122436 O5 UnitedHealthcare Response.pdf

Attachment A Solicitation Number: 122436 O5

INTENT TO PROPOSE

Date: 6/12/2025

To: Monica Casarez, Segal (mcasarez@segalco.com)

From: United HealthCare Services, Inc.

Name and Title: Jelena Edwards, Strategic Account Executive

Re: State of Nebraska – Administrative Support Services for the State of Nebraska Employee Health Care Prescription Drug Benefit Plans – RFP # 122436 O5

Non-Disclosure Agreement Authorized signer Name and Title:

Robert Broomfield, Health Plan CEO

Email: rob_broomfield@uhc.com

Phone: 860-702-5000

Company Name: United HealthCare Services, Inc.

Company Address: 9700 Health Care Lane

Minnetonka, Minnesota 55343

Designated contact to receive secure data for this RFP Name and Title: Jelena Edwards, Strategic Account Executive

Email: jelena_edwards@uhc.com

Phone 224-231-1221

In order that the State of Nebraska may assess potential vendor interest, please indicate Yes or No below and return to mcasarez@segalco.com. Thank you.

Our company intends to propose: Yes/No If No, reason for declining:

Administrative Support Services for the State of Nebraska Employee Health Care Prescription Drug Benefit Plans – RFP # 122436 O5

Yes

Declining to respond will not eliminate the vendor from future consideration for jobs with the State of Nebraska.

mailto:mcasarez@segalco.com mailto:mcasarez@segalco.com

Attachment B Solicitation Number: 122435 O5

STATE OF NEBRASKA

BUSINESS ASSOCIATE AGREEMENT

THIS BUSINESS ASSOCIATE AGREEMENT (“Agreement”) amends and is made a part of all Services Agreements (as defined below) between United Healthcare Services, Inc.

(“Business Associate”) and State of Nebraska (“Company”) on behalf of the Group Health Plans sponsored by Company (the “Plan”). This Agreement is effective July 1, 2026 or upon the effective date of the underlying Services Agreement, whichever is later (“Effective Date”).

This Agreement supersedes and replaces any prior Business Associate Agreements between the parties.

1. Definitions.

a. Catch-all definitions. The following terms used in this Agreement shall have the same meaning as those terms in the HIPAA Rules: Breach, Covered Entity, Data Aggregation, Designated Record Set, Disclose or Disclosure, Electronic Protected Health Information, Health Care Operations, Minimum Necessary, Notice of Privacy Practices, Protected Health Information or PHI, Required By Law, Secretary, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use.

Other capitalized terms used but not otherwise defined in this Agreement shall have the meaning ascribed in the HIPAA Rules.

b. Specific definitions.

(1) “Business Associate” shall generally have the same meaning as the term "Business Associate" at 45 CFR 160.103, and in reference to the party to this Agreement, shall mean the party identified above as Business Associate.

(2) “Business Associate Functions” means functions performed by Business Associate on behalf of the Plan in the course of providing or arranging for plan administration services which involve the creation, receipt, maintenance or transmission of PHI by Business Associate or its agents or Subcontractors. It is anticipated that the services provided by Business Associate will be performed as part of the Plan's “health care operations” as defined in the HIPAA Rules.

(3) “HIPAA Rules” shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164. A reference in this Agreement to a section in the HIPAA Rules means the section as in effect or as amended at the time the section is to be applied.

(4) “Individual” shall generally have the same meaning ascribed in the HIPAA Rules and shall refer only to Individuals who are covered persons under the Plan.

(5) “Services Agreements” means all agreements whether now in effect or hereafter entered into, between Company and Business Associate for the performance of Business Associate Functions by Business Associate on behalf of the Plan.

2. Purpose. The Plan is a Covered Entity under HIPAA. The HIPAA Rules require the Plan to obtain, and Business Associate to provide, satisfactory written contractual assurances before Business Associate may create, receive, maintain, or Disclose PHI to perform Business Associate Functions on behalf of the Plan. This Agreement is entered into to provide the contractual assurances required under the HIPAA Rules.

3. Obligations of Business Associate. As an express condition of performing Business Associate Functions, Business Associate agrees to:

a. Not Use or Disclose PHI other than as permitted or required by this Agreement or as otherwise Required by Law.

b. Use appropriate safeguards and comply with Subpart C of 45 CFR Part 164 with respect to Electronic Protected Health Information, to prevent Use or Disclosure of PHI other than as provided for in this Agreement.

c. Report to the Plan's designated privacy official, without unreasonable delay but in no event more than three (3) business days after discovery by Business Associate, any Use or Disclosure of PHI not provided for by this Agreement of which Business Associate becomes aware, including any Breach of Unsecured Protected Health Information as required at 45 CFR 164.410, and any Security Incident of which it becomes aware, together with any remedial or mitigating action taken or proposed to be taken with respect thereto. If Business Associate does not have available complete information in satisfaction of 45 CFR 164.410(c) within three (3) business days of discovery of the impermissible Use or Disclosure, Business Associate shall provide all information it has at such time and immediately update the Plan with additional information as it becomes available through prompt investigation. This Agreement serves as Business Associate's notice to the Plan that attempted but unsuccessful Security Incidents regularly occur and that no further notice will be made by Business Associate unless there has been a successful Security Incident or attempts or patterns of attempts that Business Associate determines to be suspicious.

