Attachment_A.pdf

Attachment A

OMES Central Purchasing | October 2025 Attachment A: Agency Solicitations | Page 1 of 75

EGWPAGENCY SOLICITATIONS

SOLICITATION NO. EV00000953

This solicitation is a contract document and is a request for proposal in connection with the contract awarded on behalf of the Oklahoma Health Care Authority Employees Group Insurance Division by the Office of Management and Enterprise Services as more particularly described below. Any defined term used herein but not defined herein shall have the meaning ascribed in the General Terms or other contract document.

I. PURPOSE

The Office of Management and Enterprise Services (OMES) Central Purchasing division is seeking responses on behalf of the Oklahoma Health Care Authority Employees Group Insurance Division from potential suppliers to provide Pharmacy Benefit Management (PBM) services through EGID. A contract resulting from this solicitation may be designated for use as a statewide contract. See 74 O.S. § 85.5(G)(3).

The contract is awarded on behalf of the Oklahoma Health Care Authority Employees Group Insurance Division from for Pharmacy Benefit Management (PBM) services, including pharmacy claims adjudication, customer service, reporting, and other services offered by and through EGID.

1. Contract Term and Renewal Options:

1.0. The initial Contract term, which begins on the effective date of the Contract, is one year and there are four (4) one-year options to renew the Contract.

1.1. The parties agree to the following terms in addition to obligations set forth in other Contract

Documents:

1.1.0. Certain additional Contract requirements and terms are attached hereto as Attachments A, B, C, and D, and Exhibit 3, which are all herein incorporated. Vendor agrees to terms in this attachment (Attachment A) and in Attachments B, C, and D, in addition to Exhibit 3.

1.2. Certain Contract requirements and terms, contextual information and additional bidding instructions are attached hereto as Exhibit 3, Exhibit 4, Exhibit 5, Exhibit 7, and Exhibit 8 which are incorporated herein. Vendor shall consult Exhibits 3, 4, 5, 7 & 8 and comply with instructions provided with regard to bid submission and acknowledges acceptance of additional terms and conditions contained therein.

2. Solicitation Criterion:

2.0. The Bid will be evaluated using a best value criterion, based on the following:

2.0.0. Experience Performing Specifications, References, and possible demonstrations.

2.0.1. Quality of Response regarding Specifications

2.0.2. Price and Cost.

2.0.3. Data Management, Report Delivery and On-line Access, Claim System Capabilities

2.0.4. Experience, Service Access and Set-up, Service Team Support

2.0.5. Implementation and Performance Guarantees

2.0.6. Formulary and UM Programs, MTM / CMS approved UM for EGWP and Specialty Programs /

Management

2.0.7. Savings Model Results, Administrative Fees / Services, Adjudication logic and rules, Accurate Part D rates / models

2.0.8. Audits, EGWP / Part D, and Regulatory Support / Updates

2.0.9. Agreement with Terms, Clauses, and Definitions, Provision of Liability Coverage, Compliance with RFP Instruction and Formatting

2.0.10. Mandatory Requirements found in Section 3.1

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3. Scope and Description:

3.0. Identification and Overview:

3.0.0. Employees Group Insurance Division (EGID)

3.0.0.0. EGID is a division of the Oklahoma Health Care Authority. EGID was established by, and operates pursuant to, the Oklahoma Employees Insurance and Benefits Act, 74 O.S. § 1301, et seq., hereinafter (Act). The Act was established for the benefit of state and education employees, employees of other state governmental entities, and quasi-state governmental entities authorized by the Act to participate in the insurance plans offered by EGID. EGID makes decisions on all policy matters affecting the group insurance plans, including member benefits, premium rates and the investment of premiums. EGID serves over 900 employer groups with multiple retirement systems. See https://oklahoma.gov/egid.html for more information about EGID and plans offered.

3.0.0.1. Pursuant to legislative authority, EGID Administrative Rules set forth the eligibility, type of participation, and benefits guidelines for all participating employers. A copy of the official Administrative Rules is on file with the Office of the Secretary of State, beginning at Oklahoma Administrative Code Title 317:145, or the Rules may be found at https://oklahoma.gov/egid/about/resources-and-notices.

3.0.1. HealthChoice

3.0.1.0. The state of Oklahoma’s self-funded health, dental, and life insurance plans administered by EGID are known as the HealthChoice plans.

3.1. Mandatory Requirements:

3.1.0. Bidders shall comply with all requirements in this section and provide proper documentation in their response to meet each Mandatory Requirement. The Bidder’s compliance with the requirements in this section shall be determined according to the sole unrestricted discretion of EGID. The Bidder must state in its proposal exactly how it does/shall comply, provide detailed information and supporting documentation, and affirm its understanding of the requirement and its agreement to comply with that requirement for the duration of the contract. Proposals failing to meet Mandatory Requirements shall not be considered.

3.1.0.0. Bidder shall submit an Executive Summary and Company Information, as outlined in 7.2 – Section Two of the Bidder Instructions. The following information must be included:

3.1.0.0.1. The length of time the Bidder has been in business.

3.1.0.0.2. A brief description of the company.

3.1.0.0.3. Company size and organization.

3.1.0.0.4. The number of years (experience) the Bidder has been providing products and/or services of the type requested.

3.1.0.1. Bidder shall specifically document experience in commercial and EGWP PBM serves for a minimum of seven (7) years. Experience may include that of acquired companies, predecessor entities, or merged organizations, provided such operations, personnel, systems, and contractual capabilities are materially integrated into the bidder’s current operations.

