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HomeMy WebLinkAboutC17-041 Kroger Prescription PlansKroger Prescription Plans SERVICE AGREEMENT Eagle County Government Eagle County Government Page I 1 C 17-041 PRESCRIPTION PLAN SERVICE AGREEMENT THIS SERVICE AGREEMENT (hereinafter referred to as the "AGREEMENT") is entered into the 1st day of January, 2017, between Kroger Prescription Plans, Inc., located at 1014 Vine Street, Cincinnati, OH 45202, hereinafter referred to as "KPP," and Eagle County Government, located at 500 Broadway, Eagle, CO 8163 1, hereinafter referred to as "Plan". WHEREAS, KPP is a corporation organized under the laws of the State of Ohio which offers comprehensive Pharmacy Benefit Management ("PBM") benefits to eligible individuals ("Eligible Members"), and WHEREAS, KPP has contracted with retail, and specialty pharmacies for the purpose of providing prescription services to Eligible Members of Plan, and WHEREAS, the Plan desires hereby to engage KPP to perform Pharmacy Benefit Management ("PBM") services relating to prescription claim processing, eligibility verification, pricing, managing and administering prescription drug programs, compliance and disease management programs, certain other PBM services, and reporting required by the Plan, and WHEREAS, KPP agrees to perform such matters, subject to the terms and conditions hereof: NOW THEREFORE, in consideration of the mutual promises and agreement herein contained, the Plan and KPP hereby agree as follows: I. DEFINITIONS 1.1. Average Wholesale Price ("AWP") The term "Average Wholesale Price" shall mean the average wholesale price for a given pharmaceutical product as published by drug pricing services such as Medi -Span or other third party pricing sources which KPP may select ("Pricing Source"). As of the Effective Date, KPP uses Medi -Span as its Pricing Source for AWP. AWP will be updated in KPP's online claims adjudication system on at least a weekly basis with data received from the Pricing Source, which if not received timely could result in delays. The applicable AWP for prescriptions dispensed shall be based on the actual NDC submitted by the pharmacy. AWP does not represent a true wholesale price, but rather is a fluctuating benchmark provided by third party pricing sources. 1.2. Benefit Plan The term "Benefit Plan" shall mean the Plan's evidence of coverage ("EDC") summary including claims processing parameters and other information specifying healthcare coverage for Eligible Members, as those parameters currently exist or may be amended in the future. The Plan will provide KPP with certain information relating to such Benefit Plans ("Benefit Plan Information") including, but not limited to, the names of the Eligible Members and their Dependents entitled to Prescription Drug Services, Eligible Members' Copayments, maximum benefit amounts, deductible amounts, pre-existing drug Eagle County Government Page 12 exclusions, and other parameters of the Eligible Members' Benefit Plan as KPP may reasonably request from time -to -time. 1.3. Brand Drug The term "Brand Drug" shall mean a prescription product identified as a "brand" by KPP using indicators from reporting services such as First Databank or other third party reporting sources which KPP may select ("Drug Attributes Source") and apply KPP's standard policies and systematic algorithms which may take into account various factors such as drug exclusivity and other elements. As of the Effective Date, KPP uses First Databank as its Drug Attributes Source. 1.4. Compound Drug The term "Compound Drug" shall mean a customized medication derived from two or more chemical compounds, devices, or powders, one of which is a federally legend drug. 1.5. Copayment The term "Copayment" shall mean such amounts (copayment, deductible, coinsurance) as are required to be collected by Participating Pharmacies from Eligible Members, pursuant to the Benefit Plan Information provided by the Plan. 1.5. Custom Network The term "Custom Network" shall mean any network designed and contracted to fit the specific needs of the Plan. 1.7. Dependents The term "Dependents" shall mean the dependents of each Eligible Member who are entitled to Prescription Drug Services through the Plan as identified in the Benefit Plan Information prepared and maintained by the Plan and delivered to KPP. 1.8. Effective Date The term "Effective Date" shall mean the date upon which this Agreement shall be effective. The Effective Date for this Agreement is the 1st day of January, 2017 or, the first day of the month post January 1, 2017 in which the contract is ratified, whichever is later. 1.9. Eligible Members The term "Eligible Members" shall mean those individuals who are entitled to Prescription Drug Services through the Plan as identified in the Eligible Member List prepared and maintained by the Plan, and delivered to KPP. 1.10. Eligible Member List The term "Eligible Member List" shall have the meaning set forth in Section 2.1. 1.11. ERISA The term "ERISA" shall mean the Employee Retirement Income Security Act of 1974, as amended. Eagle County Government Page 13 1.12. Formulary The term "Formulary" shall mean the list of outpatient prescription drugs, devices, and supplies that are covered by the Plan according to the Benefit Plan Information. 1.13. Generic Drug The term "Generic Drug" shall mean drugs that are off -patent, multi -source and single source drugs. Multi -source generic drugs are those drugs available from multiple manufacturers or those drugs available only from one manufacturer provided they had been available from multiple manufacturers in the past. Single -source generic drugs are those drugs available from one manufacturer only and that have never been available from another manufacturer. 1.14. HIPAA The term HIPAA shall mean the Health Insurance Portability and Accountability Act of 1996, Subtitle F — Administrative Simplification. 1.15. Identification Cards The term "Identification Cards" ("ID Cards") shall mean printed identification cards containing specific information about the prescription drug benefits to which the Eligible Members are entitled. KPP shall provide Identification Cards to Eligible Members. Family members will be listed on the cards at no additional cost to the Plan. 1.15. MAC The term "MAC" shall mean the then current maximum allowable cost of certain prescription products that will be reimbursed at a generic product level. 1.17. Mail Service Pharmacy The term "Mail Service Pharmacy" shall mean Postal Prescription Services (PPS) and the services of which are described in Exhibit A. 1.18. Participating Pharmacies The term "Participating Pharmacies" shall mean those organizations that contract with KPP to provide Prescription Drug Services for Eligible Members of the Plan, and shall include, but shall not be limited to, walk-ins, and specialty pharmacies. 1.19. Pharmaceutical Manufacturer The term "Pharmaceutical Manufacturer" shall mean a pharmaceutical company which has entered into an agreement with KPP to offer rebates and/or discounts for drugs and supplies. 1.20. Pharmacy Benefit Management ("PBM") Services The term "Pharmacy Benefit Management Services" shall mean KPP's Claims Processing Services, Pharmacy Network Management, rebate administration, reporting, and formulary and clinical support. These services shall be more specifically described in Exhibit A. Eagle County Government Page 14 1.21. Pharmacy Network Management The term "Pharmacy Network Management" shall mean KPP's responsibility for contract reimbursement negotiations, as well as provider relations with Participating Pharmacies. Reimbursement negotiations shall include: i) payment terms; ii) method of payment; iii) timeliness of payment; and iv) access fees, as well as any other issues related to payment to Participating Pharmacies. Provider relations shall include: i) store information updates; ii) credentialing; iii) contract compliance; iv) Eligible Member service issues; v) auditing of performance as well as any other issues related to the relationship with Participating Pharmacies. 1.22. Prescription Drug Services The term "Prescription Drug Services" shall mean those prescription drug services or supplies provided as a covered benefit to Eligible Members as set forth in the Benefit Plan. 1.23. Processed Claims or Claim Forms The terms "Processed Claims," "Claims," or "Claim Forms" shall mean all claims transmitted to KPP by Participating Pharmacies or Eligible Members as a result of dispensing Prescription Drug Services to Eligible Members. 1.24. Rebate The term "Rebate" shall mean any and all compensation that KPP receives from a Pharmaceutical Manufacturer, attributable to the purchase or utilization of Covered Drugs by an eligible participant under this Agreement, including, but not limited to, discounts, credits, rebates, regardless of how categorized; fees, market share incentives, commissions, and administrative management fees. 1.25. Specialty Products The term Specialty Products shall mean those prescription drug products provided in a separate list to the Plan. Any additional drugs added to the list must be made in good faith and be consistent with the industry prevailing characterization of the drug as a specialty drug in the marketplace by other reputable sources. Characteristics of specialty products include unique requirements for handling, shipping and storage, unique patient compliance and/or safety monitoring, and potential high cost products. 1.26. Subsidy Reports The term "Subsidy Reports" shall mean a monthly eligibility file and cost data extract representing gross covered retiree plan -related prescription drug costs for required Centers for Medicare and Medicaid ("CMS") reporting for payment of the subsidy, in such a format and contract as required under CMS rules. 1.27. Subrogation Claims The term "Subrogation Claim" shall mean those claims submitted by any Government Agency (or any person or entity acting on behalf of a Government Agency) on behalf of or in the name of an Eligible Member for which the Plan is responsible as a third -party Eagle County Government Page 15 payer by operation of applicable Laws. KPP will not be responsible for Subrogation Claims or HMS claims for terminated plans. H. DUTIES TO BE PERFORMED BY THE PLAN 2.1 Eligible Member List. The Plan or a designee shall provide to KPP a list of Eligible Members and their Dependents (the "Eligible Members List") and KPP agrees to provide mutually agreed upon refreshes and updates. The Plan shall be solely responsible for ensuring the accuracy of its Eligible Members List and shall be obligated to pay KPP for Claims accepted by KPP that are submitted by or on behalf of persons listed on any Eligible Members List. The Plan bears the risk of all fraudulent Claims submitted by Eligible Members or by unauthorized persons using an Eligible Member's ID Card or identification number for which the Plan knows or should have known were fraudulent. The Eligible Members List shall contain mutually agreed upon minimum information as required by KPP in the prescribed format. Subject to Section VI of this Agreement, KPP will be financially responsible for unauthorized paid claims in the event of KPP's negligence. 2.2 Benefit Plan Information. The Plan will deliver to KPP detailed Benefit Plan Information for each Eligible Member group. Such information shall contain all of the elements required by KPP (as set forth in Section 2.2) so that KPP may verify and price the Claims submitted by Participating Pharmacies, and to prepare the various reports specified by the Plan. In addition, the Plan shall provide any Benefit Plan Information changes that would require systems modifications to KPP at least thirty (30) days before the date such changes shall become effective (the "change date"). Failure to provide Benefit Plan Information changes in the time frame described in this Section 2.2 may result in postponement of the proposed change date. The Plan shall also provide to KPP on a timely basis any subsequent changes to applicable Benefit Plan Information related to the Prescription Drug Services administered by KPP under this Agreement. 2.3 Provision of Eligibility Information. KPP will provide Eligible Members List to the Participating Pharmacies; however, in providing this information, KPP will rely on the Eligible Members List as provided by the Plan or its designee. KPP will not pay any Claims for persons not listed on the Eligible Members List. To the extent permitted by law, the Plan shall indemnify KPP from any damages arising from inaccuracies in the Eligible Members List. KPP shall indemnify and hold harmless the Plan from any costs or damages arising from KPP's use of and/or reliance on Eligible Member information not provided by the Plan or its designee. The Plan accepts no responsibility for Eligible Member information not provided by the Plan or its designee. 2.4 Review and Notification Requirements. The Plan will review all reports, statements, and invoices provided by KPP and shall notify KPP in writing of any errors or objections within one hundred twenty (120) days of receipt. Specifically, this shall also apply to all service requests, benefit change request forms, and pharmacy operations change requests. Until the Plan notifies KPP in writing of any errors or objections, KPP will be entitled to rely on the information contained in the reports, statements, and invoices. If the Plan Eagle County Government Page 16 does not notify KPP in writing of any errors or objections within the one hundred twenty (120) day period, the information contained therein will be deemed accurate, complete, and acceptable to the Plan, and thereafter KPP shall have no liability related thereto. M. DUTIES TO BE PERFQRIVIED BY KPP 3.1 Provision of Services to the Plan. KPP shall provide to the Plan the services listed in Exhibit A. These services shall be provided at the agreed upon rates listed in Exhibit A. KPP shall perform the Services in a skillful, professional and competent manner and in accordance with the standard of care, skill and diligence applicable to consultants performing similar services. KPP represents and warrants that it has the expertise and personnel necessary to properly perform the Services and covenants that its professional personnel are duly licensed to perform the Services within Colorado. 