R2024-342 Resolution Authorizing Agreement and Amendment with BlueCross BlueShield of Ilinois for Administration of the City Group Health Benefit Plan for Calendar Year 2025

Home Browse Search

HCSC GEN ASO Traditional PBM Fee Addendum 6.19 -MedsyourWay program claims will be included in calculation of the discount and Dispensing Fee pricing guarantees.MedVourWay is the embedded drug discount card comparison program utilized where available and applicable to Employer,Network Pharmacy,and the Covered Drug PBM uses Medi-Spam as the pricing source to establish AWP,for purposes of calculating whether the above AWP discounts have been achieved. Members'cost share is the applicable copaymem,deductible,and/or coinsurance,which coinsurance is calculated based on the Employer's Contract Bate or the applicable out-of•network pricing.Zero balance logic is not employed. AWP discounts are based on the actual NOC-11 dispensed. AWP discounts do not include savings from drug utilization review or other clinical or medical management programs. The above Guaranteed Traditional Aggregate Pricing Arrangement.Rebate Credits and Administrative Fees may be subject to change if the Employees claims include 3408 pricing. in addition to the rights of the parties under the PBM Exhibit if charges occur within the pharmacy benefit management marketplace which lead to a significant deviation from the current economic environment,both parties agree to engage in good faith negotiations to amend this Addendum to make impact on both parties commercially reasonably economically neutral.tf the parties cannot agree on the terms of the amendment,either party shall be allowed to(a)proceed to dispute resolution,as set forth in the Administrative Services Agreement or(b)terminate this Addendum with 80 days'prior written notice to the other pant.Failure to reach agreement an the amendment shall not be a breach of contract. The above Guaranteed Traditional Aggregate Pricing Arrangement,Rebate Credits and Administrative Fees are based on the Network and Drug list shown above. Unless otherwise specified in this Addendum,capitalized terms used in this Addendum shall have the meanings set forth in the Administrative Services Agreement or the PBM Etdtibit,as applicable. Employer payments to Claim Administrator for Covered Services provided by Network Participants are calculated based on the pricing terms set forth in this Addendum which shall remain in effect for the term of this Addendum to the extent described in the Administrative Services Agreement.Such pricing mayor may not equal the amounts actually paid to the Network Participants or received from drug manufaeturers ie.g,rebates),or the amounts paid or received between Claim Administrator and the PBM.Asa result,the PEM or Claim Administrator may realize positive margin on prescriptions filled at retail, mall order,ESN"specialty pharmacies or prescription drug rebates.Employer acknowledges that it has negotiated for the specifrc traditional pricing terms set forth in this Addendum,and that it and its group health plan have no right to,or legal interest in,any portion of any positive margin retained by Claim Administrator or PBM and consents to Claim Administrator's and POWs retention of all such amounts. Signature of Authorized Purchaser Print Name Title Date 2 proodetary and Confldendat lydwmadon Not for use or disclosure outside Claim Administrator,Employer,Meir respective affiliated companies and third Party represenadves,except with written permission Of Claim Adm iMlor,