Express Scripts/City of Carmel
_11...
'A EXPRESS SCRIPTS~
.4I!El:I'"
~Pfl.OV..IE. D~ TO
IFOltM IV: . \ '
Dec.mtJer~, 2608
City 01 C.rm,I,:lndi.na
One Civic:Squar~
Carmel.IN'4.803.2
Alln; Cily 01 Carm,l, IndiaM
We arflple~se~ lha.l, YQlJ'~a\le.agzea_d (o_,new terms:_urlder your Ma~aged.Prescriplion Dru~:Pi9g.r"f1:'IA.greeiTIen!wilh-E_:;(pressS{:'npi
Thi5le~er wm servij 10 confirm ttlat Expfes::;,Scnplswill c{]ntinw~:to m":inage lhe costs arid utilllBli-an ol;youf preschplion,druQ.bemifll plan.
While iM,coniracling process ~asbaen i~itialtra, a'de~inlllije,agrsemenllcDnlracl has r10Ibeen- e;(ecu~ed, In:Qrde-r la{ExpiesS:Scrip~ 10 be"
'able toimpremen'i agreed.'LlpO,ri,cliange3 10 yuur'pr-esc@troo d~g program withoul a sig~gd agreement; Expr.e?s ~Scrip~s,reqlli~~s.w len
conrirmat1o!1 from,yo_ucQnceming't~_~fi~all~ial terms o!{lur ~rrangemenl.
Subject 10 the~reqLiiraments~elow,_ E~pre55,Scripts l,'Iilfimph3manllheJ,inanciaJ ieiTl1:S sei.loithlri'lhe attached,to be effedfve'J-iinu'a" ~i.
. 2009 ~r 10 b~5lness daY5',~o!(owi~g our, recelpCaf 'hisJet:er' signed,by an ilPP'_Opr?,te ~ifjcef of YOj.lrorga~.i~aliOil II recdv~c! af.taJ Jan
1:~2009, .In:addl!lQn, Ihjspricing Ls-conditioned LJpgQ a;t~re.eYf':ar e!t~n-si.Qn wilh'ESI'as,yolH,excl,!,JsivB'P.BM.,
DLJe,to,lhe well pu_btfcizea court settlem~nt_underway regarding the, use of'AWP:Pncin~8e~c~marks as a'basis lor-pharmaceutical nCing,1
lhe R0dng, indices ;"used ~lof"~is .Ag~~eem~nl may,cfiarge'du-e 10 facjors outsida,ttle':c_onlrol'-o( you ,and ESI.:, Hbenchmark,changes.afe'
ma~.e under lh.;SA9re-emen1'and'an~ S\Jbseque~t,deffli!lj,~e:q~I'I~[aCI eX,ecule~ b~(~~e~ In~,pa~[~S,,9~( inlap!_,s,t9):,A!nt,8inF:.iel.ng, ~lJ;l?ility,
as Inlended ",.d',nol la,advanlage,e1lh,r party 10 IQ' delnmenla! Iheother, Should a change.occ,UT, ESr,nall prov,de}ou Wllh'alldast 90
.days n6lice,ol"thechange(or if_ such ilaticeis.J1ot practicable" as.mucn-notice'as'isreasonable;under I~e circurnSla"nce:s), and lJe will
providB wrillen,financlal iilustralions d~mons'raling. the: prfce, .neutral im~:actQi. th& drugfjleso~rce'or- im:le:r: change" (e,g:,.spe~cif ,::.'drug
. examples.). .
Expr~ssScr"ipis;'pOlicy prohibits the,wocessing of-subsidy rap;orts as:v/etl as p-aymei1ls-018u~hiterT)s'as'ieb,ates, guaranlees,comm ~?ions ..,.'
or olhe"r simjlarpa~merlls'unm a co,r.tra~lisr~I_ly E:',(~~uted.. P1ea;i~ al~ono,!E J~al ~~, !Jl~Y nOI,~~'a~I~_,tobill lor ~ar~fac.l~rer.reb<;1tes [or
any.. QUarter,for which. wnll~~ co~traClis 1]9.1 in pl~ce, ~o!.! aleg..1 '. Oillr.ici i.' nol in Plec. e by th.' lim.e we billlhe mAnUI'iclurers.1u'lBII.y
wiihin Iwo weeks ofine end oi a,calen-dar quarler) we may'no1 be atllB to bill lor reba1es for your,program Icrlhal-quarter. .