3.1.0.1.1. The core competence of the company.

3.1.0.1.2. Number of employees allocated strictly for research.

3.1.0.1.3. Number of employees allocated strictly for support.

3.1.0.1.4. Number of clients.

3.1.0.1.5. Average client size (i.e., employee count).

3.1.0.1.6. Locations where the Bidder’s solution has been deployed.

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3.1.0.1.7. Acknowledgment of the Bidder’s understanding of EGID’s solicitation, along with organizational and conceptual approaches to be used.

3.1.0.2. Bidder shall provide at least three (3) business references from non-affiliated clients that perform similar services as outlined in 7.11 - Section Eleven of the Bidder Instructions using the Exhibit #1 Bidder Reference Worksheet.

3.1.0.3. Bidder must demonstrate its financial stability by providing EGID with copies of audited financial statements for the Bidder's three (3) fiscal years previous to the date of its response and its most recent SSAE 18 SOC1 report as outlined in 7.10 – Section Ten of the Bidder Instructions. EGID shall exercise its sole discretion in evaluating such information.

3.1.0.3.1. The contracted Supplier shall continue to provide such financial information and an SSAE 18 SOC1 report to EGID on an annual basis. If the Bidder is a wholly owned subsidiary of a parent organization, this requirement may be fulfilled by the audited financial statement of the parent organization, provided that the parent organization agrees to have the same legal and financial responsibilities under the contract as the Supplier.

3.1.0.4. Bidder shall disclose the percentage of its full-service book of business represented by EGID if it has or was to have had EGID as a client in 2025 and 2026.

3.1.0.5. To be eligible to submit a proposal under this solicitation, an organization must meet all legal requirements for doing business in the State of Oklahoma. Bidder must provide a copy of its administrator's license issued by the Insurance Commissioner for the State of Oklahoma.

3.1.0.6. PBM must demonstrate a minimum of seven (7) years of operational experience administering PBM services. Experience may include that of acquired companies, predecessor entities, or merged organizations, provided such operations, personnel, systems, and contractual capabilities are materially integrated into the bidder’s current operations.

3.1.0.7. PBM must be able to administer both a commercial and an EGWP pharmacy benefits program or administer a commercial program itself and administer an EGWP program via a subcontractor.

3.1.0.8. PBM’s, or subcontractors, of the EGWP product must be in operations with clients actively participating in its EGWP product for the past three (3) years.

3.1.0.9. The claims processing system and related operations that will be utilized by the PBM in providing the services requested in this RFP shall currently have a minimum of one (1) million covered lives for which it provides commercial (non- Medicare Part D) PBM services and the PBM, or its subcontractor, shall currently have a minimum of 20,000 covered lives for which it provides Medicare Part D PBM services.

3.1.0.10. PBM, its wholly owned subsidiary, or its EGWP subcontractor shall be a direct registered agent with CMS.

3.1.0.11. Supplier and EGID shall work collaboratively through strategic planning efforts to provide, with the highest degree of efficiency, a wide range of quality insurance benefits that are competitively priced and uniquely designed to meet the needs of a defined population.

3.1.0.12. Supplier shall comply with all applicable EGID policies and procedures which may be updated from time to time. The requirements outlined herein may be changed or amended only by written agreement signed by both Supplier and EGID.

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3.1.0.13. Supplier shall provide quality operational and administrative services on behalf of the HealthChoice. Services include pharmacy benefit management, customer services, benefits management, claims processing, utilization management and other functions as outlined herein.

3.1.0.14. Supplier shall be compliant with State and federal laws and regulations, including but not limited to the Health Insurance Portability Accountability Act (HIPAA) and other relevant enacted legislation, executive orders, or regulations.

3.1.0.15. Supplier shall be compliant with Agency-defined policies, procedures, and rules.

3.2. Qualification Requirements:

3.2.0. The Bid Response shall include an acknowledgement of the Bidder’s willingness and ability to comply with all qualification Specifications in Section 4 below, outline the ability of the Bidder to meet or exceed the qualification specifications, and indicate the Bidder’s experience with each. Bidder responses shall address the evaluation questions contained in all attachments and exhibits to ensure the State has sufficient information to evaluate and score each mandatory Specification. Any alternative method offered by Bidder to the required specifications shall be considered as to whether the alternative method is or is not in the best interest of the Plan and shall be evaluated accordingly.

3.2.0.0. In the event Bidder proposes a service requirement by different procedures with a similar result, Bidder shall explain in detail and provide the potential impact to EGID, its members, and providers.

3.2.0.1. Any additional services that Bidder intends to provide EGID, and which are included in the fees quoted in the response to this solicitation, should be described and clearly notated in Bidder's response.

3.2.0.2. Any additional services that Bidder intends to provide EGID, and which are not included in the administrative fees quoted, shall be identified and itemized in Bidder's financial proposal in Section 9 of Bid, Attachment A, and Exhibit #9

4. Qualification Requirement Specifications

4.0. HealthChoice

4.0.0. The Employee Group Insurance Division of the Oklahoma Health Care Authority (EGID) wishes to engage the services of a Pharmacy Benefit Management Firm to provide management services to maximize the value of the EGID HealthChoice pharmacy benefit for the stakeholders, the providers, and the plan. EGID requests proposals from qualified Bidders to provide pharmacy benefit management services including, but not limited to, the specifications outlined below. This RFP defines the requirements used to determine a qualified Bidder and describes requested services. or loaded with errors and indicate the specific data that failed to load and the reason for the incomplete, partially loaded, or errored data record.

