122436 O5 - Optum Response.pdf

State of Nebraska

Prescription Drug Benefits

Request for Proposal

122436 O5 optum.com 11000 Optum Circle, Eden Prairie, MN 55344

Freedom of Information Act

The following Freedom of Information Act exemption language applies to Optum Rx proposal submissions:

• Protected from Disclosure Under Federal [and State] Law.

• Exempt from the Freedom of Information Act. See 5 U.S.C. §552(b).

• Contains Confidential Commercial/Financial and Other Protected Information.

The information contained in this proposal submission includes trade secrets, is confidential and proprietary. As such, this information is valuable to Optum Rx, and Optum Rx would be harmed if the information was obtained by competitors and other entities with which it negotiates. Public release of any information contained within this proposal is restricted to non-confidential, non-proprietary items and can only occur with advance written notice that allows Optum Rx with the opportunity to take appropriate steps to prevent disclosure, obtain a protective order, or provide a redacted version.

DISCLAIMER

Table of Contents

Section I Corporate Overview

A. Bidder Identification and Information

B. Financial Statements_UHG Annual Report 10-K

C. Change of Ownership

D. Office Location

E. Relationship With the State

F. Bidders Employee Relations to State

G. Contract Performance

H. Summary of Bidders Corporate Experience

I. Summary of Bidders Personnel Management Approach

J. Subcontractors

K. Pending Litigation

L. Bankruptcy

M. Financial Ratings

Section II Technical Response

A. RFP Section II – Terms and Conditions

B. RFP Section III – Vendor Duties

C. RFP Section IV – Payment

D. RFP Section V - Project Description and Scope of Work

E. Attachment C – Confirmations and Questionnaire

F. Formulary Disruption Analysis

G. Network Disruption Analysis

H. Attachment D – Performance Guarantees optum.com 11000 Optum Circle, Eden Prairie, MN 55344

Freedom of Information Act

The following Freedom of Information Act exemption language applies to Optum Rx proposal submissions:

• Protected from Disclosure Under Federal [and State] Law.

• Exempt from the Freedom of Information Act. See 5 U.S.C. §552(b).

• Contains Confidential Commercial/Financial and Other Protected Information.

The information contained in this proposal submission includes trade secrets, is confidential and proprietary. As such, this information is valuable to Optum Rx, and Optum Rx would be harmed if the information was obtained by competitors and other entities with which it negotiates. Public release of any information contained within this proposal is restricted to non-confidential, non-proprietary items and can only occur with advance written notice that allows Optum Rx with the opportunity to take appropriate steps to prevent disclosure, obtain a protective order, or provide a redacted version.

DISCLAIMER

I. Detailed Project Work Plan_Implementation Plan

J. Contractual Agreement Form_Signed

Section III Attachments

A. Optum Rx Sample Contract

B. Attachment B – BAA_Optum Rx

C. Client Management Team Biographies

Section IV Questionnaire Exhibits

A. Standard Rebate Reporting Package

B. APAS Analysis

C. Member Communication Samples

D. Sample Score Card

E. Premium Formulary Abridged

F. Premium Formulary with NDC and UM Flags

G. Sample iQPR Report

H. PA, ST and QL Lists

I. Sample CDUR Report

J. Provider Detailing Hub Report

K. GeoAccess_State of Nebraska

L. Specialty Drug List

M. RxTrack Standard Reporting Catalog

N. Sample Client Reconciliation Report

O. ERISA Disclosure 2025 Attestation_Signed

July 18, 2025

Brook Taylor Procurement Contract Officer State Purchasing Bureau 1526 K Street, Suite 130 Lincoln, NE 68508

Hello, I am pleased to submit Optum Rx’s proposal to the State of Nebraska (the State) for pharmacy benefit management services (PBM). We deeply value the trust and collaboration we have built together and want to continue the progress we’ve made to achieve greater success together.

The attached proposal outlines how we will continue to deliver the full scope of PBM services you require – rooted in our core competencies and industry leading expertise – to manage total member cost of care, drive better health outcomes and control pharmacy trend. With our proven performance, differentiated capabilities and best in class collaborative approach, we are confident in our ability to help accelerate the State’s strategies and goals. We aim to:

• Improve access, affordability and member choice while enhancing outcomes with a focus on lowest net cost and lowering total cost of care.

• Deliver self-service reporting tools like RxTrack that offer visibility into performance and empower the State to support members on their health journey through data-driven insights.

• Set a new standard for transparency, empowering you and your members to be clear and confident on your health care journey.

• Continuing on the success of our partnership, bringing forward innovation that moves your strategy and goals forward.

Modern health care brings many challenges, including complexity and ever-increasing costs.

The traditional ways of managing the system have not delivered the simplicity, transparency, and outcomes required today – or the exceptional service your members expect. We continue to invest in and build innovative solutions that lower costs without compromising quality or service.

We build smarter connections between employers, payers, members and providers – connections that drive success through trusting relationships rather than repeated transactions.

Our approach offers:

• Collaboration to understand your goals, delivering programs and analytics for holistic, personalized, and equitable care with the ability to align plan features with your benefit strategy and priorities.

• Empowerment to manage drug costs through enhanced dashboards with proactive communication of lower cost options and price transparency along with the flexibility for you to choose the programs that work best for the unique health care needs facing your members.

• Cost and trend management that brings your plan’s data to life and ties the components of our comprehensive pharmacy offering together for focused strategies that reflect your cost containment objectives.

Thank you for your interest in continuing your relationship with Optum Rx. Together, we can build on the strength of our long-standing partnership to deliver lasting impact, supporting better outcomes, greater affordability, and continued innovation for the people you serve. Please contact me at (443) 739-4028 or at Jeff.Gottlieb@optum.com with any questions about our response. We look forward to meeting with you soon to further demonstrate our commitment to the State’s success.