Expres~ Scnpls loolo;s ~orwar~ 10 a long and mutually salisfyi_ng,worJ.:II:lg:relat~onshipw1ln YO!1,(tyoy have ?.ry.gue~tr~D,?i pl~as~. ~qfilH.~l
Jeffer,Grahama1:314-996-o917, Ple~se;.sign and return th.15Ie1t~r ~i!l (~~,19 EUen Wynne al 80O-2.a7-Q3~g:afld meillhe original la' er
allenlion'atth~ ~ddr~:5.sbeI9~'.( ,
Company:
Signatu~E'; :
Printed Name:
Title:
Oflr: Expr~ss v.:':J.y;~".st.. Lotlt~~ MO '6,1 121 ,;3 14:1;l~.(;;0900:pwww.e:q:ires~~&ciiprs.com
IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement as follows:
CITY OF CARMEL, INDIANA
by and through its Board of Public
Works and Safety
BY:
BY:
Authorized Signature
Printed Name:
Title:
FID/TIN:
'14
p. '1 at!:>
SSN if Sole Proprietor:
Date:
IZ:\[ !k<sIMr o.:...n.......1.Pr"I~i"'LOI So:nO''''\FORM5\Pror~",,>.J s~~~ fO.R.'>l Rc. 2OU'l-dox: 111'n1lO~ o;H f"rI-C) 8
-,....
,. EXPRESS SCRIPTS@
.",,~
PHARMACY BENEFIT MANAGEMENT SERVICES
ProCING SUPPLEMENT.
FOR
CITY OF CARMEL
SEPT. 9TH, 200.8
Copyrighi'ro ~OO8'E~p.r~$!j^.Sc,~ipt~! l_nc",'A!1 rig~l$reser\.'Nt.,
ThisdocLlm~"-1 is'p.r~prietllrY'aIld {:annden_ti~l_and.c.Hlllot-be i;opied or repr(}duced
",,;ilboutprior v;.rjtren'['irrniSsion'~of.Ex:pr-l'ssSc:ripts.lril. This"dQClLlne-nt has been
'deiivrred'lolhc_ redpiellt ~Qldy 'r:Or.thepurpl.1se:Of permitting the recipient
. '10;ev.lli.i~ie'1l' poti'n(i~[i:rdatiijnshtp '~i,!I!Exr>res5 Scripts;"lne:
All otber t15eS prl:.hibifecl.
RETAIL PHARMACY NETWORK AND HOME DELIVERY PRICING
8lmefilPlan
,- "',~ -..,-." --.
2'TierF'li;,Oesjaril 3-TierF'lan Oesian'with'less,than'$15.00 Differential
~H[lm'eiDeliverY Horrie,Delivery,
'Traditional; . Retail :[riscouriis"~"-'
.- .". '~".' .,
Mi~i~u~nJi~9'.tS ,-~:: ... . ..- cjtHs'counts- l::ess'than'35
'. ....r '---
. . . days'sii~pW
. .
Pricing The lower of AWl". AWp.24% AWp-17%
17% or U&C
Brands Dispensing fee $1,501Rx $OIRx $1.50IRx
Administrative fee $O/Rx $O/Rx $O/Rx
The lower of AWl". The lower of AWl". The lower of AWl".
Pricing 17%, MRA or 24% or MRA 17%, MRA
Generics U&C
Dispensing lee $1.65IRx $O/Rx $1,65/Rx
Administrative fee $DIRx $O/Rx $DIRx
Rebates - Rebate Guarantee $2.00IRx $9,OOIRx $9,OOIRx
Per Claim
. If the calculation of fhe cost of the claim is less than Express Scripts' minimum Home Delivery rafe
(currently $8,99) end less than fhe applicable copayment, fhen the member will pay the greater oftheAWP
discount price, or the Minimum Rate,
Express Scripts' Specialty Offering
Express Scripts' Exclusive specialty option IS designed to offer clients maximum cosl savings and superior
patient care. Under Ihis option, patients obtain all specialty medications through our CuraScript specialty
pharmacy at the reimbursement.rates set forth below, Specialty drugs will not be available through other
pharmacies except for:
. limited distribution products not available at CuraScript
. initial courtesy fills as allowed by Sponsor's plan design, and
. overrides for urgent situations.