4.0.1. The census data for the active and retired non-Medicare members in EGID Health Plans as of May 2026 was 95,701 primary members and 151,316 total participants. The Medicare Supplement (EGWP) members consisted of 25,821 primary members and 28,762 total participants. Most participants live in all 77 Oklahoma counties and in contiguous states. Pharmacy claims for commercial and EGWP had a combined utilization of about 3 million Rx claims in 2025. More detailed current plan design information can be found in Exhibit #6.

4.0.2. EGID currently has a transparent pricing arrangement that includes administrative fees and 100% pass-through of pharmaceutical manufacturer revenue and Group Purchasing Organization (GPO) fees, all of which are fully verifiable and auditable for both specialty and non-specialty drug utilization. EGID also maintains any willing provider pharmacy network, OMES Central Purchasing | July 2026 Attachment A: Agency Solicitations | Page 5 of 75 including an open specialty pharmacy network, in compliance with the 2019 Patient Choice Act. The State is interested in evaluating alternative specialty pharmacy arrangements to its current model. Bidders proposing a Specialty Pharmacy Network should not offer an exclusive specialty pharmacy arrangement. The State encourages bidders to propose open-network solutions and/or other innovative or flexible specialty pharmacy options for consideration.

4.0.3. EGID reserves the right, at its sole discretion, to conduct one or more Best and Final Offer (BAFO) rounds, including reverse auction events, as part of the evaluation process. During these rounds, bidders may be provided with limited information regarding their relative ranking or competitive position based on EGID's evaluation of cost, technical, operational, contractual, and other solicitation criteria. EGID may determine the type, timing, and extent of any information shared with bidders.

4.0.4. Following any BAFO or reverse auction round, EGID may, at its sole discretion, eliminate one or more bidders from further consideration, including the lowest-ranked bidder(s), or elect to retain all bidders and conduct additional rounds. Participation in any BAFO round, receipt of ranking information, or advancement to subsequent rounds does not guarantee continued consideration, contract negotiations, or award. All evaluation and selection decisions shall remain solely within EGID’s discretion.

For Oklahoma state agencies/entities, the reverse auction governing statute is 74 O.S. § 85.5(K) under the Oklahoma Central Purchasing Act.

4.0.5. Proposals submitted in response to this RFP shall adhere to all requirements outlined in subsequent sections, including the completion and submission of all required forms and certifications. Submissions will be reviewed and scored in accordance with the evaluation methodology and criteria described within this RFP. Contract awards will be made based on the best overall value determination, considering both technical merit and pricing.

5. Specifications and Requirements

5.0. Requirements

For this section, Respondent shall indicate “Fully Agree,” “Partially Agree,” or “Disagree.” If your answer is not “Fully Agree,” you must provide a brief description of your deviation in Exhibit #7. If your answer is “Fully Agree,” you may NOT include any descriptions or deviations.

If you indicate “Partially Agree” or “Disagree,” you must specifically identify all corresponding deviations language contained in the proposal exhibits, including the applicable exhibit name, section, and page reference in Attachment A. Unless explicitly identified, the maximum explanation length is 250 words.

Responses may be subject to evaluation penalties if:

• Respondent indicates “Fully Agree” in this section but includes inconsistent terms, exceptions, or limitations elsewhere in the proposal or exhibits; or

• Respondent fails to clearly identify the location of exceptions or deviations contained within the exhibits

5.1. General Administration

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5.1.1. EGID currently has one identification card for both pharmacy and medical and PBM is responsible for EGWP members. EGID will require that the PBM has the capability of producing and mailing identification cards to EGID members in the event EGID changes their current process. The PBM shall provide any co-branding requirements and a sample identification card of the required information for every network that the PBM proposes. All branding is subject to approval at the sole discretion of EGID.

5.1.2. The PBM shall provide a copy of its disaster recovery plan. [Max 500 words]

5.1.3. The PBM shall provide a detailed implementation project plan and timeline within thirty (30) business days from the award of the contract. The PBM will work with EGID to customize and finalize the implementation project plan to meet all the requirements of EGID (e.g.

eligibility testing) and provide the updated customized project plan within (15) business days from initial submission of the project plan to ensure that services can be offered by the effective date of this contract.

5.1.4. EGID is a progressive and innovative plan that will consider additional services and opportunities that the PBM would like to include in the RFP for consideration by EGID.

Describe in detail what additional services and opportunities that the PBM can provide beyond the services required in this RFP. This may include the following:

• FWA program

• Medication safety initiatives

• Adherence programs

• Specialty drug programs

• Quality programs

• Member outreach

• Clinical services program

• Medication therapy management

• Patient review and restriction programs (lock-in) [Max 500 words]

5.2. Definitions of Prescription Benefit Terminology

5.2.1. "340B Claim(s)" means a Claim for a Covered Product that was purchased through the 340B Drug Pricing Program and dispensed to a 340B eligible patient. 340B Claims are identified as and limited to: i. Claims from a dispensing pharmacy with 340B Status coded as “39” in the NCPDP DataQ database; ii. Claims from a dispensing pharmacy with 340B Status coded as "37" or “38” in the NCPDP DataQ database, where the dispensing pharmacy submitted a “20” in any of the Submission Clarification Code (SCC) fields; iii. Claims identified through Client's contracted 340B third party administrator(s) (TPA(s)). For avoidance of doubt, PBM shall not independently identify claims as 340B Claims unless explicitly directed by Client to do so.

