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R-2022-375 - 11/17/2022 RESOLUTION NO. R-2022-375 WHEREAS, the City of Round Rock (the "City") previously entered into an Administrative Services Agreement ("Agreement") with United Healthcare Insurance Company ("United Healthcare") for the provision of employee medical and pharmacy insurance benefits on September 9, 2021 by Resolution No. R-2021-236, and WHEREAS, the City Council desires to execute a Financial Renewal of said Agreement for the period of January 1, 2023 through December 31, 2024,Now Therefore BE IT RESOLVED BY THE COUNCIL OF THE CITY OF ROUND ROCK,TEXAS, That the Council hereby authorizes the Financial Renewal of the Administrative Services Agreement with United Healthcare for insurance coverage for the guarantee period of January 1, 2023 through December 31, 2024 as set forth in the Financial Renewal document from United Healthcare attached as Exhibit"A." The City Council hereby finds and declares that written notice of the date, hour, place and subject of the meeting at which this Resolution was adopted was posted and that such meeting was open to the public as required by law at all times during which this Resolution and the subject matter hereof were discussed, considered and formally acted upon, all as required by the Open Meetings Act, Chapter 551, Texas Government Code, as amended RESOLVED this 17th day of November, 2022. CRA G OR , Mayor City of ound ock, Texas ATTEST: L" - A MEAGAN S KS, Ci Clerk 0112.20222;4866-7355-0398/ss2 EXHIBIT "A„ UnitedHealtheare, September 29,2022 City of Round Rock 221 East Main Street Round Rock,TX 78664 RE: January 1,2023 Financial Renewal under the Administrative Services Agreement("ASA") between United HealthCare Services, Inc. and City of Round Rock Dear Tyler: This letter is confirmation of your Financial Renewal per the attached documents. Please feel free to contact me with any questions regarding the attachments. Please file this letter and its attachments with your ASA. Thank you, Bambi Kenney Cc. ,Associate Contract Manager Attachments: Renewal 4Q20210 1 Proprietary Information of UnitedHealth Group EXHIBIT B-FEES The Medical Fees ("Fees") are as stated below. Customer acknowledges that Fees paid for administrative services are reasonable. If authorized by Customer pursuant to this Agreement or by subsequent authorization, certain Fees will be paid through a withdrawal from the Bank Account. These Fees do not include state or Federal surcharges, assessments,or similar Taxes imposed by governmental entities or agencies on the Plan or United,including but not limited to those imposed pursuant to The Patient Protection and Affordable Care Act of 2010,as amended from time to time as these are the responsibility of the Plan. Medical Fees The following financial terms are effective for the period January 1,2023 through December 31,2024, unless otherwise specified. The Medical Fees("Fees"described below,excluding optional and non-standard fees,are adjusted as set forth in the applicable performance standard(s). Effective January 1,2023 through December 31,2023 The Fees listed below are based upon an estimated minimum of 903 enrolled Employees. Choice Plus Plan:$10.79 per Employee per month. Nexus Plan:$12.79 per Employee per month. Average Contract Size: 2.27 The Fees include a Pharmacy Administrative Fee credit in the amount of$40.00 per Employee per month. Effective January 1,2024 through December 31,2024 Choice Plus Plan: $10.79 per Employee per month. Nexus Plan:$12.79 per Employee per month. The Fees include a Pharmacy Administrative Fee credit in the amount of$40.00 per Employee per month. Payment IntegritN Services Service Description Fee Advanced Analytics and Recovery 24%of the gross recovery amount • United's large-scale analytics to identify additional recovery opportunities. • Claims re-examined every month for up to 12 months. Post-adjudicated claims. Credit Balance Recovery 10%of the gross recovery amount. • Review,validate,and recover credit balances(dollars) on existing patient accounts through a combination of analysis and technology. • On-site at hospitals and facilities. Post-adjudicated claims. Focused Claim Review 22%of the gross recovery amount. • Review of claims for inappropriate billing of services not documented in clinical notes. • Board certified,same-specialty medical directors. Pre-adjudicated claims orpost-adjudicated claims. Fraud,Waste,and Abuse Management 22%of the gross recovery or prevented amount 2 Proprietary Information of UnitedHealth Group • Detection and recovery of wasteful,abusive,and/or fraudulent claims. • Search claims for patterns which indicate possible waste