Loading...
HomeMy WebLinkAboutRES 99-351 RESOLUTION NO. �-3 BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF BEAUMONT.' THAT the City Council hereby approves a one (1) year contract with the option to renew for four additional years at no rate increase with Eckerd Health Services for a prescription drug benefit effective January 1, 2000. Any terms and conditions stated in the original specifications will apply to any extended periods. Approval on behalf of the City to renew this contract shall be made by the City Manager or his designee. BE IT FURTHER RESOLVED that the City Manager is hereby authorized to execute the contract substantially in the form attached as Exhibit "A". PASSED BY THE CITY COUNCIL of the City of Beaumont this the ,/�,t — day of U" 1999. - Mayor - Attachment E LETTER OF UNDERSTANDING/CONTRACT between ECKERD HEALTH SERVICES and THE CITY OF BEAUMONT THIS AGREEMENT, made as of the I st day of January, 2000, between TDI Managed Care Services, Inc., d/b/a/ Eckerd Health Services, a Delaware corporation, with its principal place of business at 620 Epsilon Drive, Pittsburgh, Pennsylvania 15238 ("EHS"), and City of Beaumont, with its principal place of business at 801 Main Street, Beaumont, Texas 77701. WHEREAS, Sponsor has committed to provide a prescription drug plan for eligible covered persons; and WHEREAS, EHS has established a nationwide network of retail and mail service pharmacies to accept sponsor's prescription drug plan; and WHEREAS, EHS has a remote electronic claims adjudication and processing system for adjudicating and processing claims made for prescription drugs and other goods and related services; and WHEREAS, EHS has a drug utilization review service by which the cost effectiveness, interaction and resulting therapeutic effect of various drugs is reviewed and monitored electronically; and WHEREAS, EHS has a prescription drug benefit management service for designing and managing prescription drug benefit plans; and WHEREAS, Sponsor desires to engage EHS to adjudicate and process claims on its behalf through the electronic claims adjudication and processing system and may request EHS to implement drug utilization review and benefit management services now or in the future, and EHS desires to furnish such services as described in this Agreement. NOW, THEREFORE, in consideration of the mutual premises and agreements herein contained, the parties hereto agree as follows: I. DEFINITIONS A. "Benefits" means the prescription drugs and other goods and related services covered by the Plan. OOEckerd.wpd II/5/99 Page I EXHIBIT "A" B. "Covered Person" means an individual who is eligible to receive Benefits in accordance with and under the terms of a Plan. C. "Effective Date" means the period beginning on January I, 2000. D. "Exclusions" means the prescription drugs and other goods and related services not covered by the Plan. E. "Member Pharmacies" means a nationwide network of retail and mail service pharmacies that have contracted with EHS and may accept Sponsor's Plan. F. "Plan" means Sponsor's prescription drug plan. G. "EHS Program" means the EHS Claims System, EHS DUR and the other services which EHS may provide to sponsor. H. "EHS DUR" means the concurrent drug utilization review program used by EHS. I. "EHS Claims System" means the electronic system used to adjudicate and process claims made for Benefits. II. OBLIGATIONS OF SPONSOR A. Prior to the Effective Date, Sponsor shall provide EHS, in a form approved by EHS, with information concerning the Plan, as and when needed and in sufficient detail to allow EHS to perform its obligations hereunder, including at least the following: I. The effective date and the expiration date of the Plan; 2. The classes of dependents covered, including any age limits applicable to dependent children; 3. The estimated number of Covered Persons by geographic location; 4. The manner of distribution of EHS identification cards to Covered Persons; S. The Benefits and Exclusion under the Plan; 6. The parameters ("Parameters") for determining (1) whether and to what extent Benefits are covered by the plan or Exclusions apply, and (ii) the amounts of all payments and the compensation rates to be offered for all Benefits; 7. The amount of the Plan deductible, or copayment, if any; and OOEckerd.wpd 11/5199 Page 2 8. Electronic eligibility information, including at least the following: (a) The names and identification numbers of all Covered Persons as of the Effective Date; (b) The relationship of each Covered Person to one another (e.g., qualified dependent) as applicable and such other information as may be reasonably required for adjudication of claims via the EHS Claims System; © The date of birth of each Covered Person; (d) If Sponsor's Plan includes EHS