Backup Documents 09/24/2013 Item #11GORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMEN'T'S SENT TO 1 1 G
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
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Complete routing lines # 1 through #2 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
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Route to Addressees (List in routing order)
Office
Initials
Date
1.
a ro riate.
Initial
A licable
2.
September 24, 2013 ✓
Agenda Item Number
11 G
3. Colleen M. Greene, ACA
County Attorney Office
N/A
4. BCC Office
Board of County
Commissioners
Number of Original
2
5. Minutes and Records
Clerk of Court's Office
Documents Attached
(f =33o.,r,
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addMgSetc skhnvP. may need to enntaet staff fnr additinnal nr miccina information.
Name of Primary Staff
Jeff Walker, Risk Mgt. Director
Phone Number
252 -8906
Contact / Department
a ro riate.
Initial
A licable
Agenda Date Item was
September 24, 2013 ✓
Agenda Item Number
11 G
Approved b the BCC
Does the document need to be sent to another agency for additional signatures? If yes,
N/A
Type of Document
Pharmacy Benefit Management Services
Number of Original
2
Attached
Agreement
Documents Attached
PO number or account
n/a
number if document is
by the Office of the County Attorney.
to be recorded
All handwritten strike- through and revisions have been initialed by the County Attorney's
N/A
INSTRUCTIONS & CHECKLIST
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05; Revised 11/30/12
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a ro riate.
Initial
A licable
1.
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CMG
2.
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provide the Contact Information (Name; Agency; Address; Phone on an attached sheet.
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CMG
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8.
The document was approved by the BCC on 09/24/13 and all changes made
CMG
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lilt
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05; Revised 11/30/12
11G si
MEMORANDUM
Date: October 29, 2013
To: Jeff Walker, Director
Risk Management Department
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: Pharmacy Benefit Management Services Agreement
Attached for your records is one (1) original copy of the resolution referenced
above, (Item #11G) adopted by the Board of County Commissioners on Tuesday,
September 24, 2013.
The Minutes and Record's Department has held the original document for the
Official Record of the Board.
If you have any questions, please contact me 252 -7240.
Thank you.
Attachment
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PHARMACY BENEFIT MANAGEMENT SERVICES AGREEMENT
This Pharmacy Benefit Management Services Agreement (hereinafter this "Agreement ") is
entered into by and between Envision Pharmaceutical Services, Inc., an Ohio Corporation
(hereinafter "Envision "), and Collier County Board of Commissioners, a Florida county
government (hereinafter "Plan Sponsor "). This Agreement is effective January 1st, 2014
(hereinafter the "Effective Date ").
BACKGROUND
Envision is a URAC accredited Pharmacy Benefit Management (PBM) company providing
comprehensive pharmacy benefit management services nationwide to various employers, unions,
and Plan Sponsors that establish and fund health benefit plans covering outpatient prescription
medications. Plan Sponsor has established one or more health benefit plans providing coverage
for prescription medications to covered individuals and desires to engage Envision to provide
pharmacy benefit management services in accordance with the terms and conditions of this
Agreement.
NOW, THEREFORE, in consideration of the mutual promises and agreements herein contained,
Plan Sponsor and Envision hereby agree as follows:
1. DEFINITIONS
1.1 "Administrative Fee" means the amount that Envision charges Plan Sponsor for included
services under this Agreement as set forth in Exhibit 1.
1.2 "Annual Average Effective Rate" means, for the category of drugs being reviewed, the
result calculated by the following formula: (IC /AWP) -1, where IC ( "Ingredient Cost ") is the sum
of all amounts paid by Plan Sponsor for the ingredient cost of the Covered Drugs dispensed
during the calendar year, and AWP is the sum of the Average Wholesale Price amounts
associated with the same Covered Drugs.
1.3 "Average Wholesale Price" or "AWP" shall mean the average wholesale price of a
Covered Drug indicated on the most current pricing file provided to Envision by Medi -Span® (or
other applicable industry standard reference on which pricing hereunder is based) for the actual
drug dispensed using the 11 digit National Drug Code (NDC) number provided by the dispensing
pharmacy. Envision uses a single source for determining AWP and updates the AWP source file
at least once weekly.
1.4 "Benefit Plan" means the group Plan Sponsor, insurance plan, prescription drug plan, or
other benefit plan established and funded by Plan Sponsor that covers the cost of Covered Drugs
dispensed to Covered Individuals.
1.5 "Benefit Specification Form" or "Benefit Specification Change Form" means the forms,
as modified from time to time, that are completed by Plan Sponsor that specify the terms and
provisions of the Benefit Plan and the configuration of System edits, such as which Prescription
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Drugs are covered by Plan Sponsor, any limitations or exclusions, the Benefit Plan's tier
structure and Cost Share requirements, and any conditions associated with the specific services
to be rendered by Envision under this Agreement (i.e. Clinical Prior Authorizations, Drug
Therapy Management, etc.).
1.6 "Brand Drug" means a Prescription Drug where the Medi -Span multisource ( "MONY ")
code attached to the 11 digit NDC for such drug indicates an "N" (a single - source brand name
drug product available from one pharmaceutical manufacturer and is not available as a generic),
an "M" (a branded drug product that is co- branded and not considered generic, nor is it available
as a generic, and is generally considered a single - source drug product despite multiple
pharmaceutical manufacturers), or an "O" (an original branded drug product available from one
or more pharmaceutical manufacturers as a generic). A drug is classified as a Brand Drug at the
Point -of -Sale based on the MONY code assigned by Medi -Span and shall not be reclassified for
any purposes hereunder.
1.7 "Claim" means an invoice or transaction (electronic or paper) for a Covered Drug
dispensed to a Covered Individual that has been submitted to Envision by the dispensing
pharmacy or a Covered Individual (including transactions where the Covered Individual paid
100% of the cost). A "340B Claim" is a Claim which has been processed under Section 340B of
the Public Health Service Act.
1.8 "Claims Adjudication System" or "System" means Envision's on -line computerized
claims processing system.
1.9 "Compound Drug" means a medication that requires compounding by a pharmacist
because it is not available from a pharmaceutical manufacturer in the prescribed form or
strength. Compound Drugs consist of two or more solid, semi -solid or liquid ingredients, at least
one of which is a Prescription Drug.
1.10 "Contract Year" means the complete twelve month period commencing on the Effective
Date and each consecutive complete twelve month period thereafter that this Agreement remains
in effect.
1.11 "Cost Share" means the amount of money that a Covered Individual must pay to the
Participating Pharmacy to obtain a Covered Drug in accordance with the terms of the Benefit
Plan. The Cost Share may be a fixed amount (co- payment) or a percentage of the drug cost (co-
insurance), or a deductible that must be satisfied before drugs are covered under the Benefit Plan.
1.12 "Covered Drug" means a Prescription Drug or other permitted drug (OTC), medical
supplies (e.g. diabetic testing strips), or a medical device (e.g. blood glucose monitoring device)
which is dispensed to a Covered Individual and meets the requirements for coverage under the
Benefit Plan as communicated to Envision by Plan Sponsor.
1.13 "Covered Individual" or "Member" means each individual (including the Eligible
Employee and each of his or her dependents) who has been identified by Plan Sponsor on the
Eligibility File as being eligible to receive Covered Drugs.
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1.14 `Eligibility File" means that electronic communication supplied to Envision by Plan
Sponsor (or Plan Sponsor's agent) which identifies the Covered Individuals covered under Plan
Sponsor's Benefit Plan, along with other eligibility information necessary for Envision to
provide PBM Services hereunder. Plan Sponsor acknowledges that eligibility begins on the first
day the Covered Individual is reported by Plan Sponsor (or its designee) to be effective and
continues through the last day the Covered Individual appears on the Eligibility File.
1.15 "Eligible Employee" means an active employee or a retiree of Plan Sponsor covered
under Plan Sponsor's funded Benefit Plan. For purposes of calculating the Administrative Fee,
the Per Employee, per month (PEPM) amount stated in Exhibit 1 includes the Eligible
Employee's /retiree's eligible dependents. If, however, a dependent is also an Eligible Employee
of Plan Sponsor, such dependent shall be deemed to be an Eligible Employee for purposes of
calculating the total Administrative Fee.
1.16 "Formulary" means an index of Prescription Drugs, which have been compiled by
Envision and reviewed by Envision's Pharmacy & Therapeutics Committee for safety and
efficacy (using evidence -based evaluation criteria), that is used, in conjunction with the Benefit
Plan, as a guide in the selection of Covered Drugs. The Formulary may be modified by Envision
from time to time as new medications and/or new clinical information become available.
1.17 "Generic Drug" means a Prescription Drug where the Medi -Span multisource code
attached to the 11 digit NDC for such drug indicates a "Y" (a generic drug product available
from one or more pharmaceutical manufacturers). A drug is classified as a Generic Drug at the
Point -of -Sale based on the MONY code assigned by Medi -Span and shall not be reclassified for
any purposes hereunder.
1.18 "HIPAA" means the Health Insurance Portability and Accountability Act of 1996, as
amended.
1.19 "Mail Order Pharmacy" means the Mail Order Pharmacy specified in Exhibit 1.
1.20 "Manufacturer Derived Revenue" means rebates, discounts, administrative fees, and any
other revenue earned by Plan Sponsor for Claims which comply with the utilization and benefit
design requirements of pharmaceutical manufacturer contracts with Envision and otherwise meet
the terms and conditions hereunder.
1.21 "MAC List" means a proprietary list of Prescription Drugs for which Envision establishes
a maximum price ( "MAC Price ") payable to the dispensing pharmacy. Envision maintains one
commercial MAC List per Participating Pharmacy which is used to both determine the
negotiated price payable to the dispensing pharmacy and the price charged to Plan Sponsor. Plan
Sponsor will be charged the exact negotiated amount payable by Envision to the dispensing
pharmacy without any markup or spread. Envision updates the MAC List from time -to -time as
Prescription Drugs come on the market or come off the market, or as their availability changes
due to market circumstances.
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1.22 "Participating Pharmacy" means a pharmacy (including the designated Mail Order or
Specialty Pharmacy) that has entered into a negotiated pricing agreement with Envision to
dispense Covered Drugs to Covered Individuals.
1.23 "Plan Sponsor" means the entity (identified above as Plan Sponsor) which (i) has
established and underwrites the Benefit Plan on behalf of its Covered Individuals; (ii) has
determined the rules by which the Benefit Plan is to be administered; and (iii) is financially
responsible for the payment of Administrative Fees, Fees for Additional Services and
Miscellaneous Expenses (as set forth in Exhibit 1), and Covered Drugs dispensed to Covered
Individuals hereunder.
1.24 "Point -of- Sale" means the location and time that a Covered Drug is dispensed to a
Covered Individual, and the corresponding Claim is submitted by the dispensing pharmacy for
adjudication by the Claims Adjudication System.
1.25 "Prescriber" means a licensed Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.),
Doctor of Podiatry (D.P.M.), Doctor of Dentistry (D.D.S.), or other licensed health practitioner
with independent prescribing authority in the state in which the dispensing pharmacy is located.