or error by identifying specific claims for additional review. Pre-adjudicated claims orpost-adjudicated claims. Hospital Bill and Premium Audit Services 22%of the gross recovery amount • In-depth review of hospital medical records or other related documentation compared to claimed amounts to ensure billing accuracy. • Post-adjudicated claims. Litigation and Arbitration Fees for Recoveries Outside attorneys' fees and costs or administrative process • Litigation,arbitration,or other judicial process to fees will be deducted from the gross recovery prior to the recover any Overpayments and other Plan recovery assessment of any applicable United fees(as indicated in this opportunities. Exhibit). • Outside attorneys'fees and costs or administrative process fees directly incurred with litigation, arbitration,or other judicial process. Pre-adjudicated claims orpost-adjudication claims. Third Party Liability-Subrogation and Injury 33.33%of the applicable savings amount. Coverage Coordination • Services to prevent the payment of Plan benefits,or recover Plan benefits,which should be paid by a third party. • Does not include benefits paid in connection with coordination of benefits,Medicare,or other Overpayments. Pre-adjudicated claims or post-adjudicated.claims. • Customer will not engage any entity except United to provide such services without prior United approval. Other Fees Service Description Fee Consolidated Appropriations Act,2021("CAA")Support For the 2023 plan year,United will not charge separate Services. United will support Customer's compliance with the services fees outside of base rates for the CAA Support requirements of the CAA,including the No Surprises Act Services. United shall notify Customer of United's intent ("NSA"),by the respective enforcement date as follows: to apply a charge for any support services or information provided if additional regulatory guidance changes the • NSA medical billing and the independent dispute final compliance requirements. Customer remains resolution("IDR"): responsible for the$50 government agency administration o United will determine if a claim is subject to the NSA assessment and fees charged by the IDR arbitrator. billing protections. o If United and a provider are unable to come to an agreement within the prescribed negotiation period for a claim subject to the NSA billing protections, United will manage,direct,and make decisions and Fees for CAA Support Services for plan years after 2023 submissions to support the IDR for Customer. will be provided at a future date once regulatory guidance o All qualifying payment amounts under the NSA will is received and final compliance requirements are be calculated based on an insurance market across all determined. self-insured group health plans administered by United. o United will not be using third party provider networks for services covered by the NSA. o The fees for programs in which the parties share in the savings achieved off a provider's billed charge will continue to apply to all services covered under the NSA. 3 Proprietary Information of UnitedHealth Group o Customer shall fund all settlement amounts and payments required as a result of any IDR process decision through the Bank Account. o Customer shall fund the$50 IDR administration fee and all IDR arbitrator fees through the Bank Account. • Revised medical Plan ID cards(if United provides Plan Participants with ID cards currently). • Provider directory enhancements. • Continuity of care and external appeals support for surprise medical bills. • Support related to Mental Health Parity Non-Quantified Treatment Limitations audits initiated by the U.S. Department of Labor,U.S.Department of Health and Human Services or the U.S.Department of Treasury. • Provide language to support Customer's anti-gag clause attestation requirement. • Prepare and file pharmacy benefits and drug cost reports. • Prepare and file air ambulance claims reports. • Provide and maintain price comparison information to Participants by telephone and online. Health Plan Transparency in Coverage Rule("TiC") For the 2023 plan year,United will not charge separate Support Services. United will support Customer's compliance services fees outside of base rates for the TiC Support with the requirements of the TiC by the respective enforcement Services. date as follows: • Machine-readable files accessible via a publicly available website,which Customer will be able to access and link to Customer's own website. A cost estimator tool available online for Plan Participants for the items and services as required each year. Naviguard Program $2.50 per Employee per month • Offers reimbursement methodologies