City of Carmel
Sept 9th, 2008
1
Pricing Supplement
STANDARD DISCOUNTS:
Except for the specific items iisted in the Exceptions or Limited Distribution tables below, Specialty drugs wiil
h h f '
ave t e oilowlnQ discounts:
Distribution Channel Standard Discounts DispensinQ Fee
CuraScript
. The lower of:
. AWP -15%, or $0.00
. MRA
Participating Pharmacies
The loweat of:
. AWP - 15% plus Dispensing Fee $2,00
. MRA plus Dispensing Fee
or
. U&C
Specialty products will not be available through the Express Scripts Mail Service Pharmacy,
Limited Distribution Drugs
Distribution of a small number of ail specialty drugs is limited by the manufacturer to specific pharmacy
providers, The drugs, listed below, are not available through CuraScript. If CuraScript receives a
prescription for one of the following Limited Distribulion medications, CuraScript will: .
. Determine the pharmacy that is able to dispense the medication,
. Validate that the pharmacy is contracted to provide the medication based an the patient's
insurance information and will:
o Work with. the patient and prescribing physician to initiate the transfer of the script to the
appropriate pharmacy for tUlfillment, or
o Provide the patient and physician with information regarding possible patient assistance
programs.
The cost of the medication wiil be billed through your regular invoice if il is a covered product.
ADAGEN FLOLAN REMODULlN
APOKYN KEPIVANCE SOMAVERT
ARALAST MIRENA VENTAVIS
ARCALYST ORFADIN XYREM
BEXXAR I ORTHOCLONE OKT-3 ZEMAIRA
CEPROTIN I PRIVIGEN ZEVALlN
EXJADE PROLASTIN
Drug,Name
Exceptions to Standard Pricing
The following speciaily drugs have the discounts shown for each distribution channel. Shaded ceils indicate
the Standard pricing above appliea for Ihe channel indicated,
City of Carmel
Sept. 9th, 2008
2
Pricing Supplement
Retail, CuraScript.
% Discountfrom AWP .'to DiscounifromAWP
ADVATE I 25.0%
ALPHANATE 25.0%
ALPHANINE 25.0%
ATGAM
BEBULlN
BENEFIX
BONIVA 13,0% 13,0%
BOTOX
CELLCEPT
CIMZIA
CYCLOSPORINE
EUFLEXXA
FEIBA 25,0%
FORTEO 13.0% 13.0%
HELlXATE FS 25,0%
HEMOFIL M 25,0%
HUMATE-P 25,0%
HYALGAN
IMPLANON 00 0,0%
IRESSA 13,0% 13,0%
KOATE-DVI 25,0%
KOGENATE 25,0%
LUPRON
LUPRON DEPOT
METHOTREXATE
MONARC-M 25.0%
MONOCLATE-P 25.0%
MONONINE 250%
MYOBLOC
NOVOSEVEN 25,0%
ORTHOVISC
PROFILNINE 25,0%
PROGRAF
RECLAST 13.0% 13,0%
RECOMBINATE 25,0%
REFACTO
RIBAPAK 25.0%
RIBASPHERE 25,0%
RIBATAB 25,0%
RIBAVIRIN 50,0%
SANDIMMUNE
SOMAVERT 10,0%
SUPARTZ
SYNVISC I
XYREM 12,0% I
ZENAPAX I
UPDATES
Express Scripts updales the specially drug lists as new products are introduced to the market, or as
CuraScript gains access to additional limited dislribulion drugs, and provides a monthly notice of added
drugs. Pricing for these new products will be determined by Express Scripls and Sponsor will have the
option of covering or not covering the medication.
The full current list is always available on request from your Account team.
