Orange County NC Website
Browse       Search
DocuSign Envelope ID:E8C538EF-9595-4E36-A4C9-2CA66C7BE34A <br /> time as a result of factors including, but not limited to, medical appropriateness, manufacturer <br /> arrangements and patent expirations. Additions and deletions to the Formulary are hereby <br /> adopted by Plan Sponsor. <br /> 1.14 "Generic Drug"means a Prescription Drug that is not a Brand Drug. <br /> 1.15 "HIPAA" means the Health Insurance Portability and Accountability Act of 1996, as <br /> amended. <br /> 1.16 "Limited. Distribution Drugs" means Prescription Drugs that are distributed by <br /> manufacturers through a limited number of pharmacies and wholesalers which have been <br /> selected by the manufacturer based on approved participation criteria. For purposes of this <br /> Agreement, Limited Distribution Drugs are not considered Specialty Drugs. <br /> 1.17 "Mail Order Pharmacy" means Orchard Pharmaceutical Services, LLC d/b/a <br /> EnvisionPharmacies. <br /> 1.18 "Manufacturer Derived Revenue" means retrospective Formulary rebates, discounts, <br /> administrative fees, and other revenue payable by pharmaceutical manufacturers that are <br /> received by Envision pursuant to the terms of a formulary rebate contract negotiated <br /> independently by Envision with a pharmaceutical manufacturer, and which is directly <br /> attributable to Claims that comply with the utilization and benefit design requirements of such <br /> pharmaceutical manufacturer rebate contracts and that otherwise meet the terms and conditions <br /> hereunder. <br /> 1.19 "MAC List"means a proprietary list of Prescription Drugs for which Envision establishes <br /> a maximum price ("MAC Price") payable to the dispensing pharmacy. Envision utilizes the <br /> same MAC List to both determine the negotiated price payable to the dispensing pharmacy and <br /> the price charged to Plan Sponsor. Plan Sponsor will be charged the exact amount paid by <br /> Envision to the dispensing pharmacy for the Claim without any markup or spread. Envision <br /> updates the MAC List from time-to-time as Prescription Drugs come on the market or come off <br /> the market, or as their availability changes due to market circumstances. <br /> 1.20 "Participating Pharmacy" means a pharmacy (including the designated Mail Order or <br /> Specialty Pharmacy) that has entered into a negotiated pricing agreement with Envision to <br /> dispense Covered Drugs to Covered Individuals and participates in the Network selected by Plan <br /> Sponsor. <br /> 1.21 "Plan Sponsor" means the entity (identified above as Plan Sponsor) which (i) has <br /> established and underwrites the Benefit Plan on behalf of its Covered Individuals; (ii) has <br /> determined the rules by which the Benefit Plan is to be administered; and (iii) is financially <br /> responsible for the payment of Administrative Fees, Fees for Additional Services and <br /> Miscellaneous Expenses (as set forth in Exhibit 1), and Covered Drugs dispensed to Covered <br /> Individuals hereunder. <br /> Wass-through PBMSA(041917) ©Envision Pharmaceutical Services,LLC Page 3 of 41 <br />