7978 - Amendment 1 Executed
Docusign Transmittal Coversheet
File Name
Purchasing Contact
Contract Expiration
DocuSign Envelope ID: 612F2904-7C5A-4037-AE70-85200E19B75E
12/30/27
7978 ASO for Medical Prescription Coverage - Amendment 1
Christa Christian
1
This Amendment (“Amendment”) is made to the Administrative Services Agreement (“Agreement”)
by and between United HealthCare Services, Inc. and its affiliates (“United”) and City of Denton,
Texas (“Customer”) and is effective on January 1, 2023.
Contract No. 715130 – File 7978 - ASO for Medical Prescription Coverage
Any capitalized terms used in this Amendment have the meanings shown in the Agreement. These terms
may or may not have been capitalized in prior contractual documents between the parties but will have the
same meaning as if capitalized.
The Agreement is amended as follows:
The Pharmacy Financials in Exhibit D-6 -Guarantees UnitedHealthcare in the Agreement is hereby
deleted and replaced with the following:
Pharmacy Financials
Definition Contracted pharmacy rates that will be delivered to You.
Measurement 01/01/2023 01/01/2024 01/01/2025
and Criteria Combined Discount Guarantee - Standard Select/CVS Network
Retail Brand, Average Wholesale Price (AWP) less 23.5% 23.5% 23.5%
Retail Generic, AWP less 84.0% 84.0% 84.0%
Mail Order Brand, AWP less 25.5% 25.5% 25.5%
Mail Order Generic, AWP less 86.0% 86.0% 86.0%
The Guaranteed Discount amount will be determined by multiplying the AWP by the guaranteed discount off
AWP by each component and adding the amounts together.
Dispensing Fees - Standard Select/CVS Network
Retail Brand $0.40 $0.40 $0.40
Retail Generic $0.40 $0.40 $0.40
Dispensing fee totals are calculated by multiplying the actual scripts for each type by the contracted rate for
that script type.
Minimum Rebate Guarantee (Traditional PDL)
Rebate Sharing Percentage 95.0% 95.0% 95.0%
Basis, per script Brand Brand Brand
Retail - 30 and 90 Day $455.48 $533.90 $612.10
Mail Order $885.56 $937.93 $1,021.08
Specialty Included In
Retail
Included In
Retail
Included In
Retail
Level Customer Specific
Period Annually
Payment Period Annually
Payment
Amount --
Discounts
The amount the actual discounts are less than the combined guaranteed Retail, Mail, and Specialty discount
amount.
Payment
Amount --
Dispensing Fees
The amount the combined actual dispensing fee exceeds the combined contracted dispensing fee.
Payment
Amount --
Rebates
The amount the combined actual Rebate amount is less than the combined guaranteed Rebate amount.
Conditions Discount & Dispense Fee Specific Conditions
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• Discounts are based on actual Network Pharmacy brand and generic usage of retail and mail order drugs. The
guaranteed discount amount will be determined by multiplying the AWP by the contracted discount rate off
AWP by component.
• Does not apply to items covered under the Plan for which no AWP measure exists.
• Discounts calculated based on AWP less the ingredient cost; discount percentages are the discounts divided
by the AWP. Discounts for retail and mail order generic prescriptions represent the average AWP based on
savings off Maximum Allowable Cost (MAC) pricing for MAC generics and percentage discount savings off
AWP for non-MAC generics. All other discounts represent the percentage discount savings off of AWP.
• The arrangement excludes generic medications launched as an 'at-risk' product, generic medication with
pending litigation, compound drugs, retail out of network claims, mail order drugs (for dispensing fee
arrangement) and Indian Health Service Claims.
• The Arrangement excludes usual & customary claims, vaccines, long term care facility claims, over-the-
counter claims.
• The Arrangement includes veterans’ affairs facility claims.
• The retail and mail order generic discounts exclude any generic drug that has two or fewer generic
manufacturers; the retail and mail order brand discounts include any generic drug that has two or fewer
generic manufacturers.
• The Mail Order guarantee includes drugs dispensed for 46 days or greater.
• Specialty drugs dispensed outside United's specialty Pharmacy Network are included in the retail guarantees.
Specialty drugs dispensed through United's specialty Pharmacy Network are excluded from the Retail and Mail
guarantees.
• Drugs in the following Specialty therapeutic categories are included in the retail guarantees: None.
Rebate Specific Conditions
• Assumes implementation of United's Traditional PDL
• Client directed deviations from the PDL and PDL exclusions or uptiers, or clinical programs may result in
changes to pricing and guarantees, which will be factored in at the time of rebate payment and/or
reconciliation.
• Calculation of the guaranteed rebate amount will exclude ineligible claims including claims where the plan is
not the primary payer (e.g., coordination of benefits and subrogation claims), claims approved by formulary
exception, claims not covered by Customer's benefit design or PDL, claims from 340B, long term care or
federal government pharmacies, claims for non-FDA approved products, compound drugs, consumer card or
discount card program claims and direct member reimbursement claims.