City of Carmel
Sept. 9th, 2008
3
pricing Supple'ment
Assumptions
Quoted fees and services are'validfClI' 90 diys from the date of the, proposal.
Quoted, fees are guaranteed for the term of the 3-yearcontract.
Minimum of] ,400lives will. be inlplemeh!ed on the effective date,
None ofthe menibershilllo be enrolled. is based on'a 100% copaymentbenefit plao,
Express Scripts reserves the right t!?"amend the price'quotation set' forth herein ifthere is a
material changeih,the oumber.ofpersons,included'in theprescrip;ion drug progr!lm or any
material change in'the oenefitpfan from that which waspresentedto Express' Scripts and
uponwhicli this price quotation is based, .
City of CarrheLagreesto adopt Express/Scripts, National Preferred Formulary, in ordedobe
eligible for rebale,s, wh~ther rebates;are paid or'applied. .
Rebateguarantees,assumethe current benefit pl?n design, or newbehefii plan design as
disc1ose.d bytne .client, \vill be implementedatthe time these,guarantees go into effect.
Rebate guarantees are subj,e,fto adjustment ifanyClinical 6i' trehdprograms'ilitcnded to
drive higher generic or over-the-counter (OTC) utilization arecurre;nly inplace'~vithout
Express Scripts' kngwledgeOf both the program, and drugs'within the'.program, Rebate
guarantees are also subjecl)O adjustment if the clien(chooses t6 impJemeotahy clinical or
trend tnaoilgemeht'programsintended to drive,higher generic or OTC utilization duringlhe
course,oftl1e'contract, Rel5ates.are paid onlyupon receipf:ofa signed.contract
Rebates are paid on special,t)' products dispensed through CuraSi:ripl or participating fetail
pharmacies,
. Rebate, allocations will bemade,quari.erly within 150 days from the end of the quarter
. The ,rebate guarantee does 110t apply to claims processed;throughstaff'modellhos[lital
pharmacies where,such pharmacyis'subjectto its own manufacturer contracts (rebate,or
purchase discounts), or.through pharmacies that participate,in ~he Federal govefnnient
pharmaceutical.puich.asi'ig program, '
The parties uoderstand.ihat pricin,gindices historicalty used, (and that are the l5asisin'this
Agreement), for'determihilig.the financial, cOOlponentsofpharmacy billing rates'are outside
the controf of City of<;:armel,and Express Scripts. The,parties,also understand,tljat there ,are
currently extra-market industry, legal, government, andr~guliitoryactivities, which may lead
to chal)ges, relatilig to,.br elimination of; lhesepricing indices that.cpuld alter the fir.ancia!
positions orthe panies as infended'under ,tlll,s Agr,eemenl. The parties agree that, upon
enteringinto,ahy.resultal1l Agreement aod.thereafter, theirmut,ual int,~ntha:sbeen and is to
maintain pricing stability as'iiitended.and ilotto'advantage either partytQ.,thedetrimenl'ofthe
other, Accord'ingly. to preserve this mutual intent; if Express Scripts 'undertakes aoyor all of
the,following:
(i) changesthe:A WP sourceacross,{ts bookof bus mess (<:,g" from First DataB,ank to
MediSpan); or'
City of Carmel
Sept. 9th, 2008
4
Pricing Supplement
(ii) maintains A WP as the pricing index with an appropriate adjustment as descrihed below;
in the event the A WP methodology and/or its calcu lation is changed, whether by the
existing Or alternative sources; or
Ciii)transitions tbe pricing index from AWP to another index or bencnmark (e,g., to
Wnolesale Acquisition Cost),
the Participating Pharmacy, Curascript, and Mail Service Pharmacy rates, rebates and
guarantees, as applicable, will be modified as reasonably and equitably necessary to maintain
the pricing intent under this Agreement. Express Scripts sball provide City of Carmel with at
least ninety (90) days notice of the change (or ifsuch notice is not practicable, as much notice
as is reasonable under thc circumstances), and written illustration of the financial impact of
the pricing source or index change (e,g., specific drug examples). If City of Carmel disputes
the illustration or the financial impact of the pricing source, the parties agree to cooperate in
good faith to resolve such disputes.
