Lancets Agreement.doc

ATTACHMENT 1

MODEL STATE REBATE AGREEMENT

for

LANCETS

between

THE MASSACHUSETTS EXECUTIVE OFFICE OF

HEALTH AND HUMAN SERVICES

and

[APPLICANT NAME]

[LANCETS MANUFACTURER]

This State Rebate Agreement (“Agreement”) is by and between the Massachusetts Executive Office of Health and Human Services (EOHHS), the agency which administers the Health Safety Net Office under M.G.L. c. 118E Section 65, and the single state agency for the administration of MassHealth, the medical assistance and benefit program pursuant to Title XIX of the Social Security Act (42 U.S.C. 1396), Title XXI of the Social Security Act (42 U.S.C. 1397aa et. seq.), M.G.L. c. 118E, and other applicable laws and waivers, and the above-referenced Lancets Manufacturer, hereinafter “the Manufacturer.”

RECITALS

WHEREAS, EOHHS seeks rebates and reasonable pricing for Lancets dispensed to MassHealth Members and Health Safety Net patients (HSN Patients) and for which payment is claimed through the Pharmacy Online Processing System (POPS), or for which payment is claimed through a Pharmacy of a Participating MassHealth Managed Care Entity (MCE); and WHEREAS, EOHHS and Manufacturer desire that the Lancets reasonable pricing Rebate arrangement encompass Covered Products dispensed to MassHealth Members and HSN Patients and purchased in a fee-for-service (FFS) structure and billed to EOHHS through POPS and those dispensed to MassHealth Members in an MCE structure and billed through Participating MassHealth MCE Pharmacies; and WHEREAS, the Manufacturer is willing to provide Rebates to EOHHS based on the actual dispensing of Lancets and reasonable pricing for Lancets dispensed to MassHealth Members, HSN Patients and members enrolled with MassHealth Participating MCEs.

NOW THEREFORE, in consideration of the foregoing and of the representations, warranties and covenants set forth below, the parties agree as follows:

SECTION 1 DEFINITIONS

As used herein, the following terms shall have the meanings set forth below:

Agreement – this State Rebate Agreement, including all documents attached or incorporated herein by reference.

Competing Lancets – Lancets not manufactured by the Manufacturer.

Covered Products – each of the Manufacturer’s Lancets listed in the “Covered Product” column of the chart in paragraph 1 of Attachment A and identified by an associated 11-digit NDC Code on such chart, as Attachment A may be updated from time to time during the term of the Agreement pursuant to an amendment signed by EOHHS and Manufacturer.

CMS – the Centers for Medicare & Medicaid Services of the U.S. Department of Health and Human Services, or any successor or renamed agency carrying out the functions and duties heretofore carried out by such office.

Fee-for-Service (FFS) – a delivery system, including the MassHealth Primary Care Clinician Plan and a MassHealth Primary Care Accountable Care Organization and, for purposes of this agreement, the Health Safety Net program, under which EOHHS is responsible for coverage of covered outpatient drugs and pharmacy-dispensed non-drug products, including, but not limited to, diabetes-related medical supplies for MassHealth Members and HSN Patients who are enrolled in that delivery system.

Guaranteed Net Unit Price – with respect to each Covered Product, the applicable final fixed price per Unit (i.e., per Lancet) for such Covered Products, as set forth in Attachment A, calculated as (i) the wholesale acquisition cost (WAC), minus (ii) the Rebate.

Health Safety Net – the payment program established and administered in accordance with M.G.L. c. 118E, §§ 8A, and 64 through 69 and regulations promulgated thereunder, and other applicable legislation.

Health Safety Net Office – The office within the Office of Medicaid established under M.G.L. c. 118E, § 65.

Health Safety Net Patients (HSN Patients) – Health Safety Net Patients with Health Safety Net Primary for uninsured Low Income Patients as described in 101 CMR 613.04(6)(a)1 and excluding Health Safety Net Secondary Patients as described in 101 CMR 613.04(6)(a)2.

Lancets – small, sharp instruments used to make punctures in the skin, typically to obtain small blood samples for testing. They are commonly used in procedures like blood glucose monitoring in diabetic patients. Lancets may be single-use and manually operated or integrated into lancing devices that control the depth and speed of the puncture for minimal discomfort.

MassHealth – the medical assistance and benefit programs administered by EOHHS pursuant to Title XIX of the Social Security Act (42 U.S.C. 1396 et. seq.), Title XXI of the Social Security Act (42 U.S.C. 1397aa et. seq.), M.G.L. c. 118E, and other applicable laws and waivers.