• “Rebate Credit” is a credit towards the achievement of the guaranteed Rebate amount, and/or Rebate Fee
Credit. The Rebate Credit is applied in the event of a change impacting the level of Rebates expected as a
result of the availability of clinically comparable lower Rebate drugs. The Rebate Credit is calculated as the
difference in pharmaceutical manufacturer revenue between what United would have invoiced pharmaceutical
manufacturers if the Customer continued to prefer the originator brand product and the actual pharmaceutical
manufacturer revenue received after favoring the new product (e.g. biosimilar, an authorized brand alternative,
reduction of wholesale acquisition cost (WAC) on a Brand Drug subject to Rebates, launch of a lower cost
non-Generic Drug alternative). The Rebate Credit does not apply to Generic Drugs that launch after the Brand
Drug no longer has patent protection.
United reserves the right to modify or eliminate this arrangement as follows based upon changes in Rebates:
• if changes made to United's PDL, for the purpose of achieving a lower net drug cost for Customer and
United's other ASO customers, result in significant reductions to the Rebate level
• in the event that there are material deviations to the anticipated timing of drugs that will come off patent and
no longer generate Rebates
• if there is a change impacting the availability or amount of Rebates offered by drug manufacturer(s),
including changes related to the elimination or material modification of a drug manufacturer(s) historic models
or practices related to the provision of Rebates
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• if Customer changes or does not elect an incented plan design
• United will pay Rebates consistent with the Agreement. A reconciliation of the Rebate amounts will occur
after the end of each annual contract period and when Rebate payments are substantially complete. The
reconciliation calculates the minimum rebate amount by multiplying the actual number of scripts filled by the
applicable rebate amount for that script type.
• Specialty rebates are included in the guaranteed retail per-script rebates above.
• Rebate Administrative Fee: United maintains systems and processes necessary for managing and
administering Rebate programs. As consideration for these efforts, pharmaceutical manufacturers pay United
administrative fees in addition to Rebates. Rebate Administration fees are included in the guaranteed rebate
arrangement.
• If Customer terminates pharmacy benefit services with United prior to the end of the Pharmacy Pricing Term,
United will retain any and all pending or future Rebates payable under the Agreement as of the effective date
of the termination of pharmacy benefit services.
• Drugs in the following Specialty therapeutic categories are included in the retail per-Brand guarantees: None.
• Over-the-counter and repackaged drugs, vaccines and devices are excluded from the claim counts (Insulins
and Test Strips are not excluded).
• Multisource brand drugs are excluded from the claim counts.
• Limited distribution drugs are excluded from the claim counts
General Conditions
• All pricing guarantees shall remain in effect for the entire contract period of 01/01/2023 through 12/31/2025
("Pharmacy Pricing Term"). Each twelve month period is a Guarantee Period.
• Specialty drugs typically covered under the medical benefit (administered / handled by a provider,
administered in a physician's office, ambulatory or home infusion), and/or transitioned to the pharmacy benefit,
are excluded from all guarantees.
• Drugs, products, supplies approved, covered and/or prescribed for the diagnosis, treatment or prevention of
COVID-19 are excluded from all guarantees.
• On mail order drugs, specialty drugs, and retail pharmacy drugs and services including dispensing fees,
United will retain the difference between what United reimburses the Network Pharmacy and Customer's
payment for a prescription drug product or service.
• Pricing and guarantees assume enrollment of 1,513 Employees and 3,780 Participants; pricing and
guarantees may be revised or withdrawn if actual enrollment varies by 10% or more from assumptions.
• The lessor of three logic (non-ZBL) will apply to Participant payments. Participants pay the lessor of the
discounted price, the usual and customary charge or the cost share amount.
• All pricing guarantees require the selection of United as the exclusive mail provider.
United will have no financial guarantee obligation under the Agreement for any partial Guarantee Period if
Customer terminates prior to the end of the Pharmacy Pricing Term.
• United shall on Customer’s behalf, administer a fee (“Consultant Fee”) to be paid to HonestRX
(“Consultant”). The Consultant Fees are included in Customer’s pharmacy financial terms. United shall
provide Consultant with a monthly payment for all Consultant Fees collected in the amount(s) of $4.00 pmpm
and an annual $25,000 audit budget. The Customer acknowledges there is a contract between Customer and
Consultant. Therefore, in the event that there is a dispute between Customer and Consultant over continuing to
make the Consultant Fee payment(s) or in the delivery of consulting services, Customer shall hold United
harmless in such disputes. In the event of any change whatsoever in the Consultant Fee, Customer shall
immediately notify United of such change and United may propose changes to the pharmacy financial terms.