. For each eligible prescription-drug claim, ingredient cost will be calculated at the
lesser of the applicable U&C, MRA, or A WP discount price in determining the
discount achieved for purposes of the guarantee, including 100% member copayment
(claims where full cost is paid by member).
City of Carmel
Sept. 9th, 2008
[;
Included Services
Pricing Supplement
Express Scripts' administrative fee, jncludes theJollowirig'syrvices:
PBrIlSeryices
Customer service for members
Electronic/an"lirie eligibility submission "
Standard.coordination of'benefits,(COB) (reject for
pri~a,ry ~arrier)
FSA eligibility feeds
Network' PharrT1~cy S~'Y!ces
Pharmacy help desk
,. p~armacynetworkmanagement
, HOrne DeliveryiSe.vlces
Benefit education "
Reportiri~iS"rVices
Web-based client rePorting - produced by client
Ad-hoc desktop parametric 'eports
Claims detai;"extracl frle,electro;nic:(NCPQP format)
Load:12 !!lonths claims history tor clinical ,eports
" . an?, reporting ~
Websi'te;Sel"\llces
Express-Scripts,com.tor qiie"ts & Advisors ~
~ccess'!o reportii1g lools, eligibilitYupdafe capability,
caritact directory: sales and marketirig,information,
and benefit and'enrallment support
ExpresscScripia,comfor lVi;,mbers - access to
ben'efit, drug, health and wellness information;
prescriptTon' ordering,capability; and customer,
service .
: linp'g;"i)),~r)i~liqn RackageandMemberCommunicatlOns,
New member'packets {includes two standard resin
H)'cards) . .
Member replacementcards printed,via web
'Safel)l:Managemenl
'Concurrent Dru~Util;zation Review (DUR)
T. reni:t:Niarlage'meht,
.' .'---'~ ".. ". -. - .'..
Prior Authorization--Administrative
Non-clinical Pdor A~thqriza1ion
LosUsto~eri overrides
VacaUonsuppliea
City of Carmel
Sept...9th,2008
E!ettran.ic:daims "processing
Planaetup
Software, training for access-to our .on-line
'," -.. P' .-.. .,"... . '-. ..-
'sX5Iem(s)
Ptlahllacy-reimbursement _.
Network development (upon request).
Prescription'deliveiy - standard
Annual Strategic'Account Plan report
'Biilirig'reports ... "
J nqui ryeccess.to claims" processing ,system.
Express Preview'M enrollment option - available
'during open enrollment 10 enable,members to
~evaluale pr€scripllon benefit pIan options
Digital Certificates.(up.to fivecertificales)
I mp)ementatlon:su PP<1rt
EmeigingTlierapeutics
Prior Authorization - Cliiiical Base List
Blood Glucose Metef' pr6g'ra'm '
Tlierapeulic Interchange.
6
Additional PBM Services
Pricing Supplement
PBM services
'r'o .",--
Manual/hardcopy eligibility submission
Member Submit (ee (includes Medicaid.subrogation
claims
Fees'
$1,OOlupdate (includes initial enlry)
$2.50Iclalm
",+. .. -
Netw6r~'Pha rmacy 'Senii ces,
.~ ----= "- " ".'
Pharrnac audit recoveries
Repoi1ingServices.
^. '-,' .~..
Web-based client reporting produced by Express
Scripts
Custom ad'hoc reporting
RepiacemelitMember,C6niriiiJrilcatiOn PacketS. .