1.26 "Prescription Drug" means a substance intended for use in the diagnosis, cure, mitigation,
treatment, or prevention of disease which is dispensed by a duly licensed pharmacy and required
by federal law to be dispensed only upon the authorization of a Prescriber. For purposes of this
Agreement, over - the - counter medications, medical supplies, and medical devices are not
Prescription Drugs, whether or not ordered by a Prescriber.
1.27 "Retail Pharmacy" means a state licensed retail community pharmacy that dispenses
prescription medications at its physical location. A Retail Pharmacy does not include a
pharmacy that dispenses medications to patients primarily through mail, nursing home
pharmacies, long -term care facility pharmacies, hospital pharmacies, or clinics, unless such
pharmacy is a Participating Pharmacy listed by Envision as a Retail Pharmacy.
1.28 "Specialty Drug" means a high -cost (i.e. costs more than $600.00 per month or per fill)
biotech, injectable, infused, oral, or inhaled Prescription Drug that may require special storage,
handling, or is available only through limited distribution channels, and/or requires close
monitoring of the patient's drug therapy (including a few products, such as intrauterine devices
[IUDs]). Specialty Drugs are identified on the Envision Specialty Drug List, as modified from
time to time.
1.29 "Specialty Pharmacy" means a non - Retail Pharmacy that primarily dispenses Specialty
Drugs and performs special ordering, handling and/or patient intervention services.
1.30 "Usual and Customary Price" or "U &C Price" means the retail amount the pharmacy
charges its cash paying customers for the drug dispensed, as reported to Envision by the
dispensing pharmacy.
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2. STANDARD PBM SERVICES
Envision shall perform the following pharmacy benefit management services ("PBM Services ").
Unless otherwise noted, the PBM Services specified below are included in the Administrative
Fee.
2.1 Welcome Kit: If requested by Plan Sponsor, Envision shall provide an initial "Welcome
Kit" which may include, at Plan Sponsor's option, (i) a welcome letter; (ii) plastic identification
card ( "ID Card "), up to two per family; (iii) a pocket Formulary; and (iv) mail order brochure, as
specified in the Benefit Specification Form. The standard Welcome Kits will be mailed to Plan
Sponsor or, at its option, directly to Covered Individuals. For any materials mailed directly to
Covered Individuals, Plan Sponsor shall reimburse Envision for its cost of postage. Additional
ID Cards or replacement ID Cards (i.e. for lost or stolen ID Cards) will be provided at a cost as
specified in Exhibit 1. If Plan Sponsor desires to re- design and/or re -issue ID Cards, or for
special graphic requests, additional charges may apply.
2.2 Claims Processine: During the term of this Agreement, Envision shall accept, process,
and adjudicate Claims for Covered Drugs (i) submitted electronically by Participating
Pharmacies; (ii) submitted by Covered Individuals as Direct Member Reimbursements (DMRs,
as defined below); or (iii) received from third parties, such as Medicaid, for reimbursement by
Plan Sponsor. Claims shall be checked for eligibility, benefit design, Cost Share requirements,
and exclusions to determine which Claims are successfully processed, pended for prior
authorization, or rejected for ineligibility or other factors in accordance with Plan Sponsor's
specifications as set forth in Plan Sponsor's Benefit Specification Form (incorporated herein by
this reference). For Claims that must be processed manually or require special handling,
including, without limitation, (i) DMRs or (ii) Claims received from third parties, such as
Medicaid, for reimbursement by Plan Sponsor for ineligible payments, Plan Sponsor will be
charged a Manual Claims Processing fee as set forth in Exhibit 1. After termination of this
Agreement, Envision shall process Claims received for dates of service on or before the effective
date of termination for a period of ninety (90) days ( "Run -Out Period "), subject to the following.
Plan Sponsor shall deposit and maintain, with Envision, an amount equal to the last Claims
invoice prior to termination. At the end of the Run -Out Period, the balance of the deposit shall
be promptly refunded to Plan Sponsor and, thereafter, any Claims received by Envision shall be
rejected.
2.2.1 Direct Member Reimbursement (DMR): Envision shall provide, via its website, a
form for use by Covered Individuals to obtain reimbursement for amounts paid out -of- pocket
(other than Cost Share) for Covered Drugs (e.g. Covered Drugs dispensed at a non - Participating
Pharmacy) ( "DMR Form "). Envision shall accept, process, and adjudicate DMR Claims within
ten (10) business days of receipt of the DMR form, but shall not be liable to reimburse a Covered
Individual until Plan Sponsor provides funds for such purpose.
2.2.2 Claims Adjudication System Edits: Plan Sponsor's Benefit Plan may contain
additional rules which determine the way in which Claims are to be adjudicated. These rules
may include coverage limitations or exclusions, application of clinical intervention (e.g. step
therapy, drug therapy management), application of dispensed as written (DAW) codes (e.g. to
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determine what portion of a Claim is payable by Plan Sponsor and what portion is payable by
Members), and administrative overrides to authorize the dispensing of Covered Drugs in certain
circumstances (e.g. requests for lost or stolen drugs, vacation supplies, certain package sizes,
dosage changes, invalid days' supply). For this purpose, Envision shall program edits into the
Claims Adjudication System which are applied to Claims during the adjudication process as
specified in the Benefit Specification Form. The Claims Adjudication System will provide the
dispensing pharmacy with the appropriate messaging to advise the pharmacy of the applicable
limitation, program, rule, or override.
Envision shall also program edits into the Claims Adjudication System which are applied to
Claims during the adjudication process to identify the following drug utilization conditions:
duplicate prescriptions; over - utilization/refill too soon; under - utilization; drug interactions;
pediatric warnings; geriatric warnings; acute /maintenance dosing; therapeutic duplication; drug
inferred health state; drugs exceeding maximum dose; and drugs below minimum daily dosage,
as specified in the Benefit Specification Form. The Claims Adjudication System will provide the
dispensing pharmacy with the appropriate messaging to advise the pharmacy of drug utilization
issues.
2.3 Clinical Services
2.3.1 Clinical Prior Authorizations (Initial Coverage Determinations): If Plan Sponsor
has elected to receive Clinical Prior Authorization services from Envision, for those Covered
Drugs and circumstances specified by Plan Sponsor in the Benefit Specification Form, Envision
shall contact the prescriber and verify that the requested drug is appropriate for the diagnosis in
the judgment of the prescriber. Plan Sponsor will be charged for Clinical Prior Authorizations as
specified in Exhibit 1. If additional internal appeals (redeterminations) and /or the services of an
Independent Review Organization are to be provided under this Agreement, such services shall
be included in an attached Coverage Determination and Appeals Process Addendum.
2.3.2 Drug Therapy Management (DTM) Pro ams: Envision offers clinical programs
such as Drug Therapy Care Gap Management and Medication Adherence and Persistency. If
clinical programs are to be provided under this Agreement, such services and any additional
charges shall be set forth in an attached Clinical Services Addendum.
2.4 Pharmacy Network: Envision shall arrange for the dispensing of Covered Drugs to
Covered Individuals pursuant to contracts with one or more networks of Participating
Pharmacies (referred to herein as a "Network "). The Network designated for Plan Sponsor to be
used by Covered Individuals hereunder shall be named in Exhibit 1 and specified in the Benefit
Specification Form. Plan Sponsor acknowledges that the pharmacies participating in a Network
may change from time to time, including the designated Mail Order Pharmacy and/or Specialty
Pharmacy provider. The list of Participating Pharmacies is constantly updated to reflect any
changes in the Network, including pharmacy addresses and telephone numbers, and is accessible
via Envision's website. Plan Sponsor acknowledges that (i) orders exceeding a thirty day supply
are not available at all Retail Pharmacies; (ii) Covered Drugs shall not be dispensed to Covered
Individuals without a prescription order by a Prescriber; and (iii) the availability of drugs are
subject to market conditions and that Envision cannot, and does not, assure the availability of
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any drug from any Participating Pharmacy.
2.5 Customer Service: Envision shall maintain and operate a customer service center with
toll -free customer service numbers and adequately staffed with trained personnel 24 hours a day,
7 days a week, 365 days a year, for the use of Plan Sponsor, Covered Individuals, Prescribers,
and Participating Pharmacies.
2.6 Records: Envision shall maintain such business records as may be required by applicable
law or regulation, or as may be necessary to properly document the delivery of, and payment for,
Covered Drugs and the provision of services by Envision under this Agreement. Plan Sponsor
agrees to reimburse Envision for any cost incurred from the transfer of files from or to any
vendor or pharmacy at any time during this Agreement and, upon request of Plan Sponsor, at the
termination of this Agreement.
2.7 Reports: Envision shall provide Plan Sponsor with access to a web -based report
generator through which Plan Sponsor may create and download a variety of standard and
customized reports. Envision shall provide training for a Plan Sponsor designated individual on
the capabilities of Envision's web -based reporting program. Plan Sponsor represents that the
designated individual has received training and has knowledge of the HIPAA privacy and
security regulations. Any reports that are to be provided by Envision to Plan Sponsor without
cost (other than those available from Envision's web -based reporting program) shall be mutually
determined prior to the configuration of Plan Sponsor's Benefit Plan in the Claims Adjudication
System and shall be specified in the Benefit Specification Form. Plan Sponsor shall be charged a
fee for any other reports requested by Plan Sponsor.
Included in the web -based reports described above, or provided separately, Envision shall supply
Plan Sponsor with reports of retrospective reviews to determine the drug utilization patterns of
Members (e.g. high cost/high utilization of a particular drug class, therapeutic appropriateness of
drug for a particular disease state).
2.8 Retiree Drug Subsidy (RDS) Reports: For Plan Sponsors which submit requests for drug
subsidies under the Medicare RDS program, Envision shall provide Plan Sponsor with quarterly
reports summarizing Claims paid by Plan Sponsor for Medicare Part D drugs dispensed to
Covered Individuals who Plan Sponsor has identified on the appropriate form as Medicare
eligible retirees. Plan Sponsor acknowledges that any estimated earned Manufacturer Derived
Revenue which has been passed - through to Plan Sponsor will have been deducted from the
Claim amounts reported. Unless otherwise specified herein or included under an addendum to
this Agreement, Envision shall not be responsible or liable to Plan Sponsor for any RDS services
or subsidies. Any assistance requested by Plan Sponsor and/or provided by Envision shall be
solely consultative and shall not be deemed to be an acceptance by Envision of any responsibility
or liability for the completion or submission of any RDS application or request for subsidies
under Medicare Part D.
2.9 Business Associate A eement: Envision shall execute a HIPAA Business Associate
Agreement, attached as Exhibit 2.
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2.10 Additional Services: Any services to be rendered under this Agreement which are not
included in the Administrative Fee as specified in this Section 2 shall be itemized in the Exhibits
and Addendums hereto along with any associated costs or charges.
2.11 Performance Guarantees: Envision shall provide PBM Services in accordance with the
Performance Guarantees specified in Exhibit 3. Unless otherwise stated, targets will be
measured on a Contract Year basis. The total amount of penalties payable by Envision in any
Contract Year shall not exceed ten percent (10 %) of Envision's Administrative Fee paid by Plan
Sponsor during applicable Contract Year. Unless otherwise stated, payment of penalties will be
credited towards future Administrative Fees. Failure to meet Performance Guarantees shall not
be deemed to be a breach of this Agreement.