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• United reserves the right to revise or revoke this arrangement if: a) changes in federal, state or other
applicable law or regulation require modifications; b) there are material changes to the AWP as published by
the pricing agency that establishes the AWP as used in these arrangements; c) Customer makes benefit changes
that impact the arrangements; d) there is a material industry change in pricing methodologies resulting in a new
source or benchmark; e) it is not accepted within ninety (90) days of the issuance of our initial quote; f) if
Customer changes their mail service benefit; g) Customer utilizes a vendor, that facilitates steering members to
different drugs or pharmacies to the extent these services impact the financial guarantees under this Agreement.
TRRX (02/2022)
DocuSign Envelope ID: 612F2904-7C5A-4037-AE70-85200E19B75E
1
Specialty Pharmacy
Specialty Pharmacy Discount Guarantee
Definition Specialty drug discount level based on actual specialty drug utilization for the specialty drugs dispensed through United's specialty
Pharmacy Network. United reserves the right to change the designation of a drug from specialty to non-specialty based on market
conditions.
Measurement A composite of 19.0% for drugs dispensed through United's specialty Pharmacy Network. This guarantee is effective 01/01/2023
through 12/31/2023. See chart below for a list of Specialty Drugs.
A composite of 19.0% for drugs dispensed through United's specialty Pharmacy Network. This guarantee is effective 01/01/2024
through 12/31/2024. See chart below for a list of Specialty Drugs.
A composite of 19.0% for drugs dispensed through United's specialty Pharmacy Network. This guarantee is effective 01/01/2025
through 12/31/2025. See chart below for a list of Specialty Drugs.
Specialty drugs not included on the list below and dispensed through United's specialty Pharmacy Network will be guaranteed at a
discount of 14.0%.
Criteria Actual utilization, using Average Wholesale Price (AWP) in dollars, using our data, of listed specialty drugs through Our specialty
Pharmacy Network will be multiplied against the discount target to determine the overall discount target dollars.
The overall discount target dollars may be adjusted based on utilization of unlisted drugs to which the separate 14.0% discount applies.
This total will be compared to actual discounts achieved for these drugs during the Guarantee Period.
Level
Customer Specific
Period Annual
Payment Period Annual
Payment Amount The amount the actual discounts are less than the combined guaranteed Retail, Mail, and Specialty discount amount.
Conditions • Discounts calculated based on the AWP less the ingredient cost; discount percentages are the discounts
divided by the AWP. Discounts for retail generic prescriptions represent the average savings off AWP based on
Maximum Allowable Cost (MAC) pricing for MAC generics and percentage discount savings off AWP for non-MAC
generics. All other discounts represent the percentage discount savings off of AWP.
• Specialty drugs dispensed outside United's specialty Pharmacy Network, drugs for which no AWP measure
exists and non-drug items are excluded.
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• Listed drugs which cease to be defined as specialty drugs during the Guarantee Period will be reconciled outside of the Specialty
Pharmacy guarantee in the channel in which they are dispensed (retail or mail order).
• Specialty drugs typically covered under the medical benefit (administered / handled by a provider, administered in a physician's office,
ambulatory or home infusion), and/or transitioned to the pharmacy benefit, are excluded from all guarantees.
• United reserves the right to revise or revoke this guarantee if: a) changes in federal, state or other applicable law
or regulation require modifications; b) there are material changes to the AWP as published by the pricing agency
that establishes the AWP as used in this guarantee; c) Customer makes benefit changes that impact the guarantee;
d) there is a material industry change in pricing methodologies resulting in a new source or benchmark
e) if actual specialty utilization is not substantially similar to that in the experience period data on which our quote is based.
• On specialty drugs, United will retain the difference between what United reimburses the Network Pharmacy and Customer's payment
for a prescription drug product or service.