Business Associate shall cooperate with the Plan in mitigating any harmful effects of any impermissible Use or Disclosure. In the case of a Breach as determined to exist in the sole discretion of the Plan which was due to a violation of this Agreement by Business Associate, Business Associate shall pay for the reasonable costs of investigation, mitigation and notification to affected Individuals. As an alternative to Business Associate reimbursing Company and the Plan for the costs of notification, the Plan may elect to have Business Associate directly provide the notifications to Individuals for breaches caused by Business Associate, provided that Company and the Plan shall have final approval of all content of notifications to Individuals.

d. In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), ensure that any Subcontractors that create, receive, maintain, or transmit PHI on behalf of Business Associate agree in writing to the same restrictions, conditions, and requirements that apply to Business Associate with respect to such information.

e. Within ten (10) business days of request by an Individual or notification by the Plan, make available to the Individual such Individual's PHI maintained by Business Associate in a Designated Record Set in accordance with 45 CFR 164.524. The parties agree that Individuals will be directed to Business Associate to make all requests for access to PHI. Business Associate will provide such access according to its own procedures for such access in accordance with the requirements of 45 CFR 164.524. If the requested PHI is maintained in one or more Designated Record Sets electronically and if the Individual requests an electronic copy of such PHI, Business Associate must provide the Individual with access to PHI in the electronic form and format requested by the Individual, if it is readily producible in such form and format; or, if not, in a readable electronic form and format as agreed to between Business Associate and the Individual. Business Associate shall provide the requested information directly to the Individual, along with a notice to the Individual that a copy of the individual's request has been furnished to the Plan and that the Plan may provide additional information to the Individual in response to the request.

If the Individual's request covers records not maintained by Business Associate, Business Associate shall notify the Plan within three (3) days of the request. The Plan will be responsible for providing access or otherwise responding directly to the Individual pursuant to the HIPAA Rules with respect to PHI not in the possession of Business Associate or an agent or subcontractor of Business Associate. Business Associate may charge the Individual reasonable fees related to this access, as determined by Business Associate, but only in such amounts as permitted by the HIPAA Rules. The Plan authorizes Business Associate to require payment of such fees from the Individual prior to releasing any records.

f. Business Associate agrees to receive requests for amendment and amend PHI as required by 45 CFR 164.526 on the Plan's behalf for as long as such information is maintained by Business Associate. The parties agree that Individuals will be directed to Business Associate to make all such requests for amendment of PHI. Business Associate will amend such PHI according to its own procedures for such amendment in accordance with the requirements of 45 CFR 164.526. If the Individual's request covers records not maintained by Business Associate, Business Associate shall notify the Plan within three (3) days of such request. The Plan will be responsible for amending or otherwise responding directly to the Individual pursuant to the HIPAA Rules with respect to PHI not in the possession of Business Associate or an agent or contractor of Business Associate. Business Associate shall notify the Plan of any amendments made to PHI.

g. Business Associate agrees to process all requests for disclosure accounting by Individuals for as long as such information is maintained by Business Associate.

Individuals will be directed to Business Associate to make all such requests.

Business Associate will provide the accounting that is required under 45 CFR

164.528 on the Plan's behalf directly to the Individual. Business Associate will provide such accounting according to its own procedures for such accounting in accordance with the requirements of 45 CFR 164.528.

Business Associate shall notify the Plan within three (3) days of any request made by an Individual for a disclosure accounting. The Plan will be responsible for responding directly to the Individual (or the Individual's personal representative) pursuant to 45 CFR 164.528 with respect to disclosures of PHI by persons or entities other than Business Associate or a subcontractor or agent of Business Associate.

Business Associate shall provide directly to the Individual the requested accounting of disclosures made by Business Associate or a subcontractor or agent of Business Associate, along with a notice to the Individual that a copy of the Individual's request has been furnished to the Plan and that the Plan may provide additional information to the Individual in response to the request.

h. Make its internal practices, books and records relating to this Agreement available to the Secretary of HHS and to the Plan for purposes of determining the Plan's and Business Associate's compliance with the HIPAA Rules.