5.2.2. “Adjusted Claim” means a 30-day supply Claim equivalent that shall be calculated as follows: Adjusted Claim = [Claim Days Supply] / [30 days]. For avoidance of doubt, a Claim with a 90-day supply would constitute three (3) Adjusted Rx. A Claim with a 10 (ten) day supply would constitute 1/3 (one-third) of an Rx.

5.2.3. "Administrative Fee(s)" means the fee paid to PBM for agreed upon PBM services.

5.2.4. “Average Wholesale Price” or “AWP” means the average wholesale price per unit for a product's NDC-11 on the date the claim is dispensed as set forth from the most current pricing information from Medi-Span.

5.2.5. "Authorized Generics" means a drug that is marketed, sold or distributed in the United States as a Generic Drug version of a Brand Drug where the authority for such marketing, sale and or distribution is based upon a Manufacturer’s New Drug Application (NDA) or

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Biologic License Application (BLA) for the associated Brand Drug. Also, the Authorized Generic is marketed, sold or distributed under a different labeler code, product code, trade name, trademark, or packaging (other than repacking the listed drug for use in institutions) than the Brand Drug. Authorized Generics will be identified using Medi-Span Multisource Code of “M” (co-branded product) with a Brand Drug Code of “B” (Branded Generic Name).

5.2.6. “Biosimilar Product” or “Biosimilar” means a biological product that is highly similar to a US-licensed reference biological product notwithstanding minor differences in clinically inactive components, and for which there are no clinically meaningful differences between the biological product and the reference product in terms of the safety, purity, and potency of the product as defined in the Biologics Price Competition and Innovation Act of 2009 at 42 U.S.C. §262(i)(2) and approved under Section 351(k) of the Public Health Services Act and as identified in the Purple Book.

5.2.7. "Brand Drug" or "Brand Product" means an FDA approved drug, or a drug that is designated by FDA as a DESI (Drug Efficacy Study Implementation) drug, or product, which is manufactured and distributed by an innovator drug company, or its licensee, set forth in Medi-Span’s National Drug Data File (MS) as a brand drug identified by all of the products meeting at least one of the following criteria:

1. Brand Name code of “T” and Multisource Code “M” and DAW not equal to 5

2. Brand Name code of “B” or “T” and Multisource Code of “N” and DAW not equal to 5

3. Brand Name code of “B” or “T” and Multisource Code “O” and a DAW code of 0, 1, 2, 7, 8, or 9 For the avoidance of doubt, Brand Drugs shall also include but are not limited to: brand name, vaccines, supplies, medical devices, kits, diabetic supplies, OTCs and test strips.

5.2.8. “Claim(s)” means any electronic or paper request for payment or reimbursement processed through PBM’s online claims adjudication system or otherwise transmitted or processed in accordance with the terms of an agreement in connection with EGID’s Plans, including claims in which the Member pays the full cost and EGID has no cost liability, but does not include requests for payment or reimbursement that rejected due to system edits designed to enforce EGID’s pharmacy benefit programs or were reversed or cancelled from the claim payment system.

5.2.9. “EGID-Contracted Pharmacy” means a Retail Pharmacy that has contracted with, and is identified by, EGID to dispense drugs to Members at reimbursement rates agreed-upon between the two parties.

5.2.10. "Compound Drug” shall mean a mixture of two (2) or more ingredients when at least one of the ingredients in the preparation is an FDA approved federal legend drug, and the mixture of which is not otherwise generally available in an equivalent commercial form or strength in response to a physician’s prescription to create a medication tailored to the specialized medically required need for an individual patient. A Compound Drug is identified by the compound indicator on the Claim feed.

5.2.11. "Continuity of Therapy Utilization” refers to the continued coverage of a medication that is not on PBM's formulary, by a member who was receiving the drug on or before the effective date of the agreement between the PBM and EGID.

5.2.12. "Coordination of Benefits" or “COB Claim(s)" means a Claim where more than one health insurance program, policy, or other form of coverage, including governmental or non-governmental coverage, has payment and EGID acts as the secondary or tertiary payor for the Claim.

5.2.13. "Covered Drug" or "Covered Product” means a drug, device or supplies that is covered under the benefit and requires a prescription for dispensing and/or coverage as a plan benefit. For

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5.2.14. "Data Fees" means fees received by PBM or PBM Affiliates for the sale of aggregate blinded data to a limited group of third parties including nationally recognized data integration firms.

5.2.15. "Days' Supply" means the number of days the Brand Drug, Generic Drug or Specialty Drug is to be taken as prescribed and submitted to PBM by the dispensing Pharmacy.

5.2.16. "Dispensing Fee(s)" means the fee paid to the dispensing pharmacy for the professional service of filling a claim and is equal to the Total Claim Cost less the Ingredient Cost and less the applicable sales tax. U&C Claims will always have a zero dollar Dispensing Fee.