for emergent and non-emergent out of network claims which calculates allowed amounts based on what a healthcare provider generally accepts for the same or similar service. • Includes an advocacy component where Participants can access resources,and on-line tools and materials to help Participants stay in network and where assistance is provided in explaining reimbursement methodologies. • For claims above a threshold established by United, the advocacy component includes United negotiating with a provider on behalf of a Participant with respect to Participant's balance billed amount(e.g.,non- emergent,choice claim). • If the provider objects to what it was paid from the application of the allowed amount,or member contacts United for support with resolving a balance bill,United will increase compensation for a particular claim if:(a)United reasonably concludes that the particular facts and circumstances related to a claim provide justification for reimbursement greater than that which would result from the application of the allowed amount,and(b)United believes that it would serve the best interests of the Plan and its Participants(including interests in avoiding costs and expenses of disputes over payment of claims). External Reviews If and when applicable,for each subsequent external review beyond the limited number of free reviews based upon 4 Proprietary Information of UnitedHealth Group Customer's total enrollment, a fee of$500 will apply per review. Interest Rate on Fees and Underfunding Bank Account Prime+4% Run-out Claims Administration No Charge after the Initial Term. 6 months of runout Pharmacy Benefit Rebates-Termination Pursuant to the termination section of this Agreement, if Customer terminates the Pharmacy Benefit Services portion of this Agreement only during the Term of the Agreement and termination is for any reason other than for cause, United may retain all Rebates that have not been remitted to Customer as of the effective date of such termination. Disclosure: A United affiliate provides payment services to the healthcare industry and offers medical providers with various payment methods and options, including electronic payments, virtual cards and checks. Some options are available to medical providers for a fee and may result in the receipt of transaction fees or other compensation(e.g., 1%to 3%of the total transaction amount)by a United affiliate. This has no impact on the Fees paid by Customer under this Agreement. Credits Discretionary Allowance United will provide a discretionary allowance so Customer may enhance Customer medical benefits during the term of the Agreement. The discretionary allowance may be used at Customer's discretion as Customer utilizes wellness programming and services from United. If Customer terminates the Agreement prior to December 31,2024,Customer will pay United a prorated portion of this credit. $30,000 Wellness allowance per year. 5 Proprietary Information of UnitedHealth Group EXHIBIT C-PERFORMANCE GUARANTEES FOR HEALTH BENEFITS The Fees at risk do not include Customer-elected optional and non-standard programs Fees, all credits, Payment Integrity Programs Fees, Out-of-Network Programs Fees, Commission Funds, Consultant Funds, and ancillary product Fees. The Fees payable by Customer under this Agreement will be adjusted through a credit to its fees in accordance with the performance guarantees set forth below unless otherwise defined in the guarantee. Unless otherwise specified, these guarantees apply to medical benefits and are effective for the period beginning January 1, 2023 through December 31, 2023 ("Guarantee Period"). With respect to the aspects of United's performance addressed in this exhibit,these fee adjustments are Customer's exclusive financial remedies. United shall not be required to meet any of the guarantees provided for in this Agreement or amendments thereto to the extent United's failure is due to Customer's actions or inactions or if United fails to meet these standards due to fire, embargo, strike, war, accident, act of God, acts of terrorism or United's required compliance with any law, regulation,or governmental agency mandate or anything beyond United's reasonable control. Prior to the end of the Guarantee Period,and provided that this Agreement remains in force,United may specify to Customer in writing new performance guarantees for the subsequent Guarantee Period. If United specifies new performance guarantees,United will also provide Customer with a new Exhibit that will replace this Exhibit for that subsequent Guarantee Period. Claim is defined as an initial and complete written request for payment of a Plan benefit made