i. So that the Plan may meet its obligations to evaluate requests for restrictions and confidential communications in connection with the disclosure of PHI under 45 CFR 164.522, Business Associate and the Plan agree that, to the extent that communications are within the control of Business Associate, Business Associate will perform these evaluations on behalf of the Plan. Business Associate will evaluate such requests according to its own procedures for such requests, in accordance with the requirements of 45 CFR 164.522, and shall implement such appropriate operational steps as are required by its own procedures. Such evaluation will not relieve the Plan of any additional and independent obligations to evaluate restrictions or implement confidential communications where requested by an Individual. Accordingly, Business Associate will evaluate requests for restrictions and requests for confidential communications and will respond to these requests as appropriate under Business Associate's procedures. The Plan agrees that it will not agree to such restriction or request that would affect Business Associate without the approval of Business Associate, so that Business Associate can determine whether it can reasonably administer the request.

j. So that the Plan may meet its obligation to evaluate complaints from Individuals regarding their privacy rights or privacy practices of the Plan or Business Associate, the parties agree that Individuals shall be directed to submit any such complaint to Business Associate for review and evaluation. Business Associate will evaluate such complaints according to its own procedures for complaints and shall implement appropriate operation steps as are required by its own procedures. The Privacy Officer of the Plan shall cooperate with Business Associate in the evaluation of any such complaint. Business Associate shall provide a copy of all complaints to the Plan within three (3) days of receipt by Business Associate. If the complaint appears to involve handling of PHI by the Plan, Plan Sponsor, or other Business Associate of the Plan, Business Associate shall notify the Plan, and it shall be the Plan's responsibility to review and evaluate the complaint.

k. Limit the Uses and Disclosures of, or requests for, PHI for purposes described in this Agreement to the Minimum Necessary to perform the required Business Associate Functions. Business Associate shall comply with any additional requirements for the determination of Minimum Necessary as are required from time to time by the HIPAA Rules, as amended, or through additional guidance published by the Secretary.

l. To the extent Business Associate is expressly obligated under the Services Agreements to carry out one or more of the Plan's obligations(s) under Subpart E of

45 CFR Part 164, comply with the requirements of Subpart E that apply to the Plan in the performance of such obligation(s).

m. Except for the specific Uses and Disclosures for the Business Associate's own management and administration or to carry out the legal responsibilities of Business Associate, Business Associate shall not Use or Disclose PHI in a manner that would violate the HIPAA Rules if done by the Plan.

4. Permitted Uses and Disclosures of PHI. Business Associate shall only Use or Disclose PHI as follows:

a. Business Associate may Use or Disclose PHI as Required by Law. Business Associate agrees to follow the current law covering the use and disclosure of PHI related to substance abuse and reproductive health.

b. Business Associate may Use or Disclose PHI as necessary to carry out Business Associate Functions.

c. Business Associate may Use PHI for the proper management and administration of Business Associate or to carry out the legal responsibilities of Business Associate.

d. Business Associate may Disclose PHI for the proper management and administration of Business Associate or to carry out the legal responsibilities of Business Associate, provided the Disclosures are Required by Law, or Business Associate obtains reasonable assurances from the person to whom the information is Disclosed that the information will remain confidential and be Used or further Disclosed only as Required by Law or for the purposes for which it was Disclosed to the person, and the person notifies Business Associate in writing of any instances of which it is aware in which the confidentiality of the information has been breached or compromised.

e. If specifically identified as a Business Associate Function in the Services Agreements, Business Associate may provide Data Aggregation services relating to the Health Care Operations of Covered Entity.

f. If de-identification is listed as a Business Associate Function in the Services Agreements, or if Business Associate is expressly permitted to de-identify PHI and use data thus de-identified for its own uses in the Services Agreements, Business Associate may Use PHI to de-identify the information in accordance with 45 CFR 164.514(a)-(c). Business Associate may use de-identified data only for the purposes specified in the Services Agreements.

5. Responsibilities of the Plan. The Plan agrees to:

a. Notify Business Associate promptly of any restriction on the Use or Disclosure of PHI that the Plan has agreed to or is required to abide by under 45 CFR 164.522, to the extent such restriction may affect Business Associate's Use or Disclosure of PHI.

b. Notify Business Associate of any changes in, or revocation of, the permission by an Individual to Use or Disclose PHI, to the extent that such changes may affect Business Associate's Use or Disclosure of PHI.

c. Provide Business Associate with a copy of any amendment to PHI which is accepted by Covered Entity under 45 CFR 164.526 which Covered Entity believes will apply to PHI maintained by Business Associate in a Designated Record Set.

d. Not request Business Associate to Use or Disclose PHI in any manner that would not be permissible under the HIPAA Rules if done by the Plan, with exception for any Data Aggregation services permitted under Section 4.

6. Compliance with Electronic Transactions Rule. If Business Associate conducts in whole or part electronic Transactions (as defined in 45 CFR 160.103) on behalf of Covered Entity for which the Secretary of HHS has established standards, Business Associate will comply, and will require any Subcontractor involved with the conduct of such Transactions to comply, with each applicable requirement of the Electronic Transactions Rule at 45 CFR Parts 160 and 162 and of any operating rules adopted by the Secretary of HHS with respect to Transactions.