3.2 Audit. The Plan shall have the right to audit the books and records, pursuant to Section 5.3 herein. IV. PAYMENT DUE KPP 4.1. Payments a. Compensation to KPP. The Plan will reimburse KPP in accordance with Exhibits of this Agreement. The Plan agrees to pay all valid invoices for administrative fees submitted by KPP within thirty (30) days of receipt. b. Billing and Funding. KPP shall invoice the Plan as set forth herein. All payments by the Plan shall be made via electronic fund transfer, Automated Clearing House ("ACH") debit, or other mutually agreeable method, within thirty (30) calendar days after the Plan receives an invoice from KPP. KPP shall retain cash management responsibilities over the Claims Payments to help ensure prompt payment to Participating Pharmacies. Notwithstanding the provisions above, in the event that KPP elects to render Claims Payments prior to its receipt of such funds from the Plan, such election shall not constitute a waiver of KPP's right to suspend performance or of the Plan's obligation to render payment to KPP, either as to that payment or as to any other payment, nor shall such election serve to establish a course of dealing or a course of performance between KPP and the Plan. 4.2. Sale and Use Taxes. The parties hereby agree that the payment of any and all state and local sales taxes (and use taxes, if applicable) attributable to any Prescription Drug Services delivered pursuant to this Agreement shall be the sole and exclusive obligation of the Plan using the business processes and practices established by KPP. 4.3 Notwithstanding anything to the contrary contained in this Agreement, Eagle County Government ("Plan") shall have no obligations under this Agreement after, nor shall any Eagle County Government Page 17 payments be made to consultant in respect of any period after December 31 of any year, without an appropriation therefor by County in accordance with a budget adopted by the Board of County Commissioners in compliance with Article 25, title 30 of the Colorado Revised Statutes, the Local Government Budget Law (C.R.S. 29-1-101 et. seq.) and the TABOR Amendment (Colorado Constitution, Article X, Sec. 20). V. RECORDS 5.1. Maintenance of Records. KPP shall maintain documentation of all Claims processed for six (5) years from the date of payment of the Claim or for such longer period if required by applicable law. Such documentation shall be in a format and media deemed appropriate by KPP. Upon request, the Plan shall be entitled to review and audit all Claims processed by KPP, pursuant to Section 5.3 below. 5.2. Ownership of Information. Subject to the restrictions set forth therein: a. Claims data information provided to KPP by the Plan shall be the property of the Plan. b. The Plan agrees that the aggregate compilations of information contained in any and all databases developed by KPP, and any prior and future versions thereof, are the property of KPP and protected by copyright, which shall be owned by KPP. C. KPP, its agents, employees, and contractors shall have the right to use, reproduce, and adapt all aggregate compilations of information obtained from the Plan in order to perform its duties under this Agreement or to render services to its clients. Any work, compilation, processes, or inventions developed by KPP or its agents, employees, or contractors shall be owned by KPP or the appropriate party and deemed its confidential information. 5.3. Right to Audit Claims and Business Records. The Plan, or, if permissible under KPP's agreement with its subcontractor, a mutually agreed upon third party, may inspect and audit, as often as reasonable necessary, but at least annually, aspects of the service agreement directly related to Plan, including but not limited to all financial. agreements/arrangements and business records that directly relate to the performance between the Plan and KPP. This includes the ability to audit on-site and perform a call monitoring at KPP sites. KPP's business records that directly relate performance of the services provided herein and to the billings made to the Plan for services performed hereunder. KPP may inspect and audit, or cause to be inspected and audited, once annually, the books and records of the Plan directly relating to this Agreement, including the existence and number of Eligible Members. The Plan and KPP shall fully cooperate with each other to conduct any such inspection or audit. Eagle County Government Page 18 Such audits shall be at the auditing party's sole expense, unless the cause for audits is related to KPP's or the Plan's material failure to perform key functions of contracted services, at which point the aggrieved party will bear no costs for the audit services. Such audits shall only be made during normal business hours, following thirty (30) days written notice, without undue interference to the audited party's business activity, and in accordance with reasonable audit practices. An audit of KPP's records shall be conducted at KPP's office where such records are located and shall be limited to transactions over the three (3) year period preceding such audit. If a completed audit reveals a discrepancy in the results and the previous calculations of the audited party, then the auditing party shall deliver written notice setting forth in reasonable detail the basis of such discrepancy. The parties shall use reasonable efforts to resolve the discrepancy within thirty (30) days following delivery of the notice, and unless disputed, such resolution shall be final, binding, and conclusive upon the parties. Upon a final and conclusive determination of a discrepancy revealed by an audit procedure under this Agreement, the party that owes money shall pay such sums to the other party within thirty (30) days of the delivery of the conclusive audit findings. If corrective actions in operating procedures result from the audit, the parties will work in good faith to establish a reasonable time frame for correction. The audit rights shall survive the termination of this Agreement. Audits may be performed up to two years after termination of this Agreement and the audit period may include up to three prior calendar years. The Plan acknowledges and agrees that any review by the Plan of Pharmaceutical Manufacturer rebate contracts shall be performed by a mutually agreed independent third party auditor for the limited purpose of verifying KPP's compliance with the terms of this Agreement. The Plan further agrees and acknowledges that the third party auditors shall disclose rebate contract information to the Plan in the aggregate only. Upon KPP's request, during and after the term of this Agreement, the Plan shall respond to reasonable information requests from KPP, resulting from audits by manufacturers participating in the Rebate Program, within thirty (30) days of receipt of the information request. Responses to KPP's requests for information related to manufacturer audits shall be at no cost to KPP. Such requests from KPP shall not be considered an "audit" for purposes of this Section. VI. INDEMNIFICATION 5.1. Indemnity by the Plan. To the extent permitted by law, the Plan shall indemnify and hold KPP, and its officers, directors, shareholders, employees, successors, other agents and assigns ("KPP Indemnitees"), harmless from and against any claims, liabilities, damages, judgments or other losses (including attorneys' fees) imposed upon or incurred by KPP Indemnitees arising out of or as a result of any negligent act or omission of the Plan, or its officers, directors, employees or other agents in connection with the performance of any of their respective obligations arising under this Agreement, including without limitation, the submission to Participating Pharmacies or Pharmaceutical Manufacturers of inaccurate or false information provided by the Plan, as a result of a negligent act or Eagle County Government Page 19 ormssion. 6.2. Indemnity by KPP _KPP shall indemnify and hold the Plan, and its officers, directors, shareholders, employees, successors, other agents and assigns ("Plan Indemnitees"), harmless from and against any claims, liabilities, damages, judgments or other losses (including attorneys' fees) imposed upon or incurred by Plan Indemnitees arising out of or as a result of (i) any failure to comply with federal, state and local laws, rules and regulations applicable to the services performed by KPP, or (ii) any negligent acts or omissions of KPP, or its officers, directors, employees or other agents, in connection with the performance of any of their respective obligations under this Agreement. 6.3. Limitation of Liability a. Upon any default or failure by KPP in performing any services or any other obligation hereunder, KPP shall use reasonable commercial efforts to re -perform the services or other obligation for which it is in default, provided that it has received notice of the default or failure from the Plan within thirty (30) days of the date the Plan becomes aware or should reasonably become aware of the default. If KPP fails to re -perform such services or other obligation in accordance with the provisions of this Agreement within a commercially reasonable time, the Plan shall be entitled to recover from KPP any damages incurred by the Plan arising from the default or failure by KPP, subject to the provisions of this Section 6.3. VII. DISPUTE RESOLUTION PROCEDURE 7.1. Resolution of Disputes The parties agree that any and all disputes arising out of, or relating to, this Agreement shall first be addressed by direct negotiation between the parties. The disputing party shall provide the other party with written notice of the dispute ("Notice of Dispute"), containing a detailed description of the matter in controversy. The parties agree to exercise reasonable commercial efforts to resolve the dispute as soon as practicable. In the event that the parties cannot agree on the resolution of the dispute through direct negotiations, but in no event sooner than ten (10) business days following the other party's receipt of the Notice of Dispute (unless otherwise agreed by the parties),the parties may resolve their dispute in accordance with Section 11.7 hereof. VIII. CONFIDENTIALITY 8.1. Confidential Information. The term "Confidential Information" means information of a confidential or proprietary nature relating to the subject matter described in this Agreement which is taken from or disclosed by one party (the "Disclosing Party") to the other (the "Receiving Party"). Confidential Information includes, but is not limited to, matters of a technical nature such as trade secrets, methods, compositions, data and know-how, designs, systems, processes, computer programs, files and documentation, similar items or research projects, and any information derived there from; marketing, sales, strategies, proposals, Eligible Member information, all utilization, formulary, and pharmacy and therapeutics programs developed in conjunction with The Plan and lists of Eagle County Government Page 110 actual or potential Eligible Members, Participating Pharmacies and Pharmaceutical Manufacturers as well as any other information that is designated by either party as confidential. 8.2. Treatment of Confidential Information. The Receiving Party agrees: (i) to hold the Disclosing Party's Confidential Information in strict confidence and to take reasonable precautions to protect such Confidential Information (including, without limitation, all precautions Receiving Party employs with respect to its own confidential materials); (ii) not to divulge any such Confidential Information or any information derived there from to any third party unless required in the performance of the Receiving Party's duties under this Agreement; (iii) not to make any use whatsoever at any time of such Confidential Information except for the purpose of this Agreement and will not use it for its own or any third party's benefit; and (iv) not to copy, analyze, transcribe, transmit, decompile, disassemble or reverse engineer any such Confidential Information, and not use such Confidential Information in any patent application. The confidentiality obligations of this Section 9.2 shall not apply to information which, as evidenced in writing: a. is or becomes publicly known by Receiving Party through no breach of this Agreement; b. is learned by the Receiving Party from a third party entitled to disclose it; C. is rightfully obtained by the Receiving Party prior to this Agreement; The confidential obligations contained in the foregoing clauses (i), (ii), (iii) and (iv) shall be perpetual. Receiving Party may make disclosures required by law or court order provided Receiving Party provides notice of such disclosure to the Disclosing Party. Notwithstanding anything to the contrary contained herein, KPP acknowledges and agrees that Eagle County Government is a public entity subject to the requirements of the Colorado Open Records Act (C.R.S. § 24-72-201, et. seq.) and that upon execution of this Agreement, the terms and conditions of this Agreement, including any pricing terms, will be public records open to public inspection, and Plan shall have no obligation to provide notice concerning disclosure of the same. 8.3. No Transfer Or Right Or Title. Receiving Party acknowledges that it shall not acquire any rights or title to any Confidential Information merely by virtue of its use or access to such Confidential Information hereunder. Neither the execution of this Agreement nor the furnishing of any Confidential Information hereunder shall be construed as granting, either expressly or by implication, or otherwise, the Receiving Party any license under any invention or patent now or hereafter owned by or controlled by the Disclosing Party. Each party agrees that it may not be adequately compensated for damages arising from a breach or threatened breach of any of the covenants contained in this Article 8 by the other party, and each party shall be entitled to injunctive relief and specific performance in addition to all other remedies. None of the information that may be submitted or exchanged by the parties shall constitute any representation, warranty, assurance, Eagle County Government Page 111 guarantee, or inducement by a party to the other with respect to the infringement of patents, copyrights, trademarks, trade secrets, or any other rights of third persons. IX. EXCLUSIVITY 9.1. Exclusivity. The Plan agrees that KPP shall be the sole and exclusive agent for the Plan for each of the services described in Exhibit A during the Term of this Agreement, unless agreed to in writing by both parties. X. TERM AND TERNUNATIQN 10.1. Term. This Agreement shall become effective on the Effective Date (as defined in Section 1.8) and shall be for an initial term of two (2) years, with an option for either party to extend the contract for two one-year periods, unless terminated on its contract term anniversary date by either party by certified or registered mail, mailed at least ninety (90) days prior to such date ("Term"). Termination shall have no effect upon the rights and obligations of the parties arising out of any transactions occurring prior to the effective date of such termination, except as described in Section 10.4. KPP will provide a complete renewal package to the Plan no later than 180 days prior to the end of the Initial Term and any renewal term thereafter. 