Common use of Pharmacy Network Clause in Contracts

Pharmacy Network. Brand Drugs Lower of U&C or AWP minus 15.50% plus $1.35 dispensing fee Generic MAC Drugs Lower of U&C, Catamaran MAC plus $1.35 dispensing fee Non-MAC Generic Drugs Lower of U&C or AWP minus 15.50% plus $1.35 dispensing fee Effective Overall Generic Guarantee (ingredient cost) Year 1: AWP minus 74.00% Year 2: AWP minus 74.50% Year 3: AWP minus 75.00% Year 4: AWP minus 75.50% Year 5: AWP minus 76.00% Brand Drugs Lower of U&C or AWP minus 18.50% plus $0.00 dispensing fee Generic MAC Drugs Lower of U&C, Catamaran MAC plus $0.00 dispensing fee Non-MAC Generic Drugs Lower of U&C or AWP minus 18.50% plus $0.00 dispensing fee Effective Overall Generic Guarantee (ingredient cost) Year 1: AWP minus 75.00% Year 2: AWP minus 75.50% Year 3: AWP minus 76.00% Year 4: AWP minus 76.50% Year 5: AWP minus 77.00% Brand Drugs AWP minus 23.00% plus $0.00 dispensing fee Generic MAC Drugs Catamaran MAC plus $0.00 dispensing fee Generic Non- MAC Drugs AWP minus 23.00% plus $ 0.00 dispensing fee Effective Overall Generic Guarantee (ingredient cost) Year 1: AWP minus 76.00% Year 2: AWP minus 76.50% Year 3: AWP minus 77.00% Year 4: AWP minus 77.50% Year 5: AWP minus 78.00% Retail 30 Minimum Greater of 100% or $18.00 per Net Paid brand Claim Retail 90 Minimum Greater of 100% or $30.00 per Net Paid brand Claim Mail Minimum Greater of 100% or $50.00 per Net Paid brand Claim Specialty Minimum Greater of 100% or $18.00 per Net Paid specialty brand Claim Retail 76.00% 77.00% 78.00% 78.00% 78.00% Mail 77.00% 78.00% 79.00% 79.00% 79.00%

Appears in 1 contract

Sources: Administration of a Prescription Drug Card and Mail Order Program

Pharmacy Network. Brand Drugs Lower of U&C or AWP minus 15.50% plus $1.35 dispensing fee Lower of U&C or AWP minus 17.00% plus $1.00 dispensing fee Lower of U&C or AWP minus 17.75% plus $1.00 dispensing fee Lower of U&C or AWP minus 18.00% plus $0.90 dispensing fee Generic MAC Drugs Lower of U&C, Catamaran OptumRx MAC plus $1.35 dispensing fee Lower of U&C, OptumRx MAC plus $1.00 dispensing fee Lower of U&C, OptumRx MAC plus $1.00 dispensing fee Lower of U&C, OptumRx MAC plus $0.90 dispensing fee Non-MAC Generic Drugs Lower of U&C or AWP minus 15.50% plus Lower of U&C or AWP minus 17.00% plus $1.00 dispensing fee Lower of U&C or AWP minus Lower of U&C or AWP minus $1.35 dispensing fee Effective Overall Generic Guarantee (ingredient cost) Year 1: AWP minus 74.0017.75% Year 2: AWP minus 74.50plus $1.00 dispensing fee 18.00% Year 3: AWP minus 75.00% Year 4: AWP minus 75.50% Year 5: AWP minus 76.00% plus $0.90 dispensing fee Brand Drugs Lower of U&C or AWP minus 18.50% plus $0.00 dispensing fee Lower of U&C or AWP minus 19.50% plus $0.00 dispensing fee Lower of U&C or AWP minus 20.50% plus $0.00 dispensing fee Lower of U&C or AWP minus 20.75% plus $0.00 dispensing fee Generic MAC Drugs Lower of U&C, Catamaran OptumRx MAC plus $0.00 dispensing fee Non-MAC Generic Drugs Lower of U&C or AWP minus 18.50% plus $0.00 dispensing fee Lower of U&C or AWP minus 19.50% plus $0.00 dispensing fee Lower of U&C or AWP minus 20.50% plus $0.00 dispensing fee Lower of U&C or AWP minus 20.75% plus $0.00 dispensing fee Effective Overall Generic Guarantee (ingredient cost) Year 1: AWP minus 75.00% Year 2: AWP minus 75.50% Year 3: AWP minus 76.0078.00% Year 4: AWP minus 76.5078.00% Year 5: AWP minus 77.0078.75% Year 6: AWP minus 80.0% Brand Drugs AWP minus 23.00% plus $0.00 dispensing fee AWP minus 23.50% plus $0.00 dispensing fee AWP minus 24.50% plus $0.00 dispensing fee AWP minus 24.75% plus $0.00 dispensing fee Generic MAC Drugs Catamaran OptumRx MAC plus $0.00 dispensing fee Generic Non- MAC Drugs AWP minus 23.00% plus $ $0.00 dispensing fee Effective Overall Generic Guarantee (ingredient cost) Year 1: AWP minus 76.00% Year 2: AWP minus 76.50% Year 3: AWP minus 77.0080.00% Year 4: AWP minus 77.5080.00% Year 5: AWP minus 78.0080.50% Year 6: AWP minus 81.75% $2.50 Aggregate Guarantee: AWP minus 15.50% Retail 30 Minimum Greater of 100% or $18.00 per Net Paid brand Claim Greater of 100% or $65.00 per Net Paid brand Claim Greater of 100% or $95.00 per Net Paid brand Claim Greater of 100% or $125.00 per Net Paid brand Claim Greater of 100% or $140.00 per Net Paid brand Claim Retail 90 Minimum Greater of 100% or $30.00 per Net Paid brand Claim Greater of 100% or $65.00 per Net Paid brand Claim Greater of 100% or $95.00 per Net Paid brand Claim Greater of 100% or $300.00 per Net Paid brand Claim Greater of 100% or$330.00 per Net Paid brand Claim Mail Minimum Greater of 100% or $50.00 per Net Paid brand Claim Greater of 100% or $250.00 per Net Paid brand Claim Greater of 100% or $350.00 per Net Paid brand Claim Greater of 100% or $390.00 per Net Paid brand Claim Greater of 100% or$420.00 per Net Paid brand Claim Specialty Minimum Greater of 100% or $18.00 per Net Paid specialty brand Claim Retail 76.00Greater of 100% 77.00or $250.00 per Net Paid specialty brand Claim Greater of 100% 78.00or $500.00 per Net Paid specialty brand Claim Greater of 100% 78.00or $575.00 per Net Paid specialty brand Claim Greater of 100% 78.00% Mail 77.00% 78.00% 79.00% 79.00% 79.00%or $650.00 per Net Paid specialty brand Claim Accumulator for deductibles and maximums data Included Integrated Accumulator – Near Real Time Method $0.15 PMPM

