{"component": "definition", "props": {"groups": [{"snippet_links": [{"key": "drug-benefit", "type": "clause", "offset": [10, 22]}, {"key": "management-services", "type": "definition", "offset": [23, 42]}, {"key": "without-limitation", "type": "clause", "offset": [55, 73]}, {"key": "management-of", "type": "clause", "offset": [75, 88]}, {"key": "retail-pharmacy", "type": "definition", "offset": [89, 104]}, {"key": "payment-of-claims", "type": "clause", "offset": [115, 132]}, {"key": "prescription-drugs", "type": "clause", "offset": [151, 169]}, {"key": "drug-utilization-review", "type": "definition", "offset": [171, 194]}, {"key": "formulary-management", "type": "clause", "offset": [199, 219]}], "samples": [{"hash": "cuoxJvztYoS", "uri": "/contracts/cuoxJvztYoS#pbm-services", "label": "Receivables Purchase Agreement (Medco Health Solutions Inc)", "score": 21.0, "published": true}, {"hash": "21Mzf5nN0pN", "uri": "/contracts/21Mzf5nN0pN#pbm-services", "label": "Receivables Purchase Agreement (Medco Health Solutions Inc)", "score": 18.0, "published": true}, {"hash": "1pRK9AI9bsh", "uri": "http://truecostofhealthcare.org/wp-content/uploads/2015/09/MedcoHealthSolutions2008.pdf", "label": "Senior Note", "score": 14.1704312115, "published": false}], "size": 5, "snippet": "means any drug benefit management services, including, without limitation, management of retail pharmacy networks, payment of claims to pharmacies for prescription drugs, drug utilization review and formulary management services.", "hash": "2401e7fd6a542465622d4aac899b19a4", "id": 1}, {"snippet_links": [{"key": "associated-with", "type": "definition", "offset": [16, 31]}, {"key": "prescription-benefit", "type": "definition", "offset": [36, 56]}, {"key": "management-business", "type": "definition", "offset": [57, 76]}, {"key": "not-limited", "type": "clause", "offset": [92, 103]}, {"key": "claims-administration", "type": "definition", "offset": [112, 133]}, {"key": "administration-of", "type": "clause", "offset": [158, 175]}, {"key": "pharmacy-network", "type": "clause", "offset": [178, 194]}, {"key": "and-benefits", "type": "clause", "offset": [195, 207]}, {"key": "pharmacy-services", "type": "definition", "offset": [226, 243]}, {"key": "by-phone", "type": "clause", "offset": [245, 253]}, {"key": "drug-utilization-review", "type": "definition", "offset": [278, 301]}, {"key": "disease-state-management", "type": "definition", "offset": [307, 331]}, {"key": "delivery-of", "type": "clause", "offset": [336, 347]}, {"key": "pharmacy-benefits", "type": "clause", "offset": [358, 375]}, {"key": "therapeutic-substitution", "type": "definition", "offset": [477, 501]}], "samples": [{"hash": "fAgr6XWn0pR", "uri": "/contracts/fAgr6XWn0pR#pbm-services", "label": "Employment Agreement (National Medical Health Card Systems Inc)", "score": 21.0, "published": true}, {"hash": "f7TdBFgE9Lv", "uri": "/contracts/f7TdBFgE9Lv#pbm-services", "label": "Employment Agreement (National Medical Health Card Systems Inc)", "score": 21.0, "published": true}], "size": 5, "snippet": "means, services associated with the prescription benefit management business, including but not limited to: (i) claims administration, (ii) establishment and administration of a pharmacy network and benefits, (iii) mail order pharmacy services (by phone, fax or internet), (iv) drug utilization review, (v) disease state management and delivery of specialty pharmacy benefits, (vi) formulary creation and administration, (vii) rebate negotiation and administration, and (viii) therapeutic substitution programs.", "hash": "18e668e26837241be7f5f2436ae4cf50", "id": 2}, {"snippet_links": [{"key": "services-provided-by", "type": "clause", "offset": [12, 32]}, {"key": "in-accordance-with", "type": "definition", "offset": [47, 65]}, {"key": "this-contract", "type": "clause", "offset": [66, 