by an enrollee, physician, or other healthcare provider on an accepted format. Unless stated otherwise, the claims are limited to medical claims processed through the UNET claims systems. Claims processed and products administered through any other system, including claims for other products such as vision, dental, flexible spending accounts, health reimbursement accounts, health savings accounts,or pharmacy coverage, are not included in the calculation of the performance measurements. Also, services provided under capitated arrangements are not processed as a typical claim,therefore capitated payments are not included in the performance measurements. Time to Process in 10 Days Definition The percentage of all claims United receives will be processed within the designated number of business days 101 of receipt. Measurement Percentage of claims processed 94% Time to process,in business days or less after receipt of claim business days 10 Criteria Standard claim operations reports Level Site Level Period Annually Payment Period Annually Fees at Risk Total Dollars at Risk for this metric $14,286 Payment Amount Of the Fees at Risk for this metric percentage at risk for each gradient 20% Gradients I I business days 12 business days 13 business days 14 business days 15 business days or more Procedural Accuracy Definition Procedural accuracy rate of not less than the designated percent. Measurement Percentage of claims processed without procedural i.e.non-financial)errors 97% Criteria Statistically significant random sample of claims processed is reviewed to determine the percentage of c1min dollars processed without procedural i.e.non-financial errors. Level Office Level Period Annually Payment Period Annually Fees at Risk Total Dollars at Risk for this metric $14,286 6 Proprietary Information of UnitedHealth Group Payment Amount Of the Fees at Risk for this metric,percentage at risk for each gradient 20% Gradients 96.99%-96.50% 96.49%-96.00% 95.99%-95.50% 95.49%-95.00% Below 95.00% Dollar Accuracy DAR Definition Dollar accuracy rate of not less than the designated percent in an uarter. Measurement Percentage of claims dollars processed accurately99% Criteria Statistically significant random sample of claims processed is reviewed to determine the percentage of claim dollars processed correctly out of the total claim dollars paid. Level Office Level Period Annual) Payment Period I Annually Fees at Risk Total Dollars at Risk for this metric $14,286 Payment Amount Of the Fees at Risk for this metric,percentage at risk for each gradient 20% Gradients 98.99%-98.50% 98.49%-98.00% 97.99%-97.50% 97.49%-97.00 Below 97.00% Phone service guarantees and standards apply to Participant calls made to the customer care center that primarily services Customer's Participants. If Customer elects a specialized phone service model the results may be blended with more than one call center and/or level. They do not include calls made to care management personnel and/or calls to the senior center for Medicare Participants,nor do they include calls for services/products other than medical,such as mental health/substance abuse,pharmacy (except when United is Customer's pharmacy benefit services administrator),dental,vision,Health Savings Account,etc. Average Speed of Answer Definition Calls will sequence through United's phone system and be answered by customer service within the parameters set forth. Measurement Percentage of calls answered 100% Time answered in seconds,on average seconds 30 Criteria Standard tracking reports produced by the phones stem for all calls Level Team that services Customer's account Period Annually Payment Period Annually Fees at Risk Total Dollars at Risk for this metric $14,286 Payment Amount Of the Fees at Risk for this metric,percentage at risk for each gradient 20% Gradients 32 seconds or less 34 seconds or less 36 seconds or less 38 seconds or less Greater than 38 seconds Abandonment Rate Definition The average call abandonment rate will be no greater than the percentage set forth Measurement Percentage of total incoming calls to customer service abandoned,on average Criteria Standard tracking reports produced by the phones stem for all calls Level Team that services Customer's account Period Annually Payment Period Annually Fees at Risk ' Total Dollars at Risk for this metric $14,286 Payment Amoiffl Of the Fees at Risk for this metric,percentage at risk for each gradient 20% Gradients 1.81%-2.30% 2.31%-2.80% 2.81%-3.30% 3.31%-3.80% Greater than 3.80% Call Q ality Score 7 Proprietary Information of UnitedHealth Group Definition Maintain a call quality score of not less than the percent set forth Measurement Call