7. Supervening Law. Upon the enactment of any law or regulation affecting the Use or Disclosure of PHI, or the publication of any decision of a court of the United States or of this state relating to any such law, or the publication of any interpretive policy or opinion of any governmental agency charged with the enforcement of any such law or regulation, the parties agree to amend this Agreement in such manner as is necessary to comply with such law or regulation. If the parties are unable to agree on an amendment within thirty (30) days, either party may terminate the Services Agreements on not less than thirty (30) days’ written notice to the other.

8. Liability and Indemnification. Each party shall be responsible for the acts and omissions of its own agents, employees and contractors. Notwithstanding the foregoing, and notwithstanding any limitation of liability or disclaimer of damages in the Services Agreements or elsewhere, to the extent that the Secretary determines that Business Associate is acting as an agent of the Plan under the Services Agreements or this Agreement, Business Associate shall indemnify Company and the Plan for any fines, civil monetary penalties or monetary resolutions incurred by Company or the Plan, plus reasonable attorneys' fees of Company and the Plan, arising out of or relating to the actions or omissions of Business Associate which constitute a breach of this Agreement by Business Associate. This indemnification is in addition to any additional indemnification provided by Business Associate in the Services Agreement.

9. Term and Termination.

a. Term. This Agreement shall become effective on the Effective Date and shall continue in effect until all obligations of the parties have been met, including return or destruction of all PHI in Business Associate’s possession (or in the possession of Business Associate’s agents and Subcontractors), unless sooner terminated as provided herein. It is expressly agreed that the terms and conditions of this Agreement designed to safeguard PHI shall survive expiration or other termination of the Services Agreements and shall continue in effect until Business Associate has performed all obligations under this Agreement and has either returned or destroyed all

PHI.

b. Termination. Company may immediately terminate this Agreement and the Services Agreements, if Company and/or the Plan makes the determination that Business Associate has breached a material term of this Agreement. Alternatively, Company may choose to provide Business Associate with written notice of the existence of an alleged material breach, and afford Business Associate an opportunity to cure the alleged material breach upon mutually agreeable terms.

Failure to take reasonable steps to cure the breach is grounds for the immediate termination of this Agreement.

c. Business Associate Obligations Upon Termination. Upon termination of this Agreement for any reason, Business Associate, with respect to PHI received from the Plan, or created, maintained, or received by Business Associate on behalf of the Plan, shall:

(i) Retain only that PHI which is necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities or as to which Business Associate reasonably determines such PHI is technically incapable of being returned or destroyed;

(ii) Return to the Plan or, if not provided for in the Services Agreements, destroy the PHI retained under 8.c.(i) that the Business Associate maintains in any form;

(iii) Continue to use appropriate safeguards and comply with Subpart C of 45 CFR Part 164 with respect to Electronic Protected Health Information retained by Business Associate to prevent Use or Disclosure of the PHI, other than as provided for in this Section, for as long as Business Associate retains the PHI;

(iv) Not Use or Disclose the PHI retained by Business Associate other than for the purposes for which such PHI was retained and subject to the same conditions set out at Sections 4.c. and 4.d. which applied prior to termination; and

(v) Return to the Plan or, if not provided for in the Services Agreements, destroy the PHI retained by Business Associate under Section 8.c.(i) when it is no longer needed by Business Associate for its proper management and administration or to carry out its legal responsibilities, except where Business Associate reasonably determines such PHI is not technically capable of being returned or destroyed.

10. Miscellaneous.

a. Applicability. For purposes of this Agreement, and as applicable to the Business Associate Functions of Business Associate under the Services Agreements covered by this Agreement, references to the Plan shall include the named Plan and all other group health plans subject to HIPAA and sponsored by Company that participate in an organized health care arrangement.

b. Survival. The respective rights and obligations of Business Associate and the Plan or Company hereunder shall survive termination of this Agreement according to the terms hereof and the obligations imposed on the Plan or Company and Business Associate under the HIPAA Rules.

c. Interpretation; Amendment. This Agreement shall be interpreted and applied in a manner consistent with the Plan's and Business Associate's obligations under the HIPAA Rules. All amendments shall be in writing and signed by both parties, except that this Agreement shall attach to additional Services Agreements entered into between the parties in the future without the necessity of amending this Agreement each time. This Agreement is intended to cover the entire Business Associate relationship between the parties, as amended, from time to time, through Services Agreements or other means.

d. Waiver. A waiver with respect to one event shall not be construed as continuing, or as a bar to or waiver of any right or remedy as to subsequent events.

e. No Third-Party Beneficiaries. Nothing express or implied in this Agreement is intended to confer, nor shall anything herein confer, upon any person other than the parties and their respective successors or assigns, any rights, remedies or obligations.

IN WITNESS WHEREOF, each of the undersigned has caused this Agreement to be duly executed in its name and on its behalf.