MassHealth Managed Care Entity (MassHealth MCE) – a delivery system, including a MassHealth Managed Care Organization (MCO) and MassHealth Accountable Care Partnership Plan (ACPP) as described in the MassHealth Medicaid Section 1115 Demonstration, under which the MassHealth MCE is responsible for coverage of covered outpatient drugs and diabetes-related medical supplies for eligible MassHealth Members who are enrolled in that delivery system.

MassHealth Member – any person enrolled in MassHealth and eligible to receive MassHealth Non-Drug Price List products. This refers to MassHealth Members for whom claims for Non-Drug Products are submitted to MassHealth through POPS and for whom claims for Non-Drug Products are submitted to Participating MassHealth MCEs by in-network pharmacies.

MassHealth Non-Drug Product List (MH-NDPL) – a section of the MassHealth Drug List comprised of those products not classified as drugs (e.g., blood testing supplies) that are payable by the MassHealth agency or HSN through POPS. The MassHealth Non-Drug Product List also specifies which of the included products require prior authorization.

MassHealth ACPP/MCO Uniform Preferred Pharmacy Product List (MH-MCE PPPL) – a MassHealth MCE’s published list or formulary of covered drugs and non-drug products applicable to MassHealth Members enrolled in that MCE (or an equivalent list).

Participating MassHealth MCE – a MassHealth MCE that has aligned its preferred non-drug product list (or an equivalent list) with the MH-MCE PPPL.

Pharmacy – a facility licensed by the Commonwealth of Massachusetts to dispense legend drugs, and enrolled as a MassHealth or HSN provider; or that qualifies as a Participating MassHealth MCE’s in-network pharmacy for purposes of dispensing drugs and diabetes-related medical supplies.

Pharmacy Online Processing System (POPS) – the MassHealth online, real-time computer network that adjudicates pharmacy claims, incorporating prospective drug utilization review, prior authorization, and member eligibility verification.

Preferred Status – status applicable to a Covered Product or Competing Lancets as set forth in Attachment A, if EOHHS has listed the product as not subject to Prior Authorization in the Non-Drug Pharmacy Product List section of the MassHealth Drug List, and if Participating MassHealth MCE preferred non-drug product lists have been aligned to the MH-MCE PPPL with respect to Manufacturer’s Covered Products and Competing Lancets.

Prior Authorization – approval from EOHHS or a Participating MassHealth MCE or their agent(s) that is required in certain instances before a provider may furnish medical services, equipment or supplies to MassHealth Members, HSN Patients or MassHealth Members enrolled in a Participating MassHealth MCE, as set forth in MassHealth regulations at 130 CMR 450.303, HSN regulations or other guidance, or as required by Participating MassHealth MCEs, and as may be further described in Attachment A. Prior Authorization determines only the medical necessity of an authorized service.

Rebate – for each Covered Product, an amount paid on a calendar quarter basis by the Manufacturer to EOHHS pursuant to this Agreement, for the Covered Product’s utilization under MassHealth or HSN on an FFS basis, where MassHealth or HSN is primary payer and payment is claimed through POPS, and for the Covered Product’s utilization through Participating MassHealth MCEs to in-network Pharmacies. The Rebate shall be an amount that results in the applicable Guaranteed Net Unit Price for such Covered Product as set forth in Attachment A.

Unit – a single Lancet with the 11-digit National Drug Code (NDC) described in Attachment A of this Agreement.

Wholesale Acquisition Cost (WAC) – that price which constitutes the State-defined Wholesale Acquisition Cost (WAC), as defined at 101 CMR 331.02 or any successor regulation, for the covered product as determined on the last day of the calendar quarter that corresponds to the calendar quarter for which the State utilization is reported to the manufacturer. EOHHS currently uses First Data Bank for this purpose.

SECTION 2 EOHHS OBLIGATIONS

2.1 MassHealth Non-Drug Product List / MCE Preferred Non-Drug Pharmacy Product List To be eligible for the Rebate for claims for Manufacturer’s Covered Products (as identified in Attachment A) paid by EOHHS on an FFS basis through POPS for MassHealth Members or HSN Patients, EOHHS shall list the Manufacturer’s Lancets that are Covered Products (as identified in Attachment A) on the MassHealth Non-Drug Product List (MH-NDPL), and may or may not require Prior Authorization for said Covered Products. To be eligible for the Rebate for claims for Manufacturer’s Lancets that are Covered Products (as identified in Attachment A) paid by a Participating MassHealth MCE to the MCE’s Pharmacies, the Participating MassHealth MCE must list the Covered Products on its MCE Preferred Non-Drug Pharmacy Product List (MCE-PPPL) or equivalent.