5.2.17. "Drug Manufacturer" or "Pharmaceutical Manufacturer" means a manufacturer of pharmaceutical products or any organization that engages in manufacturing, requests/solicits a manufacturer to create, develop, or produce medications with the intent of distribution. Drug Manufacturer shall include PBM or PBM Affiliates to the extent PBM or PBM Affiliates partner with a third party to create, develop, produce, manufacture, market, or co-brand pharmaceutical products.

5.2.18. "Fill Quantity" means the number of units (e.g. tablets, capsules, mL, etc.) of a product that is dispensed for a Claim as submitted to PBM by the dispensing Pharmacy.

5.2.19. “Formulary” means the list of FDA-approved prescription drugs and supplies developed by PBM’s Pharmacy and Therapeutics Committee (“P&T Committee”). The Formulary consists of (i) a ranking of Covered Products into preferred and non-preferred tiers, (ii) a listing of Non-Covered Products, and (iii) associated utilization review programs pursuant to PBM’s standard clinical criteria, which may include, but are not limited to, prior authorizations, step therapy and/or quantity limits for one or more Covered Products.

5.2.20. "Formulary Exclusions" shall mean drugs or other related products that are excluded from coverage by PBM. All designations of products as Non-Covered Products shall be approved by PBM's P&T Committee.

5.2.21. “Formulary Rebate(s)" means revenue collected by PBM or PBM Affiliates, directly or indirectly, from pharmaceutical companies or GPOs that is attributable to EGID’s specific utilization. This includes, but is not limited to, revenue driven by placement of certain prescription drugs on a formulary or preferred drug list, payments due to outcome guarantees, revenue tied to cost management strategies, etc. The only acceptable revenue to be excluded from Formulary Rebates is any revenue that is not tied in any way to EGID’s utilization. For clarity, exclusions from the Formulary Rebates definition may only be revenue that PBM or its affiliates would receive from a pharmaceutical company or GPO regardless of whether EGID is a client.

5.2.22. "Generic Drug" or "Generic Product" means an FDA approved drug, or a drug that is designated by FDA a DESI (Drug Efficacy Study Implementation) drug, or product, that is therapeutically equivalent to other pharmaceutically equivalent products, as set forth in Medi-Span’s National Drug Data File (MS) as a generic drug identified by all products meeting at least one of the following criteria:

1. Brand Name code of “G” for all Multisource Codes (M, N, O, and Y)

2. Multisource Code of “Y”

3. Multisource Code of “M” with a Brand Drug Code of “B” (Authorized Generic)

4. Multisource Code of “O” with a DAW code of 3, 4, or 6

5. Multisource Codes (M, N, O, and Y) with a DAW code of 5 (House Generic).

For the avoidance of doubt, Generic Drugs shall also include but are not limited to generic:

vaccines, supplies, medical devices, kits, diabetic supplies, OTCs and test strips.

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5.2.23. “Group Purchasing Organization” or “GPO” is an entity that aggregates the purchasing power of a group of businesses to obtain discounts or rebates from pharmaceutical manufacturers. These services may include contracting with manufacturers for Formulary Manufacturer Payments or any similar service conducted on behalf of the PBM. Any entity who provides the same or similar services as the PBM on behalf of the PBM under this Agreement shall also be considered a GPO. For purposes of this Agreement, rebate aggregators or any similar/competing entity shall also be a GPO.

PBM represents and warrants that PBM’s agreements with a Group Purchasing Organization shall contain (and will continue to contain through the term of this Agreement) provisions or obligations that are substantially similar to any provision or obligation contained in this Agreement which directly or indirectly relates to any service under this Agreement that is or may be performed by a GPO as defined herein. A breach of this representation and warranty shall be considered a material breach of this Agreement.

5.2.24. “Guaranteed Minimum Manufacturer Payment” or “Rebate Guarantee” is the minimum Rebate per Brand Drug by dispensing channel. The performance will be calculated for the annual period using the following formula for each dispensing Channel independently, then summed: 'The calculation of the Annual Rebate Guarantee Amount will be [Rebate Guarantee] multiplied by [total Brand Drug count minus the exclusions as outlined in Rebate exclusions in the Rx-Pricing, Exclusions Tab].

5.2.25. "Guaranteed Price" shall mean the resulting Ingredient Costs plus Dispensing Fees subject to the pricing guarantees (in Rx-Pricing, Discount & DF) and the pricing exclusions (in Rx- Pricing, Exclusions).

5.2.26. "Home Infusion Pharmacy" or "HIF" means a Retail Pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients with acute or chronic conditions generally pertaining to parenteral administration of drugs, biologics and nutritional formulae administered through catheters and/or needles in home and alternate sites. These Pharmacies are identified by a National Council for Prescription Drug Program’s (NCPDP’s) dispenser type code of 6.

5.2.27. "House Generics" means a Brand Drug submitted with a Dispense As Written (DAW) 5 code in place of the generic equivalent and where the pharmacy is reimbursed at a Generic Drug rate, including MAC, as applicable. For reconciliation of the Generic Drug discount guarantees, the AWP of House Generic drugs shall be the per unit AWP of the generic equivalent and not the AWP of the Brand Drug. House Generics will be identified using Medi- Span Multisource Code M, N, O, or Y and a Dispense as Written (DAW) code of 5.

5.2.28. "Incentive Rebate(s)" means a rebate collected by PBM or PBM Affiliates from pharmaceutical companies for products where restrictions on competitor products have been put in place and is attributable to EGID’s specific utilization.