Sincerely, Jeffrey Gottlieb Area Vice President of Public Sector Sales Optum Rx mailto:Jeff.Gottlieb@optum.com

Bidder:

1st Option Year 2nd Option Year

Year 1 Year 2 Year 3 Year 4 Year 5

Section I - Pharmacy Benefit Management Services Fees Estimated Number of

Enrolled Employees

Estimated Number of

Enrolled Employees

Estimated Number of

Enrolled Employees

Estimated Number of

Enrolled Employees

Estimated Number of

Enrolled Employees

Number of Enrolled Members => 28,386 28,386 28,386 28,386 28,386

PBM Fees per Member per Month (PMPM) $1.37 $1.51 $1.66 $1.81 $1.96

Pharmacy Benefit Management and Administration Fee

Toll Free Phone Lines

Monthly Data Feeds to Fund or Designee(s)

Prospective /Concurrent/Retro DUR

Standard Reports

Ad Hoc Reports

COB Program

First Level Appeals

Second Level Appeals

Urgent Appeals

Formulary and Rebate Administration

Prior Authorization Program

Fraud and Abuse Program

Step Therapy Program

Quantity Limitations

Dose Optimization

Medication Management

Custom System Overrides

Manual Claim Processing

Annual EOB Statements

Retro Termination Letters

Member-submit Claims

Drug Notification Letters

Member Formulary Guides

Member ID Cards

Member Mailing Postage

Enrollment Packet Mailing

Audit Recovery Fees

E-Prescribing

Vaccine Services

$38,888.82 $42,862.86 $47,120.76 $51,378.66 $55,636.56

CONFIDENTIAL, PROPRIETARY AND TRADE SECRET INFORMATION OF OPTUM RX

1st Option Year 2nd Option Year

Year 1 Year 2 Year 3 Year 4 Year 5

Self-Funded Population

Self-Funded Population

Self-Funded Population

Self-Funded Population

Self-Funded Population

Description Y/N 28,386 28,386 28,386 28,386 28,386

One-time Implementation Credit Y $47,027.00 $47,027.00 $47,027.00 $47,027.00 $47,027.00

General Pharmacy Program Management - including communication expenses, clinical programs, consulting fees or be used as a credit against claim invoices. Y $141,080.00 $141,080.00 $141,080.00 $141,080.00 $141,080.00

Other . . .

$188,107.00 $188,107.00 $188,107.00 $188,107.00 $188,107.00

CONFIDENTIAL, PROPRIETARY AND TRADE SECRET INFORMATION OF OPTUM RX

1st Option Year 2nd Option Year

Year 1 Year 2 Year 3 Year 4 Year 5

Self-Funded Population

Self-Funded Population

Self-Funded Population

Self-Funded Population

Self-Funded Population

Service Description

Service Fee and Structure

(PSPM, PMPM, X% of Savings, etc.)

Estimated Monthly

Total

Estimated Monthly

Total

Estimated Monthly

Total

Estimated Monthly

Total

Estimated Monthly

Total

Please refer to the Pricing Summary attached.

List and describe any additional and/or optional services proposed, the associated administration charges, and the average expected monthly total for each service. Add lines, as needed to accommodate all fees.

Note: This section will not count toward Evaluation Scoring.

Initial Contract Term

Initial Contract Term

Initial Contract Term

Section II - Credits/Allowances Indicate your willingness to offer the listed credits/allowances ("Y/N"). If "Y", then indicate the annual dollar amount of the credit/allowance for each plan year.

Section II - Credits/Allowances ANNUAL TOTAL

COST SHEET

Optum Rx

Financial Proposal Work Sheet: Enter the per Member per Month (PMPM) fees for Section I - Standard Services below for the plan designs currently in place.

Fees on any other basis, (i.e., as a percentage of claims, on a per claim basis or a combination) will NOT be considered. The ASO Fees are to be guaranteed for the three (3) year contract period. Any ancillary service relating to the administration of the health plan not specifically identified in bidder’s proposal is assumed to be included in the ASO fee. All services covered under the fee should be listed. IF THE FEE STRUCTURE IS DIFFERENT BY PLAN, COMPLETE THIS SCHEDULE FOR EACH PLAN AND LABEL EACH SCHEDULE ACCORDINGLY. Enrollment figures represent estimated counts.

CONFIDENTIAL, PROPRIETARY AND TRADE SECRET INFORMATION OF OPTUM RX

Section III - Additional and/or Optional Programs/Services

Section I - Standard Services MONTHLY TOTAL

SOLICITATION NUMBER 122436 O5

Pharmacy Benefit Management Services Fees

$0.00 $0.00 $0.00 $0.00 $0.00Section III - Additional/Optional Services MONTHLY TOTAL

Bidder: Optum Rx

CONFIDENTIAL, PROPRIETARY AND TRADE SECRET INFORMATION OF OPTUM RX

Channel Retail Retail Mail

Day Supply (DS) </=30 DS 31 - 90 DS >0 DS

AWP Discount for All Brands

Year 1 19.50% 20.20% 20.20%

Year 2 19.50% 20.20% 20.20%

Year 3 19.50% 20.20% 20.20%

Year 4 19.50% 20.20% 20.20%

Year 5 19.50% 20.20% 20.20%

AWP Discount for All Generics Including Single-

Source

Year 1 89.40% 91.50% 91.50%

Year 2 89.40% 91.50% 91.50%

Year 3 89.40% 91.50% 91.50%

Year 4 89.40% 91.50% 91.50%

Year 5 89.40% 91.50% 91.50%

Dispensing Fee/Rx

Year 1 $0.50 $0.00 $0.00

Year 2 $0.50 $0.00 $0.00

Year 3 $0.50 $0.00 $0.00

Year 4 $0.50 $0.00 $0.00

Year 5 $0.50 $0.00 $0.00

CONFIDENTIAL, PROPRIETARY AND TRADE SECRET INFORMATION OF OPTUM RX

Channel Retail Retail Mail

Day Supply (DS) </=30 DS 31 - 90 DS >0 DS

AWP Discount for All Brands

Year 1 LDD = 14%, Non-LDD- 18.50% LDD = 14%, Non-LDD- 18.50% LDD = 14%, Non-LDD- 18.50%

