: <br />•Client-requested audits must be paid for by the Client. <br />•Other fees may apply for data integration or reporting to third parties. <br />In the event Client terminates Administrative Services Agreement with us, we may use pharmacy rebates as a set-off <br />against amounts due to us from Client or may delay remittance of these rebates to allow for final adjustments. <br />Client acknowledges that Prescryptive Health provides an administrative credit to us in compensation for the services <br />provided including enrollment processing, invoice processing, and customer service among other duties. <br />(f). Payment of Rebates to us. Upon receipt of Rebates from a Pharmaceutical Manufacturer, Prescryptive will generate a <br />report that: (1) identifies each claim that received a Rebate and the corresponding amount of such Rebate; and (2) <br />calculates the total Rebates due to us, on behalf of Participating Group(s) from each Pharmaceutical Manufacturer. <br />Prescryptive shall provide such Rebate Report and pay to us one hundred percent (100%) of the total Rebates due to <br />Participating Groups within fifteen (15) business days of the end of the month in which Prescryptive received payment by <br />the Pharmaceutical Manufacturer. Prescryptive shall not have any liability to us, Participating Groups or Members for any <br />failure by any Pharmaceutical Manufacturer to pay any Rebates, any breach of a Rebate contract by any Pharmaceutical <br />Manufacturer, or any negligence or willful misconduct by any Pharmaceutical Manufacturer. <br />“Adequate Network” shall mean Prescryptive’s list of Participating Pharmacies for which 90% of Members who reside in <br />urban areas are within 3 miles of a Participating Pharmacy; 90% of Members who reside in suburban areas are within 5 <br />miles of a Participating Pharmacy; and 70% of Members who reside in rural areas are within 25 miles of a Participating <br />Pharmacy. <br />All pricing in this document is available to our new clients that become Client Groups on and after the effective date of <br />this document and to existing Sponsors on the effective date. <br />If a Client terminates either their PBM contract thru us or terminates with us altogether, and has passed runout, the Client <br />will be responsible for paying directly to Prescryptive any Medicare or Medicaid claims that are billed up to three (3) <br />years after date of service. <br />34 <br />Footnotes: <br />1 Excludes Limited Distribution Drugs which vary by individual medication. <br />2 Rebate amounts are the property of the plan sponsor and 100% are paid to the plan sponsor to reduce drug costs. <br />Pharmacy Benefits