5.2.29. "Indian Health Services, Tribal or Urban Indian Health" or "I/T/U" means a Retail Pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization as defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. These Pharmacies are identified by a National Council for Prescription Drug Program’s (NCPDP’s) dispenser type code of 8.

5.2.30. “Inflation Protection Payments” means payments (if any; and whether separately made or in the form of increased Rebates) received by PBM’s firm or PBM Affiliates from a pharmaceutical manufacturer for the purpose of adjusting for year over year price inflation of the manufacturer’s price to PBM’s firm for prescriptions on which Rebates are paid; in accordance with and pursuant to applicable pharmaceutical manufacturer agreements.

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5.2.31. "Ingredient Cost" means the discounted AWP cost of a Claim and is equal to the Total Claim Cost less the applicable Dispensing Fee and less the applicable sales tax.

5.2.32. "Limited Distribution Specialty Drugs" are those Specialty Drugs only available through limited pharmacy providers (15 or less) as determined by the drug manufacturer.

5.2.33. "Long Term Care Pharmacy" or "LTC" means a Retail Pharmacy that dispenses medicinal preparations, prescription drugs, delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally disabled, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.

These Pharmacies are identified by a National Council for Prescription Drug Program’s (NCPDP’s) dispenser type code of '04'.

5.2.34. “Mail Order Pharmacy” or "Mail Order" means an automated Pharmacy that processes prescriptions at one or more central locations and delivers them through the mail or other third-party delivery service to the locations of customers and does not have a physical customer-facing storefront. If such an automated pharmacy dispenses Specialty Drugs and non- Specialty Drugs, such Mail Order Pharmacy shall constitute a Mail Order Pharmacy solely with respect to the dispensing of non-Specialty Drugs and shall constitute a Specialty Pharmacy with respect to the dispensing of Specialty Drugs. These Pharmacies are identified by a National Council for Prescription Drug Program’s (NCPDP’s) dispenser type code of '05'.

5.2.35. "Manufacturer Administrative Fee(s)" means fees for services rendered to pharmaceutical manufacturers in relation to administrative duties in connection with aggregation, allocating, collecting, and invoicing for rebates. Manufacturer Administrative fees include any fee paid by a pharmaceutical manufacturer to PBM, PBM Affiliates, or a GPO in relation to administrative duties in connection with the collection of Formulary Rebate.

5.2.36. "Manufacturer Payments" includes Rebates, Manufacturer Administrative Fees, Inflation Protection Payments, and Data Fees, but excludes Other Pharmaceutical Manufacturer Revenue.

5.2.37. "Market Share Rebate(s)" or "Performance Rebate(s)" means a rebate collected by PBM or PBM Affiliates from pharmaceutical companies that is based on the utilization of a rebated product compared to the utilization of competitor products and is attributable to EGID’s specific utilization.

5.2.38. "Maximum Allowable Cost" or "MAC" means the price that has been established by PBM for off-patent drugs included on its MAC drug list. A copy of such MAC drug list shall be provided to Client, prior to execution and upon Client's reasonable request. The same MAC list will be used for Retail, Mail Order, and Specialty Pharmacies (i.e. same number of drugs, same drugs). The Mail Order and Specialty Pharmacy MAC list price points for individual drugs/generic class numbers shall be equal to or less (i.e., more deeply discounted) than the Retail Pharmacy MAC price points for the same drugs/generic class numbers.

5.2.39. "Member(s)" means each individual (employee or dependent) who EGID identifies in the eligibility file to be eligible for prescription drug benefits under its plan.

5.2.40. "Member Cost Share" means the amount which a Member is required to pay for a Claim in accordance with EGID’s benefit design, which may be a deductible, a percentage of the Claim price, a fixed amount and/or other charge or penalty.

5.2.41. "Member-Submitted Claim(s)" or "Paper Claim(s)" means a Claim for which the Member paid the full amount of the Claim and was then submitted to PBM by a Member for reimbursement. These Claims are identified by the claim type code of ’3’ (pharmacy submitted paper claim) or ‘4’ (member submitted paper claim).

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5.2.42. "Military Pharmacy" means a Retail Pharmacy whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to uniformed services beneficiaries. These pharmacies may be associated with Department of Defense or U.S.

Coast Guard clinic, Department of Defense hospital or freestanding. Usually associated with outpatient services. Associated with taxonomy code “332000000X”. These Pharmacies are identified by a National Council for Prescription Drug Program’s (NCPDP’s) dispenser type code of 17.

5.2.43. “Non-Covered Products” or "Formulary Exclusions" shall mean drugs or other related products that are not Covered Products. All designations of products as Non-Covered Products shall be approved by PBM’s P&T Committee.

5.2.44. “Non-Preferred Rebates” mean payments collected by PBM or PBM Affiliates from Manufacturers for Claims that may be designated as non-preferred or non-covered via Formulary or utilization management criteria and are directly or indirectly attributable to EGID’s specific utilization.

5.2.45. "Off-Invoice Wholesaler Remuneration" means various off-invoice reconciliation payments made by wholesalers to PBM that are not booked to an individual NDC and therefore not attributable to an individual EGID. Examples of these payments include but are not limited to: true-ups, distribution fees, operational excellence fees, and price-protection credits.

5.2.46. "Other Pharmaceutical Manufacturer Revenue" means any revenue that PBM or PBM Affiliates receive from pharmaceutical manufacturers. This may include but is not limited to:

Off-Invoice Wholesaler Remuneration, Pharmacy Purchase Discounts (i.e. Mail-Order Volume Discounts), Transmission Fees, and Specialty Service Fees.