Year 2 LDD = 14%, Non-LDD- 18.50% LDD = 14%, Non-LDD- 18.50% LDD = 14%, Non-LDD- 18.50%

Year 3 LDD = 14%, Non-LDD- 18.50% LDD = 14%, Non-LDD- 18.50% LDD = 14%, Non-LDD- 18.50%

Year 4 LDD = 14%, Non-LDD- 18.50% LDD = 14%, Non-LDD- 18.50% LDD = 14%, Non-LDD- 18.50%

Year 5 LDD = 14%, Non-LDD- 18.50% LDD = 14%, Non-LDD- 18.50% LDD = 14%, Non-LDD- 18.50%

AWP Discount for All Generics

Year 1 80.00% 80.00% 80.00%

Year 2 80.00% 80.00% 80.00%

Year 3 80.00% 80.00% 80.00%

Year 4 80.00% 80.00% 80.00%

Year 5 80.00% 80.00% 80.00%

Self-Funded Population

Prescription Drug Pricing and Rebates:

AWP Reimbursement Basis—Complete the following table using the drug reimbursement that your organization is willing to guarantee, on a dollar-for-dollar basis, for each year of the contract. Columns marked "AWP Discount” are to be completed using a discount from 100% AWP and dispensing fee logic. All guarantees must be based on the AWP unit cost dispensed at the point of sale, and post September 26, 2009 AWP rollback, including usual & customary and zero-balance claims prior to the impact of member cost sharing. Generic discount guarantee must include all single-source as well as multi-source generic drugs.

The aggregate brand discount guarantee for specialty drugs should include biosimilar specialty drugs. In addition to the aggregate specialty drug discount and rebate guarantees, please provide separately a list of all specialty drugs and their individual discount guarantees.

Specialty drug pricing must be based on an open (non-exclusive) basis.

Specialty Pharmacy

Guarantee Pricing for Specialty Medications

Pharmacy Network

Guaranteed Pricing for Non-Specialty Medications

COST SHEET

SOLICITATION NUMBER 122436 O5

PBM Pricing Guarantees

Dispensing Fee/Rx

Year 1 0 0 0

Year 2 0 0 0

Year 3 0 0 0

Year 4 0 0 0

Year 5 0 0 0

%-Share

Non-Specialty Medications

Year 1 $490 $1,160 $1,210

Year 2 $550 $1,305 $1,355

Year 3 $615 $1,440 $1,490

Year 4 $615 $1,440 $1,490

Year 5 $615 $1,440 $1,490

Specialty Medications

Year 1 $3,900 $3,900 $3,900

Year 2 $4,194 $4,194 $4,194

Year 3 $4,352 $4,352 $4,352

Year 4 $4,352 $4,352 $4,352

Year 5 $4,352 $4,352 $4,352

Guaranteed Minimum Per Brand Claim Rebate Guarantees

Rebates & Other Manufacturer Revenue

100%

State of Nebraska Pricing Summary

July 18, 2025 Confidential and Proprietary Page 1 of 11

Client: State of Nebraska

Members: 28,216 Pricing Model: Pass-Through Implementation Date: July 1, 2026

Term of Contract:

Year 1: 07/01/2026 to 06/30/2027

Year 2: 07/01/2027 to 06/30/2028

Year 3: 07/01/2028 to 06/30/2029

PMPM = Per Member Per Month

Administrative Fee

Administrative Fee

Base Administrative Fee $1.37 | $1.51 | $1.66 | PMPM

Broad Retail Network Pharmacy Brand Drug

Discount Brand Drug

Dispensing Fee Generic Drug

Discount Generic Drug

Dispensing Fee

Year 1 AWP−19.50% $0.50 PNPC AWP−89.40% $0.50 PNPC

Year 2 AWP−19.50% $0.50 PNPC AWP−89.40% $0.50 PNPC

Year 3 AWP−19.50% $0.50 PNPC AWP−89.40% $0.50 PNPC

Broad Retail 90 Network Pharmacy Brand Drug

Discount Brand Drug

Dispensing Fee Generic Drug

Discount Generic Drug

Dispensing Fee

Year 1 AWP−20.20% $0.00 PNPC AWP−91.50% $0.00 PNPC

Year 2 AWP−20.20% $0.00 PNPC AWP−91.50% $0.00 PNPC

Year 3 AWP−20.20% $0.00 PNPC AWP−91.50% $0.00 PNPC

Home Delivery Pharmacy Brand Drug

Discount Brand Drug

Dispensing Fee Generic Drug

Discount Generic Drug

Dispensing Fee

Year 1 AWP−20.20% $0.00 PNPC AWP−91.50% $0.00 PNPC

Year 2 AWP−20.20% $0.00 PNPC AWP−91.50% $0.00 PNPC

Year 3 AWP−20.20% $0.00 PNPC AWP−91.50% $0.00 PNPC

July 18, 2025 Confidential and Proprietary Page 2 of 11

1. Notwithstanding anything herein to the contrary, Specialty Drug discount and dispensing fee guarantees are reconciled in the aggregate. Any excess achieved in one may be credited to any other Specialty Drug ingredient cost discount or dispensing fee guarantee listed herein.

PNPB = Per Net Paid Brand Drug covered by Client’s benefit design or formulary.

Specialty Pharmacy1

Brand and Generic Drugs Guarantee

Discount Dispensing Fee

Non-Limited Distribution Brand Drug

Year 1 AWP−18.50% $0.00 PNPC

Year 2 AWP−18.50% $0.00 PNPC

Year 3 AWP−18.50% $0.00 PNPC

Generic Drug

Year 1 AWP−80.00% $0.00 PNPC

Year 2 AWP−80.00% $0.00 PNPC

Year 3 AWP−80.00% $0.00 PNPC

Limited Distribution Brand Drug

Year 1 AWP−14.00% $0.00 PNPC

Year 2 AWP−14.00% $0.00 PNPC

Year 3 AWP−14.00% $0.00 PNPC

Rebate Management – Premium Rebate

Guaranteed Amount

Retail Pharmacy Retail 90

Pharmacy Home Delivery Specialty

Year 1 $490.00 PNPB $1,160.00 PNPB $1,210.00 PNPB $3,900.00 PNPB

Year 2 $550.00 PNPB $1,305.00 PNPB $1,355.00 PNPB $4,194.00 PNPB

Year 3 $615.00 PNPB $1,440.00 PNPB $1,490.00 PNPB $4,352.00 PNPB

July 18, 2025 Confidential and Proprietary Page 3 of 11

Credits and Allowances:

General Terms

Applicable to All

Credits

The Credits described herein are hereby made available to Client. Optum Rx and Client agree to each comply with their respective obligations as necessary to establish and maintain the applicable safe harbors to the Federal Anti-Kickback Statute set forth at 42 C.F.R. §1001.952.

