2019-842 Health - Walgreens drug dispense

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aeg"40," Exhibit A Fee Schedule 1 . Self- Pay Patients . For those Eligible Patients whose prescriptions are not reimbursable by a Private Insurer, Walgreens shall be reimbursed the following amounts . 1 . 1 $ 0 . 50 administrative fee for the Inventory Maintenance Services ( "Self- Pay Administrative Fee " ) ; and 1 . 2 $ 15 . 00 dispensing fee for the 340B Pharmacy Services ( " Self- Pay Dispensing Fee" ) . At the time of dispensing , Walgreens shall collect from the Eligible Patient the patient responsibility amount in accordance with Covered Entity ' s 340E Drug Program benefit design or as may be communicated to Walgreens via the Authorization , and which such amount may include the price for the 340B Drug as set forth in the Price File ( " Self- Pay Co - Pay " ) . The Self- Pay Administrative Fee and the Self- Pay Dispensing Fee shall collectively be referred to as the "Self- Pay Fees . " If the Self- Pay Fees exceed the Self- Pay Co - Pay, Walgreens shall invoice Covered Entity in accordance with Article 5 for any remaining amounts due Walgreens . If the Self- Pay Fees are less than the Self- Pay Co - Pay , upon determination by Walgreens that Covered Entity is otherwise current in its payment obligations to Walgreens , Walgreens shall , in accordance with Article 5 , remit to Covered Entity the difference between the Self- Pay Co - Pay and the Self- Pay Fees . Notwithstanding the foregoing , if at the time of dispensing Walgreens determines the Usual and Customary Charge is equal to or less than the total of the Self- Pay Administrative Fee , Self- Pay Dispensing Fee , and the price for the 340B Drug as set forth in the Price File , such drug shall be considered a Non - Eligible 340B Drug and Walgreens shall charge the Eligible Patient the Usual and Customary Charge . 2 . Private Insurer Patients . For those Eligible Patients whose prescriptions are reimbursable by a Private Insurer, Walgreens will process and bill the Eligible Patient ' s Private Insurer for the Contracted Rate provided to the Pharmacy Location at the time of dispensing . Subject to the provisions that follow , Walgreens shall be entitled to retain 15 % of the Contracted Rate for the Inventory Maintenance Services and such billing services ( " Private Insurer Administrative Fee " ) and a $ 15 . 00 dispensing fee for the 340B Pharmacy Services ( " Private Insurer Dispensing Fee" ) . Upon determination by Walgreens that it has received the Contracted Rate for the Eligible Patient ' s prescription and provided that : ( i ) Covered Entity is current in its payment obligations to Walgreens ; and ( ii ) the Contracted Rate exceeds the sum of Private Insurer Dispensing Fee , the Private Insurer Administrative Fee , and the 340B Drug price as set forth on the Price File ; Walgreens will retain an amount equal to the sum of the Private Insurer Dispensing Fee and the Private Insurer Administrative Fee ( such sum the " Private Insurer Fee " ) and , in accordance with Article 5 , remit to Covered Entity the difference between the Private Insurer Fee and the Contracted Rate . If the difference between the Contracted Rate and the Private Insurer Fee is less than or equal to the 340B Drug price as set forth on the Price File , Walgreens agrees to accept and retain the Contracted Rate as payment in full and there will be no further adjustment between the parties . 3 . Inventory Replenishment Rate . The Inventory Replenishment Rate shall be the following . 3 . 1 Brand Name Drugs : the Average Wholesale Price of the dispensed pharmaceutical product minus 16 . 65 % . 3 . 2 Generic Drugs : the Average Wholesale Price of the dispensed pharmaceutical product minus not less than 70 % . 17 of 24 MAT- 63397 OrangeCountyHD - WAG 340E 10312019 ( be ) V1 . 0 © 2019 Walgreen Co . All rights reserved .