Nothing in this Agreement shall prohibit EOHHS or Participating MassHealth MCEs from requiring Prior Authorization for the Manufacturer’s Lancets or prohibit EOHHS from modifying or eliminating the preferred status, if applicable, of any Covered Product during the term of this Agreement.

The parties agree that the corresponding GNUP pertaining to such Covered Product(s) as set forth in Attachment A shall apply, and the resulting Rebate shall be payable by Manufacturer in such circumstance.

2.2 Rebate Invoice Submissions

EOHHS shall submit to the Manufacturer separate invoices for Rebates for claims processed through POPS for MassHealth Members and HSN Patients who receive services on an FFS basis, and claims by Pharmacies for members enrolled with a Participating MassHealth MCE, within 60 days after the end of each calendar quarter, or portion thereof, during which EOHHS or a Participating MassHealth MCE paid for the Manufacturer’s Lancets that are Covered Products as identified in Attachment A. Any amended invoice shall be submitted by EOHHS within 15 months after the end of the calendar quarter in which EOHHS or Participating MassHealth MCEs paid for said Lancets.

2.3 Patient Information

EOHHS, its agents, employees and contractors shall not provide the Manufacturer with any patient-identifiable information or protected health information (“PHI”) or any other information prohibited or regulated by laws or regulations governing confidentiality of medical or other personally identifiable information.

2.4 Discretion to Secure Additional Savings

Nothing in this Agreement shall prohibit EOHHS from entering into a rebate agreement with any other Lancet manufacturer.

SECTION 3 MANUFACTURER obligations

3.1 Rebate Payment

A. The Manufacturer agrees to provide a Rebate on a quarterly basis for each Unit of each Covered Product submitted to MassHealth or HSN for payment through POPS and paid by EOHHS during the term of this Agreement, where MassHealth or HSN is primary payer. The Manufacturer further agrees to provide such Rebate for each Unit of each Covered Product submitted to a MassHealth Participating MCE by the MCE’s Pharmacies and paid by the MassHealth Participating MCE for dates of service during the term of this Agreement. Such Rebate shall result in the applicable per Unit GNUP corresponding to the Covered Product as set forth in Attachment A.

B. The Manufacturer agrees to ensure that MassHealth and HSN providers or MassHealth Participating MCE providers will be able to purchase the Manufacturer’s Lancets that are Covered Products hereunder for a price below the WAC.

C. The Manufacturer agrees to ensure a smooth transition of MassHealth Members, MassHealth Participating MCE members and HSN Patients to new Lancets as necessary. The Manufacturer must, at a minimum, provide a dedicated toll-free telephone number and website for its customer service and its individualized Lancet training.

3.2 Payment Timeframe

The Manufacturer shall pay to EOHHS the Rebate to which EOHHS is entitled in accordance with this Agreement, within 38 days after receipt of an invoice from EOHHS, under Section 2.2 of this Agreement.

3.3 Incomplete Submission

The Manufacturer shall have no obligation to pay Rebates for claims that are not submitted as part of an invoice in accordance with this Agreement. The Manufacturer shall notify EOHHS or its designee of any incomplete submission within 30 days of the Manufacturer’s receipt of any incomplete submission.

3.4 Over-/Underpayment

If either party discovers an error in the payment of the Rebates, it shall notify the other of such error. The parties shall attempt to reconcile all differences through discussion and negotiation within 60 days of a party’s written notice of error. Any amount determined to be an overpayment, either through agreement of the parties or otherwise, shall be deducted from subsequent Rebates payable under this Agreement. If no subsequent Rebates are payable, EOHHS will refund any overpayment to the Manufacturer within 30 days of the determination of the overpayment. In the event that any amount is determined to be an underpayment, either through agreement of the parties or otherwise, the Manufacturer will remit any underpayment to EOHHS within 30 days of the determination of such underpayment. If the Manufacturer wishes to dispute an invoiced rebate, it must provide the reason for the dispute. This reason for dispute must include one of the dispute codes on the CMS official Adjustment and/or Dispute Codes for ROSI (Form CMS-304) and/or PQAS (Form CMS-304a) to the extent applicable for Lancets.