10.2. Termination With Cause. This Agreement may be terminated at any time by either party based on a material breach of any terms or conditions herein stated provided that thirty (30) days' advance written notice of such material breach shall be given to the other party and such party shall have the opportunity to cure such material breach during such thirty (30) day notice period. 10.3. Termination Due to Non -Payment. Notwithstanding the termination rights described in Section 10.2, above, in the event the Plan fails to timely wire, or otherwise transmit, to KPP the full undisputed amount of payment and such payment is not received by KPP within the time limits set forth in Section 4.1 above, KPP will notify the Plan of late payment; the Plan will be given 10 days from the date of notice of late payment to wire the full undisputed amount of payments to KPP. If the Plan fails to respond within that 10 day time period, KPP may terminate this Agreement on any date thereafter; effective on the date notice of such termination is received by the Plan. 10.4. Effect of Termination. If this Agreement is terminated pursuant to this Article 10 (i) all further obligations of the parties under this Agreement shall terminate (but not such party's obligation to make payments arising prior to the termination of this Agreement or any obligation surviving the termination hereof); (ii) all Confidential Information provided by either party shall, except for Confidential Information required by law to be retained by a party, be immediately returned by a Receiving Party (as defined in Section 8. 1), or such Receiving Party shall certify to the Disclosing Party that such materials have been destroyed; (iii) neither party shall be relieved of any obligation or liability arising from any prior breach of such party or any provision of this Agreement; (iv) KPP shall supply to the Plan upon request information regarding claims processed under this Eagle County Government Page 1 12 Agreement; and (v) the parties shall, in all events, remain bound by and continue to be subject to the provisions which by their nature are intended to survive expiration or termination of this Agreement. XI. GENERAL PROVISIONS 11.1. Insurance. KPP shall obtain (to the extent not already possessed) and maintain, with respect to the activities in which it engages pursuant to this Agreement, professional liability (errors and omissions) insurance in amounts reasonable and customary for the nature and scope of business engaged herein, as well as comprehensive liability insurance. In no event shall the amount of such insurance be less than $1,000,000.00 per occurrence and $3,000,000.00 aggregate. KPP shall deliver to the Plan such evidence of insurance satisfactory for the aforementioned purposes. KPP agrees to notify the Plan promptly upon its receipt of any notice canceling, suspending or reducing the coverage limits of its professional liability insurance or comprehensive liability insurance. 11.2. Regulatory Compliance. The Plan represents and warrants that it is an "employee welfare benefit plan" as defined in the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. §1001 et seq., and Plan's compliance with any laws and regulations applicable to the Plan, including ERISA, shall be the sole responsibility of the Plan. The Plan shall comply and ensure that Plan complies with all such laws and regulations. KPP will obtain and maintain any licenses or regulatory approvals necessary for it to perform its services under this Agreement. The Plan shall not name KPP or represent that KPP is, and KPP shall not be, a Plan Administrator or a named fiduciary of the Plan as those terms are used in ERISA. The Plan shall have complete discretionary, binding and final authority to construe the terms of the Plan, to interpret ambiguous Plan language, to make factual determinations regarding the payment of claims or provision of benefits, to review denied claims and to resolve complaints by Eligible Members. In the event that the Plan, the arrangement established by this Agreement or any payments for claims for Prescription Drug Services or fees to KPP are subjected to any form of governmental or regulatory charges, including any premium taxes, insolvency fund fees, guarantee fund fees, licensing fees or any similar charges, such charges shall be the sole responsibility of the Plan and the Plan shall hold harmless and indemnify KPP from the payment of any such charges. 11.3. Successors and Assigns; Binding Effect. Neither this Agreement nor any of the rights, interests or obligations hereunder shall be assigned by either party hereto (whether by operation of law or otherwise) without the prior written consent of the other party hereto, except that KPP may assign this Agreement to an affiliate or subsidiary without such consent. 11.4. Waiver. Any term or condition of this Agreement may be waived at any time by the party that is entitled to the benefit thereof, but no such waiver shall be effective unless set forth in a written instrument duly executed by or on behalf of the party waiving such term or condition. No waiver by any party of any term or condition of this Agreement, in any Eagle County Government Page 1 13 one or more instances, shall be deemed to be or construed as a waiver of the same or other term or condition of this Agreement on any future occasion. 11.5. Severability. In the event that any provision of this Agreement shall be determined to be invalid, unlawful, void or unenforceable to any extent, the remainder of this Agreement, and the application of such provision other than those as to which it is determined to be invalid, unlawful, void or unenforceable, shall not be impaired or otherwise affected and shall continue to be valid and enforceable to the fullest extent permitted by law. 11.6. Further Assurances. Each party hereto shall execute and cause to be delivered to each other party hereto such instruments and other documents, and shall take such other actions, as such other party may reasonably request (at or after the date hereof) for the purpose of carrying out or evidencing any of the transactions contemplated by this Agreement. 11.7 Choice of Law. Any and all claims, disputes or controversies related to this Agreement, or breach thereof, shall be litigated in the District Court for Eagle County, Colorado, which shall be the sole and exclusive forum for such litigation. This Agreement shall be construed and interpreted under and shall be governed by the laws of the State of Colorado. 11.7. Force Majeure. The performance obligations of KPP and/or the Plan respectively hereunder shall be suspended to the extent that all or part of this Agreement cannot be performed due to causes which are outside the control of KPP and/or the Plan, and could not be avoided by the exercise of due care, including but not limited to acts of God, acts of a public enemy, acts of a sovereign nation or any state or political subdivision or any department or regulatory agency thereof or entity created thereby, acts of any person engaged in a subversive or terrorist activity or sabotage, fires, floods, earthquakes, explosions, strikes, slow -downs, lockouts or labor stoppage, freight embargoes, or by any enforceable law, regulation or order. The foregoing shall not be considered to be a waiver of any continuing obligations under this Agreement, and as soon as conditions cease, the party affected thereby shall fulfill its obligations as set forth under this Agreement. In order to benefit from the provisions of this Section 11.8, the party claiming force majeure must notify the other reasonably promptly in writing of the force majeure condition. If any event of force majeure, in the reasonable judgment of the parties, is of a severity or duration such that it materially reduces the value of this Agreement, then this Agreement may be terminated without liability or further obligation of either party (except for any obligation expressly intended to survive the termination of this Agreement and except for all amounts that have become or will become due and payable hereunder). 11.8. Entire Agreement; No Third Party Beneficiaries. This Agreement, including the Exhibits: (i) constitutes the entire agreement among the parties with respect to the subject matter hereof and supersedes all prior agreements and understandings, both written and oral, among the parties with respect to the subject matter hereof, and (ii) is intended solely for the benefit of each party hereto and their respective successors or permitted assigns, and it is not the intention of the parties to confer third party beneficiary Eagle County Government Page 1 14 rights, and this Agreement does not confer any such rights, upon any other third party. 11.9. Use of Name. Neither party shall use the other party's name, trade or service mark, logo, or the name of any affiliated company in any advertising or promotional material, presently existing or hereafter established, except in the manner and to the extent permitted by prior written consent of the other party. 11.14. Notice. Any notice required or permitted by this Agreement, unless otherwise specifically provided for in this Agreement, shall be in writing and shall be deemed given: (i) one (1) day following delivery to a nationally reputable overnight courier; (ii) one (1) day following receipt by facsimile during the receiving party's business hours with written confirmation thereof; or (iii) three (3) days after the date it is deposited in the United States mail, postage prepaid, registered or certified mail, or hand delivered addressed as follows: To KPP: Kroger Prescription Plans, Inc. 1414 Vine Street Cincinnati, OH 45242 Attn: Matthew Feltman General Manager of KPP Phone: 513-762-4864 Toll Free: 1-800-917-4926 E-mail: Matthow.Feltman@kroger.com To the Plan: Eagle County Government CIO Human Resources 500 Broadway PO Box 850 Eagle, CO 81631-0850 Either party may at any time change its address for notification purposes by mailing a notice stating the change and setting forth the new address. 11.11. Counterparts: Facsimile. This Agreement may be executed in two or more counterparts, each of which will constitute an original signature and all of which shall be considered one and the same agreement and shall become effective when two or more counterparts have been signed by each of the parties and delivered to the other parties, it being understood that all parties need not sign the same counterpart. This Agreement may be executed and delivered by facsimile and upon such delivery the facsimile signature will be deemed to have the same effect as if the original signature had been delivered to the other party. The original signature copy shall be delivered to the other party by express overnight delivery. The failure to deliver the original signature copy and/or the non - receipt of the original signature copy shall have no effect upon the binding and enforceable nature of this Agreement. Eagle County Government Page 1 15 11.12. Independent Contractors. The Plan and KPP are independent entities and nothing in this Agreement shall be construed or be deemed to create a relationship of employer and employee or principal and agent or franchiser and franchisee or any relationship, fiduciary or otherwise, other than that of independent parties contracting with each other solely for the purpose of carrying out the provisions of this Agreement. Nothing in this Agreement is intended to be construed, or be deemed to create, any rights or remedies in any third party, including but not limited to an Eligible Member. Nothing in this Agreement shall be construed or deemed to confer upon KPP any responsibility for or control over the terms or validity of the Prescription Drug Services. 11.13. Consent to Amend. This Agreement or any part or section of it may be amended at any time during the Term of this Agreement only by mutual written consent of duly authorized representatives of KPP and the Plan. 11.14. Headings. The headings of Articles, Sections and Exhibits contained in this Agreement are for reference purposes only and shall not affect in any way the meaning or interpretation of this Agreement. 11.15. Compliance with Laws and Regulations. This Agreement will be in compliance with all pertinent federal and state statutes and regulations. If this Agreement, or any part hereof, is found not to be in compliance with any pertinent federal or state statute or regulation, then the parties shall renegotiate the Agreement or the part that is affected for the sole purpose of correcting the non-compliance. 11.16. Construction. a. For purposes of this Agreement, whenever the context requires: the singular number shall include the plural, and vice versa; the masculine gender shall include the feminine and neuter genders; the feminine gender shall include the masculine and neuter genders; and the neuter gender shall include the masculine and feminine genders. b. The parties hereto agree that any rule of construction to the effect that ambiguities are to be resolved against the drafting party shall not be applied in the construction or interpretation of this Agreement. C. As used in this Agreement, the words "include" and "including," and variations thereof, shall not be deemed to be terms of limitation, but rather shall be deemed to be followed by the words "without limitation." d. Except as otherwise indicated, all references in this Agreement to "Articles," "Sections" and "Exhibits" are intended to refer to Articles of this Agreement, Sections of this Agreement and Exhibits to this Agreement. 11.17. Remedies Cumulative. The rights and remedies of the parties hereto shall be cumulative (and not alternative). 11.18. HIPAA Compliance. The parties agree to be bound by the terms and conditions of the Business Associate Addendum attached hereto and incorporated herein as Exhibit B. Eagle County Government Page 1 16 1. 19. Exhibits. All exhibits to this Agreement are attached hereto and incorporated herein by reference. 