79]}, {"key": "other-documents", "type": "clause", "offset": [88, 103]}, {"key": "msn-program", "type": "definition", "offset": [141, 152]}, {"key": "relating-to", "type": "definition", "offset": [153, 164]}, {"key": "benefit-plan-design", "type": "clause", "offset": [165, 184]}, {"key": "formulary-changes", "type": "clause", "offset": [186, 203]}, {"key": "changes-to-the", "type": "definition", "offset": [218, 232]}, {"key": "to-contractor", "type": "clause", "offset": [265, 278]}], "samples": [{"hash": "dUoqemNxAsU", "uri": "/contracts/dUoqemNxAsU#pbm-services", "label": "Pharmacy Benefit Management Services Agreement", "score": 22.2241309045, "published": true}, {"hash": "4w2WPY3hZOy", "uri": "/contracts/4w2WPY3hZOy#pbm-services", "label": "Pharmacy Benefit Management Agreement", "score": 21.9284691173, "published": true}], "size": 4, "snippet": "means those services provided by 25 Contractor in accordance with this Contract and any other documents or correspondence provided by the 26 MSN Program relating to Benefit Plan design, formulary changes, or any other changes to the MSN 27 Program and communicated to Contractor which impact how or which pharmaceuticals are provided.", "hash": "70102d931f8f0ee68c8dc65c24b5af7e", "id": 3}, {"snippet_links": [{"key": "services-provided-by-contractor", "type": "clause", "offset": [12, 43]}, {"key": "in-accordance-with", "type": "definition", "offset": [44, 62]}, {"key": "this-contract", "type": "clause", "offset": [63, 76]}, {"key": "other-documents", "type": "clause", "offset": [85, 100]}, {"key": "bhs-program", "type": "definition", "offset": [135, 146]}, {"key": "relating-to", "type": "definition", "offset": [147, 158]}, {"key": "benefit-plan-design", "type": "clause", "offset": [159, 178]}, {"key": "formulary-changes", "type": "clause", "offset": [180, 197]}, {"key": "changes-to-the", "type": "definition", "offset": [212, 226]}, {"key": "to-contractor", "type": "clause", "offset": [256, 269]}], "samples": [{"hash": "lXgwCemBayy", "uri": "/contracts/lXgwCemBayy#pbm-services", "label": "Pharmacy Benefits Manager Services Agreement", "score": 20.780971937, "published": true}], "size": 3, "snippet": "means those services provided by Contractor in accordance with this Contract and any other documents or correspondence provided by the BHS Program relating to Benefit Plan design, formulary changes, or any other changes to the BHS Program and communicated to Contractor which impact how or which pharmaceuticals are provided.", "hash": "dd9b945ecccc3e22aa50f759df43847a", "id": 4}, {"snippet_links": [{"key": "services-for", "type": "clause", "offset": [28, 40]}, {"key": "health-plans", "type": "clause", "offset": [52, 64]}, {"key": "employer-plans", "type": "clause", "offset": [79, 93]}, {"key": "medicare-advantage", "type": "clause", "offset": [105, 123]}, {"key": "medicare-part-d", "type": "clause", "offset": [125, 140]}, {"key": "federal-employees-health-benefits-program", "type": "definition", "offset": [152, 193]}, {"key": "employee-plans", "type": "definition", "offset": [216, 230]}], "samples": [{"hash": "jDyvQ7lUBfa", "uri": "/contracts/jDyvQ7lUBfa#pbm-services", "label": "Limited Liability Company Agreement (SS&C Technologies Holdings Inc)", "score": 32.5893223819, "published": true}, {"hash": "95NQqXVvEsT", "uri": "https://d18rn0p25nwr6d.cloudfront.net/CIK-0001402436/e9fdea8b-cb3a-4cd5-ba26-97fcc5e80999.pdf", "label": "d18rn0p25nwr6d.cloudfront.net", "score": 9.1820670773, "published": false}], "size": 2, "snippet": "means PBM claims processing services for commercial health plans, self-insured employer plans, Medicaid, Medicare Advantage, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans.", "hash": "152ccaaa6a13d4c6d42472831aaf9be9", "id": 5}, {"snippet_links": [{"key": "without-limitation", "type": "clause", "offset": [71, 