3. PRICING AND PASS - THROUGH METHODOLOGY
3.1 Pass - Through of Discounts and Dispensin Fees: Envision has negotiated discounted
drug prices and dispensing fees with Participating Pharmacies. Envision shall pass - through to
Plan Sponsor one hundred percent (100 %) of the negotiated discount for the drug dispensed (plus
any applicable dispensing fee) without any reclassification, mark -up or spread by Envision. The
amount invoiced to Plan Sponsor shall be the exact drug ingredient cost and applicable
dispensing fee which is paid to the dispensing pharmacy, in accordance with the following:
3. 1.1 For Inaredient Cost: Envision shall invoice Plan Sponsor the lower of:
(a) The calculated negotiated amount payable to the Participating Pharmacy
based on the 11 digit NDC number of the drug dispensed; or
(b) If included on the then current Envision MAC List, the MAC Price for the
drug dispensed; or
(c) The Participating Pharmacy's U &C Price (except for drugs dispensed by
the Mail Order or Specialty Pharmacy); less
any applicable earned Manufacturer Derived Revenue and/or any applicable Covered Individual
Cost Share.
3.1.2 For Dispensing Fees: Envision shall invoice Plan Sponsor the actual dispensing
fee amount payable to the Participating Pharmacy.
3.1.3 Drug Pricing and Dispensing Fees Guarantee: Within four months after the end
of each Contract Year, Envision shall provide Plan Sponsor with a report showing the actual
Annual Average Effective Rates and Annual Average Dispensing Fees paid by Plan Sponsor for
the Contract Year. If the amounts paid by Plan Sponsor during the Contract Year for all Claims
in any category in Exhibit 1 with a specified rate (i.e. 30 Day Retail Brand Drug; 30 Day Retail
Brand Drug Dispensing Fee; 30 Day Retail Generic Drug; 30 Day Retail Generic Drug
Dispensing Fee; 90 Day Retail Brand Drug; 90 Day Retail Generic Drug; 90 Day Mail Brand
Drug; 90 Day Mail Generic Drug) are less favorable than the Annual Average Effective Rates
and Average Dispensing Fees stated in Exhibit 1, Envision shall credit Plan Sponsor with the
difference for that category. Plan Sponsor understands and agrees that if, after the Effective Date
of this Agreement, there is a substantial change in drug utilization patterns of Covered
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Individuals, or Benefit Plan setup parameters such as copay, pharmacy participation, or rules
governing the application of the Formulary, which adversely affect any guaranteed Annual
Average Effective Rate or Average Dispensing Fee, such guarantee shall be adjusted to account
for such changes. Envision shall demonstrate to Plan Sponsor the factors upon which any such
adjustment is based and the methodology used to make such adjustment. Nothing in this Section
3.1.3 shall affect Envision's obligation to pass through to Plan Sponsor 100% of all negotiated
discounts and dispensing fees for Plan Sponsor's Claims. Envision shall not be liable to Plan
Sponsor for guaranteed Annual Average Effective Rates or Annual Average Dispensing Fees if
(i) Plan Sponsor makes a change to the Benefit Plan which affects the utilization or distribution
of Covered Drugs; (ii) the specifications provided by Plan Sponsor on the initial Benefit
Specification Form are inconsistent with the specifications provided to Envision prior to the
execution of the initial Benefit Specification Form; or (iii) the utilization data provided by Plan
Sponsor (or Plan Sponsor's agent) upon which the calculation of guarantees were based is
inaccurate. Plan Sponsor is urged to submit any proposed changes to the Benefit Plan to
Envision before such changes become effective so that Envision may advise Plan Sponsor if any
changes will affect Drug Pricing or Dispensing Fees Guarantees. Plan Sponsor acknowledges
that it has no right of offset to withhold any payment due Envision under this Agreement for any
amounts owed Plan Sponsor for financial guarantees.
3.2 Manufacturer Derived Revenue
3.2.1 Pass-Through of Manufacturer Derived Revenue: Envision has negotiated
contracts with pharmaceutical manufacturers to obtain Manufacturer Derived Revenue for
eligible Prescription Drugs, and shall pass through to Plan Sponsor one hundred percent (100 %)
of all earned Manufacturer Derived Revenue paid to Envision by contracted pharmaceutical
manufacturers for Plan Sponsor's eligible Claims that comply with the terms of this Agreement.
Prescription Drugs eligible for Manufacturer Derived Revenue are included in the Formulary
provided by Envision. Plan Sponsor acknowledges that its yield of earned Manufacturer Derived
Revenue is dependent on certain factors including, without limitation, the following: (i) the
effect of terms and conditions of Plan Sponsor's Benefit Plan on the application of the
Formulary; (ii) the structure of Plan Sponsor's Benefit Plan, including but not limited to Cost
Share requirements and coverage rules such as Prior Authorizations, Quantity Limits, and Step
Therapy (as defined in the Benefit Specification Form); and (iii) the drug utilization patterns of
Covered Individuals. Plan Sponsor further acknowledges that Plan Sponsor's portion of market
share rebates is based on (i) Plan Sponsor's ability to meet and earn market share rebate levels by
pharmaceutical manufacturer and (ii) the ratio of Plan Sponsor's Claims for a particular rebated
drug to the total number of Claims for such drug for all Envision clients, as adjusted for the
effect of Plan Sponsor's Benefit Plan (e.g. tier structure and Cost Share differentials) on the
overall yield of market share rebates. Claims paid entirely by Covered Individuals (e.g. a Claim
occurring while the Covered Individual has not yet met his or her deductible), 340B Claims, and
Claims for which Envision has not been paid in full, are ineligible for Manufacturer Derived
Revenue, and no Manufacturer Derived Revenue shall be payable to Plan Sponsor for such
Claims.
3.2.2 Pass - Through Methodology: Manufacturer Derived Revenue shall be advanced
to Plan Sponsor by adjusting the Claim for an eligible Prescription Drug by the estimated earned
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Manufacturer Derived Revenue using Envision's patented Point -of -Sale Technology. Envision's
Point -of -Sale Technology generates a Claim that will be invoiced to Plan Sponsor at the net price
after applying credit for estimated earned Manufacturer Derived Revenue. (Plan Sponsor
acknowledges that, unless otherwise indicated by Plan Sponsor on the Benefit Specification
Form, if a Covered Individual pays a percentage of the drug cost (i.e. co- insurance) under the
Benefit Plan, a proportional amount of the Manufacturer Derived Revenue will be passed on to
the Covered Individual at the Point -of- Sale).
3.2.3 Sole Source: Plan Sponsor represents and warrants to Envision that, at no time
during or after the term of this Agreement, is Plan Sponsor receiving rebates and other revenues
from pharmaceutical manufacturers other than through Envision, either directly or indirectly
(through a Group Purchasing Organization, drug wholesaler, or otherwise) for Claims processed
by Envision under this Agreement. Plan Sponsor agrees that it shall not, at any time, submit
Claims which have been transmitted to Envision to another pharmacy benefit manager or carrier
for the collection of rebates and other revenues from pharmaceutical manufacturers or create a
situation which would cause a pharmaceutical manufacturer to decline payments to Envision.
Envision reserves the right to recover from Plan Sponsor, and Plan Sponsor shall refund to
Envision, any Manufacturer Derived Revenue, including any related penalties and fees, advanced
to Plan Sponsor by Envision which is connected with any Claims for which Plan Sponsor
received rebates and other revenues from pharmaceutical manufacturers from any other source or
for amounts advanced to Plan Sponsor by Envision which have been withheld by a
pharmaceutical manufacturer as a result of such Claims not meeting conditions for rebates, the
ineligibility of Claims for Manufacturer Derived Revenue (i.e. 340B Claims), or breach of this
Agreement by Plan Sponsor.
3.2.4 Manufacturer Derived Revenue Guarantee: Nine months after the end of each
Contract Year, Envision shall provide Plan Sponsor with a report reconciling Manufacturer
Derived Revenue amounts advanced to Plan Sponsor and Manufacturer Derived Revenue
amounts earned by Plan Sponsor for eligible Claims (including market share based amounts)
during the Contract Year.
(a) If the Manufacturer Derived Revenue advanced to Plan Sponsor for the
Contract Year is, overall, lower than the overall Manufacturer Derived Revenue earned by Plan
Sponsor for the Contract Year, Envision shall pay the difference to Plan Sponsor.
(b) If the Manufacturer Derived Revenue earned by Plan Sponsor for the
Contract Year is, overall, lower than the annual average earned Manufacturer Derived Revenue
guaranteed amounts specified in Exhibit 1, Envision shall pay the difference to Plan Sponsor.
Notwithstanding anything herein to the contrary, Envision shall not be liable to Plan Sponsor for
guaranteed earned Manufacturer Derived Revenue if: (i) Plan Sponsor makes a change to the
Benefit Plan which affects the application of the Formulary (e.g. tier differentials), the conditions
for rebates of pharmaceutical manufacturer contracts; or otherwise affects earned Manufacturer
Derived Revenue yields; (ii) there is a substantial change in the drug utilization patterns of
Covered Individuals; (iii) the utilization data provided by Plan Sponsor (or Plan Sponsor's agent)
upon which the calculation of guarantees were based is inaccurate; (iv) there is a loss of rebates
due to pharmaceutical manufacturer drug patent expirations, manufacturer bankruptcy, or
removal of a drug from the market; (v) there are changes in pharmaceutical manufacturer rebate
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contracting terms or policies; (vi) Plan Sponsor fails to meet and earn market share rebate levels;
(vii) if Plan Sponsor has been excluded by a manufacturer; or (viii) there is any governmental
regulation, ruling, or guidance that impacts Envision's ability to maintain current earned
Manufacturer Derived Revenue yields. Plan Sponsor acknowledges that it has no right of offset
to withhold any payment due Envision under this Agreement for any amounts owed Plan
Sponsor for financial guarantees.
4. PLAN SPONSOR RESPONSIBILITIES
4.1 Implementation: No later than thirty (30) days prior to the Effective Date, Plan Sponsor
shall provide Envision with an executed Benefit Specification Form and such data as reasonably
necessary for Envision to set up the Claims Adjudication System and commence the provision of
PBM Services as of the Effective Date. Such data includes, without limitation, prior utilization
reports, pharmacy transfer files, and eligibility. For the first month of the Agreement only,
Envision will credit Plan Sponsor an implementation credit of $0.50 per Eligible Employee.