Specialty Drug Category Drug Name Included/Excluded From
Guarantee
Specialty Drug
Category Drug Name Included/Excluded From
Guarantee
ANEMIA ARANESP Included
INFLAMMATORY
CONDITIONS ILUMYA Included
ANEMIA EPOGEN Included
INFLAMMATORY
CONDITIONS KEVZARA Included
ANEMIA PROCRIT Included
INFLAMMATORY
CONDITIONS KINERET Included
ANEMIA RETACRIT Included
INFLAMMATORY
CONDITIONS OLUMIANT Included
ANTICONVULSANT DIACOMIT Included
INFLAMMATORY
CONDITIONS ORENCIA Included
ANTICONVULSANT EPIDIOLEX Included
INFLAMMATORY
CONDITIONS OTEZLA Included
ANTICONVULSANT FINTEPLA Included
INFLAMMATORY
CONDITIONS RIDAURA Included
ANTIHYPERLIPIDEMIC JUXTAPID Included
INFLAMMATORY
CONDITIONS RINVOQ Included
ANTI-INFECTIVE ARIKAYCE Included
INFLAMMATORY
CONDITIONS SILIQ Included
ANTI-INFECTIVE DARAPRIM Included
INFLAMMATORY
CONDITIONS SIMPONI Included
ANTI-INFECTIVE PYRIMETHAMINE Included
INFLAMMATORY
CONDITIONS SKYRIZI Included
ASTHMA FASENRA Included
INFLAMMATORY
CONDITIONS STELARA Included
ASTHMA NUCALA Included
INFLAMMATORY
CONDITIONS TALTZ Included
DocuSign Envelope ID: 612F2904-7C5A-4037-AE70-85200E19B75E
3
ASTHMA XOLAIR Included
INFLAMMATORY
CONDITIONS TREMFYA Included
CARDIOVASCULAR DROXIDOPA Included
INFLAMMATORY
CONDITIONS XELJANZ Included
CARDIOVASCULAR NORTHERA Included
INFLAMMATORY
CONDITIONS XELJANZ XR Included
CARDIOVASCULAR VYNDAMAX Included IRON OVERLOAD DEFERASIROX Included
CARDIOVASCULAR VYNDAQEL Included IRON OVERLOAD EXJADE Included
CNS AGENTS AUSTEDO Included IRON OVERLOAD FERRIPROX Included
CNS AGENTS ENSPRYNG Included IRON OVERLOAD JADENU Included
CNS AGENTS FIRDAPSE Included LIVER DISEASE OCALIVA Included
CNS AGENTS HETLIOZ Included
MONOCLONAL ANTIBODY
MISCELLANEOUS BENLYSTA Included
CNS AGENTS INGREZZA Included MOOD DISORDER DRUGS SPRAVATO Included
CNS AGENTS RILUTEK Included MULTIPLE SCLEROSIS AMPYRA Included
CNS AGENTS RILUZOLE Included MULTIPLE SCLEROSIS AUBAGIO Included
CNS AGENTS RUZURGI Included MULTIPLE SCLEROSIS AVONEX Included
CNS AGENTS SABRIL Included MULTIPLE SCLEROSIS BAFIERTAM Included
CNS AGENTS TETRABENAZINE Included MULTIPLE SCLEROSIS BETASERON Included
CNS AGENTS TIGLUTIK Included MULTIPLE SCLEROSIS COPAXONE Included
CNS AGENTS VIGABATRIN Included MULTIPLE SCLEROSIS DALFAMPRIDIN Included
CNS AGENTS VIGADRONE Included MULTIPLE SCLEROSIS DIMETHYL FUMARATE Included
CNS AGENTS XENAZINE Included MULTIPLE SCLEROSIS EXTAVIA Included
CNS AGENTS XYREM Included MULTIPLE SCLEROSIS GILENYA Included
CNS AGENTS XYWAV Included MULTIPLE SCLEROSIS GLATIRAMER Included
CYSTIC FIBROSIS BETHKIS Included MULTIPLE SCLEROSIS GLATOPA Included
CYSTIC FIBROSIS CAYSTON Included MULTIPLE SCLEROSIS KESIMPTA Included
CYSTIC FIBROSIS KALYDECO Included MULTIPLE SCLEROSIS MAVENCLAD Included
CYSTIC FIBROSIS KITABIS PAK Included MULTIPLE SCLEROSIS MAYZENT Included
CYSTIC FIBROSIS ORKAMBI Included MULTIPLE SCLEROSIS PLEGRIDY Included
CYSTIC FIBROSIS PULMOZYME Included MULTIPLE SCLEROSIS PONVORY Included
CYSTIC FIBROSIS SYMDEKO Included MULTIPLE SCLEROSIS REBIF Included
CYSTIC FIBROSIS TOBI Included MULTIPLE SCLEROSIS REBIF REBIDOSE Included
CYSTIC FIBROSIS TOBI PODHALER Included MULTIPLE SCLEROSIS TECFIDERA Included
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CYSTIC FIBROSIS TOBRAMYCIN Included MULTIPLE SCLEROSIS VUMERITY Included
CYSTIC FIBROSIS TRIKAFTA Included MULTIPLE SCLEROSIS ZEPOSIA Included
ENDOCRINE BUPHENYL Included
MUSCULOSKELETAL
AGENTS EVRYSDI Included
ENDOCRINE BYNFEZIA Included NARCOLEPSY WAKIX Included
ENDOCRINE CARBAGLU Included NEUTROPENIA FULPHILA Included
ENDOCRINE CHENODAL Included NEUTROPENIA GRANIX Included
ENDOCRINE CLOVIQUE Included NEUTROPENIA LEUKINE Included