11.21 Prohibitions on Government Contracts. As used in this Section 11.21, the term undocumented individual will refer to those individuals from foreign countries not legally within the United States as set forth in C.R.S. 8-17.5-101, et. seq. and KPP will be referred to as "Consultant." If Consultanthas any employees or subcontractors, Consultant shall comply with C.R.S. 8- 17.5-101, et. seq., and this Agreement. By execution of this Agreement, Consultant certifies that it does not knowingly employ or contract with an undocumented individual who will perform under this Agreement and that Consultant will participate in the E - verify Program or other Department of Labor and Employment program ("Department Program") in order to confirm the eligibility of all employees who are newly hired for employment to perform Services under this Agreement. a. Consultant shall not: i. Knowingly employ or contract with an undocumented individual to perform Services under this Agreement; or ii. Enter into a subcontract that fails to certify to Consultant that the subcontractor shall not knowingly employ or contract with an undocumented individual to perform work under the public contract for services. b. Consultant has confirmed the employment eligibility of all employees who are newly hired for employment to perform Services under this Agreement through participation in the E -Verify Program or Department Program, as administered by the United States Department of Homeland Security. Information on applying for the E - verify program can be found at: http://www.dhs.gov/xprevprot/proggams/gc—1 185221678150.shtm C. Consultant shall not use either the E -verify program or other Department Program procedures to undertake pre-employment screening of job applicants while the public contract for services is being performed. d. If Consultant obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an undocumented individual, Consultant shall be required to: i. Notify the subcontractor and County within three (3) days that Consultant has actual knowledge that the subcontractor is employing or contracting with an undocumented individual; and Eagle County Government Page 1 17 ii. Terminate the subcontract with the subcontractor if within three days of receiving the notice required pursuant to subparagraph (i) of the paragraph (d) the subcontractor does not stop employing or contracting with the undocumented individual; except that Consultant shall not terminate the contract with the subcontractor if during such three (3) days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an undocumented individual. e. Consultant shall comply with any reasonable request by the Department of Labor and Employment made in the course of an investigation that the department is undertaking pursuant to its authority established in C.R.S. 8-17.5-102(5). f. If Consultant violates these prohibitions, County may terminate the Agreement for breach of contract. If the Agreement is so terminated specifically for breach of this provision of this Agreement, Consultant shall be liable for actual and consequential damages to County as required by law. g. County will notify the Colorado Secretary of State if Consultant violates this provision of this Agreement and County terminates the Agreement for such breach. The provisions of this Agreement shall bind and inure to the benefit of the parties hereto and their heirs, legal representatives, successors and assignees. This Agreement constitutes the entire understanding between the parties hereto. KROGER PRESCRIPTION PLANS, INC. By: Print Name: Matthew Feltman Print Title: General Manager of KPP Date: 01/26/2017 EAGLE COUNTY GOVERNMENT By: Print Nanie: Brent McFall Print Title: County Manager Date: 01/30/2017 Eagle County Government Page 1 18 EXHIBIT A I. SERVICES 1. Claims Processing Eligibility Management: KPP will process eligibility files received from the Plan or its designee and will refresh and update eligibility files on a mutually agreed upon schedule. Electronic eligibility files will be processed within a monthly average of two business days of receipt. KPP will terminate coverage as detailed during implementation planning; will add coverage for new members joining the plan within 24 hours of receipt of eligibility data; update member information (e.g. address changes) within 48 hours of receipt of eligibility data; notify appropriate party(ies) of eligibility issues within 24 hours of processing of eligibility data. i. Claims Processing Services. KPP shall provide the claims processing services related to Claims for prescriptions dispensed on or after the Effective Date of this Agreement. KPP agrees to process Claims received from Participating Pharmacies and Eligible Members, determine whether such Claims qualify for reimbursement in accordance with the terms of the Benefit Plan, and determine the payment applicable to them. KPP further agrees to process Claims within National Council for Prescription Drug Programs (NCPDP) adopted by the HIPAA Regulations for Electronic Transactions. KPP shall process Claims within the time frames established by applicable state and federal law and corresponding to the industry standards. Upon termination of this Agreement, KPP shall be solely responsible to process only those Claims which are for prescriptions dispensed before the termination date and which are received by KPP within thirty (34) days of the termination date. ii. Claims from Participating Pharmacies. The following services to be provided upon receipt of a prescription Claim: Verification that the patient for which the claim was submitted is an Eligible Member and is entitled to Prescription Drug Services; If applicable, verification that the prescriber is an authorized prescriber under the Benefit Plan; and Verification that the product dispensed is a Prescription Drug Service. iii. Collection of Deductible or Copayment by Participating Pharmacies. Prior to providing to an Eligible Member any of the Prescription Drug Services to which the Eligible Member is entitled under the Benefit Plan, the Participating Pharmacy shall be required to collect from Eligible Member the amount of any Copayment. Additionally, Participating Pharmacies shall not recover from Eligible Members any unpaid balances due Participating Pharmacies. Eagle County Government Page li 19 iv. Claim Submission. The Plan acknowledges that KPP shall require the Participating Pharmacies to send to KPP, at the expense of the Participating Pharmacies, Claims via on-line paint -of -sale terminals ("PDS"). If such a media is not available at the Participating Pharmacy, then the pharmacy shall provide the completed Claims on the Universal Claim Form ("UCF" ), and/or magnetic tapes or diskettes containing claims information. Incorrect Claims will be denied. The Claims form information shall be sent to an address designated by KPP. 2. Retail Participating Pharmacy Network KPP shall provide, maintain, and manage a national network of Participating Pharmacies. For the national network, KPP shall negotiate reimbursement rates, Maximum Allowable Cost for multi -sourced product and corresponding programs according to the needs of the Plan. The Plan acknowledges that KPP shall negotiate with Participating Pharmacies at various reimbursement rates and methodologies throughout the term of the contract. KPP management of the networks includes, but is not limited to, auditing and reporting on network functions; ensuring network compliance with all applicable contract terms; reviewing pharmacy licensure; and providing education and ongoing communication with pharmacies. Unless mutually agreed to prior to the execution date of the Agreement, the Plan acknowledges that KPP uses zero -balance logic as defined by the industry for all of its networks. KPP agrees that the Plan may, with reasonable justification, require the termination of a specific retail pharmacy for good cause including quality of care issues and loss of appropriate licensure. The Plan further agrees that KPP may, with reasonable justification, terminate a specific retail pharmacy. KPP shall notify the Plan of any terminations material to the Plan in the Participating Pharmacy network. Payments to Participating Pharmacies. KPP agrees to pay to the Participating Pharmacies, on behalf of the Plan, reimbursement as may be agreed upon by Participating Pharmacies and KPP for provisions of Prescription Drug Services to Eligible Members. Payment shall be made within the industry standard after receipt of funds from the Plan for this purpose. 3. Rebate Program i. Participation in Program. Subject to the provisions of this Section, and upon qualifying to participate in the rebate program, the Plan will be eligible to receive rebates from certain Pharmaceutical Manufacturers for prescription drugs dispensed to Eligible Members who are covered by the Plan or by plans that utilize the Plan which meet the following criteria: 1. The Plan develops, publishes, presents and distributes a drug formulary or other preferred drug list consistent with KPP's Eagle County Government Page 120 recommended drug formulary and/or the Plan's customized formulary, including all subsequent revisions; and 2. The Plan meets the eligibility inclusion criteria of each of the respective Pharmaceutical Manufacturers for the Plan's applicable agreements. KPP will provide the Plan updated formulary document templates in a mutually agreeable format on an annual basis and no later than twenty (20) days prior to the beginning of each calendar year. KPP will provide an electronic version of the formulary at no cost to the Plan. If KPP provides formulary booklets, the Plan agrees to reimburse KPP for the expenses incurred in the production of the formulary booklets. ii. Full Disclosure. KPP shall provide documentation to the Plan to provide full rebate disclosure and verify all monies billed and recovered. Moreover, should KPP receive any fees or other compensation from manufacturers for services provided under this Agreement, including administrative fees and fees for property provided or certain services rendered to a manufacturer, KPP agrees to disclose and pass through 100 % of such fees to the Plan as dictated in Exhibit A. iii. Payment of Rebates. Subject to the terms and conditions of this Agreement, on behalf of the Plan, KPP will receive the rebates paid by manufacturers to the Plan. KPP shall pay to the Plan the amount received from pharmaceutical manufacturers for all rebate programs as applied to those eligible Claims, attributable to the Plan utilizing the Plan's Eligible Members' prescriptions. KPP shall direct payment to the Plan every calendar quarter all such monies received from pharmaceutical companies for eligible prescriptions. KPP shall calculate all amounts at the close of the calendar quarter in accordance with its standard rebate calculation and disbursement methods and policies. iv. Eligible Rebate Data. Drug utilization generated from any program for providing pharmacy discounts in the absence of satisfactory pharmacy coverage underwritten by the Plan shall not be eligible to participate in the rebate program. Drug utilization which has been submitted by any entity other than KPP including, but not limited to the following government entities: Medicaid; Medicare; or other state or federal health care program which receives rebates, discounts, or other forms of price reduction directly or indirectly from pharmaceutical manufacturers, shall not be eligible to participate in this Program. The Plan shall clearly identify to KPP all members whose drug utilization or claims have been otherwise submitted to pharmaceutical manufacturers or whose claims have been or will be filed for reimbursement with government entities, including Medicaid, Medicare, or any state or federal health care program. If the Plan fails to identify such known members, pharmacies or claims and any Eagle County Government Page 121 pharmaceutical manufacturer's audit of its rebate program reveals improperly calculated rebates involving such members or claims, then the Plan shall be solely responsible for the reimbursement of any rebates improperly made or calculated and any corresponding refunds associated with the audit. v. Rebate Limitations. Except where KPP has caused any of the above or been a party to such failure, loss, cost or expenses, the Plan waives, releases, and forever discharges KPP from any claims, demands, losses, attorneys' fees, costs, expenses, or liabilities of any nature, whether known or unknown, arising from (i) a Pharmaceutical Manufacturer's breach of an agreement related to this Agreement; or (ii) a Pharmaceutical Manufacturer's negligence or misconduct. The Plan acknowledges that rebates will not be paid with respect to claims submitted by Medicaid agencies. vi. Other Pharmaceutical Relationships. Nothing in this Agreement shall preclude KPP from pursuing other, independent sources of revenue from pharmaceutical manufacturers, and engaging in other revenue-producing relationships with pharmaceutical manufacturers. 4. Clinical Services Clinical services will be provided under this Agreement so long as the Plan elects to participate in the KPP clinical and formulary programs. Clinical programs shall include: i. Concurrent Drug Utilization Review. KPP agrees to provide concurrent on-line drug utilization review to Participating Pharmacies for all claims submitted via on-line PDS terminals. This information is intended to assist the pharmacist in identifying drug interactions and other issues that may be indicative of inappropriate drug use ii. Prior Authorization. KPP shall, at the Plan's request, perform prior authorization services. Specifically, KPP shall administer rules and conditions established and/or approved by the Plan under which certain drugs or drug classes or categories may be approved as a covered benefit. iii. Formulary Management. KPP shall provide a recommended drug Formulary or preferred drug list to the Plan. The Plan may, at its discretion, provide an additional clinical review, but without such review agrees to implement, administer, and adhere to the Formulary. iv. Benefit Plan Administration. KPP shall provide support in pharmacy benefit plan development, set-up and administration on behalf of the Plan. KPP will set up and maintain plans via plan implementation documents provided by the Plan to KPP. The Plan and KPP shall mutually agree on Eagle County Government Page 122 the format of the implementation documents; however, the Plan will have the ultimate responsibility for approving any pharmacy benefit design. Additionally, the Plan acknowledges that nothing in this Agreement shall be deemed to confer upon KPP the status of named fiduciary as defined in the Employee Retirement Income Security Act of 1974, as amended, or any responsibility for the terms or validity of the Plan. v. Member Appeals. KPP shall, at the Plan's request, administer first and second level prior authorization appeal services. Specifically, KPP, at the Plan's request, shall administer a member prior authorization appeal process including rules and conditions established and/or approved by the Plan under which members may formally request an appeal review for prior authorization denials for certain drugs or drug classes or categories. The KPP Appeal Services are defined in Exhibit C. 5. Account Management KPP shall provide trained, experienced account service resources to serve as a liaison between the Plan and KPP for the purpose of facilitating operational activities, resolving issues, and providing consultative support. On an annual basis, an onsite review will occur between KPP and the Plan prior to the Plan's annual benefit planning period. 