At the request of eRX, keycentrix, llc. has made available the following acknowledgement articulating eRx’s position regarding Cardfinder transactions and appropriate use thereof by Keycentrix, llc end-users. The acknowledgement below does not bind keycentrix, llc to any of the assertions or requirements stated within it. In addition, keycentrix, llc., does not warrant or guarantee end-user adherence to terms, conditions, or assertions made by the acknowledgment. This page or any other method of relaying of information used by keycentrix, llc. to share this acknowledgement, does not constitute an agreement or warrant compliance by keycentrix, llc. or on behalf of keycentrix, llc. end-users.
Customer (and/or Customer end-user) shall submit an eRx Cardfinder transaction request with respect to an individual for transmission by eRx Network to contracted pharmacy eligibility provider(s) (“Eligibility Providers”) only if all of the following conditions are present: (a) Customer (and/or Customer’s end-user) has a Reasonable Expectation (as defined below) that insurance coverage exists for such individual; and (b) Customer (and/or Customer’s end-user) utilizes an active NPI with a valid pharmacy taxonomy that belongs to the Customer end-user; and (c) Customer (and/or Customer end-user) has an intent to bill the respective payer whose information was returned. A “Reasonable Expectation” of coverage shall exist with respect to an individual only if such individual has represented to Customer (and/or Customer end-user) that applicable insurance coverage is in effect. For example, such representation may be made by presentation of such payer’s insurance plan name (including where practicable), or other evidence of coverage by such payer. eRx Cardfinder transaction requests shall only be initiated by a Customer (and/or Customer end- user), and shall not be automatically generated by Customer’s (and/or Customer end-user’s) system or other Customer (or any other third-party) software application. If Customer (and/or Customer end-user) fails to comply with any of the foregoing requirements, or if in eRx Network’s judgment Customer’s (and/or Customer end-user’s) use of the eRx Cardfinder transaction or other transactions otherwise negatively affects eRx Network’s relationship with one or more Eligibility Providers, eRx Network shall have the right to refuse to submit any such transaction(s) to the applicable Eligibility Providers. eRx Network shall notify Customer in writing and identify with reasonable detail the alleged breach of the foregoing requirements or the reasons that Customer’s use (and/or Customer end-user’s use) of the eRx Cardfinder or other transactions otherwise negatively affects eRx Network’s relationship with any such Eligibility Providers. If such non-compliance, or the existence of such negative facts, is not cured to the satisfaction of eRx Network within thirty (30) days of Customer’s receipt of such notice, eRx Network shall have the right to continue to refuse to submit any such eRx Cardfinder transactions or other transactions to the applicable Eligibility Providers and/or to terminate the eRx Cardfinder Service (and if the eRx Cardfinder Service is the only such
service provided in connection with the Agreement, the entire Agreement) by giving Customer written notice to such effect.
Additionally, Customer (and/or Customer end-user) acknowledges that it is in the Centers for Medicare & Medicaid Services (“CMS”) interest to ensure that eligibility (E1) transactions are requested solely for Medicare purposes and that the data provided in the response is used solely to support coordination of benefits in accordance with guidance provided by CMS. Customer (and/or Customer end-user) acknowledges pharmaceutical manufacturer co-pay assistance coupon programs are not considered prescription drug coverage. Accordingly, Customer (and/or Reseller end-user) represents, on behalf of itself and its end-users, (i) it will not use an E1 transaction for the purpose of ruling out Medicare coverage in order to ensure coupon use would not violate the anti- kickback statute (Section 1128B(b) of the Social Security Act) and (ii) it will only request E1 transactions in accordance with the purposes described herein.
Customer shall not use and shall ensure that its End Users shall not use, the data or information provided through the eRx Cardfinder Services to promote or encourage Customer or its End Users maintaining pharmacy benefit manager services or to augment Customer and/or its End Users own eligibility or medication history records. In the event that Customer or it’s End Users has pharmacy benefit manager operations, Customer and/or such End User shall maintain all data and information provided through the eRx Cardfinder Services on a partitioned server on the non-pharmacy benefit manager side of an internal firewall that is separated or “walled off” from all other pharmacy benefit manager activities.
Last updated: July 16, 2020
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