DUR, sufficient information to prepare Covered Persons' profiles for use in providing EHS DUR services; (e) If Sponsor's Plan includes network planning, each Covered Person's home address; and (f) Updates to, additions to and deletions from eligibility information and Covered Persons' profiles on a continuous basis as such changes occur. B. Sponsor warrants that if the Plan provides for the reimbursement to Covered Persons of the cost of prescription drugs purchased at non-Member Pharmacies, then the Plan shall state that such reimbursement shall be conditioned upon the submission of a claim for direct reimbursement in a form approved by Sponsor and EHS, together with the Covered Person's proof of payment for the prescription drugs. C. Prior to the Effective Date, Sponsor shall provide each Covered Person with complete and accurate information describing the Plan and the EHS Program. D. Sponsor warrants that the Parameters and the information provided to EHS pursuant hereto are consistent with the Plan in all respects. E. Sponsor agrees not to sell or share the information about the discount to or with any third party, except as allowed in accordance with the Open Records Act. III. OBLIGATIONS OF EHS A. EHS shall provide eligible employees/retirees including dependents with the required number of identification cards during the initial enrollment. The City of Beaumont agrees all enrollment contracts shall provide that eligible OOEckerd.wpd 11/5/99 Page 3 employees/retirees their dependents must present their identification cards to each pharmacy at the time of seeking to have a prescription filled. Replacement cards will be provided at a charge of $.50 each and the City will remit such monies collected to EHS. B. EHS shall enter the Plan's Parameters and eligibility information received from Sponsor into the EHS Claims System. The information entered into the EHS Claims System shall be deemed correct until EHS is otherwise notified by Sponsor that corrections are required. EHS shall promptly correct any errors brought to its attention. C. EHS shall take all reasonable steps to maintain its contracts with an adequate number of Member Pharmacies in the various geographic locations where Covered Persons are resident, EHS shall furnish each Member Pharmacy with a summary description of the Plan. Sponsor acknowledges and agrees that the Member Pharmacies are chosen solely based on their willingness to provide services to the Covered Persons and their professed willingness to abide by the Pharmacy Service Agreement. Sponsor further acknowledges and agrees that EHS shall not be responsible for any negligence, fraud or misconduct of any Member Pharmacy or any employee, agent or officer of Member Pharmacy. D. EHS, or its designated agent, shall process claims received from Member Pharmacies through the EHS Claims System and may also process paper claim forms received from Covered Persons for direct reimbursement. EHS, or its designated agent, shall determine eligibility and conformity to the Plan and effect payment of eligible claims and provide notification of declined or ineligible claims. The parties acknowledge that EHS is not a fiduciary or plan administrator of Sponsor or Sponsor's Plans and that, with respect to the provision of services by EHS under this Agreement, EHS shall not assume any obligations of Sponsor, any named fiduciary or the Plan administrator. E. EHS shall invoice Sponsor for the retail and/or mail service prescription claims amounts and applicable sales tax, if any, which have been processed by EHS, or its designated agent, during the applicable period (the "Prescription Claims Invoice"). EHS shall furnish to Sponsor a Prescription Claims Invoice no less frequently than twice a month. F. EHS shall invoice Sponsor for the administrative fees specified in Exhibit A (the "Administrative Fees") which have become due during the applicable period (the "Administrative Fees Invoice"). EHS shall submit to Sponsor an Administrative Fees Invoice no less frequently than monthly. (Hereinafter the Prescription Claims Invoice and the Administrative Fees Invoice are collectively referred to as the "Invoice"). OOEckerd.wpd 11/5/99 Page 4 IV. MAIL SERVICE PHARMACY A. EHS shall arrange to provide the mail service pharmacy services described in Exhibit B. V. EHS DUR SERVICES A. If requested by Sponsor, EHS shall provide the EHS DUR services listed in Exhibit C. B. EHS, on behalf of Sponsor, may deny payment for claims to the extent the information received is not sufficient to allow for EHS DUR services. VI. BENEFIT MANAGEMENT SERVICES A. If requested by sponsor, EHS shall provide the benefit management services listed in Exhibit D. VII. REMUNERATION AND PAYMENT A. Within forty-eight (48) hours of receipt of a Prescription