Supplemental CoverMyMeds Terms of Service

Your use of Drug Authorizations and other services made available by CoverMyMeds LLC (“CoverMyMeds”) via the NaviNet platform, including any updates, new features and enhancements to such services (collectively, the “Services”) are subject to and governed by the NaviNet Use Agreement and these Supplemental CoverMyMeds Terms of Service (the “CoverMyMeds Terms”).

Capitalized terms used but not otherwise defined in these CoverMyMeds Terms shall have the meaning set forth in the NaviNet Use Agreement and shall apply to all Licensee Authorized Users utilizing the Services.

1. Description of CoverMyMeds’ Services

CoverMyMeds offers drug prior authorization (“PA”) Services for providers via the NaviNet platform. CoverMyMeds may establish business relationships with certain economic sponsors, such as pharmaceutical manufacturers and payors, to facilitate the Services and may share protected health information pursuant to a valid HIPAA Authorization that complies with 45 CFR 164 to support certain program drugs prescribed to the patient.

2. Privacy Obligations of CoverMyMeds

CoverMyMeds may use subcontractors to assist in performing some of its Services. When these subcontractors have access to PHI, they will enter into business associate agreements with CoverMyMeds to the extent required by applicable law. The Services are provided to Licensee and Licensee Authorized User at no cost, dependent upon CoverMyMeds’ ability to share data created or obtained by CoverMyMeds in the course of providing its Services as specified in these CoverMyMeds Terms and as permitted by law.

To provide the Services at no cost to health care providers, CoverMyMeds may share de-identified data with third parties including, but not limited to, pharmaceutical manufacturers for various purposes such as, but not limited to, billing and validation of certain transactions, evaluating the effectiveness of the Services, and providing data analytics and market insights, including prescribing practices. Additionally, data is used for continuous improvement of current services, such as to improve the end user experience, and streamline the prior authorization process, as well as the development of future products, and services. Licensee and Licensee Authorized Users acknowledge and agree that CoverMyMeds, or its subcontractors, or both, are hereby authorized to de-identify PHI in accordance with 45 C.F.R. § 164.514(a)-(c) of HIPAA, and subsequently use and disclose such de-identified data as permitted by applicable law, including, without limitation, for CoverMyMeds’ internal business use and third party reporting.

Licensee and Licensee Authorized Users authorize CoverMyMeds to use and disclose Licensee’s and Licensee Authorized User’s information provided in connection with the Services, including without limitation, Licensee and Licensee Authorized User’s National Provider Identifier number (“NPI number”), unless prohibited by applicable law.

Licensee and Licensee Authorized Users acknowledge and authorize that CoverMyMeds may perform data analytics in connection with Licensee Authorized User’s prescribing practices, outcomes of PAs submitted, and use and disclose such analytics for CoverMyMeds’ internal business use and third-party reporting.

Licensee and Licensee Authorized Users acknowledge and agree that CoverMyMeds or its affiliate may also engage directly with patients, and CoverMyMeds or its affiliate may use and disclose PHI pursuant to an authorization that complies with 45 CFR 164. Additionally, Licensee and Licensee Authorized Users acknowledge that patients may provide information to CoverMyMeds or its affiliate, not as part of the Services, that is the same or substantially similar to information obtained by CoverMyMeds in the course of performing its Services, and that CoverMyMeds’ or affiliate’s use and disclosure of such information is subject exclusively to the agreement or agreements between the patient and CoverMyMeds or its affiliate.

3. Licensee and Licensee Authorized User Obligations

Licensee’s and Licensee Authorized User’s use of the CoverMyMeds Services will comply with all applicable laws, regulations and ordinances, including, but not limited to, those pertaining to privacy, intellectual property, the export of data or software, coding, billing, payment, and any signature requirements for submitting PAs.

Licensee and each Licensee Authorized User represents and warrants that Licensee and Licensee Authorized User will not engage in any conduct or submit to the CoverMyMeds Services any content or other material that is illegal, inaccurate, misleading, misappropriated, dilutive, defamatory, obscene, offensive, or otherwise objectionable, or submit any promotional (for advertising or marketing purposes) content or material.

Licensee and each Licensee Authorized User represents and warrants that Licensee and Licensee Authorized User will not undertake any activity which may adversely affect the use of the CoverMyMeds Services by any person or damage, corrupt, tamper with or infect the CoverMyMeds Services or any information or telecommunication system of CoverMyMeds with a virus or other malicious computer program.

Licensee and each Licensee Authorized User represents and warrants that Licensee and Client Authorized User will not reverse engineer, disassemble, or decompile any software code or proprietary elements of the CoverMyMeds’ Services.