4.2 Eligibility Data: Plan Sponsor shall provide Envision (either directly or through an
authorized third party administrator) with an Eligibility File, at least monthly, in the HIPAA 834
standard transaction code set format, or such other format as has been previously agreed to by
Envision. Plan Sponsor shall provide timely eligibility updates (for example, additions,
terminations, change of address or personal information, etc.) to ensure accurate determination of
the eligibility status of Covered Individuals. Plan Sponsor acknowledges and agrees that (i)
Envision provides such eligibility data to the Participating Pharmacies and understands that
Envision and Participating Pharmacies will act in reliance upon the accuracy of data received
from Plan Sponsor; (ii) Envision will continue to rely on the information provided by Plan
Sponsor until Envision receives notice that such information has changed; and (iii) Envision
shall not be liable to Plan Sponsor for any Claims or expense resulting from the provision by
Plan Sponsor (or its designee) of inaccurate, erroneous, or untimely information. In addition, if
Envision must create or update eligibility by manually entering Covered Individual data, Plan
Sponsor will be charged a data entry fee as specified in Exhibit 1. In lieu of the Eligibility File,
Plan Sponsor may provide eligibility information by updating the Claims Adjudication System
directly (except for the initial Eligibility File, which must be provided to Envision during the
initial implementation), provided Plan Sponsor continues to meet Envision's conditions and
specifications for direct eligibility updates.
4.3 Benefit Plan: Plan Sponsor shall provide Envision with complete information concerning
the Benefit Plan. Plan Sponsor understands and agrees that Envision shall rely on the terms and
provisions provided by Plan Sponsor on the Benefit Specification Form. The Benefit
Specification Form may be changed from time to time by Plan Sponsor by providing Envision
with a replacement Benefit Specification Form or a Benefit Specification Change Form;
provided, however, that the form must be signed by Plan Sponsor to be effective and the form
provided to Envision at least thirty (30) days before any such change shall be implemented. The
most recent executed Benefit Specification Form shall supersede any prior dated form. Plan
Sponsor shall have sole authority to determine the terms of the Benefit Plan and the coverage of
benefits thereunder, however, Plan Sponsor understands and agrees that any change in the
Benefit Plan or System configuration (e.g. mandatory generic program, coverage of over -the-
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counter drugs or medications, source of Covered Drugs, use of Plan Sponsor Owned pharmacies,
etc.) may affect yields in earned Manufacturer Derived Revenue and/or average drug pricing.
Plan Sponsor agrees that Envision shall not be liable to Plan Sponsor for a reduction of such
yields or increase in pricing which result from any such change, or for any failure of Envision to
meet financial guarantees which are affected by such change.
4.4 Formulary: Plan Sponsor shall adopt and adhere to the Formulary provided by Envision.
Any customization of the Formulary by Plan Sponsor or use by Plan Sponsor of an alternate
Formulary must be approved, in writing, by Envision. Plan Sponsor acknowledges that
adherence to the Formulary is necessary to maximize yields in earned Manufacturer Derived
Revenue. Envision shall not be liable to Plan Sponsor for any reduction in yields of earned
Manufacturer Derived Revenue, or for any failure of Envision to meet financial guarantees
resulting from Plan Sponsor's failure to adhere to the Formulary or a change to the Benefit Plan
that affects the application of the Formulary.
4.5 Payment: Plan Sponsor shall timely pay, or cause its designee to timely pay, Envision for
services rendered hereunder in accordance with Section 4 below and Exhibit 1.
4.6 Cooperation: Plan Sponsor shall promptly provide Envision with all information (both
verbal and written) that is requested by Envision and reasonably necessary for Envision to
complete its obligations hereunder. Any information required to be provided by Plan Sponsor in
order for Envision to perform a function under this Agreement shall be deemed to be untimely if
not received by Envision at least five (5) business days prior to its due date. Further, Plan
Sponsor shall not obfuscate, delay, impede, or otherwise fail to cooperate with Envision.
5. TERMS OF PAYMENT
5.1 Fees and Rates: Plan Sponsor hereby accepts the fees and rates specified in Exhibit 1 and
acknowledges the drug pricing amounts and annual average earned Manufacturer Derived
Revenue guarantees specified in Exhibit 1 are conditioned upon Plan Sponsor's adherence to
certain conditions under this Agreement. The actual annual average discounts and earned
Manufacturer Derived Revenue will depend on Plan Sponsor's drug utilization and mix of
Participating Pharmacies.
5.2 Payments for Claims: Envision shall invoice Plan Sponsor twice each month for Claims
incurred. Plan Sponsor shall pay Envision's invoices no later than 12:00 p.m. Eastern time on
the tenth (10th) calendar day from receipt of said invoices. Invoices shall be deemed to have
been received by Plan Sponsor upon the earliest delivery of the invoice by mail, e-mail, fax, or
courier.
5.3 Payment of Administrative Fee: Beginning with the first month under this Agreement,
Envision shall provide Plan Sponsor with an invoice of Administrative Fees on or about the first
day of each month. Administrative Fees are due within seven (7) calendar days of receipt of
Envision's invoice. The monthly Administrative Fee is calculated by multiplying the number of
Eligible Employees who are eligible to receive services hereunder at any time during the prior
month (as reflected in the Claims Adjudication System) by the Administrative Fee amount set
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forth in Exhibit 1 (except for the initial invoice which is based on Plan Sponsor's initial
Eligibility File).
5.4 Fees for Additional Services and Miscellaneous Expenses: Plan Sponsor agrees to
reimburse Envision for Additional Services and Miscellaneous Expenses (e.g. postage) specified
in Exhibit 1 hereunder, within seven (7) calendar days of receipt of an invoice.
5.5 Retroactive Disenrollment or Termination: Retroactive termination or disenrollment of a
group, Eligible Employee, or Covered Individual shall not release Plan Sponsor of its obligation
to pay Claims incurred, at any time, on behalf of a Covered Individual or Administrative Fees
due to Envision for a Covered Individual during any period for which services were renderable
hereunder based on the then current eligibility. Further, termination of coverage of prescription
drugs or the entering into a policy of insurance that covers prescription drugs shall not constitute
a permitted termination of this Agreement.
5.6 Taxes, Assessment or Fees: Any sales or use taxes for Covered Drugs sold to Covered
Individuals shall be charged, collected, and paid to state and local taxing authorities by the
dispensing pharmacy. As part of the reimbursement for a Claim, Plan Sponsor shall reimburse
Envision for such taxes payable by the dispensing pharmacy. These sales or use taxes will be
added to the overall amount of the Claim and invoiced to Plan Sponsor and/or Member, in
accordance with the Benefit Plan, Further, Plan Sponsor shall reimburse Envision for any
assessments or related fees required to be paid under state or federal regulations for Plan
Sponsor's Claims.
5.7 Financial Responsibility: Plan Sponsor shall be and remain responsible for the payment
of all invoices for Administrative Fees, Additional Services, Miscellaneous Expenses, and
Claims (along with any associated Cost Share not timely paid by Members, dispensing fees, and
taxes). Plan Sponsor acknowledges that Envision will not pay pharmacies for Plan Sponsor's
Claims, nor be obligated to pay pharmacies for Claims, unless and until adequate funds are
received from Plan Sponsor.
5.7.1 Untimely_ Payments: If Plan Sponsor should fail to timely pay any amounts due
Envision hereunder for any reason, including, but not limited to, insolvency, bankruptcy,
termination of business, sale, or rebuff, Envision reserves the right to (i) suspend the provision of
services; (ii) offset such amounts owed to Envision by any amounts owed by Envision to Plan
Sponsor and/or (iii) collect from Plan Sponsor, in addition to such unpaid amounts, interest at a
rate of 1.5% per month on the outstanding balance (or, if lower, the rate of interest permitted
under the law of Plan Sponsor's state of domicile). If Envision suspends the provision of
services, Covered Individuals will be required to pay 100% of the drug cost and any dispensing
fees (or the U &C Price, if lower) to receive Covered Drugs. In addition, as a condition of
continuing to perform services under this Agreement, Envision may require Plan Sponsor to
deposit with Envision additional amounts to ensure the timely payment of future invoices and/or
discontinue advancing earned Manufacturer Derived Revenue to Plan Sponsor. Plan Sponsor
further agrees that Envision shall not be liable for any consequences resulting from the untimely
payment of Participating Pharmacies due to the failure of Plan Sponsor to timely pay Envision as
required under this Agreement. Further, if Plan Sponsor should fail to pay any amounts due
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Envision hereunder for drugs dispensed to Covered Individuals, Envision reserves the right to
pursue payment from such Covered Individuals to the extent permitted by law.
5.7.2 Financial Viability: Plan Sponsor acknowledges that Envision will periodically
conduct a credit check of Plan Sponsor. If such credit check reasonably indicates that Plan
Sponsor is not financially viable, Envision may require Plan Sponsor to deposit with Envision a
reasonable amount to ensure the timely payment of future invoices.
5.8 Financial Audit by Plan Sponsor: Within twelve months after the end of each Contract
Year hereunder, Plan Sponsor, at its sole expense, may audit Envision's records of Claims
adjudicated during the prior Contract Year. Envision shall make available to Plan Sponsor's
auditor, any and all financial records containing Plan Sponsor's information and such other
records as reasonably necessary for auditor to confirm that the amounts paid by Plan Sponsor are
the cost to Envision on the day the Covered Drug was dispensed. Plan Sponsor agrees to not use
as its auditors, any person or entity which, in the sole discretion of Envision, is a competitor of
Envision, a pharmaceutical manufacturer representative, or any other person or entity which has
a conflict of interest with Envision. Plan Sponsor understands that Envision's contracts with
pharmaceutical manufacturers, Participating Pharmacies, and other third parties may contain
non - disclosure provisions, and hereby agrees to comply with such non - disclosure provisions.
Plan Sponsor's auditor shall execute a conflicts of interest disclosure and confidentiality
agreement with Envision prior to the audit. Audits shall only be made during normal business
hours following thirty (30) days written notice, be conducted without undue interference to
Envision's business activity, and in accordance with reasonable audit practices. Plan Sponsor's
auditor may inspect Envision's contracts with Participating Pharmacies and pharmaceutical
manufacturers at Envision's offices only, and no copies of such contracts may be removed from
Envision's offices. Plan Sponsor agrees to disclose the findings and methodologies of a
completed audit, and provide Envision with a reasonable period of time to respond to such
findings and methodologies, before a demand is made by Plan Sponsor for amounts it believes
are due from Envision.
5.9 Financial Audit by Envision: Envision may, at reasonable intervals, request Plan Sponsor
to provide records for Envision's inspection which provide support for the information contained
in the Eligibility File. In addition, and if warranted, Envision may, at its own expense, inspect
and audit, or cause to be inspected and audited, once annually, the books and records of Plan
Sponsor directly relating to the existence and number of Covered Individuals. Audits shall only
be made during normal business hours following thirty (30) days written notice, be conducted
without undue interference to Plan Sponsor's business activity, and in accordance with
reasonable audit practices. Envision agrees to execute a confidentiality agreement with Plan
Sponsor prior to the audit.
6. TERM AND TERMINATION
6.1 Term: The term of this Agreement shall commence on the Effective Date and shall
remain in full force and effect for an initial term of two (2) years ( "Initial Term ") unless earlier
terminated as provided herein. Upon the expiration of the Initial Term, and each subsequent
renewal term, this Agreement shall renew automatically for an additional term of one year;
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unless, at least ninety (90) days prior to the end of such term, either party hereto notifies the
other, in writing, that this Agreement will terminate at the end of the current term.