Claims Invoice from EHS, sponsor shall initiate an Automated Clearing House (ACH) transfer or an electronic wire transfer for the Prescription Claims Invoice amount to a bank account designated by EHS. B. Within ten (10) business days of receipt of an Administrative Fees Invoice from EHS, Sponsor shall remit payment for the Administrative Fees Invoice amount to EHS. The "business day" does not include bank or City holidays. C. Eckerd Health Services shall submit the claims and administrative invoice to the City's Human Resources Department for payment within ten (10) days after the end of the accounting period of providing the covered services. Within forty-eight (48) hours of receipt of the prescription claims invoice from EHS, the City shall initiate an Automated Clearing House (ACH) transfer for the invoice amount to a bank designated by EHS. D. The invoice for the administrative fees shall be combined or submitted along with the claim invoice at the beginning of each month by EHS. The City will remit both payments as a combined total simultaneously via Automated Clearing House transfer. E. The City must remit payment for services in accordance with state regulations or the late payment allowed may be required by EHS. OOEckerd.wpd II/5/99 Page 5 VIII. RECORDS AND DATA A. EHS shall maintain for the life of the contract to prevent loss of information prior to the end of the contract period, in original form or on electronic media, the claims and paper claim forms supporting the invoices. EHS and Sponsor shall allow each other to audit, review and duplicate such records and any other records in their possession that relate primarily to the obligations undertaken by either party under this Agreement. The review and duplication of records shall be allowed upon reasonable notice during regular business hours at the place of business of the record holder and shall be subject to all applicable state and federal laws and regulations regarding the confidentiality of such records. Duplication shall be at the cost of the requesting party. Sponsor acknowledges that reimbursement rates for pharmacy services paid by EHS to Member Pharmacies are not necessarily a pass through of contracted rates between EHS and Sponsor. Accordingly, notwithstanding anything to the contrary set forth herein, Sponsor shall not have the right to audit, review or otherwise access information regarding contracted reimbursement rates or amounts of payments from EHS to Member Pharmacies. Upon request, EHS shall verify to Sponsor that all claims made by Member pharmacies for Benefits provided to Covered Persons have been paid by EHS. B. EHS shall retain full ownership rights over all compilations and analyses generated by EHS, as well as all property technology, software and other data utilized by EHS in its performance under this Agreement. Ownership rights shall include, but are not limited to, all rights associated with publication, trade secrets, copyrights, trademarks and patents. EHS shall retain the right to use all data and information received from Sponsor or Member Pharmacies provided such use shall not violate any Covered Person's right of confidentiality. Sponsor acknowledges that EHS has made it aware of the existence of manufacturer rebates and it will receive from EHS any rebates in connection with this Agreement. Sponsor agrees that EHS, or its designated agent, may submit Covered Persons' prescription claim information to drug manufacturers and/or other third parties for which EHS, or its designated agent, may receive a rebate and/or other discounts for the Sponsor. C. EHS shall submit the claims and administrative invoice to the City's Human Resources Department for payment within ten (l 0) days after the end of the accounting period of providing the covered services. Within forty-eight (48) hours of receipt of the prescription claims invoice from EHS, the City shall initiate an Automated Clearing House (ACH) transfer for the invoice amount to a bank designated by EHS. D. All records, reports and other data provided by EHS to Sponsor under this Agreement are for Sponsor's use in claims administration and plan management, and EHS disclaims all liability arising out of Sponsor's other use or dissemination of the reports and summaries. Sponsor shall treat as confidential any information which OOEckerd.wpd 11/5/99 Page 6 individually identifies a Covered Person, Member Pharmacy or physician/prescriber. Sponsor agrees to indemnify and hold EHS, its affiliates, directors, officers, employees, agents and parent harmless from any and all liability, claims, actions or demands (including reasonable attorneys' fees) caused by, arising out of, or in any way related to Sponsor's use or dissemination of the information, reports and summaries. E. EHS