4. CoverMyMeds Disclaimers

Except as expressly set forth in the Agreement, CoverMyMeds, NaviNet and their licensors, suppliers and partners make no warranties that the information available through the CoverMyMeds Service is correct, complete, or current. CoverMyMeds and NaviNet do not review any content provided for completeness or accuracy or screen it in any way. Licensee and each Licensee Authorized User acknowledges and agrees that CoverMyMeds and NaviNet are not responsible for the content of any materials or information available through the CoverMyMeds Services, whether provided by CoverMyMeds, NaviNet, Licensee, any Licensee Authorized User, or any other user, licensor, supplier or partner. Any reliance on such materials is at Licensee’s and each Licensee Authorized User’s own risk.

The CoverMyMeds Services are not intended to interfere with a health care provider’s exercise of independent clinical or professional judgment or to induce a health care provider to influence a patient’s choice of a product, including prescription products that may be paid for, in whole or in part, by any commercial or government payor.

5. Fax Substitution and Consent to Contact

Licensee and each Licensee Authorized User agree CoverMyMeds may substitute a fax number provided by Licensee or Licensee Authorized User and submitted with a PA request for submission by CoverMyMeds to health plans, PBMs or other payors on Licensee’s or Licensee Authorized User’s behalf with a CoverMyMeds fax number so that the PA determination will be faxed to CoverMyMeds and delivered as part of the Services. This substitution helps CoverMyMeds enhance the Services provided to Licensee and Licensee Authorized User, patients and other authorized providers. In the event Licensee or Licensee Authorized User wishes to disable CoverMyMeds’ substitution of its fax number for this purpose, Licensee or Licensee Authorized User may contact CoverMyMeds directly at the toll-free number (866) 452-5017 or send a toll-free fax to (844) 865-3740, at any time, and Licensee or Licensee Authorized User must identify the fax number for which it wishes to disable such substitution.

CoverMyMeds may accept other communications that are unrelated to the PAs that Licensee or Licensee Authorized User has submitted using the Services via the substituted CoverMyMeds fax number that a health plan, PBM or other payor may send to Licensee or Licensee Authorized User. CoverMyMeds will make commercially reasonable efforts to forward such unrelated communications to Licensee or Licensee Authorized User if CoverMyMeds is able to determine, with reasonable certainty, that they are intended for Licensee or Licensee Authorized User. However, CoverMyMeds disclaims any responsibility for failure to deliver to Licensee or Licensee Authorized User any communications which a health plan, PBM or other payor transmits to CoverMyMeds that are unrelated to the PA requests Licensee or Licensee Authorized User submits while using the Services and which CoverMyMeds has delivered on Licensee’s or Licensee Authorized User’s behalf.

Licensee and each Licensee Authorized User agrees that CoverMyMeds may contact (i) health care providers, (ii) health plans, PBMs and other payors, and (iii) pharmacies on Licensee’s or Licensee Authorized User’s behalf in connection with PA requests, or other Services, or both.

CoverMyMeds may also contact Licensee and Licensee Authorized User’s patients in connection with the Services, either on your behalf as directed by you or pursuant to an authorization from such patients. Licensee and each Licensee Authorized User agree that, for this purpose, CoverMyMeds may use the contact information for Licensee and Licensee Authorized User’s patients that Licensee and Licensee Authorized User have provided to CoverMyMeds.

To help Licensee and Licensee Authorized Users process prior authorization (PA) requests, CoverMyMeds needs to send Licensee and Licensee Authorized Users communication via fax, or email, or both. CoverMyMeds may also send promotional information on features and benefits available to Licensee and Licensee Authorized Users.

Licensee and Licensee Authorized Users agree that CoverMyMeds and its partners may send Licensee and Licensee Authorized User information via fax or email regarding PA requests to the fax number(s) and/ or email address(es) provided by Licensee or Licensee Authorized User to CoverMyMeds from time to time.

Licensee and Licensee Authorized Users also agree to receive marketing email and faxes and autodialed marketing calls and text messages from or on behalf of CoverMyMeds related to promotional information on items that may be of interest to Licensee and Licensee Authorized Users at the email address(es), fax numbers(s) and telephone number(s) Licensee and Licensee Authorized Users provide in connection with the use of the Services. In the event Licensee or a Licensee Authorized User no longer wishes to receive such information from CoverMyMeds via phone, email or fax, they may contact CoverMyMeds directly at the toll-free number (866) 452-5017 or send a toll-free fax to (844) 865-3740, at any time, and Licensee and Licensee Authorized User must identify the telephone number(s), fax numbers or e-mail addresses for which they do not want to receive communications.