3.5 Discretion to Market

Nothing in this Agreement shall be construed to prohibit the Manufacturer from discontinuing production, marketing or distribution of the Manufacturer’s Lancets or from transferring or licensing said products to a third party. It is understood that the Manufacturer is liable for the payment of the Rebates only for Lancets (identified as Covered Products in Attachment A) distributed directly or through the wholesale channel to MassHealth or HSN pharmacy providers or MassHealth Participating MCE provider Pharmacies and dispensed to MassHealth Members, including members enrolled with a Participating MassHealth MCE, and HSN Patients. If the Manufacturer elects to discontinue production, marketing or distribution of any of the Lancets or to transfer or license said products to a third party, the Manufacturer shall make every reasonable effort to notify EOHHS prior to such action.

3.6 Reporting of WAC

Manufacturer agrees to publish a WAC for each Covered Product by NDC with First Data Bank, or other national price compendium designated by EOHHS, throughout the term of this Agreement.

SECTION 4 Term and termination

4.1 Contract Term

This Agreement shall be in effect beginning January 1, 2027, and shall terminate on December 31, 2028, unless extended by the parties by an amendment in writing executed in accordance with Section 4.4, or unless terminated sooner under Section 4.2. The Agreement may be extended in any increments for up to three additional years at EOHHS’s option, upon terms agreed to by the parties.

4.2 Contract Termination

D. Termination for Breach

If either party commits a material breach of this Agreement, the non-breaching party shall deliver written notice by certified mail, return receipt requested, of the alleged breach to the breaching party, with an opportunity for the breaching party to cure the breach during the thirty (30) day period following delivery. Failure to cure shall give the non-breaching party the right to cancel this Agreement at the end of the thirty (30) day period. The non-breaching party shall give the breaching party final written notice of the cancellation of this Agreement.

E. Termination Without Cause EOHHS may terminate this Agreement without cause and without penalty upon thirty (30) days prior written notice to the Manufacturer.

4.3 Accrued Obligations/Remedies

The expiration or termination of this Agreement shall not affect any rights or obligations of the parties that have accrued prior to the effective date of such termination. The fact that either party exercises any right of termination it may have under this Agreement shall not prevent such party from pursuing any other remedy it may be entitled to in law or equity. Any remedy provided herein shall not be deemed an exclusive remedy unless expressly provided for as such.

4.4 Execution, Amendment and Waiver

This Agreement shall be binding only upon signature by both parties. This Agreement, or any provision, may be altered, amended, or waived by written amendment executed by both parties. The Manufacturer expressly acknowledges that the MassHealth and HSN programs are subject to state and federal oversight. The parties agree to amend this Agreement if required by any applicable state or federal agency.

The parties may agree to modify, increase or reduce the list of Covered Product(s) during the term of the Agreement by an amendment signed by both parties.

4.5 Option to Modify Scope

EOHHS reserves the right, at its sole discretion and at any time during the term of the Agreement, to modify any provision in the Agreement when EOHHS deems necessary or reasonable to reflect any change in policy or program goals, including, without limitation, to modify the scope of the Agreement and rebate amounts. EOHHS additionally reserves the right, at its sole discretion and at any time during the term of the Agreement, to amend the Agreement to implement state or federal statutory or regulatory requirements, judicial orders, settlement agreements, or any state or federal requirements, initiatives or changes affecting the MassHealth or HSN program. In the event that EOHHS seeks to implement such changes in the Agreement, except for any change required to secure any applicable state or federal approval, EOHHS will provide written notice to the Manufacturer and will initiate negotiations with the Manufacturer.

Section 5. MISCELLANEOUS

5.1 Record Keeping and Audit

The parties agree that federal and Commonwealth of Massachusetts record retention and freedom of information laws, regulations and policies govern this Agreement. As such, the Manufacturer shall retain all records relating to this Agreement for seven (7) years after the execution of this Agreement or the creation of the record, whichever is later, or for such longer period as is required by state or federal law or necessary for resolution of any litigation, claim, negotiation, audit or inquiry involving the Agreement. The Manufacturer must make such records available to EOHHS, the Commonwealth of Massachusetts or the United States government, or their authorized agents, at such times, places, and in such manner as such entities may reasonably request for purposes of audits, inspections, and examinations, provided that such activities shall be conducted during the normal business hours of the Manufacturer.

5.2 Confidentiality

The Manufacturer shall comply with all applicable state and federal laws and regulations relating to confidentiality, privacy and security.

5.3 Notices

Any notice required or permitted to be given by either party to the other shall be given in writing, in person or sent, with confirmation of receipt, by first class mail or express delivery, or by e-mail, addressed to the other party at the address set forth below.