~ ,'" .'-' ". 'L'_ . ,",',' .,... _J '
Member requested replacement packets
Clientre uested re-cardin
i_.ApP'~als11iY:MCMC
. ---" . .."" -.~
. Clinical appeals
. Non-clinical appeals
20% of audit recoveries
$100lrepon
$150/hour, with a minimum of $500
$350/review
S160/review
. Plana subject to state law (non-ERISA plans) will be
charged a retainer lee 01$1,000 per monte for appeala
handled b MCMC
MedIcllrll,Pa'hO;
d~
,-<'>
. Part 0 Subsidy enhanced service (Express Scripts
sends repons to cMs on behalf 01 client)
. Notice of Creditable Coverage
. Part o Subsidy standard service (Express Scripts
sends repons to client)
. Notice of Creditable Coverage
. Using Outside Cost ReporterNendor (ESI provides
final rebate fi ures
rtIe<!ic''fre:PiI(!tl
. Pan B Services (Retail and Mall Benefit)
$1.12 PM PM for Medicare-qualified members with a
minimum annual fee 01$7,500
$1,35/letler + postage
$062 PMPM for Medicare-qualified members wilh a
minjmum ann'ualfee of $5,000
$1,35/leller + postage
$0.42 PM PM
$0.42 PM PM for Medicare-qualified members
City of Carmel
Sept, 9th, 2008
7
Pricing Supplement
Optional Total Health al'!d'Trend l\IIanagem~nt Services
Express Scripts offers'a.'corhprehensive,slliteoftrend 'and total healtlFmanagement'programs. We
'q - .
have identified'programsb~low.mostoften imp]emented.byour,p]an s'pohsors, .This olferi~g jnay
change onbe i:1iscontinlled from time to time as we' U p,d ate 'our offering to meet the,needs ofthe,
,mark~tp]ace. Expres,sScriptsalso.offe'rs additional prograins,aswe]l as savings:guarantees,
under ce,l1ain'cond[tiqns, Information concef!liilg'~ucbprograri1s, guarmltees, andfe.es, if
applicahle, is'available on request.
Trend Manag.~mentil?rograms
Drug Quantity Management"
Prior'Authorization - Cllnicai Supplemental List"
Prior Authorization -Oiher Clinical Overrides (e.g. non.
standaro .Prior AuthorizaXioD 'Dedications, medical excepllons)
Step Therapy- individual modules'and packages available
More than 25 modules available. the mO'SI I1tilized'inClude:
ACElnhib1!ors.a'nd angibtensln"2,eceptorblackers (ARBs),
non-steroidal a'nii.innammatory drugs (NSAIOS) and COX.2s,
proton'pump-inhibiiors (PPls), selectiveaerotonin reuptake.
,lIlliibitors (SSRis): Hrv\G'enha,k~d 2al~ium' chan6el bloclierS,
'Ieuk.otri,me pathwayinhibitars:topical immunomoaulators,
olherantidepressanls:
Formulary Rapid Response
SO GenericCop~y
. List of drugs subject tochangeaithedi~cretion oftxpress Scripts,
F~~s
$002;PMPM
$O,o'3PMi"M
"$20/request'
$25/physicianreview
Pri.ci~g varies. by module
$0:01 PMPM
S1.25/member mailing or $1,OoOfor
mem beLldentJfl Qatiqn. and, aut&orh:ation
T6talHea Ith'Ma1i"gemenlJ>tQ'gfams~.
.> - -~ . . ".-- .-
. .", ',-. :.'.., .-
, Ma.!l~ging,Me<!iSe,tl,OI'! :r;her~pY:~,f,](S,,~ely
Medicallon Adherence
Retrospecliva.DUR
RelrOSoeclive OUR - Seniors
RxPredict$
Fe,eSJ
$o,02,PMPM
lIicludes,allseven modules
$O,03/Rx
W02/R~
$0,05 PMPMfor.six months each,time
t,he report is run (e.g: 100,000 members.
'$005 PMPM . six months). A
sJbsequenlcharge willoccu'rwith the
second.J~p.ort. The~eds a'minimum
charee of $3,000.
'.' ,-~ .