89]}, {"key": "administration-of", "type": "clause", "offset": [113, 130]}, {"key": "pharmacy-benefits", "type": "clause", "offset": [131, 148]}, {"key": "claims-adjudication", "type": "clause", "offset": [165, 184]}, {"key": "pharmacy-network-management", "type": "clause", "offset": [193, 220]}, {"key": "pharmacy-operations", "type": "clause", "offset": [233, 252]}], "samples": [{"hash": "eGgF5bqaHlm", "uri": "/contracts/eGgF5bqaHlm#pbm-services", "label": "Vendor Services Agreement (Medix Resources Inc)", "score": 21.0, "published": true}], "size": 2, "snippet": "means any one or more services typically provided by a PBM, including, without limitation, design, management or administration of pharmacy benefits, pharmaceutical claims adjudication, retail pharmacy network management, mail order pharmacy operations, rebate management, and formulary design and/or management.", "hash": "aa323c403c5579819fef8d0217669f47", "id": 6}, {"snippet_links": [{"key": "without-limitation", "type": "clause", "offset": [71, 89]}, {"key": "administration-of", "type": "clause", "offset": [113, 130]}, {"key": "pharmacy-benefits", "type": "clause", "offset": [131, 148]}, {"key": "claims-adjudication", "type": "clause", "offset": [165, 184]}, {"key": "pharmacy-network-management", "type": "clause", "offset": [193, 220]}, {"key": "pharmacy-operations", "type": "clause", "offset": [233, 252]}, {"key": "proprietary-information", "type": "definition", "offset": [314, 337]}, {"key": "information-and-data", "type": "clause", "offset": [376, 396]}, {"key": "the-business", "type": "clause", "offset": [411, 423]}, {"key": "other-assets", "type": "definition", "offset": [482, 494]}, {"key": "not-limited", "type": "clause", "offset": [537, 548]}, {"key": "trade-secrets", "type": "definition", "offset": [553, 566]}, {"key": "source-codes", "type": "clause", "offset": [605, 617]}, {"key": "original-works-of-authorship", "type": "clause", "offset": [640, 668]}, {"key": "marketing-plans", "type": "definition", "offset": [754, 769]}, {"key": "information-systems", "type": "clause", "offset": [771, 790]}, {"key": "new-products", "type": "clause", "offset": [814, 826]}, {"key": "financial-statements", "type": "clause", "offset": [840, 860]}, {"key": "fees-charged", "type": "clause", "offset": [923, 935]}, {"key": "this-agreement", "type": "clause", "offset": [942, 956]}, {"key": "customer-lists", "type": "definition", "offset": [966, 980]}, {"key": "supplier-lists", "type": "definition", "offset": [986, 1000]}, {"key": "available-to-the-public", "type": "definition", "offset": [1005, 1028]}, {"key": "information-generally-available", "type": "clause", "offset": [1071, 1102]}, {"key": "improper-disclosure", "type": "definition", "offset": [1143, 1162]}, {"key": "by-a-party", "type": "clause", "offset": [1163, 1173]}, {"key": "such-information", "type": "definition", "offset": [1211, 1227]}], "samples": [{"hash": "dDrPtjOnukX", "uri": "/contracts/dDrPtjOnukX#pbm-services", "label": "Vendor Services Agreement (Medix Resources Inc)", "score": 19.0, "published": true}], "size": 1, "snippet": "means any one or more services typically provided by a PBM, including, without limitation, design, management or administration of pharmacy benefits, pharmaceutical claims adjudication, retail pharmacy network management, mail order pharmacy operations, rebate management, and formulary design and/or management. \"Proprietary Information\" means all proprietary and non-public information and data that concerns the business, technology, systems, finances, personnel, operations, or other assets and activities of a Party, including, but not limited to, trade secrets, ideas, processes, formulas, systems, source codes, data programs, other original works of authorship, know-how, improvements, discoveries, developments, designs, inventions, techniques, marketing