CTR051357_A4_Employee_Benefits_Pharmacy_Management_Extension_and_New_Pricing.doc

Contract Amendment Arizona Department of

Administration

State Procurement Office

100 N. 15th Avenue, Suite 305 Phoenix, AZ 85007

Contract ID: CTR051357

Supplier: MedImpact Healthcare Systems Inc

Contract Amendment # 4

Employee Benefits Pharmacy Management This Amendment Number 4 to extend the Contract period of January 1, 2022 through December 31, 2025 and to document new 2023, 2024 and 2025 pricing is hereby executed in accordance with Special Terms and Conditions, Section 3.0 Contract Administration and Operations, Paragraph 3.2 Contract Extensions.

RECITALS

The State and Supplier entered into that certain agreement titled Master Service Agreement effective as of August 28, 2020 pursuant to which Supplier is to provide Employee Benefits Pharmacy Management Services.

Thereafter, Amendment Number 1 to add Data Match Requirements and Medicaid Reclamation Claims Processing was executed on December 3, 2020:

Add to Scope of Work:

· MedReconciliation™ (Subrogation Claims)

MedImpact will process Subrogation Claims and dual eligibility identification on behalf of Client for the Government Agencies, as follows:

· Government Submitted Claims. Government Agencies may submit Subrogation Claims for, on behalf of, or in the name of Eligible Members. MedImpact will process and pay these Subrogation Claims on behalf of Client as set forth in this Agreement. Any amounts payable to a Government Agency will be deemed Covered Benefits under the Benefit Plan. If the Government Agency submits the Subrogation Claims on-line using the on-line claims adjudication system, the provisions contained herein shall still apply except the Subrogation Claims Processing fee may be replaced with the standard Claims Processing Fee.

· Government Agency Request(s) for Eligible Member List. Government Agencies may submit requests for Eligible Member Lists to MedImpact and, if requested by Client, Client agrees that MedImpact may submit Eligible Member Lists to the Government Agencies in response to such requests or allow Government Agencies to have electronic access to such lists, under a data use agreement. Eligible Member Lists may include up to three (3) years of eligibility data or such longer time required by Law.

· Processing Subrogation Claims. Notwithstanding any other provision of this Agreement, Client acknowledges and agrees that when processing Subrogation Claims, Client and Benefit Plan requirements may not apply (e.g., statutory time frames for submission of Claims may exceed Client specified time frames; days’ supply limitations may not apply; prior authorization requirements may not apply). Client agrees that any Subrogation Claims that are received after the termination or expiration of this Agreement, but filled prior to the termination or expiration, shall be processed as agreed to under this Agreement for the duration of the Claims run-out period agreed to in this Agreement (as applicable) and thereafter shall be returned to the submitter with notice to submit to Client for processing. MedImpact will not process Subrogation Claims that predate this Agreement. In all other respects, Subrogation Claims shall be payable by Client as all other Claims are under this Agreement.

Pricing:

· Subrogation Claims Processing: $4.00 per Claim

Thereafter, Amendment Number 2 to add COVID Vaccinations was executed on January 25, 2021.

Thereafter, Amendment Number 3 to remove the temporary reduction in the COVID-19 vaccines administrative fee effective 1/1/22 was executed on 12/1/21.

ALL OTHER REQUIREMENTS, SPECIFICATIONS, TERMS AND CONDITIONS REMAIN UNCHANGED

ACKNOWLEDGEMENT AND AUTHORIZATION