quality score to meet or exceed 93% Criteria Random sampling of calls is each assigned a customer service quality score,using United's standard internal call quality assurance program. Level Office that services Customer's account Period Annual) Payment Period Annual) Fees at Risk Total Dollars at Risk for this metric $14.286 Payment Amount Of the Fees at Risk for this metric,percentage at risk for each gradient 20% Gradients 92.99%-91.00% 90.99%-89.00% 88.99%-87.00% 86.99%-85.00% Below 85.00% Employee Member Satisfaction Definition The overall satisfaction will be determined by the question that reads"Overall,how satisfied are you with the way we administer your medical health insurance Ian?" Measurement Percentage of respondents,on average,indicating a grade of satisfied or higher 80% Criteria Operations standard survey,conducted over the course of the year;may be customer specific for an additional charge. Level Office that services Customer's account Period Annual) Payment Period Annual) Fees at Risk Total Dollars at Risk for this metric $7.143 Payment Amount Of the Fees at Risk for this metric,percentage at risk for each gradient N/A Gradients Not applicable Customer Satisfaction Definition The overall satisfaction will be determined by the question that reads"How satisfied are you overall with UnitedHealthcare?" Measurement Minimum score on a 10- oint scale score 6 Criteria Standard Customer Scorecard Survey Level Customerspecific Period Annual) Payment Period Annual) Fees at Risk Total Dollars at Risk for this metric $7.143 Payment Amount Of the Fees at Risk for this metric,percentage at risk for each gradient N/A Gradients Not applicable Effective 3anuary 1,2023 through December 31,2024 each twelve month period is a,"Guarantee Period" Pharmacy Financials Definition Contracted pharmacy rates that will be delivered to You. Measurement O1/O1/2023 01/01/2024 and Criteria Combined Discount Guarantee-Broad Network Retail Brand,Average Wholesale Price(AWP)less 19.2% 19.4% Retail Brand--90 Day Supply,AWP less 23.1% 23.3% Retail Generic-30 and 90 Day Supply,AWP less 83.2% 83.4% Mail Order Brand,AWP less 25.5% 25.5% Mail Order Generic,AWP less 85.5% 85.5% The Guaranteed Discount amount will be determined by multiplying the AWP by the guaranteed discount off AWP by each component and adding the amounts together. Dispensing Fees-Broad Network Retail Brand-30 Day $0.60 $0.60 Retail Brand--90 Day Supply $0.10 $0.10 8 Proprietary Information of UnitedHealth Group Retail Generic-30 Day $0.60 $0.60 Retail Generic--90 Day Supply $0.10 $0.10 Dispensing fee totals are calculated by multiplying the actual scripts for each type by the contracted rate for that script ty e. Fixed Rebate Guarantee(Traditional PDL) Basis,per script Brand Brand Retail-30 Day $61.73 $64.86 Retail-90 Day Supply $181.00 $182.77 Mail Order $144.18 $135.29 Specialty $328.03 $338.82 Credits and Allowances Rebate Fee Credit(PEPM) $40.00 $40.00 Annual Audit Credit(flat amount) $20,000.00 $20,000.00 Fees Clinical Prior Authorizations(per review) $50.00 $50.00 Direct Member Reimbursement(per paper claim) $2.50 $2.50 Level Customer Specific Period Annually Payment Period Annually Payment The amount the actual discounts are less than the combined guaranteed Retail,Mail,and Specialty discount Amount amount. Discounts Payment Amount -- 1-he amount the combined actual dispensing fee exceeds the combined contracted dispensing fee. Dispensing Fees Payment Amount The amount the combined actual Rebate amount is less than the combined guaranteed Rebate amount. Rebates Conditions Discount&Dispense Fee Specific Conditions •Discounts are based on actual Network Pharmacy brand and generic usage of retail and mail order drugs. The guaranteed discount amount will be determined by multiplying the AWP by the contracted discount rate off AWP by component. •Does not apply to items covered under the Plan for which no AWP measure exists. •Discounts calculated based on AWP less the ingredient cost;discount percentages are the discounts divided by the AWP. Discounts for retail and mail order generic prescriptions represent the average AWP based on savings off Maximum Allowable Cost(MAC)pricing for MAC generics and percentage discount savings off AWP for non-MAC generics. All other discounts represent the percentage discount savings off of AWP. •The arrangement excludes generic medications launched as an'at-risk'product,generic medication with pending litigation,compound drugs,retail out of network claims,mail order drugs(for dispensing fee arrangement)and Indian Health Service Claims. •The Arrangement excludes usual&customary claims,vaccines,long term care facility claims. •The Arrangement includes veterans'affairs facility claims,over-the-counter claims. •The 90 day supply Retail guarantee includes drugs dispensed for 84 days or greater. •The Mail Order guarantee includes drugs dispensed for 46 days or greater. •When a drug is identified as a brand name drug,it will be considered a brand name drug for the calculation of discount guarantees.When a drug is identified as a generic drug,it will be considered a generic drug for the calculation of discount guarantees. 