Company:

State of Nebraska

Signature:

Printed Name:

Title:

Date Signed:

Business Associate:

Signature:

Printed Name:

Title:

Date Signed:

DOCS/1204654.1

Jennifer Dumas (07/17/2025 12:20 EDT) Jennifer Dumas

07/17/2025 Contract Negotiator

Jennifer Dumas https://unitedhg.na3.adobesign.com/verifier?tx=CBJCHBCAABAAflM1gYpyauO54FLpzlHovPAd1C_--V2T

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 Employees=> 13,809 13,809 13,809 13,809 13,809

PBM Fees per Member per Month (PMPM) - NOTE: United's admin fee is Per EMPLOYEE Per Month (PEPM) . Due to billing system restraints we are unable to provide on a PMPM basis.

$2.50 $2.60 $2.70 $2.80 $2.90

Pharmacy Benefit Management and Administration Fee

Toll Free Phone Lines

Monthly Data Feeds to Fund or Designee(s) - Not included, additional cost applies

Prospective /Concurrent/Retro DUR

Standard Reports

Ad Hoc Reports - Not included, additional cost applies

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 - Not included , additional cost applies

Manual Claim Processing - Not included, additional cost may apply

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

$34,522.50 $35,903.40 $37,284.30 $38,665.20 $40,046.10

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 13,809 13,809 13,809 13,809 13,809

One-time Implementation Credit N N/A N/A N/A N/A N/A

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

Yes - once per enrolled member $5.00 $5.00 $5.00 $5.00 $5.00

Other . . . N N/A N/A N/A N/A N/A

$5.00 $5.00 $5.00 $5.00 $5.00

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

Monthly Data Feeds to Fund or Designee(s) Cost varies by request; Per file

Ad hoc Reporting or Data/Eligibility Feeds

Cost varies by request; Per report or file

Variable Copay Program

$.45 Per Eligible Member Per

Month

Customization of any service

Cost varies by request; Per

Request

$0.00 $0.00 $0.00 $0.00 $0.00

COST SHEET

United HealthCare Services, Inc.

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. United Response: United's base pharmacy administration fee is Per EMPLOYEE Per Month (PEPM). Due to billing system restraints we are unable to provide on a PMPM basis.

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.

Section III - Additional and/or Optional Programs/Services

Section I - Standard Services MONTHLY TOTAL

SOLICITATION NUMBER 122436 O5

Pharmacy Benefit Management Services Fees

Section III - Additional/Optional Services MONTHLY TOTAL

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

Bidder:

Channel Retail Retail Mail

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

AWP Discount for All Brands

Year 1 19.5% 20.0% 20.0%

Year 2 19.5% 20.0% 20.0%

Year 3 19.5% 20.0% 20.0%

Year 4 19.5% 20.0% 20.0%

Year 5 19.5% 20.0% 20.0%

AWP Discount for All Generics Including

Single-Source

Year 1 88.0% 88.0% 91.5%

Year 2 88.0% 88.0% 91.5%

Year 3 88.0% 88.0% 91.5%

Year 4 88.0% 88.0% 91.5%

Year 5 88.0% 88.0% 91.5%

Dispensing Fee/Rx

Year 1 $0.34 $0.00 $0.00

Year 2 $0.34 $0.00 $0.00

Year 3 $0.34 $0.00 $0.00

Year 4 $0.34 $0.00 $0.00

Year 5 $0.34 $0.00 $0.00

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 19%;

Unlisted 14%

LDD 14%; Non-LDD 19%; Unlisted

14% LDD 14%; Non-LDD 19%; Unlisted 14%

Year 2 LDD 14%; Non-LDD 19%;

Unlisted 14%

LDD 14%; Non-LDD 19%; Unlisted

14% LDD 14%; Non-LDD 19%; Unlisted 14%

Year 3 LDD 14%; Non-LDD 19%;

Unlisted 14%

LDD 14%; Non-LDD 19%; Unlisted

14% LDD 14%; Non-LDD 19%; Unlisted 14%

Year 4 LDD 14%; Non-LDD 19%;

Unlisted 14%

LDD 14%; Non-LDD 19%; Unlisted

14% LDD 14%; Non-LDD 19%; Unlisted 14%

Year 5 LDD 14%; Non-LDD 19%;

Unlisted 14%

LDD 14%; Non-LDD 19%; Unlisted

14% LDD 14%; Non-LDD 19%; Unlisted 14%

AWP Discount for All Generics

Year 1 Generic 80%; Unlisted 14% Generic 80%; Unlisted 14% Generic 80%; Unlisted 14%

Year 2 Generic 80%; Unlisted 14% Generic 80%; Unlisted 14% Generic 80%; Unlisted 14%

Year 3 Generic 80%; Unlisted 14% Generic 80%; Unlisted 14% Generic 80%; Unlisted 14%

Year 4 Generic 80%; Unlisted 14% Generic 80%; Unlisted 14% Generic 80%; Unlisted 14%