6. Call Center Support KPP shall provide a toll-free call center to the Plan during regular hours of business. KPP shall provide a toll-free call center to all Participating Pharmacies; these hours shall be seven days per week twenty-four hours a day. It is agreed, however, that The TPA shall be notified of any material changes to schedule of business hours. KPP shall provide member call center services for the Plan's Eligible Members and Participating Pharmacies. The hours of service shall be seven days per week twenty- four hours a day. 7. Ancillary Services In the event that the Plan requests additional or ancillary services other than those described herein, including consultative services, KPP shall attempt to accommodate the Plan at a mutually agreed upon rate set forth in writing and signed by the parties prior to the performance of the services. H. PRESCRIPTION DRUG SERVICES KPP shall provide Pass -Through Pricing to Plan. KPP's obligation to provide Pass - Through Pricing shall require KPP to invoice Sponsor the exact amount paid for each dispensed and Paid Claim. This includes retail, mail and specialty paid claims. The Plan will be utilizing the Non- Preferred Network. Eagle County Government Page 123 With respect to the categories set forth below, KPP guarantees to Plan the following average annual rates during each Contract Year during the term hereof: Charges related to Prescription Drug Services provided by all Kroger -owned retail pharmacies as relates to traditional days supply (i.e., '30 days') limits, the lesser of: • Brand: AWP — 17.05% + $0.85 or U&C • Generic: AWP — 17.05% or MAC + $0.85 or U&C • Generic Net Effective Rate: 81.00% Charges related to Prescription Drug Services provided by all non -Kroger retail network pharmacies as relates to traditional days supply (i.e., '30 days') limits, the lesser of; • Brand: AWP — 16.75% + $0.95 or U&C • Generic: AWP — 16.75% or MAC + $0.95 or U&C • Generic Net Effective Rate: 79.00% Charges related to 90 day Prescription Drug Services provided by all Kroger - owned retail pharmacies, the lesser of: • Brand: AWP — 22.50% + $0 or U&C • Generic: AWP — 22.50 % or MAC + $0 or U&C • Generic Net Effective Rate: 83.00% Charges related to 90 day Prescription Drug Services provided by all Non - Kroger -owned retail pharmacies, the lesser of: • Brand: AWP — 21.75% + $0 or U&C • Generic: AWP — 21.75 % or MAC + $0 or U&C • Generic Net Effective Rate: 83.00% Charges related to Pharmacy Services provided by Kroger's mail order service: • Brand: AWP — 24% + $0 • Generic: AWP — 24% or MAC + $0 • Generic Net Effective Rate: 84% Charges related to Pharmacy Services provided by Kroger Specialty Pharmacy service: • See Specialty Rx Rate Table- Exhibit D • Dispensing Fee: $0 • Excluding limited distribution products HLADMIIVISTRATION FEES For the compensation provided herein, KPP agrees to provide the following services to the Plan as defined within the Agreement. For the Services provided herein, the Plan agrees to compensate KPP as follows: Eagle County Government Page 124 1. Claims Processing 2.00 per approved paid electronically submitted claim 2. General Services 3. General Fees Fee 2.1 Claims Processing Services including: Included 3.1 • Eligibility Management Plan shall identify and provide to KPP those Claims, in sufficient detail, that require • Eligibility Verification KPP to reprocess, including those required to refund excess cost sharing paid by or • On -Line Electronic Claims Processing/Administration for a QHP Member due to improper cost-sharing reduction. Such reprocessing may • Direct Member Reimbursement 2.2 National Pharmacy Network Services including: Included (ii) issuing an EOB to a QHP Member; (iii) issuing a check to a QHP Member; (iv) • Negotiation of the Network Pharmacy Discount Contracts issuing a credit to the Participating Pharmacy • Administration of the National Pharmacy Network 3.2 Reprocessing/Retroactive Claims Adjustments (per Plan request/ not due to KPP • Management and Administration of Maximum Allowable Cost (MAC) List error) • Pharmacy Reimbursement Any such reprocessing shall not entitle Client to a refund of any fees or amounts • Pharmacy Help Desk 2.3 Pharmaceutical Manufacturer Rebate Services including: Included On-line Claims Data Access • Negotiation Pharmaceutical Manufacturer Rebate contracts 3.5 Benefit Plan 1 group set up Fees • Management and Administration of Pharmaceutical Rebate program 3.6 2.4 Client and Member Services including: Included Clinical Prior Authorization Service • Member Help Desk • Account Management 3.$ 2.5 Custom KPP Reporting Package Inc lu ded 2.6 Access to Clinical Programs Included 2.7 Account Management Included 2.$ Implementation Services Included 2.9 Subrogation Claims Included 3. General Fees Eagle County Government Page 125 Fee $9.00 per paper claim 3.1 Manual Claims Credit Processing Plan shall identify and provide to KPP those Claims, in sufficient detail, that require KPP to reprocess, including those required to refund excess cost sharing paid by or for a QHP Member due to improper cost-sharing reduction. Such reprocessing may include, but is not limited to, (i) updating the QHP Member's accumulator record; (ii) issuing an EOB to a QHP Member; (iii) issuing a check to a QHP Member; (iv) issuing a credit to the Participating Pharmacy 3.2 Reprocessing/Retroactive Claims Adjustments (per Plan request/ not due to KPP $2.00 per electronic error) claim Any such reprocessing shall not entitle Client to a refund of any fees or amounts already paid to MedIn pact and/or Participating Pharmacies. 3.4 On-line Claims Data Access Included 3.5 Benefit Plan 1 group set up Fees Included 3.6 Member Communication — Printing At Cost 3.7 Clinical Prior Authorization Service $45.00 per each intervention 3.$ Administrative over -rides Included Eagle County Government Page 125 4. Manual Entry Serviees lillimFee 4.1 Manu d Entry Pharmacy Reimbursement- UCF or Other $9.00 per clai m 5. ID Cards Fee 5.1 1 Initial ID cards At cost 5.2 1 ID cards after implementation At cost 6. Rebate Retention 6.1 The Plan acknowledges that KPP shall retain 0 % of Pharmaceutical ManufacturerI Included Rebates as Dart of the nezotiated Plan administrative fees. 7. Explanation of Benefits Services 7.1 Explanation of Benefits $2.50 per EDB plus S. Claims Processins: Miscellaneous Services 9. Postage and Services 9.1 All Pharmacy Reimbursements 1 Check -runs Current United States Postal Service Rates 9.2 Eligible Member -specific mailings Time & Materials 10. Clinical Services 10.1 Pharmacy Fraud Waste and Abuse ("FWA") Program KPP's Pharmacy FWA program further scrutinizes Participating Pharmacies, Eligible Members, or prescribers that KPP identifies as displaying potentially Quoted upon request Eagle County Government Page 126 Fee 8.1 Connectivity • Service Provider Charges- Virtual Private Network (VPN) • User Security for Operational Databases- Online User IDs lnclLIdCd 8.2 Data Retention- On-line- IS Months Included 8.3 Data Retention- On-line- each additional month $0.005 per transaction 8.4 Base Claims Extract- On-line- IS months Included 8.5 Base Claims Extract- On-line- each additional month $0.005 per transaction 8.6 Base Claims Extract- Off-line- 6 years Included 8.7 Restored Archived Data- once per Contract year Included 8.8 Restored Archived Data- each additional restore $500.00 8.9 Custom- Claims Extract or Data Restore Mutually Agreed Consulting Rate 9. Postage and Services 9.1 All Pharmacy Reimbursements 1 Check -runs Current United States Postal Service Rates 9.2 Eligible Member -specific mailings Time & Materials 10. Clinical Services 10.1 Pharmacy Fraud Waste and Abuse ("FWA") Program KPP's Pharmacy FWA program further scrutinizes Participating Pharmacies, Eligible Members, or prescribers that KPP identifies as displaying potentially Quoted upon request Eagle County Government Page 126 Eagle County Government Page 127 fraudulent and/or suspicious behaviors based on desk or onsite audits. Additional information on suspicious activity may be received from Plan; KPP's customer service center; news media and journals; and anti -fraud organization meetings and communications. The FWA program includes: Prospective Audit — KPP's FWA prospective audit tool reviews approved claims for discrepancies prior to payment, based on various FWA algorithms. Participating Pharmacies are contacted regarding discrepancies via phone or fax requesting the prescriber instructions for dispensed medication(s). The auditor strives to complete the investigation prior to claims payment processing. Plan receives a report each quarter identifying any lass prevented by KPP's early pre -payment intervention. Retrospective Audit — KPP FWA retrospective claim audit focuses on known potential and suspected areas of aberrant behavior, using MEDIC reported targets, areas of high incidence of fraud and other potential areas of FWA, data mining, and other reports. Special desk audits may be done to monitor individuals, Participating Pharmacies, and/or regions known to have a history of fraudulent activity. Plan receives five (5) reports and a quarterly summary report outlining all audit activity completed during the quarter. Research and Investigation — Plan may request that KPP conduct additional research on Participating Pharmacies, Eligible Members, or prescribers displaying potentially fraudulent and/or suspicious behaviors based on information provided to Plan by KPP, Eligible Members, or Plan's special investigations unit. KPP researches reported suspicious activity, which may include contacting applicable parties by letter, fax, or telephone. A report is completed and sent to Plan. A maximum of fifteen (15) hours per year included in fee. Quarterly Reports. KPP will provide five (5) reports, on a quarterly basis, for Plan use in analyzing potential fraud, waste, or abuse. The reports are designed to focus on frequently encountered conditions indicative of potential fraud, waste, or abuse conditions at the Eligible Member, Participating Pharmacy, and prescriber levels. Plan is responsible for performing analysis of such reports. FWA program includes, at no additional charge, desk audits and standard quarterly audit reports. 10.2 Electronic Prescribing Program $0.178/ e -prescribing query transaction fee* KPP will provide MedPrescription®, KPP's standard e -prescribing program, which consists of the following services: *Eligibility and a. KPP will contract with one or more third party vendors ("Connectivity medication history Vendors") to perform patient identification services by providing membership queries are separate information to the Connectivity Vendor(s) allowing the Connectivity Vendor(s) queries and subject to to build a master patient index (MPI) database through KPP's contract with separate transaction Connectivity Vendor(s). fees unless the b. The Connectivity Vendor(s) will facilitate the electronic transmission of patient eligibility query is eligibility and medication history information between physician software followed by a vendors and KPP to promote electronic prescribing. medication history c. KPP will implement and support a real time electronic interface to allow e- query, in which case they will be counted as Eagle County Government Page 127 prescribing queries that may include eligibility and/or medication history (each one query and subject an E -Prescribing Query"), from a Connectivity Vendor for Plan's Eligible to one transaction fee Members at the point of prescribing, in a format and manner agreed upon by KPP and the applicable Connectivity Vendor. KPP will use data that is currently available in KPP's database as provided by Plan, Participating Pharmacies, and $250/hour for research Eligible Members to respond to such queries in a format and manner agreed and custom report upon by KPP and the applicable Connectivity Vendor. development, upon d. KPP will implement and support a monthly formulary file that will allow request prescriber to query formulary in support of e -prescribing. 10.3 1 Employer Subsidy Claims File KPP shall provide the information as set forth herein and as directed by Plan for Plan to comply with the requirements of CMS employer retiree drug subsidy (RDS) program. Plan shall retain overall authority, responsibility, and accountability for reporting such information to CMS. RDS Cost Report Options. KPP can provide RDS reporting for RDS -only groups or mixed eligibility groups at the individual member level (as defined by member attribute and RDS start date). All RDS Eligible Members' claim history is processed through the KPP pre-processed drug lists ("PPDL") (US Patent No. 8,265,950) to determine Part D eligibility. All drugs that are not eligible for RDS subsidy as defined by CMS are excluded from the cost reporting which includes edits to meet CMS Non -Matched NDC requirements for Part D and RDS reporting. KPP also offers two calculation methods for B vs. D reporting. These options are: (1) Report only Part D eligible claims (full exclusion of Part B drugs); or (2) Report Part D and Part B vs. D eligible claims with a percentage reduction factor applied per guidelines. Plan shall choose a single option for reporting throughout the plan year. Option A: RDS cost file & reconciliation reporting files. KPP provides monthly $2,000.00 summary reports with all required RDS data elements ready for submission to per month application CMS. All reporting is provided monthly and then three (3) additional months ID following the close of the plan year to allow for any retroactive claims activity. Detail and summary reporting is also provided for final RDS reconciliation. These reports include (a) Monthly Cost File (summarized by Unique Benefit Option Identifier) includes estimated cost adjustment information as specified by Plan and (b) Monthly Reconciliation File (detailed by member). $500 per upload for up Option B: RDS custom reporting files specified by Pian. KPP provides a monthly to five (5) application Claims extract file to support Plan's calculation of RDS costs and Plan generates ID's; $100 per reports for submission to CMS. Custom IT programming invoiced at current rate. additional application ID submitted Monthly RD Claims File Submission to CMS/Cost Reporter. Upon request from $500.00 ler upload for Plan, KPP shall be designated as the monthly Cost Reporter. Each month, KPP will up to three (3) upload the RDS Cost Report to the RDS website (via .csv file or mainframe) on application ID's; $100 Plans behalf and provide Plan a copy of the audit trail following the submission. KPP will require Plan to set up designee access for cost reporting on per additional the RDS website to upload the information. A copy of the actual files is also application ID provided to Plan. Plan will be responsible for eligibility uploads to CMS. submitted Eagle County Government Page 128 11.4otianal Services 11.1 MedResults® $0.08 per member per month ("PMPM") Member/Prescriber Preferred Medication Communication Program Physician and/or Member outreach programs are designed