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DocuSign Envelope ID:E8C538EF-9595-4E36-A4C9-2CA66C7BE34A <br /> Covered Individuals who Plan Sponsor has identified on the appropriate form as Medicare <br /> eligible retirees. Plan Sponsor acknowledges that any estimated Manufacturer Derived Revenue <br /> which has been passed-through to Plan Sponsor will have been deducted from the Claim <br /> amounts reported. Unless otherwise specified herein or included under an addendum to this <br /> Agreement, Envision shall not be responsible or liable to Plan Sponsor for any RDS services or <br /> subsidies. Any assistance requested by Plan Sponsor and/or provided by Envision shall be solely <br /> consultative and shall not be deemed to be an acceptance by Envision of any responsibility or <br /> liability for the completion or submission of any RDS application or request for subsidies under <br /> Medicare Part D. <br /> 2.9 Additional Services: Any services to be rendered under this Agreement which are not <br /> included in the Administrative Fee as specified in this Section 2 shall be itemized in the Exhibits <br /> and Addendums hereto along with any associated costs or charges. <br /> 2.10 Performance Guarantees: Envision shall provide PBM Services in accordance with the <br /> Performance Guarantees specified in Exhibit 3. <br /> 3. PRICING AND PASS-THROUGH METHODOLOGY <br /> 3.1 Pass-Through of Discounts and Dispensing Fees: The amount invoiced to Plan Sponsor <br /> shall be the exact drug ingredient cost and applicable dispensing fee which is paid to the <br /> dispensing pharmacy when the Claim is adjudicated without any reclassification, mark up, or <br /> spread by Envision, in accordance with the following: <br /> 3.1.1 For Ingredient Cost: Envision shall invoice Plan Sponsor the lower of: <br /> (a) The calculated negotiated amount payable to the Participating Pharmacy <br /> based on the 11 digit NDC number of the drug dispensed; or <br /> (b) If included on the then current Envision MAC List, the MAC Price for the <br /> drug dispensed; or <br /> (c) The Participating Pharmacy's U&C Price (except for drugs dispensed by <br /> the Mail Order Pharmacy or Specialty Pharmacy); less <br /> any applicable Manufacturer Derived Revenue and/or any applicable Covered Individual Cost <br /> Share. <br /> 3.1.2 For Dispensing Fees: Envision shall invoice Plan Sponsor the actual dispensing <br /> fee amount payable to the Participating Pharmacy. <br /> 3.2 Manufacturer Derived Revenue <br /> 3.2.1 Pass-Through of Manufacturer Derived Revenue: Envision shall pass through to <br /> Plan Sponsor one hundred percent (100%) of all Manufacturer Derived Revenue earned by Plan <br /> Sponsor for eligible Claims. Prescription Drugs eligible for Manufacturer Derived Revenue are <br /> included in the Formulary provided by Envision. Plan Sponsor acknowledges that the <br /> Manufacturer Derived Revenue earned by Plan Sponsor is dependent on certain factors <br /> including, without limitation, the following: (i) the effect of terms and conditions of Plan <br /> \Pass-through PBMSA(041917) ©Envision Pharmaceutical Services,LLC Page 8 of 41 <br />