It is the intention of the parties that, in establishing the terms of the Credits, neither Optum Rx nor Client gives or receive any remuneration in return for or to induce the provision or acceptance of business for which payment may be made in whole or in part by a federal health care program on a fee-for-service or cost basis. In addition, neither OptumRx nor Client shall shift the financial burden of the Credits to the extent that increased payments are claimed from any federal health care program. To the extent required by Laws, Client agrees to fully and accurately disclose and report any such discount, rebate, credit or allowance to Medicare, Medicaid or other government health care programs as a discount against the price of the Prescription Drugs provided under this Agreement. In connection with the foregoing, the following Credits are made available to Client to reimburse the fair market value of agreeable expenses, items, and services described below related to transitioning, administering, and implementing the pharmacy benefit (collectively “the Credits”).

Implementation

Allowance

Optum Rx shall provide Client with a one-time implementation allowance of up to $5.00 per net new Member to cover expenses associated with the transition of services to Optum Rx.

This allowance may be used by Client to offset legitimate, necessary and commercially reasonable expenses that are related to the Client’s transition from its previous pharmacy benefit manager to Optum Rx. Client shall be responsible for all other transition expenses in excess of the implementation credit herein provided to Client. Eligible expenses shall include any printing or postage related to special communications required for the transition, customized ID cards, customized programming or, upon mutual agreement, third-party transitional consulting expenses. The implementation allowance must be utilized within the first six months after the Effective Date. Client will be required to submit documentation to support the expenses it may seek reimbursement for. If Client terminates this Agreement for any reason before the end of the Initial Term, Client shall refund to Optum Rx within 30 days after the effective date of such termination the full implementation allowance. It is the intention of the parties that, for the purposes of the Federal Anti-Kickback Statute, this implementation allowance shall constitute and shall be treated as a discount against the price of drugs within the meaning of 42 U.S.C. 1320a – 7b(b)(3)(A). To the extent required by Laws or contractual commitment, Client agrees to fully and accurately disclose and report any such discount to Medicare, Medicaid or other government health care programs as a discount against the price of the Prescription Drugs provided under this Agreement.

Pharmacy

Management

Allowance

Client shall receive a pharmacy management allowance (PMA) of up to $5.00 per Member annually, which must be utilized within the applicable year and will not carry over to the following year. This PMA allowance is to be used by Client to offset the cost of actions intended to maximize the value of the pharmacy program. Funds may be used for items including, but not restricted to, programming for customization, design and implementation of clinical or other programs, communications, documented expenses related to staff education and industry conference attendance, auditing, data integration and analytics, consulting fees (excluding market checks), and engagement of relevant vendors that impact the pharmacy program strategy and results. Client will be required to submit documentation to support the expenses for which it seeks reimbursement. If Client terminates this Agreement for any reason before the end of the Initial Term, Client shall refund to Optum Rx within 30 days after the effective date of such termination the full PMA allowance applicable to the year of termination. It is the intention of the parties that, for the purposes of the Federal Anti-Kickback Statute, this PMA allowance shall constitute and shall be treated as a discount against the price of drugs within the meaning of 42 U.S.C. 1320a-7b(b)(3)(A). To the extent required by Laws or contractual commitment, Client agrees to fully and accurately disclose and report any such discount to Medicare, Medicaid or other government health care programs as a discount against the price of the Prescription Drugs provided under this Agreement.

July 18, 2025 Confidential and Proprietary Page 4 of 11

General Financial Terms

General Terms:

• This pricing proposal is valid from the date of this proposal.

• The Agreement must be signed at least 90 days before the Effective Date of the pricing.

• The Agreement Effective Date will be July 1st, 2026 with prior notice of award 120 days before the Agreement Effective Date.

• This pricing proposal is for a three (3) year contract term, subject to the terms and conditions in this pricing proposal.

• Offer is valid for a minimum of 28,216 total Members as of the Agreement Effective Date.

• Under the Pass-Through Pricing Model, Client shall pay the actual retail pharmacy rates paid by Optum Rx for Prescription Drugs electronically processed and dispensed to a Member through Optum Rx’s retail Pharmacy Network, which are estimated to be the effective rates set forth above. Optum Rx's compensation for its services shall be the Claims Administration Fees set forth above. In the event Client enrolls in additional services, incremental Administrative Fees may apply.

• The Member will pay the lower of (i) Member Cost-Sharing Amount, (ii) Client contracted rate, plus dispensing fee; or (iii) the pharmacy’s Usual and Customary charge for the product.

• Optum Rx applies, where applicable, zero balance pricing logic, also referred to as minimum copay. The Member will pay the lower of (i) Member Cost-Sharing Amount or (ii) the pharmacy's Usual and Customary charge for the product.

• Discounted ingredient costs are based upon: (i) published AWP and (ii) the actual 11 digit National Drug Code, specific to the quantity dispensed submitted by a Network Pharmacy at the time of adjudication.

• Retail 90 pricing applies to retail Claims with greater than 83 days’ supply.

Guarantee Reconciliation:

• Discount and dispensing fee guarantees apply to Network Pharmacies that adjudicate covered Prescription Drugs in accordance with Optum Rx’s lower of logic (i.e. lesser of MAC, U&C, submitted cost, or contracted discount rate) and contracted dispensing fee rates. Discount and dispensing fee guarantees are reconciled at the component level and are effective average annual rates. Such discount and dispensing fee guarantees are not reconciled on an individual Claim basis. Excess discounts in one line-item category cannot be credited to another category for purposes of satisfying the guarantee applicable to the other category, however, retail 30/90 generic guarantees will be reconciled together as one component. Any credits due to Client relating to the discount guarantees set forth above shall be issued ninety (90) days after the measurement period.

