Pharmacy Program Claims Clause Samples

Pharmacy Program Claims. (a) Employer will reimburse Claim Administrator for Claims submitted under the pharmacy program based on the pricing set forth in the BPA Addendum. (b) Pricing Guarantees: Within two hundred ten (210) days after the end of each Guarantee Period during the initial and renewal Term, Claim Administrator will provide to Employer a report of the reconciliation of the pricing guarantees for AWP discount and dispensing fees for the Guarantee Period. Any and all pricing guarantees described in the BPA Addendum can be used to offset any and all guarantee shortfall(s). If in aggregate, actual performance is less than the guaranteed pricing, Claim Administrator will pay Employer any shortfall(s) on a dollar-for-dollar basis. Notwithstanding the foregoing, in no event will pricing guarantees, such as, but not limited to AWP discount and dispensing fees, be applicable if Employer terminates the Prescription Drug Program or this PBM Exhibit prior to the end of the Term. Compound Drug Claims, Foreign Claims, reversed claims, and out-of-network claims are excluded from the calculation of the guaranteed average annual AWP discounts shown in the BPA Addendum. Zero Balance Due Claims are included in the guaranteed average annual AWP discounts as shown in the BPA Addendum; however, the discounts are considered prior to application of Copayments/Deductibles and Coinsurance and not as a one hundred percent (100%) discount, when calculating the overall average discount. Additional pricing terms, including claims excluded from the pricing guarantees, may be set forth in the BPA Addendum. Brand Drugs: See BPA Addendum. The overall effective AWP Brand Drugs discount and Dispensing Fee are calculated in the aggregate on an annual basis and include all Covered Brand Drug Claims submitted by Network Participants under the pharmacy program, including only the Claims paid in accordance with 1 (a) above.
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Pharmacy Program Claims i. Employer will reimburse Claim Administrator for Claims submitted under the pharmacy program based on the pricing set forth in the BPA Addendum. ii. Payment by Employer is subject to applicable Copayment/Deductible and/or Coinsurance or other coverage features set forth in the Benefit Plan designated by Employer under the pharmacy program.
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Pharmacy Program Claims. (a) Employer will reimburse Claim Administrator for Claims submitted under the pharmacy based on the pricing set forth in the BPA Addendum. (b) Payment by Employer is subject to applicable Copayment/Deductible and/or Coinsurance or other coverage features set forth in the Benefit Plan designated by Employer under the pharmacy program. In each case, if applicable, Employer will pay Claim Administrator the price set forth in subsection (a) above, plus any Provider Taxes and any federal, state, or local sales, use or other tax or assessment related to any Prescription Drug Products and Services less the Member’s cost share as established by Employer. In no event will Employer be charged if the Member Copayment/Deductible or Coinsurance covers one hundred percent (100%) of the Covered Prescription Drug Products and Services. Member Deductible and Coinsurance will be calculated as described in the Agreement, and Member is also responsible for the applicable Copayment plus applicable taxes. Zero balance logic is not employed.
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Pharmacy Program Claims i. Employer will reimburse Claim Administrator for Claims submitted under the pharmacy program at the Pass-Through Price. ii. AWP Discount and Dispensing Fee Pricing Guarantees: Within two hundred ten (210) days after the end of each Guarantee Period during the initial and renewal Term, Claim Administrator will provide to Employer a report of the reconciliation of the pricing guarantees for AWP discount and Dispensing Fees for the Guarantee Period. Any and all AWP discount and Dispensing Fee pricing guarantees described in the BPA Addendum can be used to offset any and all AWP discount and Dispensing Fee guarantee shortfall(s), or otherwise used to offset AWP discount and Dispensing Fee guarantee shortfall(s) as described in the BPA Addendum. When appropriate and subject to and contingent on the Rebate terms set forth in the BPA Addendum, if actual performance is less than the guaranteed pricing, Claim Administrator will pay Employer any shortfall(s) on a dollar-for- dollar basis. Notwithstanding the foregoing, in no event will pricing guarantees, such as, but not limited to AWP discount and Dispensing Fees, be applicable if Employer terminates the Prescription Drug Program or this PBM Exhibit prior to the end of the Guarantee Period.
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Related to Pharmacy Program Claims

  • Product Claims The parties acknowledge that NCR Voyix, not Apple, is responsible for addressing any claims you or any third party relating to the Software or your possession and/or use of the Software, including, but not limited to: (a) product liability claims; (b) any claim that the Software fails to conform to any applicable legal or regulatory requirement; and (c) claims arising under consumer protection or similar legislation.

  • Medicaid Program Parties (applicable to any Party providing services and supports paid for under Vermont’s Medicaid program and Vermont’s Global Commitment to Health Waiver):

  • Third Party Programs This Licensed Software may contain third party software programs (“Third Party Programs”) that are available under open source or free software licenses. This License Agreement does not alter any rights or obligations You may have under those open source or free software licenses. Notwithstanding anything to the contrary contained in such licenses, the disclaimer of warranties and the limitation of liability provisions in this License Agreement shall apply to such Third Party Programs.

  • Safety Program The Contractor shall design a specific safety program for the Work for the site(s). The Contractor shall establish and require all Subcontractors to establish reasonable safety programs. The Contractor shall also submit its standard monthly safety reports to the Owner and Design Professional. No imposition of responsibility on the Contractor for safety under this Contract shall relieve any subcontractor of its responsibility for safety of persons or property on or near the Project Site. The Contractor shall include in his plant he names of the person in charge of Safety.

  • Product Recalls (a) If either Party reasonably decides or is required by any government authority or court of competent jurisdiction, to initiate a product recall, withdrawal or field correction with respect to, or if there is any governmental seizure of, the Product, the Party initiating or required to initiate such action will notify the other Party promptly of the details regarding such action, including providing copies of all relevant documentation concerning such action. The Parties will assist each other in investigating any such situation and all regulatory contacts that are made and all activities concerning seizure, recall, withdrawal or field correction will be jointly coordinated by HSL and LMI. (b) If any such recall, withdrawal, field correction or seizure occurs due solely to (i) failure of any Product produced by HSL hereunder to conform to Specifications (including, without limitation, being adulterated or misbranded) or any warranty or other requirement set forth in this Agreement, (ii) the failure of HSL to comply in all material respects with any applicable law, rule, regulation, guideline, standard, court order or decree or (iii) the negligent or intentional wrongful act or omission of HSL in connection with the production of Product hereunder, then HSL shall bear the **** of any such seizure, recall, withdrawal or field correction and shall reimburse LMI for its ****, including any purchase price payments made to HSL and related taxes to the extent related to such recalled Product. To the extent any such recall, withdrawal, field correction or seizure occurs for any reason other than that set forth in the immediately preceding sentence, then LMI shall bear the **** of any such seizure, recall, withdrawal or field correction. If both HSL and LMI contribute to the cause of a seizure, recall, withdrawal or field correction, the cost and expense thereof will be shared in proportion to each Party’s contribution to the problem. For the purposes of this Agreement, the expenses of any recall, withdrawal, field correction or seizure shall include, without limitation, the out-of-pocket expenses of notification and destruction or return of the recalled Product and all other out-of-pocket costs incurred in connection with such recall but shall not include a Party’s lost profits. HSL’s reimbursement for the costs of LMI Materials related to such recall, withdrawal or field correction is limited by Section 5.6(c).