Year 5 Generic 80%; Unlisted 14% Generic 80%; Unlisted 14% Generic 80%; Unlisted 14%

Dispensing Fee/Rx

Year 1 $0.00 $0.00 $0.00

Year 2 $0.00 $0.00 $0.00

Year 3 $0.00 $0.00 $0.00

Year 4 $0.00 $0.00 $0.00

Year 5 $0.00 $0.00 $0.00

%-Share

Non-Specialty Medications

Year 1 $133 PMPM $133 PMPM $133 PMPM

Year 2 $157 PMPM $157 PMPM $157 PMPM

Year 3 $184 PMPM $184 PMPM $184 PMPM

Year 4 $184 PMPM $184 PMPM $184 PMPM

Year 5 $184 PMPM $184 PMPM $184 PMPM

Specialty Medications

Year 1 $133 PMPM $133 PMPM $133 PMPM

Year 2 $157 PMPM $157 PMPM $157 PMPM

Year 3 $184 PMPM $184 PMPM $184 PMPM

Year 4 $184 PMPM $184 PMPM $184 PMPM

Year 5 $184 PMPM $184 PMPM $184 PMPM

Guaranteed Minimum Per Brand Claim Rebate Guarantees United Response: Shared 100% rebate minimum guarantess are on a Per Member Per Month

(PMPM) basis.

COST SHEET

SOLICITATION NUMBER 122436 O5

PBM Pricing Guarantees

Rebates & Other Manufacturer Revenue

100%

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. United Response: Not confirmed. Our quote requires exclusive specialty. Carve out or slicing of specialty or any other pharmacy service/component is not permitted.

Specialty Pharmacy

Guarantee Pricing for Specialty Medications

Pharmacy Network

Guaranteed Pricing for Non-Specialty Medications

United HealthCare Services, Inc.

State of Nebraska Executive Summary

July 2025 unitedhealthcare.com Page 1

U N I T E D H E A L T H C A R E P H A R M A C Y ; S T A T E O F N E B R A S K A P H A R M A C Y B E N E F I T S P A R T N E R S H I P Thank you for the opportunity to reaffirm why UnitedHealthcare and UnitedHealthcare Pharmacy are the right partners to continue delivering integrated pharmacy benefits to the public servants and families of the State of Nebraska. This pharmacy proposal is expressly contingent upon the award of the medical business. Our partnership, built over more than a decade, has consistently delivered high service ratings, cost-effective solutions, and improved health outcomes.

We understand your goal: to provide a better experience for your members—delivering the right care, at the right place, and at the right price. In today’s complex pharmacy landscape—shaped by rising specialty drug costs, ultra-high-cost gene therapies, the growing demand for GLP-1s, and an evolving regulatory environment—having a trusted PBM partner is more critical than ever.

At UnitedHealthcare Pharmacy, we are committed to delivering affordable, evidence-based drug benefits that put your teammates at the center of care. Our integrated approach simplifies the experience for both teammates and care providers—leveraging innovation, technology, and data to maximize value from day one.

Here’s how we help you deliver expert, cost-effective care:

THE RIGHT CONNECTIONS

We integrate medical and pharmacy benefits to manage total cost of care—not just medication costs. This visibility allows us to make real-time decisions, place drugs on the right formulary, and adjust coverage as needed.

THE RIGHT COST

• For the State: We reduce total cost of care through cross-benefit drug management, evidence-based exclusions, and member affordability strategies.

• For your Teammates: We offer digital tools and coverage insights that help teammates understand their pharmacy costs and find lower-cost alternatives.

THE RIGHT EXPERIENCE

• For the State: Continued partnership with a seasoned account management team that has supported you for over a decade—bringing consistency, deep understanding, and trusted collaboration.

• For your Teammates: We support teammates with personalized advocacy, streamlined digital tools, and clinical guidance. This leads to higher engagement, better decision-making, and lower out-of-pocket costs, which are ultimately driving productivity and satisfaction.

COMMITMENT TO THE STATE OF NEBRASKA

Since 2012, we’ve supported the State of Nebraska with tailored benefit programs. Our current proposal reflects:

• A pharmacy contract and experience that is integrated with medical, ensuring simplicity and alignment

State of Nebraska Executive Summary

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• A clear understanding of the State’s goals for cost-effective, high-quality benefits for active employees, retirees, COBRA participants, and dependents

• A commitment to transparency, innovation, and community engagement

We appreciate your continued trust and look forward to building on our shared success. UnitedHealthcare Pharmacy is ready to help the State of Nebraska navigate the future of pharmacy care with confidence, clarity, and compassion.

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Prepared: 7/14/2025

Unless otherwise specified, these arrangements apply to pharmacy benefits and are effective for the period beginning 07/01/2026 and ending on 06/30/2029 (each twelve month period is a "Guarantee Period"). With respect to the aspects of United's performance addressed in this exhibit, these fee adjustments are Customer's exclusive financial remedies.

Definition Pharmacy rate guarantees.

