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Res 2016-077/approving an administrative services agreement with United Healthcare Services, Inc. for the provision of medical, pharmacy, dental, flexible spending accounts (fsa), retiree, online enrollment tool and cobra benefits administration in a tot
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Res 2016-077/approving an administrative services agreement with United Healthcare Services, Inc. for the provision of medical, pharmacy, dental, flexible spending accounts (fsa), retiree, online enrollment tool and cobra benefits administration in a tot
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Resolutions
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Approving
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2016-77
Date
6/21/2016
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resulting from direct access connection, and (b) misuse and/or unauthorized disclosure of passwords and user IDs <br />provided by United which impact the System. <br />Termination. United reserves the right to terminate Customer's System access (i) on the date Customer fails to accept <br />the hardware, software and browser requirements provided by United, including any amendments thereto or (ii) <br />immediately on the date United reasonably determines that Customer has (i) breached, or allowed a breach of, any <br />applicable provision of this Section or (ii) materially breached or allowed a material breach of, any other applicable <br />provision of this Agreement. Customer's System Access will also terminate upon termination of this Agreement, <br />provided however that if six (6) months run -out is provided in accordance with Exhibit A - Services, Customer may <br />continue to access applicable functionalities within the Systems during the run -out period. Upon any of the <br />termination events described in this Agreement, Customer agrees to cease all use of Systems, and United will <br />deactivate Customer's identification numbers, passwords, and access to the System. <br />Section A7 Pharmacy Benefit Services <br />Pharmacy Network. United or its affiliate will provide the Pharmacy Benefit Services described in this Section. <br />United will make Network Pharmacies available to Customer Participants, through United's affiliate. United will <br />determine which pharmacies are Network Pharmacies. Network Pharmacies can change at any time and United will <br />when reasonably possible provide Customer with at least sixty (60) calendar day advance notice if any material <br />changes occur to the network. Upon request, United will provide Customer information on the reimbursement rate to <br />United's affiliated Network Pharmacies. <br />Mail Order Pharmacy Services. United will provide, through United's affiliate, mail order pharmacy services for <br />Customer's Participants. Customer's pricing terms for mail order pharmacy services are based on package sizes of <br />100 units, 16 ounce quantities or the next closest quantity available and at least a 46 day supply. Prescriptions filled <br />through the mail order pharmacy that are less than a 46 day supply will be processed at retail pricing and will be <br />counted with retail utilization. United will retain the difference between the package size of 100 units or 16 ounces <br />and the actual manufacturer's package size which the mail order pharmacy's price is based on. <br />Prescription Drug List (PDL). Customer has adopted one or more of United's PDLs for use with Customer's benefit <br />plans. Customer agrees not to copy, distribute, sell, or otherwise provide the PDL to another party without United's <br />prior written approval, except to Participants as described below. On termination of this Agreement or if Customer <br />deletes the Pharmacy Benefit Services portion of this Agreement, Customer will stop all use of the PDL. <br />While Customer is the ultimate decision -maker on selecting the design of Customer's PDL(s), Customer has requested <br />that United supply and assist Customer with, certain PDL development and management functions including but not <br />limited to drug tiering decisions. United's intent is to provide Customer with the same PDL and management strategies <br />that United develops and employs in the management of United's fully insured business. <br />United makes the final classification of an FDA - approved prescription drug product to a certain tier of the PDL by <br />considering a number of factors including, but not limited to, clinical and economic factors. Clinical factors may <br />include, but are not limited to, evaluations of the place in therapy, relative safety or relative efficacy of the prescription <br />drug product, as well as whether supply limits or notification requirements should apply. Economic factors may <br />include, but are not limited to, the prescription drug product's acquisition cost including, but not limited to, available <br />Rebates, and assessments on the cost effectiveness of the prescription drug product. <br />United may periodically down -tier the placement of a prescription drug product among the tiers. These changes may <br />occur without prior notice. Once a year, United may also up -tier the placement of a prescription drug product among <br />the tiers and/or recommend specific prescription drug product exclusions from coverage. United will provide notice <br />of at least sixty (60) calendar days to Customer of material changes to the PDL, United's drug tier classification <br />procedures, coverage exclusions, and clinical programs. If Customer chooses not to implement a particular coverage <br />exclusion or clinical program change, Customer needs to inform United in writing sixty (60) days prior to the effective <br />date of the exclusion or change. Current drug placement and related information may be obtained from the website, <br />or by calling customer service. <br />Claims Processing. United will process the claims received from a Network Pharmacy in accordance with the <br />Summary Plan Description, as well as the pricing and other terms of the Network Pharmacy's participation agreement. <br />On mail order pharmacy services, United will retain the difference between what we reimburse the Network Pharmacy <br />and Customer payment for a prescription drug product or service. <br />15 <br />
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