Requirements for Agreements with Pharmacy Sample Clauses

Requirements for Agreements with Pharmacy. Benefit Managers (PBMs) (a) Contractor shall ensure that contracts with PBMs meet requirements related to transparency, rebate pass back, cost pass-through at 100%, reporting of administrative fees and of pharmacy paid-amounts at a claim level. (b) Contractor shall obtain a third party market check and audit on an annual basis to ensure PBMs are compliant with requirements and is market competitive. This third party market check and audit shall: i. Be completed and delivered to Contractor by July 1 each year (beginning in 2021) and subsequently shared with the Oregon Health Authority within 7 days of delivery; and ii. Clearly identify the comparator data used as a benchmark for this market check and the current performance of each PBM. (c) Contractor shall include language within its PBM contract that the PBM contract is subject to amendment based on the market check report findings, and includes the following contractual provisions: i. If the market check report finds that current market conditions can yield “in the aggregate” gross plan pharmacy cost savings (defined as eligible charges plus base administrative fees) from three quarters of a percent (0.75%) to ninety-nine one hundredths of a percent (0.99%), the parties may elect to initiate discussions to review the existing pricing terms and other applicable provisions under the PBM contract to establish whether an adjustment should be considered. ii. If the market check report finds that current market conditions can yield “in the aggregate” gross plan pharmacy cost savings of a one percent (1.0%) or more, the parties shall execute an amendment to the existing pricing terms and other applicable provisions under the PBM contract within 30 days, to be effective on the later of 30 days post signature or by no later than October 1st of the evaluation year. (d) In no event shall Contractor enter into a pay for performance contract with any PBM prior to receipt of OHA’s Administrative Notice of approval. (e) Contractor shall align its prescription drug formulary with the fee-for-service Preferred Drug List (PDL) for any and all medications in drug classes required by OHA.
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Related to Requirements for Agreements with Pharmacy

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HHSC will not withhold or pay on behalf of the Contractor any sums for income tax, unemployment insurance, Social Security or any other withholding, or make available to the Contractor any of the benefits, including workers' compensation insurance coverage and health and retirement benefits, afforded to HHSC employees; and 2. the Contractor must indemnify HHSC from any liability, including attorneys' fees and legal expenses, incurred by HHSC with respect to claims that HHSC should have been withholding or making payments on behalf of the Contractor or providing benefits to the Contractor's employees. H. That nothing in this Contract is intended to create a joint venture, a partnership or a principal-agent relationship. I. That the Contractor assigns to HHSC all claims for overcharges associated with this Contract arising under the anti-trust laws of the United States, 15 U.S.C. §§ 1-38, or the anti-trust laws of the state of Texas, Tex. Bus. & Com. Code, §§ 15.01-.40. J. That HHSC has authority to monitor and conduct fiscal and program compliance reviews of the Contractor and its subcontractor(s) to the extent of services provided under the terms of this Contract. The Contractor will grant on-site access at reasonable times to all records relating to services provided and payments received under the terms of this Contract to state and federal auditing agencies and personnel and representatives of HHSC and HHS when it is deemed necessary by such agencies for purposes of inspection, monitoring, auditing or evaluating Contractor's performance under this Contract and compliance with applicable state and federal laws, rules and regulations; the applicable HHSC provider handbook or manual; and this Contract. That for Title XX programs, HHSC shall, by Form 2029, Information Worksheet – POS Contract, set the rate or maximum amount of funds or both available to be paid to Contractor by HHSC. Form 2029 is incorporated into and made a part of this Contract and is effective for the time stated on the form. Form 2029 may be amended by HHSC as necessary to comply with state and federal laws and regulations or renewed by HHSC by a new Form 2029 and incorporated into and made part of this Contract. K. 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That any breach or violation of any of the provisions of this Contract or state or federal regulations shall make this entire Contract, at HHSC's option, subject to termination. N. That if HHSC does not renew the Contractor's contract due to the Contractor's noncompliance with applicable federal or Texas statutes or rules, the Contractor cannot enter into another contract for a Community Services program until the application denial period established by HHSC expires. O. That the venue for any lawsuit between HHSC and the Contractor shall be Travis County, Texas. P. That this Contract may be terminated by:

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