Maraging,Overal! liealtll
Car" Management
Disease Management
Tllre~-~i-sease: suite'
Fi\ie".disease suite
S'ix-dlsease .suite
City of Carmel
Sept. 9th, 2008
$OOt/claim Asthma
$O.01iclaim ~ Cardiovascular Disease
$O,02/C1aini - CHF
$0,02/claim -Depression
$O:Ot/claim'- Diabetes
$O:.03/claim - 81 Disease
$0.02/c1aim- Hypertension
$O,02iclaim ~ Mi raine
Priced upon.request
8
Pricing Supplement
Total Health Managemeni;Programs" . Fees
.."._ ..... '0'__ ,-.. __ ._, p __
ExpressAlliance Levei 1
5,000-20,000 ,lives $0,04 PMPM
20,000-50,000 lives $0.02 PMPM
50,000+ lives $001 PMPM
ExpresaAlllance Level 2
5,000-20,000 lives $0,20 PMPM
20,000-50,000 lives $O,1OPMPM
50,000+ lives $0.09 PMPM
ExpressAlliance Lever3
5,000-20,000 lives $0.35 PMPM
20,000-50,000 lives $0.20PMPM
50,000+ lives $0.18 PMPM
RxPredict$ $0.05 PMPM for six months each time
the report is run (e,g, 100,000
members' $0.05 PMPM' six months),
A subsequenl charge will occur with the
second report. There is a minimum
charne of $3000.
High Utilizer & Case Management Report $150/report
,. All programs are optional and will only be Implemented upon client request
City of Carmel
Sept. 9tt!, 2008
9
Pricing Supplement
Billing and Payment
Billing Information'
Billing Frequency
Payment Options.
Weekly or twice per month
Wire Transfer
Payments must be transferred within two days of receipt of the Express Scripts
invoice/billing statement
Payments must be made within two days of receipt of the Express Scripts
invoice/billing statement
Automated Clearing
House (ACH)
Pre-Aulhorized Debit Funds must be available in the client's bank account within 48 houraof receipt
Tranaaction of the Express Scripts invaicelbiiling statemenl
Please note that each client is subject to a standard credit evaluation,
City of Carmel
Sept. 9th, 2008
10
Pricing Supplement
Financial Disclosure to Express Scripts Clients
Express Scripts is a provider of pharmaceutical benefits management ("PBM") and other related
services to thousands of client groups including managed care organizations, health insurers, employer
groups, third-party administrators and government entities, Express Scripts' subsidiary companies,
some of which provide services related to supporting our PBM services, include Express Scripts Mail
Pharmacy Service, lnc" CuraScript Pharmacy, Inc" Express Scripts Specialty Distribution Services,
Inc" and Phoenix Marketing Group, LLC. This disclosure provides an overview of the revenue
sources that allow us to deliver competitive pricing arrangements to our clients,
Express Scripts offers its clients, either directly or through its subsidiary companies, a variety of
services related to the management of prescription drug benefits, The specific services provided to
each client are documented under the Pharmacy Benefit Management Agreement, or other similar
agreement, with our client Express Scripts' PBM services typically include claims processing and
adjudication, pharmacy network contracting and management, formulary development and
managemenl, rebate management and administration, trend management, and clinical program
development and fulfillment, Some of our clients also utilize our mail service pharmacy to provide
their members with convenient access to safe and affordable prescription drugs through home
delivery, In addition to the administrative fees paid to us by our clients for these core PBM services,
Express Scripts derives revenue from other sources, including arrangements with pharmaceutical
manufacturers and retail pharmacies. Some of Ihis revenue relates to utilization of products by
members of the clients for whom we provide PBM services.