General Pricing Terms:

• The financial guarantees herein are annual guarantees, Optum Rx will have no obligation to Client for any financial commitment associated with any partial contract year (i.e. a period of time that is less than12-months).

• The effective overall Generic Drug discount rate includes MAC, and non-MAC Generic Drug Claims subject to the discount and dispensing fee guarantee exclusions set forth herein.

• Compound Prescription Drug Claims, 340B Claims, OTC’s, Indian health services and tribal Claims, direct member reimbursement Claims, coordination of benefit Claims, long term care Claims, infusion Claims, Claims with ancillary charges such as vaccines, Claims filled at in-house or Client-owned pharmacies, fraudulent Claims, covid test kits, and covid anti-virals, Claims subject to State mandated minimum pharmacy reimbursement requirements, and Claims filled outside the Optum Rx Pharmacy Network will be excluded from the discount and dispensing fee guarantees. Additionally, claims in Puerto Rico, Guam, Northern Mariana Islands, Virgin Islands, Hawaii, Massachusetts, and Alaska will be excluded from the guarantees.

• Usual & Customary Claims are excluded in the discount guarantees.

• Zero balance Claims are included in the discount guarantees prior to the application of Member Cost-Sharing Amount.

July 18, 2025 Confidential and Proprietary Page 5 of 11

• Compound Prescription Drugs shall be adjudicated using the standards in the most recent version of NCPDP guidelines which includes individual multi-ingredient pricing, the lower of U&C, MAC, or AWP minus and a dispensing fee of $10. Multi-ingredient Compound Prescription Drugs filled through NCCP approved providers may also be charged a level of effort (LOE) compounding fee based on the Claim’s LOE code.

• Claims filled at multi-pack pharmacies, including Optum affiliated multi-pack pharmacies, are included in the Retail 30 guarantee.

• Optum Rx may, from time to time, receive and retain reimbursement from pharmacies for its costs in connection with transmitting Claims and discounts on its own behalf from wholesalers and Drug Manufacturers as a purchaser of pharmaceutical products for its Home Delivery and Specialty Pharmacies.

Home Delivery Pharmacy:

• Specialty guarantees include Claims filled at Optum Specialty Pharmacy and retail pharmacies.

• Non-specialty Claims filled at Optum Specialty Pharmacy are reconciled under the retail guarantees.

Specialty Pharmacy:

• Optum Specialty Pharmacy shall be the exclusive specialty providers under this Agreement and Members will receive Specialty Drug Covered Prescription Services only from Optum Specialty Pharmacy not any other retail, Home Delivery, or specialty pharmacy. Notwithstanding the foregoing, Limited Distribution Drugs not dispensed by Optum Specialty Pharmacy may be obtained from other Network Pharmacies. Under an exclusive arrangement, grace fills at retail will not be allowed. The Specialty Drug List will be provided to Client upon request and may be updated from time to time.

• Retail and Home Delivery guarantees exclude Specialty Drug Claims.

Rebate Terms:

• “Rebate” means any retrospective formulary rebate payment, [or price protection or Manufacturer Administration Fee] that Optum Rx receives from Drug Manufacturers, pursuant to the terms of a rebate contract independently negotiated by Optum Rx on its own behalf, that is contingent upon and directly related to the use of a valid Prescription Drug by a Member during the Term. “Rebate” does not include any discount, price concession or other direct or indirect compensation the Optum Rx Specialty Pharmacy, Home Delivery Pharmacy, or a group purchasing organization receives for the purchase of Prescription Drug inventories or for the provision of any product, service, (including clinical services, care management, or other services tied to the dispensing of products) or tool, including analytical services used in the review of data.

• Optum Rx will remit to Client 100% of the Rebates received by Optum Rx. Optum Rx guarantees that the Rebates remitted to Client during a contract year shall not be less than the Per Net Paid Brand Drug Claim (PNPBDC) Rebate amounts specified in the Rebate table above (“Guaranteed Rebate Amount”). In the event that the Rebates paid to Client during a contract year are less than the Guaranteed Rebate Amount, Optum Rx shall pay to Client, as an additional rebate from Optum Rx, the amount of such deficiency within 150 days following the end of the contract year. Optum Rx may withhold Rebates until this Agreement is signed.

• Rebate Credit: As determined by Optum Rx, when reconciling Guaranteed Rebate Amounts, Optum Rx may add Rebate Credit. “Rebate Credit” is a credit applied towards the achievement of the Guaranteed Rebate Amount. The Rebate Credit applies whenever there is a change impacting the level of Rebates expected as a result of the availability of clinically comparable lower rebated drugs. The Rebate Credit is calculated as the difference between the expected Rebate revenue associated with the original rebated product or high WAC alternative (e.g. an originator brand drug, originator biologic, or high WAC product) and the actual Rebate amount received. A Rebate Credit eligible reduction in Rebates may result from: (i) the introduction of a biosimilar or authorized brand alternative; (ii) WAC reduction on a brand drug subject to rebates; (iii) WAC change of a biosimilar; (iv) utilization shifts between biosimilars, the originator biologic, or a low WAC alternative; or (v) the launch of a lower cost non-Generic Drug.

• Calculation of the Guaranteed Rebate Amount excludes ineligible Claims, such as: Claims where the plan is not the primary payer; Vaccines; House generic Claims (DAW 5); Compounds; direct member

July 18, 2025 Confidential and Proprietary Page 6 of 11 reimbursement Claims; 340B Claims, Claims from long term care or federal government pharmacies;

Consumer card or discount card program Claims; or Covid test kits, and Covid anti-virals, or; if applicable, Claims associated with any Client initiated split fill or medical benefit optimization program. The Guaranteed Rebate Amount is reconciled in the aggregate annually.