Measurement 07/01/2026 07/01/2027 07/01/2028 and Criteria

Retail Brand, Average Wholesale Price (AWP) less 19.50% 19.50% 19.50%

Retail Brand -- 90 Day Supply, AWP less 20.00% 20.00% 20.00%

Retail Generic - 30 and 90 Day Supply, AWP less 88.00% 88.00% 88.00%

Mail Order Brand, AWP less 20.00% 20.00% 20.00%

Mail Order Generic, AWP less 91.50% 91.50% 91.50%

Dispensing Fees - Broad Network Retail Brand - 30 Day $0.34 $0.34 $0.34

Retail Brand -- 90 Day Supply $0.00 $0.00 $0.00

Retail Generic - 30 Day $0.34 $0.34 $0.34

Retail Generic -- 90 Day Supply $0.00 $0.00 $0.00

Rebate Sharing Percentage 100.0% 100.0% 100.0%

Basis, per member per month PMPM PMPM PMPM

Guaranteed Minimum $133.00 $157.00 $184.00

Pharmacy Management Allowance (once per enrolled member)

$5.00 $5.00 $5.00

Pharmacy Administration Fee (PEPM) $2.50 $2.60 $2.70 Level Period Payment Period Payment Amount -- Discounts The amount the actual discounts are less than the guaranteed discount amount for each individual component.

Payment Amount -- Dispensing Fees The amount the combined actual dispensing fee exceeds the combined guaranteed dispensing fee.

Payment Amount -- Rebates

Conditions

Credits and Allowances

State of Nebraska Pharmacy Financials

The Standard Medical Service Fees (excluding Optional and Non-Standard Fees) and that portion of the Standard Medical Service Fees attributable to Commission Funds, if applicable, (hereinafter referred to as “Fees”) payable by Customer under this Agreement will be adjusted through a credit to Customer's Service Fees in accordance with the arrangements set forth below unless otherwise noted.

The arrangements will become effective upon the later of (1) the effective date of the Guarantee Period; or (2) the date the Agreement is signed by both parties. In the event these arrangements become effective later than the effective date of the Guarantee Period the arrangements will commence with the Agreement Period during which the Agreement is signed by both parties.

United shall not be required to meet any of the guarantees provided for in this Agreement or amendments thereto to the extent United's failure is due to Customer's actions or inactions or if United fails to meet these standards due to fire, embargo, strike, war, accident, pandemic, act of God, acts of terrorism or United's required compliance with any law, regulation, or governmental agency mandate or anything beyond United's reasonable control.

Prior to the end of the Guarantee Period, and provided that this Agreement remains in force, United may specify to Customer in writing new arrangements for the subsequent Guarantee Period. If United specifies new arrangements, United will also provide Customer with a new Exhibit that will replace this Exhibit for that subsequent Guarantee Period.

Pharmacy Financials

Component Discount Guarantee - Broad Network

The Guaranteed Discount amount will be determined by multiplying the AWP by the guaranteed discount off AWP by each component.

Dispensing fee totals are calculated by multiplying the actual scripts for each type by the contracted rate for that script type.

Minimum Rebate Guarantee (Advantage PDL)

The amount the actual Rebate amount is less than the guaranteed Rebate amount.

Discount & Dispense Fee Specific Conditions

• 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.

Fees

Customer Specific Annually Annually

This document, including attachments, is confidential and proprietary UnitedHealthcare information and may be used only by personnel in relation to this quote.

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State of Nebraska Pharmacy Financials

Rebate Specific Conditions

• Assumes implementation of United's Advantage PDL

United reserves the right to modify or eliminate this arrangement as follows based upon changes in Rebates:

- Usual & Customary (U&C) claims

- Vaccine claims

• 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 following are excluded from the Discount Guarantee arrangement

- Compound Drug claims

- Retail out-of-network claims

- Mail Order scripts (for dispense fee arrangement)

- Indian Health Service claims

The following are included in the Discount Guarantee arrangement

- Claims where the plan is the secondary payer (COB claims)

- Veterans Affairs (VA) facility claims

- Long Term Care (LTC) facility claims

• All Specialty drugs are excluded from the Retail and Mail guarantees and are included in the Specialty discount guarantee.

• 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.

• PMPM guarantees may be adjusted in the event the ratio of enrolled Participants to Subscribers varies by more than 5% from assumptions or if 340B rejection rates materially deviate those assumed in developing the guarantees.

• When a drug is identified as a brand name drug, it will be considered a brand name drug for the calculation of discount guarantees.

When a drug is identified as a generic drug, it will be considered a generic drug for the calculation of discount guarantees.

- Over the Counter (OTC) claims

• The 90 day supply Retail guarantee includes drugs dispensed for 84 days or greater; claims with less than 84 days' supply are included with Retail 30.