to help the Plan achieve the following goals: increase generic utilization, increase formulary compliance, improve clinical management and improve quality. Claims are targeted at the point of sale and letters are generated the next business day. Eagle County Government Page 129 Custom RDS Member Eligibility File Creation $500.00 per month 10.4 Additional or Customized Reports $2251 hour All additional or customized reports shall be submitted directly to Plan electronically or on paper as mutually agreed upon. 10.5 Custom Formulary In the event the Plan requires any change to In the event Plan utilizes a custom Formulary, no later than sixty (60) days prior to a KPP Formulary the Effective Date and within three (3) Business Days of Plan approval of any (including but not subsequent changes to the Formulary, KPP shall provide Plan with both a print and limited to prior electronic copy of a comprehensive print Formulary and all other Formulary authorization documentation in a format mutually agreeable via web link or other agreed upon guidelines or access. Each calendar quarter, KPP shall provide Plan a print copy of the most utilization management current Formulary applicable to that quarter. KPP shall provide Plan with the edits), it may be custom Formulary information at the NDC level and shall include all utilization and considered and treated restriction edits (including but not limited to prior authorization guidelines, as a custom Formulary utilization management edits, quantity edits, step therapy guidelines, and tier edits). and may be subject to Upon receipt of complete custom Formulary information from KPP in a usable and additional fees, as acceptable format, unless Plan utilizes the EFS, KPP shall load and maintain Plan's mutually agreed upon custom Formulary in its systems and use it for processing Eligible Member claims. by the parties, and the Failure to provide custom Formulary information, including updates and changes custom Formulary thereto, within the time frames described in this paragraph may result in requirements. postponement of the Effective Date or proposed change date or, should the parties mutually agree to meet the original scheduled Effective Date or proposed change $6,000/year for each date, in a late fee being assessed to Plan to compensate KPP for costs incurred to initial formulary data meet the original scheduled date. print file With custom Formularies, Plan is responsible for the custom Formulary development, requirements, changes, notifications (e.g., to prescribers, Eligible $4,000 for each Members, pharmacies, or others), and drug updates; for KPP in creating, printing, subsequent formulary and distributing printed and electronic custom Formulary materials, including data print file, per each posting Plan's Formulary on a website; and for ensuring that the print Formulary, formulary template Formulary posted on websites, and plan benefits are identical. (separate rate applies if Custom Formulary Print Preparations. KPP shall provide to Plan on a monthly quarterly file is basis, electronic versions of comprehensive and abridged formulary documents in a requested) print ready format inclusive of Plan specific introduction (if provided by Plan) and the drug table, and index. 11.4otianal Services 11.1 MedResults® $0.08 per member per month ("PMPM") Member/Prescriber Preferred Medication Communication Program Physician and/or Member outreach programs are designed to help the Plan achieve the following goals: increase generic utilization, increase formulary compliance, improve clinical management and improve quality. Claims are targeted at the point of sale and letters are generated the next business day. Eagle County Government Page 129 Eagle County Government Page 130 MedResults® - Cost Focused Programs ■ Formulary Alignment/Formulary Compliance - This program targets non- formulary Brand medications and sends letters to either physicians or members encouraging them to switch to a formulary Brand or formulary Generic alternative. ■ Dose Optimization (aka Strength) - This program identifies patients who may benefit from modifying the dosing strength of a drug. It delivers education messages to physicians asking them to move members from twice daily dosing to once daily dosing. This program can also target moving members from one tablet to half tablet. MedResults® - Quality Focused Programs ■ Drug -Drug Interaction (DDI) — This program identifies members who are potentially taking medications inappropriately by targeting claims that have been filled after being flagged as a Level 1 drug interaction. The letter requests a response from the physician (for example, physician will discontinue an interacting medication, physician previously aware of the drug interaction, or physician will evaluate for an alternative medication). 11.2 Qgtional High Cost Generic Performance Management Program $0.25 PMPM High Cost Generic Performance Management An array of services and intervention programs designed to optimize the utilization between generic products within a the Plan's membership that we have found successful in delivering significant cost savings enhancing the overall cost-effective utilization of prescription drugs within pharmacy benefit programs. High Cost Generic Performance Management Components Consultative Services — KPP will analyze brand and generic drug utilization patterns within a population and apply our predictive modeling algorithms to identify the mix of generic drugs driving the Plan drug cost trends and provide recommendations for an intervention program designed to enhance the overall performance of the Plan's prescription drug program. Standard Management Program — KPP will work with the Plan to manage high cost generics as follows: • Application of member incentive program applied at point of sale (POS) utilizing a standardized high cost generics list developed and managed by KPP applied across many clients offering an optimum balance of savings and management overhead. All high cost generics have cheaper alternative to minimize member disruption. • Copayments for High Cost Generics will be increased to be the copayment of preferred brands across all groups. Implementation Services — KPP will implement the member incentive programs selected in our POS adjudication systems ensuring that member impacts are minimized and set-up compatible with the Plan's overall benefit management approach. • Active Prescription Conversion — Based upon our consultation with the Plan Eagle County Government Page 130 Eagle County Government Page 131 and agreed upon implementation plan KPP will contact physicians who prescribed high cost generics to prescribe lower cost alternatives. • Call Center Support. Based upon our consultation with the Plan and agreed upon implementation plan, Members will have access to KPP's call center support to answer any questions they may have on high cost generics. Reporting & Performance Management Services — KPP will provide reporting at least quarterly that demonstrates the key performance management statistics resulting from application of KPP's High Cost Generic Performance Management program along with objective evidence demonstrating the impact on overall cost performance of the Plan's prescription drug program. 11.3 Standard retrospective Drug Use Evaluation (DUE) Programs $0.02 PMPM Quality focused physician outreach program reporting focusing on by care quality and safety management incorporating the identification of members utilizing medications in a manner suggesting less than optimum drug therapy utilization with template communication to prescriber requesting a reassessment of therapy. Therapeutic area defined by KPP clinical staff and one program administered quarterly. Standard letter template and data file included. Plan is responsible for printing and sending outreach. 11.4 Enhanced Retrospective Drug Use Evaluation (DUE) Programs Bundled Fee $0.14 PMPM Physician outreach programs focused on care quality along with safety management interventions incorporating the identification of members utilizing medications in a manner suggesting less than optimum drug therapy utilization with written communication to prescriber requesting a reassessment of therapy. Care Quality Programs Quarterly claims sweep on a three month rotating basis with follow-up Individual program communication to prescriber no more often than quarterly. fees Migraine — Prophylaxis in Severe Disease Hypertension - Anti -Hypertensive Use in Diabetics $0.02 PMPM Cardiovascular — Lipid Medication Use in Diabetics $0.02 PMPM Asthma - Controller Use in Asthma $0.03 PMPM Osteoporosis — Fracture Prophylaxis $0.03 PMPM $0.02 PMPM High Risk Safety Management Programs Monthly claims sweep with follow-up communication to prescriber monthly. Potentially inappropriate Medications in Elderly/Beers Polypharmacy — Potentially Inappropriate Multi -drug Therapy $0.02 PMPM $0.03 PMPM Includes outreach fees. 11.5 Refill Reminder Program Letter Program: $0.30 PMPM Member outreach program focused on medication non -adherence incorporating the identification of members whose refill patterns suggest less than optimal medication utilization with communication to the member reminding him/her to refill Eagle County Government Page 131 Eagle County Government Page 132 medications. Letter -based or automated telephonic (NR) interventions available to improve adherence in the following therapeutic classes: • Oral Diabetes Agents • Hypertension (ACEIARBIDRI) • Hypercholesterolemia (Statins) Additional features of the IVR program include collection of member response data identifying reasons for non -adherence for further plan sponsor intervention (ie. "I'm having side effects" or "I don't believe I need to take if'). NR: Eligibility: PMPM 0-99,999: $0.49 100K -500K: $0.37 X500,000: $0.24 Additional classes available at $0.04 PMPM each 11.6 Overutilization & Safety Controls Programs Acetaminophen Safety Controls at POS KPP will provide a point -of --sale ("POS") intervention that will identify dispensing $0.03 PMPM of daily doses of the ingredient acetaminophen ("APAP") of greater than 4gmlday. The intervention will calculate doses in excess of 4gmlday across multiple claims containing APAP. Claims identified that meet or exceed 4 gm/day of APAP will be denied. This intervention can be overridden in two ways: 1) via a Therapeutic Prior Authorization request, or 2) via the use of professional pharmacy services ("PPS") codes submitted by the Participating Pharmacy upon receipt of the POS intervention message. Opioid Cumulative Dosing Program $0.02 PMPM KPP will provide a POS intervention that will identify and deny an incoming claim when an Eligible Member's Morphine equivalent dose per day ("MED") is equal to or exceeds a threshold (i.e. over 200 mg) across a single or multiple opioid - containing claim(s). The intervention is non-overridable except via a Therapeutic Prior Authorization. The intervention also allows an incoming claim with cumulative MED over a lower threshold (i.e. over 120 mg) that can be overridden by Therapeutic Prior Authorization or PPS codes. Opioid Overutilization Intervention Data Files $0.02 PMPM KPP will provide Plan enhanced retrospective drug utilization review ("DUR") using proprietary advanced analytics to identify Eligible Members receiving opiates with MED in excess of 120 mg/day over a ninety (90) day consecutive period (monthly rolling six (6) month look -back) from three (3) or more prescribers and three (3) or more Participating Pharmacies. Data files of retrospectively targeted Eligible Members, prescribers, and claims data will be provided in KPP's standard data file format. KPP will not be responsible for Eligible Member outreach, but will monitor prescriber fax -back response and follow-up if needed. Any customization of criteria or data file format may incur additional fees at the clinical consulting rate set forth in this Agreement. Opioid Overutilization Intervention Data Files & Letters $0.03 PMPM KPP will provide to Plan enhanced retrospective DUR using proprietary advanced analytics to identify Eligible Members receiving opiates with MED in excess of 120 mg/day over a ninety (90) day consecutive period (monthly rolling six (6) month look -back) from three (3) or more prescribers and three (3) or more Eagle County Government Page 132 pharmacies. Data files of retrospectively targeted Eligible Members, physicians and claims data will be provided in KPP's standard data file format, and KPP will generate notifications to Eligible Members and prescribers to verify an Eligible Member's prescribed medications. KPP will not be responsible for monitoring provider fax -back response and follow-up if needed. Plan shall approve all template notification letters. Plan may terminate Program services herein upon thirty (30) days prior written notice to KPP in accordance with this Agreement. Eagle County Government Page 133 EXHIBIT B BUSINESS ASSOCIATE ADDENDUM This Business Associate Addendum (the "Addendum") is entered into by and between Kroger Prescription Plans, Inc. ("KPP" or the "Business Associate') and Eagle County Government (the "Covered Entity") and is effective upon the date this Addendum has been signed by the Covered Entity. This Addendum shall supplement the Services Agreement between the Covered Entity and the Business Associate ("Services Agreement"). WHEREAS, the Business Associate and the Covered Entity have entered into a Services Agreement whereby the Business Associate provides certain services to or on behalf of the Covered Entity; WHEREAS, the Business Associate may receive from, or may create, receive, maintain or transmit on behalf of, the Covered Entity, PHI in order to provide services under the Services Agreement; and WHEREAS, to comply with the requirements of the privacy, security, breach notification and enforcement regulations under the Health Insurance Portability and Accountability Act of 1996, as amended (the "HIPAA Rules"), the Covered Entity and the Business Associate desire to enter into this Addendum documenting the permitted uses and disclosures of PHI by the Business Associate and other rights and obligations of each of the parties. NOW THEREFORE, for good and valuable consideration, receipt and sufficiency of which are hereby acknowledged, the parties, intending to be legally bound, hereby agree as follows: A. Definitions. For the purposes of this Addendum, the following terms shall have the meanings as indicated below which are intended to be consistent with the definitions of such terms as they are defined in the HIPAA Rules. Terms used, but not otherwise defined in this Addendum, shall have the same meanings as those terms are defined in the HIPAA Rules. 1. Breach. The term Breach shall have the same meaning as the term "breach" in 45 C.F.R. §164.402, limited to breaches of PHI not rendered unusable, unreadable or indecipherable to unauthorized persons through the use of a technology or methodology specified by the Secretary in guidance issued under Section 13402(h) of Public Law 111-5. 