plans, information systems, strategies forecasts, new products, unpublished financial statements, budgets, projections, licenses, rates, prices (including the fees charged under this Agreement), costs, customer lists, and supplier lists not available to the public. Proprietary Information does not include information generally available to the public other than as a result of improper disclosure by a Party or its agents or employees receiving such information under this Agreement.", "hash": "d99aea89c4f361659be38dc083d19245", "id": 7}, {"snippet_links": [{"key": "associated-with", "type": "definition", "offset": [15, 30]}, {"key": "prescription-benefit", "type": "definition", "offset": [35, 55]}, {"key": "specialty-pharmacy-business", "type": "definition", "offset": [71, 98]}, {"key": "not-limited", "type": "clause", "offset": [114, 125]}, {"key": "claims-administration", "type": "definition", "offset": [134, 155]}, {"key": "administration-of", "type": "clause", "offset": [180, 197]}, {"key": "pharmacy-network", "type": "clause", "offset": [200, 216]}, {"key": "and-benefits", "type": "clause", "offset": [217, 229]}, {"key": "pharmacy-services", "type": "definition", "offset": [248, 265]}, {"key": "by-phone", "type": "clause", "offset": [267, 275]}, {"key": "drug-utilization-review", "type": "definition", "offset": [300, 323]}, {"key": "disease-state-management", "type": "definition", "offset": [329, 353]}, {"key": "delivery-of", "type": "clause", "offset": [358, 369]}, {"key": "pharmacy-benefits", "type": "clause", "offset": [380, 397]}, {"key": "mental-health", "type": "clause", "offset": [439, 452]}, {"key": "therapeutic-substitution", "type": "definition", "offset": [615, 639]}, {"key": "pharmaceutical-products", "type": "definition", "offset": [683, 706]}], "samples": [{"hash": "gNuKcwfNlLE", "uri": "/contracts/gNuKcwfNlLE#pbm-services", "label": "Stock Purchase Agreement (National Medical Health Card Systems Inc)", "score": 18.0, "published": true}], "size": 1, "snippet": "means services associated with the prescription benefit management and Specialty Pharmacy business, including but not limited to: (i) claims administration, (ii) establishment and administration of a pharmacy network and benefits, (iii) mail order pharmacy services (by phone, fax or internet), (iv) drug utilization review, (v) disease state management and delivery of specialty pharmacy benefits, including growth hormones, transplants, mental health, women's health, men's health, and certain respiratory ailments, (vi) formulary creation al1d administration, (vii) rebate negotiation and administration, (viii) therapeutic substitution programs and (ix) specialty compounding of pharmaceutical products.", "hash": "ed17d14664113bb8a828a06af291848c", "id": 8}, {"snippet_links": [{"key": "pharmacy-benefit-management-services", "type": "definition", "offset": [6, 42]}, {"key": "preliminary-statements", "type": "clause", "offset": [61, 83]}], "samples": [{"hash": "aUJkYQ9RWjp", "uri": "/contracts/aUJkYQ9RWjp#pbm-services", "label": "Pharmacy Benefit Services Agreement (Advance Paradigm Inc)", "score": 18.0, "published": true}], "size": 1, "snippet": "means pharmacy benefit management services as defined in the Preliminary Statements.", "hash": "8a3ef12dde6609500c2739f7757820f4", "id": 9}, {"snippet_links": [], "samples": [{"hash": "6DuJTyolT6x", "uri": "/contracts/6DuJTyolT6x#pbm-services", "label": "Administrative Services Agreement (Health Net Inc)", "score": 21.1533196441, "published": true}], "size": 1, "snippet": "shall have the meaning set forth in Section 9.1(d).", "hash": "fc0e123c02e231627e12cc6e4ed075cb", "id": 10}], "next_curs": "ClkSU2oVc35sYXdpbnNpZGVyY29udHJhY3RzcjULEhpEZWZpbml0aW9uU25pcHBldEdyb3VwX3Y1NiIVcGJtLXNlcnZpY2VzIzAwMDAwMDBhDKIBAmVuGAAgAA==", "definition": {"title": "PBM