6.2 Termination: This Agreement may be terminated as follows:
6.2.1 For Cause: By either party hereto in the event the other party breaches any of its
material obligations hereunder; provided, however, that the defaulting party shall have thirty (30)
days to correct such breach after written notice is given by such non - breaching party specifying
the alleged breach;
6.2.2 Insolvency: By either party hereto in the event the other party (i) is adjudicated
insolvent, under state and/or federal regulation, or makes an assignment for the benefit of
creditors; (ii) files or has filed against it, or has an entry of an order for relief against it, in any
voluntary or involuntary proceeding under any bankruptcy, insolvency, reorganization or
receivership law, or seeks relief as therein allowed, which filing or order shall not have been
vacated within sixty (60) calendar days from the entry thereof; (iii) has a receiver appointed for
all or a substantial portion of its property and such appointment shall not be discharged or
vacated within sixty (60) calendar days of the date thereof; (iv) is subject to custody, attachment
or sequestration by a court of competent jurisdiction that has assumed of all or a significant
portion of its property; or (v) ceases to do business or otherwise terminates its business
operations, is declared insolvent or seeks protection under any bankruptcy, receivership, trust
deed, creditors arrangement or similar proceeding;
6.2.3 Failure to Pay: By Envision, in addition to any other remedy available to
Envision hereunder, in the event Plan Sponsor fails to pay Envision according to terms of this
Agreement.
6.3 Notices: All notices required in this Section 6 shall be reasonably specific concerning the
cause for termination and shall specify the effective date and time of termination.
6.4 Effect of Termination: Termination of this Agreement for any reason shall not release
any party hereto from obligations incurred under this Agreement prior to the date of termination.
Except as otherwise agreed, in writing, no services shall be provided by Envision after the
effective date of termination. Envision reserves the right to suspend advancing earned
Manufacturer Derived Revenue to Plan Sponsor upon Plan Sponsor's notification of termination.
7. CONFIDENTIAL INFORMATION
7.1 Confidentiality: Except as otherwise stated herein or required by law, neither party
hereto shall disclose any information of, or concerning the other party which has either been
provided by one party to the other or obtained by a party in connection with this Agreement
(including this Agreement and the terms of this Agreement) or related to the services rendered
under this Agreement, all of which information is deemed confidential information. All data,
information, and knowledge supplied by a party hereto shall be used by the other party
exclusively for the purposes of performing this Agreement. Upon termination of this
Agreement, each party shall return to the other party or destroy (if such destruction is certified)
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all confidential information provided including, without limitation, all copies and electronic
magnetic versions thereof. Notwithstanding any of the foregoing to the contrary, "confidential
information" shall not include any information which was known by a party prior to receiving it
from the other party, or that becomes rightfully known to a party from a third party under no
obligation to maintain its confidentiality, or that becomes publicly known through no violation of
this Agreement.
7.2 Protected Health Information: Plan Sponsor will have access to Protected Health
Information (PHI) (as defined by HIPAA) contained in reports provided by Envision or accessed
by Plan Sponsor via Envision's website. Plan Sponsor agrees, for itself and its employees, that
PHI shall not be used for any impermissible purpose, including, without limitation, the use of
PHI for disciplinary or discriminatory purposes, and any user names and passwords assigned to
designated individuals shall not be shared with non - designated individuals. In addition, Plan
Sponsor, for itself and its Covered Individuals, authorizes Envision to use and share PHI as
necessary to carry its obligations hereunder.
8. INDEMNIFICATION
8.1 Limited Indemnification by Envision: Envision hereby agrees to indemnify, hold
harmless, and defend Plan Sponsor and its employees, officers, directors, trustees, shareholders,
and agents from and against any and all liabilities, actions, claims, damages, costs, losses and
expenses (including without limitation, reasonable costs of investigation and attorneys' fees)
caused by or arising out of (i) any act or omission by Envision in the performance of the services
provided under this Agreement; or (ii) any breach of any representation, covenant, or other
agreement of Envision contained in this Agreement.
8.2 Limited Indemnification by Plan Sponsor: To the extent allowable by law, Plan Sponsor
hereby agrees to indemnify, hold harmless, and defend Envision and its employees, officers,
directors, shareholders, affiliates and agents from and against any and all liabilities, actions,
claims, damages, costs, losses and expenses (including without limitation, reasonable costs of
investigation and attorneys' fees) caused by or arising out of (i) the provision by Plan Sponsor or
its designee of untimely, incomplete, or erroneous information; or (ii) Plan Sponsor's failure to
comply with state or federal law in the operation of its Benefit Plan.
8.3 Limitation of Liability: Except for the indemnification obligations set forth above (i)
each party's liability to the other hereunder will in no event exceed the actual proximate losses or
damages caused by breach of this Agreement; and (ii) in no event will either party or any of their
respective affiliates, directors, employees or agents, be liable for any indirect, special, incidental,
consequential, exemplary or punitive damages, or any damages for lost profits relating to a
relationship with a third party, however caused or arising, whether or not they have been
informed of the possibility of their occurrence.
8.4 Survival: This Section 8 shall survive the expiration or termination of this Agreement for
any reason.
9. RELATIONSHIP WITH CONTRACTED PHARMACIES
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Plan Sponsor acknowledges that Envision is neither an operator of pharmacies nor exercises
control over the professional judgment used by any pharmacist when dispensing drugs or
medical supplies to Covered Individuals. Nothing in this Agreement shall be construed to usurp
the dispensing pharmacist's professional judgment with respect to the dispensing or refusal to
dispense any drugs or medical supplies to Covered Individuals. Plan Sponsor agrees that it shall
not hold Envision responsible, nor shall Envision be liable to Plan Sponsor or Covered
Individuals, for any liability arising from the dispensing of drugs or medical supplies to Covered
Individuals by any pharmacy.
10. GENERAL
10.1 Standards of Performance: Envision shall perform its obligations under this Agreement
with care, skill, prudence, and diligence, and in accordance with the standards of conduct
applicable to a fiduciary. Envision shall disclose all administrative fees and drug costs charged
to Plan Sponsor, disclose all earned Manufacturer Derived Revenue collected by Envision for
Plan Sponsor's Claims, and permit Plan Sponsor to audit such fees, costs, and revenues, as set
forth in this Agreement. Envision shall also disclose to Plan Sponsor any activity, policy, or
practice that presents a conflict of interest with the performance of its obligations hereunder.
Notwithstanding anything to the contrary, Plan Sponsor retains the sole responsibility for the
terms and provisions of the Benefit Plan; its compliance with applicable law, including, without
limitation, any federally mandated requirements; and the interpretation and determinations of
coverage under the Benefit Plan. Unless otherwise agreed in writing, Plan Sponsor shall also be
responsible for the disclosing or reporting of information regarding the Benefit Plan or changes
in the Benefit Plan (e.g., calculation of co- payments, deductibles; or creditable coverage) as may
be required by law to be disclosed to governmental agencies or Covered Individuals.
10.2 Independent Contractors: Envision and Plan Sponsor are independent contractors.
Notwithstanding anything herein to the contrary, neither party hereto, nor any of its respective
employees, shall be construed to be the employee, agent, or representative of the other for any
reason, or liable for any acts of omission or commission on the part of the other. Plan Sponsor
acknowledges that, notwithstanding anything herein to the contrary, Envision negotiates
contracts with pharmacies, pharmaceutical manufacturers, and vendors on its own behalf and not
specifically or exclusively for Plan Sponsor.
10.3 Exclusivity: During the term of this Agreement, Envision shall be the sole provider of
PBM Services to Plan Sponsor, including, without limitation, the exclusive contractor of rebates
with pharmaceutical manufacturers for Plan Sponsor's Claims.
10.4 Assignment: Except as follows, this Agreement may not be assigned by either party
hereto without the express written consent of the other party, which may not be unreasonably
withheld. Envision may assign this Agreement to a commonly controlled subsidiary or affiliate
company, or a controlling parent company.
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10.5 Binding Effect: ffect: This Agreement and the exhibits and schedules attached hereto shall be
binding upon and inure to the benefit of the respective parties hereto and their respective
successors and assigns.
10.6 Intellectual Property: Each party hereto reserves the right to and control of the use of
their names, symbols, trademarks or service marks presently existing or hereafter established,
and no party may use any names, symbols, trademarks or service marks of any other party
without the owner's written consent.
10.7 Waiver: Neither the failure nor any delay on the part of either party hereto to exercise
any right, power or privilege hereunder will operate as a waiver thereof, nor will any single or
partial exercise of any such right, power or privilege preclude any other or further exercise
thereof, or the exercise of any other right, power or privilege. In the event any party hereto
should waive any breach of any provision of this Agreement, it will not be deemed or construed
as a waiver of any other breach of the same or different provision.
10.8 Severability: The invalidity or unenforceability of any term or provision of this
Agreement shall in no way affect the validity or enforceability of any other term or provision.
10.9 Change in Law or Market Conditions: If any law, regulation, or market condition (e.g. an
applicable industry standard reference on which pricing hereunder is based, changes the
methodology for determining drug price in a way that materially changes the pricing or
economics of this Agreement), either now existing or subsequently occurring, affects the ability
of either party hereto to carry out any obligation hereunder (a "Material Change "), Envision and
Plan Sponsor shall renegotiate the affected terms of this Agreement, in good faith, to preserve, to
the extent possible, the relative positions of the parties that existed prior to such Material
Change. Either party may notify the other party of a Material Change. If a successful
renegotiation is not achieved within thirty (30) days after notification of a Material Change, any
failure of the affected party to meet its obligations hereunder due to the effect of such Material
Change shall not be deemed to be a breach of this Agreement; however, if continuation of this
Agreement without modification is in violation of any law or regulation, or makes it
impracticable for the affected party to meet its obligations hereunder, either party may terminate
this Agreement with sixty (60) days prior written notice.
10.10 Headings: The section or paragraph headings contained in this Agreement are for
reference purposes only and shall not affect the meaning or interpretation of this Agreement.
10.11 Entire Agreement: This Agreement shall constitute the entire agreement between
Envision and Plan Sponsor with respect to the subject matter herein and supersede any prior
understanding or agreements of any kind preceding this Agreement with respect to such subject
matter. Any modification or amendment to this Agreement, or additional obligation assumed by
Envision or Plan Sponsor in connection with this Agreement, shall be binding only if evidenced
in a writing signed by both parties hereto. No term or provision of this Agreement shall establish
a precedent for any term or provision in any other agreement.
10.12 Acceptance of Offer: Notwithstanding anything herein to the contrary, this Agreement
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shall not be binding upon the parties hereto unless and until this Agreement is signed and
executed by a duly authorized officer of each of the parties. The signing of this Agreement by
Plan Sponsor constitutes an offer only until the same has been accepted by Envision.
