RFP APPENDIX E - K.xlsx

Financial Requirements

(If Not Confirmed)

You must adhere to the exclusions shown on the 'Exclusions' tab.” “Confirmed” if you are in agreement with the pre-populated Excluded/Included designations on the ‘Exclusions’ tab; otherwise, select “Not Confirmed” and change the pre-populated Excluded/Included designations on the ‘Exclusions’ tab accordingly.

You must adhere to the exclusions shown on the 'Exclusions' tab.” “Confirmed” if you are in agreement with the pre-populated Excluded/Included designations on the ‘Exclusions’ tab; otherwise, select “Not Confirmed” and change the pre-populated Excluded/Included designations on the ‘Exclusions’ tab accordingly.

"Delivery Channel" shall mean Retail 30, Retail 90, Retail Specialty, Mail, and Mail Specialty, individually, for example.

"Pricing Component” shall mean brand discounts, generic discounts, brand dispensing fees, and generic dispensing fees.

If the AWP of a generic product is $10, the discounted cost is $6 and the Eligible Member Cost Share is also $6 (leaving a zero balance due from the plan), the discount % off of AWP for both billing and guarantee purposes would be 40% off of AWP.

19. Confirm that no other monies (audit/clinical/therapeutic interchange, DUR savings) will be included in any calculations:

Calculations include adjudication, billing, guarantee reconciliation, etc.

The amount at risk will be the full value of the missed performance, not a calculation of CLIENT's net plan cost impact.

23. Confirm that your organization's financial proposal is based on the plan design, clinical rules and data contained within this RFP.

(No changes need to be made by CLIENT in order to attain the financial pricing terms offered.)

This will apply to adjudication, billing, guarantee reconciliation, etc.

(If Not Confirmed)

41. Confirm that your organization’s contract and adjudication system will reflect the below claim billing formula:

Lower of AWP-X% + dispensing fee, MAC + dispensing fee, or U&C

42. AWP-X% represents your organization's most aggressive retail pharmacy contract rate with each pharmacy PROVIDE YOUR ORGANIZATION’S PROPOSED AGGREGATE ANNUAL GUARANTEED BRAND DISCOUNT ON THE “FINANCIAL OFFER” TAB

Any excess Eligible Member Cost Share will not be retained by your organization.

(If Not Confirmed)

48. Confirm that your organization will propose MAC pricing at mail.

The Mail MAC list and price schedule will be the same (or better) as the Retail MAC list and pricing schedule.

49. Confirm that your organization's contract and adjudication system will reflect the below claim billing formula:

Lower of AWP-X% + dispensing fee or MAC + dispensing fee

50. AWP-X% represents a minimum fixed discount for all claims should the MAC price be less aggressive CONFIRM THAT YOUR ORGANIZATION IS NOT PROPOSING AN AGGREGATE ANNUAL GUARANTEED BRAND DISCOUNT

Any excess Eligible Member Cost Share will not be retained by your organization.

For example, your organization will not price mail claims at the retail rate if below a days' supply threshold.

This requirement pertains not only to claim-level mail pricing, but to aggregate mail guarantees as well.

(If Not Confirmed)

56. Confirm that your organization's financial proposal will include an "all in" aggregate annual minimum Specialty Drug guarantee using this RFP's Specialty Drug definition.

Confirm any and all exclusions shown on the 'Exclusions' tab.

57. Confirm that your organization's contract and adjudication system will reflect the below claim billing formula:

Lower of AWP-X% + dispensing fee or MAC + dispensing fee.

If so, confirm that HIV drugs receive the specialty guarantee.

(If Not Confirmed)

Minimum rebate guarantee cannot exclude any brand product that is filled as brand claim, regardless of how the claim is billed.

You must adhere to the exclusions shown on the 'Exclusions' tab.” “Confirmed” if you are in agreement with the pre-populated Excluded/Included designations on the ‘Exclusions’ tab; otherwise, select “Not Confirmed” and change the pre-populated Excluded/Included designations on the ‘Exclusions’ tab accordingly.

The full rebate credit will be provided to CLIENT provided that the plan allows up to 30 days' supply at retail and up to 90 days' supply at mail.

Your organization will not prorate guarantees based on the utilized days' supply or set a minimum days' supply amount upon which rebate guarantees are contingent.

(a) A change in government legislation which materially impacts the current economics of the rebating process between manufacturers and managed care organizations which then has a material adverse impact on the rebates that your organization receives, OR

(b) A generic product is introduced to the market ahead of the anticipated generic launch date based upon your organization’s current published generic pipeline report.