2. Breach Notification Rule. The term Breach Notification Rule shall mean the Standards for Notification in the Case of Breach of Unsecured Protected Health Information at 45 C.F.R. Part 164, Subpart D. 3. Designated Record Set. The term Designated Record Set shall mean a group of Records maintained by or for the Covered Entity that is: a. Comprised of the medical and prescription Records and/or billing Records about Individuals; Eagle County Government Page 134 b. The enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan; or C. Used, in whole or in part, by or for the Covered Entity to make decisions about Individuals. 4. Electronic Protected Health Information. The term Electronic Protected Health Information ("EPHP') shall mean a subset of PHI that is transmitted or maintained in Electronic Media. 5. Individual. The term Individual shall have the same meaning as the term "individual" in 45 C.F.R. § 164.103 and includes a person who qualifies as a personal representative in accordance with 45 C.F.R. §164.502(g). 6. Privacy Rule. The term Privacy Rule shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 C.F.R. Part 160 and Part 164, Subparts A and E. 7. Protected Health Information. The term Protected Health Information or ("PHI") shall have the same meaning as the term protected health information in 45 C.F.R. § 164.103, limited to the information created, received, maintained, or transmitted by the Business Associate from or on behalf of the Covered Entity pursuant to this Addendum. 8. Record. The term Record shall mean any item, collection, or grouping of information that includes Protected Health Information and is maintained, collected, used or disseminated by or for the Covered Entity. 9. Required by Law. The term Required by Law shall have the same meaning as the term is defined in 45 C.F.R. § 154.103. 10. Secretary. The term Secretary shall mean the Secretary of the Department of Health and Human Services or his or her designee. 11. 'Security Rule. The term "Security Rule' shall mean the Security Standards for the Protection of Electronic Protected Health Information at 45 C.F.R. Parts 150 and 154, Subparts A and C. 12. Unsecured PHI. The term Unsecured PHI shall have the meaning as the term is defined in 45 C.F.R. § 164.402. B. Status of Parties. The Business Associate is an independent contractor of the Covered Entity. Nothing in this Addendum shall be construed to create a joint venture, partnership, or agency. No employee or agent of the Business Associate shall be deemed to be an employee or agent of the Covered Entity, and no employee or agent of the Covered Entity shall be deemed to be an employee or agent of the Business Associate. Eagle County Government Page 135 C. Business Associate Obligations. The Business Associate covenants and agrees that it shall: 1. Not use or disclose PHI other than as permitted or required under the Services Agreement, this Addendum or as Required by Law. 2. Use appropriate safeguards and comply with the Security Rule with respect to EPHI to prevent the use or disclosure of PHI other than as provided in this Addendum. 3. Mitigate, to the extent practicable, any harmful effect that is known to the Business Associate of a use or disclosure of PHI by the Business Associate in violation of the HIPAA Rules or in violation of the requirements of this Addendum. 4. Report to the Covered Entity any use or disclosure of PHI not provided for by this Addendum of which it becomes aware, including, but not limited to, any Breach and any Security Incident of which it becomes aware within ten (10) days after the Business Associate learns of such use, disclosure or Breach. However, if a delay is requested by a law enforcement official in accordance with 45 C.F.R. §164.412, the Business Associate may delay notifying the Covered Entity for the applicable time period. 5. Enter into a written contract with subcontractors that create, receive, maintain, or transmit PHI on behalf of the Business Associate in accordance with 45 C.F.R. §164.308(b)(2) and § 164.502(e)(1)(ii). Such contract shall require that the subcontractor agree to the same restrictions and conditions that apply to the Business Associate with respect to PHI in this Addendum. 6. Provide access to an Individual's PHI in a Designated Record Set pursuant to 45 C.F.R. § 164.524 within thirty (30) days of a written request from the Covered Entity or from an Individual to the extent that the Business Associate has a Designated Record Set for an Individual. The Business Associate's response shall be made to the Covered Entity. If the Business Associate is unable to provide the Covered Entity with access within the required time frame, the Business Associate shall notify the Covered Entity so the Covered Entity may request an extension from the Individual. If the request for access relates to PHI that is maintained electronically in a Designated Record Set in the Business Associate's control or custody, the Business Associate shall provide an electronic copy in the form and format specified in the request if it is readily producible in such format. If the electronic copy is not readily producible in such format, the Business Associate shall work with the Covered Entity to meet its electronic access obligations under 45 C.F.R. § 164.524. 7. Respond to requests for amendment(s) to an Individual's PHI in a Designated Record Set pursuant to 45 C.F.R. §164.526 within thirty (30) days of a written request from the Covered Entity or the Individual to the extent that the Business Eagle County Government Page 136 Associate has a Designated Record Set for an Individual. The Business Associate's response shall be made to the Covered Entity. If the Business Associate is unable to respond to the amendment request within the required time frame, the Business Associate shall notify the Covered Entity so the Covered Entity may request an extension from the Individual. 8. Make internal practices, books, and records, including policies and procedures relating to the use and disclosure of PHI, available to the Secretary for purposes of determining compliance with the HIPAA Rules. 9. Document certain disclosures of PHI and information related to such disclosures and provide an accounting of such information pursuant to 45 C.F.R. § 164.528 within thirty (30) days of a written request from the Covered Entity or the Individual. The Business Associate's response shall be made to the Covered Entity. If the Business Associate is unable to provide an accounting within the required time frame, the Business Associate shall notify the Covered Entity so the Covered Entity may request an extension from the Individual. 10. Use and maintain computer software and hardware in compliance with the security provisions of the Privacy Rule as well as industry standards. 11. Comply with the requirements of the Privacy Rule that apply to the Covered Entity to the extent that the Business Associate agrees to carry out one or more of the Covered Entity's obligations under the Privacy Rule. To the extent that the Business Associate subcontracts one or more of the Covered Entity's obligations under the Privacy Rule, the Business Associate shall ensure in accordance with Section C.5 that the subcontractor agrees to comply with the requirements of the Privacy Rule that apply to the Covered Entity in the performance of these obligations. D. Permitted Uses and Disclosures. The Business Associate agrees that it shall not use or disclose PHI in any manner, form, or in any means that is contrary to its obligations under the Services Agreement or this Addendum. Notwithstanding the foregoing, the parties agree that the Business Associate may: 1. Use or disclose PHI to perform functions, activities, or services for, or on behalf of, the Covered Entity as specified in the Services Agreement or in this Addendum, provided that such use or disclosure would not violate the Privacy Rule if done by the Covered Entity, except for the specific uses and disclosures set forth in sections D.4. and D.5. below. 2. Use or disclose PHI as Required by Law. 3. Use its professional judgment when making decisions about the minimum necessary uses, disclosures and requests of PHI while performing its obligations and activities specified in this Addendum, except that the Business Associate will not be obligated to comply with the minimum necessary limitation if neither the Business Eagle County Government Page 137 Associate nor the Covered Entity is required to limit its use, disclosure, or request to the minimum necessary under the HIPAA Rules. 4. Use PHI when necessary for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate. The Business Associate may disclose PHI when necessary for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate if the disclosure is Required by Law or the Business Associate obtains reasonable assurances from the person to whom the information is disclosed that (a) it will be held confidentially and used or further disclosed only as Required by Law or for the purpose for which it was disclosed and (b) the person notifies the Business Associate of any instances of which it is aware in which the confidentiality of the PHI has been breached. 5. Use PHI to provide data aggregation services relating to the health care operations of the Covered Entity. E. Covered Entity Obligations. The Covered Entity covenants and agrees that it shall: 1. Provide the Business Associate with a copy of the notice of privacy practices that the Covered Entity produces in accordance with the HIPAA Rules, as well as any changes to that notice. 2. Provide the Business Associate with any changes in, or revocation of, permission by an Individual to use or disclose PHI, to the extent that those changes affect the Business Associate's permitted or required uses and disclosures. 3. Notify the Business Associate of any restriction to the use or disclosure of PHI that the Covered Entity has agreed to or is required to abide by in accordance with the HIPAA Rules, to the extent that such restriction may affect the Business Associate's use or disclosure of PHI. 4. Not request the Business Associate to use or disclose PHI in any manner that would be impermissible under the Privacy Rule if used or disclosed by the Covered Entity. F. Term and Termination Provisions. 1. Term. This Addendum shall be effective as of the date signed by the Covered Entity and shall terminate upon the first to occur of the following: (a) the termination of the Services Agreement; or (b) the termination of this Addendum pursuant to Section F.2. below. The provisions of Section F.3. shall survive any termination of this Addendum. Eagle County Government Page 138 2. Termination for Cause. Upon the Covered Entity's knowledge of a material breach by the Business Associate, the Covered Entity shall either: a. Provide an opportunity for the Business Associate to cure the breach and end the violation within a reasonable time designated by the Covered Entity (but not more than thirty (30) days), and terminate this Addendum and the Services Agreement if the Business Associate does not cure the breach or end the violation within the time specified by the Covered Entity; or b. Immediately terminate this Addendum and the Services Agreement if the Business Associate has breached a material term of this Addendum and the Covered Entity has determined that the cure is impossible. 3. Effect of Termination. a. Except as provided in Subsection F.3.b. below, upon termination of this Addendum for any reason, the Business Associate shall return all PHI to the Covered Entity or destroy PHI to the extent the Covered Entity does not request its return. This provision shall apply to PHI that is in the possession of subcontractors or agents of the Business Associate. The Business Associate shall retain no copies of PHI. b. In the event that the Business Associate reasonably determines that returning or destroying the PHI is not feasible, the Business Associate shall provide to the Covered Entity written notification of the conditions that make return or destruction not feasible. Upon the mutual agreement of the Business Associate and the Covered Entity that return or destruction of PHI is not feasible, the Business Associate shall extend the protections of this Addendum to such PHI and limit further uses and disclosures of PHI to those purposes that make the return or destruction not feasible, for so long as the Business Associate maintains the PHI. G. Miscellaneous. The parties further agree: 1. Regulatory References. A reference in this Addendum to a section in the HIPAA Rules shall have the same meaning as in effect or as amended. 2. Amendment. The parties agree to take such action as is necessary to amend this Addendum from time to time as is necessary for the Covered Entity to comply with the requirements of the HIPAA Rules. This Addendum may only be amended in a writing signed by both parties. 3. Interpretation. Any ambiguity in the Services Agreement or in this Addendum shall be resolved in favor of a meaning that permits the Covered Entity to comply with the HIPAA Rules. Eagle County Government Page 139 4. Governing Agreement. The terms and conditions of this Addendum shall supersede all conflicting terms and conditions of all prior agreements, including the Services Agreement, with respect to the subject matter set forth herein. S. Severability. The invalidity or unenforceability of any provisions of this Addendum shall not affect the validity or enforceability of any other provision of this Addendum, which shall remain in full farce and effect. 5. Construction and Interpretation. The section headings contained in this Addendum are for reference purposes only and shall not in any way affect the meaning or interpretation of this Addendum. 7. Entire Agreement. This Addendum constitutes the entire agreement between the parties with respect t0 its subject matter and constitutes and supersedes all prior agreements, representations and understandings of the parties, written or oral, with regard to this same subject matter. IN WITNESS WHEREOF, the parties hereto have duly executed this Addendum as of the date first written below by the Covered Entity. KROGER PRESCRIPTION PLANS, INC. ("Business Associate") �w.