10.13 Dispute Resolution
10.13.1 Mediation: Prior to the initiation of any action or proceeding permitted by this
Agreement to resolve disputes between the parties, the parties shall make a good faith effort to
resolve any such disputes by negotiation. The negotiation shall be attended by representatives of
Envision with full decision - making authority and by Plan Sponsor's designated representative
who would make the presentation of any settlement reached during the negotiations to the Plan
Sponsor's Board of County Commissioners for approval. Failing resolution, and prior to the
commencement of depositions in any litigation between the parties arising out of this Agreement,
the parties shall attempt to resolve the dispute through Mediation before an agreed -upon Circuit
Court Mediator certified by the State of Florida. The mediation shall be attended by
representatives of Envision with full decision - making authority and by Plan Sponsor's
designated representative who would make the presentation of any settlement reached at
mediation to the Plan Sponsor's Board of County Commissioners for approval. Should either
party fail to submit to mediation as required hereunder, the other party may obtain a court order
requiring mediation under Florida Statutes, section 44.102.
10.14 Choice of Law and Forum: This Agreement shall be construed, interpreted, and
governed according to the laws of the State of Florida, without regard to its conflicts of laws
rules, except to the extent such laws are preempted by applicable Federal Law. Any suit or action
brought by either party to this Agreement against the other party relating to or arising out of this
Agreement must be brought in the appropriate federal or state courts in and for Collier County,
Florida, which courts have sole and exclusive jurisdiction on all such matters.
10.15 Force Majeure: Neither Envision nor Plan Sponsor will be deemed to have breached this
Agreement or be held liable for any failure or delay in the performance of all or any portion of its
obligations under this Agreement if prevented from doing so by a cause or causes beyond its
control. Without limiting the generality of the foregoing, such causes include acts of God or the
public enemy, fires, floods, storms, earthquakes, riots, strikes, boycotts, lock -outs, acts of
terrorism, acts of war, war - operations, restraints of government, power or communications line
failure or other circumstances beyond such party's control, or by reason of the judgment, ruling
or order of any court or agency of competent jurisdiction, or change of law or regulation (or
change in the interpretation thereof) subsequent to the execution of this Agreement. The party
claiming force majeure must provide the other party with reasonable written notice. However, as
soon as the cause preventing performance ceases, the party affected thereby shall fulfill its
obligations as set forth under this Agreement. This Section 10.15 shall not be considered to be a
waiver of any continuing obligations under this Agreement, including, without limitation, the
obligation to make payments.
10.16 Fax Communications: Plan Sponsor agrees that Envision may communicate with Plan
Sponsor via fax, and by doing so, such fax is not a violation of the Telephone Consumer
Protection Act, 47 U.S.C. §227.
\PBMSA (frm062413) 0 Envision Pharmaceutical Services, Inc. Page 19 of 35
6.
11G '
10.17 Notices: All notices required under this Agreement shall be in writing, signed by the
party giving notice and shall be deemed sufficiently given immediately after being delivered by
hand, or by traceable overnight delivery service, or by registered or certified mail (return receipt
requested), to the other party at the address set forth below or at such address as has been given
by proper notice.
10.18 Representations: Plan Sponsor represents and warrants that (i) it is self - insured; (ii) the
entering into this Agreement for PBM Services is not in violation of any other agreement; (iii)
has no undisclosed conflicts of interest; and (iv) it maintains, and shall continue to maintain
throughout the term of this Agreement, any and all licenses, governmental authority, or other
authorization required to operate an entity of its type. Envision represents that there are no
organizational arrangements that could potentially create a conflict of interest that affects clinical
or financial decisions. In addition, each signatory named below represents and warrants that he
or she (i) has read this Agreement, Exhibits, and other attachments, and fully understands and
agrees to the content therein; (ii) has entered into this Agreement voluntarily; (iii) has not
transferred or assigned or otherwise conveyed in any manner or form any of the rights,
obligations or claims which are the subject matter of this Agreement; and (iv) has the full power
and authority to execute this Agreement. This Agreement is not binding unless executed by all
signatories below.
[SIGNATURE PAGE FOLLOWS]
1PBMSA (frm062413) ® Envision Pharmaceutical Services, Inc. Page 20 of 35
9
I I G
PHARMACY BENEFIT MANAGEMENT SERVICES AGREEMENT
SIGNATURE PAGE
IN WITNESS WHEREOF, Envision and Plan Sponsor have executed this Agreement as of the
Effective Date above.
For ENVISION:
By : —_/t�' --
B I. Katz, R. Ph., President
Envision Pharmaceutical Services, Inc.
Address:
Envision Pharmaceutical Services, Inc.
2181 East Aurora Road
Twinsburg, OH 44087
PH: 330 -405 -8080
FX: 330 - 405 -8081
\PBMSA (frm062413)
For PLAN SPONSOR:
.er, Chairwoman 51 kZH l L-'�
Board of Commissioners
Address:
Collier County Board of Commissioners
3299 Tamiami Trail East
Naples, FL 34112 -4901
PH: 239 - 252 -8906
FX: 239 - 252 -8048
E -MAIL: AliceToppe @colliergov.net
FEIN: 59- 6000558
ATTEST:
D t E. Brock, Clerk of Courts
By:
Attest as�-��frh�
signature only.
p ved as to fo d eg 'ty:
toji4l3
By. u
Scott R. Teach
Deputy County Attorney
® Envision Pharmaceutical Services, Inc.
Page 21 of 35 G
`90
11G 'I
EXHIBIT 1
DRUG PRICING AND FEES
Designated Pharmacy Network
Broad Network
Drug Pricing and Dispensing Fees( ')
Supply /Source
BRAND
GENERIC
For Contract Year
Drug Price (B)
Dispensing
Drug Price (C)
Dispensing
2014
(Annual Average;
Fee (N)
(Annual Average
Fee (D)
(based on 2 year
Effective Rate
(Annual
Effective Rate
(Annual
Agreement)
Guarantee)
Average
Guarantee)
Average
Guarantee)
Guarantee) ;
Retail Pharmacy
Y
WP minus 15.15%
$1.40
AWP minus
$1.50
77.50%
Mail Order Pharmacy
(at Orchard
Pharmaceutical
AWP minus 20.50%
N/A
AWP minus
77,75%
N/A
Services)
Specialty Pharmacy (at
Orchard
Pharmaceutical
(Pass - Through of Contract Rate with Dispensing Pharmacy)
Services)
Supply /Source
BRAND
GENERIC
Drug Price (B)
Dispensing
Drug Price (C)
Dispensing
For Contract Year
(Annual Average
Fee (D)
(Annual Average
g
Fee (D)
2015
Effective Rate
(Annual
Effective Rate
(Annual
Guarantee)
Average
Guarantee)
Average
Guarantee)
Guarantee)
Retail Pharmacy
y
WP minus 15.25%
$1.40
AWP minus
$1.50
77.75%
Mail Order Pharmacy
(at Orchard
Pharmaceutical
AWP minus 20.50%
N/A
AWP minus
78.00%
N/A
Services)
Specialty Pharmacy (at
Orchard
Pharmaceutical
(Pass - Through of Contract Rate with Dispensing Pharmacy)
Services)
(A) Calculated price using the applicable negotiated contract rate (i.e. AWP or MAC rate, or U &C Price) for
\BAA- Plan Sponsor [Rev. 08 -08 -2013] 22 �q
11G
the designated Network. The AWP discounts shown in the table above are Annual Average Effective Rates
using current Medi -Span published values. If the calculated price is lower than the allowable amount under
any state Medicaid "Favored Nations" rule, Envision shall pass - through, and Plan Sponsor shall pay, the
Medicaid allowable amount.
(B) Annual Average Effective Rate for Brand Drugs is calculated using the actual price paid by Envision
(before deducting earned Manufacturer Derived Revenue) to Participating Pharmacies in the designated
Network, plus any Cost Share, (the Ingredient Cost) for all Brand Drug Claims (including Claims paid at the
U &C Price) during a Contract Year, excluding (i) Compound Drugs; (ii) drugs dispensed at a Specialty
Pharmacy; (iii) Claims from non - Participating Pharmacies, LTC pharmacies, or government owned or
operated pharmacies (e.g. Veterans Administration); (iv) Claims paid at government required amounts (e.g.
Medicaid); (v) 340B Claims; (vi) non - Prescription Drugs; and (vii) Claims from Plan Sponsor's owned
pharmacies, if any.
(c) Annual Average Effective Rate for Generic Drugs is calculated using actual price paid by Envision to
Participating Pharmacies in the designated Network, plus any Cost Share, (the Ingredient Cost) for all
Generic Drug Claims (including Claims paid at the U &C Price) during a Contract Year, excluding (i)
Compound Drugs; (ii) drugs dispensed at a Specialty Pharmacy; (iii) Claims from non - Participating
Pharmacies, LTC pharmacies, or government owned or operated pharmacies (e.g. Veterans Administration);
(iv) Claims paid at government required amounts (e.g. Medicaid); (v) 340B Claims; (vi) non- Prescription
Drugs; and (vii) Claims from Plan Sponsor's owned pharmacies, if any.
(D) Annual Average Dispensing Fee is the average per Claim fee for all Claims by Envision to Participating
Pharmacies in the designated Network (including Claims paid at the U &C Price) during a Contract Year,
excluding (i) Compound Drugs; (ii) drugs dispensed at a Specialty Pharmacy; (iii) Claims from non -
Participating Pharmacies, LTC pharmacies, or government owned or operated pharmacies (e.g. Veterans
Administration); (iv) Claims paid at government required amounts (e.g. Medicaid); (v) non - Prescription
Drugs; and (vi) Claims from Plan Sponsor's owned pharmacies, if any.
Annual Average Earned Manufacturer Derived Revenue Guarantee(')- (n,(G)
For Contract Year 2014:
• For Brand Drugs at a Retail Pharmacy - $12.85 per paid Brand Drug Claim
• For Brand Drugs at the Mail Order Pharmacy- $34.95 per paid Brand Paid Claim
For Contract Year 2015:
• For Brand Drugs at a Retail Pharmacy - $13.30 per paid Brand Drug Claim
• For Brand Drugs at the Mail Order Pharmacy- $35.65 per paid Brand Paid Claim
(F) Earned Manufacturer Derived Revenue guarantees are stated as annual average amounts per Contract
Year.
(F) Guarantees require Plan Sponsor to maintain a Benefit Plan that has a tier structure with a minimum $20
differential in Cost Share between preferred Brand Drugs and non - preferred Brand Drugs.
(G) 340B Claims, Claims paid entirely by Covered Individuals, and Claims processed from Plan Sponsor's
owned pharmacies, if any, shall be excluded from the calculation of the guarantees above.
Administrative Fee (Payable to .Envision; not including fees payable to . Plan Sponsor's TPAs,
consultants, or brokers, if any)
For Contract Year 2014: $3.80 Per Employee, Per Month (PEPM)
For Contract Year 2015: $3.90 PEPM
\BAA- Plan Sponsor [Rev. 08 -08 -20131
23
11G
Fees for Additional- Services and Miscellaneous Expenses
1.
Replacement by Envision of lost or stolen ID
$1.00 per card plus $0.15 per packet and
Cards
cost of postage
2.
Manual Claims Processing (including DMRs)
$1.50 per Claim processed
3.