5.2.47. "Over-the-Counter Claim(s)" or "OTC Claim(s)" means a Claim for products that do not necessarily require a prescription for a Member to purchase and that EGID has chosen to or has been required to include as covered products under the prescription drug benefit. OTC Claims are defined as having an ‘O’ or 'P' indication in Medi-Span’s Rx-OTC Indicator Code.

5.2.48. “Pharmacy and Therapeutics Committee" or "P&T Committee” shall mean an independent body of health care professionals and academicians recognized as national experts and leaders in their fields of specialty who periodically review new drugs introduced to the market, re-evaluate selected therapeutic drug classes and drugs in the pharmaceutical development pipeline, and evaluate any current, relevant drug safety issues.

5.2.49. “Participating Pharmacy” means a Retail Pharmacy, Mail Order Pharmacy, Specialty Pharmacy, non-traditional pharmacy (such as I/T/U, LTC, HIF, Military, TER or VA) or other Pharmacy that participates in the PBM’s network of Participating Pharmacies pursuant to an agreement between the Participating Pharmacy and PBM or between the Participating Pharmacy and EGID for such Pharmacy’s dispensing of Covered Drugs to Members

5.2.50. "Pass Through Pricing”, "Pass-through", or "Transparent Pricing" means a pricing structure comprised of fixed guaranteed discounts at PBM's Mail Order Pharmacy and Specialty Pharmacy and a full pass through of PBM's contracted rates with Participating Pharmacies and pharmaceutical manufacturers. In this arrangement, PBM retains the difference between Mail Order and specialty acquisition costs and the amounts guaranteed to EGID.

PBM passes through (1) its contracted rates with Participating Pharmacies and (2) all Manufacturer Payments it receives from pharmaceutical manufacturers in excess of EGID’s guaranteed Manufacturer Payments. The amount billed to EGID at Retail Pharmacies will be equal to the amount paid by PBM to the Retail Pharmacies.

5.2.51. "PBM Affiliates" of a party shall mean an entity:

(i) which is directly or indirectly, through one or more intermediaries, controlling such party;

(ii) which is under the same direct or indirect ownership or control as such party; or

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(iii) which is directly or indirectly, through one or more intermediaries, owned or controlled by such party.

(iv) owned by PBM or its parent company(ies) and any entities that are directly or indirectly owned by any entity in the upstream ownership chain of PBM, including but not limited to the parent or any other owners of the parent.

For purposes of this definition and the Agreement, “control” (including the terms controlling, controlled by or under common control with) means (a) the possession, direct or indirect, (b) the power to direct or cause the direction of the management or policies of an entity, or (c) the ability to direct an entity’s affairs or to control the composition of its board of directors or equivalent body, whether through (i) 50% of more of voting securities,

(ii) partnership or membership interests, (iii) by contract or (iii) any other means.

Further, a Group Purchasing Organization shall also be considered a PBM Affiliate to the extent the GPO meets the above definition.

5.2.52. “Pharmacy" means a pharmacy that participates in the PBM network pursuant to an agreement between the pharmacy and PBM.

5.2.53. "Pharmacy Discount Cards” shall mean a prescription drug saving program that negotiates discounts at retail pharmacies by partnering with pharmacy benefit managers in order to provide underinsured, terminated employees, and part-time employees with access to lower medication prices. Pharmacy Discount Card programs are marketed and distributed for free to patients who access the program by using the free card or mobile app provided by the savings program.

5.2.54. "Pharmacy Purchase Discount(s)" or "Volume Discount(s)" means discounts, paid at time of purchase or retrospectively, received by PBM or its affiliates from pharmaceutical manufacturers which are attributable to or based on products purchased by PBM affiliated dispensing pharmacies.

5.2.55. “Preferred Specialty Network” means a network arrangement where EGID receives preferred pricing versus non-preferred Specialty Pharmacies.

5.2.56. “Pricing Source” means Medi-Span Prescription Guide including supplements.

5.2.57. “Rebate” or “Formulary Rebate” means compensation or remuneration of any kind received or recovered from a pharmaceutical manufacturer by PBM, any affiliate, or any subcontractor, acting in the capacity as a group purchasing organization for EGID, either directly or indirectly, related to the purchase and utilization of covered products by eligible members under the EGID pharmacy benefit plan, regardless of how such amounts are categorized, including, but not limited to, base and formulary rebates; incentive rebates;

credits; price protection rebates; market share incentives; promotional allowances;

commissions; educational grants; market share of utilization; drug pull-through programs;

implementation allowances; clinical detailing; rebate submission fees; and any administrative or management fees. Rebates also include any bona fide fees, including Manufacturer Administrative Fees or corporate fees, that PBM, any affiliate, or any subcontractor, including but not limited to any group purchasing organization, receives from a pharmaceutical manufacturer for administrative costs including but not limited to formulary placement, and/or access. Rebates do not include pharmacy purchase discounts and related service fees PBM, or its affiliates receive from pharmaceutical companies which are attributable to or based on the purchase of product to stock, or the dispensing of products from PBM’s affiliated mail order and specialty drug pharmacies. For the avoidance of doubt, manufacturer data access or data submission fees, and payments for rebate contracting services, including contract aggregation payments, and similar fees and/or payments shall also be considered “Rebates,” and 100% of Rebates shall be passed