9 Proprietary Information of UnitedHealth Group •Specialty drugs dispensed outside United's specialty Pharmacy Network are included in the retail guarantees. Specialty drugs dispensed through United's specialty Pharmacy Network are excluded from the Retail and Mail guarantees. •Drugs in the following Specialty therapeutic categories are included in the retail guarantees:None. Rebate Specific Conditions •Assumes implementation of United's Traditional PDL •Client directed deviations from the PDL and PDL exclusions or uptiers,or clinical programs may result in changes to pricing and guarantees,which will be factored in at the time of rebate payment and/or reconciliation. •Calculation of the guaranteed rebate amount will exclude ineligible claims including claims where the plan is not the primary payer(e.g.,coordination of benefits and subrogation claims),claims approved by formulary exception, claims not covered by Customer's benefit design or PDL,claims from 340B,long term care or federal government pharmacies,claims for non-FDA approved products,compound drugs,consumer card or discount card program claims and direct member reimbursement claims. •"Rebate Credit"is a credit towards the achievement of the guaranteed Rebate amount,and/or Rebate Fee Credit. The Rebate Credit is applied in the event of a change impacting the level of Rebates expected as a result of the availability of clinically comparable lower Rebate drugs.The Rebate Credit is calculated as the difference in pharmaceutical manufacturer revenue between what United would have invoiced pharmaceutical manufacturers if the Customer continued to prefer the originator brand product and the actual pharmaceutical manufacturer revenue received after favoring the new product(e.g.biosimilar,an authorized brand alternative,reduction of wholesale acquisition cost(WAC)on a Brand Drug subject to Rebates,launch of a lower cost non-Generic Drug alternative). The Rebate Credit does not apply to Generic Drugs that launch after the Brand Drug no longer has patent protection. United reserves the right to modify or eliminate this arrangement as follows based upon changes in Rebates: •if changes made to United's PDL,for the purpose of achieving a lower net drug cost for Customer and United's other ASO customers,result in significant reductions to the Rebate level •in the event that there are material deviations to the anticipated timing of drugs that will come off patent and no longer generate Rebates •if there is a change impacting the availability or amount of Rebates offered by drug manufacturer(s),including changes related to the elimination or material modification of a drug manufacturer(s)historic models or practices related to the provision of Rebates •if Customer changes or does not elect an incented plan design •United will pay Fixed Rebates consistent with the Agreement. To the extent Rebates paid to United exceed the Fixed Rebate amount,We will retain the excess,including any Rebates United may earn on prescription drug products in any tiers not included in this arrangement and any related interest. •Rebate Administrative Fee: United maintains systems and processes necessary for managing and administering Rebate programs. As consideration for these efforts,pharmaceutical manufacturers pay United administrative fees in addition to Rebates. Rebate Administration fees are included in the guaranteed rebate arrangement. •If Customer terminates pharmacy benefit services with United prior to the end of the Pharmacy Pricing Tenn, United will retain any and all pending or future Rebates payable under the Agreement as of the effective date of the termination of pharmacy benefit services. •Drugs in the following Specialty therapeutic categories are included in the retail per-Brand guarantees:None. •Vaccines are excluded from the claim counts. •Limited distribution drugs are excluded from the claim counts Credits and Allowances •Rebate Fee Credit: In addition to the guaranteed rebates,Customer will receive a rebate fee credit. Under this arrangement,rebates retained by United are used to lower the medical administration fee. 10 Proprietary Information of UnitedHealth Group •Pharmacy Management