Claim Adjustment Checks (charged to Plan
Sponsor for reimbursements made to Covered
Individuals for Claim adjustments requested by
Plan Sponsor.)
$8.50 per check
4.
Manually create or update the Eligibility File
$1.00 per Covered Individual data entry
5.
Ad Hoc Computer or Report Programming
$150.00 per hour
6.
Clinical Prior Authorizations (Initial Coverage
Determinations)
$8.00 per authorization
7.
Drug Therapy Care Gap Management
$0.55 per Member, per month
8.
Medication Adherence and Persistency (up to
three disease states)
$0.55 per Member, per month
\BAA- Plan Sponsor [Rev. 08 -08 -2013] 24
0
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EXHIBIT 2
BUSINESS ASSOCIATE AGREEMENT
This BUSINESS ASSOCIATE AGREEMENT (the "Agreement") is effective the 0 day of
January, 2014 (the "Effective Date "), by and between Envision Pharmaceutical Services, Inc.
( "Business Associate ") and Collier County Government ( "Plan Sponsor "), each referred to
individually herein as a "Party" or collectively as the "Parties ".
RECITALS
A. Plan Sponsor sponsors a health benefit plan that provides coverage for prescription
medications and supplies to covered members. Plan Sponsor has entered into a service
agreement with Business Associate to provide certain administrative services to, or on
behalf of, Plan Sponsor.
B. In order for Business Associate to provide services to Plan Sponsor, Plan Sponsor may
disclose certain Protected Health Information ( "PHI ") (as defined in Article 1 of this
Agreement) of Plan Sponsor's members to Business Associate and anticipates that
Business Associate will create, receive, maintain or transmit PHI on behalf of Plan
Sponsor.
C. The Parties desire to protect the privacy and security of all PHI in compliance with the
Health Insurance Portability and Accountability Act ( "HIPAA "), as amended by the
Health Information Technology for Economic and Clinical Health Act of 2009 ( "the
HITECH Act "), and the regulations promulgated there under. The purpose of this
Agreement is to ensure such compliance.
D. This Agreement incorporates provisions 42 U.S.C. § 17931(a) and 42 U.S.C. § 17934(a)
of the HITECH Act.
NOW, THEREFORE, the Parties, in consideration of the mutual agreements herein contained,
and for other good and valuable consideration, the receipt and adequacy of which are hereby
acknowledged, do hereby agree as follows:
Article 1: Definitions
For the purposes of this Agreement, the following defined terms shall have the following
definitions. Except as otherwise stated herein, the defined terms used in this Agreement shall
have the meanings given them under HIPAA and the regulations thereunder, including any
amendments thereto.
1.1 "Breach" shall mean the acquisition, access, use, or disclosure of PHI in a manner not
permitted under Subpart E of 45 C.F.R. Part 164, which compromises the security or
privacy of the PHI.
"Breach" excludes:
\BAA- Plan Sponsor [Rev. 08 -08 -2013] 25
G4,
11G
(1) Any unintentional acquisition, access, or use of PHI by an employee or a person
acting under the authority of Business Associate, if such acquisition, access, or use was
made in good faith and within the scope of the authority, and does not result in further
use or disclosure in a manner not permitted under Subpart E of 45 C.F.R. Part 164.
(2) Any inadvertent disclosure of PHI by a person authorized to access PHI at Business
Associate to another person authorized to access PHI at Business Associate, and the
information received as a result of the disclosure is not further used or disclosed in a
manner not permitted under Subpart E of 45 C.F.R. Part 164.
(3) A disclosure of PHI in which Business Associate has a good faith belief that an
unauthorized person to whom PHI is disclosed would not reasonably have been able to
retain the information.
1.2 "Designated Record Set' shall have the meaning prescribed to it in 45 C.F.R. § 164.501.
1.3 "HHS" shall mean the U. S. Department of Health and Human Services.
1.4 "HIPAA Standards" shall mean the standards for privacy and security of Individually
Identifiable Health Information found at 45 C.F.R. Parts 160 and 164.
1.5 "Individual" shall have the same meaning as the term "individual" in 45 C.F.R. § 160.103
and shall include a person who qualifies as a personal representative in accordance with
45 C.F.R. § 164.502(g).
1.6 "Individually Identifiable Health Information" shall have the meaning prescribed to it in
45 C.F.R. § 160.103.
1.7 "Protected Health Information" shall have the meaning prescribed to it in 45 C.F.R. §
160.103, limited to Individually Identifiable Health Information transmitted or
maintained in any form or medium that Business Associate creates or receives from or on
behalf of Plan Sponsor.
1.8 "Required by Law" shall have the same meaning as the term "required by law" in 45
C.F.R. § 164.103.
1.9 "Secretary" shall mean the Secretary of HHS or his or her designee.
1.10 "Security Incident" shall mean the attempted or successful unauthorized access, use,
disclosure, modification, or destruction of information or interference with system
operations in an information system.
1.11 "Unsecured PHI" shall mean PHI that is not rendered unusable, unreadable, or
indecipherable to unauthorized persons through the use of technology or methodology
specified by the Secretary in the guidance issued under section 13402(h)(2) of Public
Law 111 -5.
Article 2: Business Associate Use and Disclosure of PHI
\BAA- Plan Sponsor [Rev. 08 -08 -2013]
26 U
11G
2.1 Purpose. As further described above under Recitals, Business Associate performs certain
administrative services for Plan Sponsor.
2.2 Receipt and Use of PHI. Performance of administrative services by Business Associate
requires that Business Associate receive and use PHI obtained from or on behalf of Plan
Sponsor, or that Business Associate create, receive, maintain, or transmit PHI on behalf
of Plan Sponsor. To perform these administrative services, Business Associate may use
or disclose PHI provided such use or disclosure would not violate the HIPAA Standards
if done by Plan Sponsor. However, Business Associate may use PHI internally to carry
out its legal responsibilities and for its proper management, internal auditing, and
administration, and at the request of Plan Sponsor, to provide data aggregation services to
Plan Sponsor as permitted by the HIPAA Standards.
2.3 Disclosure of PHI. Performance of administrative services by Business Associate may
require that Business Associate disclose PHI to agents or subcontractors of Business
Associate. Business Associate may disclose PHI to third parties with which it contracts
to assist in providing administrative services, and to its agents to carry out Business
Associate's legal responsibilities, for proper management, internal auditing, and
administration, only if (a) Business Associate obtains reasonable assurances from such
third parties or agents that the PHI will be held by them confidentially and used or further
disclosed only as Required by Law or for the purpose for which it was disclosed to them,
(b) such third parties or agents agree to implement reasonable and appropriate safeguards
to protect the confidentiality, integrity, and availability of PHI, and (c) such third parties
or agents agree to notify Business Associate of any instance of which they are aware that
the confidentiality of the information has been breached or that a Security Incident has
occurred. Notwithstanding the foregoing, Business Associate will be permitted to
exchange PHI freely with any Business Associates of the Plan Sponsor with which the
Plan Sponsor has executed a Business Associate Agreement/Addendum.
2.4 Satisfactory Assurances. Plan Sponsor may not transfer or transmit PHI to Business
Associate or permit Business Associate to create, receive, or transmit PHI on behalf of
Plan Sponsor without satisfactory assurances from Business Associate that it will
appropriately safeguard the information.
Article 3: Duties of Business Associate
3.1 Limitations on Use of PHI. Business Associate shall not use PHI except as permitted or
required by this Agreement or as Required by Law. Business Associate shall only use
PHI in a manner that is consistent with the HIPAA Standards.
3.2 Limitations on Disclosure of PHI. Business Associate shall not disclose PHI except as
permitted or required by this Agreement or as Required by Law. Business Associate
shall only disclose PHI in a manner that is consistent with the HIPAA Standards.
3.3 Minimum Necessary. Business Associate shall request, use and disclose the minimum
amount of PHI necessary to accomplish the purpose of the request, use or disclosure, in
accordance with 42 U.S.C. § 17935(b).
\BAA- Plan Sponsor [Rev. 08 -08 -20131 27 Q
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11G
3.4 Safeguarding PHI. Business Associate shall use appropriate safeguards, and comply with
Subpart C of 45 CFR Part 164, to prevent the use or disclosure of PHI other than as
provided for by this Agreement. Business Associate shall comply with the provisions of
45 C.F.R. §§ 164.308, 164.310, 164.312 and 164.316 in the same manner that such
provisions apply to Plan Sponsor, and implement administrative, physical, and technical
safeguards that reasonably and appropriately protect the confidentiality, integrity, and
availability of the PHI that it creates, receives, maintains, or transmits on behalf of Plan
Sponsor as required by the HIPAA Standards.
3.5 Third Party Agreements. Business Associate may need to enter into agreements with
third parties, including agents or subcontractors, in order to satisfy its obligations to Plan
Sponsor. In accordance with 45 C.F.R. § 164.502(e)(1)(ii) and 164.308(b)(2), should
third parties, agents, or subcontractors create, receive, maintain, or transmit PHI on
behalf of Business Associate, Business Associate shall require such third parties or agents
to agree, in writing, to (a) be bound by the same restrictions, conditions, and requirements
that apply to Business Associate with respect to such information, and (b) implement
reasonable and appropriate administrative, technical and physical safeguards to protect
PHI and the confidentiality, integrity and availability of PHI. Notwithstanding the
foregoing, Business Associate will be permitted to exchange PHI freely with any
Business Associates of the Plan Sponsor with which the Plan Sponsor has executed a
Business Associate Agreement/Addendum.
3.6 Reporting of Security Incidents. Business Associate shall identify and respond to Plan
Sponsor any suspected or known Security Incidents, mitigate, to the extent practicable,
harmful effects of Security Incidents that are known to Business Associate, and document
Security Incidents and their outcomes.
3.7 Reporting of Unauthorized Uses and Disclosures. If Business Associate becomes aware
that Unsecured PHI has been, or is reasonably believed to have been accessed, acquired,
used, or disclosed as a result of a Breach by Business Associate, its employees, officers,
or other agents, except as provided in 45 C.F.R. § 164.412, Business Associate shall
notify Plan Sponsor of the Breach, in writing, without unreasonable delay, and no later
than thirty (30) calendar days after discovering the Breach. Business Associate is
deemed to have discovered the Breach on the first day Business Associate knows about
the Breach, or by exercising reasonable diligence, would have been known to any person,
other than the person committing the Breach, who is an employee, officer, or other agent
of Business Associate.
3.8 Content of Notification. To the extent possible, Business Associate's notice to Plan
Sponsor shall include the identification of each Individual whose Unsecured PHI has
been, or is reasonably believed to have been, accessed, acquired, used, or disclosed
during the Breach.
At the time of notification or soon thereafter as information becomes available, Business
Associate shall provide the following information to Plan Sponsor:
(a) A brief description of what occurred, including the date of the Breach and the date
of discovery of the Breach, if known;
\BAA- Plan Sponsor [Rev. 08 -08 -2013]
28 .a�
,.
i IG
(b) A description of the types of Unsecured PHI involved in the Breach;
(c) Steps Individuals should take to protect themselves from potential harm resulting
from the Breach;
(d) A brief description of what Business Associate is doing to investigate the Breach,
to mitigate harm to Individuals, and to protect against any further Breaches; and
(e) Contact procedures for Individuals to ask questions or learn additional
information, including a toll -free telephone number, an e -mail address, website or
postal address.