• The financial guarantees set forth in this exhibit are subject to all of the terms contained in this exhibit.

• Upon request Optum Rx offers 100% pass-through prescription drug and rebate pricing options in accordance with applicable law.

Pricing Conditions/Reservations of Rights:

• Client Directed Change: At any time between the date of the RFP and the Effective Date or during the Term or the Agreement, Optum Rx may adjust affected financial provision (effective as of the date of the change) for Client or Client’s customer(s), if any of the following occur: (a) Client or Client’s customer makes any change to its formulary, utilization management or clinical programs, Benefit Plan, Cost Share, exclusions, specialty drug list, or makes a change that impacts a pharmacy network guarantee; (b) any unexpected releases of Generic Drugs to market or the withdrawal or recall of existing Brand Drugs; (c) formulary changes initiated by Optum Rx that promote overall lower net costs, but reduce Rebates; (d) there is a change impacting the availability or amount of Rebates offered by Drug Manufacturers, including changes related to the elimination or material modification of a Drug Manufacturer’s historic models or practices related to the provision of Rebates, which may include changes in historic practices regarding rejection of Claims submitted by Optum Rx for Rebates; or (e) either (i) more than ten percent (10%) of the Rebate value of Claims submitted by Optum Rx to Drug Manufacturers for Rebates are denied by Drug Manufacturers for reasons that such Claims are subject to any federal discount program (e.g., 340B, ITU, etc. (“Federal Discount Program Discounts”); or (ii) Client adopts any formulary, utilization or optimization program for Claims subject to Federal Discount Program Discount that impacts the availability or amount of Rebates.

• Market Event: At any time between the date of the RFP and the Effective Date or during the Term of the Agreement, Optum Rx reserves the right to modify or amend the financial provisions of this Agreement in the event of an external event or industry change impacting Optum Rx’s performance under the Agreement, including but not limited to: (a) any government imposed change in federal, state of local laws or interpretation thereof or industry wide change that makes Optum Rx’s performance of its duties hereunder materially more burdensome or expensive, including changes to the AWP benchmark or methodology; or (b) the unexpected movement of a branded product to off-patent or if Generic Drugs, Authorized Brand Alternative Drugs, low priced Brand Drugs or over-the-counter substitutes become available; (c) the addition of biosimilar products to the Client’s formulary that were not underwritten into ORx’s financial offer as of the date of this proposal; or (d) if there is a change impacting the availability or amount of Rebates offered by Drug Manufacturers, including changes related to the elimination or material modification of a Drug Manufacturer’s historic models or practices related to the provision of Rebates. The pricing guarantees included in Optum Rx’s offer account for the known rebate impacts of the Inflation Reduction Act’s AMP Cap provision. Accordingly, as of the date of this offer, the actual manufacturer rebate related reductions in affected classes (i.e. insulin & respiratory products) is underwritten into ORx’s financial offer. Any subsequent manufacturer action occurring after the date of Optum Rx’s offer, may require equitable adjustment of the pricing guarantees.

• Change in Scope: At any time between the date of the RFP and the Effective Date or during the Term of the Agreement, Optum Rx reserves the right to modify or amend the financial provisions of this Agreement if any of the following occur: (i) a change in the scope of services to be performed under this Agreement, including, but not limited to, a change in the Plan Specifications or the exclusion of a service line (i.e. retail & Home Delivery) from Client’s service selection; (ii) a change of greater than 20% in the total number of Members from the number provided to Optum Rx during pricing negotiations; (iii) any substantive change in Client’s formulary, Member Cost Share, Benefit Plan design, exclusions, utilization management programs, or administrative edits; or (iv) Optum Rx is no longer the exclusive Specialty Pharmacy provider. For modifications or amendments made pursuant to (i), (ii), (iii), or (iv) above, Client agrees to provide Optum Rx at least ninety (90) days’ notice prior to making any changes. In the event the pricing needs to be modified, Optum Rx shall provide Client with notification of any pricing modifications 45 days prior to implementation.

• The effective date of any changes to Rebate arrangements shall be effective as of the date of the change.

July 18, 2025 Confidential and Proprietary Page 7 of 11

Market Check. Following the initial eighteen (18) months of this Agreement, State of Nebraska’s Plan may conduct one market check during the Initial Term to confirm its financial terms are competitive with those currently available in the market for a substantially similar customer. Such analysis shall be conducted by a mutually agreed upon third party, including no less than four substantially similar customers under active contracts, that account for the following comparison plan factors which must be the same or similar in relation to State of Nebraska: (a) life count within 10% of total membership; (b) same customer type (direct, coalition, TPA, health plan, etc.); (c) same line(s) of business (commercial, Medicare, Medicaid, etc.); (d) same types of services (retail, home delivery, specialty, etc.); (e) comparison of pricing for the same contract year; (f) same or similar plan design, networks, Formulary, clinical and trend programs, and mix and utilization; (g) pricing quoted within past six-month period; and (h) other relevant factors necessary to provide an appropriate comparison (collectively the “Comparison Plan Factors”).

The market check will compare the aggregate value of pricing terms including the combined net value of: (i) ingredient cost discounts and dispensing fees from retail pharmacies, home delivery pharmacies, and specialty pharmacies; (ii) rebates, including manufacturer derived administrative fees; (iii) administrative fees; and (iv) Client credits. Client’s analysis shall be evaluated on the basis of total aggregate comparison of all pricing terms offered by a single vendor to a single plan and not on the basis of individual or best price points available from multiple vendors to a single plan or a single vendor to multiple plans. A copy of Client’s current market price analysis will be submitted to Optum Rx.

Consultant shall provide a reasonably detailed description of the methods and assumptions used in the analysis including the methods and assumptions related to the calculation of the individual pricing components. Optum Rx shall have a reasonable opportunity (i.e., not more than thirty (30) business days after all information necessary to perform its analysis is received) to evaluate the report. In a mutually agreeable format, Client, or its designee, shall provide any information necessary for Optum Rx to validate Client’s compliance with the terms of this Section including, but not limited to, relevant details about any benchmark plans (inclusive of any Comparison Plan Factors) Client relied upon in selecting any price point(s)/financial guarantees used to develop Client’s market check report.