ENDOCRINE CUPRIMINE Included NEUTROPENIA NEULASTA Included
ENDOCRINE CYSTADANE Included NEUTROPENIA NEUPOGEN Included
ENDOCRINE CYSTADROPS Included NEUTROPENIA NIVESTYM Included
ENDOCRINE CYSTARAN Included NEUTROPENIA NYVEPRIA Included
ENDOCRINE DEPEN TITRATABS Included NEUTROPENIA UDENYCA Included
ENDOCRINE D-PENAMINE Included NEUTROPENIA ZARXIO Included
ENDOCRINE EGRIFTA Included NEUTROPENIA ZIEXTENZO Included
ENDOCRINE FIRMAGON Included ONCOLOGY - INJECTABLE ELIGARD Included
ENDOCRINE GATTEX Included ONCOLOGY - INJECTABLE INTRON A Included
ENDOCRINE H.P. ACTHAR Included ONCOLOGY - INJECTABLE LEUPROLIDE Included
ENDOCRINE IMCIVREE Included ONCOLOGY - INJECTABLE SYNRIBO Included
ENDOCRINE ISTURISA Included ONCOLOGY - ORAL ABIRATERONE Included
ENDOCRINE JYNARQUE Included ONCOLOGY - ORAL AFINITOR Included
ENDOCRINE KEVEYIS Included ONCOLOGY - ORAL AFINITOR DISPERZ Included
ENDOCRINE KORLYM Included ONCOLOGY - ORAL ALECENSA Included
ENDOCRINE KUVAN Included ONCOLOGY - ORAL ALKERAN Included
ENDOCRINE MYALEPT Included ONCOLOGY - ORAL ALUNBRIG Included
ENDOCRINE NATPARA Included ONCOLOGY - ORAL AYVAKIT Included
ENDOCRINE NITYR Included ONCOLOGY - ORAL BALVERSA Included
ENDOCRINE OCTREOTIDE ACETATE Included ONCOLOGY - ORAL BEXAROTENE Included
ENDOCRINE PENICILLAMINE Included ONCOLOGY - ORAL BOSULIF Included
ENDOCRINE PROCYSBI Included ONCOLOGY - ORAL BRAFTOVI Included
ENDOCRINE RAVICTI Included ONCOLOGY - ORAL BRUKINSA Included
ENDOCRINE SAMSCA Included ONCOLOGY - ORAL CABOMETYX Included
ENDOCRINE SANDOSTATIN Included ONCOLOGY - ORAL CALQUENCE Included
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ENDOCRINE SAPROPTERIN Included ONCOLOGY - ORAL CAPECITABINE Included
ENDOCRINE SIGNIFOR Included ONCOLOGY - ORAL CAPRELSA Included
ENDOCRINE
SODIUM
PHENYLBUTYRATE Included ONCOLOGY - ORAL COMETRIQ Included
ENDOCRINE SOMATULINE DEPOT Included ONCOLOGY - ORAL COPIKTRA Included
ENDOCRINE SOMAVERT Included ONCOLOGY - ORAL COTELLIC Included
ENDOCRINE SYPRINE Included ONCOLOGY - ORAL DAURISMO Included
ENDOCRINE THIOLA Included ONCOLOGY - ORAL ERIVEDGE Included
ENDOCRINE TOLVAPTAN Included ONCOLOGY - ORAL ERLEADA Included
ENDOCRINE TRIENTINE Included ONCOLOGY - ORAL ERLOTINIB Included
ENDOCRINE XERMELO Included ONCOLOGY - ORAL ETOPOSIDE Included
ENDOCRINE XURIDEN Included ONCOLOGY - ORAL EVEROLIMUS Included
ENZYME DEFICIENCY CHOLBAM Included ONCOLOGY - ORAL FARYDAK Included
ENZYME DEFICIENCY CYSTAGON Included ONCOLOGY - ORAL FOTIVDA Included
ENZYME DEFICIENCY GALAFOLD Included ONCOLOGY - ORAL GILOTRIF Included
ENZYME DEFICIENCY MIGLUSTAT Included ONCOLOGY - ORAL GLEEVEC Included
ENZYME DEFICIENCY NITISINONE Included ONCOLOGY - ORAL GLEOSTINE Included
ENZYME DEFICIENCY ORFADIN Included ONCOLOGY - ORAL HYCAMTIN Included
ENZYME DEFICIENCY PALYNZIQ Included ONCOLOGY - ORAL IBRANCE Included
ENZYME DEFICIENCY STRENSIQ Included ONCOLOGY - ORAL ICLUSIG Included
ENZYME DEFICIENCY SUCRAID Included ONCOLOGY - ORAL IDHIFA Included
ENZYME DEFICIENCY TEGSEDI Included ONCOLOGY - ORAL IMATINIB MESYLATE Included
ENZYME DEFICIENCY ZAVESCA Included ONCOLOGY - ORAL IMBRUVICA Included
GAUCHERS DISEASE CERDELGA Included ONCOLOGY - ORAL INLYTA Included
GENETIC DISORDER DOJOLVI Included ONCOLOGY - ORAL INQOVI Included
GENETIC DISORDER ZOKINVY Included ONCOLOGY - ORAL INREBIC Included
GROWTH HORMONE
DEFICIENCY GENOTROPIN Included ONCOLOGY - ORAL IRESSA Included
GROWTH HORMONE
DEFICIENCY HUMATROPE Included ONCOLOGY - ORAL JAKAFI Included
GROWTH HORMONE
DEFICIENCY INCRELEX Included ONCOLOGY - ORAL KISQALI Included
GROWTH HORMONE
DEFICIENCY NORDITROPIN Included ONCOLOGY - ORAL KISQALI FEMARA Included