3.9 Burden of Proof. Business Associate shall have the burden of demonstrating that it made
all notifications to Plan Sponsor, including evidence showing the necessity of any delay,
or that the use or disclosure did not constitute a Breach.
3.10 Mitigation of Disclosure of PHI. Business Associate agrees to mitigate, to the extent
practicable, any harmful effect that is known to Business Associate of a use or disclosure
of PHI by Business Associate in violation of the requirements of this Agreement.
3.11 Access to PHI. Within ten (10) business days of Plan Sponsor's written request, Business
Associate shall provide Plan Sponsor or an Individual who is the subject of the PHI with
access to PHI in Business Associate's possession, if Business Associate's information
consists of a Designated Record Set in order for Plan Sponsor to comply with 45 C.F.R. §
164.524.
3.12 Availability of PHI for Amendment. The Parties acknowledge that the HIPAA Standards
permit an Individual who is the subject of PHI to request certain amendments of his or
her records. Within ten (10) business days of Plan Sponsor's written request, Business
Associate shall make PHI contained in a Designated Record Set in Business Associate's
possession available for amendment and shall incorporate any amendments in accordance
with 45 C.F.R. § 164.526.
3.13 Accounting of Disclosures. Business Associate agrees to document disclosures of PHI,
and to make available, within ten (10) business days of Plan Sponsor's written request,
information to Plan Sponsor concerning Business Associate's disclosure of PHI for
which Plan Sponsor needs to provide an Individual with an accounting of disclosures as
required by 45 C.F.R. § 164.528. Should an accounting of the PHI of a particular
Individual be requested more than once in any twelve (12) month period, Business
Associate may charge Plan Sponsor a reasonable, cost -based fee.
3.14 Compliance with Subpart E of 45 C.F.R. Part 164. To the extent Business Associate
carries out Plan Sponsor's obligations under Subpart E of 45 C.F.R. Part 164, Business
Associate shall comply with the requirements of Subpart E that apply to Plan Sponsor in
the performance of such obligations.
3.15 Availability of Books and Records. For purposes of determining compliance of Plan
Sponsor with the HIPAA Standards, Business Associate agrees to make available to the
\BAA- Plan Sponsor [Rev. 08 -08 -2013] 29
11 G
Secretary its internal policies and procedures, books and records relating to the use and
disclosure of PHI received from, or created or received by Business Associate on behalf
of, Plan Sponsor.
3.16 Treatment of PHI at Termination.
With respect to PHI received from Plan Sponsor, or created, maintained, or received by
Business Associate on behalf of Plan Sponsor, upon termination of this Agreement for
any reason, Business Associate, shall:
(a) Retain only that PHI which is necessary for Business Associate to continue its
proper management and administration or to carry out its legal responsibilities;
(b) Return to Plan Sponsor or, if agreed to by Plan Sponsor, destroy the PHI that is
not retained by the Business Associate under (a) above;
(c) Continue to use appropriate safeguards and comply with Subpart C of 45 CFR
Part 164 to prevent use or disclosure of the PHI, other than as provided for in this
Agreement, for as long as Business Associate retains the PHI;
(d) Not use or disclose the PHI retained by Business Associate other than for the
purposes for which such PHI was retained and subject to the same conditions set
out at in Section 2.2 and Section 2.3 which applied prior to termination; and
(e) Return to Plan Sponsor or, if agreed to by Plan Sponsor, destroy the PHI retained
by Business Associate when it is no longer needed by Business Associate for its
proper management and administration or to carry out its legal responsibilities.
Article 4: Duties of Plan Sponsor
4.1 Limitations in Notice of Privacy Practices. Plan Sponsor shall notify Business Associate
of any limitations in the notice of privacy practices of Plan Sponsor under 45 C.F.R. §
164.520, to the extent that such limitation may affect Business Associate's use or
disclosure of PHI.
4.2 Changes in Permission. Plan Sponsor shall notify Business Associate of any changes in,
or revocation of, the permission by an Individual to use or disclose his or her PHI, to the
extent that such changes may affect Business Associate's use or disclosure of PHI.
4.3 Restriction on Use or Disclosure of PHI. Plan Sponsor shall notify Business Associate of
any restriction on the use or disclosure of PHI that Plan Sponsor has agreed to or is
required to abide by under 45 C.F.R. § 164.522, to the extent that such restriction may
affect Business Associate's use or disclosure of PHI.
Article 5: Term and Termination
5.1 Term. The term of this Agreement shall be effective as of the Effective Date stated
above, and shall terminate on the date Business Associate discontinues the provision of
\BAA- Plan Sponsor [Rev. 08 -08 -2013] 30
NO
11 G
services to or on behalf of Plan Sponsor, or on the date Plan Sponsor terminates for cause
as authorized in Section 5.2, whichever is sooner.
5.2 Termination for Cause. Business Associate authorizes termination of this Agreement by
Plan Sponsor, if Plan Sponsor reasonably determines that Business Associate has violated
a material term of the Agreement and Business Associate has not cured the breach or
ended the violation within the time specified by Plan Sponsor or ten (10) business days,
whichever is greater. Plan Sponsor shall provide Business Associate notice of such
breach or violation, in writing, with sufficient specificity as to reasonably permit
Business Associate to cure such breach or violation. Plan Sponsor understands that, upon
termination of this Agreement, Business Associate will no longer be authorized to create,
receive, or transmit PHI on behalf of Plan Sponsor, except as otherwise provided herein.
5.3 Survival of Certain Rights and Obligations. The respective rights and obligations of
Business Associate under Section 3.16 of this Agreement shall survive the termination of
this Agreement.
Article 6: Miscellaneous
6.1 Regulatory References. A reference in this Agreement to a section in the HIPAA
Standards means the section as in effect or as amended.
6.2 Amendment. The Parties to this Agreement agree to take such action as is necessary to
amend this Agreement from time to time as is necessary to comply with the requirements
of the HIPAA Standards and any other applicable law.
6.3 Prior Business Associate Agreements or Addenda. This Agreement shall supersede any
prior Business Associate Agreement or Business Associate Agreement Addenda.
6.4 Interpretation. Any ambiguity in this Agreement shall be interpreted to permit
compliance with the HIPAA Standards.
6.5 HIPAA. Business Associate will comply with all requirements under HIPAA that apply
to business associates.
IN WITNESS WHEREOF, the Parties have, by their duly authorized representatives, executed
this Agreement to be effective as of the date first above written.
By.
CJ
�e
0
\BAA- Plan Sponsor [Rev. 08 -08 -2013] 31
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EXHIBIT 3
PERFORMANCE GUARANTEES
1BAA- Plan Sponsor [Rev. 08 -08 -20131
32
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��
\BAA- Plan Sponsor [Rev. 08 -08 -20131 33
--
The amount of time that
elapses between when a call
is received into the customer
service queue and the time
Percent of calls that will be
95% answered in an average
the phone is answered by a
answered within 30 seconds
of 30 seconds or less
Customer Service
$10,000.00
Representative (CSR).
Measurement and target
determination will be based
on an annual average.
Percentage of calls that are
not answered by a CSR
(caller hangs up before call is
answered). Calculated as the
number of calls that are not
Percent of calls abandoned <5%
answered divided by the $10,000.00
number of calls received.
Measurement and target
determination will be based
on an annual average.
„. rrf.
Percentage of all calls made
to Envision that were
resolved by initial CSR.
Percent of calls with
Calculated as the total calls
resolution at end of first call
to Envision minus total
(i.e. no further in ui b
q y >90%
number of unresolved calls
caller required to obtain in
divided by the total number $10,000.00
requested information or
of calls received.
action)
Measurement and target
determination will be based
on an annual average.
Percent of written inquiries
Response time for all written
responded to by paper within
inquiries will be based on the
10 business days or
99%
number of business days
responded to electronically
subtracting the date received
$10,000.00
within 2 business days
at Envision from the date the
response was sent.
Based on network pharmacy
Pharmacy Network Access >95% access within, 10 miles for
Plan Sponsor's Covered $10,000.00
Individuals.
m �Sil -y'
Account Management Initial client inquiries will be
Responsiveness Two (2) business days acknowledged and responded $10,000.00
to within two business days.
��
\BAA- Plan Sponsor [Rev. 08 -08 -20131 33
Eligibility information
submitted to Envision will
become effective within 2
Enrollment Processing Two (2) business days business days following the
date of receipt. Assumes
complete and accurate
information is sent to
Envision.
$10,000.00
Program Implementation December 2&, 2013 Date of implementation $10,000.00
Distribution of ID Cards December 20'', 2013 Date of distribution $10,000.00
Acceptable monthly claims
data extracts provided to By the 15th of the close of
Verisk and other firms that each month for prior month
the School Board may as agreed upon in the final
designate contract
For the applicable Pharmacy
Channel, If Actual GDR —
Guaranteed GDR <0, Then
Generic efficiency rates for Retail 75.50% the (GDR X (Total claims —
entire contract period Mail 72.25% Total Generic Claims)) X
(Avg Brand Plan Paid
Amount - Avg Generic Plan
Paid Amount)
Quarterly and annual reports
will be delivered, in hard
Quarterly and year end copy, to CCHCC within 30
reports delivery time frame business days of the close of
the quarter and contract year,
respectively.
More than 95% of all
prescriptions requiring no
intervention will be
processed within two (2)
Turnaround Time business days.
More than 98% of
prescriptions requiring
administrative or clinical
intervention will process
$1 0,000.00
$10,000.00
$10,000.00
$10,000.00
11G
\BAA- Plan Sponsor [Rev. 08 -08 -2013] 34
GQ'
Turnaround Time I Ten (10) business days
Turnaround Time I Ten (10) business days or
earlier
Emergency Fill I Twenty four (24) hours
within five (5) business days.
Turnaround time will be
measured by time and date
stamp and will be defined as
the time the prescription is
received in the facility to the
time it ships.
Envision shall accept,
process, and adjudicate DMR
Claims within ten (10)
business days of receipt of
the DMR form, but shall not
be liable to reimburse a
Covered Individual until Plan
Sponsor provides funds for
such purpose.
Claims for compound drug
Claims from participating
compounding pharmacies
that are delayed due to an act
or omission of Envision shall
be electronically adjudicated
at the compounding
pharmacy within ten (10)
business days, or processed
as a DMR as set forth herein.
If a Covered Individual does
not receive a Specialty Drug
that was previously shipped
by the Specialty Pharmacy
for any reason shall receive
that Specialty Drug within
twenty four (24) hours of
authorization from Plan
Sponsor.
$2,500.00 per occurrence
$2,500.00 per occurrence
$2,500.00 per occurrence
'Exclusions from GDR calculation include products such as OTC's, Vaccines, Compounds, Specialty drugs, DAW's (0,3,4,5,6,9)
and branded generics for purposes of marketing.
\BAA- Plan Sponsor [Rev. 08 -08 -2013]
35