If the parties agree that the market check report validates an annualized savings of greater than three percent between the median of the financial terms for such substantially similar customers and State of Nebraska’s financial terms, the parties will negotiate in good faith a revision to the Agreement’s financial terms. Any revisions to financial terms, resulting from the parties’ negotiations, are effective the first day of the following contract year, subject to the parties having executed an amendment to the Agreement at least 60 days prior to the effective date. If Optum Rx is unable or unwilling to offer revised pricing terms after good faith negotiations, either party may terminate the Agreement upon at least one hundred eighty (180) days’ notice of termination to the other party. If Client terminates within the first three

(3) years of the Initial Term of the Agreement, Client will reimburse Optum Rx for any allowances paid or credited to Client by Optum Rx, prorated monthly over the first three (3) years of the Initial Term.

Standard Services (Included in Base + Administrative Fee) Claims Processing Services

• Eligibility management

• Eligibility verification

• Online electronic Claims processing/administration

• Data retention – 15 months

• Operational Online Data – 12 months

• Accumulator for deductibles and maximums data – batch method

• Real-Time Audit System – filters 100 percent of claims before payment

• Enhanced Savings Program

• Lower Cost Alternatives

• PreCheck MyScript ePrescribing

Termination Services and File Transfer

• Up to 12 files included in standard format, $1,500 per additional file thereafter

Optum Rx Pharmacy Network Services

• Administration of the Optum Rx Pharmacy Network

• Pharmacy Help Desk – available 24 hours a day, seven days a week

July 18, 2025 Confidential and Proprietary Page 8 of 11

Pharmaceutical Manufacturer Rebate Services

• Optum Rx Standard Formularies

• Collection and Distribution of Manufacturer Rebates

Clinical Services

• Administrative Prior Authorization, Step Therapy, Quantity Limits

• Drug Recall Reporting

• Concurrent Drug Utilization Review (CDUR)

• Administration of Optum Rx Formularies

• Administration of Optum Rx standard Utilization Management programs

Benefit Plan Administration

Member Services

• Toll-free Member Services Help Desk - available 24 hours a day, seven days a week

• Member Website and mobile app

Client Services

• Client Management Team

• Implementation support

• Standard Reporting Package

Member Communications

• Welcome Booklet with ID cards (two per family); Postage, shipping and handling cost are pass through

Online Client Access to Member Eligibility

• Verifying, entering, and updating member eligibility

• Viewing Member Claims history

Online Client Website Access

• Access to general and plan-specific information

• Setup and training for up to twenty users

• $400 per additional license each year

• Website access through optumrx.com

− Pharmacy locator, refill Home Delivery Pharmacy, claims history

− Health, wellness and disease education

Home Delivery/Mail Service and Specialty Pharmacy

• Standard postage included

• Member directed Home Delivery express shipments may incur additional charge

July 18, 2025 Confidential and Proprietary Page 9 of 11

Clinical Services (Included and Available at Additional Charge)1 Clinical Prior Authorizations

• Technician/Pharmacist Review

• Technician/Pharmacist Review (GLP-1)

$50 per review on-shore; $65 per review designated team + on-shore

$20 per review incremental fee (assumes

Client’s adoption of Optum Rx’s standard clinical criteria)

• State-mandated Physician Review

$135 per review on-shore

Prior Authorization Appeals

Internal Clinical Appeals Not Requiring Physician Review $160 per review

Internal Clinical Appeals Requiring Physician Review $350 per review

External clinical appeal $550 per review

Peer to Peer Physician/Pharmacist Review

• Peer to Peer Review Service $75 per review (Pharmacist)

• Physician Review Service $150 per review (Physician)

Administration of Appeals Process Managed by Client $35 per review

Optum Rx Medical Insights Management

• Optum Rx Medical Insights Management $0.25 PMPM

• Performance Guarantee Included

Optum Rx Medication Safety Management

• Optum Rx Medication Safety Management $0.11 PMPM

• Performance Guarantee Included

Optum Rx Care Gap Management

• Optum Rx Care Gap Management $0.05 PMPM

• Performance Guarantee Included

Meds on Track

• Top 3 Conditions + Chronic Non-Specialty + Specialty Medications + Behavior Health Medications + Meds on Track for Medication Assisted Therapy

$0.26 PMPM

• Top 3 Conditions + Chronic Non-Specialty + Specialty Medications

$0.19 PMPM

• Top 3 Conditions $0.14 PMPM

• Performance Guarantee

Included

• Meds on Track Behavior Health conditions + Optum Rx Meds on Track Program for Medication Assisted Therapy (MAT) - ROI not offered for this program.

$0.13 PMPM

July 18, 2025 Confidential and Proprietary Page 10 of 11

Diabetes Management Program Options

• High-Risk member counseling + Meds on Track+ Care Gap

Management programs

$195.00 per counseled member per year +

$0.08 PMPM

• High-Risk member counseling + Meds on Track $195.00 per counseled member per year +

$0.06 PMPM

• High-Risk member counseling + Care Gap Management programs

$195.00 per counseled member per year +

$0.02 PMPM

• High-Risk member counseling $195.00 PMPM

Opioid Risk Management Solution

• Utilization Management Standard UM/transactional fees

• Enhanced cDUR Standard included. Customization: $1,000 per edit.

• Enhanced Benefit Design

• Adjust Refill Window Standard included. Customization: $1,000 per edit.

• Enhanced DEA edit by scope of practice Standard included. Customization: $1,000 per edit.