GROWTH HORMONE
DEFICIENCY NUTROPIN AQ Included ONCOLOGY - ORAL KOSELUGO Included
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GROWTH HORMONE
DEFICIENCY OMNITROPE Included ONCOLOGY - ORAL LAPATINIB Included
GROWTH HORMONE
DEFICIENCY SAIZEN Included ONCOLOGY - ORAL LENVIMA Included
GROWTH HORMONE
DEFICIENCY SEROSTIM Included ONCOLOGY - ORAL LONSURF Included
GROWTH HORMONE
DEFICIENCY ZOMACTON Included ONCOLOGY - ORAL LORBRENA Included
GROWTH HORMONE
DEFICIENCY ZORBTIVE Included ONCOLOGY - ORAL LUMAKRAS Included
HEMATOLOGIC BERINERT Included ONCOLOGY - ORAL LYNPARZA Included
HEMATOLOGIC CABLIVI Included ONCOLOGY - ORAL MATULANE Included
HEMATOLOGIC CINRYZE Included ONCOLOGY - ORAL MEKINIST Included
HEMATOLOGIC DOPTELET Included ONCOLOGY - ORAL MEKTOVI Included
HEMATOLOGIC FIRAZYR Included ONCOLOGY - ORAL MELPHALAN Included
HEMATOLOGIC HAEGARDA Included ONCOLOGY - ORAL MESNEX Included
HEMATOLOGIC ICATIBANT Included ONCOLOGY - ORAL NERLYNX Included
HEMATOLOGIC MOZOBIL Included ONCOLOGY - ORAL NEXAVAR Included
HEMATOLOGIC MULPLETA Included ONCOLOGY - ORAL NILANDRON Included
HEMATOLOGIC OXBRYTA Included ONCOLOGY - ORAL NILUTAMIDE Included
HEMATOLOGIC PROMACTA Included ONCOLOGY - ORAL NINLARO Included
HEMATOLOGIC RUCONEST Included ONCOLOGY - ORAL NUBEQA Included
HEMATOLOGIC SAJAZIR Included ONCOLOGY - ORAL ODOMZO Included
HEMATOLOGIC TAKHZYRO Included ONCOLOGY - ORAL ONUREG Included
HEMATOLOGIC TAVALISSE Included ONCOLOGY - ORAL ORGOVYX Included
HEMOPHILIA - INFUSED ADVATE Included ONCOLOGY - ORAL PEMAZYRE Included
HEMOPHILIA - INFUSED ADYNOVATE Included ONCOLOGY - ORAL PIQRAY Included
HEMOPHILIA - INFUSED AFSTYLA Included ONCOLOGY - ORAL POMALYST Included
HEMOPHILIA - INFUSED
ALPHANATE/VON
WILLEBRAND Included ONCOLOGY - ORAL PURIXAN Included
HEMOPHILIA - INFUSED ALPHANINE SD Included ONCOLOGY - ORAL QINLOCK Included
HEMOPHILIA - INFUSED ALPROLIX Included ONCOLOGY - ORAL RETEVMO Included
HEMOPHILIA - INFUSED BENEFIX Included ONCOLOGY - ORAL REVLIMID Included
HEMOPHILIA - INFUSED COAGADEX Included ONCOLOGY - ORAL ROZLYTREK Included
HEMOPHILIA - INFUSED CORIFACT Included ONCOLOGY - ORAL RUBRACA Included
HEMOPHILIA - INFUSED ELOCTATE Included ONCOLOGY - ORAL RYDAPT Included
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HEMOPHILIA - INFUSED ESPEROCT Included ONCOLOGY - ORAL SPRYCEL Included
HEMOPHILIA - INFUSED FEIBA Included ONCOLOGY - ORAL STIVARGA Included
HEMOPHILIA - INFUSED HEMOFIL M Included ONCOLOGY - ORAL SUNITINIB Included
HEMOPHILIA - INFUSED HUMATE-P Included ONCOLOGY - ORAL SUTENT Included
HEMOPHILIA - INFUSED IDELVION Included ONCOLOGY - ORAL TABLOID Included
HEMOPHILIA - INFUSED IXINITY Included ONCOLOGY - ORAL TABRECTA Included
HEMOPHILIA - INFUSED JIVI Included ONCOLOGY - ORAL TAFINLAR Included
HEMOPHILIA - INFUSED KOATE Included ONCOLOGY - ORAL TAGRISSO Included
HEMOPHILIA - INFUSED KOATE-DVI Included ONCOLOGY - ORAL TALZENNA Included
HEMOPHILIA - INFUSED KOGENATE FS Included ONCOLOGY - ORAL TARCEVA Included
HEMOPHILIA - INFUSED KOVALTRY Included ONCOLOGY - ORAL TARGRETIN Included
HEMOPHILIA - INFUSED MONONINE Included ONCOLOGY - ORAL TASIGNA Included
HEMOPHILIA - INFUSED NOVOEIGHT Included ONCOLOGY - ORAL TAZVERIK Included
HEMOPHILIA - INFUSED NOVOSEVEN RT Included ONCOLOGY - ORAL TEMODAR Included
HEMOPHILIA - INFUSED NUWIQ Included ONCOLOGY - ORAL TEMOZOLOMIDE Included
HEMOPHILIA - INFUSED PROFILNINE Included ONCOLOGY - ORAL TEPMETKO Included
HEMOPHILIA - INFUSED REBINYN Included ONCOLOGY - ORAL THALOMID Included
HEMOPHILIA - INFUSED RECOMBINATE Included ONCOLOGY - ORAL TIBSOVO Included
HEMOPHILIA - INFUSED RIXUBIS Included ONCOLOGY - ORAL TRETINOIN Included