OMES Central Purchasing | July 2026 Attachment A: Agency Solicitations | Page 13 of 75 through to EGID. All items listed above are fully auditable by EGID during an eligible rebate audit and Vendor may not redact any manufacturer Rebate contracts selected for audit. This Rebate requirement applies to all new forms of Rebates created during the initial term of this contract and any renewals. [Max 500 words]

5.2.58. “Rebate Credit" is a credit applied towards the Formulary Rebate that are due to Client if certain conditions outlined below are met. A Rebate Credit will apply if the minimum Rebate guarantee is impacted as described below due to a Rebate Credit Qualifying Event:

1. Any Biosimilar product launched after pricing is negotiated (either through an RFP or subsequent market checks), where the WAC reduction is greater than or equal to 45% compared to the Reference Product. a. For Biosimilar products that do not meet the above criteria, a Rebate Credit can still be granted if the PBM offers a separate Discount Guarantee specific to the Biosimilar Product that reflects at least a 10% Net Cost Savings in comparison to the Reference Product at the time of the Biosimilar launch. The Biosimilar product will be excluded from the applicable channel Discount Guarantee and will only be reconciled with the additional Discount Guarantee until the product is removed from Rebate Credit Eligibility. PBM Agrees that: (i) The Net Cost savings will be measured by comparing the discounted Ingredient Cost of the Reference Product minus the drug specific Rebate for the Reference product before the launch of the Biosimilar, compared to the discounted ingredient cost of the Biosimilar product minus the drug-specific Rebate for the Biosimilar product (if available). (ii) PBM agrees that the AWP, WAC, and Discount Guarantee on the Biosimilar product will not change during the period the Biosimilar product is eligible for Rebate Credits.

2. Any other subsequent product impacted by any future AMP Cap-driven price reduction that results in a WAC or Rebate decrease, as demonstrated and communicated to Client, subject to mutual agreement which shall not be unreasonably withheld (collectively, a “Rebate Credit Qualifying Event”). Rebate Credits will no longer apply for any eligible products, as identified above, after a market check, renewal, or RFP. The Rebate Credit does not apply to Generic Drugs that launch after the Brand Drug no longer has patent protection. Rebate Credit will not be applicable to products and/or claims that are excluded from rebate guarantees. PBM will provide 60 days advance notice of any applicable Covered Product that qualifies for Rebate Credits, along with detailed modeling to illustrate financial impact to Client. Rebate Credit will not apply to any medication considered, defined, and/or reconciled as a generic medication.

The “Rebate Credit” shall be determined as:

1. For Biosimilars: the difference between the Rebate revenue associated with the original rebated product (e.g., an originator Brand Drug or biologic, etc.) as of the last date that the product was preferred by the Formulary, and the actual rebate amount received for the biosimilar product following the Rebate Credit Qualifying Event. In instances where the Wholesale Acquisition Cost (WAC) of any Biosimilar Claim processed and the WAC of the reference Brand Drug is less than the Rebate Credit applied, PBM will cap the Rebate Credit at the difference in WAC. PBM will provide an explanation and modeling which shall be reviewed by the Client in advance of any proposed Rebate Credit application.

Notwithstanding anything to the contrary, nothing herein is intended to amend or otherwise deviate from either parties' rights listed in the Agreement.

2. For Other Agreed Upon Products impacted by future AMP Cap-driven price reduction: the difference between the Rebate revenue before price reduction and the Rebate revenue amount received following the Rebate Credit Qualifying Event. In instances where the Wholesale Acquisition Cost (WAC) reduction is less than the Rebate Credit applied, PBM will cap the Rebate Credit at the difference in WAC. For the avoidance of doubt, the Rebate Credit calculation shall be specific to the medication dispensed and shall be applied only to claims for the drug that experienced a Rebate Credit Qualifying Event. PBM will provide

OMES Central Purchasing | July 2026 Attachment A: Agency Solicitations | Page 14 of 75 an explanation and modeling which shall be reviewed by the Client in advance of any proposed Rebate Credit application. Notwithstanding anything to the contrary, nothing herein is intended to amend or otherwise deviate from either parties' rights listed in the Agreement."

5.2.59. “Rebate Guarantee” is the minimum Rebate per Brand Drug by dispensing channel paid by Vendor to Client. Amounts due will be calculated for the annual period using the following formula for each dispensing Channel independently, then summed: [Rebate Guarantee] multiplied by [total Brand Drug count minus the exclusions as outlined in Rebate exclusions in the Rx-Pricing, Exclusions Tab].

5.2.60. “Retail Pharmacy” or "Retail" means any type of Pharmacy other than a Mail Order Pharmacy or Specialty Pharmacy, and includes any independent pharmacies, supermarket pharmacies, chain pharmacies or mass merchandiser pharmacies having a state license to dispense medications to the public.

5.2.61. "Sales Tax" means a tax imposed by local, state, or federal government at the point of sale on a Claim that is collected by the dispensing Pharmacy.

5.2.62. "Single Source Generic(s)" or "SSG(s)" are Generic Drugs that are manufactured by one generic drug manufacturing company. For the avoidance of doubt, Single Source Generics will be reconciled with Generic Drugs for any financial guarantees.

5.2.63. Per Section 1330.1 of Title 74 (SB1447), PBM must adapt “Specialty Drugs” are defined as certain pharmaceuticals, biotech or biological drugs,…