Allowance: United will provide a credit allowance to help Customer mitigate costs appropriately associated with the administration of the pharmacy program. This credit allowance is available once the parties have an executed Agreement and the first month of service fees under the Agreement has been received by United. Upon presentation of receipts of allowable costs,a credit will be issued in United's fee billing system in the amount of the receipted expenses,the total amount not to exceed the full credit. •If Customer terminates pharmacy benefit services with United prior to the end of the Pharmacy Pricing Term, Customer will repay United a prorated portion of the amount of the Pharmacy Management Allowance that has been paid as of the termination date. All unpaid credits are forfeit. General Conditions •All pricing guarantees shall remain in effect for the entire contract period of 01/01/2023 through 12/31/2024 ("Pharmacy Pricing Term"). Each twelve month period is a Guarantee Period. •Specialty drugs typically covered under the medical benefit(administered/handled by a provider,administered in a physician's office,ambulatory or home infusion),and/or transitioned to the pharmacy benefit,are excluded from all guarantees. •Drugs,products,supplies approved,covered and/or prescribed for the diagnosis,treatment or prevention of COVID-19 are excluded from all guarantees. •Guarantee terms are subject to change based on an evaluation of customer specific utilization data. •On mail order drugs,specialty drugs,and retail pharmacy drugs and services including dispensing fees,United will retain the difference between what United reimburses the Network Pharmacy and Customer's payment for a prescription drug product or service. • Pricing and guarantees assume enrollment of 903 Employees and 2,053 Participants;pricing and guarantees may be revised or withdrawn if actual enrollment varies by 10%or more from assumptions. •The lessor of three logic(non-ZBL)will apply to Participant payments. Participants pay the lessor of the discounted price,the usual and customary charge or the cost share amount. •All pricing guarantees require the selection of United as the exclusive mail provider. United will have no financial guarantee obligation under the Agreement for any partial Guarantee Period if Customer terminates prior to the end of the Pharmacy Pricing Term. •United shall on Customer's behalf,administer a fee("Consultant Fee")to be paid to HonestRX("Consultant"). The Consultant Fees are included in Customer's pharmacy financial terms. United shall provide Consultant with an annual audit credit of$20,000 and monthly payment for all Consultant Fees collected in the amount of $4.00 pmpm. The Customer acknowledges there is a contract between Customer and Consultant. Therefore,in the event that there is a dispute between Customer and Consultant over continuing to make the Consultant Fee payment(s)or in the delivery of consulting services,Customer shall hold United harmless in such disputes.In the event of any change whatsoever in the Consultant Fee,Customer shall immediately notify United of such change and United may propose changes to the pharmacy financial terms. •United reserves the right to revise or revoke this arrangement if. a)changes in federal,state or other applicable law or regulation require modifications;b)there are material changes to the AWP as published by the pricing agency that establishes the AWP as used in these arrangements;c)Customer makes benefit changes that impact the arrangements;d)there is a material industry change in pricing methodologies resulting in a new source or benchmark;e)it is not accepted within ninety(90)days of the issuance of our initial quote;f)if Customer changes their mail service benefit;g)Customer utilizes a vendor,that facilitates steering members to different drugs or pharmacies to the extent these services impact the financial guarantees under this Agreement. TRRX 02/2022 Specialty Pharmacy Specialty Pharmacy Discount Guarantee 11 Proprietary Information of UnitedHealth Group Definition Specialty drug discount level based on actual specialty drug utilization for the specialty drugs dispensed through United's specialty Pharmacy Network. United reserves the right to change the designation of a drug from specialty to non-specialty based on market conditions. Measurement A composite of 19.0%for drugs dispensed through United's specialty Pharmacy Network. This guarantee is effective 01/01/2023 through 12/31/2023. See chart below for a list of Specialty Drugs. A composite of 19.0%for drugs dispensed through United's specialty Pharmacy Network. This guarantee is effective 01/01/2024 through 