2017-528-E HR - Envision Pharmaceutical Services, LLC for pharmacy benefits

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DocuSign Envelope ID:E8C538EF-9595-4E36-A4C9-2CA66C7BE34A drug and adjusted by applicable modifiers, including those established by the FDA (e.g. NDA, ANDA, BLA, authorized generic, and/or bio-similar), and other criteria generally used in the industry to determine brand-generic drug status. 1.5 "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. 1.6 "Claims Adjudication System" or "System" means Envision's on-line computerized claims processing system. 1.7 "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. 1.8 "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 teens 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. 1.9 "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. 1.10 "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. 1.11 "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. 1.12 "Eligible Employee" means an active employee or a Retiree of Plan Sponsor covered under Plan Sponsor's funded Benefit Plan. For purposes of this Agreement, a Retiree is a retired individual who is covered,primarily,by Plan Sponsor and not Medicare Part D. 1.13 "Formulary" means an index of Prescription Drugs and supplies developed by Envision's pharmacy and therapeutics committee, which is hereby adopted by Plan Sponsor, and shall be used in conjunction with the Benefit Plan as a guide in the selection of Covered Drugs. The Prescription Drugs and supplies on the Formulary will be modified by Envision from time to \Pass-through PBMSA(041917) ©Envision Pharmaceutical Services,LLC Page 2 of 41