Network Pharmacies - Express Scripts contracts for its own account with retail pharmacies to
dispense prescription drugs to members of the clients for whom we provide PBM services, The rates
paid by Express Scripts to these pharmacies differ from one network of pharmacies to the next, and
among pharmacies within a network, Express Scripts generally contracts with clients 10 be paid an
ingredient cost for drugs dispensed in a given retail network selected by the client at a uniform rate
that applies to all pharmacies in the selected network, Thus, where the rate paid by a client exceeds
the rate negotiated with a particular pharmacy, Express Scripts will realize a positive margin on the
applicable prescription, The reverse may also be true, resulting in negative margin for Express
Scripts, In addition, when Express Scripts receives payment from a client before payment to a
pharmacy is due, Express Scripts retains the benefit of the use of the funds between these payments,
Manufacturer Rebates and Associated Administralive Fees - Express Scripts contracts for its own
account with pharmaceutical manufacturers to obtain rebates attributable to the ulilization of certain
prescription products by individuals who receive benefits from clients for whom we provide PBM
services, Rebate amounts vary based on the volume of utilization as well as the benefit design and
formulary position applicable to utilization of a product. Express Scripts often pays all or a portion of
the rebates it receives to a client based on the client's PBM services agreement, Express Scripts
retains the financial benefit of Ihe use of any funds held until payment is made to a client. In
connection with our maintenance and operation of Ihe systems and other infrastructure necessary for
managing and adminislering the rebate process, Express Scripts also receives administrative fees from
pharmaceutical manufacturers participating in the rebate program discussed above, The services
provided to participating manufacturers include making certain drug utilizalion data available, as
allowed by law, for purposes of verifying and evaluating the rebate payments, Administrative fees
retained by Express Scripts in conneclion with its rebate programs do not exceed 3,5% of the A WP of
the produclS for which rebates are payable 10 Express Scripts,
Pharmacy Dispensing and Distribution - Express Scripts has several licensed pharmacy subsidiaries,
including our specialty pharmacies. These entities purchase prescription drug inventories, either
directly from manufacturers or from drug wholesalers, for dispensing to patients or for distribution to
physician offices, Purchase discounts off the acquisition cost of these products are made available by
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Sept. 9th, 2008
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Pricing Supplement
manufacturers in the form of both up-front and relrospective discounts, Such discounts are not
considered part of the rebates paid to Express Scripts by manufacturers in connection with our rebate
program, While rebates are directly attributable to the utilization of pharmaceutical products by
individuals who receive benefits from clients for whom we provide PBM services, product acquisition
price discounts are based on a pharmacy's inventory needs and, in the case of specialty pharmacies,
the perfomlance of related patienl care service obligations, The purchase discounts obtained by these
facilities are not based on any client's benefit design, When an Express Scripts subsidiary pharmacy
dispenses or distributes a product from its inventory, the purchase price paid for the dispensed
product, including applicable dispensing fees, may be greater or less than the pharmacy's acquisition
cost for the product net of purchase discounts, In general, our pharmacies realize an overall positive
margin between this net acquisition cost and the amounts paid for the dispensed products,
Pharmaceutical Program Services - Our specialty pharmacies, including CuraScript Pharmacy, Inc,
and Express Scripts Specialty Distribution Services, Inc" receive compensation from manufacturers
for their administration of programs related to the distribution of certain pharmaceutical products,
This compensalion is based on the fair market value of the services provided and is unrelated to the
drug formulary development process or drug utilization applicable totheclients for whom we provide
PBM services, Examples of Ihese services include (i) administering patient assistance programs for
indigent patients; (ii) administering product sample distribution programs; and (iii) dispensing
prescription medications 10 patients enrolled in clinical trials,
Data Reporting - Express Scripts sells certain data resulting from its PBM and pharmacy services to
healthcare data aggregators and similar entities from time .to time, We do not sell any data unless we
are permitted to do so by the terms of our client contract and by applicable patient privacy laws, In
addition, as a condition to receiving access to certain products, a specialty phannaceutical
manufacturer often will require a purchasing specialty pharmacy to report selected information to the
manufacturer regarding the pharmacy's service levels and other de-identified dispensing-related data
with respecl to patients who receive such manufacturer's product A portion of the discounts or other
compensation made available to our specialty pharmacies represents compensation for such reporting,
All such reporting activities are conducted in compliance with applicable patient privacy laws,
Other Pharmaceutical Manufacturer Services - Phoenix Marketing Group, LLC special izes in the
provision of sample fulfillment, sample accountability, alternative sampling, direct mail fulfillment,
and literature fulfillment services for pharmaceutical manufacturers, Because ilsservices involve only
warehousing and fulfillment-related functions, this subsidiary entity does not review products
clinically and it never uses" sells or has access to Express Scripts' client or member information,
Compensalion paid to Phoenix Marketing Group, LLC by pharmaceutical manufacturers is based on
the fair market value of such services, as established most often through an "RFP" process, and any
such compensation is unrelate~d to the drug formulary development process or drug utilization
applicable to the cliems for whom Express Scripts,provides PBM services,
Revised July, 2005
Express Scripts does nol conduct business in a fiduciary capacity to plan sponsors or members,
Express Scripts exercises no discretion with respecno the management of the plan or control of plan
assets.
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