Agreement - Blue Cross Blue Shield - Self Fund Medical Insurance for CIty Employees for 2019

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All of the pharmacy guarantees listed on the previous page are effective January 1, 2019, for a term of 3 years, and the following apply: We can revise our price quote or alter the terms of the guarantees if one of the following occurs: The client does not notify Anthem of the offer acceptance 45 days prior to the effective date. The client does not implement the recommended clinical and cost -of -care management programs that are part of the Plan. The client does not adopt our formulary. • A change in the proportionate mix of the client's retail and home delivery prescription drug claims of more than 10%. • A change in pharmacy utilization patterns of more than 10%. • A change results in Anthem no longer being the exclusive source of drug rebates for the client. • Anthem is no longer the sole administrator for the pharmacy benefit portion of client's Plan. • The client has an onsite pharmacy with 340b designation or any such designation where the pharmacy receives upfront pricing discounts from pharmaceutical manufacturers, which was not disclosed or known by Anthem as of the effective date of the ASO Agreement. o Any excess achieved in a pharmacy financial guarantee will be used to make up for, and offset, a shortfall in other pharmacy financial guarantees. o Network guarantees will be calculated on the total eligible claim paid claims. o Our guarantees exclude the following claims: Prescriptions filled in Massachusetts, Alaska, Hawaii, or Puerto Rico, or filled in any state which imposes some form of Most Favored Nations limitations on pharmacy reimbursement; Vaccines; Prescriptions filled through the Employers on -site pharmacy; Over-the-counter drugs; Dispense As Written Claims; Drugs subject to patent litigation; Government Reimbursement Claims. o If there are changes in the AWP reporting source or if there are changes in how AWP is calculated, including changes in the mark-up factor used to calculate AWP, the terms of any financial relationship between the parties that relate to AWP will be modified. o Our formulary will be provided to members and providers. o Guarantees apply to commercial claims only. Medicare EGWP claims are excluded from all guarantees. o Guarantees applies only as long as there are at least 25,000 Annualized Adjusted Prescription Drug Claims. o As a portion of our reasonable compensation for services provided, we will retain the difference, if any, between the invoiced amount to the employer and the amount paid to the PBM for prescription drugs dispensed to members. o The client must use Anthem recommended formulary to be eligible for rebates, whether the rebates are paid or applied as a credit. Pricing guarantees do not apply to claims processed