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Prescription Drug List (PDL) Customer has adopted one or more of United's PDLs for use with Customer's <br /> benefit plans. Customer agrees not to copy, distribute, sell, or otherwise provide the PDL to another party without <br /> United's prior written approval, except to Participants as described below. On termination of this Agreement or if <br /> Customer terminates the Pharmacy Benefit Services portion of this Agreement„ Customer will stop all use of the <br /> PDL. <br /> While Customer is the ultimate decision-maker on selecting the design of Customer's PDL(s), Customer has <br /> requested that United supply, and United has assisted Customer with, certain PDL development and management <br /> functions including but not limited to drug tiering decisions. United's intent is to provide Customer with the same <br /> PDL and management strategies that United develops and employ in the management of United's fully insured <br /> business. United makes the final classification of an FDA-approved prescription drug product to a certain tier of the <br /> PDL by considering a number of factors including,but not limited to, clinical and economic factors. Clinical factors <br /> may include, but are not limited to, evaluations of the place in therapy, relative safety or relative efficacy of the <br /> prescription drug product, as well as whether supply limits or notification requirements should apply. Economic <br /> factors may include,but are not limited to,the prescription drug product's acquisition cost including,but not limited <br /> to,available Rebates and assessments on the cost effectiveness of the prescription drug product. <br /> United may periodically down-tier the placement of a prescription drug product among the tiers. These changes <br /> may occur without prior notice. Once a year, United may also up-tier the placement of a prescription drug product <br /> among the tiers and/or recommend specific prescription drug product exclusions from coverage. United will <br /> provide notice to Customer of material changes to the PDL, United's drug tier classification procedures, coverage <br /> exclusions, and clinical programs. If Customer chooses not to implement a particular coverage exclusion or clinical <br /> program change, Customer needs to inform United in writing sixty (60) days prior to the effective date of the <br /> exclusion or change. Current drug placement and related information may be obtained from the member website,or <br /> by calling customer service. <br /> Claims Processing. United will process the claims received from a Network Pharmacy in accordance with the <br /> Summary Plan Description, as well as the pricing and other terms of the Network Pharmacy's participation <br /> agreement. On mail order and retail pharmacy services, United will retain the difference between what United <br /> reimburses the Network Pharmacy and Customer's payment for a prescription drug product or service. United <br /> maintains systems for processing pharmacy claims and may receive access fees as compensation for services United <br /> provides to Network Pharmacies. <br /> Section 4.7 Pharmacy Benefit Rebates. <br /> Allocation and Payment of Rebates.United will negotiate with drug manufacturers for the payment of Rebates to <br /> United. The amount of Rebates that is available depends on many factors including whether Customer has an <br /> incentive benefit design, arrangements with drug manufacturers, the volume of prescription drug claims and the <br /> structure of the PDL. United will pay Customer an amount equal to 80%of the Rebates United receives(and United <br /> may pay interest on this amount as described in this Section). United will retain the balance of such Rebates (and <br /> any related interest) as part of United's compensation. Customer agrees that all payments associated with Rebates <br /> and any related interest are not due and owing to Customer until United actually pays them to Customer pursuant to <br /> this Agreement. <br /> Customer will only receive Rebates to the extent that Rebates are actually received by United. For example, if a <br /> government action or a major change in pharmaceutical industry practices eliminates or materially reduces <br /> manufacturer Rebate programs, Customer's payment amount may be reduced or eliminated. In such event, United <br /> shall promptly notify Customer and revise or eliminate such payment effective with the date of the reduction or <br /> elimination in Rebate payments. In addition, reduction or elimination of Rebates in this event shall constitute a <br /> change in the Agreement as described in the Service Fees Section such that United has the right to increase the <br /> service fees for the Pharmacy Benefits Management services or increase the percentage of Rebate dollars retained <br /> by United. <br /> United will pay Customer the agreed upon Rebates within thirty (30) calendar days of United's receipt of such <br /> Rebates, generally four times per year. For any Rebates not paid to Customer within thirty (30) calendar days of <br /> United's receipt, United will pay Customer interest on such Rebates from the date of receipt until United makes <br /> payment to Customer, less approximately thirty (30) days for processing. United will retain interest earned during <br /> this processing timeframe. United will pay Rebates to Customer in the agreed upon amount no less than annually. <br /> 6 <br />