and Sponsor acknowledge that certain information, reports and data generated under this Agreement are subject to applicable confidentiality of medical records laws, and the parties agree to comply in all material respects with such laws. Sponsor represents that is has received from each Covered Person his/her consent for EHS to obtain and/or possess prescription and medical information relating to him/her. IX. TERM AND TERMINATION OF AGREEMENT A. This agreement shall commence as of January I, 2000, and continue for a period of one year. At the end of one (1) year, the City may renew this contract for a period of four (4) additional years. There shall be no rate increase in price should an extension be granted. Any terms and conditions stated in the original specifications will apply to any extended periods. Approval on behalf of the City to renew this contract shall be made by the City Manager or his designee. B. This Agreement may be terminated as follows: 1. By either party, with or without cause, on sixty (60) days prior notice to the other. Upon receipt of said notice, this Agreement shall terminate at the expiration of the then current term. 2. By either party in the event the parties are unable to agree on changes in Administrative Fees as provided in Article VII hereof, 3. By either party if the other party shall materially default in its performance of this Agreement. The terminating party shall provide the other party thirty (30) days' prior notice specifying the nature of the default. Such notice shall not be effective and this Agreement shall not terminate if the other party shall cure, or undertake reasonable efforts to cure, such default within the thirty (30) day period. C. This agreement/contract shall be governed by the laws of the State of Texas where such services are provided and shall be subject to cancellation with 60 days written notice by either party with or without cause. OOEckerd.wpd 11/5/99 Page 7 D. In the event of a termination hereunder: I. EHS shall have the right to notify its Member Pharmacies that Covered Persons' EHS identification cards for the Plan become invalid as of the termination date; 2. The liability of Sponsor for obligations incurred up to the effective termination date, including all costs of collection and reasonable attorneys' fees, shall survive termination; and 3. Articles VIII and XI hereunder shall survive termination. X. NOTICES All notices pertaining to this Agreement shall be delivered in person, sent by certified mail, delivered by air courier, or transmitted by facsimile and confirmed in writing (sent by air courier or certified mail) to a party at the address or facsimile number shown in this Agreement, or such other address or facsimile number as a party may notify the other party from time to time. Notices delivered in person, and notices dispatched by facsimile prior to 4:30 PM, recipient's time, Monday through Friday (legal holidays excepted), shall be deemed received on the day sent. All other facsimiles and notices shall be deemed to have been received on the business day following receipt-, provided, however, if such day falls on a weekend or legal holiday, receipt shall be deemed to occur on the next business day. Notices may also be transmitted electronically between the parties provided that proper arrangements are made in advance to facilitate such communications and provide for their security and verification. Notices to EHS shall be addressed to: TDI Managed Care Services, Inc. d/b/a Eckerd Health Services 620 Epsilon Drive Pittsburgh, Pennsylvania 15238 Attn.: Sr. Vice President Facsimile No. 412-967-2333 Notices to Sponsor shall be addressed to: City of Beaumont P. O. Box 3827 (801 Main Street) Beaumont, Texas 77701 Attn: Glenda E. Lundy, Human Resources Director Facsimile No. 409-880-3108 OOEckerd.wpd 11/5/99 Page 8 A. The EHS Claims System is dependent upon the accurate transmission and processing of data by electronic means. EHS shall not be liable for any damages or claims arising out of any interruption in transmission or processing. B. Nothing in this Agreement shall be construed or be deemed to create any rights or remedies in any third party, including, but not limited to, a Covered Person. C. EHS shall use ordinary care and reasonable diligence in the performance of its duties under this Agreement. Sponsor acknowledges that this Agreement is not a contract for the sale of goods, and EHS DISCLAIMS ALL EXPRESS AND ALL IMPLIED WARRANTIES OF ANY KIND, INCLUDING, BUT NOT LIMITED TO, ANY WARRANTY AS TO THE QUALITY, ACCURACY OR SUITABILITY FOR ANY PARTICULAR PURPOSE OF THE INFORMATIONAL DATA GENERATED THROUGH THE EHS CLAIMS SYSTEM. D. The parties agree that in no event shall EHS have any liability to Sponsor or any Covered Person in connection