• The Mail Order guarantee includes drugs dispensed for any days' supply

• 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

• If the average Specialty Brand days' supply declines below 31

• Rebate guarantee payments or reconciliations may be adjusted in the event of a change impacting the level of Rebates due to the utilization of therapeutically equivalent, lower Rebate drugs (e.g. biosimilar, authorized brand alternative, lower cost non-Generic Drug alternative) or the reduction of Wholesale Acquisition Cost on a Brand Drug subject to Rebates. In the event a payment or reconciliation adjustment is required, such adjustment will be based on the difference between a) pharmaceutical manufacturer revenue prior to the introduction of the lower Rebate drugs and b) the actual pharmaceutical manufacturer revenue received after the introduction of the lower Rebate drugs. Such adjustment does not apply to Generic Drugs that launch after the Brand Drug no longer has patent protection.

• The Rebate guarantees account for projected Rebate reductions in the following classes of Prescription Drugs in connection with the elimination of the Average Manufacturer’s Price (AMP) Cap pursuant to the American Rescue Plan Act of 2021: Insulin products and Respiratory Medications. United reserves the right to modify any Rebate guarantees if there are any additional changes Specific to AMP Cap to Rebates received from pharmaceutical manufacturers.

• The Rebate guarantees assume Stelara is excluded from coverage; Rebate payment or reconciliation adjustments will not apply to utilization of therapeutically equivalent, low WAC Stelara biosimilars.

This document, including attachments, is confidential and proprietary UnitedHealthcare information and may be used only by personnel in relation to this quote.

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State of Nebraska Pharmacy Financials

· be initiated after the first anniversary of the Effective Date of the Agreement

· be conducted by a mutually agreed upon third party

· Within 10% of total membership count

· Same customer type (carve-in, coalition, etc.)

· Same line of business (commercial, Medicare, Medicaid, etc.)

· Same types of services (retail, home delivery, specialty, etc.)

· Comparison of pricing for same contract year

· Pricing quoted within past six-month period

· A majority of membership located in a comparable geographic region

· The market check will compare the aggregate value of pricing terms including the combined net value of:

· Rebates

· Administrative fees

· Client Credits

General Conditions

• Pharmacy Management Allowance: United will provide a credit allowance to help Customer mitigate costs appropriately associated with the administration of the pharmacy program. This credit allowance is available once the parties have an executed Agreement and the first month of service fees under the Agreement has been received by United. Upon request from the Customer, a credit will be issued in United's fee billing system

Market Check

Credits and Allowances

• The Parties acknowledge and agree that United has priced the pharmacy benefit services under this Agreement in reliance on Customer’s commitment to receive such services from United for the entire Pharmacy Pricing Term. In the event that Customer terminates pharmacy benefit services under this Agreement prior to the end of the Pharmacy Pricing Term, the following will apply:

- United will retain 100% of all pending and future Rebates payable under the Agreement as of the effective date of the termination of pharmacy benefit services and no reconciliation of minimum rebate guarantees will apply.

• All pricing guarantees require the selection of United’s PBM as exclusive provider of pharmacy benefit services, including but not limited to retail, mail order, and specialty networks.

Customer may conduct one market check during the Pharmacy Pricing Term to confirm its financial terms are competitive with those currently available in the market for substantially similar customers. Such analysis shall:

· include no fewer than four substantially similar customers under active contracts as determined by the following criteria which must be included in the market check report:

· Ingredient cost discounts and dispensing fees from retail pharmacies, home delivery pharmacies, and specialty pharmacies

If the market check report validates an annualized savings of greater than three (3) percent between the median of the financial terms for such substantially similar customers and Customer’s financial terms for time period that is the subject of the market check, the parties will negotiate in good faith to revise the financial terms. United responds to Customer within 30 days of receipt of the complete market check report containing sufficient information for United to validate that the analysis was conducted in accordance with the above criteria. 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 agreed to revisions in writing at least 30 days prior to the effective date.

• All pricing guarantees shall remain in effect for the entire contract period of 07/01/2026 through 06/30/2029 ("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.

• In the event vaccines are covered under the pharmacy benefit, vaccines will be excluded from the discount, dispense fee and rebate guarantees.

• On mail order and 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.

• Pricing and guarantees assume enrollment of 13,809 Employees and 28,592 Participants; pricing and guarantees may be revised or withdrawn if actual enrollment varies by 10% or more from assumptions.

• The lesser of three logic (non-ZBL) will apply to Participant payments. Participants pay the lesser of the discounted price, the usual and customary charge or the cost share amount.

• United's Price Edge program applies

This document, including attachments, is confidential and proprietary UnitedHealthcare information and may be used only by personnel in relation to this quote.

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State of Nebraska Pharmacy Financials

Brand / Generic Reconciliation Definition

PTRX (12/2024)

• In the event any of the terms herein is inconsistent with the requirements of any federal, state or other applicable law or regulation, then the inconsistent term(s) will be null and void and United will have the right to revise, reprice or revoke this arrangement.

• United reserves the right to…