2014-318 HR - UnitedHealthCare for United HealthCare Application for Excess Loss Insurance Policy $1,625,322

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Pharmaev Financials Definition Contracted hannac rates that will be delivered to Customer. Measurement and Criteria a ComWned Discounts - Retail Brand,Average Wholesale Price(AWP)less 16.4% Retail Generic,AWP less 79.5% Mail Order Brand,AWP less 22.1% Mail Order Generic,AWP less 68.0% The Guaranteed Discount amount will be determined by multiplying the AWP by the guaranteed discount off AWP by each com anent and adding the amounts together. Dispensing Fee Guarantee Retail Brand $1.38 Retail Generic $1.38 Dispensing fee totals are calculated by multiplying the actual scripts for each type by the contracted rate for that scri t ,Minimum Rebate!Gus rantee" Rebate Sharing Percentage 80.0% Basis,per script Brand Retail $20.91 Mail Order $41.88 Level Customer Specific Period Annually Pa "ent Period Annually Payment Amount ! The amount the actual discounts are less than the combined guaranteed discount amount. Discounts Payment A-mount The amount the combined actual dispensing fee exceeds the combined guarantee dispensing fee. -TDis -' Fees Payment A,mount The amount the combined actual Rebate amounts are less than the combined guaranteed Rebate amount -Rebates Conditions. Discount Specific Conditions •Discounts are based on actual Network Pharmacy brand and generic usage of retail and mail order drugs. The contracted discount amount will be determined by multiplying the AWP by the contracted discount rate off AWP by component •Does not apply to items covered under the Plan for which no AWP measure exists. •Discounts calculated based on AWP less the ingredient cost;discount percentages are the discounts divided by the AWP. Discounts for retail generic prescriptions represent the average savings off AWP based on Maximum Allowable Cost(MAC)pricing for MAC generics and percentage discount savings off AWP for non-MAC generics. All other discounts represent the percentage discount savings off of AWP. •The arrangement excludes all specialty drugs, generic medications launched as an"at-risk"product, generic medications with pending litigation,compound drugs,retail out of network claims,mail order drugs (for dispensing fee arrangement)and non-drug items. •The retail and mail order generic discounts exclude any generic drug that has two or fewer generic manufacturers; the retail and mail order brand discounts include any generic drug that has two or fewer generic manufacturers. Rebate Specific Conditions United reserves the right to modify or eliminate this arrangement as follows based upon changes in Rebates: •if changes made to United's PDL,for the purpose of achieving a lower net drug cost for Customer and United's other ASO customers,result in significant reductions to the Rebate level •in the event that there are material deviations to the anticipated timing of drugs that will come off patent and no longer generate Rebates General Conditions •On mail order drugs and retail pharmacy drugs and services including dispensing fees,United will retain the difference between what we reimburse the Network Pharmacy and Customer's payment for a prescription drug product or service. •A minimum of 896 Employees and 1,481 Participants enrolled in the pharmacy plan is required, •United reserves the right to revise or revoke this arrangement if: a)changes in federal,state or other IR RIB(©5/3.U13) !; applicable law or regulation require modifications;b there are material changes to the AWP as published 27