12/31/2024. See chart below for a list of Specialty Drugs. Specialty drugs not included on the list below and dispensed through United's specialty Pharmacy Network will be guaranteed at a discount of 14.0%. Actual utilization, using Average Wholesale Price(AWP) in dollars, using our data, of listed Criteria specialty drugs through Our specialty Pharmacy Network will be multiplied against the discount target to determine the overall discount target dollars. The overall discount target dollars may be adjusted based on utilization of unlisted drugs to which the separate 14.0%discount applies. This total will be compared to actual discounts achieved for these drugs during the Guarantee Period. Level Customer Specific Period Annual Payment Period Annual Payment The amount the actual discounts are less than the combined guaranteed Retail, Mail, and Amount Specialty discount amount. Conditions •Discounts calculated based on the AWP less the ingredient cost; discount percentages are the discounts divided by the AWP. Discounts for retail generic prescriptions represent the average savings off AWP based on Maximum Allowable Cost(MAC)pricing for MAC generics and percentage discount savings off AWP for non-MAC generics. All other discounts represent the percentage discount savings off of AWP. •Specialty drugs dispensed outside United's specialty Pharmacy Network,drugs for which no AWP measure exists and non-drug items are excluded. •Listed drugs which cease to be defined as specialty drugs during the Guarantee Period will be reconciled outside of the Specialty Pharmacy guarantee in the channel in which they are dispensed (retail or mail order). •Specialty drugs typically covered under the medical benefit(administered/handled by a provider, administered in a physician's office, ambulatory or home infusion), and/or transitioned to the pharmacy benefit, are excluded from all guarantees. •United reserves the right to revise or revoke this guarantee if: a)changes in federal, state or other applicable law or regulation require modifications; b)there are material changes to the AWP as published by the pricing agency that establishes the AWP as used in this guarantee; c)Customer makes benefit changes that impact the guarantee; d)there is a material industry change in pricing methodologies resulting in a new source or benchmark e)if actual specialty utilization is not substantially similar to that in the experience period data on which our quote is based. •On specialty drugs, United will retain the difference between what United reimburses the Network Pharmacy and Customer's payment for a prescription drug product or service. Specialty Drug Drug Name Included/Excluded Specialty Drug Drug Name Included/Excluded Category From Guarantee Category From Guarantee INFLAMMATORY ANEMIA ARANESP Included CONDITIONS ILUMYA Included INFLAMMATORY ANEMIA EPOGEN Included CONDITIONS KEVZARA Included INFLAMMATORY ANEMIA PROCRIT Included CONDITIONS KINERET Included INFLAMMATORY ANEMIA RETACRIT Included CONDITIONS OLUMIANT Included 12 Proprietary Information of UnitedHealth Group ANTICONVULSA INFLAMMATORY NT DIACOMIT Included CONDITIONS ORENCIA Included ANTICONVULSA INFLAMMATORY NT EPIDIOLEX Included CONDITIONS OTEZLA Included ANTICONVULSA INFLAMMATORY NT FINTEPLA Included CONDITIONS RIDAURA Included ANTIHYPERLIPID INFLAMMATORY EMIC JUXTAPID Included CONDITIONS RINVOQ Included INFLAMMATORY ANTI-INFECTIVE ARIKAYCE Included CONDITIONS SILIQ Included INFLAMMATORY ANTI-INFECTIVE DARAPRIM Included CONDITIONS SIMPONI Included PYRIMETHAMI INFLAMMATORY ANTI-INFECTIVE NE Included CONDITIONS SKYRIZI Included INFLAMMATORY ASTHMA FASENRA Included CONDITIONS STELARA Included INFLAMMATORY ASTHMA NUCALA Included CONDITIONS TALTZ Included INFLAMMATORY ASTHMA XOLAIR Included CONDITIONS TREMFYA Included CARDIOVASCUL INFLAMMATORY AR DROXIDOPA Included CONDITIONS XELJANZ Included CARDIOVASCUL INFLAMMATORY AR NORTHERA Included CONDITIONS XELJANZ XR Included CARDIOVASCUL IRON AR VYNDAMAX Included OVERLOAD DEFERASIROX Included CARDIOVASCUL IRON AR VYNDAQEL Included OVERLOAD EXJADE Included IRON CNS AGENTS AUSTEDO Included OVERLOAD FERRIPROX Included IRON CNS AGENTS ENSPRYNG Included OVERLOAD JADENU Included CNS AGENTS FIRDAPSE Included LIVER DISEASE OCALIVA Included MONOCLONAL ANTIBODY MISCELLANEOU CNS AGENTS HETLIOZ Included S BENLYSTA Included MOOD DISORDER CNS AGENTS INGREZZA Included DRUGS SPRAVATO Included MULTIPLE CNS AGENTS RILUTEK Included SCLEROSIS AMPYRA Included MULTIPLE CNS AGENTS RILUZOLE Included SCLEROSIS AUBAGIO Included MULTIPLE CNS AGENTS RUZURGI Included SCLEROSIS AVONEX Included MULTIPLE CNS AGENTS SABRIL 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