EXHIBIT 10.1
AGREEMENT BETWEEN CHOICECARE LONG ISLAND
AND
NATIONAL MEDICAL HEALTH CARD SYSTEMS, INC.
AGREEMENT, made as of this 1st day of April, 1990 between ChoiceCare Long
Island, ("Contractor") having its principal office at 00 Xxxxxxx Xxxxxxxx
Xxxxxxxxx, Xxxxxxxxx, Xxx Xxxx 00000 and NATIONAL MEDICAL HEALTH CARD SYSTEMS,
INC. ("Administrator") having its principal office at 00 Xxxxxx Xxxx Xxxxx, Xxxx
Xxxxxxxxxx, Xxx Xxxx, 00000.
WITNESSETH
WHEREAS, the Contractor provides health and welfare benefits to persons
and their dependents ("eligible participants") eligible to receive them and is
desirous of including a prescription drug program ("Program") as part of such
benefits; and
WHEREAS, the Administrator is engaged in the business of administering
claims for prescription drugs furnished through licensed retail pharmacies
("participating pharmacies");
NOW, THEREFORE the parties hereby agree as follows:
(1) Administrator shall enter into agreements with participating
pharmacies to fill prescriptions of the Fund's eligible participants in
accordance with the terms and conditions herein provided.
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(2) Administrator shall supervise the operation of the program for the
benefit of such eligible participants.
(3) From time to time the Contractor will provide Administrator with a
list of eligible participants.
(4) Within seven (7) working days after receipt of the list of eligible
participants, the Administrator shall issue an Identification Card to each
eligible participant.
(5) Prescriptions covered under the Program must be provided by a licensed
physician, dentist, podiatrist or other person licensed under law to prescribe
drugs and must fall into one of the categories set forth in Addendum I.
(6) Administrator shall pay the participating pharmacies for each
prescription dispensed hereunder. The Contractor shall determine the
professional fee and reimbursement schedule to be paid to participating
pharmacies. Said schedule shall be set forth in Addendum I. Administrator shall
pay the participating pharmacies when it has received payment of invoices from
Contractor on a bi-monthly basis.
(7) The Administrator will review all Prescriptions to confirm that they
meet the eligibility requirements described in Addendum I.
(8) The term of this Agreement shall be from March 15, 1990 to March 31,
1991.
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Unless otherwise agreed by the parties at the time of any such
termination, this Agreement shall continue to be operative for consecutive one
year periods with respect to obligations incurred hereunder prior to the date of
termination. When a termination date is agreed upon, the Administrator will have
the right to process all claims filled by members under the program up to that
termination date and submitted for payment within six (6) months from
termination of this Agreement.
(9) The Administrator shall deliver to the Contractor at regular
intervals, a schedule ("Schedule") of prescriptions processed and funds
disbursed by the Administrator. All necessary documentation will be provided to
the Contractor. The Contractor agrees to reimburse the Administrator within Ten
(10) days on receipt of Administrator's invoice.
(10) The Contractor shall have the right on reasonable notice to the
Administrator and during normal business hours, to inspect the Administrator's
books and records to substantiate payments made to the Administrator on behalf
of the Contractor. In the event that such inspection discloses an error in
invoicing or payment, a prompt settlement of differences shall be made. The
costs of such inspection shall be borne by the Contractor.
(11) The Administrator will assist in the design of all forms,
Identification Cards, and instructional information, and will provide a
reasonable supply to the Contractor without charge.
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(12) All notices hereunder shall be in writing and shall be deemed to have
duly given if delivered or mailed first class, postage prepaid, registered or
certified mail, return receipt requested to the parties at their addresses set
forth at the beginning of this Agreement or at such other addresses as the
parties may specify by notice delivered in accordance with this paragraph.
(13) This Agreement is being executed and delivered, and is to be
performed in the State of New York and shall be enforced in accordance with the
law of such State.
(14) This Agreement and its addendums constitutes the entire agreement
between the parties pertaining to the subject matter hereof and can be changed
only by a writing executed by both of the parties.
IT WITNESS WHEREOF, the parties hereto have executed this Agreement the
day and year first above written.
BY Xxxxx [Illegible]
-----------------------------------
TITLE Assistant Secretary/Treasurer
--------------------------------
NATIONAL MEDICAL HEALTH CARD
SYSTEMS, INC.
BY Xxxxxxx X. Xxxxxxx
-----------------------------------
TITLE President
--------------------------------
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ADDENDUM I - Plan Parameters
1. Prescriptions covered under this Program must be provided by a licensed
physician, dentist, podiatrist or other person licensed under law to prescribe
drugs and must fall into one of the following:
(a) Drugs which by law can only be obtained by prescription and subject
to the legend, "Caution, Federal Law Prohibits Dispensing without a
Prescription". (Except vitamins and dietary supplements.)
(b) Prescription drugs requiring compounding.
(c) Insulin with dosage indicated, and, which must be dispensed only in
a licensed pharmacy or out-patient hospital pharmacy in the United
States.
2. The following shall not be covered under the Program:
(a) Non-legend patent or proprietary medicine or medication except
insulin, not requiring a prescription (i.e., over the-counter drugs,
vitamins).
(b) cosmetics, dietary supplements and health or beauty aides not
requiring a prescription.
(c) Drugs to hospital in-patients.
(d) Drugs covered by claims made under workers compensation insurance.
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3. Prescriptions filled under the Program shall not exceed the larger of
thirty-four (34) day supply or one hundred (100) unit doses whichever is
greater. Refills will be permitted as per law when indicated on the original
prescription.
4. Administrator shall pay the participating pharmacies for each prescription
dispensed hereunder, the prescription cost determined as Average Wholesale Cost
for independent pharmacies and Ninety Five (95%) for chain pharmacies plus
professional fee. The Contractor shall determine the professional fee paid to
participating pharmacies.
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ADDENDUM II
Administrative Fees
1. For the services listed below to be provided by the Administrator, the
Contractor agrees to pay the Administrator the following:
(a) A service fee of ..59 for each claim processed and paid.
(b) $.25 per identification card issued.
2. Administrative fees shall be paid upon submission of a Statement of Charges
by the Administrator to the Contractor on a twice monthly basis.
- SERVICES -
- Production of Identification Cards.
- A computerized bi-monthly claims report with each invoice which list all
claims for the prior two week period.
- Computerized quarterly drug usage reports.
- Card recovery letter program for terminated members.
- Toll free WATS service throughout the United States.
- All standard forms needed for the effective operation of the program.
- Handling and postage expense for checks to pharmacies and members with
explanation.
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- Computer generated alphabetical membership listing as required.
- Pharmacy directories as required.
- Reports - Exhibit I
- Monthly Customer Accounting Tape
- I.D. card mailing to "eligible participants" other than postage
- Notification and explanation of benefits to members as approved by
Contractor.
- Audits of pharmacies.
- Hot stamping clients logos on I.D. cards - one color.
- Provide electronic access via modem to "eligible participants" data files
and to update eligibility.
Additional Services - billed at actual cost
- Postage for mailing cards directly to members.
- Custom designed reports.
- Hot stamping more than one color.
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