Drug Cost Reporting. Claim Administrator will provide on behalf of Employer, based on the type of pharmacy coverage and data Claim Administrator administers and maintains for Employer, health and drug cost reporting to the extent within the possession of Claim Administrator as contemplated by Section 204 of the CAA according to Claim Administrator’s standard processes and procedures, unless otherwise mutually agreed in writing. SAMPLE
Drug Cost Reporting. If requested by Participating Group, Caremark agrees to upload directly to the CMS RDS website, in an electronic format required by CMS and on the frequency indicated by Participating Group, the drug costs incurred by Participating Group’s Covered Retirees as Caremark reasonably believes is required by 42 CFR §423.888(b)(2) and (b)(4). Participating Group, shall remain fully responsible for determining whether drug cost data provided by Caremark meets CMS’ requirements, including, without limitation, the definitions of “gross retiree costs” and “allowable retiree costs” as provided in 42 CFR §423.882. In the case of direct uploads to the CMS RDS website, Xxxxxxxx agrees to upload the data in sufficient time for Participating Group to review and formally initiate the request for payment via the RDS website. In the case of submissions to the Participating Group, Caremark agrees to provide such data in sufficient time to allow Participating Group to submit such information via the CMS RDS website within the time periods specified by CMS. Additionally, Caremark agrees to respond to the records returned from CMS related to the submission of the Participating Group’s drug cost data. For all interim and final drug cost data whether uploaded by Caremark or Participating Group to the RDS website, Participating Group shall be responsible for reviewing the cost data, determining whether it meets CMS requirements, deciding to submit the payment request, accepting the terms of the payment agreement and providing its electronic signature for final submission of the payment request to CMS. The CMS RDS Payment Instructions are available on the Medicare Retiree Drug Subsidy Center website at xxxx://xxx.xxx.xxx.xxx and may be amended by CMS from time to time.