Services", "size": 24, "snippet": "means any drug benefit management services, including, without limitation, management of retail pharmacy networks, payment of claims to pharmacies for prescription drugs, drug utilization review and formulary management services.", "id": "pbm-services", "examples": ["County will continue to pay Contractor in accordance with this Agreement for any Fees for <strong>PBM Services</strong> provided during the term and any run-off period.", "The termination or expiration of this PBM Schedule or the <strong>PBM Services</strong> hereunder by itself as permitted under this Section shall in no event constitute or result in the termination or expiration of this Agreement.", "In consideration of the <strong>PBM Services</strong> provided by ESI, Sponsor will pay the applicable claims reimbursement amounts (\u201cClaims Reimbursements\u201d) and other administrative fees (\u201cAdministrative Fees\u201d) pursuant to the terms set forth on Exhibit A (\u201cClaims Reimbursements,\u201d \u201cAdministrative Fees\u201d and any other charge or fee that is the responsibility of Sponsor as may be described elsewhere in this Agreement are hereinafter referred to collectively as \u201cFees\u201d).", "In addition, ESI may contract with third party vendors to provide information technology support services and other ancillary services, which services are not <strong>PBM Services</strong> hereunder, but rather are services that support ESI\u2019s conduct of its business operations.", "Customer Agreement Cigna <strong>PBM Services</strong> \uf0a7 Processing of new prescriptions received via physician fax or mail Services provided by Cigna, through Cigna Pharmacy Management, are the following.", "It is agreed by the Parties that Contractor submitted a proposal in response to Request for Proposal No. 042-541490-CC for Pharmacy Benefit Manager/Administrator Services (RFP) and in accordance with the RFP proposed to have all services described herein fully implemented in accordance with this Contract by September 1, 2012, with Contractor assuming responsibility for provision of <strong>PBM Services</strong> effective October 1, 2012.", "Upon reasonable notice, ESI will have the right to terminate <strong>PBM Services</strong> to any Plan (or, if applicable, Members) located in a state requiring a pharmacy benefit manager to be a fiduciary to Sponsor, a Plan, or a Member in any capacity.", "CONTRACTOR shall provide its <strong>PBM Services</strong> based on the 14 following MSN Program guidelines.", "Meritain is empowered to act on behalf of Client in connection with the PBM Plan only to the extent expressly stated in this PBM Schedule, and except as provided in this Section: (i) the <strong>PBM Services</strong> will not include the power to exercise discretionary authority over Plan operations or Plan assets (if any), and (ii) Meritain will not for any purpose be deemed to be the &quot;Plan Administrator&quot; of the Plan or a &quot;fiduciary&quot; with respect to the Plan.", "The Company shall be reasonably satisfied with the then financial operating performance under the <strong>PBM Services</strong> Agreement, dated as of August 6, 1997 and effective on October 1, 1997, between Pro-\u2587\u2587\u2587\u2587 Holdings, Inc., and Health Plan of Nevada, Inc., HMO Texas, L.L.C., Sierra Health and Life Insurance Company, Inc., and Sierra Healthcare Options, Inc."], "related": [["program-services", "Program services", "Program services"], ["system-services", "System Services", "System Services"], ["pharmacy-services", "Pharmacy services", "Pharmacy services"], ["ecosystem-services", "ecosystem services", "ecosystem services"], ["cloud-services", "Cloud Services", "Cloud Services"]], "related_snippets": [], "updated": "2025-07-06T21:56:45+00:00"}, "json": true, "cursor": ""}}