with, nor shall EHS have any responsibility for the acts or omissions of any Member Pharmacy or pharmacist who, performs any services in connection with this Agreement. EHS shall not, under any circumstances, be liable or responsible for injury, including death, suffered by any Covered Person from any prescription drug dispensed or not dispensed by any Member Pharmacy or pharmacist using the EHS DUR system for any purpose, or for any side-effects or other consequential or incidental damages of any kind or description whatsoever from the use, or refrain from use, of any such prescription drug, it being expressly understood that such liability and responsibility rests entirely upon the Member Pharmacy or pharmacist dispensing the prescription drug. E. In no event shall EHS, its affiliates, directors, officers, employees, agents and parent be liable for (1) any third party claims against Sponsor, its affiliates, directors, employees or agents for losses or damages, or (ii) any indirect, special, incidental, consequential (including lost profit or savings) damages, even if EHS is informed of their possibility. F. In no event shall the liability of EHS, its affiliates, directors, officers, employees, agents and parent under or in connection with this Agreement exceed the actual loss or damage to Sponsor, up to the amount of the Administrative Fees paid to EHS by Sponsor hereunder for the three (3) month period immediately preceding the date on which the claim arose. G. The EHS agrees to fully indemnify, hold harmless and defend the City, its officers, agents, servants and employees from and against any and all claims, demands, costs and expenses for damages arising out of personal injury, including death, to any and all persons, of whatever kind or character, whether real or asserted, arising out OOEckerd.wpd 11/5/99 Page 9 of or in connection with this contract or the performance thereof, to the extent caused by alleged negligence of officers, agents, servants, employees, contractors or subcontractors of the EHS; EHS assumes all liability in any and all claims or suits for personal injury, including death, to any and all persons, of whatever kind or character, whether real or asserted, arising out of or in connection with this contract or the performance thereof, to the extent caused by alleged negligence of officers, agents, servants, employees, contractors or subcontractors of EHS, and specifically including negligence by the City of Beaumont, its officers, agents or employees in connection with the performance of this contract. XII. GENERAL A. Neither this Agreement nor any of the obligations to be performed hereunder may be assigned, directly or indirectly, by either party without the prior written consent of the other party; provided, however,that the preceding restriction shall not apply to the transfer by EHS of all or substantially all of EHS Claims System processing or EHS DUR services or to any transfer made by EHS to a subsidiary or parent of EHS. Any assignment or attempted assignment in violation of this restriction shall be void. This Agreement binds and inures to the benefit of the parties hereto and their permitted successors and assignees. B. Neither party shall be liable in any manner for any delay or failure to perform its obligations hereunder which are beyond such party's reasonable control, including without limitation, any delay or failure due to strikes, labor disputes, riots, earthquakes, storms, floods or other extreme weather, fires, explosions, acts of God, embargoes, war or other outbreak of hostilities, delay of carriers, suppliers or telecommunications providers, or government acts or regulations. C. Any failure by either party to enforce or require the performance by the other party of any of the terms or conditions of this Agreement shall not constitute a waiver of a breach of any such term or condition thereafter occurring. D. This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original as against any party whose signature appears thereon, and all of which shall together constitute one and the same agreement. This Agreement shall become binding when one or more counterparts hereof, individual or taken together, shall bear the signatures of all of the parties reflected hereon as the signatories. E. Any invalidity, illegality or unenforceability of any provision of this Agreement in any jurisdiction shall not invalidate or render illegal or unenforceable the remaining provisions hereof in such jurisdiction and shall not invalidate or render illegal or unenforceable such provision in any other jurisdiction. OOEckerd.wpd 11/5/99 Page 10 F. This Agreement shall be governed and construed in accordance with the laws of the State of Texas. Any action or proceeding by or against either party