(b)
(c)
(d)
City of Nashua
Use appropriate safeguards to prevent use or disclosure of the Protected Health
Information other than as provided for by this Agreement and mitigate to the extent
practicable, any harmful effect known to PDA of use or disclosure of Protected Health
Information in violation of this Agreement;
(d)
(e)
(f)
(g)
(h)
(i)
@)
(k)
(I)
(m)
“Individual” shall have the same meaning as the term “individual” in 45 CFR 160.103
and shall include a person who qualifies as a personal representative in accordance with
45 CFR 164.502(g).
“Health Plan Administrator” or “Plan Administrator” shall have the same meaning as
set forth in the Health Plan’s Plan Document or in the absence of such designation shall be
the Plan Sponsor.
(ATTACHMENT B)
BUSINESS ASSOCIATE AGREEMENT
This BUSINESS ASSOCIATE AGREEMENT (this “Agreement”) is entered into by and between Part D
Advisors, Inc., a Michigan corporation (“PDA”) and the City of Nashua Health Plan (the “Health Plan”)
(together, the “Parties”), effective as provided below.
RECITALS
PARTI
ADVISORS
Additionally, PDA can use medical data to identify drugs that are either Part B or Part D drugs depending on the
situation in which they are administered.
The Medicare Database as the Source of Truth
—|
PART) «=
ADVISORS
PDA’s RDS Reopening Process
EXHIBIT B
TO
AGREEMENT WITH
City of Nashua
ILLUSTRATIVE LIST OF INFORMATION
REQUIRED FROM
PHARMACY BENEFIT MANAGERS
(Non-Exhaustive)
CATEGORY a ] TYPE
Billing Transactions Patient Gender
Prescribe ID Qualifier
Prescribe ID
Patient Date of Birth
Product ID National Drug Code
Compound Code
Quantity Dispensed
Days Supply
Fill Number
Product Strength
Dosage Form
ACKNOWLEDGMENT AND APPROVAL
The undersigned duly authorized officer of Plan Sponsor hereby acknowledges, understands, and
agrees, on behalf of Plan Sponsor, to this Exhibit A, which shall, upon execution of the parties
hereto, become an integral part of the Agreement for Part D Subsidy Services made by and between
PDA and Plan Sponsor as currently in effect.
PART D ADVISORS, INC. City of Nashua, on behalf of itself and
the City of Nashua Health Plan
By: By:
Name: Name:
Title: Title:
Date: Date:
EXHIBIT A
TO
AGREEMENT WITH
City of Nashua
This Exhibit is Effective April 7, 2017
COMPENSATION
PDA’s compensation for the services provided pursuant to the Agreement shall be a Performance
Bonus with respect to the Reconciled Plan Year:
Drug Subsidy Services
6.08
6.09
6.10
6.11
Notice. Any notice required to be given hereunder between the parties shall be written,
effective upon receipt and shali be served by facsimile or by personal delivery or certified
mail, return receipt requested to the address cited in the signature block of this Agreement or
to such other address as shall be specified by like notice by either party.
6.02
6.03
6.04
6.05
6.06
6.07
best judgment as to the approach to adopt, subject to the Plan Sponsor’s final approval,
but PDA cannot guarantee the complete accuracy of the adopted approach.;