Opioid Risk Management Solution (Add-On offerings)

• Refill Window 90% Scheduled II-V Controlled Drugs (80%

Specialty-Mail) Included

• Comprehensive UM option Included, PA fees will apply

• UM à la carte option Included, PA fees will apply

Opioid Risk Management Solution (Buy-Up offerings)

• Member Education $0.04 PMPM

• Retrospective Intervention on Abused Meds $0.07 PMPM

• Intensive Case Management $0.04 PMPM

Opioid Risk Management Solution (Member Opioid Risk Analysis)

• Monthly Subscription $250.00 per month + $1500.00 implementation fee

• One-Time Request $3000.00 per request

Personalized Rx Counselor Program

• On Demand Comprehensive Medication Review $0.05 PMPM + $100 per On Demand CMR consultation

• Comprehensive Medication Review + Targeted Medication Review

$0.27 PMPM

• Comprehensive Medication Review + Targeted Medication

Review Performance Guarantees Included

• Comprehensive Medication Review + Targeted Medication

Review + On Demand Comprehensive Medication Review

$0.27 PMPM + $100 per On Demand CMR consultation

• Comprehensive Medication Review + Targeted Medication Review + On Demand Comprehensive Medication Review Performance Guarantees

Included

July 18, 2025 Confidential and Proprietary Page 11 of 11

Orphan Drug Management Program $300 per counseled member per year

Clinical Analytics Services Quoted upon request

Trend Forecast Quoted upon request

Custom Formulary and Utilization Management Services Quoted upon request

Pharmacy &Therapeutics (P&T) Support Services Quoted upon request

Custom Publication Support Services Quoted upon request

This is not an inclusive list. Optum Rx may charge for any products or services not specifically represented herein.

1 All pricing is reflective of the current program, subsequent program enhancements, if any, may require an additional charge.

Additional Fees as Applicable Variable Copay Program (ORx Specialty Pharmacy) $150 per impacted Rx1

Variable Copy Program (ORx Specialty Pharmacy +

ORx Home Delivery Pharmacy)

$150 per impacted specialty Rx

$50 per impacted non-specialty Rx

Client Website Additional Users 20 included, $400 per year per additional user

Direct Member Reimbursement (DMR) $2.50 per processed Claim plus the Administrative Fee

Ad-hoc Reporting $150 per hour, with a minimum of $500

Manual Eligibility Maintenance $0.50 per record

ID cards - Subsequent mailings, replacements, or additional $2 per ID card plus postage, shipping and handling

Explanation of Benefits (EOB) $2 per EOB plus postage, shipping and handling

Custom Mailings Production plus postage, shipping and handling

Investigatory Audit 25% of recovered amount

Retail Pharmacy Audit Administration No administrative or retention fees

Advanced Pharmacy Audit Services 10,000 – 24,999 lives = $0.100 PNPNC

RxTRACK License Fee

15 customer users included

5 vendor users included

$100 per additional annual fee

RDS Support Services $1.25 PMPM

Integrated Accumulator - Near Real Time Method $0.15 PMPM

Rebate Hub - Rebate Estimate Tool & Dashboards $0.14 PMPM (5 users includes one virtual training session per year)

Custom Specialty Drug List Management $75,000 per year

Shipping & Handling of Temperature Sensitive Products $27.30 per impacted Rx

This is not an inclusive list. Optum Rx may charge for any products or services not specifically represented herein.

1 A onetime $1 per Member implementation fee, capped at $10,000, shall apply, if the Variable Copy Program is required to integrate with any Client owned or in-house pharmacy.

a. BIDDER IDENTIFICATION AND INFORMATION The bidder should provide the full company or corporate name, address of the company's headquarters, entity organization (corporation, partnership, proprietorship), state in which the bidder is incorporated or otherwise organized to do business, (including whether the Bidder is in good standing in the state in which it is formed or incorporated), year in which the bidder first organized to do business and whether the name and form of organization has changed since first organized. The Bidder should also provide this information for the branch or local office or other subordinate element that will perform or assist in performing the work on this contract.

OptumRx, Inc. (Optum Rx) is a wholly owned subsidiary of OptumRx Holdings, LLC.

Corporate Address: 11000 Optum Circle, Eden Prairie, MN 55344 Entity: Corporation State of Incorporation: California OptumRx, Inc. is authorized to do business in all 50 states.

From our inception in 1989 to the establishment of Optum Rx in 2011 to today, we have worked closely with our customers to provide high-quality pharmacy care services designed to promote optimized care. We manage over 1.6 billion pharmacy claims annually and serve more than 62 million members across a broad spectrum of customers, including public and government entities, health plans, Medicare and Medicaid plan sponsors, employer groups, collective bargaining groups and third-party administrators. We are more than a pharmacy benefit manager—we are a pharmacy care services company focused on driving transformative change and delivering quality holistic care.

Our history timeline illustrates our adaptive and innovative strength, capitalizing on ways to make the health care system work better for everyone.

Year Milestone

1989 Established as part of PacifiCare Health Systems, Inc.

1995 Acquired Prescription Solutions 2001 Adopted the Prescription Solutions Name 2005 Acquired as subsidiary of UnitedHealth Group

2008 Acquired Fiserv’s health-related businesses, including the pharmacy benefit management division, Innoviant

2011 Changed name to OptumRx, Inc. and became a part of Optum, a UnitedHealth Group health services business

2015 Combined with Catamaran, making us the nation’s third largest PBM

2015 Acquired AxelaCare Health Solutions, a leading provider of home infusion solutions

2016 Acquired Helios, a workers’ compensation health care services company

Year Milestone

Acquired Avella, an oncology-focused specialty pharmacy and provider of compounding services and custom pharmaceutical therapies to hospitals and physicians

Combined with Genoa Healthcare, a provider of pharmacy, telepsychiatry and medication management services for individuals with behavioral health and other complex, chronic health conditions

2020 Acquired Diplomat, a provider of specialty and infusion pharmacy services and pharmacy solutions

Acquired divvyDOSE, a full-service delivery pharmacy focused on serving individuals with multiple chronic conditions through multi-dose packaging solutions

Launched Optum Frontier Therapies, a pharmacy services business to serve the needs of people with rare diseases while creating access to therapies at the frontier of health care

2022 Completed Optum combination with Change Healthcare

2024 CPS Solutions, LLC (CPS) joins Optum Rx and PharmScript joins Genoa Healthcare

FlexCare Infusion Centers joins Optum Infusion Pharmacy, adding multi-state ambulatory infusion…