To Manufacturer:

[LEGAL NAME]

[LEGAL ADDRESS]

Attn: [CONTRACT MANAGER] Email: [CONTRACT MANAGER EMAIL] To EOHHS:

Massachusetts Executive Office of Health and Human Services

MassHealth Pharmacy Program 100 Hancock Street, Room 7021 Quincy, MA 02171

Attn: Kimberly Lenz, Chief Pharmacy Officer Email: kimberly.lenz@mass.gov

5.4 Force Majeure

Noncompliance with any obligations hereunder due to force majeure, such as acts of God, laws or regulations of any government, war, civil commotion, destruction of production facilities and materials, fire, earthquake or storm, labor disturbances, shortage of materials, failure of public utilities or common carriers, and any other causes beyond the reasonable control of the parties, shall not constitute breach of contract.

5.5 Assignment

Neither party shall have the right to assign this Agreement to a third party without the prior written consent of the other party, which consent shall not be unreasonably withheld. Any permitted assignee shall assume all obligations of its assignor under this Agreement. No assignment shall relieve any party of responsibility for the performance of any obligations that have accrued prior to such assignment.

5.6 No Waiver of Rights

The failure of either party to insist upon the strict observation or performance of any provision of this Agreement or to exercise any right or remedy shall not impair or waive any such right or remedy in the future. Every right and remedy given by this Agreement to the parties may be exercised from time to time as often as appropriate.

5.7 Entire Agreement

This Agreement (including Attachments) constitutes the entire agreement of the parties with respect to the subject matter hereof, and supersedes all prior agreements, representations, negotiations, and undertakings not set forth or incorporated herein. The terms of this Agreement shall prevail notwithstanding any variances with the terms and conditions of any written or verbal communication subsequently occurring, except as otherwise provided herein.

This Agreement (including attachments) may not be amended or modified except by a written amendment executed by both parties in accordance with Section 4.4 of this Agreement.

5.8 Order of Precedence

The Manufacturer’s RFA response specified below is incorporated by reference into this Agreement. Any ambiguity or inconsistency between these documents shall be resolved by applying the following order of precedence:

F. This Agreement and any amendments hereto;

G. The Request for Applications for Rebates for Lancets for MassHealth Members, including members enrolled with Participating MassHealth MCEs, and HSN Patients dated February 6, 2026, and all amendments thereto; and H. The Manufacturer’s RFA response submitted on [date], and all clarifications thereto.

5.9 Governing Law

The laws of the Commonwealth of Massachusetts shall govern this Agreement. In the event of a lawsuit involving this Agreement, venue shall be proper only in Suffolk County, Massachusetts.

5.10 Effect of Future Laws

In the event of the enactment, promulgation, rescission, modification or interpretation of any law or regulation after the date hereof which would (a) materially and/or adversely affect the manner in which either party is obligated to perform under this Agreement, (b) adversely affect for either party the net prices or Rebate or other terms applicable under this Agreement, or (c) have the effect of requiring the net prices or Rebates or other terms applicable under this Agreement to be extended or offered to any third party, each party shall have the right to enter into good faith negotiations with the other in order to seek to agree on reasonable terms for maintaining the intent of this Agreement affected by such event. If the parties do not agree within 60 days of a party’s written request for negotiations, either party may terminate this Agreement with respect to the affected Covered Products upon expiration of the 60-day period, with immediate effect.

5.11 Compliance with Law

In connection with its respective obligations under this Agreement, each party shall comply with all applicable federal, state and local laws and regulations, including without limitation any disclosure or consent requirements.

5.12 Authority

EOHHS and the Manufacturer each represent and warrant to the other that the person signing below has all requisite legal power and authority to execute this Agreement on behalf of each party and each party shall thereby be bound.

5.13 Counterparts

This Agreement may be executed in counterparts.

IN WITNESS THEREOF, the parties set forth below execute this Agreement:

Executive Office of Health and Human Services:

[Manufacturer LEGAL NAME]

By:

By:

Name:

Title:

Date:

Date:

ATTACHMENT A

Covered Products

(Lancets) State Rebates apply to MassHealth and HSN Patient FFS claims paid through POPS, and include claims paid to Pharmacies through Participating MassHealth MCEs The provisions of the following paragraphs 1 – 4 of Attachment A apply to the Agreement, including this Attachment A.

1.

