Exhibit_4_Performance_Guarantees.xlsx

This is a Performance Guarantees exhibit for a Pharmacy Benefit Manager (PBM) Request for Proposal (RFP) issued by the Oklahoma Health Care Authority Employees Group Insurance Division (EGID) through the Office of Management and Enterprise Services (OMES) Central Purchasing division. The exhibit outlines comprehensive service performance guarantees that the selected PBM vendor must agree to meet, covering implementation services, ongoing account management, claims processing, customer service, pharmacy network operations, specialty pharmacy services, and Medicare Part D requirements. Vendors must indicate their concurrence with performance guarantee terms and agree to provide quarterly reports validating compliance, permit EGID to allocate up to 30% of annual aggregate dollars at risk to individual guarantees, and accept automatic penalty payments within specified timeframes without written requests. The guarantees are measured and reconciled quarterly within thirty calendar days from the close of measurement periods and audited on a scheduled basis by EGID using EGID-specific data rather than vendor book of business data.

The exhibit specifies detailed performance metrics across multiple service categories with established financial penalties for non-compliance. Implementation guarantees include benefits setup completion within six weeks, ID card production and distribution within five business days, and pre-implementation audits at least fifteen days prior to the effective date with a penalty of $30,000 per audit. Ongoing service guarantees establish specific performance thresholds including 99.9% claims processing accuracy for retail and 99.99% for mail order and specialty, 99.98% system availability, telephone service standards of 30 seconds average answer time with no more than 2% call abandonment, 98% first-call resolution rates, and 95% member satisfaction. Specialty pharmacy guarantees address Proportion of Days' Covered metrics of 80% or greater for auto-immune, multiple sclerosis, cancer, and hepatitis C drugs, 92% specialty member satisfaction, 99.996% dispensing accuracy, hemophilia assay matching within 2% variance, and zero avoidable emergency room visits. Medicare Part D requirements include 99% RDS submission accuracy, timely Explanation of Benefits filing, and 99% Prescription Drug Event error correction, with measurement frequency determined by the specific guarantee type.