HEMOPHILIA - INFUSED SEVENFACT Included ONCOLOGY - ORAL TUKYSA Included
HEMOPHILIA - INFUSED TRETTEN Included ONCOLOGY - ORAL TURALIO Included
HEMOPHILIA - INFUSED VONVENDI Included ONCOLOGY - ORAL TYKERB Included
HEMOPHILIA - INFUSED WILATE Included ONCOLOGY - ORAL UKONIQ Included
HEMOPHILIA - INFUSED XYNTHA Included ONCOLOGY - ORAL VENCLEXTA Included
HEMOPHILIA -
INJECTABLE HEMLIBRA Included ONCOLOGY - ORAL VERZENIO Included
HEPATITIS B ADEFOVIR DIPIVOXIL Included ONCOLOGY - ORAL VITRAKVI Included
HEPATITIS B BARACLUDE Included ONCOLOGY - ORAL VIZIMPRO Included
HEPATITIS B EMPAVELI Included ONCOLOGY - ORAL VOTRIENT Included
HEPATITIS B ENTECAVIR Included ONCOLOGY - ORAL XALKORI Included
HEPATITIS B EPIVIR HBV Included ONCOLOGY - ORAL XELODA Included
HEPATITIS B HEPSERA Included ONCOLOGY - ORAL XOSPATA Included
HEPATITIS B LAMIVUDINE HBV Included ONCOLOGY - ORAL XPOVIO Included
DocuSign Envelope ID: 612F2904-7C5A-4037-AE70-85200E19B75E
8
HEPATITIS B VEMLIDY Included ONCOLOGY - ORAL XTANDI Included
HEPATITIS C EPCLUSA Included ONCOLOGY - ORAL YONSA Included
HEPATITIS C HARVONI Included ONCOLOGY - ORAL ZEJULA Included
HEPATITIS C LEDIPASVIR/SOFOSBUVIR Included ONCOLOGY - ORAL ZELBORAF Included
HEPATITIS C MAVYRET Included ONCOLOGY - ORAL ZOLINZA Included
HEPATITIS C PEGASYS Included ONCOLOGY - ORAL ZYDELIG Included
HEPATITIS C PEGINTRON Included ONCOLOGY - ORAL ZYKADIA Included
HEPATITIS C
SOFOSBUVIR/VELPATASV
IR Included ONCOLOGY - ORAL ZYTIGA Included
HEPATITIS C SOVALDI Included ONCOLOGY - TOPICAL TARGRETIN Included
HEPATITIS C VIEKIRA PAK Included ONCOLOGY - TOPICAL VALCHLOR Included
HEPATITIS C VOSEVI Included OPHTHALMIC OXERVATE Included
HEPATITIS C ZEPATIER Included OSTEOPOROSIS FORTEO Included
HEREDITARY ANGIODEMA ORLADEYO Included OSTEOPOROSIS TERIPARATIDE Included
IMMUNE MODULATOR ACTIMMUNE Included OSTEOPOROSIS TYMLOS Included
IMMUNE MODULATOR ARCALYST Included PARKINSONS DISEASE APOKYN Included
IMMUNOLOGICAL AGENTS LUPKYNIS Included PARKINSONS DISEASE INBRIJA Included
IMMUNOLOGICAL AGENTS PALFORZIA Included PARKINSONS DISEASE KYNMOBI Included
INFERTILITY CETROTIDE Included PULMONARY DISEASE ESBRIET Included
INFERTILITY
CHORIONIC
GONADOTROPIN Included PULMONARY DISEASE OFEV Included
INFERTILITY FOLLISTIM AQ Included
PULMONARY
HYPERTENSION ADCIRCA Included
INFERTILITY GANIRELIX ACETATE Included
PULMONARY
HYPERTENSION ADEMPAS Included
INFERTILITY GONAL-F Included
PULMONARY
HYPERTENSION ALYQ Included
INFERTILITY GONAL-F RFF Included
PULMONARY
HYPERTENSION AMBRISENTAN Included
INFERTILITY MENOPUR Included
PULMONARY
HYPERTENSION BOSENTAN Included
INFERTILITY NOVAREL Included
PULMONARY
HYPERTENSION LETAIRIS Included
INFERTILITY OVIDREL Included
PULMONARY
HYPERTENSION OPSUMIT Included
INFERTILITY PREGNYL Included
PULMONARY
HYPERTENSION ORENITRAM Included
INFLAMMATORY ACTEMRA Included PULMONARY REVATIO Included
DocuSign Envelope ID: 612F2904-7C5A-4037-AE70-85200E19B75E
9
CONDITIONS HYPERTENSION
INFLAMMATORY
CONDITIONS CIMZIA Included
PULMONARY
HYPERTENSION SILDENAFIL Included
INFLAMMATORY
CONDITIONS COSENTYX Included
PULMONARY
HYPERTENSION TADALAFIL Included
INFLAMMATORY
CONDITIONS DUPIXENT Included
PULMONARY
HYPERTENSION TRACLEER Included
INFLAMMATORY
CONDITIONS EMFLAZA Included
PULMONARY
HYPERTENSION TYVASO Included
INFLAMMATORY
CONDITIONS ENBREL Included
PULMONARY
HYPERTENSION UPTRAVI Included
INFLAMMATORY
CONDITIONS HUMIRA Included
PULMONARY
HYPERTENSION VENTAVIS* Included
*Includes Nebulizer
10/2021
DocuSign Envelope ID: 612F2904-7C5A-4037-AE70-85200E19B75E
1
This Amendment will not affect any of the terms, provisions or conditions of the Agreement except as