or with respect to or arising out of this Agreement shall be instituted and litigated in the state or federal courts located in the State of Texas and no other. G. This Agreement, together with the Exhibits hereto, constitutes the entire understanding between the parties hereto with respect to the subject matter hereof. Except as otherwise expressly contemplated herein, no prior oral or written communication with respect to the subject matter hereof, nor any supplement, modification, waiver or amendment of this Agreement unless executed in writing by the parties hereto, shall be binding. Notwithstanding the provisions of this Section G, EHS may amend this Agreement or any Exhibit hereto without the consent of Sponsor in order for this Agreement to fully comply with all applicable federal, state or local laws and regulations. H. Assignment: Neither party may assign their rights or obligations under this Agreement without the prior written consent of the other party. I. No Third Party Beneficiaries: This Agreement is not a third party beneficiary contract and shall not, in any manner whatsoever, increase the rights of any Beneficiary with respect to the City or the duties of City to any Beneficiary or create any rights on behalf of Beneficiaries regarding EHS. Thee City and EHS reserve the right to amend or terminate this Agreement as set forth herein without notice to, or consent of, any such Beneficiary. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their respective officers or representatives duly authorized so to do. TDI MANAGED CARE SERVICES, INC. CITY OF BEAUMONT d/b/a ECKERD HEALTH SERVICES James F. Smith, Sr. Vice President Stephen J. Bonczek, City Manager OOEckerd.wpd 11/5/99 Page I I EXHIBIT A PRICING AND ADMINISTRATIVE FEES A. RETAIL PHARMACY PRICING: The lower of Usual and Customary or: BRAND DRUGS: GENERIC DRUGS: B. MAIL SERVICE PHARMACY PRICING BRAND DRUGS: GENERIC DRUGS: C. ADMINISTRATIVE FEES BASE CLAIMS PROCESSING FEE (PER PAID CLAIM) DIRECT MEMBER REIMBURSEMENT (PER SUBMITTED CLAIM) FOREIGN DIRECT MEMBER REIMBURSEMENT (PER SUBMITTED CLAIM) SUBMISSION OF ELIGIBILITY (FROM PAPER DOCUMENTS) Start Up (Per Person) Updates (Per Person) ADDITIONAL REPLACEMENT ID CARDS (SET OF TWO) (Two EHS identification cards included in base fee) D. OTHER FEES REPORTING (OTHER THAN STANDARD) Customized Programming Per Hour In the event Sponsor requests non-standard or customized services, the additional cost of such services shall be paid by Sponsor at an additional charge to be mutually agreed upon by the parties in writing before the services are provided. SPONSOR COMMUNICATIONS MATERIALS (SEE NOTE) NOTE: Start up materials include two EHS identification cards, Plan brochure, mail service enrollment and postage paid envelope, and formulary. (Actual cost of postage will be billed to Sponsor for direct mailings of communication materials to Covered Persons.) There is no charge for bulk shipments of communication materials to Sponsor locations. OOEckerd.wpd 11/5/99 Page 12 EHS BASIC PER CLAIM SERVICES Basic per claim services provided in the paid claim fee include: EHS CLAIMS SYSTEM - A fully automated on-line, real-time claims processing system. EHS Claims System provides greater ability to tailor prescription drug plans to maximize benefits and to utilize a range of proven cost management approaches. NETWORK MANAGEMENT - EHS maintains a Help Desk with 800 number service for the Member Pharmacies to facilitate the point-of-service processing available through the EHS Claims System. COMPREHENSIVE REPORT PACKAGE - A standard package of reports includes relevant cost, utilization control data and savings information related to the specific services selected. CONCURRENT EHS DUR - EHS Claims System will transmit informational concurrent drug utilization review messages to Member Pharmacies as described in Exhibit C. EHS IDENTIFICATION CARDS - EHS will provide identification cards in accordance with Article III, B. CUSTOMER SERVICE - EHS maintains a Help Desk with 800 number service for Covered Persons to answer inquires concerning Member Pharmacy locations and prescription benefit questions. OOEckerd.wpd 11/5/99 Page 13 EXHIBIT B MAIL SERVICE PHARMACY EHS shall arrange to provide mail service pharmacy services through Express Pharmacy Services ("Express"). A. ENROLLMENT MATERIALS Express will provide to EHS for distribution to Sponsor and/or Covered Persons an enrollment package including a carrier envelope, a brochure describing the details of the services provided, a postage paid order envelope, a Sponsor announcement letter, and patient profile request forms. B. PROVISION OF PRESCRIPTION DRUGS Express will provide prescription drugs to all Covered Persons in the United States who have provided Express with prescription