�liesuB9 By: Print Name: Matthew Feltman Print Title: General Manager of KPP DaLe: 01/26/2017 EAGLE COUNTY GOVERMENT ("Covered Entity") By: Print Name: Brent McFall Print Title: Date- 01/30/2017 Eagle County Government Page 140 EXHIBIT C KPP APPEAL SERVICES Administrative Appeals If an Eligible Member has a concern regarding an administrative plan benefit edit, the Eligible Member may contact the KPP member services helpdesk. Working with client -approved guidelines, the KPP member service representative can resolve most Eligible Member administrative benefit issues quickly and satisfactorily. If an Eligible Member feels that the issue has not been resolved after speaking with the KPP member services representative or feels the plan guidelines are inappropriate, the Eligible Member is directed to contact their respective Plan's Benefit Services department to discuss their concern with the specific plan benefit edit in question. Medication Prior Authorization (PA) Appeals A member or their physician on the member's behalf may submit a written appeal request for pre -service or post -service PA appeals due to a PA request denial. PA appeal forms are available from KPP for the Eligible Member or their physician to complete and submit to KPP to initiate an appeal review. Written PA appeal requests should be faxed or mailed to the following address: Kroger Prescription Plans, Inc. Attn: Appeals Department 1014 Vine Street Cincinnati, OH 45202 1-866-762-1014 (Fax) SUBMISSION TIMELINES FOR ELIGIBLE MEMBER PA APPEALS If an Eligible Member decides to file a PA appeal, they must submit the appeal within one hundred eighty (180) days from the date of the pre -service or post -service PA denial notice. A physician or other authorized representative of the Eligible Member may file an appeal on behalf of an Eligible Member. KPP shall work with the Eligible Member or their authorized representative or physician to resolve the appeal. If the Eligible Member is not satisfied with the determination of the first level appeal, they may file a written request for a second level appeal with KPP within ninety (90) calendar days of receipt of the first level appeal determination letter. FEES *The Plan acknowledges that the appeal cost for the second level varies based upon the outside source utilized for the appeal. Eagle County Government Page 141 EXHIBIT D Specialty Rx Rate Table rug Name ABACAVI R HIV 25.00% ABACAVI R SULFATE/ LAMI VUDI NEIZI DOVUDI NE HIV 25.00% ABRAXANE ONCOLOGY- INJECTABLE 17.00% ACTEMRA AUTOI MMUNE I NR. AMMATORY DI SORDERS 17.00% ADCETRI S ONCOLOGY- I NJECTABLE 17.00% ADG RCA PULMONARY ARTERI AL HYPERTENSI ON 17.00% ADVATE HEMOPHILIA 35.00% ADYNOVATE HEMOPHILIA 22.00% AFI NI TOR ONCOLOGY- ORAL 17.00% AFSTYLA AFSTYLA KIT 25OUNIT 30.00% AFSTYLA HEMOPHILIA 30.00% ALDURAZYME ENZYME DER G ENCY OR LYSOSOMAL STORAGE DISORDERS 17.00% ALFERON ONCOLOGY- I NJECTABLE 17.00% ALI MTA ONCOLOGY- I NJECTABLE 17.00% ALKERAN ONCOLOGY- I NJECTABLE 17.00% ALPHANATE HEMOPHILIA 35.00% ALPHANI NE HEMOPHILIA 35.00% ALPROLI X HEMOPHILIA 22.00% APTI VUS HIV 17.00% ARANESP HEMATOPOI ETI CS 17.00% ARRANON ONCOLOGY- I NJECTABLE 17.00% ARZERRA ONCOLOGY- I NJECTABLE 16.00% ASTAGRAF TRANSPLANT 17.00% ATRI PLA HIV 17.00% AUTOPLEX HEMOPHILIA 17.00% AVASTI N ONCOLOGY- I NJECTABLE 18.009 AVONEX MULTI PLE SCLEROSI S 17.00% AZACITIDINE ONCOLOGY- I NJECTABLE 18.00% BARACLUDE HEPATITIS B 17.00% BAYGAM HEMOPHILIA 17.00% BEBULI N HEMOPHILIA 12.00% BELEODAO ONCOLOGY- I NJECTABLE 17.00% BENDEKA ONCOLOGY- I NJECTABLE 17.00% BEN ER X HEMOPHILIA 10.00% BENLYSTA SYSTEMI C LUPUS ERYTHEMATOSUS 17.00% BETASERON MULTI PLE SCLEROSI S 17.00% BETHKI S CYSTI C FI BROSI S 16.00% BICNU ONCOLOGY- I NJECTABLE 17.00% BI VIGAM I MMUNE GLOBULI N 25.00% BOSULI F ONCOLOGY- ORAL 16.00% BUPHENYL HYPERAMMON EMI A 17.00% BUSULFE)C ONCOLOGY- I NJECTABLE 17.00% Eagle County Government Page 142 Eagle County Government Page 143 CAMPTOSAR ONCOLOGY- I NJECTABLE 17.00°1 CAPECITABI NE ONCOLOGY -ORAL 37.00°1 CAR MUNE I MMUNE GLOBULI N 20.509 CAYSTON CYSTIC FI BROSI S 16.009 CELLCEPT TRANSPLANT 17.009 CEP ROT I N THROMBOLYTI C 17.009 CEREZYME ENZYME DEFICIENCY 17.009 CI MZI A AUTOI MMUNE I N FLAMMATORY DI SORDERS 17.009 CLADRI BI NE ONCOLOGY- I NJECTABLE 25.009 CLOLAR ONCOLOGY- INJECTABLE 17.009 COAGADEX HEMOPHILIA 20.009 COMBI VI R HIV 17.009 COMPLERtA HIV 17.009 COPAXONE MULTI PLE SCLEROSI S 17.009 LORI FACT HEMOPHILIA 17.009 COSENTYX AUTOIMMUNE INFLAMMATORY DISORDERS 17.009 CRI XI VAN HIV 17.00% CYRAMZA ONCOLOGY- I NJECTABLE 17.009 CYTOGAM I MMUNE GLOBULIN 20.509 DACOGEN ONCOLOGY- I NJECTABLE 17.009 DAKLI NZA H EPATI TI S C 17.009 DAFZALEX ONCOLOGY- INJECTABLE 17.009 DEPOCYT ONCOLOGY- I NJECTABLE 17.009 DI DANOSI NE HIV 25.009 DOCETAXEL ONCOLOGY- I NJECTABLE 42.509 DOXI L ONCOLOGY- I NJECTABLE 17.009 DYSPORT NEUROMUSCULAR 17.009 EDURANT HIV 17.009 EGRI FTA HIV 17.009 ELAPRASE ENZYME DEFICIENCY 16.009 ELIGARD HORMONAL THERAPI ES 17.009 ELLENCE ONCOLOGY- I NJECTABLE 17.009 ELOCTATE HEMOPHILIA 15.509 ELOXATI N ONCOLOGY- I NJECTABLE 17.009 EMTRI VA HIV 17.009 ENBREL AUTOI MMUNE I NFLAMMATORY DI SORDERS 17.009 ENOXAPARI N ANTI COAGULANTS 42.509 ENTECAVI R H EPATI TI S B 40.009 ENTYVIO AUTOI MMUNE I NFLAMMATORY DI SORDERS 17.009 ENVARSUS TRANSPLANT 17.009 EPCLUSA HEPATITIS C 17.009 EPI VIR HBV HIV 17.009 EPOGEN HEMATOPOI ETI CS 17.009 EPZI OOM HIV 17.009 ERBI TUX ONCOLOGY- I NJECTABLE 17.009 ERI VEDGE ONCOLOGY- ORAL 17.009 Eagle County Government Page 143 Eagle County Government Page 144 ETOPOPHOS ONCOLOGY- I NJECTABLE 17.00°1 ETOPOSI DE ONCOLOGY - INJECTABLE 17.00°1 EUFLE?O(A OSTEOARTHRITIS 17.009 EVOMELA ONCOLOGY- I NJECTABLE 17.009 EVOTAZ HIV 17.009 E?CTAVIA MULTI PLE SCLEROSI S 17.009 FABRAZYME ENZYME DEFICIENCY 16.009 FASLODEX ONCOLOGY- I NJECTABLE 17.009 FEI BA HEMOPHILIA 30.009 FERRI PROX I RON OVERLOAD 17.009 FI RAZYR HEREDITARY ANGI OEDEMA 16.009 FI RMAGON ONCOLOGY- I NJECTABLE 17.009 FLEBOGAMMA I MMUNE GLOBULIN 17.009 FWDARA ONCOLOGY- I NJECTABLE 17.009 FOLOTYN ONCOLOGY- I NJECTABLE 16.009 FON DAPARI NUX ANTICOAGULANTS 37.009 FORTEO OSTEOPOR09 S 17.009 FUST LEV ONCOLOGY- I NJECTABLE 17.009 FUZEON HIV 17.009 GAMASTAN I MMUNE GLOBULIN 20.509 GAMMAGARD I MMUNE GLOBULI N 20.509 GAMMAGARD I MMUNE GLOBULIN 23.009 GAMMAKED I MMUNE GLOBULIN 23.009 GAMMAPLEX I MMUNE GLOBULIN 23.009 GAMMAPLEX I MMUNE GLOBULI N 25.009 DAMMAR I MMUNE GLOBULI N 20.509 GAMUNE)C-C I MMUNE GLOBULI N 20.509 GAZYVA ONCOLOGY- I NJECTABLE 17.009 GEMCI TABI NE ONCOLOGY- I NJECTABLE 37.009 GEMZAR ONCOLOGY- INJECTABLE 17.009 GENGRAF TRANSPLANT 17.009 GENOTROPI N GROWTH HORMONE 17.009 GEN VOYA HIV 17.009 GI LENYA MULTI PLE SCLEROSI S 17.009 GLATOPA MULTI PLE SCLEROSI S 27.009 GLEEVEC ONCOLOGY- ORAL 17.009 GLEOSTI NE ONCOLOGY- ORAL 17.009 HALAVEN ONCOLOGY- I NJECTABLE 17.009 HARVONI H EPATI TI S C 17.009 HELI XATE HEMOPHILIA 35.009 HEMOR L HEMOPHILIA 35.009 HEPAGAM B HEPATITIS B 17.009 HEPSERA HEPATITIS B 17.00% HERCEPTI N ONCOLOGY- I NJECTABLE 16.00% HEXALEN ONCOLOGY- ORAL 17.009 HIZENTRA I MMUNE GLOBULI N 25.009 Eagle County Government Page 144 Eagle County Government Page 145 HT FACTOR HEMOPHILIA 20.009 HUMATE-P HEMOPHILIA 25.009 HUMATROPE GROWTH HORMONE 17.009 HUMI RA AUTOI MMUNE I NFLAMMATORY DI SORDERS 17.009 HYALGAN OSTEGARTH RI TI S 17.009 HYCAMTI N ONCOLOGY- I NJECTABLE 16.009 HYCAMTI N ONCOLOGY- ORAL 16.009 HYPERHEP B SID HEPATITIS B 17.009 HyperRHO & D I MMUNE GLOBULIN 17.009 HYQVIA I MMUNE GLOBULIN 20.509 I BRAN CE ONCOLOGY -ORAL 16.009 I DELVION HEMOPHILIA AND RELATED BLEEDING DI SORDERS 17.009 I MATI NIB MESYLATE ONCOLOGY- ORAL 28.509 IMMUNE GLOBULIN I MMUNE GLOBULIN 20.509 I NFLECTRA AUTOI MMUNE INFLAMMATORY DI SORDERS 17.009 I N LYTA ONCOLOGY- ORAL 16.009 I NTELENCE HIV 17.009 INTRON -A ONCOLOGY- I NJECTABLE 17.00% I NVI RASE HIV 17.009 I SENTRESS HIV 17.009 I STORAX ONCOLOGY- I NJECTABLE 17.009 I VEEGAM I MMUNE GLOBULI N 20.509 IXEMPRA ONCOLOGY- I NJECTABLE 17.009 IXINITY HEMOPHILIA 22.009 IXINITY IXINITY INJ 15000NIT 22.009 JADENU I RON OVERLOAD 17.009 JETREA OPHTHALMIC AGENTS 17.009 JEVTANA ONCOLOGY- I NJECTABLE 17.009 KADCYLA ONCOLOGY- I NJECTABLE 17.009 KALBITOR AUTOIMMUNE INFLAMMATORY DISORDERS 17.009 KALETRA HIV 17.009 KALYDECO CYSTI C FI BROSI S 16.009 KEPI VAN CE ONCOLOGY- I NJECTABLE 17.009 KEYTRUDA ONCOLOGY- I NJECTABLE 17.009 KI NERET AUTOI MMUNE I NFLAMMATORY DI SORDERS 17.009 KI TABI S CYSTI C FI BROSI S 16.00% KOATE-DVI HEMOPHILIA 35.009 KOGENATE HEMOPHILIA 35.009 KONYNE HEMOPHILIA 25.009 KRYSTEXXA GOUT 17.009 KUVAN METABOLIC ENZYMES 17.009 KUVAN PHENYLKETONURIA 17.009 LAM VUDI NEI ZI DOW DI NE HIV 25.009 LEUM NE HEMATOPOI ETI CS 17.009 LEUPROU DE HORMONAL THERAPI ES 30.009 Eagle County Government Page 145 Eagle County Government Page 146 LEVOLEUCOVOR ONCOLOGY- SUPPORTIVE CARE 17.00°1 LEM VA HIV 17.00°1 LOVENOX ANTI COAGULANTS 55.00°1 LUCENTI S OPHTHALMIC AGENTS 17.00°1 LUMIZYME ENZYME DER CI ENCY OR LYSOSOMAL STORAGE DI SORDERS 17.009 LUPRON HORMONAL THERAPI ES 17.009 MACUGEN OPHTHALMIC AGENTS 17.009 MAKENA HORMONAL THERAPI ES 16.009 MEKI NI ST ONCOLOGY- ORAL 16.009 MELATE HEMOPHILIA 20.009 MODERI BA H EPATI TI S C 18.009 MONARGM HEMOPHILIA 25.009 MONOCLATE HEMOPHILIA 35.009 MONONI NE HEMOPHILIA 25.009 MOZOBI L HEMATOPOI ETICS 17.009 MYCOPHENOLAT TRANSPLANT 70.009 MYFORTI C TRANSPLANT 17.00% MYLERAN ONCOLOGY- ORAL 17.00% MYOBLOC NEUROMUSCULAR 17.00% NASI -HB HEPATITIS B 17.009 NAGLAZYME ENZYME DER G ENCY OR LYSOSOMAL STORAGE DISORDERS 17.009 NEORAL TRANSPLANT 17.009 NEULASTA HEMATOPOI ETI CS 17.009 NEUPOGEN HEMATOPOI ETI CS 17.009 NEVI RAPI NE HIV 25.009 NEVI RAPI NE HIV 25.009 NI N LARO ONCOLOGY- ORAL 16.009 NI PENT ONCOLOGY- I NJECTABLE 17.009 NORDITROPIN GROWTH HORMONE 17.009 NORVI R HIV 17.009 NOVOFJ GHT HEMOPHILIA 27.009 NOVOSEVEN HEMOPHILIA 27.009 NPLATE I MMUNE THROMBOCYTOPENI C PURPURA 17.009 NUCALA ASTHMA 17.009 NULOJI X TRANSPLANT 17.009 NUTROPI N GROWTH HORMONE 16.009 NUWI O HEMOPHILIA 17.009 OBI ZUR HEMOPHILIA 20.009 OCTAGAM I MMUNE GLOBULI N 20.509 OCTREOTI DE ACROMEGALY 30.009 ODEFSEY HIV 17.009 OLY90 HEPATITIS C 17.009 OMNITROPE GROWTH HORMONE 17.009 ONCASPAR ONCOLOGY- I NJECTABLE 17.009 OPDI VO ONCOLOGY- I NJECTABLE 16.009 Eagle County Government Page 146 Eagle County Government Page 147 ORENGA AUTOIMMUNE I NR-AMMATORY DISORDERS 17.00°1 ORENGA AUTOI MMUNE I NR-AMMATORY DI SORDERS 16.00°1 ORKAMBI CYSTI C FI BROSI S 16.009 ORTHOVI SC OSTEGARTH RI TI S 17.009 OTEZLA AUTOI MMUNE I NR-AMMATORY DI SORDERS 17.009 OXALI PLATI N ONCOLOGY- I NJECTABLE 28.009 PACLITAXEL ONCOLOGY- I NJECTABLE 25.009 PANGLOBULI N I MMUNE GLOBULI N 20.509 PEGASYS H EPATI TI S C 17.009 PEG -INTRON H EPATI TI S C 17.009 PERJETA ONCOLOGY- I NJECTABLE 17.009 PLEGRI DY MULTI PLE SCLER09 S 17.009 POLYGAM S1 D I MMUNE GLOBULIN 20.509 POMALYST ONCOLOGY- ORAL 16.009 PRALUENT ANTI HYPERLI PI DEMI CS, MI SC 16.009 PREZCOBI X HIV 17.009 PREZI STA HIV 17.009 PRI VI GEN I MMUNE GLOBULIN 25.009 PROCRIT HEMATOPCI ETI CS 17.009 PROFI LNI NE HEMOPHILIA 25.009 PROGRAF TRANSPLANT 17.009 PROLEUKIN ONCOLOGY- INJECTABLE 17.009 PROMACTA I MMUNE THROMBOCYTOPENI C PURPURA 17.009 PULMOZYME CYSTIC FI BROSI S 17.009 RAPAMUNE TRANSPLANT 17.009 REBETCL H EPATI TI S C 17.009 REGI F MULTI PILE SCLEROSI S 17.009 RECLAST OSTEOPOR09 S 17.009 RECOMBI NATE HEMOPHILIA 32.009 REMICADE AUTOI MMUNE I NR-AMMATORY DI SORDERS 17.009 REPATHA CARDIOVASCULAR AGENT 16.009 RESCRI PTOR HIV 17.009 RETI SERT CH RANI C NONINFECTIOUS UVEITIS 17.00% RETROVI R I V INFUSION HIV 17.009 RETROVI R HIV 17.009 REVATI O PULMONARY ARTERI AL HYPERTENSI ON 17.009 REVLI MI D ONCOLOGY- ORAL 16.009 REYATAZ HIV 17.009 RiaSTAP HEMOPHILIA 22.009 RI BAPAK H EPATI TI S C 35.009 RI BASPHERE HEPATITIS C 70.009 RI BAVI RI N H EPATI TI S C 70.009 RITUXAN ONCOLOGY- I NJECTABLE 16.009 RI XUBI S HEMOPHILIA 17.009 SAIZEN GROWTH HORMONE 17.009 Eagle County Government Page 147 Eagle County Government Page 148 SAMSCA ELECTROLYTE DI SORDERS 17.00°1 SANDI MMUNE TRANSPLANT 17.00°1 SANDOGLOBULI N I MMUNE GLOBULI N 20.509 SANDOSTATI N ACROMEGALY 17.009 SELZENTRY HIV 17.009 SI MPONI AUTOI MMUNE INFLAMMATORY DI SORDERS 17.009 SI MULECT I MMUNE GLOBULI N 17.009 SI BOLI MUS TRANSPLANT 25.009 SOLI RI S PAROXYSMAL NOCTURNAL HEMOGLOBI NURIA (PNH) 17.009 SOMATULI NE ACROMEGALY 17.009 SORIATANE PSORIASI S 17.009 SOVALDI H EPATI TI S C 17.009 SPRYCEL ONCOLOGY- ORAL 17.009 STAVUDI N E HIV 25.009 STELARA AUTOI MMUNE I NFLAMMATORY DI SORDERS 17.009 STI MATE HEMOPHILIA 17.009 STRI BI LD HIV 17.009 SUPARTZ OSTEOARTHRITIS 17.009 SUPPRELI N HORMONAL THERAPI ES 17.009 SUSTI VA HIV 17.009 SUTENT ONCOLOGY- ORAL 16.009 SYLATRON ONCOLOGY- I NJECTABLE 17.009 SYLVANT ONCOLOGY- I NJECTABLE 17.009 SYNVI SC OSTEOARTHRITIS 17.009 TACROLI MUS TRANSPLANT 70.009 TAR NLAR ONCOLOGY- ORAL 17.009 TALTZ AUTOI MMUNE I NFLAMMATORY DI SORDERS 17.009 TARCEVA ONCOLOGY- ORAL 17.009 TARGRETI N ONCOLOGY- ORAL 17.009 TASIGNA ONCOLOGY- ORAL 16.009 TAXOTERE ONCOLOGY- I NJECTABLE 17.009 TECFI DEKA MULTI PLE SCLEROSI S 17.009 TECHN I VI E H EPATI TI S C 17.00% TEMODAR ONCOLOGY- INJECTABLE 17.009 TEMODAR ONCOLOGY- ORAL 17.009 TEMOZOLOMI DE ONCOLOGY- ORAL 45.009 THALOMI D ONCOLOGY -ORAL 16.009 THERACYS ONCOLOGY- I NJECTABLE 17.009 THROMBATE II I ANTICOAGULANTS 17.009 THYMOGLOBULN I MMUNE GLOBULI N 17.009 THYROGEN ONCOLOGY- I NJECTABLE 17.009 TI VI CAY HIV 17.009 TORI CYSTI C FI BROSI S 16.009 TOBRAMYCI N CYSTI C FI BROSI S 35.009 TOPOSAR ONCOLOGY - I NJECTABLE 17.009 TOPOTECAN ONCOLOGY- I NJECTABLE 20.009 Eagle County Government Page 148 Eagle County Government Page 149 TREANDA ONCOLOGY- I NJECTABLE 17.00°1 TRELSTAR HORMONAL THERAPI ES 17.009 TRETTEN HEMOPHILIA 10.009 TRI SENOX ONCOLOGY- I NJECTABLE 17.009 TRI UMEO HIV 17.009 TRIZIVIR HIV 17.009 TRUVADA HIV 17.009 TYBOST HIV 17.009 TYKERB ONCOLOGY- ORAL 17.009 TYZEKA HEPATITIS B 17.009 UNI TUXI N Neu rob lastoma 16.009 VALCYTE HIV 17.009 VALGANCI CLOVI R HIV 35.009 VALSTAR ONCOLOGY- I NJECTABLE 17.009 VANTAS HORMONAL THERAPI ES 17.009 VECTI BI ONCOLOGY- I NJECTABLE 17.009 VELC4DE ONCOLOGY- INJECTABLE 17.009 VENOBLOBULI N I MMUNE GLOBULI N 20.509 VICTRELIS HEPATITIS C 17.009 VI GAZA ONCOLOGY- I NJECTABLE 17.009 VI DEX HIV 17.009 VI EW RA H EPATI TI S C 17.009 VI MIZI M METABOLI C ENZYMES 17.009 VI NBLASTI NE ONCOLOGY- I NJECTABLE 18.509 VI NCASAR ONCOLOGY- I NJECTABLE 18.509 VI RACEPT HIV 17.009 VI RAMUNE HIV 17.009 VI RAZOLE RESPI RATORY SYNCYTIAL VI RUS 17.009 VI READ HIV 17.009 VI TEKTA HIV 17.009 VI VAGLOBI N I MMUNE GLOBULI N 20.509 VOTRI ENT ONCOLOGY- ORAL 17.009 VPRIV ENZYME DEFICIENCY 16.00% WI LATE HEMOPHILIA 25.009 WI NRHO I MMUNE GLOBULIN 20.509 XALKORI ONCOLOGY- ORAL 16.009 XELJANZ AUTOIMMUNE INFLAMMATORY DISORDERS 17.009 XELODA ONCOLOGY- ORAL 17.009 XEOMI N NEUROMUSCULAR 17.009 XGEVA ONCOLOGY- SUPPORTI VE CARE 17.00% XIAFLEX DUPUYTREN'S OONTRACTURE 17.009 XOLAI R ASTHMA 15.509 XTANDI ONCOLOGY- ORAL 15.509 XYNTHA HEMOPHILIA 32.009 YERVOY ONCOLOGY- I NJECTABLE 17.009 Eagle County Government Page 149 Eagle County Government Page 150 YONDELI S ONCOLOGY- I NJECTABLE 17.00°1 ZALTRAP ONCOLOGY- I NJECTABLE 17.00°1 ZANOSAR ONCOLOGY- I NJECTABLE 17.009 ZAR}0 O HEMOPHILIA 17.009 ZELBORAF ONCOLOGY -ORAL 18.009 ZEPATIER HEPATITIS C 17.009 ZERI T HIV 17.009 ZI AGEN HIV 17.009 ZI DOVUDI NE HIV 25.009 ZOLADEX HORMONAL THERAPI ES 17.009 ZOLEDRONI C ONCOLOGY- SUPPORTIVE CARE 25.009 ZOLEDRONI C OSTEOPOROSI S 25.009 ZOLI NZA ONCOLOGY- ORAL 17.009 ZOMETA ONCOLOGY- SUPPORTIVE CARE 17.009 ZORBTIVE GROWTH HORMONE 17.009 ZORTRESS TRANSPLANT 17.009 ZYDELIG ONCOLOGY- ORAL 17.009 ZYTIGA ONCOLOGY- ORAL 17.009 Eagle County Government Page 150