The Agreement shall apply to each Covered Product (Lancets) of the Manufacturer listed in the “Covered Products” column below and identified by the corresponding 11-digit NDC Number(s). Under this paragraph, MassHealth Member utilization through Participating MCEs is included, in addition to MassHealth Member and HSN Patient FFS claims paid through POPS.

Table1. MassHealth and HSN Patient FFS claims paid through POPS and claims paid to Pharmacies through Participating MassHealth MCEs

(Lancets) Preferred Exclusive Basis

(1 of 1)

Guaranteed Net Unit Price

(per unit) Contingent on an exclusive position Preferred Dual Basis

(1 of 2) Guaranteed Net Unit Price

(per unit) Contingent on a 1 of 2 position Preferred 1 of Many

(1 of 3 or more) Guaranteed Net Unit Price (per unit) Contingent on a 1 of Many position Non-Preferred Guaranteed Net Unit Price (per unit)

2.

For purposes of the chart in Paragraph 1 of this Attachment A, above:

· The designation “Exclusive Basis (1 of 1)” from the chart above and associated Guaranteed Net Unit Price(s) apply if the Manufacturer’s Covered Products are (i) the only Lancets listed on the MassHealth Non-Drug Product List without requiring prior authorization (PA), and (ii) if Participating MassHealth MCE preferred non-drug product list(s) have been aligned to the MH-MCE PPPL with respect to Manufacturer’s Covered Products and the competing Lancets of other manufacturers.

· The designation “Dual Basis (1 of 2)” from the chart above and associated Guaranteed Net Unit Price(s) apply if the Manufacturer’s Covered Products and the Competing Lancets of one other manufacturer are (i) listed on the MassHealth Non-Drug Product List without requiring PA, and (ii) if Participating MassHealth MCE preferred non-drug product list(s) have been aligned to the MH-MCE PPPL with respect to Manufacturer’s Covered Products and the competing Lancets of other manufacturers.

· The designation “1 of Many (1 of 3 or more)” from the chart above and associated Guaranteed Net Unit Price(s) apply if the Manufacturer’s Covered Products and the Competing Lancets of two or more other manufacturers are (i) listed on the MassHealth Non-Drug Product List without requiring PA, and (ii) if Participating MassHealth MCE preferred non-drug product list(s) have been aligned to the MH-MCE PPPL with respect to Manufacturer’s Covered Products and the Competing Lancets of other manufacturers.

· The designation “Non-Preferred” from the chart above and associated Guaranteed Net Unit Price(s) apply if Manufacturer’s Covered Products are (i) listed on the MassHealth Non-Drug Product List as requiring PA, and (ii) if Participating MassHealth MCE preferred non-drug product list(s) have been aligned to the MH-MCE PPPL with respect to Manufacturer’s Covered Products and the competing Lancets of other manufacturers.

3.

For purposes of determining these designations, the following apply:

· All capitalized terms, including “Lancets,” not otherwise defined below shall have the meaning set forth in Section 1 of the Agreement.

· “Prior authorization” has the meaning set forth in Section 1 of the Agreement; provided, however, that such term used in this Attachment A shall not refer to any requirement to obtain approval from EOHHS or its agent, HSN or a Participating MassHealth MCE, in order to exceed any quantity/dose limit imposed on Lancets. Subjecting the Manufacturer’s Covered Products to approval to exceed established limits shall not impact such Covered Products’ designation.

· Other manufacturers’ Competing Lancets shall be considered subject to Prior Authorization even if no Prior Authorization applies to (a) outstanding refills as of the effective date of this Agreement; (b) claims for which MassHealth or HSN is secondary payer; (c) claims for MassHealth Members or HSN Patients that are not submitted through POPS; and (d) claims that are not submitted to Participating MassHealth MCEs by Pharmacies.

· Covered Products shall have “Preferred Status" and shall not be considered subject to Prior Authorization even if Prior Authorization applies to (a) outstanding refills as of the effective date of this Agreement; (b) claims for which MassHealth or HSN is secondary payer; (c) claims for MassHealth Members or HSN Patients that are not submitted through POPS; and (d) claims that are not submitted to Participating MassHealth MCEs by Pharmacies.

4.

All Rebate and Guaranteed Net Unit Price (GNUP) amounts are expressed on a per Unit (i.e., per NDC code) basis. The Rebate will automatically be recalculated in accordance with the formula specified in Section 1 of the Agreement, should the WAC for Lancets change.

� Manufacturer should fill in specific information into this table.

PAGE

EOHHS Lancets Rebate Agreement