request forms containing sufficient information to maintain a patient profile. Prescriptions will be mailed to Covered Persons within an average three business days of receipt of prescription request forms, subject to product availability and the need to contact the Covered Person's physician for prescription clarifications. C. QUANTITY TO BE DISPENSED Express will generally provide a 90-day supply of a Covered Drug, drugs will be limited to a 30-day supply without refill. OOEckerd.wpd 11/5/99 Page 14 EXHIBIT C EHS DUR SERVICES A. DESCRIPTION OF SERVICES EHS shall provide the concurrent EHS DUR system which operates through the EHS Claims System. The EHS Claims System will edit claims for the following: I. Drug-Drug Interactions 2. Therapeutic Duplications 3. Excessive Daily Doses 4. Excessive Utilization S. Insufficient Daily Doses 6. Drug-Age Conflicts 7. Drug-Disease Contraindications 8. Drug-Pregnancy Contraindications 9. Controlled Substance Abuse 10. Refill-Too-Late/Noncompliance B. PHARMACIST DISCRETION The information generated in connection with EHS DUR services is intended as an informational guide to, and not a substitute for, the knowledge, expertise, skill, and judgment of physicians, pharmacists, or other health care providers. EHS, on behalf of Sponsor, shall advise Member Pharmacies that the EHS DUR system should not be relied upon as a substitute for their professional judgment. Sponsor acknowledges and agrees that the EHS DUR system will provide information to the Member Pharmacy, but the EHS DUR system cannot prevent Member Pharmacies from dispensing prescriptions or providing other goods and services in opposition to information they receive through the EHS DUR system. Sponsor acknowledges that Member Pharmacies are individually responsible for acting or not acting upon information generated and transmitted through OOEckerd.wpd 11/5/99 Page 15 the EHS DUR system, and for performing services in each jurisdiction consistent with the scope of their licenses. C. PATIENT INFORMATION LIMITATIONS The EHS DUR system is highly automated, without any individual review in most circumstances. Therefore, the EHS DUR system is necessarily limited by the amount of Covered Person information input into the EHS Claims System from prescription claims and from information provided by Sponsor. Meaningful Covered Person information which may not be available to EHS for purposes hereof, includes, but is not limited to, Covered Person diagnoses, utilization of drugs obtained without utilizing the EHS Claims System and weight and other physical idiosyncrasies of a Covered Person. EHS shall have affirmative obligation to acquire information concerning any Covered Person where information is insufficient or not available to enable the EHS DUR system to determine whether or not intervention or reporting is indicated. D. EHS DATABASE LIMITATIONS The EHS DUR database is a collection of databases of clinical drug data and drug dispensing information developed and maintained partly by EHS and partly by independent drug database companies. Sponsor acknowledges and agrees that EHS has and may consult with outside software and other vendors, as well as consulting health care professionals and any recognized compendia, to provide databases and other information as EHS deems necessary or helpful to include in the EHS DUR database. EHS shall endeavor to update the EHS DUR database on a reasonable basis to reflect changes in standards for pharmaceutical prescribing; however, Sponsor acknowledges that no database will contain all currently available information on accepted medical practice or prescribing practices. In most cases, vendors and professionals limit or exclude warranties regarding the information or services provided to EHS. Such limitations and exclusions are incorporated into Article XI by this reference. BASED UPON THE FOREGOING, SPONSOR FURTHER ACKNOWLEDGES AND AGREES THAT EHS SHALL NOT BE RESPONSIBLE FOR ANY TORTS, COSTS, DAMAGES, EXPENSES, CLAIMS,SUITS OR PROCEEDINGS OF ANY TYPE ARISING IN CONNECTION WITH (1) MEDICAL OR SCIENTIFIC JUDGMENTS MADE IN CREATING THE EHS DUR DATABASE OR ANY OTHER DATABASES AND REPORTS UPON WHICH THE EHS DUR SERVICES ARE BASED OR (1 1) ANY FAILURE TO INCLUDE INFORMATION IN THE EHS DUR DATABASE. OOEckerd.wpd 11/5/99 Page 16 EXHIBIT D BENEFIT MANAGEMENT SERVICES A. BENEFIT DESIGN CONSULTATION EHS shall provide benefit design consultation for Sponsor based upon the request of the Sponsor. Services include but are not limited to: modeling analysis for proposed program changes, cost projections, suggested program changes to minimize cost and maximize program quality, and generic substitution analysis to identify the potential generic substitution rate for the Sponsor. OOEckerd.wpd 11/5/99 Page 17