stated herein.
City of Denton, Texas
United HealthCare Services, Inc.
By ________________________________ By ________________________________
Authorized Signature Authorized Signature
Name ________________________________ Name ________________________________
Title ________________________________ Title ________________________________
Date ________________________________ Date ________________________________
ASA AMEND 7.2016
DocuSign Envelope ID: 612F2904-7C5A-4037-AE70-85200E19B75E
2/6/2023
Christa Christian
Senior Buyer
Marti Skinner
2/7/2023
Associate Contract Manager
Certificate Of Completion
Envelope Id: 612F29047C5A4037AE7085200E19B75E Status: Completed
Subject: 7978 - ASO for Medical Prescription Coverage, Amendment 1
Source Envelope:
Document Pages: 15 Signatures: 2 Envelope Originator:
Certificate Pages: 5 Initials: 0 Christa Christian
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-06:00) Central Time (US & Canada)
901B Texas Street
Denton, TX 76209
Christa.Christian@cityofdenton.com
IP Address: 198.49.140.10
Record Tracking
Status: Original
2/6/2023 4:54:31 PM
Holder: Christa Christian
Christa.Christian@cityofdenton.com
Location: DocuSign
Signer Events Signature Timestamp
Christa Christian
christa.christian@cityofdenton.com
Senior Buyer
City of Denton
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 198.49.140.10
Sent: 2/6/2023 5:06:52 PM
Viewed: 2/6/2023 5:07:02 PM
Signed: 2/6/2023 5:07:18 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Marti Skinner
martha_skinner@uhc.com
Associate Contract Manager
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 198.203.181.181
Sent: 2/6/2023 5:07:22 PM
Viewed: 2/7/2023 7:00:38 PM
Signed: 2/7/2023 7:01:21 PM
Electronic Record and Signature Disclosure:
Accepted: 2/7/2023 7:00:38 PM
ID: 469fd8db-22a2-4c6d-847d-2d2f25cc1f2f
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Linda Kyle
linda.kyle@cityofdenton.com
Security Level: Email, Account Authentication
(None)
Sent: 2/7/2023 7:01:25 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Carbon Copy Events Status Timestamp
Cheyenne Defee
cheyenne.defee@cityofdenton.com
Procurement Administration Supervisor
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 2/7/2023 7:01:27 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Deby Skawinski
Deby.Skawinski@cityofdenton.com
Deputy Director, Risk & Compliance
Security Level: Email, Account Authentication
(None)
Sent: 2/7/2023 7:01:27 PM
Electronic Record and Signature Disclosure:
Accepted: 2/7/2023 2:22:15 PM
ID: b00fc7b0-5b62-4d3b-92bd-4f34c0b9c2eb
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 2/6/2023 5:06:52 PM
Certified Delivered Security Checked 2/7/2023 7:00:38 PM
Signing Complete Security Checked 2/7/2023 7:01:21 PM
Completed Security Checked 2/7/2023 7:01:27 PM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
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All notices and disclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through your DocuSign user account all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or
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you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
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us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
electronically from us.
Electronic Record and Signature Disclosure created on: 7/21/2017 3:59:03 PM
Parties agreed to: Marti Skinner, Deby Skawinski
How to contact City of Denton:
You may contact us to let us know of your changes as to how we may contact you electronically,
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