Appears in 1 contract

Sources: Administration of a Prescription Drug Card and Mail Order Program Contract

Pharmacy Network. Brand Drugs Lower of U&C or AWP minus 15.50% plus $1.35 dispensing fee Lower of U&C or AWP minus 17.00% plus $1.00 dispensing fee Lower of U&C or AWP minus 17.75% plus $1.00 dispensing fee Generic MAC Drugs Lower of U&C, Catamaran OptumRx MAC plus $1.35 dispensing fee Lower of U&C, OptumRx MAC plus $1.00 dispensing fee Lower of U&C, OptumRx MAC plus $1.00 dispensing fee Non-MAC Generic Drugs Lower of U&C or AWP minus 15.50% plus $1.35 dispensing fee Lower of U&C or AWP minus 17.00% plus $1.00 dispensing fee Lower of U&C or AWP minus 17.75% plus $1.00 dispensing fee Effective Overall Generic Guarantee (ingredient cost) Year 1: AWP minus 74.00% Year 2: AWP minus 74.50% Year 3: AWP minus 75.0077.00% Year 4: AWP minus 75.5077.00% Year 5: AWP minus 76.0077.50% Year 6: AWP minus 77.75% Brand Drugs Lower of U&C or AWP minus 18.50% plus $0.00 dispensing fee Lower of U&C or AWP minus 19.50% plus $0.00 dispensing fee Lower of U&C or AWP minus 20.50% plus $0.00 dispensing fee Generic MAC Drugs Lower of U&C, Catamaran OptumRx MAC plus $0.00 dispensing fee Non-MAC Generic Drugs Lower of U&C or AWP minus Lower of U&C or AWP minus 19.50% plus $0.00 dispensing fee Lower of U&C or AWP minus 20.50% plus $0.00 18.50% plus $0.00 dispensing fee dispensing fee Effective Overall Generic Guarantee (ingredient cost) Year 1: AWP minus 75.00% Year 2: AWP minus 75.50% Year 3: AWP minus 76.0078.00% Year 4: AWP minus 76.5078.00% Year 5: AWP minus 77.0078.75% Year 6: AWP minus 79.0% Brand Drugs AWP minus 23.00% plus $0.00 dispensing fee AWP minus 23.50% plus $0.00 dispensing fee AWP minus 24.50% plus $0.00 dispensing fee Generic MAC Drugs Catamaran OptumRx MAC plus $0.00 dispensing fee Generic Non- MAC Drugs AWP minus 23.00% plus $ $0.00 dispensing fee AWP minus 23.50% plus $0.00 dispensing fee AWP minus 24.50% plus $0.00 dispensing fee Effective Overall Generic Guarantee (ingredient cost) Year 1: AWP minus 76.00% Year 2: AWP minus 76.50% Year 3: AWP minus 77.0080.00% Year 4: AWP minus 77.5080.00% Year 5: AWP minus 78.0080.50% Year 6: AWP minus 80.75% Retail 30 Minimum Greater of 100% or $18.00 per Net Paid brand Claim Greater of 100% or $65.00 per Net Paid brand Claim Greater of 100% or $95.00 per Net Paid brand Claim Greater of 100% or $125.00 per Net Paid brand Claim Greater of 100% or $135.00 per Net Paid brand Claim Retail 90 Minimum Greater of 100% or $30.00 per Net Paid brand Claim Greater of 100% or $65.00 per Net Paid brand Claim Greater of 100% or $95.00 per Net Paid brand Claim Greater of 100% or $300.00 per Net Paid brand Claim Greater of 100% or $320.00 per Net Paid brand Claim Mail Minimum Greater of 100% or $50.00 per Net Paid brand Claim Greater of 100% or $250.00 per Net Paid brand Claim Greater of 100% or $350.00 per Net Paid brand Claim Greater of 100% or $390.00 per Net Paid brand Claim Greater of 100% or $410.00 per Net Paid brand Claim Specialty Minimum Greater of 100% or $18.00 per Net Paid specialty brand Claim Retail 76.00Greater of 100% 77.00or $250.00 per Net Paid specialty brand Claim Greater of 100% 78.00or $500.00 per Net Paid specialty Greater of 100% 78.00or $575.00 per Net Paid specialty Greater of 100% 78.00% Mail 77.00% 78.00% 79.00% 79.00% 79.00%or $625.00 per Net Paid specialty brand Claim brand Claim brand Claim

Appears in 1 contract

Sources: Administration of a Prescription Drug Card and Mail Order Program Contract