(If Not Confirmed)

• Contract between PBM and GPO;

• Contract between GPO and Pharmaceutical Manufacturer;

• Contracts will include but not limited to:

o Base Rebates o Incentive Rebates o Manufacturer admin fees o Inflation Protection o Market Share

• Auditing will be subject to those manufactures that make up a minimum of 50% of rebate dollars

(If Not Confirmed)

90. Confirm that your organization will allow a fair and flexible market check to be conducted ONCE during the initial agreement to preserve competitiveness of financial terms.

Such market check will be conducted by CLIENT's third party consultant of their choosing.

CLIENT will be the only party to have termination for convenience rights.

*This assumes that CLIENT has signed-off on the benefit set-up 30 business days prior to the effective date.

104. Confirm that your organization will provide a client allowance to be used for expenses associated with the pharmacy benefit, including, but not limited to:

Communications, internal costs, ancillary PBM charges/programs, consulting fees, etc.

Funds will be calculated on a per member basis (employee + spouse + dependents) based on enrollment at implementation.

Funds will be available during the entire term of the contract, will not expire, and may be carried over from year to year of the contract.

(Indicate amount offered on "Financial Offer" tab).

&KFF0000CONFIDENTIALITY NOTICE: This document and all associated documents are proprietary and confidential and are not intended for distribution outside of your organization.

&P &A &G

Financial Offer

The fixed dispensing fee per claim.

The fixed dispensing fee per claim.

The fixed dispensing fee per claim.

Minimum Rebate Guarantees

If you do not confirm that the proposed rebate guarantees account for a WAC/rebate decrease, provide the following:

- Projected average AWP per unit cost for current Reference Biologic claims (if utilization remained with Reference Biologic) versus projected average AWP per unit cost for claims for Biosimilar(s) to Reference Biologic each year.

- Projected rebates per unit for current Reference Biologic claims (if utilization remained with Reference Biologic) versus rebates per unit for Biosimilar(s) to Reference Biologic claims for each year.

Formulary Option 2 (IF APPLICABLE) Minimum Rebate Guarantees

If you do not confirm that the proposed rebate guarantees account for a WAC/rebate decrease, provide the following:

- Projected average AWP per unit cost for current Reference Biologic claims (if utilization remained with Reference Biologic) versus projected average AWP per unit cost for claims for Biosimilar(s) to Reference Biologic each year.

- Projected rebates per unit for current Reference Biologic claims (if utilization remained with Reference Biologic) versus rebates per unit for Biosimilar(s) to Reference Biologic claims for each year.

If per member, member should be defined as employee + spouse + dependent = 3 members.

If per member, member should be defined as employee + spouse + dependent = 3 members.

Any amount entered below $100 will be considered per member.

If per member, member should be defined as employee + spouse + dependent = 3 members.

Any amount entered below $100 will be considered per member.

If per member, member should be defined as employee + spouse + dependent = 3 members.

If per member, member should be defined as employee + spouse + dependent = 3 members.

For each Compound Drug, the Participating Pharmacy will provide the following:

(a) compound indicator; (b) eleven-digit NDC, quantity, and submitted ingredient cost for each component in the recipe; (c) total quantity and total Usual & Customary price; and (d) level of effort fee.

PBM will determine the appropriate ingredient cost, or NDC, for each component using the lower of (I) the AWP discount; (2) MAC; or (3) the submitted ingredient cost. PBM shall apply a level of effort charge to the Compound Drug in addition to the appropriate dispensing fee.

(a) U&C;

(b) Ingredient Cost plus Dispensing Fee plus vaccine administration fee.

(a) U&C;

(b) Ingredient Cost plus Dispensing Fee plus vaccine administration fee.

(a) U&C;

(b) Ingredient Cost plus Dispensing Fee plus vaccine administration fee.

&KFF0000CONFIDENTIALITY NOTICE: This document and all associated documents are proprietary and confidential, and are not intended for distribution outside of your organization.

&P &A &G

Specialty Pharmacy Offer

&KFF0000CONFIDENTIALITY NOTICE: This document and all associated documents are proprietary and confidential, and are not intended for distribution outside of your organization.

&P &A &G

Claims and Trend Assumptions

Instructions: Complete all light blue shaded cells in this document.

&"Arial,Regular"&10&K000000Data Class: &B&KC41230Restricted &B&"Arial,Regular"&12&K000000

&"Arial,Regular"&10&K000000Data Class: &B&KC41230Restricted &B&"Arial,Regular"&12&K000000

Exclusions

Minimum Guarantees

"Inflammatory Conditions" shall mean products with the MediSpan GPI-8 codes 66290030*, 66270015*, 66270040*, 52504070*, 90250585*.

"Insulins" shall mean products with the MediSpan GPI-4 code 2710*.