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

Browse Search

DocuSign Envelope ID:E8C538EF-9595-4E36-A4C9-2CA66C7BE34A incomplete; (v)there is a substantial change in drug utilization patterns of Covered Individuals; or (vi) Plan Sponsor terminates before completion of the applicable, full Contract Year. In addition, Plan Sponsor agrees that Envision's liability to Plan Sponsor for shortfalls in financial guarantees, in the aggregate, for any Contract Year shall be limited to amounts paid by Plan Sponsor to Envision for Administrative Fees during the applicable Contract Year, and Plan Sponsor has no right of offset to withhold any payment due Envision under this Agreement for any amounts Plan Sponsor believes are owed by Envision for financial guarantees. Annual Average Manufacturer Derived Revenue Guarantee(E),(F),(G),(H) For Contract Year 1: • $39.70 Per Eligible Employee,per month(PEPM) For Contract Year 2: • $43.14 PEPM For Contract Year 3: • $47.31 PEPM (E)Manufacturer Derived Revenue guarantees are stated as annual average amounts per Contract Year. (F) Guarantees require Plan Sponsor to maintain a Benefit Plan that has a tier structure with a minimum $20 differential in Cost Share between preferred Brand Drugs and non-preferred Brand Drugs. (G)Guarantees are based an annual average Eligible Employee count of 1,041. If the annual average Eligible Employee count exceeds 1,041 guarantees are subject to change. Guarantees require Plan Sponsor to utilize current Envision Standard Formulary with the understanding that members active as of the Effective Date of this Agreement shall continue to receive Specialty Medication Therapy utilizing the Specialty Drug initially prescribed. Plan Sponsor acknowledges that the annual average Manufacturer Derived Revenue guaranteed amounts specified in this Exhibit 1 are conditioned upon Plan Sponsor's adherence to certain conditions under this Agreement. (a) If the Manufacturer Derived Revenue advanced to Plan Sponsor for the Contract Year is, overall, lower than the overall Manufacturer Derived Revenue earned by Plan Sponsor for the Contract Year, Envision shall pay the difference to Plan Sponsor, after application of any additional offset allowed under this Agreement. (b) If the Manufacturer Derived Revenue earned by Plan Sponsor for the Contract Year is, overall, lower than the annual average Manufacturer Derived Revenue guaranteed amounts specified above, in the aggregate, Envision shall pay the difference to Plan Sponsor, after application of any additional offset allowed under this Agreement. Notwithstanding anything herein to the contrary, Envision shall not be liable to Plan Sponsor for any shortfall in guaranteed Manufacturer Derived Revenue if: (i) Plan Sponsor makes a change to the Benefit Plan at any time (regardless of whether or not such change is required by law); (ii) the configuration of System edits is modified by Plan Sponsor; (iii) Plan Sponsor does not adhere to the Formulary; (iv) the utilization data provided by Plan Sponsor (or Plan Sponsor's agent) upon which the calculation of guarantees were based is inaccurate, incomplete; (v)there is a substantial change in drug utilization patterns of Covered Individuals; (vi) there is a loss of rebates due to pharmaceutical manufacturer drug patent expirations, manufacturer bankruptcy, or removal of a drug from the market; (vii) there are changes in pharmaceutical manufacturer rebate contracting terms or policies; (viii) Plan Sponsor's Benefit Plan does not meet the conditions for rebates of pharmaceutical manufacturer contracts including market share rebates; (ix) if Plan Sponsor has been excluded by a manufacturer; (x)there is any governmental regulation, ruling, Wass-through PBMSA(041917) ©Envision Pharmaceutical Services,LLC Page 25 of 41